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August 20, 2007 |
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IN THIS ISSUE
Editor's Column: No Thanks, We'll Just Resubmit the Doctor's
Bill
'Consumer-Directed' Health Care Could Mean Billions, But Not For
Docs
NPI And Data
Dissemination
Henry Ford Bi-County
Hospital Changes Name
Dr. Welch: Education Trumps Hospital Time For Moms
'Doctor, I'm
Tired, I'm Sleepy' |
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Editor's Column: No Thanks, We'll Just Resubmit
The Doctor's Bill
By JOSEPH
WEISS, MD
Alex Berenson is a New York Times business reporter who covers the
pharmaceutical industry, its mergers and boardroom intrigues. In a
departure from his usual beat, he took on health care financing. In
his article in the July 29 Times: Sending Back The Doctor’s Bill, he
stated that the cause of the excess expense in American health care
is physicians’ income. His solution is to bring American physician
salaries in line with our European counterparts. In his view, if we
make that adjustment, America will have plenty of money to cover the
cost of health care.
According to the
information he has at hand, Berenson asserts that American
physicians average $200,000 a year while their European counterparts
earn $120,000. He fails to point out that the American salaries are
in 2006 figures and the European results come from a 2002 review.
Berenson ignores the July 2006 New England Journal of Medicine
article (NEJM 355: 375-ff, July 2006) that reported that primary
care physicians in the British pay-for-performance system are
earning $173,000 per year.
Berenson’s
solution is to herd American physicians into large groups, pay these
physicians fixed salaries and give them bonuses based on the health
of the patient for whom they care.
Nothing he
presents is plausible.
Physician
compensation as a percentage of health care costs has remained at 22
percent for the past 10 years. Paying a physician in proportion to a
patient’s outcome is difficult, as outcome is hardly possible to
define and many patients are under the care of two or more
physicians.
Berenson ended
his article with this sentence: “The whole health care system is set
up to pay for services rendered when the patient and society is
(sic) interested in health.” He implies that physicians are moved by
profit and indifferent to the real purpose of health care.
He is wrong. We
pay auto mechanics to fix brakes and render other services when car
owners and the public really seek safe driving. Ultimately, both
safety at the wheel and good health derive in large part from the
manner by which the individual, with the vehicle and body he is
given, directs his way of life.
Mr. Berenson errs
in making physicians scapegoats. The problem of expense in health
care comes not from how much we gain, but because of how little we
control.
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'Consumer-Directed Health Care Could
Mean Billions, But Not For Docs
By PAUL
NATINSKY
As consumers begin to realize their desire to better control their
health care costs and inconveniences, companies equipped to help
them are expected to receive a windfall of about $40 billion in
“revenue opportunities” during the next few years.
According to an
article on PR Newswire, innovations leading to these opportunities
include health care finance management tools, quick insurance
coverage verification and fast information about alternative
treatments.
In a new report,
Diamond Management & Technology Consultants, Inc. identifies several
areas where new pots of gold can be found. Not surprisingly, the
biggest opportunity lies in “integration and infrastructure,” read
administration costs. The rest are fairly predictable, ranging from
managing health care spending accounts to providing credit to those
who need help paying for services. Again, not surprisingly, almost
all of these “advisors” are decidedly peripheral to actual health
care provision.
Perhaps the most
ironic new opportunity is the is the $3.4 billion to be had advising
patients and companies about how to stay healthy. Funny, I thought
that job was already taken by men and women who look great in white
long coats. Last I heard there was no additional money in the pot to
adequately pay those who have trained for up to a decade to provide
those services.
For those
interested in the full report, titled, Seismic Shifts in the
Health/Wealth Landscape, e-mail
health/wealthconvergence@diamondconsultants.com and request a
copy.
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NPI And Data Dissemination
The reporting
of legacy numbers in the "Other Provider Identifier/Other Provider
Identifier Type Code" fields in the National Plan and Provider
Enumeration System (NPPES) will assist Medicare in successfully
creating linkages between providers' NPIs and the identifiers that
Medicare has assigned to them (such as PINs).
You should be
aware that if you remove your legacy numbers from the "Other
Provider Identifier/Other Provider Identifier Type Code" fields,
linkages that Medicare has established using the reported Medicare
legacy numbers will be broken and your Medicare claims could be
rejected.
You will want
to make sure that your social security number is not listed in the
"Other Provider Identifier/Other Provider Identifier Type Code"
field, because this field contains information that will be
disclosed through the data dissemination process.
The latest date we have on the Data Dissemination is Sept. 4.
NPPES health care provider data that are disclosable under the
Freedom of Information Act (FOIA) will be disclosed to the public by
the US Centers for Medicare & Medicaid Services (CMS). In
accordance with the e-FOIA Amendments, CMS will be disclosing these
data via the Internet. Data will be available in two forms:
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A
query-only database, known as the NPI Registry
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A
downloadable file
CMS is
extending the period of time in which enumerated health care
providers can view their FOIA-disclosable NPPES data and make any
edits they feel are necessary prior to the initial disclosure of
data.
