Manage My Practice

Health and Human Services Secretary Kathleen Sebelius today announced the launch of HealthCare.gov on Facebook: http://www.facebook.com/Healthcare.gov.

HealthCare.gov on Facebook offers Facebook users a new tool to understand and stay informed about the Affordable Care Act, said Secretary Kathleen Sebelius. This new page is another resource that people can use to learn about and discuss health care issues that are important to them, their family, or their small business.

HealthCare.gov on Facebook provides additional resources that allow consumers to take health care into their own hands.

HealthCare.gov on Facebook allows people to:

• Search for insurance coverage using our Insurance Finder tool. The tool asks users to fill out two fields with basic information about themselves and the state they live in. Users are then redirected to a page on HealthCare.gov that continues with the insurance finder process based on the information provided.
• Share thoughts and ideas with other members of the HealthCare.gov network.
• Learn more about what the Affordable Care Act means for individuals, families, or small businesses.
• Stay informed with new blog posts and webchats.

To join HealthCare.gov on Facebook visit http://www.facebook.com/Healthcare.gov, and click the Like button at the top of the page.

*Text from today’s press release

What is a NPI again?

The National Provider Identifier (NPI) is a Health Insurance Portability and Accountability Act (HIPAA) Administrative Simplification Standard. The NPI is a unique identification number for covered health care providers. Covered health care providers and all health plans and health care clearinghouses must use the NPIs in the administrative and financial transactions adopted under HIPAA. The NPI is a 10-position, intelligence-free numeric identifier (10-digit number). This means that the numbers do not carry other information about healthcare providers, such as the state in which they live or their medical specialty. The NPI must be used in lieu of legacy provider identifiers in the HIPAA standards transactions.

As outlined in the Federal Regulation, The Health Insurance Portability and Accountability Act of 1996 (HIPAA), covered providers must also share their NPI with other providers, health plans, clearinghouses, and any entity that may need it for billing purposes.

When should you get a new NPI?

The National Provider Identifier (NPI) is meant to be a lasting identifier, and is expected to remain unchanged even if a health care provider changes his or her name, address, provider taxonomy, or other information that was furnished as part of the original NPI application process. There are some situations, however, in which an NPI may change such as when health care provider organizations determine they may need a new NPI due to, for example, certain changes of ownership, the conditions of a purchase, or a new owners subpart strategies. There also may be situations where a new NPI is necessary because the current NPI was used for fraudulent purposes.

A health care provider (or the trustee/legal representative of a health care provider) should deactivate its NPI in certain situations, such as retirement or death of an individual, disbandment of an organization, or fraudulent use of the NPI. To deactivate an NPI, a health care provider (or the trustee/legal representative of a health care provider) must complete a CMS-10114 and mail it to the NPI Enumerator.

Does the NPI replace the tax ID number?

The billing provider’s tax ID number and NPI are always required on claims. Any other providers identified on the claim, such as rendering provider or service facility, must be identified with their NPI only. Their tax ID number should not be included.

For eligibility, claim status inquiry, referral and precertification, only the NPI (no tax ID number) is used.

How does a rendering physician report their National Provider Identifier (NPI) on a claim that includes Physician Quality Reporting Initiative (PQRI) or Electronic Prescribing Incentive Program (eRx) quality-data codes (QDCs)? What if he/she is part of a group and the group NPI is used on the claim?

Your individual National Provider Identifier (NPI) must be included on the claim line items for the quality-data codes (QDCs) you submit as well as the line items for the services to which the QDC is applicable. The PQRI/eRx QDC must be included on the same claim that is submitted for payment at the time the claim is initially submitted in order to be included in PQRI analysis.

If a group NPI is used at the claim level, the individual rendering physician’s NPI must be placed on each line item, including all allowed-charge and quality-data line items. See the PQRI Implementation Guide for a sample CMS-1500 claim. This is available as a download from the Measures/Codes section of the CMS PQRI website. For eRx, see the Claims-Based Reporting Principles for eRx, available on the CMS eRx website.

If a health care provider with a National Provider Identifier (NPI) moves to a new location, must the health care provider notify the National Plan and Provider Enumeration System (NPPES) of its new address?

