Medicare–The Missing IT Infrastructure the US Government Never Got The Chance to Build And A Few Other Housekeeping Issues…

We read every day about the budget, budget cuts and all the OMG political antics in the papers and elsewhere on the web every day. It’s confusing and complicated, for everyone. Medicare never got the shot out of the barrel that Social Security did by comparison, in other words they don’t have a solid back bone with an IT infrastructure with government employees running the system. What does that mean? In many areas it’s like comparing apples to oranges, especially when discussing budgets, administration an so on.

Let’s back step a little bit to when this administration took over and I’ll go back to talk about IT infrastructure that was in the news at the time. We had many years of neglect simply due to choices that were made by both politicians and in some instances our vote as citizens. Did we know what we were really voting on in some areas, probably not and self included there too. I remember the news stories coming out about the White House when the new folks moved in. They found many computers still running Windows 98, and some of the computers were just old, so during the Bush administration does this give you a hint as to how the White House at that time viewed technology and IT infrastructure? It should. How long as XP from Windows been around, a long time and most citizens had long upgraded way before the new administration took over.

During the prior administration, the Department of the Interior had a web site that used to go down about once a week and again that was in the news and our current CIO and CTO saw that as a hot spot and who wouldn’t. It’s kind of embarrassing not to mention lacking functionality to see this happen. Didn’t bother the prior administration much though as they sat working away on their Windows 98 machines in the White House.

One other area worth a mention too was the FDA under the prior administration. I have been doing this blog for around 4 years now so there’s some archives built up around here and I went back to one that was a bit satirical where I posted about asking Intel to get the FDA some “Classmate” computers after reading that several of the investigators and others in the agency were still writing up reports and other items in long hand and didn’t have a computer.

“Hello Intel...anybody listening...maybe Craig Barrett...could we get some Classmates over there to help out?? “

Again this is something I’m sure that has changed dramatically at the FDA in the last couple of years as you just can’t function that way anymore. At the time we had programs going to help children in other countries get cheap inexpensive computers and yet our own FDA was right in there too with a need for computers, again priorities I think sometimes with luddites who don’t get it.

FDA scientists plea for agency reform – Technology will help with Transparency

The agency relies on manufacturers and clinical investigators to initiate recalls and failure reports when a technology is not beneficial or is potentially harmful to patients too, so we have another system here that was over looked for years. Back in 2007 Craig Barrett was talking about his horse ranch with all of his horses that had electronic medical records too.

"I have a ranch with 45 horses, and they all have electronic medical records, and they all get e-mail updates when their shots are needed," he told the summit.

Back on track here with Medicare after reading a couple of those examples with other agencies this might give you a couple hints as to where the leaders were at the time an their thinking. The US grew up with Social Security and thus put systems in place to administer it. Sure they outsource some as every area of government is a collection of both government and external systems with private industry today to some extent as that is the way IT infrastructure works.

Social Security has it’s own IT Infrastructure at the base of their operations, Medicare does not, it was pretty much all outsourced as far as the mechanics of how it works. It’s an old technology called COBOL but it still works and kicks those checks out, maintains data base information and so on. As a matter of fact the Social Security Death Index data base is the #1 authority chosen to reference when finding out if someone is still alive or dead, that’s the brain right there and the source if one were looking. You kind of wonder why certain IT systems don’t perhaps use it as a cross reference when you see stories like this in the news with dead employees to the tune of $2 million are getting premium payments made, in other words the City of Buffalo in this instance had no idea of whether or not current and retired employees were dead or alive.

City of Buffalo Has Paid Over $2 Million to Provide Health Insurance for Hundreds of Dead People-Some as Many as 4 Years

Yes that is embarrassing when the government provides this tool at least and nobody chooses to check. We have the same thing going on with all the MD rating sites too, nobody checks and lot of flawed information out there too and some profit off of providing flawed data to consumers and don’t really care if their information is up to date or not.

Now Medicare is set up with contractors for processing claims, so your claim does not go to a government computer system, it goes to a contractor which is either a direct insurance company or usually a subsidiary of one. Is this maybe a shock to those who are not working with the system, could be. We are back stepping here to when a lot of legislation took place and the insurance industry saw this as one big gift too as they went to work setting up their IT infrastructure to handle the business and they get contracts to do this.

So now the government had a system set up to handle all these claims and it has been this way for years, and on the other side of the coin, a complete IT infrastructure was never built. They have a lot of computers and systems and a big overall data base of claims for all of Medicare, that is what has been processed and paid and given to them by the contractors, the insurance companies who do the IT work and process those claims. This may be over simplistic for some readers here but I’m going over it as some just don’t know how this works.

Insurers Made $450 Million with Interest Income by Holding Medicare Funds for Around 46 Days Before Releasing Payment

By comparison, Social Security has the capabilities with computers and systems, and the IT control over what happens. There’s a big difference here and are you starting to see where the big hole is? Both Social Security and Medicare costs are rising and of course we all know that there’s more of us getting to that age, and then again you have to look at technology coupled with research and development too. They have an impact and this area of cost doesn’t seem to get mentioned a lot as far as it’s fair value. I think its very valuable, but when it comes down to lawmaking I don’t think we get much further than a spread sheet with knowing addition and subtraction for the most part from all the accounts I read today.

