Author: dondennison

Article – Imaging centers hit with surprise 30% cut for MRI codes

dondennison Radiology ,

Full article is here, but requires (free) registration. A short summary (no registration required) is also available here.

The full article is worth a read as it goes into several reimbursement changes happening and pending.

An excerpt…

Because of adjustments made by the Centers for Medicare and Medicaid Services (CMS) in its assumptions about room use time for 2013, reimbursements for CPT code 73721 (lower extremity joint MRI) and 73221 (upper extremity joint MRI) have been cut dramatically, according to Mike Mabry, executive director of the Radiology Business Management Association (RBMA).

“To calculate [relative value units (RVUs)], Medicare estimates labor, medical supply, and equipment costs associated with every procedure,” Mabry told AuntMinnie.com. “For these two codes, CMS decreased its estimate of the amount of time the room would be used, from 63 minutes to 33 minutes. They cut the room time in half for those two codes, which results in lower equipment and direct costs and a lower technical component. That’s why freestanding centers are seeing cuts in the range of 30% for these two MRI codes.”

Rick Davis, vice president of Palm Coast Imaging, a freestanding center in Palm Coast, FL, was shocked when he saw his center’s Medicare explanation-of-benefits report.

“In 2012, reimbursement for CPT code 73721 was $427.21,” Davis told AuntMinnie.com. “This year, the Centers for Medicare and Medicaid Services reduced the reimbursement to $297.58. If managed care companies follow suit, freestanding centers will find it difficult to remain open.”

Articles on Mobile Health Applications and FDA Regulation

dondennison Healthcare IT , ,

Check these out…

Dear FDA: Qualcomm’s Robert Jarrin lists his wishes for FDA regulatory action

Where is the ‘fine line’ between safety and free rein for mobile development?

Some thoughts…

  • At risk of ending up on some government list of subversives, I question how often FDA (or equivalent agency in other countries) regulations actually result in protecting patients when they are applied to health IT products. Yes, good design, development, and validation practices are necessary for quality products. And, yes, health IT products are managing very important, not to mention legally protected, information that—when misused or when a defect affects its operation—can result in improper actions being taken …sometimes with adverse effects. But, for those that have worked for a registered medical device manufacturer, we spend more time with our eyes on paperwork than we should be. Time we could be spending on better design, or additional testing before launch. Too much of the paperwork is about evidence creation, and not about actual quality. Many process and method innovations developed in general IT product development are often difficult to adapt to the expected models in the FDA’s so called good manufacturing practices (GMP), and therefore do not achieve the same benefits/results.
  • If the U.S. government is generating revenue from the new medical device excise tax, is it possible that the FDA may be motivated to determine that more, not fewer, mobile apps are medical devices, and therefore subject to taxation? OK, I may have crossed the line into full-fledged conspiracy theory there. Sorry about that.

 

Blog – March Madness in Radiology: the Push for ACOs

dondennison Radiology ,

March Madness in Radiology: the Push for ACOs

This excerpt…

Prompt, consistent report delivery must be available and employ current technologic standards that streamline this, including tablet and smartphone delivery to providers. Rigorous quality reviews, peer evaluation and communication between radiologist and technical centers must be used to improve quality. Electronic methods of tracing and evaluating incidents should be employed.

…is on the money, but this technology platform should be part of the EMR (probably sourced as an add-on) and managed by the same group that manages the EMR, not Radiology. Radiology should indeed provide the guidance to configure the platform to meet Radiology’s needs, but they aren’t the only specialty that needs these tools, so a shared service is the best approach.

Article – Trainees in Radiology and Other Specialties See Dream Jobs Disappearing

dondennison Radiology

Trainees in Radiology and Other Specialties See Dream Jobs Disappearing

…this article has been shared in many places, but if you haven’t read it, do.

Also, see this blog post response.

Article – EHR Adoption Report: The Latest Trends

dondennison Healthcare IT

EHR Adoption Report: The Latest Trends

Some interesting tidbits…

The Office of the National Coordinator (ONC) for Health Information Technology’s most recent data briefs, reporting hospital adoption of EHR technology based on American Hospital Association (AHA) data, indicated the number of nonfederal acute-care hospitals with EHR systems–also known as electronic medical record (EMR) systems–has more than tripled since 2009, increasing from 12.2 percent to 44.4 percent.

Use of electronic active medication lists and clinical decision support rules increased to 87 percent, from 62 percent and 66 percent, respectively. The percentage of hospitals using computerized provider order entry (CPOE) jumped 167 percent, from 27 percent in 2008 to 72 percent in 2012.

The ACP/AmericanEHR study showed user satisfaction fell 12 percent from 2010 to 2012, with the percentage of very dissatisfied clinicians increasing by 10 percent. Thirty-nine percent of physicians would not recommend their EHR to a colleague. The numbers were similar for physicians in a variety of practice settings.

…physicians do not like being forced to use electronic technologies and that EHRs do not measure up to what they are used to in their day-to-day lives, which include iPad apps and smartphones, saying that record systems are fairly rigid with a flat interface.

Article – Get set: New HIPAA has teeth

dondennison Policy

In this article, the new HIPAA Privacy and Security final rule—also known as the HIPAA Omnibus Rule—which became effective on March 26, 2013, is discussed.

Some thoughts…

  • Access to protected health information by 3rd parties, such as vendor support staff, is mentioned. In the related article referenced at the bottom (note: link is broken; corrected link here), it mentions that “Third parties account for 40 percent of the breaches reported and 75 percent of the records exposed”. It will be interesting to see how effective a vendor’s support staff will be when they are unable to analyze data referenced in a reported problem; invalid or corrupt data is a common enough problem that analyzing the original data to eliminate this as a root cause of the problem is a routine task. Also, wide scale analysis of databases to detect frequency of missing or invalid data elements is also a common method. If this data is not made available, or is stored in an encrypted form (at rest), it will be interesting to see how effective current support methods and tools will be (may need to be updated).
  • Same question as above for Business Intelligence (BI) applications that often mine databases (and sometimes files) containing patient record information.
  • Encryption of data on disk (by the storage subsystem or the application) is relatively common (often as an option), but encryption of the database files is less common (though technically feasible with many database management systems). It seems to me that most of the detected and reported breaches are of laptops and portable media (e.g. USB drives).
  • I wonder, if this rule is heavily enforced, if the fines will become enough of a revenue source to be viewed as a way of offsetting the costs of enforcement, or even funding—much like speeding and parking tickets subsidize police operations.