Yes. A covered health care provider must notify the NPPES of the address change within 30 days of the effective date of the change. We encourage health care providers who have been assigned NPIs, but who are not covered entities, to do the same. A health care provider may submit the change to NPPES via the web or by paper. If paper is preferred, the health care provider may download the NPI Application/Update Form (CMS-10114) from the Centers for Medicare & Medicaid Services’ forms page or may call the NPI Enumerator (1-800-465-3203) and request a form.

What happens when you join a group?

In Section 4B of the CMS-855I, the NPI of the Group should be entered if it has been issued to the Group. If you are joining a group, the group is responsible for providing you with their current Provider Identification Number (PIN) and the NPI, if they have been issued.

If you are a solo physician with an incorporated practice, how many NPIs should you have?

An individual is eligible for only one NPI. In the above example, there are two health care providers: the physician and the corporation. The physician would obtain an NPI (Entity Type Code 1, Individual). The corporation would obtain an NPI (Entity Type Code 2, Organization). Generally, the corporations NPI would represent the Billing and Pay-to Providers and the physicians NPI would represent the Rendering, Referring/Ordering, Attending, Operating and/or Other Providers. These physicians should ensure that their enrollment records with the health plans to whom they will be sending claims are up to date, that those health plans are aware of the assigned NPIs, and that the NPIs are used in a way that is compatible with their enrollment.

I do not submit healthcare claims to Medicare; do I need a National Provider Identifier (NPI)?

Where can you look up NPIs?

My current practice is getting ready to go live on Electronic Medical Records (EMR) in just two short months, but it’s taken us over a year to get here. When I first started this job, we were supposed to go live with EMR in two months. After I’d had a chance to speak with everyone, I just knew the timing wasn’t right for the EMR. We would need to be able to run, and at that moment we were just starting to crawl.

What were the signs we weren’t ready?

• communication problems with the vendor, who provided the existing practice management system and the new EMR
• issues with the practice management system which had been mis-identified as being support-related
• basic decisions had not been made: one shared medical record for all clinics or individual records for each clinic?
• no single point person who was keeping everything together
• lots of frustrated and worried faces – did we know what we were doing?

A sigh of relief…

Although we knew we wanted the EMR and we had already made the investment, we also knew it might be a train wreck if we didn’t get some other questions answered first. When I announced we were going to delay the go-live until we had some other issues resolved, there was a sigh of relief from all involved.

What did we do to get ready for EMR?

1. We attacked the support problems by rerouting all support issues through one person – me. I kept a detailed log of all support issues and the resolution of each. I found the vendor to be surprisingly helpful and issues relatively easy to resolve. As I asked questions and we fixed issues, we found that much of our problem was training-related.
2. We held a major training event where all non-clinical staff were retrained to use the practice management system and everyone was given new cheat sheets for the correct way to use the system.
3. We realized that staff were worried about the impact of the EMR because the providers were overwhelmed with the current workload. They didn’t know how we would get through the pre-live work, the huge challenge that is the go-live and first few months of adjustment. After some intense evaluation, we changed our scheduling strategy and moved established visits from 15 minutes to 20 minutes, adding four work-in appointments and setting rules for adding more than four work-ins.
4. We took the vitals out of the halls and into the exam rooms, making the office quieter and the patient interactions private.
5. We also got control of most of our paper processes that weren’t working. We color-coded messages, re-educated patients about new ways of communicating with us and we managed to bring our fax and phone call volumes down to a manageable number.
6. We assigned nurses to the providers and asked the provider-nurse duos to put their arms around their patient panels as a team. The patients love it. We moved a float nurse to a triage nurse position to start taking all requests for same day sick visits and scheduling them appropriately.
7. We are soon to add an answering service (I prefer the term “virtual receptionist”) to our phones. The virtual receptionists (1000 miles away!) will take calls for the nurses and providers, typing them directly into our EMR.
8. We also started a front-end collection system, bringing our accounts receivable under control by adding automated eligibility, a new financial policy, collecting co-pays at check-in, calling patients with old balances before they arrived for their visit, and instituting a discount for non-insured patients.

How will you know when your practice is ready for EMR?

