MEDICAL BILLING – OVER 50% AMERICANS CAN’T AFFORD TO GO TO THE DOCTOR

The sorry state of affairs in the American medicare industry reflects the inability of many Americans to afford quality healthcare. Many can’t afford medical billing despite having insurance. The Obamacare premiums are making it difficult for them to continue with the payments.

Can’t Afford To Go To the Doctor – HealthPocket

A recent survey by HealthPocket revealed the difficulties that many Americans face. The Affordable Care Act is reducing people’s ability to afford health insurance. They have so many other expenses that they can’t afford to take out money for health insurance.

The survey results show that a lot of Americans can only afford $100.

Here are the results.

  • Around 52.5% say that they can only afford $100 or more.
  • Only 15.95% can afford $200 each month.
  • The number of Americans drops 11.6% who can pay $300 each month.
  • The percentage further reduces to 5.5% for $400 in health insurance deductible assistance.
  • Only 4.8% say they can set aside $500 each month.
  • Only one out of ten Americans or 9.8% say that they can give away $500 a month for health insurance.

Medical Billing – A Difference of Perception

If you talk to someone who represents the health providers, you may not get a clearer picture of medical billing. However, if you talk to someone who is at the receiving end of the medical billing, you understand the underlying issues.

Here is how a medical billing advocate, Maureen Lamb explains the situation.

“If you are talking to someone who is sympathetic but unable to fix your errors or negotiate a discount, you are wasting your time. It may require unique approaches to break through the resistance. When phone calls, faxes, and emails don’t work, it’s time to write a letter documenting your request for a discounted bill, and request help from the management team of an organization.”

Crowdfund Provides Limited Relief

Many Americans are turning to other options. They consider crowdfunding as a way to get assistance. If they can’t afford to go to the doctor, they turn to crowdfund. It may include relying on different options including business startups and charitable organizations. However, they only offer limited funds and many find it hard to meet their medical bills.

There is a long way to go before we can see these crowdfunding sources catching up to the medical needs of many Americans. However, their strong social presence does suggest a ray of hope for the future. These platforms relying on websites like Twitter, Facebook, and other social media networks to get assistance.

We are hearing many success stories from the charitable institutions helping troubled patients. Cassidy did come up with thousands of dollars for the chemotherapy. However, she had to manage so many other expenses that it was becoming difficult for her to afford her medical bill. She was able to get some funds to get herself treated in the hospital. Such efforts show a strong community, willing to stand with each other and overcome the difficulties in paying medical bills.

Some Ways to Overcome the US Healthcare Problems

Here are some fixes that can help the struggling US healthcare industry.

  • The current NIH spending stands at around $34 billion. However, it does not have the purchasing power which hurts the welfare of patients relying on medications. The increase in taxation on the pharma industry would help sort some of those issues out.  Here is what CEO of Dana-Farber Cancer Institute has to say about NIH. “I believe they’re the crown jewel of the healthcare system. Glimcher says of the NIH. They train the next generation of American doctors. They take care of very complicated patients. They are the place where new ideas are born, but we are starving.”
  • There is a hope that smartphones would help revolutionize the way healthcare industry uses IT. The use of smartphones can help increase patient engagement, a significant step towards improving the quality of healthcare.
  • Some healthcare industry experts also believe that patients need to have adequate housing and high-quality food. Access to healthy food and safer housing will help them fight many of the illnesses caused due to these reasons.
  • Bring the scientists to the forefront of the research in the healthcare industry. The innovators need to be rewarded and incentivized for their contributions. It will help motivate more scientists to come with cures of the most deadly diseases.

MIPS QUALITY MEASURES 2017 APPLICABLE TO LTPAC MEDICINE

The following article looks at CMS MIPS quality measures for LPTAC medicine. However, before we go towards the MIPS quality details, we need to look at the underlying purpose and objectives.

Purpose

CMS (Centers for Medicare and Medicaid Services) is always working on improving the policy to provide better healthcare facilities. Therefore, the new measures are aimed to help improve the overall care delivery and also reward clinicians who are better engaging patients, families, and caregivers.

Here is how CMS looks at MIPS.

“To these ends, and to ensure the Quality Payment Program works for all stakeholders, we further recognize that we must provide ongoing education, support, and technical assistance so that clinicians can understand requirements, use available tools to enhance their practices, and improve quality and progress toward participation in APMs, if that is the best choice for their practice.”

Key Strategic Objectives

Let us have a look at the strategic objectives set by CMS.

  • The engagement of patients and the improvement of beneficiary outcomes.
  • To further the clinical experiences that offer flexible yet transparent programs.
  • Ensure meeting of diverse needs of the physician practices typically those with small practices.
  • Further the capabilities of the IT systems that meet various data needs of the end user including reporting and submission.
  • Work on improving information and data sharing to ensure its timely availability.
  • Enable customized communication while keeping MIPS quality measures specifications into perspective.

