HMT: Medicare payments, data breach, tech addiction stress, and more
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Health Management Technology News
December 13, 2013

In this issue:

Developing A Viable Alternative To Medicare’s Physician Payment Strategy

Nearly 365,000 Americans selected plans in the Health Insurance Marketplace in October and November

Kaiser Permanente reports privacy breach to 49,000 patients

When someone's tech addiction causes you stress


Developing A Viable Alternative To Medicare’s Physician Payment Strategy

Since 1992 Medicare has reimbursed physicians on a fee-for-service basis that weights physician services according to the effort and expense of providing those services and converts the weights to dollars using a conversion factor. In 1997 Congress replaced an existing spending constraint with the Sustainable Growth Rate (SGR) to reduce reimbursements if overall physician spending exceeded the growth in the economy. Congress, however, has routinely overridden the SGR because of concerns that reduced payments to physicians would limit patients’ access to care. Under continued pressure to override scheduled fee reductions or eliminate the SGR altogether, Congress is now considering legislation that would reimburse physicians to improve quality and lower costs—two things that the current system does not do. This article reviews several promising models, including patient-centered medical homes, accountable care organizations, and various payment bundling pilots, that could offer lessons for a larger reform of physician payment. Pilot projects that focus exclusively on alternative ways to reimburse physicians apart from payments to hospitals, such as payments for episodes of care, are also needed. Most promising, Congress is now showing bipartisan, bicameral interest in revising how Medicare reimburses physicians.

Read more details

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Nearly 365,000 Americans selected plans in the Health Insurance Marketplace in October and November

1.9 million customers made it through the process but have not yet selected a plan; an additional 803,077 assessed or determined eligible for Medicaid or CHIP

Health and Human Services (HHS) Secretary Kathleen Sebelius announced today that nearly 365,000 individuals have selected plans from the state and federal Marketplaces by the end of November. November alone added more than a quarter million enrollees in state and federal Marketplaces. Enrollment in the federal Marketplace in November was more than four times greater than October’s reported federal enrollment number.

Since October 1, 1.9 million have made it through another critical step, the eligibility process, by applying and receiving an eligibility determination, but have not yet selected a plan. An additional 803,077 were determined or assessed eligible for Medicaid or the Children’s Health Insurance Program (CHIP) in October and November by the Health Insurance Marketplace.

“Evidence of the technical improvements to HealthCare.gov can be seen in the enrollment numbers. More and more Americans are finding that quality, affordable coverage is within reach and that they'll no longer need to worry about barriers they may have faced in the past – like being denied coverage because of a pre-existing condition,” Secretary Kathleen Sebelius said. “Now is the time to visit HealthCare.gov, to ensure you and your family have signed up in a private plan of your choice by December 23 for coverage starting January 1. It's important to remember that this open enrollment period is six months long and continues to March 31, 2014.”

Read the entire story

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Kaiser Permanente reports privacy breach to 49,000 patients

Healthcare giant Kaiser Permanente has notified about 49,000 patients of a privacy breach at its Anaheim Medical Center.

Kaiser said a computer flash drive was reported missing Sept. 25 inside the hospital's nuclear medicine department. The storage drive included patient names, date of birth, their medical record number and the type and amount of a specific medication.

The files didn't contain Social Security numbers or financial information, the company said.

"Kaiser Permanente takes the protection of our members' personal and health information seriously, and we apologize for this occurrence," said Kaiser spokeswoman Peggy Hinz.

The Oakland healthcare system said the missing data weren't encrypted or password-protected. The company advised patients to monitor their medical records "to ensure no fraudulent use of their medical information has taken place."

Ginger Buck, a retiree in San Bernardino County, said Kaiser notified her last week that she was among the 49,000 patients affected by the incident. She's been a Kaiser patient since 1997.

"I'm really angry and devastated," Buck said. "I'm concerned with what may happen with my information down the road."

Kaiser is one of the nation's biggest HMOs with 9.1 million members, and it also operates 38 hospitals across the country. It reported $50.6 billion in revenue last year.

Many health insurers, hospitals and other medical providers continue to struggle with safeguarding sensitive patient information.

Read the entire Los Angeles Times article

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When someone's tech addiction causes you stress

We all have our stressful holiday stories.

My most recent one doesn't involve guilt trips, family squabbles or eccentric relatives. It's about getting stuck at the far end of a restaurant dinner table with an extended family member who spent the entire meal on her smartphone.

For the better part of two hours, I tried to find someplace to look other than the woman's forehead while she texted, tweeted, took a mind-boggling number of selfies and stepped out for a call "that was really urgent."

I later found out (from one of her tweets) that she had also been playing dominoes with her online friends throughout the meal. And before you judge "young people" for these indiscretions, the woman was well into her 30s.

I didn't know this woman well enough to ask her to put away her device nor did I want to cause a scene, so at first I tried to engage her in conversation. Halfway through appetizers, I admitted defeat and did my best to pick up stray bits of chatter from farther down the table. I went home that night with the mother of all tension headaches.

Read the entire CNN story

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December 2013 HMT digital book


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