• You are not overwhelmed on a day-to-day basis. If your practice isn’t running well without an EMR, it is not going to run better with an EMR. If you are having operational issues, consider having a consultant help you set up new processes to handle the hurdles you’re facing now. The EMR does not fix operational issues, with the possible exception of lost paper charts.
• Your staffing is stable. There will always be some employees coming and going, but if you are experiencing one of those cyclical shifts when you have several new staff at once (especially nurses), you might want to give them a little more time to get a handle on their jobs before introducing EMR.
• You have your practice management act together – your PM works well and is up-to-date.
• Your finances are in order. If it takes several months of lower productivity, followed by less collections, you can weather the storm because you are on top of the dollars.

Q: Tell us about the process leading up to the creation of Infield and how you decided to focus on a mobile application?
Infield has always been devoted to mobile. We were originally in the public health space, but we caught the Health 2.0 bug and started looking at the intersection of patients and care providers. We honed in on texting because it includes the 60% of patients that dont have a smart phone.

Q: Your product is suitable for a large practice or a hospital. Can you describe how a client would use your product for specific populations or health issues or to enhance a service line?
A clinic or hospital would enroll its patients into specific strings of messages based on the patients condition. For example, hypertension patients would receive a Heart Healthy Tip-of-the-week, while diabetics might receive weekly tips on diet and exercise. Physical therapy patients could receive texts about stretching or light exercise ideas. The goal is to keep the patient close to the provider in-between visits. An additional benefit to the provider is keeping patients on track with appointments and office visits, thereby driving revenue to the provider.

Q: We talked about the client creating the content for the text messages – can you give some examples of text messages that a practice or hospital might send to a patient newly diagnosed with diabetes?

Lets imagine the texts are coming from Valley General Hospital.

Week 1 text: An after dinner walk often helps get 20-min of exercise. Join Valley Generals walking club! 800-555-1212. Text STOP to stop

Week 2 text: Monitors and strips are often covered under insurance or Medicaid. Call us to learn more: 800-555-1212. Text STOP to stop

Week 3 text: Dizziness or shortness of breath can be serious. Valley Gen nurse line @ 800-555-1212. Text STOP to stop

Week 4 text: Stay on track with your appointments, even if you dont feel sick. Valley Gen. appt line @ 800-555-1212. Text STOP to stop

Whats important is that the patient is receiving gentle nudges to adopt a healthier lifestyle, while also receiving contact data to achieve those results. For the provider, the calls to action often result in increased revenue.

Patients can “Text STOP to stop” at any time to stop receiving messages.

Q: What’s the process for connecting the patient with the messages, and who makes that connection?
There are two ways. 1. At discharge: the discharge nurse brings up a simple Website that lists the conditions available (diabetes, hypertension, and obesity, for example). He or she chooses a condition, types in a patients phone number, and hits send. 2. Self-directed: the patient is handed a business card with instructions on how to self-enroll. Text HEART to 12345 for English-hypertension. Text CORAZON to 12345 for Spanish-hypertension.

Q: I was impressed that you offer the service in different languages – which languages are available or can you make any language available upon request?
Offering content in multiple languages is crucial to reaching patients who dont use the Internet or e-mail. For example, young Hispanics are 5x more likely to text than use email in any given day. Infield can offer the content in any language thats supported on a mobile phone.

Q: I’ve heard of obstetric practices texting pregnant women and giving them lots of support and information during their pregnancy. Are there other success stories about specific populations or specific illnesses or diseases?
Youre referring to Text4Baby a fantastic example of aggregating patients (pre-natal moms) and offering quick snippits of information. In addition, there are recent examples of texting increasing drug compliance and at-home therapy compliance. Were offering the ability for individual providers to customize the content and offer it to their patients exclusively.

Q: Can Infield handle medication reminders or support group reminders or texts that would be sent on a different time line than 2 messages per week?
Yes. We can change the intervals based on whats best for the patient and the provider.

Q: Could your product be launched in a community to improve the health of an entire community and maybe be supported by a grant?
Yes. In fact, we are currently on a number of grant applications to offer health improvement through community health initiatives. We worked with the community centers to meet the grant requirements.

