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Mnet Health News delivers the latest news and information articles for the world of healthcare.

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Patients May be Reluctant to Focus on Costs

One proposed initiative to cut health care spending is to get patients involved in weighing costs of treatment options when making medical decisions. A recent study in Health Affairs assessed patients’ willingness to consider costs when choosing care options.

Following a study of twenty-two focus groups of insured individuals, researchers identified four barriers to patients’ willingness to consider comparable lower cost care options.

• Preference for what patients perceive as the best care, regardless of expense;

• Inexperience with making trade-offs between health and money;

• Lack of interest in costs borne by insurers and society as a whole;

• Noncooperative behavior characteristics of a “commons dilemma,” in which people act in their own self-interest despite recognizing, they are depleting limited resources.

According to the abstract, “Surmounting these barriers will require new research in patient education, comprehensive efforts to shift public attitudes about health care costs, and training to prepare clinicians to discuss costs with their patients.”

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HIPAA Omnibus Final Rule

On Jan. 17, 2013, the U.S. Dept. of Health and Human Services released the long-awaited omnibus final rule designed to strengthen the privacy and security protections for health information afforded under the Health Insurance Portability and Accountability Act (HIPAA). Such changes marked the most sweeping changes to the HIPAA Privacy and Security Rules since they were first implemented. The omnibus final rule is comprised of four final rules, discussed below. Please note this article is intended only to provide an overview of several of the notable provisions within the omnibus final rule; however, it is not an exhaustive explanation of the rule.

HIPAA Privacy, Security and Enforcement Rules

The final rule provides modifications to HIPAA’s Privacy, Security and Enforcement Rules mandated by the Health Information Technology for Economic and Clinical Health (HITECH) Act, as well as other modifications to improve the rules. Amongst the major changes, the modifications make clear that certain HIPAA Privacy and Security Rules apply directly to business associates (BAs), in the same manner that the requirements apply to covered entities, and that BAs are civilly and criminally liable for violations of such provisions. The final rule also expands the definition of “business associate” to include certain personal health record vendors and subcontractors under HIPAA’s umbrella. Notably, the new rule fails to define the “minimum necessary standard,” rather HHS stated that how a BA will apply the minimum necessary standard will vary based on circumstances, and that BA agreements should limit the BA’s use and disclosure of protected health information (PHI) in accordance with the covered entity’s minimum necessary policies and procedures. HHS noted that it intends to issue further guidance on the minimum necessary standard. The rule also expands individuals’ rights by permitting patients to request electronic copies of health information. Additionally, patients may instruct a provider not to share treatment information with their health plan when the individual pays for such service out of pocket, in full. The rule also strengthens the limitations on the use and disclosure of PHI for marketing and fundraising purposes, and generally prohibits the sale of PHI for remuneration without the individual’s authorization. Under the rule, covered entities are required to make modifications to privacy notices and redistribute the revised notices. The rule also attempts to streamline individuals’ ability to authorize the use of their health information for research purposes and make it easier for parents and others to provide proof of child immunization to schools.

Civil Money Penalty Structure

The final rule adopts the HITECH Act’s tiered structure of increasing penalty amounts that correspond to the levels of culpability associated with a violation. The first category (lowest penalty tier) covers situations where the covered entity or BA did not know, and by exercising due diligence would not have known, of a violation. The second category (next highest penalty tier) applies to violations due to reasonable cause. The final rule clarifies that “reasonable cause” means “an act or omission in which a covered entity or business associate knew, or by exercising reasonable diligence would have known, that the act or omission violated an administrative simplification provision, but in which the covered entity or business associate did not act with willful neglect.” The third and fourth categories apply to circumstances where the violation was due to willful neglect that is corrected within a certain time frame (second highest penalty tier) and willful neglect that is not corrected (highest penalty tier). While HHS has discretion to determine the amount of penalty to impose within each tier, HHS reiterated that the Department would not impose the maximum penalty amount in all cases. Instead, the penalty amount would be determined on a case-by-case basis, depending on the nature and extent of the violation and resulting harm, as well as the financial condition and size of the covered entity or BA. Further, the final rule clarifies that a covered entity may be held liable for the acts of its agents. The rule states that whether a BA is considered an agent of a covered entity will be fact specific, taking into account the terms of the BA agreement and the totality of the circumstances involved in the relationship between the parties.

