Sunday, April 5, 2015

The Opportunity for Consumerism in the American Healthcare Delivery System

My social media compatriot and editor-in-chief of Health IT Outcomes Ken Congdon recently wrote an article titled “The Problem With Consumerism In Healthcare.”

This was a good opinion piece that, in my opinion, really addressed more than one issue. In terms of Ken's take on healthcare consumerism, I think he's conflating the labeling of a movement for a more informed, involved healthcare patient consumer with the insanely over-regulated pharmaceutical industry and profit motive endemic in America and its healthcare delivery system. Consumerisn in healthcare is about putting more and better information into the hands and minds of an increasingly health literate American populace. I won’t address the longer, more detailed part of the article comparing how past and current pharmaceutical market realities bode ill for healthcare consumerism as I think these are largely two separate albeit related issues.

Here’s my take on healthcare consumerism

For too long people have just gone along with what the medical profession, health plans and supporting industries (device makers, pharmaceutical firms, imaging centers, labs, etc) have given them. They accepted what they got, may have grumbled a lot but went on with their lives. But with the ever increasing costs for healthcare services and the increasing shift of costs to individuals, people need to adopt a consumer mindset. Information empowers and emboldens. Look what the Internet has done for automobile, airline, hotel and entertainment consumers. Of course, people showing up at the ER with appendicitis, pancreatitis, or gall stones – and victims of traumatic injuries – are not going to be shopping around and will largely take what they can get. (i.e. be at the mercy of their local healthcare delivery system) but that's no reason to continue as we've been going with our healthcare purchases.

Too many people for too long a time have made little, if any, effort to participate in their healthcare decisions, opportunities and care. Providers and payers offered little helpful information; indeed they seemed to make what little information they did provide unduly complex and hard for the common person to understand. Hell, I’ve been in claims administration for 20+ years and sometimes still struggle to understand what certain providers and payers are giving to me. 

Information Empowers and Emboldens – Effects Change

I appreciate that the “non-shopper” category can account for a majority of healthcare expenses in the U.S. But why shouldn’t those using non-emergent, non-critical services be consumers? We need to start somewhere. I don’t think we need to sway the non-shoppers as much as we have to sway the system. I suspect once healthcare consumerism become more widespread and supported by tools that innovative companies like HealthSparq, PokitDok, and Castlight Health provide, that a more empowered and embolden consumer will begin to demand change from the acute, emergent and critical care service sectors. So Ken and I agree that empowerment is a key aspect we need to advance.


One last point, and I suspect this won’t endear me to my social media friend Ken Congdon and others is that I would argue that individuals, collectively and individually, need to do what’s best for themselves the patient. But true change must start with the individual. Not from someone else. Not from the Government. Not from the elites that know what's best for you. Programs exist and can be implemented to help those that truly, honestly can't help themselves. But I argue that an organic, grass roots approach to changing the American healthcare delivery system will be more easily accepted and longer lasting than one imposed by government mandate and more regulations. As peoples health literacy increases and individuals have access to better and more complete information, the opportunities for change – whether voluntary, forced by a collective group of activist individuals or imposed by voters via regulation – will effect the positive change we all know is needed in the U.S. healthcare delivery system. Empowerment indeed.

Thursday, March 26, 2015

What if Diner’s Paid Their Restaurant Bill with Their Health Insurance?

Menu: Credit-Rachel Feierman/WHYY
I’ve been seeing the above menu floating around the social media sphere with the title “What if Restaurants Billed Like Hospitals and Providers?” I think this menu really captures and conveys one of the major issues with healthcare billing – particularly for hospital inpatient facilities that use the so-called “Charge Master:” it’s so complex that the average healthcare consumer can't understand it.
I had shared this menu with some work mates and one of the fellows, a systems architect, suggested there was a corollary of the diner paying with his medical insurance.