Q: Where do you see mHealth going in the next two years? Can you give us a hint about functionality that your product might have in the near future?
The ability for patients to support each other via mobile devices is something were very excited about. So, instead of a gentle nudge to improve my health from my doctor, I got one from my best friend or coworker or walking partner. Patients helping each other — one-to-one — is what were excited about.

Doug Naegele is president of Infield, a provider of mobile solutions that bring patients closer to healthcare providers. Previously he held positions in healthcare banking, technology development, and drug discovery. The latter, at Vertex Pharmaceuticals, yielded numerous US patents and drug candidates for Hepatitis C and autoimmune disease. Doug holds an undergraduate degree from Harvard University and an MBA from The George Washington University. You can contact Doug here: doug@goinfield.com and his company website is www.InfieldHealth.com.

WASHINGTON, DC U.S. Department of Health and Human Services Secretary Kathleen Sebelius wrote Americas Health Insurance Plans (AHIP), the national association of health insurers, calling on their members to stop using scare tactics and misinformation to falsely blame premium increases for 2011 on the patient protections in the Affordable Care Act. Sebelius noted that the consumer protections and out-of-pocket savings provided for in the Affordable Care Act should result in a minimal impact on premiums for most Americans. Further, she reminded health plans that states have new resources under the Affordable Care Act to crack down on unjustified premium increases.

The text of Sebelius letter is below.

Ms. Karen Ignagni
President and Chief Executive Officer
Americas Health Insurance Plans
601 Pennsylvania Avenue, NW
South Building, Suite 500
Washington, DC 20004

Dear Ms. Ignagni:

It has come to my attention that several health insurer carriers are sending letters to their enrollees falsely blaming premium increases for 2011 on the patient protections in the Affordable Care Act. I urge you to inform your members that there will be zero tolerance for this type of misinformation and unjustified rate increases.

The Affordable Care Act includes a number of provisions to provide Americans with access to health coverage that will be there when they need it. These provisions were fully supported by AHIP and its member companies. Many of the legislations key protections take effect for plan or policy years beginning on or after September 23, 2010. All plans must comply with provisions such as no lifetime limits, no rescissions except in cases of fraud or intentional misrepresentation of material fact, and coverage of most adult children up to age 26. New plans must comply with additional provisions, such as coverage of preventive services with no cost sharing, access to OB / GYNs without referrals, restrictions on annual limits on coverage, a prohibition on pre-existing condition exclusions of children (which applies to all group health plans), access to out-of-network emergency room services, and a strengthened appeals process. And health plans that cover early retirees could qualify for reinsurance to sustain that coverage for businesses, workers, and retirees alike.

According to our analysis and those of some industry and academic experts, any potential premium impact from the new consumer protections and increased quality provisions under the Affordable Care Act will be minimal. We estimate that that the effect will be no more than one to two percent. This is consistent with estimates from the Urban Institute (1 to 2 percent) and Mercer consultants (2.3 percent) as well as some insurers estimates. Pennsylvanias Highmark, for example, estimates the effect of the legislation on premiums from 1.14 to 2 percent. Moreover, the trends in health costs, independent of the legislation, have slowed. Employers premiums for family coverage increased by only 3 percent in 2010 a significant drop from previous years.

Any premium increases will be moderated by out-of-pocket savings resulting from the law. These savings include a reduction in the hidden tax on insured Americans that subsidizes care for the uninsured. By making sure insurance covers people who are most at risk, there will be less uncompensated care, and, as a result, the amount of cost shifting to those who have coverage today will be reduced by up to $1 billion in 2013. By making sure that high-risk individuals have insurance and emphasizing health care that prevents illnesses from becoming serious, long-term health problems, the law will also reduce the cost of avoidable hospitalizations. Prioritizing prevention without cost sharing could also result in significant savings: from lowering peoples out-of-pocket spending to lowering costs due to conditions like obesity, and to increasing worker productivity today, increased sickness and lack of coverage security reduce economic output by $260 billion per year.

Given the importance of the new protections and the facts about their impact on costs, I ask for your help in stopping misinformation and scare tactics about the Affordable Care Act. Moreover, I want AHIPs members to be put on notice: the Administration, in partnership with states, will not tolerate unjustified rate hikes in the name of consumer protections.