Breach Notification for Unsecured Protected Health Information

The final rule modifies the definition of “breach” and the risk assessment factors for determining whether a breach has occurred. Under the revised definition of “breach,” an impermissible use or disclosure of PHI is “presumed to be a breach unless the covered entity or business associate, as applicable, demonstrates that there is a low probability that the protected health information has been compromised.” This low-probability standard replaces the “significant risk of harm” standard set forth in the interim final rule published on Aug. 24, 2009. HHS clarified that breach notification is not required if a covered entity or BA demonstrates through a risk assessment that there is a low probability that the PHI has been compromised. The final rule outlines the factors that covered entities and BAs must consider when performing a risk assessment. Such factors include, at minimum, (1) the nature and extent of the PHI involved, including the types of identifiers and the likelihood of re-identification; (2) the unauthorized person who used the PHI or to whom the disclosure was made; (3) whether the PHI was actually acquired or viewed; and (4) the extent to which the risk to the PHI has been mitigated. HHS recommends that covered entities and BAs examine their policies to ensure that all required factors are considered when conducting a risk assessment to determine whether a breach has occurred.

Genetic Information Nondiscrimination Act (GINA)

The final rules also modifies the HIPAA Privacy Rule as required by the Genetic Information Nondiscrimination Act (GINA) to prohibit most health plans from using or disclosing genetic information for underwriting purposes.

The new rule is effective March 26, 2013, with a compliance date of Sept. 23, 2013. The final rule may be viewed in the Federal Register at www.federalregister.gov/a/2013-01073.

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Multiple entities collecting on same account

To avoid confusion, misrepresentation, and excessive contacts, providers and their collection partners should exercise caution to ensure only one entity is collecting on an account at a time.

When forwarding an account 
for collection, health care providers should cease internal collection efforts and refrain from placing the account simultaneously with multiple collection partners.

If more than one entity attempts to collect a debt at the same 
time, the consumer may become confused as to which entity is actually collecting the debt and who to contact for payment, complaints or other inquiries. Additionally, payments made on the account will likely be credited only with the entity that received payment rather than with all parties collecting on the account, leading to inaccurate account balances.

The amount of the debt may also vary depending on collection costs—as collection costs added to outstanding account balances are presumably different between agencies and a collection agency may be seeking collection costs while the provider is not. Consequently, if more than one entity at a time collects an account (either multiple collection agencies or a collection agency and a provider), a misrepresentation of the debt is bound to occur, as payments may not be credited by all the parties seeking collection and the amount owed may be different at each agency.

Further, a consumer will likely be contacted more frequently when multiple parties are attempting to collect on the same debt, which could frustrate or irritate the consumer. Such actions could also result in violations of the Fair Debt Collection Practices Act, which governs the practices of most third-party debt collectors.

Written by Pulse

For more information, please contact David Brooks via email at dbrooks@mnetfinancial.com or by phone at (949) 900-6125 x205

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Healthcare Collections Adapt to the World of Mobile Technology

Technology is making it easier than ever before to conduct business intelligently. Mobile technologies, such as smartphones and tablet computers, are positioned to change the way that collection vendors conduct business with clients and their patients. In fact, many collection vendors are using mobile technology to increase efficiency, add accessibility, and improve the collection experience.

A recent Pew Research report pointed out that 44% of U.S. adults currently own and use a smart phone, 18% of adults own and use a tablet, and these numbers are growing rapidly. “A significant cross-section of the population now has access to smartphones, tablets or notepad computers,” states David Hamilton, CEO of Mnet Financial, “and use of these devices is increasing healthcare collections and patient satisfaction.”

