The HIT Transition Weblog

If the HISsies Fit...

We're dang sorry we won't be at HIMSS08 later this month.  Not because we want to run the gauntlet of HIT vendor account execs (tip: If "I'm just a consultant!" doesn't work, tell them you're an investigator from the SEC). No, we're just sorry to miss Mr. HIStalk's party Monday night.  But if you're going, we definitely want to extend you his invitation:

The initial response to HIStalk’s reception at HIMSS on Monday, 2/25 is strong. I peeked at the signup list and I’m impressed: informatics people, clinicians, CIOs, VPs, media people, investment folks, and 10 CEOs (!) have RSVP’ed in just the first few days. I’m immensely flattered and I’m honored that you’ve chosen to spend a little time with the HIStalk crowd and the sure to be dolled up Inga (incognito, but lookin’ fine, I predict). If you’re reading this, you are invited - please RSVP here so we can haul in enough liquor and fancy food to keep you happy. ... If you’ve never been to the Peabody Orlando, it’s really nice and is an easy stroll from the convention center (right on the property, pretty much).

Free booze and canapes is usually enough to get us to turn out, but the big deal will be when MrH (or his yet-to-be-identified surrogate) hands out the HISsie Awards for the best and worst of healthcare IT.  We'll be there in spirit, tough. And maybe more than spirit. Remember our little HealthFault video?

Speaking of videos, Michael has produced DVD versions of two of our most popular webinars, Real-Time Adjudication Drivers and Deliverables and Getting ROI from Health IT: An Independent Analysis.Unlike Mr. HIStalk, who claims to be gainfully employed, this is our day job.  Thanks for your support.

Red Tuesday: Jan 1 2008

On our Black Swans list for 2008, one of the biggest birds will swoop in on the very first day of the year: January 1.  That's when a huge number of health plan enrollments roll over, and the move to the High Deductible Health Plan model is going to hit providers hard in the pocketbook.  Hence our suggested name for the eventful date: Red Tuesday.

Forecast for the Rich: Richer
The Nashville Business Journal cites unnamed analysts in guessing 2009 HDHP enrollment will double from January 2007's 4.5 million.  But one named analyst is more specific, calling HDHPs "the best idea I've seen for a health plan in 25 years." I guess that's great news if you're a health plan.

The Doctor Will See You Now, Mr. Wimpy
Will providers notice?  Not from what I'm hearing.  Physicians, clinics, hospitals, labs, etc., may be "concerned" about the migration of a big chunk of A/R from a few hundred points of cantankerous collections (i.e. health plans) to tens of thousands of points of empty and slow-paying pockets (i.e. patients), but they're not generally looking at the numbers that matter: Patient Responsibility as a percent of total billing (not "revenue" -- that assumes the money will be collected).  And multiply that by the likelihood of collecting any patient receivable, factoring in that their bill just went up by a thousand percent.

You Mean I'm Going to Stay This Color?
Maybe they will get the picture after the month closes?  Make that Fuscia Friday (Feb 1, 2008), or maybe give them three business days to close and call it Ruby Tuesday (Feb 5)?  Probably not. Months aren't trends.  January's always a slow month, right?

Maybe they'll look at the results after the first quarter.  That would be about April 3.  Surely they should be able to see how much money they are losing by then.  What color should we give it? Thrush Thursday!

But wait.  They won't even bill most of their January patients until the claims get settled by the health plans, and that takes at least 50-60 days.  January's patient payments won't even be overdue by the end of March.  They'll cash their refund checks on April 16, then buy that new Buick, and...

HIT Forums Point the Way for 2008 (Part 1 of 2)

I was fortunate enough to attend two healthcare IT conferences last week; one as a journalist (really!) and the other as an invited speaker and guest.  Officially, I was gathering information at the first conference and sharing information at the second conference.  Unofficially, I was flogging our products and services -- upcoming webinars on Real Time Adjudication, HIT ROI for provider organizations and the Black Swans of Healthcare IT; and our just-released 5-volume set of healthcare IT funding sources.  Nobody seems to have discovered these ulterior motives so please keep my secret to yourself.  Whatever you do, don't forward this email to everyone you know that might care about saving money or avoiding disaster next year!

How the Other Half of One Percent Lives
The Collaborative Communications Summit is a boutique conference for C-suiters.  The concept is to put the event in a tony venue that pampers the executive appetite and bring in a raft of brilliant speakers and those who move and shake the industry. Last week’s CCS topic, “Transforming Healthcare through Health Information Technology,” was enough to pique my interest when I read about it a few months back. When the conference organizers offered us a media sponsorship that included a free press pass, we jumped on it.  I was already going to be in LA to speak at the Blue Cross Blue Shield Association's Blue Health IT Symposium, so I could make the CCS event for the price of a couple nights at the hotel.  How much could that be?

Historically, my conference experience has been more focused on getting in the thick of things with the doers and persuaders than rubbing elbows with the financers and deciders. I’m pretty familiar with the Metro system in DC, the shuttles at O’Hare and the rental car agencies at DFW, but finding my way to CCS’s ivy-cloaked venue, the Peninsula in Beverly Hills, was a different sort of commute. In my more skeptical moments, I fully prepared myself for one of those fly-and-bye junkets we hear about – the execs make an appearance at the keynote, then head for the golf course, spa or shopping district.

It’s good to be wrong sometimes.

The President is a Lot Smarter Than You Think!
No, not that president.  I’m talking about the president of the company – maybe even your company. The CCS sessions were substantive and dealt with the underlying causes of the challenges and dysfunctions facing the healthcare industry, and the ways that healthcare IT can – and cannot – hope to address them.  The event was intimate – all the sessions took place in a single conference room laid out cabaret style with round tables and a raised dais at one end. 

