I hope this is a good educational meeting as they need it.  imageWhen this letter went out it was all over the web and about the lack of knowledge here on how the incentives and educational process was working.  Electronic medical records no doubt are the way to go and I think that question was answered years ago as heck I was writing software for an EMR years ago myself.  This is really sad that they don’t understand the investment here and I will go a little further to say that as on the “consumer” end they may not be participating much in their own care or maybe even as simple as paying attention to their own visits to their doctors.  Otherwise I don’t we would have seen such a letter sent. 

Digital Illiterate “Algo Duped” GOP Lawmakers Call for Suspending of Incentive Payments to Providers–Also Sent Letter to HHS Telling Them To Expect More From Meaningful Users–Walk A Mile in a Healthcare CIO’s Shoes Please…

I guess they don’t read the news about hospitals walking a fine line today with trying to stay out of the red and stay in business as those hospitals, if if were not for the incentives couldn’t afford to transition to electronic records.  Again maybe newspapers and all the articles and opinions written about this topic may not circulate in DC?   How does one miss it? 


If you happen to read Dr. Halamka’s blog from Harvard he too said they were wrong in their assumptions and he was much nicer than me and said he would gladly spend some time and bring them up to date.  So bring the folks from the House who wrote the letter on over too:)  You don’t get much better input than his for sure and they would be wise to take him up on his offer…from his blog…

“I'm happy to walk them through the Standards and Certification Regulations (MU stage 1 and stage 2) so they understand that the majority of their letter is simply not true  - it ignores the work of hundreds of people over thousands of hours to close the standards gaps via open, transparent, and bipartisan harmonization in both the Bush and Obama administrations.”

They also said enough was not being done to make the transition faster.  Again, I guess they have not read up or asked any questions to this point.  One thing that Congressman and the general public needs to be aware of….

           “The short order code kitchen burned down a few years ago”

So what does that mean?  We have a very complex Health IT iimageinfrastructure today and that has not sunk in yet.  Years ago someone could come to us technologists and describe what they wanted and we would build it, not that easy today since data systems talk to each other and integrate, not like the old client/server silos we used years ago. 
This brings me to a political statement if I can here as in the debates we keep hearing about uprooting the Medicare system and changing it to a voucher system.  I just wish we would hear some real logic here and understand that a process of such would take 7 or 8 years and the US may not even have enough engineers to do this as Ryan keeps talking about, so repealing the healthcare law entirely and changing it is impossible.  They can use the transition to electronic medical records as an example since this is what they are questioning.  I keep hearing this in the debates and it’s farce and just generates useless chatter.  Now modifications of at smaller levels can be done but again, even that takes time…so one more time…

          “The short order code kitchen burned down a few years ago”

Perhaps this meeting will end up facilitating a level of communication between Congressmen and technologists?  Bill Gates tried for years to get through some thick heads maybe lost in the70s in DC with very little effect so his foundation is doing its own thing now and rather well I imagemight add.
  The accusations on the billing too was an astounding accusation.  For years, and I’ll use one example of a standard office visit, doctors were afraid to bill more than the 99213 code for a standard office visit.  If they spend more time and have an extended visit and document properly to include required elements of the visit, they can get more money for a 99214 or a 99215, which is perfectly legal and money they earn if they have an extended visit as it was set up that way.

Now with electronic medical records, it’s easier and more convenient not to mention more complete to make sure all those elements are there and that’s what most are doing, so add this up against all the MDs in the US using electronic records and of course there’s more codes that are tiered as such as well and that will probably account for a lot of the increased billing to Medicare.  This normal and of course does not include the out and out “fraud” folks out there that exist and they are criminals and and make it tough for all of us and should be prosecutes.  I can’t tell you how many times I heard doctors who were still using “paper” were afraid to use anything higher than the 99213 code even when they did the work as they were afraid of the “red” tape and slowing down the process of getting their claim paid, and that does happen when an extended visit is billed when Medicare looks for the substantiating documentation.