Apps and Mobile-Ready Websites

Tablet computers and smartphone applications, or “apps,” appear to be here for the long-term; the downloading and use of apps has increased each year since their introduction. In the collection world, apps and mobile-ready websites can be extremely beneficial because they give patients the opportunity to pay their bills conveniently anytime and from anywhere.

“The more tools that you provide for the patient to use, the more likely you will be to get the debt resolved,” explains Hamilton. “When a collection vendor pays attention to patient needs, the patient’s interactions with the vendor are greatly enhanced and a positive experience and sense of rapport are felt.” A self-pay portal should be a part of any app used by a collection vendor. A patient should have the ability to easily make payments using a credit card, debit card, or electronic check; be able to communicate with a representative of the company; and have the ability to review balance information as well.

Mnet Financial is at the forefront of these new technologies. “Our goal is to give our clients’ patients every possible option available so that they can bring about a resolution to their medical debt,” states Stacy Eaton, Mnet Financial Collection Manager. “That’s why our website was created to be compatible with mobile devices. When a patient uses a smartphone or other mobile device to visit our website, the mobile version is automatically accessed, giving the patient easy access to a full range of debt resolution tools.”

Applications and mobile-ready websites are prime examples of how the collection industry is adapting to meet the needs of patients and providers in the world of mobile technology, but they are not the only options. Watch for the next installment of “Healthcare Collections Adapt to the World of Mobile Technology,” as we discuss the topic further.

Written by Mnet Financial

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CMS Releases Stage 2 EHR Criteria

On March 7, 2012, the Centers for Medicare and Medicaid Services (CMS) released a proposed rule outlining Stage 2 standards for certified electronic health records (EHR) and extending the effective date of Stage 2 requirements one year. Providers now have until 2014, rather than 2013, to implement Stage 2 meaningful use criteria.

Background
The Health Information Technology for Economic and Clinical Health (HITECH) Act established programs under Medicare and Medicaid to provide incentive payments to eligible professionals and eligible hospitals that adopt and make "meaningful use" of EHR technology.

Under the HITECH Act, the Medicare EHR incentive programs provide incentive payments to eligible professionals, eligible hospitals, and critical access hospitals that are meaningful users of certified EHRs.

CMS has established a three-stage approach to implement the requirements for demonstrating meaningful use, each with different implementation dates and varying requirements for establishing meaningful use.

Initially, reasonable criteria for meaningful use are based on currently available technological capabilities and providers' practice experience. Over time more extensive criteria will be required as developments in technology and providers' capabilities advance.

Stages
Stage 1, which began in 2011, sets forth a set of 15 core objectives eligible professionals must meet and 14 core objectives hospitals must meet. Eligible professionals and hospitals must choose five "menu" requirements to satisfy the meaningful use criteria. Some objectives set forth in the rule for Stage 1 are:
- Implement drug-drug, drug-allergy, drug-formulary checks.
- Report information for quality improvement and public reporting.
- Maintain an up-to-date problem list of current and active diagnoses
- Generate and transmit permissible prescriptions electronically (eRx).
- Use computerized physician-order entries (CPOE), which is defined as entailing the provider's use of computer assistance to directly enter medical orders (for example, medications, consultations with other providers, laboratory services, imaging studies, and other auxiliary services) from a computer or mobile device.

Under the recent proposed rule, Stage 2 meaningful use requirements will include rigorous expectations for health information exchange, including more demanding requirements for e-prescribing, incorporating structured laboratory results, and the expectation that providers will electronically transmit patient care summaries to support transitions in care across unaffiliated providers, settings and EHR systems.

Stage 2 also expands on Stage 1 criteria in the areas of disease management, clinical decision support, medication management support for patient access to their health information, transitions in care, quality measurement and research, and bi-directional communication with public health agencies.

