We Have the Wrong Priorities: How to Improve Healthcare By Dave Jakielo, CHBME all know that federal government officials continue to think that they are the experts on fixing what’s “wrong” with healthcare, but as time passes, they have proven to be somewhat clueless on how to improve the system. let’s look at two misguided initiatives they have imposed upon the healthcare provider community . Electronic Medical Records (EMRs) utilizing an emr is a great idea in theory; however, government officials failed to set up a program that would really benefit patients and providers. Because they didn’t develop standards before they had practitioners rush to implementation, we are now faced with having hundreds of independent systems that can’t communicate or share information with one another. While my doctor may have a great emr system in Pittsburgh that stores my entire healthcare history, outlines any issues I may have, and details what prescriptions I take or have taken, if I show up unconscious in an emergency room in Denver, the treatment team has to start from scratch. Why shouldn’t they have access to my healthcare information? and I don’t even need to be 2,000 miles away! If I get taken to a hospital in Pittsburgh that isn’t part of the healthcare system that my physician belongs to – even if it is across the street – that treatment team might as well be on mars. Physician Quality Reporting System as stated on the Centers for medicare & medicaid services’ (Cms) website, “PQrs is a reporting program that uses a combination of incentive payments and payment adjustments to promote the reporting of quality information by eligible professionals.” The data could be reported using a registry reporting page. For that, the requirements state: each eligible professional must satisfactorily report on at least 50 percent of eligible instances for at least nine measures across three NQs domains to qualify for the 2014 PQrs incentive payment. If fewer than nine measures or if less than three NQs domains are reported via a qualified registry, Cms will apply a measure-applicability validation (maV) process when determining incentive eligibility. FROM THE rOaD Plus, there are three other options for reporting that a provider could use: • eHr Incentive Program reporting page • group Practice reporting Option • Qualified Clinical Data registry (QCDr) page I don’t know why we are spending time developing and implementing complex, cumbersome, and expensive systems when we could implement some simple solutions that would have a positive impact on the entire system. Now for a few solutions. One way we could stabilize the rising cost of care is to mandate a national fee schedule with just a variance based on geographical location. It is mind boggling that third-party payors have provider relations staff who individually negotiate payment schedules with each and every participating provider. Why should the amount a provider is reimbursed for a level 3 office visit be subject to how good a negotiator someone on their staff is? medicare figured out years ago that the way to go was a common fee schedule based on relative value units (rVus) – why shouldn’t every payor be forced to adopt the same? Finally, it makes no sense that healthcare premiums are based on an employer’s utilization experience. If a small employer has an employee with a serious illness, the next year, their premiums will more than likely skyrocket. so, should we teach employers to hire only healthy, low-risk employees? I think that insurers should be required to offer a pricing schedule in which it costs the same amount for an individual policy, a parent-plus policy, and a family policy. Variations in monthly premiums from employer to employer reward large companies and severely penalize small firms. Instead of continuing to create giant bureaucratic programs, let’s spend our time streamlining the policies and bringing some common sense into this convoluted marketplace. Dave Jakielo, CHBME, is an international speaker, consultant, executive coach, and author and is president of Seminars & Consulting. Sign up for his free weekly success tips at www.Davespeaks.com or text “Davespeaks” to 22828. Dave can be reached via email, Dave@Davespeaks.com, or phone, 412-921-0976. We 38 HBma BIllINg • NOVemBer.DeCemBer.2014
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