This is how the check would be paid

When the server presents the check to the customer, the customer immediately tosses the bill in the trash. He pulls out his Diner Resource Guidelines (DRG’s) and begins calculating the amount he’s willing to pay. Since he’s a male over 20 years of age he selects the base rate for “Lunch, Eat-in Restaurant > 20 Yr old W/ Beverage” for the geographical region in which the restaurant is located.

Since the restaurant is part of a national chain, he applies a national adjustment equalizer factor to account for the restaurant chain’s above average, outlier overhead costs. (The chain is part of the American Restaurant Association and had lobbied hard to obtain this special status.) Since the diner enjoyed a mug of Bud Light with his lunch, the restaurant was supposed to obtain a pre-authorization for the alcoholic drink but they didn't. So the diner omits the cost of the Bud Light from his calculation.

Finally, the diner applies a Reverse Gratuity deducting 15% from the total charges – pre-tax – to cover administration fees associated with time spent waiting to be seated and also for having to calculate the payment due amount. He writes the total amount down on an napkin and hands it to his wife, who will audit the charges and pay the restaurant within 30 days.

Not Far from The Way it Works

Funny? Yeah. I think so. But not really because this is how healthcare payments work.

Monday, March 23, 2015

@ShimCode Interviews @HITConfGuy About the 2015 HIMSS Conference in Chicago

Who's this @HITConfGuy who covers Health IT Conferences without a commercial angle?

I ran into @HITConfGuy waiting in line at the local IHOP restaurant the other day and asked him if he was willing to do an impromptu interview over breakfast. After a little hemming and hawing he agreed. Here’s the largely unedited interview straight from my recorder. I’ve omitted the interaction with the server and the people sitting nearby. This @HITConfGuy is quite the talker.

The Interview

ShimCode-Q: Thanks for agreeing to this interview. Before we get going, weren’t you the guy who did the last few HIMSS Conferences as @HIMSS12, @HIMSS13 and @HIMSS14?

   HITConfGuy-A: Uh…yes I was.

ShimCode-Q: Well how come you aren’t doing this year’s 2015 HIMSS Conference in Chicago as @HIMSS15?

   HITConfGuy-A: My brother-in-law the lawyer told me not to talk about that.

ShimCode-Q: Was it because you couldn’t get the @HIMSS15 Twitter account?

   HITConfGuy-A: Uh…My brother-in-law the lawyer told me not to talk about that. Can you pass the syrup?

ShimCode-Q: Did someone at HIMSS contact you about your use of the @HIMSS15 Twitter account and threaten to sue you for everything you have?

   HITConfGuy-A: Haha…no. No one from HIMSS gave me any grief about using the account. And my brother-in-law the lawyer told me not to talk about that. Plus I don't have anything because I have four kids all in their 20's and I've spent all my money. And then that pesky 2001 stock market thing and the Great Recession took a toll on me.

ShimCode-Q: But I can see that you’re covering the 2015 HIMSS Conference using a new twitter account called @HITConfGuy. Is that correct?

   HITConfGuy: Yes that’s correct. Can I use your napkin?

ShimCode-Q: Why do you think you’re qualified to curate healthcare information technology topics and information?

   HITConfGuy-A: I’ve been working in healthcare and IT – for insurance companies, risk-bearing providers, providers, software vendors and consulting firms – since 1993. I’ve held various roles from developer to systems analyst, director-level and consulting roles.

   Moreover, I work as a project management consultant and I'm hands-on involved with a lot of different projects; mostly related to implementing government mandated requirements and programs related to implementing certain aspects of the ACA - which is also known as Obamacare to many.

   Most importantly, I'm always reading, researching, discussing, writing about and reading some more about anything I can find that’s related to healthcare IT. I have many friends and associates in the same line of work and we’re always discussing how healthcare IT impacts payers and providers. I’m a very curious person. Are you going to eat that sausage?

ShimCode-Q: No. You can have it. So you think you know a little bit about a wide range of topics huh?

