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Health Management Technology News
  July 3, 2014
In this issue:
 Supreme Court ventures into healthcare 'minefield'

 Brace for jarring healthcare costs

 How patient portals are changing healthcare

 Michigan awards $90M deal to builder of problem-plagued

 Healthcare data analytics gone wrong

 5 recent employee whistle-blower cases

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Supreme Court ventures into healthcare 'minefield'

Ruth Bader Ginsburg is by far the most diminutive Supreme Court Justice in the Roberts Court, but her dissent on Monday in Burwell, HHS v. Hobby Lobby was described by many as “blistering.”

The full text is available online (PDF here) and her dissent begins on page 60.

Whether you agree with the dissent or not ? it was definitely full throated and included this battlefield warning:

The court, I fear, has ventured into a minefield. Supreme Court Justice Ruth Bader Ginsburg [Page 93?94]

Like all of healthcare and much of legal precedent, that minefield is multifaceted ? and starts with the mechanics of covering contraception as a healthcare benefit (both generally under Obamacare and then with new cloudiness under Hobby Lobby’s surgically isolated exemption). Even Austin Frakt over at The Incidental Economist acknowledged the confusion earlier today:

How this will actually work out depends on how exactly the costs of contraception are calculated. Are they net the cost of avoided pregnancies or not? Is this in the regs? Where? And what is that net cost anyway? Austin Frakt ? The Incidental Economist ?On an administrative fix to the Hobby Lobby Decision (July 1, 2014)

A lengthy (if slightly dated) analysis by (cited by Austin) arrived at this summary regarding the coverage ambiguity.

Read the full article from Forbes here  

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Brace for jarring healthcare costs

Many consumers who buy their health insurance on the new government exchanges or who get it through their employer could be in for a shock.

An increasing number of these are high-deductible plans, where the first one to several thousand dollars of medical spending comes out of a consumer’s pocket — before the insurance kicks in.

That will seem like a spike in medical inflation, even though the cost of care is expected to rise by much less than it has in past years.

“So far, there are no signs that prices are increasing noticeably,” said Larry Levitt, a senior vice president with the Kaiser Family Foundation. “If anything, prices are increasing less than utilization. All the action now is in increased health care use. That’s what’s driving any increase in cost.”

Consumers are getting more care from doctors and hospitals. Prices for specialty drugs are climbing. Hospitals are buying up physician teams and outpatient clinics and then raising prices at those offices.

Read the full article from The Dallas Morning News here  

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How patient portals are changing healthcare

A few years ago, when Bill Baillie’s doctor, James Legan, walked into the exam room with his laptop instead of “the big thick file” that Legan normally carried, it signaled a new era in Legan’s medical practice.

Legan, a family practice physician in Great Falls, Montana, had just introduced patient portals – which, like electronic health records, are taking medicine into the virtual world.

“About a week before my annual physical, when I had my blood work done, 24 to 48 hours later I would have my blood work [results] available to me on the portal. If there was anything out of whack, I could have some intelligent questions prepared,” Baillie, 61, of Great Falls, Montana, says of his experience using the portal. “If you need a prescription renewed or have a question for Jim, you hop on the portal, and his nurse usually has an answer back to you within an hour. It’s increased their response time greatly.”

Legan says that 744 of his patients, or three-quarters of his practice, are using the portals. “It really has transformed face-to-face visits,” Legan says, explaining that portals allow patients and doctors to be on the same page when it comes to patients’ medical information. Having information archived electronically also allows both patients and doctors to review old information that could be clinically relevant. That type of access, Baillie says, allows you to ask questions like, “'What were you eating two years ago when your blood sugar was so low?’”

“Before [patients] even get home” from the doctor, Legan adds, “They have a summary of what we’ve talked about. It shows up on their secure patient portal.”

Read the full article from U.S. News and World Report here  

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Michigan awards $90M deal to builder of problem-plagued

The State of Michigan has awarded computer contracts worth nearly $90 million to the Canadian firm that built the federal government’s Affordable Care Act website and took much of the blame for its disastrous launch.

Officials in the administration of Gov. Rick Snyder chose CGI Technologies and Solutions, whose parent company is headquartered in Montreal, over three U.S.-based firms.

CGI did not submit the lowest bid. Accenture, a management consulting and technology firm headquartered in New York, offered the lowest price by nearly $5 million, but “CGI provided best value,” Kurt Weiss, a spokesman for the Michigan Department of Technology, Management and Budget, said Friday.

State officials were “aware that there may be potential arguments that CGI is not a qualified vendor based on their recent involvement with health care at the federal level” and the website, Weiss said.

“But the feeling of all involved was that those allegations are simply false,” Weiss said. “CGI is a leader in the field, and they are recognized for excellence in … implementation, particularly in a government setting.”

Read the full article from The Detroit Free Press

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Healthcare data analytics gone wrong

Ever since the Centers for Medicare and Medicaid Services (CMS) decided to penalize hospitals financially for avoidable readmission of patients within 30 days of their discharge, health systems have been coming up with inventive ways to keep patients out of the hospital while also trying to bring in more revenue.

Most of these approaches make sense. They've created population health management programs that analyze patient data to spot those at high risk for readmission, for instance, and then offer preventive measures to those patients. They've created care-coordination systems to make sure discharged patients arrive safely at their next destination, whether it be their home, a rehabilitation unit, or a nursing facility. Most hospitals have also redoubled their efforts to educate patients at discharge so that they understand how to take their medications and see the value of making follow-up appointments with their primary care physicians.

But some healthcare providers are going too far in their attempt to maintain a healthy revenue stream while trying to absorb the CMS penalties or reduce the risk of incurring them. A recent New York Times article points out that some providers are using the services of data analytics vendor MedSeek, which "offers services intended to help hospitals 'virtually influence' the behavior of current and would-be patients." The vendor helps healthcare providers refine their marketing by analyzing metrics such as age, sex, race, income, culture, religious beliefs, and family status. The goal: Help providers "scientifically identify well-insured prospects."

Read the full article from Information Week

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5 recent employee whistle-blower cases

The following is a roundup of recent case settlements and updates of lawsuits filed under the qui tam, or whistle-blower, provision of the False Claims Act.

1. $89M Judgment Entered Against Florida Oncologist in False Claims Act Case
An $89 million judgment was entered against Wasfi Makar, MD, for violations of the False Claims Act.

2. Court Dismisses $50M False Claims Act Case Against Huron Consulting Group
The U.S. Appeals Court for the Second Circuit affirmed the dismissal of a False Claims Act lawsuit against Chicago-based Huron Consulting Group.

3. Shands HealthCare to Pay Additional $3.25M in Whistle-Blower Case Settlement
Gainesville, Fla.-based Shands HealthCare agreed to pay an additional $3.25 million to settle allegations six of its facilities violated the False Claims Act by submitting fraudulent claims to Medicare, TRICARE and Medicaid.

Read the full article from Becker’s Hospital Review here  

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Industry News

HHS announces auto-enrollment plans for current Marketplace consumers for 2015

CMS fraud prevention system identified or prevented $210 million in improper payments

Secretary Burwell announces steps to bolster management and accountability

AMA outlines ways to address physician shortages

AMA adopts telemedicine policy to improve access to care for patients


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