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Tuesday, August 31, 2010
Medical transcription outsourcing: Providing comprehensive and economical services
The healthcare sector is dynamic with constantly changing needs, new developments, new inventions and new discoveries. It is also a sector that has to work under several constraints and strict code of ethics. The constant endeavor of most healthcare facilities is to maintain high standards of service, trying to keep the bottom-line in the black, all this while performing under a strict code of ethics.
The process of healthcare depends on various inputs to be able to deliver quality healthcare. One of the vital ingredients leading to the successful provision of quality healthcare is information from patient records. Medical transcription is the process of creating patient records from the audio records of the healthcare professional’s narration of his/her encounter with the patient. Accurate and creation of patient records is not only important for quality healthcare, but also important for receivables management and as evidence in case of litigation.
Outsourcing medical transcription ensures that the healthcare facility offers comprehensive and economical solutions for its documentation needs.
How does outsourcing medical transcription provide comprehensive solutions?
Outsourcing medical transcription provides comprehensive solutions for documenting patient-healthcare professional encounters, including:
Accuracy: Outsourcing medical transcription ensures that the patient records are created with maximum accuracy possible. Use of medical transcriptionists trained to be domain experts and stringent quality checks involving several levels consisting of medical transcriptionists, proof readers, unit-in charges and the quality check team ensures that more than one set of qualified “ears” listen to the dictation and try to capture the maximum information possible
Turnaround time: Apart from the accuracy of information in patient records, it is also vital that the information is available to the healthcare professionals on time. Outsourcing medical transcription ensures that turnaround time commitments are adhered to using the right team, right processes and the right technology
Specialty transcription: Medical transcriptionists trained to be specialists in one or two specialties ensure that as new specialties are added to the healthcare facility, there are qualified teams available to provide accurate and timely transcription
Weekend and Holiday transcription: Outsourcing medical transcription provides ensures that the service is available to the healthcare facilities round the clock, including holiday and weekend transcription requirements
Coping with varying volumes of transcription requirements: It is impossible to predict the inflow of patients. And medical transcription requirements are dependent on the inflow of patients. Therefore it is impossible to predict the medical transcription requirements. Outsourcing ensures that healthcare facilities can rest easy on coping with varying volumes of transcription
Formats/Templates: Healthcare professionals require patient records in specific formats or templates. Outsourcing medical transcription ensures that the specifications required by the healthcare professionals is taken into consideration
Archive: Most healthcare facilities support staff and sometimes, healthcare professionals spend an enormous amount of time tracing transcripts. Outsourcing to a professional medical transcription service provider ensures that they have archives making it easy to trace and retrieve transcripts
Flexible modes of dictation: Most healthcare professionals are starved of time, outsourcing medical transcription helps them manage time by allowing them to retain familiar modes of dictation
Managing document flow: Outsourcing medical transcription ensures that healthcare professionals and support staff save on time spent on uploading dictation and downloading transcripts by having a system in place that enables all these functions
Remote printing & faxing: Outsourcing medical transcription also ensures that the healthcare professionals may avail facilities like remote faxing and printing easing their burden
HL7 Interface: Outsourcing medical transcription also ensures that healthcare facilities can protect their investments in EMR/EHR by HL7 integration
Security: Protecting confidential patient information is one of the main concerns of healthcare facilities. Outsourcing medical transcription ensures the security of this information throughout the medical transcription process by securing people, processes and infrastructure
How is outsourcing medical transcription economical?
Lowers cost by more than 40%: By outsourcing medical transcription, healthcare facilities can save more than 40% on their current costs
Restricts costs to cost per line: Outsourcing medical transcription also restricts the cost of transcription to the rate per line and ensures that additional expenses like overheads, utilities, management resources, Information technology expenses are curbed.
It can be concluded that outsourcing medical transcription provides a comprehensive and economical solution to the documentation needs of healthcare facilities.
TransDyne offers quality medical transcription at reasonable prices, done by expert medical transcriptionists with a very quick turnaround time executed through secure HIPAA and HITECH compliant channels, with very high levels of accuracy and all this with technology that is advanced but easy to use!
To avail comprehensive and economical medical transcription services from TransDyne, click here.
More Hospital CEOs Join the Millionaire's Club, This Time in Baltimore
As we predicted, more stringent requirements by the US Internal Revenue Service for financial reporting by not-for-profit organizations, including hospitals and hospital systems, have produced an enlarging parade of revelations of obese pay packages for hospital leaders. The latest report came out courtesy the Baltimore Sun:
The article described some of the more corpulent compensation packages.
St Joseph Medical Center
One was from St Joseph Medical Center, already under fire for for the lavish use of cardiac procedures by one of its staff doctors:
Mercy Medical Center:
Johns Hopkins
One might expect the CEO of the Johns Hopkins hospital system to be paid well, but he was paid particularly well since he also seemed to have the full-time, separately paid position of dean of the medical school:
A chart of the compensation of all CEOs is here. As noted in the article, eight CEOs got more than $1 million, and another three got over $900,000.
A Baltimore Sun commentator noted that not only did the CEOs get large salaries, but:
As we have noted before, he pointed out that it is unseemly for not-for-profit hospitals, which are supposed to be devoted to the mission of caring for patients, usually explicitly including poor patients, and which are funded to a great extent by government programs and the income from donations, to make millionaires out of their top hired executives:
People who donate to hospitals, thinking they are doing so to provide better health care, or to help out the less fortunate, may be surprised to hear about the hospital CEO as millionaire:
I am glad that newspaper commentators are getting even more wound up on this issue than I have:
But it gets worse. People who love to play golf on company money, and feel entitled to make a million or more are not the right people to lead organizations that are supposed to focus first on health care, including health care for the less fortunate. Moreover, people who get used to the pay and perks are likely to focus on keeping them coming, rather than the mission, even if they started out with some devotion to the mission. Furthermore, the excessive pay and perks are perverse incentives, telling the CEOs that they are wonderful people, they can do no wrong, and should stand for no criticism, all further diverting them from what they really are supposed to be doing: upholding the mission.
As we have said many times before, true health care reform would encourage leadership of health care who understand health care and care about its mission, rather than those who see a quick way to make a small fortune.
Baltimore-area hospital CEOs and presidents boast seven-figure salaries, club and gym memberships, and paid financial planning and tax services as part of compensation packages from their nonprofit employers.
According to a survey of Baltimore-area hospitals, the highest-ranking executives were often the recipients of financial payouts and perquisites that many private-sector companies have abandoned in the face of intense public debate about excessive CEO pay. The heads of hospital systems, which oversee many facilities, tended to make the biggest salaries and incentives. Eight top executives made more than $1 million, and the largest CEO pay package totaled $7.8 million.
The article described some of the more corpulent compensation packages.
St Joseph Medical Center
One was from St Joseph Medical Center, already under fire for for the lavish use of cardiac procedures by one of its staff doctors:
St. Joseph Medical Center, a member of Catholic Health Initiatives, said in a statement that it offers a level of compensation that allows it to compete for talent. The hospital paid former CEO John K. Tolmie $846,128 in salary, bonus and other pay, the latest IRS filing shows.
'Hospital CEOs have one of the most demanding, high-pressure jobs in the nation, dealing on a daily basis with everything from ever-changing regulations to workforce shortages and lower reimbursement for services,' the hospital statement said.
Tolmie resigned in May 2009 after being on administrative leave to avoid a conflict of interest during a federal investigation. Since then, one of the hospital's cardiologists, Dr. Mark G. Midei, has been accused of performing hundreds of unnecessary heart procedures.
Mercy Medical Center:
Mercy Medical Center head Thomas Mullen made $1.08 million in compensation during fiscal 2009. The hospital said in a statement that it 'believes this compensation to be appropriate given the responsibilities of serving as a president and CEO of a $520 million health system.'
Johns Hopkins
One might expect the CEO of the Johns Hopkins hospital system to be paid well, but he was paid particularly well since he also seemed to have the full-time, separately paid position of dean of the medical school:
Edward Miller, CEO of Johns Hopkins Medicine, made $729,297. He also gets paid separately for his position as dean of the School of Medicine at Johns Hopkins University. The fiscal 2009 filing for the medical school was not yet available. But Miller collected $1.4 million for that job the year before.Summary
A chart of the compensation of all CEOs is here. As noted in the article, eight CEOs got more than $1 million, and another three got over $900,000.
