Medical Billing and Reviews - Health Care 2006

Transcription

1 George Blumenthal 1

2 The Future of Healthcare IT Is in the Clouds George Blumenthal 1

3 Milano Finanza February

4 Cellular Communications International, Inc. 3

5 A Smashing Victory Points assigned by BAIN and Citibank Italia Oggi April 2, 1994 Omnitel Unitel* Investments pledged Lit. 2 trillion Lit. 1.5 trillion Financial bid Lit. 750 billion Lit. 707 billion *Consortium led by Berlusconi 4

6 The HITECH Act $50,000,000,000+Funding To Revolutionize Healthcare I.T. Sections 4101, 4102, 4201 Entitlements $40 Billion $25 Billion for Eligible Professionals $15 Billion for Hospitals Sections Section 6001 and Titles I, XII Grants $10 Billion For HIEs, Rural Broadband, Regional Extension Centers, Education and Training, Comparative Effectiveness Research 5

7 The Cost of Healthcare Is Destroying The USA USA Germany Italy Israel Health Care Costs $ 7,900 $ 4,200 $3,100 $ 2,700 % GDP 17% 12% 10% 8% Life Expectancy Smokers 16% 22% 23% 20% Obesity 34% 15% 10% 14% Ambulatory Visits/ Capita Gross National Income/Capita $47,000 $38,000 $31,000 $28,000 Source: OECD Health Data

8 Expenditure Disparities End of Life Care Costs Mayo Clinic Cleveland Clinic Johns Hopkins Hospital UCLA Medical Center Medicare Spending $53,430 $55,330 $85,730 $93,840 Physician Visits Days in Hospital Hospital Beds Source: The Dartmouth Atlas of Health Care 2008, as printed in Time Magazine June 29,

9 Elyria Has 3 Times the Rate of Angioplasties as Cleveland Front page New York Times,

10 Healthcare Wastes 57% of patients must recount medical or personal information 30% of all U.S. healthcare costs go to duplicative care 26% of patients receive conflicting information Source: Markle Foundation, Robert Wood Johnson Foundation, Achieving Electronic Connectivity in Healthcare,

11 U.S. Adults Receive 55% of Overall Breast Cancer Hypertension Asthma Pneumonia Hip Fracture 76 Diabetes Mellitus Overall Breast Cancer Hypertension Asthma Pneumonia Hip Fracture Diabetes Mell McGlynn, June 26,

12 Would You Fly Without a Checklist? 11

13 Would You Fly if a 747 Crashed Every 12 Hours? Annual Deaths Hospital Acquired Conditions 180,000 Lung Cancer 158,000 Breast Cancer 40,200 Pancreatic Cancer 36,800 Traffic Accidents 33,000 Prostate Cancer 32,000 AIDS 18,000 Total 318,000 Adverse Events in Hospitals: National Incidence Among Medicare Beneficiaries HHS Office of Inspector General November

14 Medicare Demonstration Project Recommended Care 92% 91% 70% 64% Pneumonia Heart Failure Source: Medicare/Premier Hospital Quality Incentive Demonstration (HQID) 13

15 Surgical Checklist A Surgical Safety Checklist to Reduce Morbidity and Mortality The rate of death declined from 1.5% to 0.8% Inpatient complications declined from 11% to 7% January 29,

16 Catheter-Related Bloodstream Infections in the ICU 8,0 7,7 6,0 4,0 Per 1000 Catheter Days 2,0 1, months December 28,

17 erx Is a No-Brainer 16

18 Cornell Medical College 2 in 5 handwritten prescriptions had errors Prescription errors reduced from 43% to 7% with e-prescribing Source: Kaushal, R. et al, Electronic Prescribing Improves Mediation Safety in Community-Based Office Practices, Journal of General Internal Medicine, 25(6): 530-6, February 26,

19 Kaiser erx and Safety 75% reduction in allergic drug reactions and excessive dosages 45% reduced in the average time spent in the ICU Source: Clinical Information: Achieving the Vision, 2002; Kaiser Permanente 18

20 Physician Benefits of erx 50% of office phone calls are related to prescriptions 1 erx can generate time savings of 1 hour per nurse and 30 minutes per file clerk per day 2 1. The Physician s ehealth Report, November/ December Rhode Island Electronic Prescribing Project 19

21 The HITECH Act $50,000,000,000+Funding To Revolutionize Healthcare I.T. Sections 4101, 4102, 4201 Entitlements $40 Billion $25 Billion for Eligible Professionals $15 Billion for Hospitals Sections Section 6001 and Titles I, XII Grants $10 Billion For HIEs, Rural Broadband, Regional Extension Centers, Education and Training, Comparative Effectiveness Research 20

22 Medicaid Is at the Center of Healthcare The MITA Business Architecture, May 8,

23 Bonuses and Penalties for Eligible Professionals ARRA 1 Medicaid 2 Bonus $63,750 $63,750 $63,750 $63,750 $63,750 $63,750 ARRA Medicare 3 Bonus $44,000 $44,000 $39,000 $24,000 Penalty -1% -2% -3% eprescribing 4 Bonus 2% 1% 1% 0.5% Penalty -1% -1.5% -2% PQRI Bonus 2% 1% 0.5% 0.5% 0.5% Penalty -1.5% -2% -2% Total Annual Penalties -1% -1.5% -2% -2.5% -4% -5% 1. American Recovery and Reinvestment Act of Assumes 30% of patient volume is in underserved areas or communities 3. Assumes Medicare Part B revenues exceeds $25, eprescribing and PQRI bonuses and penalties are a percentage of Medicare Part B revenues received 22

