March 2013 Client Newsletter
When Congress enacted the
sequestration process in 2011, they specifically linked the Medicare Part A and
Part B sequestration cuts to commence in a manner according to a process
outlined in Section 256 of legislation enacted in 2010 called the "Pay As You
In that legislation, it states
that any cuts mandated by the Office of Management and Budget are to take
effect for Part A and Part B of Medicare, one month after the date that OMB
issues the mandatory order. Therefore,
if, as expected, OMB issues the sequestration order tomorrow, the cuts will not
take effect for Part A and Part B of Medicare until April 1. So providers have a 30 day grace period
before we begin to see the actual cuts.
Government agencies do have
flexibility in their spending so all of the "doom & gloom" is not accurate.
And, even at the Program level, they have discretion. Layoffs are not a
Also on this point, the
Administration and Congress are in agreement that there is $33 Billion in
unnecessary farm subsidy money sitting at the Department of Agriculture that is
no longer needed. If the Administration would allow for reprogramming,
that money could be taken from Ag and applied against the $85 billion for
sequestration and reduce sequestration by more than 1/3.
Earlier today the Washington Post,
no less, called out the Secretary of Education on one of his statements.
He said more than 30,000 teachers were going to be laid off due to the
sequester. When asked for specifics, he gave them the name of a school in
West Virginia. However, when the Post Reporter contacted the Superintendent
of schools, they said no. No layoffs. Maybe next year, but none due
to sequestration this year and probably not next year. They would just
reprogram money to avoid teacher layoffs.
When the Post went back to the
Secretary of Education to see what was up, they said that they just took the
total amount of money that would have to be cut from a program account, divided
it by the average teacher salary ($70,000) for that program and used that
number as an example but could not actually produce any teachers who were being
laid or nor did they know how local school districts might apply the cuts at a
Lots of partisan politics going on
for the benefit of some BIG congressional egos.
Occasionally insurance checks somehow get lost in the mail
resulting in delayed payment to the provider.
The best way to avoid this is direct deposit (also known as EFT (Electronic Fund Transfer) and is the same as save way that Social Security,
AARP and others require.
We STRONGLY suggest you
consider Direct Deposit/ EFT for as many payments as possible since it avoids
delay due to nearly all external factors, including bad weather, theft,
misplacing checks, etc. And no one needs
to go to the bank to deposit those checks - just check your bank account
A reminder that CMS will use 2013 as the reporting year for
Medicare cuts beginning in 2015 if providers do not participate in PQRS in
2013. Thus, if you want to insure that
you do not get the 1.5% reduction in Medicare payments beginning in 2015,
followed by a 2% reduction beginning in 2016 you MUST participate in 2013.
EHR's - BY THE NUMBERS
Software Advice, a vendor neutral software research company,
released the following statistics about Health IT:
- The number of Eligible Professionals that have successfully attested for
- 623 -
The number of vendors listed on the Office of the National Coordinator's
Certified Health IT Product List.
These numbers strongly support the case that the
implementation of Health IT is growing quickly and is changing the way the
medical community delivers quality healthcare. But implementation of an
EHR system is only the beginning. Meaningful Use of an EHR system is the
foundation upon which the growth of Health Information Exchanges (HIEs) and the
movement toward Patient-Centered Medical Homes will be built upon. NJ-HITEC urges providers throughout the
Garden State to get on board before they fall too far behind.
payment for GO444 - Annual depression screening
Medicare pays when this code is
billed with an office visit, but not when billed with an Annual
Wellness Visit. Consider doing the
Depression Screening during a separate visit.
More EHR - DISCONTINUED
recently announced they were discontinuing support of Medinotes and MyWay. Why
are EHRs discontinued? How can a buyer keep from purchasing an EHR that might
products that have been discontinued:
- Misys will not be certified for MU -
Customers encouraged to move to Allscripts
- GE discontinued Advance EHR (Jan
- Medinotes is discontinued by
Allscripts effective 12/31/2012
- Epocrates announced EHR was
discontinued (May 2012)
- Allscripts MyWay will not be upgraded
for Meaningful Use Stage 2 (announced Oct 2012)
there any common themes?
- When a company owns several EHRs and
in particular EHRs that serve the same practices sizes, they are likely to
discontinue the "duplicate" EHRs.
- Expensive EHRs are not as marketable
to smaller practices and thus more likely to be shuttered and/or replaced.
- Companies may have difficulty
maintaining products that they did not build.
- EHR is competitive - newer products
that do not have full competitive functionality and/or insufficient market
share to be profitable may be closed. These companies may close or other
vendors may purchase them for their customers/market share and not the
can you avoid getting stuck? Some things to look for:
- How many customers do they currently
- Ownership. Public companies may have
very high growth and profit motives vs. customer service orientation.
Companies funded by venture capital generally have very high growth
expectations with the goal of being purchased by another company.
- How long has the company been in
- When was the last version of the
- Does the vendor charge extra for new
- Is there a Meaningful Use guarantee
for Stage 2 and 3?
- Does it feel right? For example a "free" or really low cost EHR has to cover their costs somehow - are they
just looking to hook you so they can raise their rates later or sell their
company to another one looking to buy market share and then switch you to
one has a crystal ball so no matter what you do make sure that your EHR
contract gives you your data in the event you cancel or otherwise need to move
to another EHR down the road.
- How old is the technology? If the
system still looks and operates much as it did 5 years ago the company may
not be investing for the future.