A Baltimore Sun commentator noted that not only did the CEOs get large salaries, but:
Close to a dozen had personal dues for 'social clubs' financed by your charitable donations, tax dollars and health insurance premiums. Many enjoy lavish and opaque executive retirement plans that also put upward pressure on the medical costs that threaten government budgets and the economy.
As we have noted before, he pointed out that it is unseemly for not-for-profit hospitals, which are supposed to be devoted to the mission of caring for patients, usually explicitly including poor patients, and which are funded to a great extent by government programs and the income from donations, to make millionaires out of their top hired executives:
Hospitals aren't Goldman Sachs. They're not Stanley Black & Decker or Microsoft, either. They're nonprofits, getting charitable donations and huge government subsidies beyond all the loot they rake in from Medicare and Medicaid. If the newly required disclosures on the IRS 'Form 990' put pressure on hospital boards and CEOs to tone it down, it's about time.
People who donate to hospitals, thinking they are doing so to provide better health care, or to help out the less fortunate, may be surprised to hear about the hospital CEO as millionaire:
For some hospital donors, the revelations are transparently shocking.
'Donors are completely outraged,' says Ken Berger, president of Charity Navigator, an organization that helps people make smart giving choices. 'Donors tell us more than anything that they're just blown away by the fact that an organization that is a charity basically is creating millionaires in its leadership.'
'The most common remark we get is this: 'I've been giving to this organization for years, and I can't believe what the CEO is making, and I will never support this organization again.' '
I am glad that newspaper commentators are getting even more wound up on this issue than I have:
Why any hospital executive should need a company-paid club membership is a deep mystery. It can't be to woo potential donors. No donor with half a brain wants to endow an institution so employees can play golf with her money.
It shouldn't be to wine and dine business prospects. A hospital's business is collecting revenue for medical care. To be frank, there's too much of that going on already for the good of the country's wallet. Hospitals are far too focused on sales and marketing and not enough on delivering quality, efficient care.
Hospital trustees on any compensation committee can deliver a windy treatise about how pay for senior executives is ethical, carefully considered and worth every penny.
It's all a crock. The 'independent' compensation consultants that boards rely on are often referred by the CEO himself. The consultants know they can't make waves, or they won't get hired to rubber-stamp executive pay at other hospitals. To justify high pay, boards and consultants often use unrealistic comparisons from much bigger institutions or from the for-profit sector.
It doesn't take $1 million to get a great boss.
But it gets worse. People who love to play golf on company money, and feel entitled to make a million or more are not the right people to lead organizations that are supposed to focus first on health care, including health care for the less fortunate. Moreover, people who get used to the pay and perks are likely to focus on keeping them coming, rather than the mission, even if they started out with some devotion to the mission. Furthermore, the excessive pay and perks are perverse incentives, telling the CEOs that they are wonderful people, they can do no wrong, and should stand for no criticism, all further diverting them from what they really are supposed to be doing: upholding the mission.
As we have said many times before, true health care reform would encourage leadership of health care who understand health care and care about its mission, rather than those who see a quick way to make a small fortune.
The August HIT Standards Committee Meeting
The agenda began with comments from Jon Perlin and me reflecting on the busy Summer, reacting to the final rules, and planning for the future of policies and technologies to support interoperability. I summarized my experience with questions and feedback on the Standards Final Rule. Thus far, questions about consistency of content, vocabulary, and standards named in quality measures have been clarified without requiring changes in the rule.
Sam Karp and Aneesh Chopra summarized the Enrollment Workgroup deliverables that satisfy the requirements of Section 1561 of Affordable Care Act. The recommend use of the NIEM framework to support standards and processes going forward. They recommend the creation of web services on top of existing legacy systems as well as create a reference implementation of running software that could be used by states and other stakeholders (note, this does not imply creating a single Federal hub for all transactions). They recommended use of the HIPAA Content standards (834, 270, 271) and codification of human readable business rules using tools such as OMG�s SBVR. Finally, they made a number of privacy/security recommendations that highlight consumer access to data and disclosure logging.
Deven McGraw and Paul Egerman summarized the Privacy & Security Tiger Team Recommendations. Most important are the consent recommendations that require the patient be provided with an opportunity to give meaningful consent before the provider releases control over exchange decisions. The trigger is when the decision to disclose or exchange the patient�s identifiable health information from the provider�s record is not in the control of the provider or that provider�s organized health care arrangement (�OHCA�), patients should be able to exercise meaningful consent to their participation.
Doug Fridsma provided an overview of Standards and Interoperability Framework and its associated RFPs.
The awardees thus far are:
Harmonization of Core Concepts (NIEM Framework) - Deloitte
Implementation Specifications - Deloitte
Pilot Demonstration Projects - Lockheed
Reference Implementation - Lockheed
Testing - Stanley
Tools and Services - Stanley
The role of the HIT Standards Committee will be to provide oversight, coordination and prioritization advice on the Standards and Interoperability Framework to ONC.
Jamie Ferguson presented the Vocabulary Task Force Update.
Judy Murphy and Liz Johnson presented the Implementation Workgroup Update.
The work ahead in September is defining the Standards requirements for Meaningful use Stage 2 and 3. It will be a busy Fall!
Monday, August 30, 2010
"Trouble Coming Every Day" as Discussed by our Fellow Health Care Skeptics
With apologies to the late Frank Zappa... even though we are going through the dog days of summer, the parade of health care troubles in the news is never ending, so I thought I would recap some of the more interesting issues discussed by some of my fellow health care skeptic bloggers.
We have discussed the ongoing decline of primary care. On DB's Medical Rants, Dr Robert Centor takes on the topic: "The system has, without consciously meaning to, held primary care in contempt." The result is a "quiet rebellion: of primary doctors.
We have discussed whether the currently fashionable idea of "accountable care organizations" (ACOs) might turn out to be a cover for health care oligopolies. See what Paul Levy, CEO of the Beth Israel/ Deaconess Medical Center said about them in his blog, Running a Hospital.
We frequently talk about the manipulation or suppression of clinical research studies by those with vested interests in the results pointing in a particular direction. On the Hooked: Ethics, Medicine and Pharma blog, Dr Howard Brody wondered why the FDA will not even reveal the identities of the clinical researchers who did the studies on which it based its decision to approve the Infuse bone growth enhancement device.
Prof Carl Elliott has done an outstanding job investigating commercially funded and implemented clinical research. Dr Brody reviewed his new book, White Coat, Black Hat. In the Carlat Psychiatry Blog, Dr Daniel Carlat reviewed Prof Elliott's new article in Mother Jones on how a pharmaceutical company sponsored drug trial went badly awry.
We asked whether the former CEO of a for-profit hospital chain who resigned after the company paid a > $1.7 billion penalty to settle charges of fraud would be a proper candidate to be governor of Florida. After Rick Scott won the Florida Republican primary, Maggie Maher, writing in the Health Beat blog, took on Scott's dubious past as prologue to a worrisome future.
Well I'm about to get sick
From watchin' my TV
Been checkin' out the news
Until my eyeballs fail to see
I mean to say that every day
Is just another rotten mess
And when it's gonna change, my friend
Is anybody's guess
So I'm watchin' and I'm waitin'
Hopin' for the best
Even think I'll go to prayin'
Every time I hear 'em sayin'
That there's no way to delay
That trouble comin' every day
No way to delay
That trouble comin' every day
- Frank Zappa
We have discussed the ongoing decline of primary care. On DB's Medical Rants, Dr Robert Centor takes on the topic: "The system has, without consciously meaning to, held primary care in contempt." The result is a "quiet rebellion: of primary doctors.
We have discussed whether the currently fashionable idea of "accountable care organizations" (ACOs) might turn out to be a cover for health care oligopolies. See what Paul Levy, CEO of the Beth Israel/ Deaconess Medical Center said about them in his blog, Running a Hospital.
We frequently talk about the manipulation or suppression of clinical research studies by those with vested interests in the results pointing in a particular direction. On the Hooked: Ethics, Medicine and Pharma blog, Dr Howard Brody wondered why the FDA will not even reveal the identities of the clinical researchers who did the studies on which it based its decision to approve the Infuse bone growth enhancement device.
Prof Carl Elliott has done an outstanding job investigating commercially funded and implemented clinical research. Dr Brody reviewed his new book, White Coat, Black Hat. In the Carlat Psychiatry Blog, Dr Daniel Carlat reviewed Prof Elliott's new article in Mother Jones on how a pharmaceutical company sponsored drug trial went badly awry.