Now when it comes to medical records and automated billingimage, sure that’s worth a look and we have seen some of that but HHS now has the technology to run queries and look for obvious abuse too, which they didn’t have before so they can audit big hospital system and find such items if they have developed a pattern and are being abused.  Maybe the senators forgot about that part of what’s happening at HHS too, and it’s still fairly new, but a semi automated audit is in the stars.  HCA was in the news about their potential coding situation and billing and who knows, maybe they just got better and more accurate with their billing but then again if they are more profitable than others, maybe take a look.  That new audit software HHS has should get a work out. 

How is HCA a For Profit Hospital Chain, Making All That Money–Billing in the ER a Contributing Factor for Reimbursements–The Algorithms Move Money and Created Some Very Large Profits And Others Generated ER Care Parameters for the Facilities

Again I hope this ends up to be a productive meeting and perhaps they will learn more about the world of Health IT and perhaps the entire Government IT infrastructure while they are at it.  I should add one more item in here too and this has been a campaign of mine for a while on taxing the data sellers who get the data for nothing and profits for free. When you look at the NICC situation and the people that have died due to the FDA not having enough staff to do routine inspections on drug and compounding companies in the US, don’t you think that Walgreens as an example would be happy to pay an excise tax on that revenue so they can be assured the FDA is on the job inspecting and ensuring we have safe drugs?  Walgreen made short of $800 million on selling data in 2010, so see how big that pot can be when you include banks, high frequency trading companies, social network companies, etc. to license and have them pay a quarterly excise tax. 

They need money to also hire more engineers for the device end of the business, but does anyone do anything about it to fund the FDA and the NIH?  Nope…it could be a very good idea to let HHS and the ONC keep working the program and move over and focus on this item, as people are dying…more a the link below on the FDA needing funds….

Meningitis Fungus Investigation and Research Continues With FDA Inspection While Massachusetts Hospitals Contact Cardiac Patients About a Heart Medication Also Created at NECC

One more time….

        “The short order code kitchen burned down a few years ago”

I could go on and I have but I would like to see Congress use better tools to make laws too like IBM Watson so all could use speech recognition and query from the same sources and that way both the House and Senate have the same information and then can go off to committees to continue their work and shoot the the GOP and Democrats just might even get along better if they worked collaboratively with everyone at least having the same starting place.  After this meeting is done, could someone look into revolutionizing the way we make laws?   If we could entertain a shift in focus over to the items at the link below we might all come out ahead and who knows, folks in Congress might become better participants in their own healthcare at the same time…it’s what they want us to do as consumers so what’s good for the goose is good for Congress:)  BD

Congress To Investigate the Data Sellers - Need To Create a Law to Tax Them As The Algorithms Used For This Business Generate Billions of Dollars, Partly Why Corporate Profits Are So High - Remove the Medical Device Tax as They Produce Needed Jobs/Tangibles

Two weeks after top House Republicans called for HHS to halt meaningful-use incentive payments to providers, four senators have requested a meeting with staff members from the CMS and HHS' Office of the National Coordinator for Health Information Technology to discuss the program.

Sens. John Thune (R-S.D.) and Tom Coburn (R-Okla.) of the Senate Finance Committee and Sens. Richard Burr (R-N.C.) and Pat Roberts (R-Kansas) of the Senate Help, Education, Labor and Pensions Committee, sent a letter to HHS Secretary Kathleen Sebelius (PDF) indicating that a recent briefing with the administration's staff was not long enough for lawmakers to get answers to all of their questions about the final rule for the second stage of the government's electronic health-record system incentive program. The program pays providers for adopting and meaningfully using EHR systems.

The lawmakers posed several questions they want members of the CMS and the ONC to address, including whether the use of taxpayer-subsidized EHRs increases the use of diagnostic tests rather than reduces them. They also ask in the letter whether some healthcare providers received subsidies for EHR systems that were already established before the adoption of federal standards and mandates, and whether the digitalization of records and adoption of EHRs have raised providers' billing of Medicare and consequently increased the cost of the program for taxpayers.



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