Gibson Revisited

via HIPAA Blog

Alamo Woman Convicted of Selling FBI Agent’s Medical Records (PDF) | U.S. Attorney’s Office S.D. Tex. | 3.7.06

(McALLEN, TX) Liz Arlene Ramirez, 36, of Alamo, Texas, has been convicted of selling the confidential medical record information of a Special Agent with the Federal Bureau of Investigation (FBI) to a person she believed to be working for a drug trafficker. United States Attorney Chuck Rosenberg announced her conviction today, and noted that Ramirez faces a maximum punishment of ten (10) years in federal prison, without parole, and a $250,000 fine at her sentencing set for June 8, 2006. Ramirez, who was indicted and arrested in November 2005, has been permitted by the court to remain free on a $50,000 bond pending her sentencing.

At a hearing held on Monday, March 6, 2006, before United States District Judge Randy Crane, Ramirez pleaded guilty to the federal felony offense of wrongfully using a unique health identifier with the intent to sell individually identifiable health information for personal gain.

The United States proved that during the spring of 2005, Ramirez, who was employed at a doctor’s office under contract to provide physicals and medical treatment to FBI agents, offered to and agreed for a price to provide the personal and medical information of an FBI agent to a person she thought was working for a drug trafficker. The person was actually a confidential source (CS) of information to the FBI, who recorded their various meetings. In her final meeting with the CS, Ramirez received $500, the price she set for providing the medical records of the agent.

The FBI initiated this investigation after the CS notified them of Ramirez’s offer in early 2005. Assistant United States Attorney Steven Schammel is prosecuting the case.

See Gibson here, here, and here.

Medicare Meaning Lean

Medicare Cuts for Hospitals May Mean Lean Times for EPs | ACEP | 3.06

Proposed cuts to Medicare’s Part A programs “would have a significant financial impact on emergency physicians,” said Dr. David C. Seaberg, a member of the board of directors with the American College of Emergency Physicians.

…

Medicare Part A payment reductions would affect the hospital update at market basket over this time period, as well as the payment updates for skilled nursing facilities, home health, hospice care, and inpatient rehabilitation.

Most emergency physicians are not hospital employees–they either belong to an independent group or a faculty plan. These groups would be affected…

The cuts would directly affect the reimbursement situation in emergency departments, because “roughly 25% of the patients most emergency departments care for are Medicare patients,” Dr. Seaberg said.

With hospitals taking a direct financial hit, the trickle-down effect would be a decrease in emergency physicians’ Medicare payments…”[s]ince most third-party payers base their rates on Medicare rates, perhaps all payers would lower their rates as well,”…

A more indirect effect of the cut would be that “we have physicians out in the community who no longer want to take Medicare patients,” he said. “So where are these patients going to go: [these] older patients with significant comorbid diseases, who are sicker than the average patient? They’re going to go to the ER,”…

I must have read this piece three or four times—and finally gave up trying to make sense of it. I concluded that this was just another fluff piece pandering to the overall fear and misunderstanding of the Medicare program.

From “The Official U.S. Government Site for People with Medicare“:

What does “affect the hospital update at market basket” mean? Is this the economic usage of market basket as a surrogate marker for the market performance? If so, the sentence, in total, makes no logical since.

The article gives us three options on the affect of Medicare A reductions upon emergency physicians:

• Direct Effect
• Trickle-Down Effect
• Indirect Effect

Two final points of nonsense are:

1. The linkage of Medicare Part A reductions with community physicians and their willingness to see patients. Sorry, but the physicians in the community, regardless of their willingness, are not affected by Medicare Part A—that’s Medicare Part B.
2. What exactly is the linkage between a third-party payer’s rates based upon Medicare Part A and the rates based upon Medicare Part B—separate and distinct programs and funding mechanisms. There is no way to link hospital reimbursement under Part A with physician reimbursement under Part B.

Is there an affect of Medicare Part A reductions on the setting in which emergency physicians practice? Absolutely, and it is inseparately linked to the fiscal well-being of the hospital—and that’s the real lean and mean about Medicare Part A reductions.

Pincher Maneuver

And now, four-star hospitals | LAT | 3.6.06

There is a couch that pulls out into a bed for family members, a carpeted floor, a flat-screen television set and a roomy bathroom stocked with plenty of plush towels and a cozy waffle-quilt bathrobe. “The rooms are bigger, the food is like eating in a fancy restaurant….There’s no comparison,” says Jack Light, 70, of Westlake Village, who had a partial knee replacement there in late 2005.

“The service at the hotel…”

Whoops. He meant to say hospital.

…

Hospitals like this might be the wave of the future, providing patients with care that is highly specialized, excellent, comfortable, efficient, courteous and largely infection-free. They might also be part of an economic tsunami that flattens the revenue general hospitals need to keep their emergency rooms, trauma centers, intensive care units and medical wards open—services that no one covets, but anyone could need, at any unexpected, vulnerable moment.

