Tuesday, November 17, 2015

Considering the tension between providing care and contacting law enforcement

A member of the Public Policy and Government Relations Committee shared this article, "Patient's Arrest for False ID Reminds CEs To Review Police, Validation Procedures," found at https://aishealth.com/archive/hipaa1015-01

The first half of the article focuses on a case of a hospital calling law enforcement when a patient presented with a false ID – in this case a fake driver’s license.  The second half of the article discusses broader issues of how providers might respond to such circumstances and highlights requirements under HIPAA and EMTALA.  We have highlighted some of the text below.  This is definitely worth a read.  What are your policies on this issue?

The HHS Office for Civil Rights (OCR) is investigating whether a Texas clinic acted appropriately following the arrest of a patient, RPP has learned. The woman, who is not a U.S. citizen, was taken into custody while waiting to see her doctor for allegedly presenting a fabricated driver’s license; she has not been charged with violating immigration laws.

OCR spokeswoman Rachel Seeger told RPP the agency is “reviewing the news report(s) to determine our authority under both HIPAA and civil rights laws to take action in the matter.”

The incident involves Blanca Borrego, 44, who was handcuffed and removed from an obstetrician-gynecologist’s office, part of Memorial Herman Health System of Houston, in front of her two daughters. Court documents show Borrego, a native of Mexico, spent 12 days in jail charged with a felony prior to her release on $35,000 bail.

To date, officials with Memorial Hermann, a nonprofit organization that includes 13 hospitals, have not admitted to any wrong-doing nor apologized. They stated that while they did call the local sheriff’s office, they “did not ask” for Borrego to be arrested.

The officials acknowledged that “what happened to the patient is unfortunate” and that the Sept. 4 incident, which caused a national furor among immigration rights organizations and others, provides them “an opportunity to evaluate our processes.”

Law Enforcement Issues Are Tricky

Other HIPAA covered entities (CEs) may wish to do the same in light of this situation, which pits policies for working with law enforcement and for thwarting identity fraud against the need to render care while complying with HIPAA, other federal laws and state regulations.

Memorial Hermann officials have not commented beyond a statement issued on Sept. 15 that described the actions that occurred prior to the arrest and referred to the situation as “a unique event in Memorial Hermann’s history.” They also would not answer any questions submitted by RPP.

The statement refers to Borrego by name. Among the questions Memorial Hermann did not answer was whether it had Borrego’s permission to discuss her situation. Failure to obtain consent to discuss a patient by name led to the imposition of a corrective action plan and a $275,000 payment by the owners of Shasta Regional Medical Center two years ago (RPP 7/13, p. 1).

According to Memorial Hermann’s statement, the arrest was at the discretion of “local law enforcement,” which became involved only after Borrego “presented potentially false identification” at the clinic.

Borrego “was unable to provide another valid form of identification and in an effort to verify the authenticity of the suspicious driver’s license, the office then called the licensing bureau of the Texas Department of Public Safety (DPS),” Memorial Hermann officials say in the statement. “DPS instructed our staff to contact local law enforcement to validate the driver’s license number. This inquiry confirmed a false identification. Local law enforcement took this information and made the decision to arrest the patient.”

The statement adds that clinic officials “did not ask for this individual to be arrested” and “did not press charges.”

Memorial Herman does not “ask patients about residency or immigration status nor do we report an undocumented patient to law enforcement. To be clear, this incident has nothing to do with immigration or residency status,” the statement says.

“What happened to the patient is unfortunate,” the statement concludes. “We also appreciate the sensitivity of this matter. As such, we consider this an opportunity to evaluate our processes.” Which processes are at issue was not addressed, and, as noted, the system would not respond to any of RPP’s queries.

 ‘Medical Care Should Take Precedence’

 In an interview, Clarissa Guajardo, Borrego’s attorney, tells RPP her client never got to see her doctor and that if the medical staff had problems with the materials she provided to prove her identity,that should have been dealt with afterward.

 Guajardo says she has not seen what Borrego presented and thus could not say whether falsification or fabrication was involved. But she stresses that she believes Borrego was mistreated by the clinic staff, who she says were instructed to keep Borrego waiting until arresting officers could arrive.

“Certainly her medical care should have taken precedence over law enforcement activities,” Guajardo says. She is exploring whether staff were permitted under HIPAA to contact law enforcement in this situation and whether they violated any Texas privacy laws.

Borrego’s arraignment is scheduled for Oct. 20. Guajardo is hoping a grand jury declines to indict her client or that any charges, if they are brought, will be of a lesser nature. Borrego’s visa expired a dozen years ago, according to numerous reports.

RPP spoke to several health care experts to get their take on the incident and, generally, to clarify how HIPAA’s provisions related to law enforcement apply to a case of this nature.