   HITConfGuy-A: I think I know a lot of bit about a wide range of topics. The challenge is that the topics keep changing and a body needs to stay on top of things. This Obamacare stuff has really turned healthcare upside down. But I’m trying hard to keep abreast by constantly reading and researching and talking with people in the business. And my day to day job gives me some special insight into the challenges and opportunities providers and health plans face on a daily basis.

ShimCode-Q: I noticed that you provide a lot of detailed and useful information in your tweets and don’t just jabber on about how great everything is; plugging vendors and taking an overt commercial approach to your shares. You don’t appear to be selling anything. What’s up with that?

   HITConfGuy-A:.You’re correct. I am sort of an oddball in that regard. My family and friends don’t understand I’m doing this on my own time and for my own pleasure. They think someone is paying me to do this. I see so many other social media channels that are really just thinly veiled marketing pieces for a particular vendor, product or service. Some are pretty blatant.

ShimCode-Q: I heard that you offered some sort of information monitoring service to the first 100 people that followed you. Can you tell me about that?

   HITConfGuy-A: Sure. It’s really just an experiment for me to see if I can build a methodology and system to automate the collection of customized information desired by a fairly large group of people in an efficient basis. Sort of like mass customization to a market of one. By offering this service I’ve put myself on the spot to deliver. I’ve already had second thoughts about this but I’ll stick with it and see how it comes out. I think it’ll be pretty worthwhile. I'm taking an entire week of PTO to do this so it's actually quite an investment on my part.

ShimCode-Q: So you’re not getting any re-numeration or doing this for some ulterior motive?

   HITConfGuy-A: What's a re-numeration? Just kidding. Nope. Unless you count me learning about how to build a social media information search and retrieval system an ulterior motive.

ShimCode-Q: Well cool. Can I join in that service?

   HITConfGuy-A: Were you one of my first 100 or so followers?

ShimCode-Q: No.

   HITConfGuy-A: Then no. Sorry. I gotta run. Would you do me a solid and pay for my breakfast? I gotta run. I have a real job during the day.

ShimCode-Q: I will if you tell me how I can learn more about you and the 2015 HIMSS Conference in Chicago.

   HITConfGuy-A: You can check out my blog at and you can follow me on Twitter. To learn more about the HIMSS Conference hit up their website here. Ya know something, I do have a little time and I'm feeling like some dessert.

And that was it. He ordered another stack of IHOP's Blueberry Pancakes and didn't utter another word - a few grunts and groans and other sounds...but not another word.

Tuesday, February 10, 2015

How to Participate in a Tweet Chat - Like #FLBlueChat

A tweet chat like the #FLBlueChat chat starting on February 11th at 12:00EST can be a great resource for obtaining useful information and tips about a specific topic. It’s also a great way to make new acquaintances. In advance of this new chat on the topic of the ICD-10 mandate, I wanted to share some information on participating in tweet chats and getting the most bang for your tweet chat buck.

Prepare for the Chat

1. If available, review the chat questions prior to the event. These are often posted on a blog or other page. Spend a little time ideating your contributions and questions.

2. Use a tool to make it easy on yourself

Some chats move very fast. Most popular Twitter clients can be used to follow and participate in a Twitter chat using the official Hashtag for the chat. A few of the popular tools include:

You can also follow a Hashtag in a Twitter client like Tweetdeck or Hootsuite. Just set up a search for the #FLBlueChat Hashtag and all of the tweets with that Hashtag should show up in the search window. I use Tweetdeck and setup multiple search columns; each using the designated Hashtag and one of the topic tags. For instance “#FLBlueChat T1”

Quick tip: for all of the tools above, consider filtering out retweets to remove the clutter.

3. Prior to the start of the chat, you may want to RT the host’s tweet announcing the chat. This can also inform your followers that your Twitter stream may be overly active for a short period of time - assuming you plan to share a lot.