Already, my Department has provided 46 states with resources to strengthen the review and transparency of proposed premiums. Later this fall, we will issue a regulation that will require state or federal review of all potentially unreasonable rate increases filed by health insurers, with the justification for increases posted publicly for consumers and employers. We will also keep track of insurers with a record of unjustified rate increases: those plans may be excluded from health insurance Exchanges in 2014. Simply stated, we will not stand idly by as insurers blame their premium hikes and increased profits on the requirement that they provide consumers with basic protections.

Americans want affordable and reliable health insurance, and it is our job to make it happen. We worked hard to change the system to help consumers. It is my hope we can work together to stop misinformation and misleading marketing from the start.

Sincerely,

Kathleen Sebelius

A QR (Quick Response or Quick Read) Code is a two-dimensional matrix/bar code. Users hold their phone up to the code displayed on a sign, in a book, on a computer screen, tv, or almost anywhere. The phone camera snaps the code and takes the user to a website or video with more information – no typing needed – just point and click.

QR Codes are most common in Japan where they are currently the most popular type of two dimensional codes. (definition courtesy of Mashapedia = wikipedia and Mashable)

1. Billboards advertising hospitals and medical groups will have QR codes so travelers can get more information about facilities or get directions to the closest Emergency Department, Urgent Care or family practice.
2. Television advertising for pharmaceuticals will have QR codes so viewers can get more information on the spot.
3. Healthcare facilities will have QR codes for all types of information and videos that providers and nurses will instruct patients to scan based on their health problems.
4. Magazines and newspapers will have QR codes that readers can scan to get health information and health product coupons.
5. Scanning QR codes when exercising or purchasing healthy foods will get you reward points with your health plan, your doctor or your employer.
6. Comparison of foods that you should or should not buy in grocery stores based on your individual health problems will be easy when you scan the food’s QR codes.
7. Caregivers will scan QR codes to receive information and videos for caring for their loved one at home.
8. When purchasing over the counter medications, vitamins and supplements, you will scan the QR to make sure the medication isn’t contraindicated for any prescription medication you are taking.
9. Scanning the QR code on food or cleaning products will let you know if they contain anything that you are allergic to.
10. At health fairs, attendees will scan QR codes for more information on health topics and your facility and services.
11. Disposable diapers will each come with a unique QR code that Moms (and babies) can scan to get childcare tips, games, songs and medical advice.
12. Urgent Care facilities and Emergency Rooms will have QR codes for instant access to wait times.
13. QR codes in healthcare facilities will let users download helpful mobile healthcare applications like those that help you control your chronic illness or lose weight.
14. In print advertising for physicians, potential patients will scan the QR code to view the physicians talking about their background, their specialties and their desire to have you as a new patient!
15. Referring patients to facilities or specialty practices will be much easier when patients scan the QR code for the referral and receive information, instructions and directions to the appointment.
16. Healthcare facilities will give out t-shirts and carrying bags promoting their services and the QR codes on them will spread the word to others. (Yes, people will scan each others’ t-shirt codes!)
17. Patients taking home holter monitors and CPAPs will be able to scan the QR code on the machine to get a “how-to” video on using it.
18. Patients taking home sample medications from physician offices will have QR codes on the bag to scan to remember how they are to take the samples.
19. Temporary tatoo QR codes will identify those patients who won’t wear identifying bracelets, have dementia, or tend to wander away.
20. Hospital patients will scan the menu broadcast on their TV to order their daily meals.
21. If you are going to be late to your doctor’s appointment, you will scan a QR code to email an alert to the office that you are on the way. (Wait, maybe that’s too easy!)
22. Pharmacies will have QRs loaded with prescription prices by insurance company plan on their website so providers can compare different drugs and chose the best drug for the patient at the best price.

As Manage My Practice just passed the two-year mark, it seems like an excellent time to hear what’s on your mind. Please take 2 minutes or so and answer my 5-question survey.

Bob Cooper and I connected on LinkedIn when he responded to a question in a way that I thought was quite different from all the other answers. That inspired me to view his profile, see his book and contact him about answering some questions about his book for MMP readers.