We asked whether the former CEO of a for-profit hospital chain who resigned after the company paid a > $1.7 billion penalty to settle charges of fraud would be a proper candidate to be governor of Florida. After Rick Scott won the Florida Republican primary, Maggie Maher, writing in the Health Beat blog, took on Scott's dubious past as prologue to a worrisome future.
Well I'm about to get sick
From watchin' my TV
Been checkin' out the news
Until my eyeballs fail to see
I mean to say that every day
Is just another rotten mess
And when it's gonna change, my friend
Is anybody's guess
So I'm watchin' and I'm waitin'
Hopin' for the best
Even think I'll go to prayin'
Every time I hear 'em sayin'
That there's no way to delay
That trouble comin' every day
No way to delay
That trouble comin' every day
- Frank Zappa
Health IT Personnel - Aliens in Healthcare?
--------------------------------
Sept. 1
Important note - it appears the survey results referenced below were contaminated by activists who could not allow this survey to occur unmolested. From HIStalk, the source of the survey, a site ordinarily read by a relatively narrow health IT-involved audience:
The Aug. 30 post below may reflect sabotage of the poll.
-- SS
--------------------------------
It is commonly accepted that respect for patient's cultural, ethical and religious views must be taken into account in their care. In fact, that understanding and respect for those values are critical.
I think it also fair to say that many if not most practitioners of medicine also believe in a force higher than themselves, even if not formally involved in organized religion.
I, in fact, minored in the history of religion in college. One of the most valuable pre-med courses I participated in concerned religious beliefs about illness, death and dying.
In a remarkable survey at the anonymous HIStalk health IT industry/rumor blog site, however, these views seem alien to many of the HIT personnel who frequent that site.
As of this time (8/3/2010, 10:15 AM EST) the tally of responses to this sidebar question at that site in part created after reactions to a CIO essay on religious values here:
are as follows:
While informal, I'd say a red flag is raised. These results go against mainstream values in medicine, and the values of our American culture and heritage at large.
Some of the comments in particular were revealing of contempt for these values and arrogant certitude typical of the IT field in general:
Example 1:
Example 2:
Example 3:
Example 4:
Example 5:
While people in healthcare and anywhere else in this country are free to believe in God or not, people in healthcare should be sympathetic to those who do, no matter what their own personal feelings.
These comments and the survey results in general, I fear, show contempt for religious values and for those who hold them.
There's a comment about these folks actually having a cybernetic religion of sorts:
I agree with that assessment.
Others in a Middle Eastern oil-producing country I once visited to implement IT for care improvement of children with birth defects, in part out of interest in personally living by example and promoting cultural and religious reconciliation, have a different term for that particular religion: idolatry.
I can't say I disagree with that, either.
"Compassion" and "contempt" may both begin with the letter "c", but are essentially incompatible.
Those with contempt for common patient values such as religious beliefs should not be working on tools critical for safe care delivery, in my opinion.
In fact, I'd rather have this type of arrogant, contemptuous healthcare facilitator not working in healthcare at all.
-- SS
Sept. 1
Important note - it appears the survey results referenced below were contaminated by activists who could not allow this survey to occur unmolested. From HIStalk, the source of the survey, a site ordinarily read by a relatively narrow health IT-involved audience:
If you�ve been following the current poll and comments on Ed Marx�s Blessing of the Hands post, you may wonder why the comments suddenly turned ugly. An atheist blogger linked to it and his followers dropped by to vote and opine. Since the point was to find out what industry people think, here�s the stat that counts: the poll was running 50-50 when it was just real readers voting.
The Aug. 30 post below may reflect sabotage of the poll.
-- SS
--------------------------------
It is commonly accepted that respect for patient's cultural, ethical and religious views must be taken into account in their care. In fact, that understanding and respect for those values are critical.
I think it also fair to say that many if not most practitioners of medicine also believe in a force higher than themselves, even if not formally involved in organized religion.
I, in fact, minored in the history of religion in college. One of the most valuable pre-med courses I participated in concerned religious beliefs about illness, death and dying.
In a remarkable survey at the anonymous HIStalk health IT industry/rumor blog site, however, these views seem alien to many of the HIT personnel who frequent that site.
As of this time (8/3/2010, 10:15 AM EST) the tally of responses to this sidebar question at that site in part created after reactions to a CIO essay on religious values here:
Should hospital IT employees be expected to have a higher level of compassion and spiritual beliefs than their counterparts in other industries?
are as follows:
No - 90% (519 votes)
Yes - 10% (59 votes)
While informal, I'd say a red flag is raised. These results go against mainstream values in medicine, and the values of our American culture and heritage at large.
Some of the comments in particular were revealing of contempt for these values and arrogant certitude typical of the IT field in general:
Example 1:
Higher level of compassion and sense of responsibility yes, spiritual beliefs - no. Relying on belief in many cases may cause more harm than good. Of course, some types of spiritual beliefs lead to heightened sense of responsibility (like the one Ed Marx has demonstrated), but not all, and heightened sense of responsibility is not dependent on one's spiritual beliefs.
Example 2:
I understand the meaning of the word COMPASSION, as the expression of sympathy for a separate person in different circucmstances. I expect that understanding is the common on. I have some ideas on how it works conceptually, and I expect I could find common ground with a great many people on that subject. I understand the meaning of the term SPIRITUAL BELIEFS, as the holding of a baseless conviction as to the existence of disembodied consciousness. I am confident that those who have them would express them as convictions or the equivalent of convictions, that they are unable to point to evidence supporting their convictions, would agree their beliefs entail disembodied consciousness, but would prefer to put it some other way. I have no understanding at all of how a disembodied consciousness would be able to exert influence on embodied third parties, or how a person who believes in the existence of disembodied consciousness might explain it. Perhaps I am missing something obvious. If so, I would appreciate someone explaining it here.
Example 3:
I agree ... I'm very tired of this idea that only religious people can be moral or compassionate or sensitive. It's simply not true. And competence, the most important quality in an IT person, has absolutely no connection to religiosity.
Example 4:
Good grief, I hope I don't get sick and then have to go to a hospital full of staff that think that their religious bend can help heal people. Annointing oil? What a bunch of mumbo-jumbo.
Example 5:
Lol, this ceremony probably makes the chaplains maintain a sense of importance. Sorry to puncture the bubble, but your magic oil and mumbo jumbo belong to the first century desert tribes, not a 21rst century hospital.
While people in healthcare and anywhere else in this country are free to believe in God or not, people in healthcare should be sympathetic to those who do, no matter what their own personal feelings.
These comments and the survey results in general, I fear, show contempt for religious values and for those who hold them.
There's a comment about these folks actually having a cybernetic religion of sorts:
You folks *do* have a religion. You worship machines.
I agree with that assessment.
Others in a Middle Eastern oil-producing country I once visited to implement IT for care improvement of children with birth defects, in part out of interest in personally living by example and promoting cultural and religious reconciliation, have a different term for that particular religion: idolatry.
I can't say I disagree with that, either.
"Compassion" and "contempt" may both begin with the letter "c", but are essentially incompatible.
Those with contempt for common patient values such as religious beliefs should not be working on tools critical for safe care delivery, in my opinion.
In fact, I'd rather have this type of arrogant, contemptuous healthcare facilitator not working in healthcare at all.
-- SS
#TSAMastery #af Another Great Interview Experience - This past week we had the privilege to be interviewed by Teach ... http://ht.ly/18MKn3
Food Allergy and 504 Plans at School
As I prepare for our annual 504 meeting with our school later this week, I am reminded about how far we have come. It was only in 2008, that Congress expanded the definition of who is eligible for federal protection. Now, individuals are protected- even if they don't suffer a disability all the time.
Prior to 2008, parents had to fight for any accommodations for their food allergic children at school. It was at the discretion of the school district how food allergy would be handled. When my child with food allergies entered school 5 years ago, we did not have any type of formal written agreement. The school did allow him to carry an EpiPen® (beginning in kendergarten) and a special food allergy table was established in the cafeteria. After a disappointing experience in 2nd grade, where he was excluded from making gingerbread houses with his grade due to his food allergy, we insisted on something more formal. We were offered an IHP, an Individualized Healthcare Plan.
The IHP was a document between us as parents and the school nurse. It was a good start, but not enough, as it didn't include key players within the school system like teachers, bus drivers and even the facilities and maintenance department (they're the only ones who knew the ingredients in the soap in dispensers near school sinks).