24 20 Objectives to Accomplish Stage 1 MU* 5 of 10 Menu Objectives 15 Core Objectives 1 Core Objective Requires Satisfying 6 of 44 Clinical Quality Measures *Meaningful Use 23

25 20 Objectives to Accomplish Stage 1 MU* 5 of 10 Menu Objectives 15 Core Objectives 1 Core Objective Requires Satisfying 6 of 44 Clinical Quality Measures *Meaningful Use 23

26 20 Objectives to Accomplish Stage 1 MU* 5 of 10 Menu Objectives 15 Core Objectives 1 Core Objective Requires Satisfying 6 of 44 Clinical Quality Measures *Meaningful Use 23

27 Checklist Objectives for Stage 1 MU Core Objectives C01 CPOE for Medication Orders 30% Menu Objectives M01 Drug Formulary Checks Enable function M03 Patient Lists 1 report M04 Patient Reminders 20% C02 Drug Interaction Checks Enable C03 Maintain Problem List function 80% C04 Permissible Prescriptions 40% C05 Active Medication List 80% C06 Medication Allergy List 80% C07 Record Patient Demographics 50% C08 Record Vital Signs 50% C09 Record Smoking Status 50% C10 Clinical Quality Measures-CQMs C11 (from within this Objective you must choose six measures) Clinical Decision Support Rule 1 C12 Electronic Copy of Health 50% C13 Information Clinical Summaries 50% C14 Electronic Exchange of Clinical 1 test C15 Information Protect Electronic Health 1 risk Information analysis M07 Medication Reconciliation 50% M09 NQF 0013 NQF 0028 NQF 0421 NQF 0018 NQF 0027 NQF 0061 Immunization Registries Data 1 test Submission Clinical Quality Measures Numerators / Denominators Hypertension: Blood Pressure Measurement Preventive Care and Screening Measure Pair: a. Tobacco Use Assessment, b. Tobacco Cessation Adult Weight Screening and Follow- Intervention Up 1/1 No exclusions 1/1 for a 1/1 for b No exclusions 2/2 Possible exclusions Controlling High Blood Pressure 1/1 No exclusions Smoking and Tobacco Use Cessation, Medical Assistance Diabetes: Blood Pressure Management 2/2 No exclusions 1/1 Possible exclusions 24

28 Rules-Based Engines Measures are added each year Measures are adjusted from year to year Measures are retired 25

29 Imagine MD Secure N-Tier Architecture 26

30 Imagine MD Provides 4 Real-Time Levels of Assurance of MU 1. MU Indicators 2. Patient level compliance dashboard 3. Provider level compliance dashboard 4. Dashboards provide necessary steps to achieve compliance for each MU objective 27

31 Real-Time Meaningful Use Dashboard 28

32 Multiple Language Capability English 29

33 Italian 30

34 Russian 31

35 Multiple Language Capability Page Code with place holders User Preferred Language P h r a s e LanID1 LanID2 (German) L a n I D 2 Code (English) (Portuguese) 1 Personal Details Persönliche Angaben Detalhes pessoais 2 Show History Historie anzeigen Mostrar Histórico 3 MRN MRN MRN 4 Status Status Status 5 Primary Provider Primary-Anbieter Provedor primário Phrases Data Table Page Display Engine English German Portuguese

36 Electronic Interconnection of Doctors Regulatory Reference Mandatory Data To Be Transmitted Electronically Prescription Code Personal ID Note for Pharmaceutical Association Exceptions Data of Filings Type of Prescription Prescription Transmission to Central Repository Diagnosis and ICD 9-CM Code 33

37 Progetto Tessera Sanitaria Web Services per la Trasmissione dei Certificati di Malattia all INPS 34

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40 Linkem Overview License holder of 84MHz of spectrum covering 80% of the population and 42MHz of spectrum covering the remaining 20% Over 190 million of capital funded to date FOR MORE INFORMATION PLEASE VISIT OUR WEBSITE: 84MHz of frequency spectrum 42MHz of frequency spectrum 37

41 Brescia Key to Icons: Location of TI DSLAMs Linkem customers who do not have access to DSL Linkem customers who have access to DSL, but have reported DSLAM which is nearing saturation DSLAM which has reached full saturation Locations of Linkem s BTS 38

42 Brescia Key to Icons: Location of TI DSLAMs Linkem customers who do not have access to DSL Linkem customers who have access to DSL, but have reported DSLAM which is nearing saturation DSLAM which has reached full saturation Locations of Linkem s BTS 39

43 Latina Key to Icons: Location of TI DSLAMs Linkem customers who do not have access to DSL Linkem customers who have access to DSL, but have reported DSLAM which is nearing saturation DSLAM which has reached full saturation Locations of Linkem s BTS 40

44 Latina Key to Icons: Location of TI DSLAMs Linkem customers who do not have access to DSL Linkem customers who have access to DSL, but have reported DSLAM which is nearing saturation DSLAM which has reached full saturation Locations of Linkem s BTS 41

45 Avezzano Key to Icons: Location of TI DSLAMs Linkem customers who do not have access to DSL Linkem customers who have access to DSL, but have reported DSLAM which is nearing saturation DSLAM which has reached full saturation Locations of Linkem s BTS 42

46 Avezzano 43

47 Avezzano Key to Icons: Location of TI DSLAMs Linkem customers who do not have access to DSL Linkem customers who have access to DSL, but have reported DSLAM which is nearing saturation DSLAM which has reached full saturation Locations of Linkem s BTS 44

48 WiMAX Dish for WiFi in 45

49 Outdoor Dish 46

50 George Blumenthal 47

51 The Future of Healthcare IT Is in the Clouds George Blumenthal 47