Caveats for Individuals and Groups

The new MIPS quality measures take into consideration two LTPAC setting codes. These codes are the basis for the MIPS quality measures specifications. These MIPS quality measures are for application on individuals as well as groups.

Eligibility Criteria

Here are some considerations to undertake.

To qualify for the MIPS incentive payments you need to report on the following.

  • There are 6 measures with at least one of them as an outcome measure relating to poor diabetes control. The new quality measures mark high specialty and ambulatory practices.
  • Each measure’s applicability should be up to 90 days.
  • Around 50 percent of your patients have to qualify for one of those 6 measures.
  • The minimum number acceptable for the incentive payments stands at 20 patients.
  • The health practitioner can only report some measures after a specific diagnosis. Therefore, health clinicians have to be careful when selecting these measures.

Avenues for Submission

You can submit your measures to multiple avenues including EHR, claims, QCDR, and Registry. Registry seems to be the most suitable option for groups that aim to report when using the individual measures.

Why Consider Registry for Submission?

Here are the reasons why you must consider submission via Registry.

  • Since you can submit all 2017 QMs via Registry, you do not rely on any other methods.
  • Claims Reporting for 2017 QMs only supports a subset. Therefore, be careful to see the claims if the Claims Reporting offers support for it or you need to use Registry instead.
  • The group gets a measure of review or control when using Registry before you submit the data. Therefore, it gives a buffer, allowing you to remove any errors that you may find.

Avoiding Penalties is Critical

Make sure to always keep the benchmarks in perspective. By following them you can reduce your chances of getting a penalty. It will also help you satisfy base reporting requirements for MIPS.

Make sure that the data you submit for one patient satisfies that particular measure. If you are able to satisfy all six measures, the data would become a prime example for others to follow. In that case, you may be able to find your data published on CMS’s site for Physician Compare.

How 2017 MIPS Quality Measures Differ?

Previously, there was not much detail available. However, 2017 MIPS by CMS offers detailed benchmarking, relying upon the methodology which involves different performance points.

These individual performance points add to make a total score. Therefore, in 2017, you need to focus on performance as it is a critical year for it. Physicians should know the way they are graded to their performance, comparing it with the past year. It is vital to carefully select QMs which would help you score above average performance.

Here is how CMS elaborates this concept.

“By developing a program that is flexible instead of one-size-fits-all, we’re trying to meet clinicians where they are so that they can make the choice about how to participate in a way that is best for them, their practice, and their patients. Reducing burden, ensuring flexible program design, and improving how we measure cost and quality performance supports clinicians in doing what they do best – making their patients healthy.”

FAKE MEANINGFUL USE MAY COST EHR $1BILLION IN LAWSUITS

An estate of a cancer patient, Stjepan Tot, filed a class action lawsuit against eClinicalWorks. The estate maintains the patient could not refer to earlier cancer symptoms due to faulty meaningful use software.

eClinicalWorks is hit with a class action lawsuit since the patients can no longer trust the accuracy of their medical records. The lawsuit point towards the flaws in the software clearly, defying the meaningful use core objectives.

Lawsuit Adds to eClinicalWorks Financial Struggles

eClinicalWorks had to deal with a huge settlement claim of $155 million only six months ago. The False Claim Act alleged that eClinicalWorks incentivized its customers to promote its products.

Details of the $1 Billion Lawsuit Against EHR Vendor

Kristina Tot, who represents Stjepan Tot estate, filed the lawsuit in New York’s Southern District. She claimed $999 million in monetary damages for gross negligence. Furthermore, the lawsuit also states that Stjepan Tot died because of cancer.

He could not search his electronic medical records to ascertain when was the first diagnosed with cancer. As there was no accuracy in the display of the medical records.

The lawsuit also alleges that millions of patients relying on eClinicalWorks cannot sort out their medical history. Thus, the software provided by eClinicalWorks fails to meet the meaningful use core objectives. Therefore, eClinicalWorks software does not meet the necessary requirements.

eClinicalWorks Lawsuit Reminds of the Report by HHS-OIG

The US Department of Health and Human Services or HHS-OIG released a report this June. The report samples 100 electronic health record providers getting payments from CMS for meaningful use. This report points to the failure of meeting meaningful use requirements of these health care providers, using incentive payments to the tune of $729 million. HHS-OIG found many of these healthcare providers not qualifying for these meaningful use incentives.

Large Scale Implications of eClinicalWorks Lawsuit

This lawsuit would have widespread implications for eClinicalWorks customers. The lawsuit indicates over 850,000 health service providers relying on this software. These new findings clearly reflect the need for better checks on software development companies offering health care provides with the EHR software.