Enter last year and our first 504 Plan. We held a group meeting- parents, nurse, principal, guidance counselor, classroom teacher and head of facilities for the school district (also in charge of our bus company contract). Together we completed an individualized document to best meet my son's needs. This year my son will join the meeting and we will all work together to update the 504 Plan as needed.
The 504 Plan makes everything much easier because everyone, including the student, knows what they are responsible for. I like this recent article about 504 Plans for those who aren't familiar with federal protection for food allergic students.
Are most of you using 504 Plans or do you use other documents or tools at school?
Prior to 2008, parents had to fight for any accommodations for their food allergic children at school. It was at the discretion of the school district how food allergy would be handled. When my child with food allergies entered school 5 years ago, we did not have any type of formal written agreement. The school did allow him to carry an EpiPen® (beginning in kendergarten) and a special food allergy table was established in the cafeteria. After a disappointing experience in 2nd grade, where he was excluded from making gingerbread houses with his grade due to his food allergy, we insisted on something more formal. We were offered an IHP, an Individualized Healthcare Plan.
The IHP was a document between us as parents and the school nurse. It was a good start, but not enough, as it didn't include key players within the school system like teachers, bus drivers and even the facilities and maintenance department (they're the only ones who knew the ingredients in the soap in dispensers near school sinks).
Enter last year and our first 504 Plan. We held a group meeting- parents, nurse, principal, guidance counselor, classroom teacher and head of facilities for the school district (also in charge of our bus company contract). Together we completed an individualized document to best meet my son's needs. This year my son will join the meeting and we will all work together to update the 504 Plan as needed.
The 504 Plan makes everything much easier because everyone, including the student, knows what they are responsible for. I like this recent article about 504 Plans for those who aren't familiar with federal protection for food allergic students.
Are most of you using 504 Plans or do you use other documents or tools at school?
A Meaningful Use and Standards Rule FAQ Part II
As a followup to the HIMSS Webinar I gave last week, here's an FAQ in the spirit of last month's Meaningful Use and Standards Rule FAQ.
1.. The Emergency Department is mentioned in 9 Core Measures and 3 Menu Measures, yet industry discussions seem to focus on the ED for CPOE and Discharge instructions. What functions do ED Information Systems need to support? Are these functions for just admitted patients or all ED Patients?
In my conversations with CMS, I believe that CMS will be issuing a corrections notice to clarify the role of the ED in the rule.
2. There are 44 Quality measures for Eligible Professionals. Do EHRs need to support all 44 measures to be certified?
To achieve certification, EHRs must support the 3 Core Measures, the 3 Alternate Quality Measures and at least 3 others from the remaining 38 measures.
3. Can eligible professionals from ancillary service providers such as stand alone radiology imaging centers qualify for meaningful use?
Although it seems a bit of stretch, if these professionals can meet all the meaningful use measures, then can qualify. This implies that radiologists will have to chart weight/height, ask about smoking status, record race/ethnicity etc.
4. The original implementation guide for the CCD specified one preferred vocabulary for each data content type. The Final rule includes SNOMED-CT and ICD9 as problem list vocabularies. Is there an inconsistency?
No, the C32 2.5 implementation guide supports all the vocabularies specified in the final rule. See Keith Boone's blog for details.
The XML for CCD in the C32 v. 2.5 implementation can accept any vocabulary for structured data elements.
5. The Quality Measures in Meaningful use mention vocabularies like RxNorm and SNOMED-CT to compute numerators and denominators. The Standards Final Rule offers vocabulary options. Is this an inconsistency?
No. The Final Rule for certification indicates �Any source vocabulary that is included in RxNorm, a standardized nomenclature for clinical drugs produced by the United States National Library of Medicine.� The Final Rule further difines the following source vocabularies as being included in RxNorm: GS � Gold Standard Alchemy, MDDB � Medi-Span Master Drug Data Base, MMSL � Multum MediSource Lexicon, MMX � Micromedex DRUGDEX, MSH � Medical Subject Headings (MeSH), MTHFDA � FDA National Drug Code Directory, MTHSPL � FDA Structured Product Labels, NDDF � First DataBank NDDF Plus Source Vocabulary, NDFRT � Veterans Health Administration National Drug File � Reference Terminology, SNOMED-CT � SNOMED Clinical Terms (drug information), and VANDF � Veterans Health Administration National Drug File. �Consequently, an one of these �source vocabularies� identified by NLM may be used, or any other source vocabulary successfully included within RxNorm.� (pages 132-133 of DHHS Final Rule 45 CFR Part 170, RIN 0991-AB58)
In creating value sets for the measures, providing 11 options (those listed in the Final Rule) was overly cumbersome, as was selecting NDC codes. By listing medications with RxNorm codes, the measures allow any user of an acceptable source vocabulary to map to the medications required by the measure. The measure criteria, therefore, can be used by any compliant EHR that uses a source vocabulary.
In general the measure specifications provide currently used terminologies as expected in the Final Rule. However, since there is a requirement for billing to use ICD-10 by 2013, the measures also provide, for those considering future implications, ICD-10 and SNOMED for appropriate concepts. While ICD-10 and SNOMED are not required, many have appreciated the ability to consider how to map their local term usage to these potential future options. Note, all measures provide �Groupings� (or nested) value sets which include a number of options. For example, all conditions (diagnoses) include ICD-9, OR ICD-10, OR SNOMED. There is one exception: persistent asthma is not an available concept in ICD-9. Therefore the measure provides an option of �persistent asthma� in ICD-10 OR SNOMED; it also provides the option of �asthma� using ICD-9 with a constraint that severity = persistent. The measures do not seek to require any terminology that is not specified in the Final Rule. The decision to include ICD-10 and SNOMED options was a conscious decision made in concert with CMS.
6. The Syndromic Surveillance implementation guide in the Final Rule seems to be the wrong document - it's the CDC's "Public Health Information Network HL7 Version 2.5 Message Structure Specification for National Condition Reporting Final Version 1.0 and Errata and Clarifications National Notification Message Structural Specification" which is for disease reporting, not symptom reporting.
It's true that the wrong implementation guide is included in the final rule. ONC is hard at work correcting this. We'll discuss it today at the HIT Standards Committee August meeting.
#TSAMastery #af PPC Doesnt Stand For What You Think - Hey there, If you have been marketing online for even just a s... http://ht.ly/18MzDJ
Sunday, August 29, 2010
Medical transcription outsourcing: Know the service provider
Medical transcription is the process of creating records of the patient-healthcare professional encounter. Medical transcription aids healthcare professionals by providing access to relevant information about the patient’s health history. Having detailed patient records aids the healthcare professionals provide quality healthcare without having to rely on repetitive inputs from patients, handwritten notes or relying on their memory. Patient records help healthcare facilities in starting the coding and billing process leading to claims. It can be said that medical transcription is vital for both patient care as well as to ensure efficient fund flow management.
Outsourcing medical transcription has been found to be an effective solution for the documentation needs of healthcare facilities. Outsourcing medical transcription enables creation of patient records in a timely, accurate, secure and cost effective manner. By outsourcing medical transcription, the healthcare facility is essential gaining a long-term partner.
Considering that medical transcription is an important link in the chain leading to quality healthcare, it is very important to choose the right service provider. Given below are some of the details that play an important part in choosing the right medical transcription service provider:
Experience:
How long has the service provider been in the business of providing outsourced medical transcription service?
While outsourcing medical transcription it is important to source a service provider who has experience in the medical transcription business. Outsourcing to a fly-by-night operator can, not only be very costly but could also be dangerous.
Versatility:
Does the service provider have experience servicing healthcare facilities of all types?
While outsourcing it is important not only to ascertain how long the medical transcription service provider has been in business, but also whether the service provider has experience in serving the varied needs of healthcare facilities of all types
Check references:
Can the service provider provide testimonials?
While outsourcing it is important to check the experience of the service provider in providing similar services, by verifying the testimonials of customers who have already availed similar services.
Commitment to quality:
What are the measures used by the service provider to ensure accuracy?
Accuracy of information captured in the patient record is vital as it affects both the quality of healthcare as well as reimbursements. It is important to assess the service provider on the basis of their training methods and quality checks in place to gauge their ability to provide quality medical transcription.
Confidentiality:
What are the measures used by the service provider to protect patient data?