Medicare Contractors Are Not Getting Their Act Together with Consultation Coding – Are Claims Falling into a “Black Hole”

Years ago we were at the choice of either “pay me now” or “pay me later” for building government infrastructures for Medicare and by the time politics and everything else got involved, we got the “pay me later” choice and this is kind of where we are at today, along with everything else that has transpired with technology and the “sleepers” in the White House prior to this administration didn’t do anyone any favors. In retrospect as we get smarter, we can see the decisions made back then and where it lead us to today. Again, when you compare Social Security Infrastructure to Medicare, Medicare got ripped in this department years ago and this is what we have today. See how many years it has taken to even open an ear of curiosity here, this is from March of 2011, recent.

Lawmakers Finally Asking About Medicare Contractor Conflict of Interests-Subsidiary Watch and Inquiries-Mergers and Acquisitions

You can slice it any way you want, but it all comes down to data. IT systems back up and run the programs for laws that are created. Don’t fool yourself and miss this fact as it is what it is. This is why I put the word “algorithm” center stage here on this blog to bring around this awareness so you know that formulas are running everything in reference to decisions that are made. Denial is not a river in Egypt either. There’s little incentive too for contractors to do much about fraud, it’s the government’s problem as they are the “hired hands” to run the IT infrastructure to process claims that the government never built.

Little Progress on Fighting Healthcare Fraud – Look At Who’s Getting the Anti-Fraud Contracts

Sometimes when you see the news today, give this some thought and don’t lose track of how we got here. News gets so distorted sometimes and we end up thinking that obese people are evil as they get portrayed that way in the news, doctors are not capable and are all crooks, we sadly see that too. Sure there are bad eggs out there everywhere but I have never seen such sad journalistic quality with some of these stories at times, but I do recognize with some it is their job to grab ratings too, so some of that comes with their job descriptions too. I always in fact see myself as a partner of journalists with being able to talk about specifics in an area where I may have some expertise and connect a few more dots, which I would not be doing of they had not brought the news to the forefront to begin with.

Proof and transparency is good, but witch hunts dies a while back but we still see it with a lot of blame shifting too. The fact is that with budgets today, we were dealt this problem years ago with decisions to pass the buck and not build an IT infrastructure and the side shows we see are a bit of a circus and lack some real intelligence as collaboration is the key today, and there’s not one big Senator, Representative or President that’s going to have all and answers under their hat. People like that don’t exist today because we are so diversified and busy and have so much information to process, you can’t do it.

Medicare Federal Investigators Getting Algorithms to Analyze And Find Fraud-Good Move as Contractors Efforts Are Weak With Risking Loss Of Transaction Revenue

This is where the side shows come in with still thinking in these paradigms and none of it usually works and it gets discussed, tossed out or what ever. We have a few folks that we elected that could spend some time getting over themselves and learning up when it comes to digital literacy and learn to recognize and use the tools that the rest of the world is using, especially big business. Why do you think lawmakers have such issues with businesses and why the 2 don’t come together better, digital literacy would help bridge that gap with learning to collaborate.

There is light though as CMS is working to build some infrastructure so they have their own for reporting, analysis and so on so we are not at the mercy of complete reliance on IT infrastructures built by the insurance companies.

CMS Releases Plan for a Much Needed IT Infrastructure Upgrade With Computers, Data Systems And Those Updated Algorithms

Again I just thought that all of this was worth a mention as when I talk to people all the time, they have no idea how all this was rooted in the processes we are trying to solve today. So much of what is criticized in some government operations is actually an outsourced problem with either insurance company or other businesses with failure rates and perhaps some less than honest pesky algorithms that get in here as everyone works their profit angles to the penny today. Big business doesn’t always do it better as we all learned in 2008 with the crash of Wall Street; however they do have us on IT infrastructure and intelligence all the time and that’s a fact and sure they mis use some of it too, but they run those algorithms to figure out how to make money.

An algorithm can be created for accurate results or desired results and the 2 should be the same, but think back to 2008, that was not the case.

Next time when you think about some of the government entities, also give some thought to how we got there, with the “pay me later” choice that was made by those who were in office at the time and kind of look at the vast difference of where we were then and where we are today. I want a smart Congress that realizes this and can step up to the plate an deal with it without all the side shows and stuff that drags us down and makes us look not so smart, there’s a lot of that out here with foot in mouth disease and so much of this comes fro digital illiteracy as they don’t quite know what to approach to solve. Here’s one example that is pretty clear cut on the topic with some thinking IT infrastructure grows on trees too. It’s an interesting piece as Dow Jones seems to want someone to make big money for this and Grassley wants HHS to fork out millions, but you can see by this example how the shoot outs at the old corral are not working.

Digital Illiteracy Is Killing Us With New Bill Wanting MD Medicare Compensation Put Online-No Clue on the Cost, Time and Truckloads of Errors to Audit and Correct

Sad they just saw the whole IBM presentation as a game from what I have read on the web and couldn’t find a sole in Congress to see the value.

IBM Watson Capabilities Being Pitched to Financial Industry-Congress Must Not Have Felt They Needed This So Further Behind We Fall With Effective Intelligent Lawmaking

In summary you can see where our IT infrastructure took a dive in many areas and there are some agencies like DOD that are the opposite and are on fire. They too are a combination of both internal and outsourced capabilities but they seem to do a much better job managing it. They have their issues like everyone else but they are miles ahead of many with their own basic infrastructure and this huge energy center too. Have you seen this from the DOE with their high powered computing?

Maybe we could build that Medicare IT infrastructure and run it here with the DIR as you can see technologies to create cures for disease are in there too. So by comparison, when you see something like this, and then look at what was created at HHS, it makes you very sad to see what restrictions they were dealt and again the huge levels of digital illiteracy that stands to fail us all soon if we don’t get with it. BD