These changes will be reflected by a larger number of core objective requirements for Stage 2. Every objective that is optional in Stage 1 will be required in Stage 2. All menu set items likely will be moved to core measures, percentages will be increased, and some new menu objectives will be added. For example, under the proposed Stage 2 regulations to qualify for meaningful use payments hospitals, physicians and other eligible professionals will have to place orders through CPOE for more than 60 percent of their medication, laboratory and radiology orders. Under Stage 1, there is only a 30 percent CPOE threshold and only medication orders are counted.

To view a full list of Stage 2 "core" and "menu" set objectives, see the HHS proposed rule available at:
http://www.gpo.gov/fdsys/pkg/FR-2012-03-07/pdf/2012-4443.pdf.

For Stage 3 of the meaningful use criteria, beginning in 2016, the proposed rulemaking focuses on promoting improvements in quality, safety and efficiency, decision support for national high priority conditions, patient access to self-management tools, and access to comprehensive patient data and population health. Stage 3 will also provide higher standards for meeting meaningful use. Further clarification regarding Stage 3 requirements will be released as the effective date nears.


Written by Pulse

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Uninsured Rate for 18- to 25-Year-Olds Levels Off

The Gallup-Healthways Well-Being Index survey found the percentage of 18- to 25-year-old Americans without health insurance has plateaued at the 24 percent range, after declining from about 28 percent after the health care law provision allowing adults up to age 26 to stay on a parent's plan was implemented.

The uninsured rate for 18- to 25- year olds remained at 24 percent in the first quarter of 2012. The uninsured rate for this group first began to decline in the fourth quarter of 2010, decreasing to 26.3 percent from 28.0 percent in the third quarter of that year. The rate then decreased to 24 percent in the first quarter of 2011 and has remained around that level since.

The survey also stated that the uninsured rate for 26- to 64-year olds also leveled off, with one in five Americans in this age group reporting not having health insurance for the past year.

Gallup-Healthways Well-Being Index also showed the percentage of seniors who are uninsured has remained the same over the past four years. Very few adults aged 65 and older report not having health insurance, likely because they qualify for Medicare.

The Well-Being Index indicated the percentage of all adults who get their health insurance through an employer has declined to 44.5 percent. The percentage of adults who have a government plan through Medicare, Medicaid or military/ veterans' benefits has increased over time, now at 25.3 percent. The percentage of Americans who say they get their health insurance through "something else," which could mean they purchase it themselves, has held steady near 11 percent over the years.

According to results from the Gallup-Healthways Well-Being Index survey, the percentage of all U.S. adults without health insurance was 17.3 percent in the first quarter of 2012, similar to its levels for the past year, although clearly lower than in 2008, 2009 and 2010, before the health care law provision took effect.

Written by Pulse

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Who's Using a Hospital System's Social Media Page and Why?

Researchers found that more than 71 percent of individuals using Summa Health System's social media platforms already used social media to seek personal health information.

Summa researchers distributed an Internet-based survey on the hospital's Facebook, Twitter and blog and received feedback from more than 150 respondents. The survey sought to map out the user characteristics of a hospital system's social media structure and why users were using the hospital's social media pages.

According to the findings, 95.5 percent of respondents were female and 93.6 percent were Caucasian. Respondents were mostly age 50- 59 (33.8 percent) and 40-49 (26 percent). Sixty percent reported having a bachelor degree or higher. Aside from seeking personal health information (71.5 percent), social media was used to seek family health information (29 percent) and for hospital programming (27 percent).

The study's author concluded that hospitals have a huge opportunity to discuss health issues with patients using social media platforms. Hospitals, however, must still be cautious of HIPAA concerns and online professionalism.


Written by Pulse

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More than 100,000 Providers Paid for Using Electronic Health Records

More than 100,000 health care providers are using electronic health records that meet federal standards and have benefitted from the Medicare and Medicaid Electronic Health Record (EHR) Incentive Programs, the Centers for Medicare & Medicaid Services (CMS) and the Office of the National Coordinator for Health Information Technology (ONC) announced on June 19, 2012.