One of the major concerns while outsourcing medical transcription is the security of confidential patient data. It is important to ensure that the service provider is not just using standard FTP and Email for transferring data, as this does not support encryption. It is important to assess whether the service provider has inbuilt security measures to secure technology. The security measures used by the service provider to secure processes and people also needs to be assessed.
Prompt Services:
What is turnaround time guaranteed by the service provider?
Turnaround time of finished transcripts is another important factor to be assessed while outsourcing medical transcription. This can be evaluated based on the availability of the right team (well trained medical transcriptionists) and the right processes with the service provider.
Pricing and Pricing methods:
What is pricing method used by the service provider?
Lowered cost of transcription is one of the main benefits healthcare facilities hope to gain from the outsourcing process. It is important to not only get a quote from the service provider for medical transcription services, it is equally important to find out the components of pricing and the billing method used by the service provider.
Technology:
What is the technology used by the service provider?
The technology used by the service provider plays an important part in security, easy to use features and other benefits like interface with EMR, remote printing & faxing, archive facilities etc.
Sample of services:
Does the service provider offer a free trial?
A free trial of services provided by the medical transcription service provider gives the healthcare facility an opportunity to assess whether the service provider can deliver services as promised.
TransDyne, a leader in the outsourced medical transcription industry has been providing outsourced medical transcription services for over a decade with the following benefits:
- Medical transcription with an accuracy of above 99% using a team of well trained specialty medical transcriptionists and having a stringent four-level quality check method
- Meets turnaround time requirements of healthcare facilities using the right people, right processes and the right technology
- Uses the character line method of billing, which is explained to the customers in advance, so that all the components of cost are understood
- Has security measures to protect confidential information that not only meet HIPAA/HITECH standards, but exceed them
- Uses technology that is not only advanced but easy to use
- Has been providing outsourced medical transcription solutions for over a decade and has the testimonials of satisfied customers
- Has multiple channels of interaction for customer service to ensure quick resolution of any issues
- Offers free trial of services for a limited period
To avail outsourced medical transcription services from TransDyne, click here
Similar Conclusions on Health IT Via Observation and Via Research: Is HIT 'Mission Impossible'?
The Wall Street Journal reported on a study in Health Affairs entitled "A Progress Report On Electronic Health Records In U.S. Hospitals" by Harvard researcher Ashish Jha and colleagues.
An Aug. 27 WSJ Health Blog post was entitled "Only 2% of Hospitals Could Have Met �Meaningful Use� in 2009."
While the topic of this Healthcare Renewal post is not about Jha's new article per se, I will provide the article's summary:
No surprises there. Jha has previously published research articles I've mentioned on Healthcare renewal such as at "Science or Politics? The New England Journal and "The 'Meaningful Use' Regulation for Electronic Health Records" and "Hospitals Under the Knife: Sacrificing Hospital Jobs for the Extravagance of Healthcare IT?":
Jha's response was quite interesting. There are a number of issues he raises:
I find this interesting for several reasons.
First point of interest:
On doing health IT badly, and on health IT not being "plug and play":
I came to the same industry-challenging conclusions a decade ago observationally that Jha came to through empirical research and review of the literature. On "doing health IT badly", in the late 1990's I'd written the following (now at my academic health IT site here):
Second point of interest:
Jha did mention two systematic reviews as describing hundreds of articles in the literature supporting potential benefits of health IT, one in May 2006 by Chaudhry et. al in the Annals of Internal Medicine (link), and one by Goldzweig et. al in Jan. 2009 in Health Affairs (link).
These reviews were rather weak on substance, though, in terms of robustness that could support spending hundreds of billions of dollars on health IT as national policy. The former article concluded:
The articles' conclusions matched my own writings from observation and critical thought about what I was seeing personally and hearing from Medical Informaticists in the field.
Third point of interest:
In the WSJ blog post comment section, several commenters including Dr. Jha opined on the issue of lack of regulation of health IT as a factor in its limited diffusion and benefit to date. In a comment of 8:06 am August 29, 2010 Jha wrote:
This argument goes back to the customary notion of the clinician as "learned intermediary" thus providing a shield from liability for the vendors of commercial HIT systems.
Here I disagree with Jha. I would argue, again from observation, that this notion is obsolete.
For example, in an item from the HIStalk blog site news of 8/30/10 (link):
An Aug. 27 WSJ Health Blog post was entitled "Only 2% of Hospitals Could Have Met �Meaningful Use� in 2009."
While the topic of this Healthcare Renewal post is not about Jha's new article per se, I will provide the article's summary:
Despite all the talk about digitizing the health-care world, only 11.9% of U.S. hospitals had adopted at least basic electronic medical records by last year, and only about 2% had done enough to qualify for future government financial incentives, a study finds. The study, published online in Health Affairs, covers responses from 3,101 hospitals surveyed by the American Hospital Association
... It�s actually not surprising that hospitals were slow to adopt new systems in 2009, given the horrible economic conditions, difficulty of raising money for capital investments and uncertainty over what the final government requirements would be. �I�d be shocked if we didn�t see an uptick in 2010 and an even bigger one in 2011,� Jha tells the Health Blog. �But are we going from 2% to 40%? No. We might go from 2% to 5% [in 2010] to 15% or 20% in 2011.�
No surprises there. Jha has previously published research articles I've mentioned on Healthcare renewal such as at "Science or Politics? The New England Journal and "The 'Meaningful Use' Regulation for Electronic Health Records" and "Hospitals Under the Knife: Sacrificing Hospital Jobs for the Extravagance of Healthcare IT?":
... Ashish Jha�s research at the Harvard School of Public Health that compared 3,000 hospitals at various stages in the adoption of computerized health records and found little difference in the cost and quality of care. A New York Times story "Little Benefit Seen, So Far, in Electronic Patient Records" on those findings is here.What is of interest to me are statements made by Jha in response to questions asked by the WSJ reporter Katherine Hobson. Hobson: "We hear from a lot of physicians and others who are doubtful about the benefits of electronic records, and we asked Jha about the evidence supporting quality and safety improvements."
Jha's response was quite interesting. There are a number of issues he raises:
[Jha] "There are really two sides of the coin. I can point to about 400 studies done really well that show electronic health records can have a substantial impact on improving quality and safety. [But] we had a paper published earlier this year [Electronic Health Records� Limited Successes Suggest More Targeted Uses - ed.] showing that when hospitals adopted EHRs, there was no impact on quality. So how to reconcile that?"
[Hobson] Jha says we have evidence that �when high-performance hospitals develop their own systems, implement them and tweak them, they can work wonders.� But the benefits gained from purchasing an off-the-shelf product and failing to implement or tweak it to meet an institution�s particular needs are likely to be �far less pronounced,� he says. �If you adopt a new technology, and do it badly, you can end up making productivity worse� or causing harm, he says.
[There must be a lot of organizations meeting that description for such low impacts on quality to be the norm - ed.]
�This is not a plug and play.�
I find this interesting for several reasons.
First point of interest:
On doing health IT badly, and on health IT not being "plug and play":
I came to the same industry-challenging conclusions a decade ago observationally that Jha came to through empirical research and review of the literature. On "doing health IT badly", in the late 1990's I'd written the following (now at my academic health IT site here):
... While clinical IT is now potentially capable of achieving many of the benefits long claimed for it such as improved medical quality and efficiency, reduced costs, better medical research and drugs, earlier disease detection, and so forth, there is a major caveat and essential precondition: the benefits will be realized only if clinical IT is done well. For if clinical IT is not done well, as often occurs in today�s environment of medical quick fixes and seemingly unquestioning exuberance about IT, the technology can be injurious to medical practice and biomedical R&D, and highly wasteful of scarce healthcare capital and resources.
Those two short words �done well� mask an underlying, profound, and, as yet, largely unrecognized (or ignored) complexity. This website is about the meaning of "done well" in the context of clinical computing, a computing subspecialty with issues and required expertise quite distinct from traditional MIS (management information systems, or business-related) computing.
I'd also made the observation, to the consternation of health IT marketing departments I'm sure, that health IT was not plug-and-play in an essay entitled "Cultures of mismanagement: toxic to healthcare quality" about my experiences as a CMIO:
... To make matters worse [in an ongoing EPR project], the executive team then gave a key EPR staff member, a Senior Resident who'd done an excellent job writing and programming custom templates for the EPR system, a difficult time on promised payment for his services.