4. As the old saw goes about God giving us two ears and one mouth, computers support connecting multiple monitors but only one keyboard. Consider using two monitors to be able to read and listen more than you speak or type. :)

“Listen” and Absorb

1. When you first join the chat, scan the tweets being shared. Note the type of information being shared and who’s doing the sharing.

2. Introduce yourself at the beginning of the chat. This is especially important if you’re a first-timer/relatively new or if you’re Tweeting as a brand. “Hey all, Steve here from suburb of Phoenix – healthcare payer IT guy”.

3. If you just plan on lurking, say so and get it out of the way: “Hey all, Steve from Arizona. Excited to lurk and learn today.”

4. You might want to let others know you’ll be participating in a chat in advance. This is a nice way to support the host and let your network know you may be a bit noisy during that time.

Jump In and Participate

1. Re-tweeting what others share is a common way to support statements from other tweet chat participants and share them with your own Twitter network.

2. Ask questions! Hosts love questions. Sometimes even irrelevant questions because some hosts think EVERYTHING is related to their topic. It may be helpful to preface your tweet with “Question:”

3. Be sure to include the Hashtag in each of your tweets! If you ask a question or respond to someone in the chat, use the Hashtag so others will see your tweet.

4. Note the account names of those sharing interesting information, comments or perspective. You may want to consider following them or adding them to a list of those to observe for a while prior to following.

It’s Not Over Until You Say It Is!

1. When the chat ends, tweet a message of thanks to the host(s) and anyone who made the chat more worthwhile to you. Consider following those accounts whose contributions you found especially valuable.

2. Follow-up. If everything went well you’ve made a new connection or two. Follow-up in the coming days with a friendly tweet. Continue the conversation that was started and begin to build the new relationship.

3. Review the chat summary or transcript. Many hosts will post a transcript of the tweet chat. This is particularly helpful if the chat was fast moving. @Symplur is a free tool you can use to review transcripts and statistic summaries for tweet chats that have registered on the site.

4. Storify is a tool used to create a transcript o a series of tweets and add some commentary and context to the chosen tweets. If someone has “Storified” the chat using @Storify, then check that out. Moreover, you can subscribe to stories and obtain new information that may be subsequently added.

Come Join Us!

I hope the above information was helpful. Why not come join the first of a series of #FLBlueChat chats on Wednesday, February 11th @ 12:00pm EST. 

Saturday, January 31, 2015

ICD-10 Conversations - Almost Every Day of the Week!

About four years ago when I was just starting to get involved with the ICD-10 mandate, there was a dearth of information about ICD-10 available on the web.  That's all changed.  Anyone who has anything to do with ICD-10 doesn't have to start from scratch. There's plenty of good information freely available to anyone who knows how to do a simple search.

And a couple organizations have stepped up with recurring programs aimed at sharing a wide range of ICD-10 related content. Here are a few of the more popular programs:

Talk Ten Tuesdays – Stay on Top of the Game

This weekly program, sponsored by ICD10monitor, a division of Panacea Healthcare Solutions, Inc., is an online news and information source created to help healthcare providers make informed decisions as they transition to ICD-10. Here's a link to their upcoming broadcasts and their archives.

I think Talk Ten Tuesdays was one of the first recurring programs about ICD-10. Chuck Buck is the lead moderator of Talk Ten Tuesdays - quite the character and always entertaining - AND informative! You can follow @ICD10Monitor here.

What’s Up Wednesdays – Together Let’s Get ICD-10 Ready

This program is sponsored by BlueCross of Northeastern Pennsylvania. You can find program information here and recordings from previous shows here. Here's information from their most recent program on January 21, 2015.

Open Line Fridays 

This monthly program is sponsored by FLBlue and offered In alliance with representatives from Baptist Health South Florida, Lee Memorial Hospital, Mayo Clinic, Tampa General Hospital, Availity®1 LLC, Secure EDI, Springs Family Physicians LLC, and Health Data Consulting. You can find program information here and recordings from previous shows here. 

