Monthly Archives: January 2015

Fee for Service Reimbursement: No Longer Big Man on Campus

Recently, CMS announced to transition half of their payments over to a value-based model by 2018.  On Wednesday, a consortium of 20 payers and major health systems announced a similar goal but upped the ante to 75% of their business to a value-based reimbursement model.

Read more here.

Anthem’s $500 Million Move to the Cloud

With the changing IT landscape, many organizations both large and small are finding it more cost-effective and operationally better to store data on the cloud.  Anthem recently announced a whopping $500 million contract w/IBM for a hybrid approach where there will be data stored on IBM’s cloud servers but also leave some data operations and storage at Anthem’s data centers.

Read more here.

Fill Up Your Car, Buy Snacks, and Get a Physical? Healthcare Moving to Increasingly Non-Traditional Settings

We all know that healthcare delivery is increasingly changing from one away from an acute care setting (which is a lot more expensive and not as convenient for a lot of patients) to one that fits into the rhythm of one’s daily life.  We see that in the nurse practitioner led walk-in clinics in drug stores, urgent care centers open on nights and weekends, and other ways to bring healthcare to consumers.  Here is an article of a primary care physician who opened a practice inside a Virginia truck stop (yes, you read that correctly) as a way to keep his practice alive and also as a way of meeting an underserved population, truck drivers.

Breaking News: CMS Chief Marilyn Tavenner to Step Down

Last Friday it was announced the current head of CMS Marilyn Tavenner is to resign at the end of February.  By all indications, she had bipartisan support from both sides of the aisle but she seems to have been caught up in the politics surrounding the troubled rollout back in October of 2013.

CMS’ #2 administrator Andrew Slavitt is slated to step in until a replacement is found and undergoes the confirmation process.


National Patient Identifier-An Idea Whose Time Has Finally Come?

In the era of increasing digitization of healthcare data and a greater call for interoperability of said data, have we reached a tipping point to finally begin implementing a unique identifier for everyone in the United States?  Say, something similar to what was implemented several years ago for providers–NPI or National Provider Identifier.  This one would also be an NPI but for National Patient Identifier.

Is this even possible?

Did you know that the idea for a ‘national patient identifier’ was a part of the original 1996 HIPAA legislation.  However, this piece stalled and was later removed due to concerns voiced by privacy stalwarts.  We have been dealing for years–even decades–with stolen identities and hijacked sensitive personal data having everyone on edge.  (Remember the days when our social security number was floating around EVERYWHERE?  At one time, I even had my SSN printed on my personal checks!)  However, this key piece of identifying information does throw a (pretty large) monkey wrench in trying to match up health IT data coming from within and outside an organization.  This hampers overall interoperability efforts especially w/HIEs.

Most provider entities (especially hospitals and health systems) have quite a time w/their MPI (Master Patient Index) as it is.  Before I worked at a large health system implementing their EMR solution, I was clueless as to how hard this can be.  For example, take a common name such as John Smith.  What if John is admitted to the hospital and tells the registration clerk his nickname, Johnny, and doesn’t have his insurance card on him but knows he has Blue Cross.  The registration person enters Johnny Smith into the system.  What about if this same patient uses another derivation of the name, Jonathan, his full name but it differs than what is on his insurance record.  If this same person comes in for a follow-up visit in two weeks and has moved and gives his name as Jonathan but the registration clerk miskeys his name and enters Johnathan (w/an h)? This is all the same person but he has three different first names and at least two different addresses.  All for the same patient.  How is an organization to know that this is one person?  Here’s an interesting article that delves a bit further into this issue.