They believed such a customization function was trivial and wasteful, and essentially reneged on their agreements with the Resident. When challenged by the informaticist and others that this person's services were essential, the views were met with indifference, if not disdain, for facts and logic. In fact, the executive team clung persistently to a mind-numbing leap of logic: they seemed to believe that just as home computers were "plug and play", so was [or should be - ed.] clinical IT. Their attitudes seemed to reflect a belief that the EPR team and resident were basically deceiving them.
... Unfortunately, healthcare IT is never plug-and-play, and in IT a person is either part of the solution or part of the problem.
Second point of interest:
Jha did mention two systematic reviews as describing hundreds of articles in the literature supporting potential benefits of health IT, one in May 2006 by Chaudhry et. al in the Annals of Internal Medicine (link), and one by Goldzweig et. al in Jan. 2009 in Health Affairs (link).
These reviews were rather weak on substance, though, in terms of robustness that could support spending hundreds of billions of dollars on health IT as national policy. The former article concluded:
Limitations: Available quantitative research was limited and was done by a small number of institutions. Systems were heterogeneous and sometimes incompletely described. Available financial and contextual data were limited.
Conclusions: Four benchmark institutions have demonstrated the efficacy of health information technologies in improving quality and efficiency. Whether and how other institutions can achieve similar benefits, and at what costs, are unclear.
The articles' conclusions matched my own writings from observation and critical thought about what I was seeing personally and hearing from Medical Informaticists in the field.
Third point of interest:
In the WSJ blog post comment section, several commenters including Dr. Jha opined on the issue of lack of regulation of health IT as a factor in its limited diffusion and benefit to date. In a comment of 8:06 am August 29, 2010 Jha wrote:
... On the issue of FDA approval [of HIT devices - ed.] � this is a tricky issue on which reasonable people can disagree. FDA regulates devices that are used on patients (not on doctors and nurses) traditionally so you could make a very reasonable argument that this is out of their scope.
This argument goes back to the customary notion of the clinician as "learned intermediary" thus providing a shield from liability for the vendors of commercial HIT systems.
Here I disagree with Jha. I would argue, again from observation, that this notion is obsolete.
For example, in an item from the HIStalk blog site news of 8/30/10 (link):
... [a reader] sent a UPMC internal document describing a quality improvement project at Shadyside [Shadyside Hospital, Pittsburgh - ed.]. Before Cerner was implemented, the ED stocked 95% of the meds they used in their automated dispensing cabinet and the other 5% were requested by tubing the paper order to pharmacy, resulting in a pretty good turnaround time of 28 minutes. With CPOE, the ED had no good way to alert pharmacy about those 5% of meds, so turnaround time shot up to over two hours. An ED nurse came up with a solution: tubing a yellow �Stat ED Med� card to pharmacy along with an index card listing the patient and med needed, dropping TAT back to six minutes.
From the medical informatics perspective, the lesson here is that the physician is effectively no longer a �learned intermediary� between computer and patient when a complete system of EMR, CPOE, decision support etc. linked to Pyxis medication dispensing and other machines is constructed.
This model from the earlier days of simple advice-giving and-records keeping health IT no longer holds (arrows represent interaction):
[Computer] <---> [Clinician] <---> [Patient]
Rather, the computer has become a cybernetic governor of care, as in a programmatic intermediary between clinician and patient regulating care operations:
[Clinician] <---> [Computer] ---> [Patient] (note one way arrow).
The fact that a �workaround� a.k.a. an �override around the cybernetic regulator of care� had to be created in order for appropriate care to be delivered in a critical care environment supports the latter conceptual and legal model.
You should not have to work around something that is not in the way.
In other words, the computer is now the intermediary. There only way around it are workarounds. Articles by Koppel on CPOE and barcoding workarounds are other examples of how the health IT system is now the intermediary between clinician and patient, not the clinician as learned intermediary between IT and patient.
One might also ask - what is the cognitive impact of continually devoting intellectual power to create work arounds, which add to the already complex multi-tasking of clinicians? It likely is not a positive contributor to the best care.
These and many other issue contribute to the low diffusion of health IT in 2010. It is interesting that much of this was known to people in Medical Informatics (at least those without industry conflicts of interest) through in situ observation of health IT projects, going back many years, in fact decades with regards to the pioneers (as mentioned in my post "Healthcare IT: How Much More Out of Control Can An Industry Be?").
Finally:
The question should be asked: will health IT ever achieve the benefits claimed for it? Will it ever "revolutionize", or even make substantial contributions to medicine in a cost effective, non negatively-disruptive fashion?
Will we ever stop "doing it badly" (per Jha) and start consistently "doing it well" (per me?)
I am beginning to believe that health IT will never be successful without a major revolution in the IT field itself.
In 1969, EMR and Medical Informatics pioneer Donald A. B. Lindberg, M.D., now Director of the U.S. National Library of Medicine at NIH, made the observation that
"... computer engineering experts per se have virtually no idea of the real problems of medical or even hospital practice, and furthermore have consistently underestimated the complexity of the problems�in no cases can [building appropriate clinical information systems] be done, simply because they have not been defined with the physician as the continuing major contributor and user of the information" (Lindberg DAB: Computer Failures and Successes, Southern Medical Bulletin 1969;57:18-21).
I believe the problem was -- and is -- not "computer engineering experts" but "business computing personnel."
First, there's the issue of the customs and traditions of business IT. As I've written before, these rigid traditions are antithetical to the poorly bounded, rapidly changing, improvisation-rich world of clinical medicine.
Second, the current status quo is highly profitable to the vendors, resulting in reactionary mindsets and conduct.
Third, there is a lack of appropriate intellectual capital in leadership roles in health IT. Medicine is a largely scientific field. Automation in the field is a highly scientific endeavor. Yet the field is dominated by business computing personnel (usually of a management information systems background), instead of true computer scientists and engineers, human factors scientists, information scientists, and the like.
If my observations of who went into science/medicine/perhaps law vs. who went into business-related fields when I graduated high school and college are indicators, the very best scientific minds are poorly represented in healthcare IT leadership circles.
In summary, both observations of health IT and research on health IT show many stumbling blocks towards achieving major, unequivocal, reproducible benefit with a robustness that could support spending tens or hundreds of billions of dollars on the technology in ambitious national-scale implementations.
I fear that under the current culture of IT, achieving effective national health IT is Mission Impossible.
Your mission, Mr. Phelps, should you choose to accept it...
A vast body of new, critical thinking about the technology and its industry is needed.
Aug. 30 note: As a result of a complaint to the blog owner (not to me, curiously) that I am not providing answers to the problems I write about...
... his long screed ends with "national Health IT is mission impossible"... and while he says "new, critical thinking is needed", he doesn't say what that is. His next post is even more out there.
... I will add this:
I do not have the answers (if I did, I'd sell them). This is a serious social problem. The best I can do, and have done, is point out what not to do - and even that has not had much of an effect despite ten years of public writing in numerous venues.
I do know that believing there's a major problem is the first and most important step to solving these vexing issues. We as a country and culture have not yet reached that point; irrational exuberance prevails. Thinking about health IT requires a reboot, but denial of the problems must stop before that can occur. I exert my efforts largely in an attempt to bring the health IT patient out of denial.
Final addendum 8/31:
On reconsideration, it's not as if I haven't offered advice on "what to do" as well; see for example my post "Science or Politics? The New England Journal and The 'Meaningful Use' Regulation for Electronic Health Records."
-- SS
Can a $1 Billion Group of Babies Provide Fair Value in Health Care?
The issue of executive compensation in health care seems to be attracting more media attention.
A St Louis Post-Dispatch editorial noted how executive compensation for for-profit health insurance CEOs has grown. It started with a quote from Steven Hemsley, the CEO of UnitedHealth:
Here is a summary of the compensation information:
As an aside, the article noted how the compensation received by CEOs of the larger US health care corporations of all types, not just health insurance companies, has grown:
Even the CEOs of not-for-profit hospital systems have become million dollar babies:
However, the editorial was a bit vague about why paying CEOs of health care organizations so much was a bad idea, although it did imply that it was unseemly given that much of health care is funded by government programs, and not-for-profit health care organizations receive tax breaks that give "the public an even larger stake in their efficient operation"
In my humble opinion, there are other big problems with the massive compensation that hired managers of health care organizations now command.
Paying them so much instantly vaults them into the upper class, and the CEOs of larger health care corporations now live a life style more reminiscent of aristocracy than of that of the patients who depend on them. Such riches isolate those who receive them in their own bubbles. Can one really expect a million, or ten million, or hundred million dollar CEO to really care about the health of individual patients?