CMS must build
in time to resolve any errors or problems that may be encountered
with edits that health care providers submit. Therefore, in order
to ensure edits are reflected in the NPI Registry when it first
becomes operational and in the first downloadable file,
physicians
and other health care providers need to submit their edits no later
than Monday, August 20.
Health care
providers who submit edits on paper need to ensure they are mailed
in time for receipt by the NPI Enumerator by Aug. 20.
CMS will be making FOIA-disclosable NPPES health care provider data
available beginning Tuesday, Sept. 4.
The NPI Registry will become operational on September 4 and the
downloadable file will be ready approximately one week later.
Physicians and
other health care providers should refer to the document entitled,
"Information on FOIA-Disclosable Data Elements in NPPES," dated June
20, 2007 for assistance in making their edits.
The delay in
the dissemination of NPPES data does not alter the requirement that
HIPAA covered entities must comply with the requirements of the NPI
Final Rule no later than May 23, 2008. All NPI contingencies that
may be in place must be lifted by that date.
If you are
still not sure what an NPI is and how you can get it, share it and
use it, you can obtain more information and education on the NPI
through the CMS NPI webpage
www.cms.hhs.gov/NationalProvIdentStand.
Providers can apply for an NPI online at
https://nppes.cms.hhs.govor
can call the NPI enumerator to request a paper application at (800)
465-3203.
For more
information about reimbursement issues, contact Stacie Saylor at
MSMS at (517) 336-5722 or ssaylor@msms.org.
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Henry Ford Bi-County Hospital Changes Name
In early July
2007, Henry Ford Macomb Hospitals, formerly St. Joseph's Healthcare,
became the newest member of the Henry Ford Health System. With the
new alignment, changes will allow Henry Ford to position Henry Ford
Hospitals in Clinton Township and Warren (formally the Henry Ford
Bi-County Hospital) and health centers to deliver care in Macomb
County.
Henry Ford
Macomb Hospital - Warren Campus houses the nation’s longest running
osteopathic medical training program, having acquired the program,
first established in 1927, from Detroit Osteopathic Hospital.
Henry Ford
currently operates Henry Ford Macomb Hospitals in Clinton Township
and Warren as well as four medical centers in Macomb County. The
health care system, the largest in metro Detroit, also owns Henry
Ford Hospital in Detroit, Henry Ford Wyandotte Hospital, and
Kingswood Hospital in Ferndale, and is building a 300-bed hospital
in West Bloomfield.
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Education Trumps Hospital Time For Moms
Dr. Robert
Welch,
WCMSSM member and chairman and program director of obstetrics and
gynecology at St. John Health's Providence Hospital in Southfield
was among the national experts quoted in an Aug. 6 HealthDay story
about preparing new mothers to leave the hospital.
Among his
comments were: "This study shows that the time in the hospital is
not the issue; education is a more important issue.”
He pointed out
that changes in society may have created this issue. In the past,
when women came home from the hospital, a grandmother was often
there to help out and teach newborn care.
For the full
story, visit:
http://www.healthday.com/Article.asp?AID=607040
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'Doctor, I'm Tired, I'm Sleepy'
SLEEP APNEA: 'DOCTOR, I'M TIRED, I'M
SLEEPY'
OAKWOOD ,HERITAGE HOSPITAL
CME PROGRAM, APPROVED CME CATEGORY I
WEDNESDAY, SEPTEMBER 5, 2007
8:00 AM -CONFERENCE ROOMS #1 & 2
Lyle D. Victor, MD Board Certified -American
Board of Internal Medicine
I
Pulmonary Diplomate -American Board of Sleep Disorders Medicine
Vijay
K. Khanna, MD Board Certified -American Board of Internal Medicine
I
Pulmonary Chief of Staff, Oakwood Heritage Hospital
OBJECTIVES -Sleep Apnea
Present information regarding the epidemiology, diagnosis, and
treatment of Sleep Apnea
VIJAY
KHANNA, MD, FACP, CHIEF OF STAFF
R.
RAJARAMAN, MD, DIRECTOR" CONTINUING MEDICAL EDUCATION
OAKWOOD
HERITAGE HOSPITAL
110000 SOUTH TELEGRAPH TAYLOR, MI 48180 (313) 295 -6794
"Oakwood Heritage
Hospital is accredited by the Michigan State Medical Society
Committee on CME Accreditation to provide continuing medical,
education for physicians",
"Oakwood Heritage
Hospital designates this educational activity for a maximum of one
(1) credit ANA PRA Category 1 Credit{slM. Physicians
should only claim credit commensurate with the extent of their
participation in the activity".
DISCLOSURE
-AllCMEactivitiesproviders mustdisclosetoparticipants,
priortoeducationalactivities, theexistence ofany
significantfinancial orotherrelationshipafacultymember
oftheproviderhaswith themanufacturer(s) ofanycommercial product(s)
orprovider (s) ofany commercial services (s) discussed in an
education presentation.
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