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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 Go Act."

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 necessity.

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 community level.

Lots of partisan politics going on for the benefit of some BIG congressional egos. 

Preventing Lost Insurance Checks

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 online.


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.


Software Advice, a vendor neutral software research company, released the following statistics about Health IT:

  • 115,918 - The number of Eligible Professionals that have successfully attested for Meaningful Use.
  • 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.  

Medicare 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. 


Allscripts 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 be discontinued?

Some products that have been discontinued:

  • Misys will not be certified for MU - Customers encouraged to move to Allscripts

  • GE discontinued Advance EHR (Jan 2012)

  • 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)

Are there any common themes?

  1. When a company owns several EHRs and in particular EHRs that serve the same practices sizes, they are likely to discontinue the "duplicate" EHRs.
  2. Expensive EHRs are not as marketable to smaller practices and thus more likely to be shuttered and/or replaced.
  3. Companies may have difficulty maintaining products that they did not build.
  4. 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 technology.

How can you avoid getting stuck? Some things to look for:
  • How many customers do they currently have?
  • 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 business?
  • When was the last version of the software released?
  • Does the vendor charge extra for new releases?
  • 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 another EHR?
  • 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.

No 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.
2013 Client Newsletter Archive