Furthermore, paying them so much, usually regardless of their performance, their companies' performance, or the health effects of their products and services gives them perverse incentives to maintain their position at any cost, even at the cost of the patients they are supposed to serve.
So, we do not receive "fair value for the $2.6 trillion we, as a society, are expecting to spend on our health care system." But we cannot really expect a billion dollar group of babies to fix that.
True health care reform would decrease perverse incentives throughout the systems, spread the power in organizations more broadly, and make leaders accountable.
A St Louis Post-Dispatch editorial noted how executive compensation for for-profit health insurance CEOs has grown. It started with a quote from Steven Hemsley, the CEO of UnitedHealth:
Today the American people are questioning whether or not we receive fair value for the $2.6 trillion we, as a society, are expecting to spend this year on our health care system. The vast majority, including those of us at UnitedHealth Group, believe the answer is, 'No.'
Here is a summary of the compensation information:
Modern Healthcare, a leading health industry trade journal, published its annual executive compensation survey this week. Topping the list is Stephen Hemsley, quoted above, who gave a speech to the Detroit Economic Club last year questioning the value Americans receive for all that health spending. [Note: We discussed Hemsley's compensation here.]
His take for 2009: $106 million � $7.5 million in salary and benefits and $98.5 million in stock options.
Mr. Hemsley is not alone. The CEOs at insurance giants Cigna, Humana, Aetna, Coventry Health Systems and WellPoint all took home between $10 million and about $18 million. Many of those companies already have announced double-digit premium increases for next year.
In all, the CEOs of America�s 10 largest health insurance companies made $228.1 million in salary and stock options during 2009, according to the liberal advocacy group Health Care For America Now. (That's enough to buy health insurance for at least 47,284 people, based on figured cited in this Kaiser Family Foundation survey on average premiums.)
Since 2000, those CEOs have received slightly less than $1 billion in compensation, the group said.
As an aside, the article noted how the compensation received by CEOs of the larger US health care corporations of all types, not just health insurance companies, has grown:
Researchers analyzed pay and benefits for 342 CEOs of corporations in the Standard & Poor�s 500 index.
They found that health care CEOs received an average compensation of $10.5 million last year. That�s 40 percent more than the average for all S&P 500 companies � 77 percent higher than chief executives at financial services companies.
Even the CEOs of not-for-profit hospital systems have become million dollar babies:
Last year, the average compensation for hospital system CEOs was $1 million. That�s enough to hire five new primary care doctors.
However, the editorial was a bit vague about why paying CEOs of health care organizations so much was a bad idea, although it did imply that it was unseemly given that much of health care is funded by government programs, and not-for-profit health care organizations receive tax breaks that give "the public an even larger stake in their efficient operation"
In my humble opinion, there are other big problems with the massive compensation that hired managers of health care organizations now command.
Paying them so much instantly vaults them into the upper class, and the CEOs of larger health care corporations now live a life style more reminiscent of aristocracy than of that of the patients who depend on them. Such riches isolate those who receive them in their own bubbles. Can one really expect a million, or ten million, or hundred million dollar CEO to really care about the health of individual patients?
Furthermore, paying them so much, usually regardless of their performance, their companies' performance, or the health effects of their products and services gives them perverse incentives to maintain their position at any cost, even at the cost of the patients they are supposed to serve.
So, we do not receive "fair value for the $2.6 trillion we, as a society, are expecting to spend on our health care system." But we cannot really expect a billion dollar group of babies to fix that.
True health care reform would decrease perverse incentives throughout the systems, spread the power in organizations more broadly, and make leaders accountable.
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Saturday, August 28, 2010
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More Examples of US Hospital Market Consolidation: Connecticut and Florida
Two recent stories from two different parts of the US continue the theme of ever increasing concentration of power in our health care system.
Connecticut
The Hartford Business Journal reported on growing interest in mergers among small Connecticut hospitals.
Note that this story suggests the rationale has everything to do with financial issues, and little to do with patient care issues.
Note also that the recent US attempt at health care reform, later characterized as health insurance reform, is seen as driving, not preventing mergers.
Florida
The Orlando Sentinel reported on increasing merger hospital merger activity in central Florida.
The latter case could apparently lead to quite a substantial local concentration of power:
This story contained some protestations from hospital leaders that it is all about the patients:
On the other hand,
Furthermore, just as history tells us, monopoly may be good for monopolists but not for everyone else.
While at least the folk wisdom among doctors is that the federal authorities will jump on any two doctors who informally discuss their prices, in the laissez faire, let the good times roll era of the 1980s through 2000s, there seemed to be little governmental concern about hospital (or health care in general) consolidation of power:
Summary
As we just noted, advocates of laissez faire commercialized health care often trumpet the advantages of competitive markets as a rationale for deregulation. While there are theoretic, and possibly empiric reasons to think that competitive markets are the optimal way to distribute goods and services, we recently discussed aspects of health care that make it extremely hard for health care markets to be ideally competitive.
In the 1960s, it became recognized that physicians' professionalism, hospitals' devotion to their missions, and sometimes even (gasp) government regulation might partially compensate for distortions in the health care market. However, as supposed free market advocates became more powerful, they pushed for the commercialization of medicine and hospitals, reducing professionalism and mission support, and the hollowing out government regulation. (However, why did the people who attacked medical societies' codes of ethics as monopolistic have no interest in attacking market domination by insurers or hospital systems? Inquiring minds want to know.)
As we said last time, true health care reform would help physicians and other health care professionals uphold their traditional values, including, as the AMA once stated, "the practice of medicine should not be commercialized, nor treated as a commodity in trade." True health care reform would put health care "delivery" back in the hands of mission-focused, not-for-profit organizations, which put patients' health, safety and welfare first.
Connecticut
The Hartford Business Journal reported on growing interest in mergers among small Connecticut hospitals.
Rising costs and reductions in government reimbursements related to health care reform could lead to consolidation among the state�s 29 acute care hospitals in the coming months and years, industry experts said.
Indeed signs of consolidation in Connecticut are already taking shape. Danbury and New Milford hospitals, for example, recently signed an affiliation agreement that will put both organizations under the control of a single corporate parent.
Meanwhile, the Central Connecticut Health Alliance, which is the parent company of the Hospital of Central Connecticut, has signed a memorandum of understanding to affiliate with Hartford Healthcare. If that deal gets federal regulatory approval, the two organizations would be integrated under the Hartford Healthcare umbrella.
Note that this story suggests the rationale has everything to do with financial issues, and little to do with patient care issues.
In some cases, deals could be fueled by the needs of cash-strapped, independent hospitals to find larger, more stable partners. In other cases, independent hospitals that have remained financially stable may look to form partnerships to gain greater access to capital markets.
'There are a lot of hospitals that are struggling financially and I think the changes that health care reform is going to bring with reimbursements could be the straw that breaks the camel�s back,' said Vincent Capece, the senior vice president and chief operating officer of Middletown-based Middlesex Hospital, which has nearly 300 beds. 'It will force hospitals to either go out of business, or find a partner.'
Mergers or partnerships allow smaller, independent hospitals to leverage the purchasing power of larger institutions � especially with insurance companies � and consolidate backroom or administrative services, among other benefits.
Note also that the recent US attempt at health care reform, later characterized as health insurance reform, is seen as driving, not preventing mergers.
Hospital officials say talks of mergers, or other types of partnerships, are likely to continue as the economy remains on shaky ground and health reform changes the landscape of how the industry does business.
Officials say reform will lead to reduced Medicare reimbursements from the federal government and require significant capital investments as hospitals prepare for larger patient loads and acquire new technology to provide more efficient care.
Florida
The Orlando Sentinel reported on increasing merger hospital merger activity in central Florida.
In health-care circles, the summer of 2010 may be remembered as the end of small, independent hospitals in Central Florida. Three community facilities here have set their course toward consolidation by joining � or announcing plans to join � large systems.
This month, Health Central, the last independent hospital in Orange County, voiced its intention to partner with a hospital chain. In July, the Wuesthoff hospital system in Brevard County was purchased by a for-profit corporation in Naples that owns 60 hospitals across the country. And on July 1, a partnership between Bert Fish Medical Center and Florida Hospital took effect, giving the system the option to buy the New Smyrna Beach facility.
The latter case could apparently lead to quite a substantial local concentration of power:
In Orlando, two major hospital chains dominate: Orlando Health, which owns all or part of eight hospitals, and Florida Hospital, which owns or operates 13 hospitals in Central Florida and 18 throughout the state.