The EHR Incentive Programs, established by the Health Information for Clinical and Economical Health Act of 2009, provide incentive payments to eligible professionals, hospitals, and critical access hospitals as they adopt, implement, upgrade, or meaningfully use certified EHR technology in ways that improve care.

As of the end of May 2012:
- More than 110,000 eligible professionals and over 2,400 eligible hospitals have been paid by the Medicare and Medicaid HER Incentive Programs.
- Approximately 48 percent of all eligible hospitals and critical access hospitals in the U.S. have received an incentive payment for adopting, implementing, upgrading, or meaningfully using an EHR.
- One out of every 5 Medicare and Medicaid eligible professionals in the U.S. has received an incentive payment for adopting, implementing, upgrading, or meaningfully using an EHR.
- Over $5.7 billion in EHR Incentive Program payments were made.
- More than $3 billion in Medicare EHR Incentive Program payments were made between May 2011 (when the first payments were released) and the end of May 2012.
-More than $2.6 billion in Medicaid EHR Incentive Program payments were made between January 2011(when the first states launched their programs) and the end of May 2012.


Written by Pulse

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Slow Health Care Spending Growth Predicted for 2013

Health care spending in the United States is expected to grow at a historically low rate of 7.5 percent in
2013, the fourth consecutive year of relatively low growth, according to a report by the PwC Health Research Institute. The projection continues a pattern of slower medical growth, a reflection of the sluggish economy, increased focus on cost containment by the industry, lower use of services by cost-conscious patients and efforts by employers to hold down expenses.

According to the report, employers are focused on two primary strategies to control medical costs in 2013, increasing the employee share of costs and expanding health and wellness programs. The survey also showed that plan design features with the most significant changes in 2012 were a considerable increase in in-network deductibles, emergency room co-payments and prescription drug copayments.

The report stated one of two factors expected to "inflate" the trend in 2013 is an uptick in the consumption of health care as newly hired workers obtain coverage and patients who postponed elective procedures feel more confident about spending. Medical and technological advances that provide more specialized, sophisticated and expensive treatment also are expected to push up overall healthcare spending.

Four factors researchers expects will "deflate" the medical cost trend in 2013 are: market pressure to reduce medical supply and equipment costs; increased popularity of new methods to deliver primary care; increased availability of comparative cost information; and accelerated savings from the pharmaceutical patent cliff.

The report is available at http://www.pwc.com/us/en/health-industries/behind-thenumbers/key-findings.jhtml.



Written by Pulse

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HHS Announces 89 New Accountable Care Organizations

Health and Human Services (HHS) announced on July 9, 2012, that 89 new Accountable Care Organizations (ACOs) began serving 1.2 million people with Medicare in 40 states and Washington, D.C. on July 1, 2012. ACOs are organizations formed by groups of doctors and other health care providers that have agreed to work together to coordinate care for people with Medicare. These 89 new ACOs have entered into agreements with Centers for Medicare and Medicaid Services (CMS), taking responsibility for the quality of care they provide to people with Medicare in return for the opportunity to share in savings realized through high quality, well-coordinated care.

Participation in an ACO is purely voluntary for providers. The Medicare Shared Savings Program (MSSP), and other initiatives related to ACOs, is made possible by the 2010 Affordable Care Act. Federal savings from this initiative could be up to $940 million over four years.

Beginning this year, new ACO applications will be accepted annually.


Written by Pulse

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Election Aftermath: What Effect on ASC’s & Health Care?

The recent Presidential election and subsequent Inauguration clearly had serious implications for the field of health care and ASC’s regardless of one’s political leanings. The liberal wing of the Democratic Party was concerned that a Romney administration would put an end to one of the most noteworthy pieces of social legislation in recent memory. At the same time, the Conservative arm of the Republican Party believed that a second term for President Obama would prove to be the catalyst for the implementation of a monstrous entitlement program. For those in the field of health care though, the biggest source of anxiety as Election Day drew near was the thought that this issue would leave the system in total chaos.