George Vancore is the lead moderator for Open Line Fridays and, like Chuck Buck, is quite the character and always adds a lot of fun to an already exciting topic! You can follow @FLBlue here.

What about Monday's and Thursday's?

So who's going to fill these slots?

For more information on ICD-10 and other health information technology-related topics, be sure to subscribe to this blog and consider following me on Twitter.

Tuesday, January 27, 2015

ICD-10 Codes in Non-Claim HIPAA Transactions

Most everyone involved with ICD-10 knows that the HIPAA 837 Healthcare Claims Transactions (Professional, Institutional & Dental) contain ICD-10 diagnosis and procedure codes and, therefore, must be considered when making their systems and processes ICD-10 compliant. But what other HIPAA transactions contain ICD-10 diagnosis and procedure codes?

Based on the amount of information shared on the web and some cursory research I’ve performed looking for information and guidance on non-claim HIPAA transactions impacted by ICD-10, it appears that not many people are aware that there are other HIPAA transactions that can also contain ICD-10 codes.

Which Non-Claim HIPAA Transactions Contain ICD-10 Codes?

WEDi has published a document titled “ICD-10 Impact to HIPAA Transactions”  that identifies all HIPAA transactions impacted by ICD-10. These HIPAA transactions include the following:

Healthcare Eligibility Benefit Inquiry and Response (270 & 271)

These two transactions includes the following:

1. Diagnosis Codes and a Diagnosis Code Qualifier for each code
2. Procedure Codes and a Procedure Code Qualifier for each code

Benefit Enrollment and Maintenance (834)

This transaction includes Diagnosis Codes and a Diagnosis Code Qualifier for each code.

Healthcare Services Review – Request for Review and Response (278)

1. Diagnosis Codes and a Diagnosis Code Qualifier for each code.
2. Procedure Codes and a Procedure Code Qualifier for each code.
3. Surgical Procedure Codes and a Surgical Procedure Code Qualifier for each code.

But We’ve Already Addressed this via our 5010 Upgrade!

Just because your organization is 5010 compliant doesn’t necessarily mean you’re out of the woods with your HIPAA transactions when it comes to ICD-10. Most 5010 upgrades merely tested the format of 5010 transactions and their ability to carry ICD-10 codes and qualifiers. Little, if any, focus was likley given to making sure ICD-10 procedure and ICD-10 diagnosis codes were correctly assigned to the transactions and that the transactions were correctly processed in applications: front-end or downstream. 

And it seems unlikely many organizations got into testing various processing scenarios.

Special Processing Scenarios. Like What?

There are some special processing scenarios organizations may want to consider when addressing the 278 Healthcare Services Review transactions. For instance,

What is the appropriate response to a 278 referral inquiry if the inquiry is submitted after 10/1/2015 but the original referral request was submitted prior to 10/1/2015? Is it ok to respond with a transaction containing ICD-9 codes? Will the transaction even pass any transaction compliance checks performed by your EDI tools or clearinghouse?

What about a request for a referral extension? Referrals submitted prior to 10/1/2015 will contain ICD-9 codes and would typically be valid for up to a year. If a referral request extension is submitted on 10/2/2015, which ICD code set should be used? 

I’m sure there are other considerations.

It’s Imperative!

As WEDI states in the document I noted above: “it is imperative that we have a clear understanding of where the ICD-10-CM and ICD-10-PCS codes are used in the transactions required under HIPAA and used in the health care industry to exchange diagnosis and procedure information.

Friday, December 26, 2014

List of Healthcare-Related "Top 10" Lists

It's that time of year! In case you've missed any, here's a collection of what I think are some of the better "Top 10" lists pertaining to healthcare-related topics. For more "top" information throughout 2015, consider following me on Twitter.

Last Updated: 1/05/14 @ 18:00 pm MST

General Healthcare

Providers & Payers