…

Such a threat prompted Congress, in 2003, to impose an 18-month moratorium on building more for-profit specialty hospitals. (Right now there are about 100 nationwide, including at least eight in California and one—Thousand Oaks—in Southern California.) Congress also worried that physicians referring patients to hospitals they owned could represent a conflict of interest that might affect medical care.

…

They concentrate on bypass surgery, angioplasty, knee and hip replacements, stomach stapling, prostate removal and sports medicine—all of which turn a tidy profit.

None of them serve traditional money-losers for hospitals such as patients who require not procedures but extended medical care—for AIDS, cancer, diabetes or pneumonia. They don’t serve victims of violence, auto accidents, skiing mishaps and fires, none of whom are money-makers. No one is scrambling to open for-profit trauma centers or for-profit AIDS hospitals.

Instead, critics charge, these doctor entrepreneurs are skimming the cream, building palace-like facilities and referring their most healthy and profitable patients to their own hospitals. Sicker, more costly patients continue to go to community hospitals, skewing the mix of patients and putting already financially strapped local hospitals in an even deeper bind.

The California Hospital Assn., which represents the state’s 430 general hospitals, thinks destabilization is well underway. “We think [specialty hospitals] create an unfair playing field,” says association spokeswoman Jan Emerson.

Hospitals: Is the Price Right? | CBS 60 Minutes | 3.5.06

(CBS) Most Americans know that if you get sick enough to go to a hospital, it’s going to be expensive. But you may be surprised to learn that hospitals all over the country charge their highest prices, by far, to those who can afford it least—the 46 million Americans who don’t have health insurance.

Hospitals charge uninsured patients two, three, four or more times what an insurance company would pay for the same treatment. And, when the uninsured can’t pay, they often find themselves the target of collection agencies or in bankruptcy court.

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The bottom line: Forbes found that, while St. Joseph’s was billing Ferlini almost a quarter of a million dollars, it would accept just under $50,000 as full payment from an insurance company for the same treatment.

The hospital charged Ferlini more than $5,800 a day for intensive care, nearly 2½ times more than what an insurance company would pay.

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60 Minutes got a different perspective from Sen. Charles Grassley, R-Iowa. The Senate Finance Committee, which he heads, is investigating hospital charges and collection practices.

Asked how widespread the problem is with the uninsured, Sen. Grassley says, “From media reports, from advocate groups, from individuals and from my own investigation, I think it’s very, very widespread. It’s an institutional bias against uninsured people. And it’s something to be outraged about.”

…

“What I’m told by the hospital association is ‘Please understand, we’re making changes. We have quote—new policies—that are dealing with this.’ Am I to believe that?” Rather asked Grassley.

“I’ve been told that they were going to do that. They’ve told me that. I haven’t seen the changes I ought to see. But if I don’t see it very, very soon, we’ll probably be doing some legislating in that area,” the senator replied.

Grassley Senate Finance Committee, on two fronts, forming a pincher maneuver on general acute hospitals. Fronts:

1. Specialty hospitals and the cream skimming of general acute hospitals.
2. General acute hospitals shifting the financial burden to the uninsured.

A question begging to be asked, are the uninsured, that fall into the health safety-net indirectly funding the well-insured that can, at all cost, avoid the health safety-net?

Open Source & Integration

Open Source Software: A Primer for Health Care Leaders (PDF)| CHCF | March 2006

As information technology in the health care industry evolves from an administrative tool for billing and bookkeeping to a clinical tool for improving the quality and efficiency of health care, the scope of information sharing is expanding beyond the walls of individual institutions. Achieving this level of integration will require that software models overcome a host of technical obstacles, and that they are accessible, affordable, and widely supported.

This report examines the development and distribution of open source software, a well–established software development model—and a potential solution to the looming challenges of integration—characterized by collaboration among individuals and organizations with common interests, sharing intellectual property, and a commitment to standards.

It explores open source basics, including the advantages open source presents, and how it works. The report also offers industry perspectives, explores the potential impact on EMR systems and regional health information networks, and compares open source to traditional, proprietary software.

While not heralding the end of commercial software vendors, the report concludes that conditions are ripe for open source solutions to take root in health care, and that it will likely become the standard for capturing, sharing, and managing patient information to support quality care. It also notes that health care businesses have the opportunity to take the lead and drive the shift to this new model.

Open source software? When you consider the myriad of commercial software solutions, especially legacy software, that are used in healthcare + the myriad of commercial (esp., legacy) hardware solutions deployed across the spectrum of healthcare institutions—open source (software and hardware) may be the only way to integrate and create a universally accessible and useable digital milieu.

28%

Good rant at Aggravated DocSurg via GruntDoc.

The AMA does not speak for me. In fact, it does not speak for the majority of physicians in this country, with only about 28% of actively practicing US doctors counted in their membership rolls. It is an organization that has repeatedly shown that it is far out of touch with the average physician and patient.

100% correct!

Merit Badges

Excellent discussion on the “to be detestable” subject of merit badge CMEs over on GruntDoc, see “Merit Badge Certifications and CME“