Some Reform but More to Come

Even though the Affordable Care Act will not be fully operational until 2014, there has already been a massive amount of money exchanged since the first phase of reform was put in place in 2010. For example, many young adults who are up to 26 years of age have been added to their parent’s health insurance policies. Another new option available was that people under the age of 65 who are covered by private health insurance have now been offered an array of free wellness benefits; and in 2012 a report from HHS showed about 54 million had taken advantage of them. Also, some states have already begun to set up consumer assistance bureaus for the benefit of consumers and to create the infrastructure for an exchange that will facilitate the purchase and sale of private health insurance options. Putting an end to what had already been set in motion would very likely have created a sense utter pandemonium.

But when the Supreme Court upheld the constitutional nature of the health reform in 2012, the challenge of legitimacy was effectively squelched. With the re-election of President Obama, Administration officials will now be in place during the full-scale implementation of the law, which should imply that patients and providers alike can expect the Affordable Care Act to be put into effect methodically in the coming years. It has also been reported recently that new regulations regarding reform were held back prior to the election to avoid added controversy. Because of this, it can be expected that a stockpile of regulations will be quickly released in the near future; with some of them possibly addressing the question of what expenses and services will be required under the new reform.

The governors of many states will now have to make the choice of whether or not they wish to create an insurance marketplace to regulate small business and individual health plans. If a state chooses not to set up such an exchange, the federal government will step in instead. Governors and legislatures on the state level will also have to decide whether they wish to allow wider eligibility for the public option insurance program. It has also been reported that some Republicans are expected to get on board with certain aspects of the law now that it has firmly been set in place.

Leaders of Ambulatory Surgery Centers across the country seem to be in agreement that the currently divided Congress should prevent any further funding by the Government. Some suggest that ASC lobby efforts should be promoted. Others ponder whether or not the new Act could be good for ASCs, since it will require that a greater number will be insured. Will a greater number of insured patients increase the volume at ASC facilities? If so, will these facilities find a way to prosper even though the reimbursement level has decreased? A majority of the leaders in the ASC world appear to agree that whatever adversities arise; they can be overcome once the rules have been fully revealed. What the rules are and how they will be carried out should become ever clearer in the near future.

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Final Rule Increases Payments to Hospitals

On Aug. 1, 2012, the Centers for Medicare & Medicaid Services (CMS) issued a final rule that updates fiscal year (FY) 2013 Medicare payment policies and rates for inpatient stays at general acute care and long-term care hospitals (LTCHs), and builds on the Obama Administration's work to slow growth in future health care costs by improving patient care.

The final rule also implements key elements of the Affordable Care Act's hospital value-based purchasing and hospital readmissions reduction programs. The rule advances Administration efforts to tie Medicare payments to quality health care across the delivery system, with new quality reporting measures for general acute care hospitals in FY 2015 and FY 2016; new measures for long-term care hospitals in FY 2016, and new quality reporting programs for psychiatric hospitals and cancer hospitals. In addition, the rule establishes new reporting and other requirements for the Ambulatory Surgical Center Quality Reporting (ASCQR) Program.

Under the final rule, payment rates to general acute care hospitals will increase by 2.8 percent and LTCH payments are expected to increase by $92 million or 1.7 percent in FY 2013.

To provide hospitals with an incentive to reduce hospital readmissions and improve care coordination, the Affordable Care Act created a Hospital Readmissions Reduction Program that will reduce payments beginning in FY 2013 (for discharges on or after October 1, 2012) to certain hospitals that have excess readmissions for three selected conditions: heart attack, heart failure and pneumonia. The rule finalizes a methodology and the payment adjustment factors to account for excess readmissions for these three conditions.

For further information, please visit http://www.cms.gov/apps/media/press_ releases.asp.

Written by Pulse

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