Both are likely suitors for Health Central, which operates a 171-bed hospital, a nursing home and other health-care services in west Orange County.
Officials from Orlando Health did not respond to requests for interviews.
Florida Hospital system already is involved in a partnership with Bert Fish Medical Center that could lead to a purchase of the facility in 2015. As part of the agreement, Florida Hospital, which is owned by Winter Park-based Adventist Health System, would provide $24 million in capital improvements for Bert Fish in the next five years, pay off the hospital's debt and prop up an underfunded pension plan. In addition, residents in the hospital's taxing district were told their tax rates would go down.
The partnership cements Florida Hospital's dominance in Volusia and Flagler counties, where it already owns hospitals in DeLand, Orange City, Daytona Beach, Ormond Beach and Palm Coast. Its sole remaining competitor is Halifax Health, which owns hospitals in Daytona Beach and Port Orange.
This story contained some protestations from hospital leaders that it is all about the patients:
Florida Hospital officials say their goal is not to create health-care monopolies.
'We're a church-sponsored, church-related organization,' said Florida Hospital Vice President Richard Morrison. 'It's our mission to serve people � and if we can come to other communities and bring what we think is a distinctive approach to health care, then we'll do that.'
On the other hand,
'Hospitals today are like mom-and-pop grocery stores were 40 years ago,' said Dr. Kevin Schulman of Duke University's Fuqua School of Business. Before there was a Publix in every neighborhood, there were small grocery stores. Today, like the grocers, hospitals are joining forces or selling out to regional chains.
For the hospitals, there's strength in numbers, Schulman said. A large hospital system has more leverage when negotiating with insurance companies. Likewise, there's power in purchasing.
But these widespread hospital mergers 'have led to more market power for hospitals. Another word for that is 'monopoly,'' Schulman said.
Furthermore, just as history tells us, monopoly may be good for monopolists but not for everyone else.
A single small hospital doesn't have much clout to bargain with insurance companies. On the other hand, a hospital system that dominates a market is more likely to be able to charge higher rates to insurers � and their customers, say experts.
'There may be some efficiencies in being larger,' said Dr. Robert Berenson, a health-policy expert at the Urban Institute, a think tank in Washington. 'More to the point, however, it gives a hospital much more leverage in negotiating with health plans.'
And although there are many forces driving hospitals to join larger systems, Berenson says the results have been clear to health-care economists.
'There's some theory that [consolidation] improves quality,' he said, 'but the reality is, it drives up prices.'
While at least the folk wisdom among doctors is that the federal authorities will jump on any two doctors who informally discuss their prices, in the laissez faire, let the good times roll era of the 1980s through 2000s, there seemed to be little governmental concern about hospital (or health care in general) consolidation of power:
'Because many hospitals are not-for-profit entities, we seem to have given them a lot more latitude from an antitrust perspective, [Dr Kevin] Schulman said. 'Yet they act like the worst of the for-profit monopolies.'
Summary
As we just noted, advocates of laissez faire commercialized health care often trumpet the advantages of competitive markets as a rationale for deregulation. While there are theoretic, and possibly empiric reasons to think that competitive markets are the optimal way to distribute goods and services, we recently discussed aspects of health care that make it extremely hard for health care markets to be ideally competitive.
In the 1960s, it became recognized that physicians' professionalism, hospitals' devotion to their missions, and sometimes even (gasp) government regulation might partially compensate for distortions in the health care market. However, as supposed free market advocates became more powerful, they pushed for the commercialization of medicine and hospitals, reducing professionalism and mission support, and the hollowing out government regulation. (However, why did the people who attacked medical societies' codes of ethics as monopolistic have no interest in attacking market domination by insurers or hospital systems? Inquiring minds want to know.)
As we said last time, true health care reform would help physicians and other health care professionals uphold their traditional values, including, as the AMA once stated, "the practice of medicine should not be commercialized, nor treated as a commodity in trade." True health care reform would put health care "delivery" back in the hands of mission-focused, not-for-profit organizations, which put patients' health, safety and welfare first.
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Friday, August 27, 2010
Medical transcription outsourcing: Need for Secure services
Medical transcription is the process of documenting the patient-healthcare professional encounter in detail. Patient records are an important component of healthcare. Patient records play an important role in the following:
- Record of symptoms, diagnoses and treatment
- Record of pre-existing health conditions
- Record of Allergies and current medication
- Progress of treatment
- Basis for referrals
- Statutory requirement
- Evidence in case of litigation
- Basis for coding and billing
Outsourcing medical transcription has been found to be one of the most efficient, effective and economic methods for creating patient records. Time and again emphasis has been placed on the importance of ensuring security of confidential patient information. And the outsourced medical transcription service provider has an enormous responsibility in protecting patient information, as medical transcription is the process of creating these records. The process of medical transcription also involves transmission of this information back and forth during the transcription process this adds to the need for stringent security measures.
HIPAA (Health Insurance Portability and Accountability Act) was established to protect confidential patient information. More recently HITECH has come into force and has expanded the concerns of HIPAA and enhanced the powers of HIPAA to enforce measures and standards for protection of confidential patient information.
Why is security of confidential patient information, an important component of medical transcription?
The root of protecting patient information arises from the sacrosanct patient-healthcare professional relationship. A patient-healthcare professional relationship is central to the practice of medicine and is essential for the delivery of high-quality healthcare. The quality of patient-healthcare professional relationship is important to both parties. The better the relationship in terms of mutual respect, knowledge, trust, shared values and perspective about diseases & life, the better the amount of information, enhancing accuracy of diagnosis and quality of care.
In fact the confidentiality of the information regarding the patient as provided to the healthcare professional/healthcare facility is one of the components of the foundation for the medical code of ethics
As medical transcription is a vital link in the chain for delivering quality healthcare, it is important that the medical transcription service provider understands and acknowledges the need for confidentiality and has measures in place to ensure security. Security of patient records is not only mandatory by law, but also the moral responsibility of the service provider.
What are measures to be taken by the medical transcription service provider to protect confidential patient information?
The process of outsourcing medical transcription to a medical transcription service provider would involve:
- Uploading audio files (narration of patient-healthcare professional encounter) to the server
- Transmission of audio files
- Downloading the audio files
- Transcribing the audio files
- Transmission of the finished transcripts
- Downloading the finished transcripts by the healthcare facility.
Considering the procedure involved security of data is applicable at all stages:
- When Data is at rest: This would be safety of data when it is stored prior to transmission to the medical transcription service provider and when the finished transcripts are stored before transmitting back to the healthcare facility.
- When Data is in motion: This would include safety of data during uploading audio files, transmission of audio files, downloading audio files and transmission of finished transcripts
- When Data is in use: This would involve safety of data when the audio files are being transcribed.
- When Data is disposed: This would involve safely disposing of defunct files in such a way to ensure that they are completely destroyed and cannot be accessed by unauthorized entities.
TransDyne, a leader in the outsourcing medical transcription industry understands the need for maintaining confidentiality of patient information and has measures in place to ensure HIPAA / HITECH compliance.
How does TransDyne ensure HIPAA/HITECH compliance?
Use of the right systems and software: The use of 128-bit data encryption, multi-tiered application architecture, design level security safeguards, firewall protected networks, sterilized e-mail servers, denial of access procedures and multi-modal alerts safeguards data when it is at rest and when data is in motion.
Use of processes: Use of processes like company owned & managed facilities, not engaging any sub-contractors, employing manned security at the entry/exit points, round-the-clock video surveillance and the lack of removable storage media protect the data in use. The other measures taken for ensuring security of data in use are limiting the access to the application by User ID and an encrypted password. Access to files is limited based on the user's role. Once a user is logged in, if no activity is performed for certain time, the user is automatically logged out of the system. This ensures that there is complete security of data when it in use.
Educating people: Educating people on the importance and procedures for HIPAA/HITECH compliance gives them a professional outlook. Having them give a commitment in writing further ensure HIPAA/HITECH compliance. This protects the data in all stages.
TransDyne believes in maintaining security standards that not only meet HIPAA/HITECH standards, but also exceed them. TransDyne also provides medical transcription services with accuracy levels of above 99%, guaranteed turnaround time of 24 hours with an option of 4-12 hour turnaround time for STAT reports at a very reasonable price!
To avail secure medical transcription services from TransDyne, click here.
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