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Health Management Technology News
  August 19, 2014
In this issue:
 
  Community Health Systems says personal data stolen in cyber attack

  Pervasive Medicare fraud proves hard to stop

  Consumers driving healthcare innovation

  Partners HealthCare executives see double-digit pay raises

  Texans can’t check healthcare increases

  Hospital strategy: The growing risk of being known
for nothing


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Community Health Systems says personal data stolen in cyber attack

U.S. hospital operator Community Health Systems Inc. said personal data, including patient names and addresses, of about 4.5 million people were stolen by hackers from its computer network, likely in April and June.

The company said the data, considered protected under the Health Insurance Portability and Accountability Act, included patient names, addresses, birth dates, telephone numbers and Social Security numbers. It did not include patient credit card or medical information, Community Health Systems said in a regulatory filing.

It said the security breach had affected about 4.5 million people who were referred for or received services from doctors affiliated with the hospital group in the last five years.

The FBI warned healthcare providers in April that their cyber security systems were lax compared to other sectors, making them vulnerable to hackers looking for details that could be used to access bank accounts or obtain prescriptions, Reuters previously reported.

The company said it and its security contractor, FireEye Inc unit Mandiant, believed the attackers originated from China. They did not provide further information about why they believed this was the case. They said they used malware and other technology to copy and transfer this data and information from its system.

Read the full article from Reuters here

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Pervasive Medicare fraud proves hard to stop

The ordinary looking office building in a suburb of Baltimore gives no hint of the high-tech detective work going on inside. A $100 million system churns through complicated medical claims, searching for suspicious patterns and posting the findings on a giant screen.

Hundreds of miles away in a strip mall north of Miami, more than 60 people – prosecutors, F.B.I. agents, health care investigators, paralegals and even a forensic nurse – sort through documents and telephone logs looking for evidence of fraudulent Medicare billing. A warehouse in the back holds fruits of their efforts: wheelchairs, boxes of knee braces and other medical devices that investigators say amount to props for false claims.

An array of outside contractors used by the government is poorly managed, rife with conflicts of interest and vulnerable to political winds, according to interviews with current and former government officials, contractors and experts inside and outside of the administration. Authority and responsibilities among the contractors are often unclear and in competition with one another. Private companies – like insurers and technology companies – have responsibility for enforcement, often with little government oversight.

Read the full article from The New York Times here

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Consumers driving healthcare innovation

Everyone in the U.S complains about healthcare – the rising costs of insurance premiums and co-pays, the lack of innovation, the poor experience at doctor’s offices and hospitals, and price of medications.

The landscape of big healthcare is eroding faster than the biggest players can adapt.

Thanks to malpractice, the Internet, the rise of specialists and decline of general practitioners, integration with complementary and alternative medicine, and other factors – consumers feel as if they must drive their own healthcare.

Gone are the days when actions are blindly followed, as in, “The doctor told me to take this _____ and do _____.” Instead, Internet research leads to second-guessing and attempts at self-diagnoses. Both scenarios lead to information anxiety. Too little and too much unfiltered information causes this quiet despair. The emerging paradigm finds consumers lost, bewildered, looking for sources and solutions that help make healthcare make sense for them – and willing to switch to what works for them.

This tension creates a gap of opportunity for disruptive entrants into the market. With $2.8 trillion at play, everyone will race to get their piece of the pie, from well-established companies outside of healthcare, to service providers offering new models of care, to start-ups. Hopefully, healthcare companies will recognize the need to transform their business model and their product and service mix, or risk dying on the vine.

Read the full article from The Memphis Daily News here

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Partners HealthCare executives see double-digit
pay raises

Top executives from Partners HealthCare received pay raises of nearly 20 percent from fiscal year 2012 to fiscal year 2013.

The numbers come from tax documents released by each institution. Though comparisons among all hospitals are difficult, there were no hospital systems in Greater Boston where executives earned more.

Among Partners' top earners, CEO Dr. Gary Gottlieb earned a 17 percent compensation bump, putting him at $2.61 million total compensation, which includes a base salary of $1.36 million and a number of other benefits and non-taxable expenses.

Brigham and Women’s Hospital CEO Dr. Elizabeth Nabel saw an 18 percent jump in total compensation, putting her at $2.38 million in the 2013 fiscal year. Dr. Peter Slavin, the president for Massachusetts General Hospital, also saw a 19 percent increase to $2.17 million in total compensation.

Eric Beyer, who served as CEO of Tufts Medical Center through September 2013, saw a similarly sized compensation increase. While he received $744,722 between the Tufts Medical Center and related organizations in fiscal year 2012, he earned $910,787 from Tufts the following year, an 18 percent increase.

Read the full article from Boston Business Journal here

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Texans can’t check healthcare increases

Several states have saved consumers millions in health insurance premiums by keeping a firm hand on rate hikes and spotlighting carriers’ proposed prices.

Those hoping for similar results in Texas, however, may be out of luck.

Texans have no opportunity to compare which health insurance companies propose the biggest increases each year before new prices take effect. Nor do customers have access to all the explanations given to state regulators to justify such changes.

“There is no standard in Texas for releasing this information to consumers and to advocates who want to make sure consumers are getting the best deal on their health insurance policies,” said Blake Hutson, a senior associate for healthcare reform at Consumers Union’s Southwest office in Austin. “We’re the worst of the worst when it comes to protecting consumers from unjustified rate increases in health insurance.”

The Affordable Care Act set out to bring more scrutiny and transparency to rate reviews nationwide, requiring that experts review premiums going up 10 percent or more for individual and small group health plans. Since that mandate took effect in 2011, the pace of surging premiums has slowed, according to the Health and Human Services Department.

Regulatory powers and public disclosure still vary widely from state to state, however. For instance, the Texas Insurance Department does not put proposed increases for health plans on its website, though some other states do.

Nor do the Centers for Medicare and Medicaid Services, which leave it up to states whether to disclose such information in a public forum, a federal official said on background.

Read the full article from Star-Telegram here

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Hospital strategy: The growing risk of being known
for nothing

In a recent blog post, Christopher Kerns, Managing Director at the Advisory Board, detailed his guarded skepticism about today's population health efforts. It's an interesting piece on the limited success, so far, of accountable care organizations and the potentially significant influence of private exchanges.

Intentionally or not, while pondering private exchanges, Mr. Kerns instigated an interesting conversation about branding. The narrative goes something like this:

In private exchanges, health benefit consultants work with insurance companies to fashion provider networks for employers. Employers give their employees a fixed sum of money to purchase the coverage they deem best for them among these networks. This could have a disruptive impact on the healthcare landscape. In these personal moments, employees weigh various narrow and broad provider networks, plan benefits and premium prices to make their coverage decision, and healthcare becomes more consumer-driven than it ever has been before.

So, as healthcare becomes more consumer-driven, Mr. Kerns asserts, "Individual patients, who could potentially select tailored, ultra-narrow provider networks through private exchanges, usually care most about convenience and access relative to themselves."

Read the full article from Becker’s Hospital Review here

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August 2014  HMT digital book
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Industry News

CMS: Open Payments system reopens

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Secretary Burwell announces Region II Director of HHS

Deadline for ICD-10 allows health care industry ample time to prepare for change


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