1. How did you get started working in the healthcare field?

I was recruited by an executive search firm to work for an academic medical center in the fields of Human Resources and Organizational Development.

2. How much of your business is in the healthcare market?

Approximately 80% of my clients are in the healthcare field.

3. What are the types of issues you are called upon to help resolve for healthcare clients?

I am frequently called upon to enhance interdisciplinary collaboration on patient care units and other departments using my Organizational Huddle Process, improve patient satisfaction, enhance staff satisfaction and retention, develop leadership competency, executive coaching, and strategic planning.

4. What is the most common issue you see healthcare entities struggling with?

The most common issue I see healthcare entities struggling with is maintaining effective staffing ratios in an environment of shrinking reimbursements.

5. If you use your crystal ball, what types of issues do you see healthcare entities facing with the full impact of healthcare reform hitting in 2014?

The greatest issue I see is how to effectively run the business during a time of great uncertainty. Healthcare leaders will need to be great change agents. They will need to engage staff at all levels to understand and embrace the changes as they evolve, and incorporate recommended strategies that will continue to grow the business. Healthcare organizations will need to stick with business strategies that are viable, and know when to get out of businesses that are not going to be profitable.

6. You say your new book Heart and Soul in the Boardroom helps leaders to inspire employees to new heights of engagement, satisfaction, and loyalty. We know that healthcare employees (providers, administration, nurses, clerical staff) are all struggling with burnout, change, and economic issues. Give us advice on leading employees in a very difficult time in healthcare,

My advice is to engage staff in running the business, show concern for their career aspirations and development, and work hard to serve their needs. Its true that many people are working harder to just keep up with the pace of change. Our job as leaders is to show every member of our team how much we truly value them and really mean it!

7. What is the secret to managers taking care of themselves when they are responsible for keeping the business going, keeping the physicians happy, keeping the staff happy and keeping the patients happy?

Managers must seek to keep themselves happy. This means that they find joy and meaning in their work. Learn to appreciate every interaction with every internal and external customer. For example, find joy in looking at the smile on an employees face after you give a sincere compliment. Find happiness in everything you do, including drinking your favorite cup of coffee. Say good morning and thank you to all. Show concern for everyone you deal with. And perhaps the most important thing you could do is to learn to detach. This means that you give everything you have to achieve a positive outcome, but you also recognize that you do not control the outcome. Be grateful for what you have make a gratitude list every day.

8. You and I talked about living an authentic and integrated life. What does that mean to you and how can managers achieve this?

An authentic and integrated life means that you live your values everyday, and at all times. You understand that who you are at work is no different from who you are outside of work. Your values should come from a place of service, always exhibiting behaviors that are kind and considerate to others. You brand yourself as someone who is consistent, reliable, and everyone knows what you stand for at all times. Others know that your intentions are pure and good.

9. When can we expect your next book and what will it be about?

Heart and Soul in the Boardroom is my third book, and I dont know when I will write my next one. What I can say for sure is this the next book will be a result of my being inspired to be of service others.

Bob Cooper is the founder and president of RL Cooper Associates, an innovative healthcare organizational and management consulting firm. With over twenty-five years experience in people and organizational development, Mr. Coopers focus is placed on identifying strategies that maximize organizational effectiveness and fundamental transformation by enabling individuals and groups to reach their full potential. In addition to Heart and Soul in the Boardroom, Mr. Cooper is the author of Huddle Up Creating and Sustaining a Culture of Service Excellence, and Leadership Tips To Enhance Staff Satisfaction and Retention. Mr. Cooper holds an MS in Human Resource Management and a BA in Economics. He is also a member of Strathmores Whos Who. Bob can be contacted at rlcooperassoc@aol.com.

The CLIA regulations require a facility to be appropriately certified for each test performed. To ensure that the Medicare and Medicaid programs only pay for laboratory tests categorized as waived complexity under CLIA in facilities with a CLIA certificate of waiver, laboratory claims are currently edited at the CLIA
certificate level.

New test list here (pdf.)

All CLIA waived tests here (pdf.) – updated July 6, 2010