The vendors were there, of course, but held back from the full frontal sales pitches that seems increasingly characteristic of HIT forums as the industry heats up.  Instead we got case studies, policy analyses and trends.  The interactive style remained consistent throughout, which lent a sense of industry gestalt to the proceedings.

Bullets over Bel Aire
Here are some of the things that seemed to emerge from the group mind.

Will RTA Keep Primary Care Providers Engaged?

One of the things that jumped out at me during last week's ASC X12/WEDI Real Time Adjudication Conference was that the consequences of high deductible health plans was going to affect certain provider settings much more severely than others.

The push to make patients responsible for a larger component of their health care spending makes sense to employers, who see the immediate consequences of the choices are making today.  The long range impact of those choices doesn't necessarily play into such calculations, given the transient nature of the modern workforce.

Be Very Afraid
Providers are -- or should be -- scared to death, because patients are notoriously negligent in paying their medical bills.  Moving a large percentage of your revenue from the conflict-ridden but semi-reliable private payer category into the conflict-ridden but entirely unreliable patient responsibility category means a lot of dollars will go uncollected.  An increasing number of dollars will be at stake as the HDHP phenomenon becomes more widespread.

Providers will need to change their processes just to maintain viability.  But some providers will be much harder hit because of their patient mix and the types of services they offer.

Real Time Pilot Shows $6-8 per Claim ROI

A story in Healthcare Finance News reports on several Real Time (Claims) Adjudication (RTA) projects, including Blue Cross Blue Shield of Tennesee, Humana and Cigna.

Humana’s pilot, involving a 10-physician practice in Texas, yielded savings of $6 to $8 per claim. “The site saved $14,000 in billing costs alone,” said Janna Meek, director of Humana’s integrated provider solutions.

Tennessee's anectodal evidence is also persuasive:

One provider reported being able to collect 70 percent of patient-owed fees from those covered by high-deductible health plans when patients were checking out.

But, as the piece points out, the standards are not there yet: "Although the technology strategies vary, payers are either starting or expanding pilot programs that adjudicate claims in real time for providers. "

We'll be covering all this and more in next month's webinar Real Time Adjudication: Drivers and Deliverables.

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

Aetna, Ingenix a Bigger Deal?

I just got my hands on a copy of the press release detailing the agreement between Aetna and Ingenix.  Turns out, it's much more than standards-based Real Time Adjudication (RTA), as if that weren't enough.  The payer will be using the EDI testing and validation technology enabled by Ingenix's Claredi division to automate direct connections.  Is it possible that the payer finally acknowledged the plainly-stated regulatory requirement that they provide free claims submissions to providers capable of conducting standard transactions?

Or did they just want to cut their monthly Emdeon bill?

No matter, they're going to be giving providers a host of new, valuable services.  Read on....

Aetna, Ingenix Partner for Real Time Claims

Aetna and Ingenix have inked a five year deal to implement Real Time Adjudication through an Ingenix portal.  The wording of the release suggests that they might be doing this as a true standards-based RTA system, rather than the Direct Data Entry (DDE -- aka "Duplicate Data Entry") that others have deployed.  If so, Ingenix could be positioning itself to be an "all-payer" RTA service.

Will provider vendors be smart enough to ping one-off 837 transactions and to catch the replies in whatever format they might see?  The competitive advantage of enabling same-day collections suggests that some will....

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

The Wal-Mart Effect on Healthcare

Once again, the Mr. HISTalk site has me thinking.  This time, it's a reader's forum post on the possible impacts of Wal-Mart's entrance into the health care delivery market.  A fellow calling himself Art Vandelay lays out some pretty thoughtful possibilities.  His narrative investigates every aisle of inquiry, from the push toward transparency in pricing and wait times to the impact a nationwide, HIT-enabled provider network could have on road warriors strapped with high deductibles and a runny nose.

As a neighbor (the Behemoth of Bentonville is a short drive from Tulsa, close enough that we can hear it breathing at night), I've long been intrigued by the Wal-Mart Effect and the impact it might have on US healthcare.  Not just as an entity, but as a model of monopsony: The dominant influence that a single purchaser (oops -- I almost said "single payer") can have on a market.

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)

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.

Consumer Directed Health Care and Real Time Claims

Just got done with the first day of the X12/WEDI Real Time Adjudication Conference.  Some are now abbreviating this as RTCA (for Real Time Claims Adjudication),  What's RTCA, you say?  Well, that's one of the questions we're debating.

Basically, the concept means the patient walks in, gets treatment and the provider can submit the claim, get the health plan's payment amount (but not necessarily the payment) and the patient responsibility amount -- all before the patient leaves the office.  The provider gives the patient the bill and receives payment or at least an accurately quantified promise. 

The WEDI/X12 conference was just announced a few weeks ago, but there are a couple hundred movers and shakers here in Reston, Virginia.  Why the sudden interest?  In an acronym, CDHC: Consumer Directed Health Care.  Or, more to the point, CDHC as manifest in High Deductible Health Plans.  The Cure for Healthcare is making the patients responsible for their own care.  But giving the patients more responsibility can't reduce healthcare costs if they walk out the door and don't pay.  That's not patient responsibility -- that's industry irresponsibility.

The good news for us is, it's a perfect storm for introducing a new technology: RTCA.  RTCA could capture that elusive patient responsibility that is the core premise of CDHC.  There are lots of incentives for everyone to make this work -- and soon.