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Health Management Technology News
  April 16, 2014
In this issue:

 Hospitals sue CMS over ‘Two-Midnight’ Rule, pay cut accompanying regulation

 Many states avoiding paying for glitchy health care sites

 Inovalon provides reason for optimism for the future of healthcare

 Health Management Technology’s Resource Guide sign-up

 BlackBerry buys minority stake in healthcare IT firm

 Maine report urges steps to prevent shortage of health-care professionals

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Hospitals sue CMS over ‘Two-Midnight’ Rule, pay cut accompanying regulation

In two related lawsuits filed April 14, the hospital industry challenged the Department of Health and Human Services' “two-midnight” rule for inpatient admissions, which industry says imposes regulatory burdens that could compromise care for seniors.   In one complaint filed in the U.S. District Court for the District of Columbia, the American Hospital Association and other industry groups and individual hospitals challenged an August 2013 HHS policy for determining when a patient is an “inpatient” for purposes of Medicare reimbursement.

The AHA's filing said that this “new rule provides that a Medicare beneficiary is not an 'inpatient' unless the admitting physician expects that beneficiary to need care in the hospital for a period spanning two midnights.” The August 2013 rule was for fiscal year 2014 payments.

In a statement from the AHA, the plaintiffs said hospitals “take issue with the wholly arbitrary requirement that a physician must certify at the time of admission that a Medicare patient is expected to need care in the hospital for a period spanning two midnights to be considered an inpatient.” In the statement, Rich Umbdenstock, president and chief executive officer of the AHA, said that the two-midnight rule “undermines medical judgment and disregards the level of care needed to safely treat patients.” He added, “Hospitals stand by a physician's decision on what care is appropriate for each patient. The two-midnight rule is misguided and we feel confident the court will agree.”

Read the full Bloomberg BNA article here  

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Many states avoiding paying for glitchy health care sites

Glitches in the Obamacare rollout last year weren’t limited to the federal government. A number of states whose health care exchanges were riddled with errors now are withholding or trying to claw back more than $100 million from the contractors they blame for the foul-ups.

Oregon, whose exchange was so bad that officials parted with two directors and had to process almost all enrollments manually, was withholding $26 million from Oracle Corp. Vermont officials claimed $5 million in damages from CGI Group Inc., which handled the state’s exchange and also was blamed for the flawed federal site.

CGI has waived its rights to the $5 million in a revamped deal with Vermont that also ties upcoming payments to performance deadlines.

“This was a lawyered-up process,” said Lawrence Miller, Vermont’s chief of health care reform, describing the frustrations that led up to the latest deal. “The parties were in their respective corners.”

Health care exchanges are virtual markets where Americans can purchase private health care plans under the Affordable Care Act, often with the help of government subsidies. The federal exchange serves three dozen states, while 14 states and the District of Columbia are running their own.

Contractual wrangling in some of the states is playing out as the White House shakes up its health care team, celebrates 7.5 million enrollments in the first round and settles in for a seven-month lull between Obamacare’s enrollment periods.

Read the full article from the Washington Times here  

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Inovalon provides reason for optimism for the future of healthcare

Most of the news surrounding the state of healthcare is depressing. Obamacare is a political quagmire. The cost of care is rising while service is declining or so the conventional wisdom goes.  But Inovalon and its energetic founding CEO, Dr. Dunleavy offer reason for optimism.

Inovalon is a technology company that provides advanced methodologies of big data analytics on the information that informs and improves healthcare. But the real mission of this innovative company is to change healthcare by changing the role data plays in care quality, effectiveness, and efficiency.  And to hear Dr. Dunleavy tell it, they might be well on their way to accomplishing that mission. “Everything we do here is about how to take in the various often disparate data sources that construct the healthcare landscape – such as claims, laboratory, pharmacy, medical benefits, demographic information, provider information, and facility information – and apply advanced analytics onto that data to identify the difference between current state and desired state.  That gap between current state and desired state across a number of different constituencies is what our life is all about, because then we can apply additional analytics that tell us how to close that gap,” says Dr. Dunleavy.

By applying these analytics and then leveraging interconnectivity capabilities, Inovalon enables healthcare providers to change healthcare outcomes on a massive scale across the country. “Our whole theme at Inovalon is bringing big data analytics to the point of care. It’s a fantastic thing to see, and it’s happening at scale today,” says Dr. Dunleavy.

The Bowie, Maryland-based Inovalon is a fast-growing, 2,500 person company whose analytics touch approximately 140 million insured Americans, 540,000 physicians, and about 220,000 clinical facilities around the country.  Approximately one-half of the entire insured US healthcare system is touched in one way or form by the analytics of Inovalon.  And those analytics are pointed at clinical and quality outcomes, disease and comorbidity accuracy, utilization, and compliance.

Read the full article from Forbes here  

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BlackBerry buys minority stake in healthcare IT firm

BlackBerry Ltd said on Tuesday it bought a minority stake in privately held healthcare IT firm NantHealth, a move that offers a glimpse into the type of niche markets the smartphone maker is targeting as it attempts to engineer a turnaround.

Waterloo, Ontario-based BlackBerry, a pioneer in the smartphone industry, has fallen on hard times as its market share has waned in recent years. As the company attempts to stem losses and remain relevant it is now focused on expanding its services segment that caters to the needs of large clients like banks, law firms and government agencies, among others.

BlackBerry's Chief Executive John Chen, who took the reins at the company less than six months ago, sees healthcare as one of the sectors in which the company has an advantage, due to a heightened focus on patient privacy and BlackBerry's vast array of networks that can manage and secure data on mobile devices.

"BlackBerry's capabilities align closely with NantHealth's," said Chen in a statement on Tuesday. "This investment represents the type of forward-looking opportunities that are vital to our future."

The financial terms of the deal itself were not disclosed, but NantHealth said it does not seek any further funding from BlackBerry beyond its current investment.

Read the full Reuters article here  

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Maine report urges steps to prevent shortage of health-care professionals

Maine is likely to suffer a shortage of medical professionals in the coming years unless the industry boosts student enrollment at health-care-related schools in the state and recruits more workers from outside Maine, according to a report issued this week.

The work force development problem will be especially dire in the fields of dentistry and psychology, in which two-thirds of all current practitioners in the state are over 50 years old, said the report, by the Maine Department of Labor’s Center for Workforce Research and Information.

Occupations for which nearly half of the existing practitioners are over 50 include pharmacists, nurse practitioners and licensed practical nurses, it said.

Overall, the need to replace currently practicing health-care professionals is expected to outstrip the need to expand Maine’s medical work force because of population growth, the report said.

As a result, the future job market in Maine will be favorable to those seeking employment in a variety of health-care specialties, it said, but hospitals and medical clinics are expected to face difficulties maintaining a full staff.

“Barring an economic downturn and an associated decline in job opportunities, closing the gap will require strategies for increasing program capacity, retaining existing workers for longer, increasing in-migration, or other means for enhancing supply,” the report said.

In response to the strong demand for workers, the number of Maine graduates in various health-care fields has increased by 33 percent from 2007 to 2011, although recipients of bachelor’s and graduate degrees increased by only 12 percent, according to the report.

Read the full article from the Portland Press Herald here  

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