Even years after the privacy rule went into effect, sharing information with law enforcement remains a complicated area for hospitals and other CEs because of the interplay of state laws and the fact that some types of reporting is voluntary, meaning the protected health information (PHI) can be shared, while in some cases under state law it must.

In addition, providers may feel intimidated or threatened into providing more information or assistance than they’re comfortable with, or than is allowed.

In 2013, a New Mexico jury awarded a man $1.6 million in compensation for having been forced to undergo a colonoscopy and other medically unnecessary procedures ordered by judicial officials; local police suspected the man was hiding drugs in his body but none were found (RPP 12/13, p. 1).

Hoping to clarify some of these issues for both health care providers and law enforcement officials as they have a “shared responsibility,” the Oregon Association of Hospitals and Health Systems developed a 27-page report, “HIPAA and Law Enforcement: Guidelines for Release of Protected Health Information.” This was published in 2012 and updated in 2013.

While this provides information related to Oregon state law as well as HIPAA, CEs regardless of their location may find it useful because it contains three flow charts to help providers know how to respond when law enforcement officials request PHI, when disclosures are mandatory, and when they are voluntary. It also has a series of questions and answers that address situations CEs face. (See https://tinyurl.com/ob7c8oj.).

“A hospital’s first obligation to all patients is caring for their medical needs. When a patient is also involved in a criminal investigation, either as a suspect, witness or victim, that obligation remains the priority,” the Oregon guide states. “Law enforcement officials, however, also have an important job to do that often involves seeking access to patients, their medical information or other evidence held by the hospital.”

CEs will not find much to go on under HIPAA as to whether they are asking for too much information when trying to validate a patient’s identity. “HIPAA generally is silent about specifically requesting identification from patients,” says Becky Williams, a former nurse who chairs the Health Information Technology/HIPAA Practice Group at Davis Wright Tremaine LLP. But “[v]erification of identity is consistent [with] best practices to prevent medical identity theft,” adds Williams, who is based in Seattle.

Conversely, HIPAA does “recognize the need to verify the identity of a person requesting protected health information,” Williams says. She recommends that providers who have a question about the identity of a patient they’re treating “keep records of the patient separate until it can be confirmed that the patient presenting actually is the individual he or she claims to be.”

“This may help avoid ‘polluting’ the medical records of an identity theft victim,” Williams points out.

Among the factors to consider are whether –– and when –– CEs should contact law enforcement. One relevant provision in HIPAA is §164.512(f)(5) Permitted disclosure: Crime on premises, which states that a CE “may disclose to a law enforcement official protected health information that the covered entity believes in good faith constitutes evidence of criminal conduct that occurred on the premises” of the CE.

“Some folks take the position that if someone is knowingly presenting false documents that may result in fraud or identity theft, this represents a crime on premises,” says Frank Ruelas, principal and founder of the consulting firm HIPAA College. “As such they use this as a basis for a disclosure –– using minimum necessary –– to law enforcement.”

It also would not be unthinkable to conclude that patients who are undocumented and admit to being in the United States illegally are committing a crime on premises. But CEs making such a call need to be aware of how this scenario would play out, particularly if it went public.

In addition, health care providers who are providing any services with federal dollars –– such as through Medicare or Medicaid, which is virtually all of them –– are not permitted to discriminate against individuals based on their ethnicity, gender and other characteristics.

This is specified in the Civil Rights Act, which OCR enforces for health care purposes, and in the Affordable Care Act. A Brooklyn hospital recently agreed to a settlement with OCR over allegations it violated the civil rights and the ACA, following a discrimination complaint filed by a transgender patient (RPP 8/15, p. 1).

Emergency Care Cannot Be ‘Interrupted’

Faced with a patient who may be committing a crime or meet other categories for which HIPAA permits notification to law enforcement, CEs must consider timing and whether care should be interrupted.

For example, the federal Emergency Medical Treatment and Active Labor Act (EMTALA) regulation, applicable to emergency services, “requires that individuals be provided a medical screening exam,” Ruelas explains. But, he adds, “EMTALA is clear that no processes, such as insurance verification, eligibility, etc., should delay the receipt of care by an individual who presents at the dedicated emergency department.”

However, EMTALA does not apply to the provision of non-emergency care.

“A regular medical practice [is] not required to work for free, and if the patient is engaging in medical identity theft, for example, then the practice probably won’t get paid,” says Jeff Drummond, a partner with Jackson Walker, LLP, in Dallas. Drummond stresses that he is not commenting on this case in particular.

One option if the patient is in an outpatient setting is to refer him or her to a free clinic or other provider. Ruelas says staff could ask if the patient “feels he or she has an ‘emergent condition,’ then we can call 911 and have them taken to an emergency department.”

This is not an ideal situation, Ruelas acknowledges, but says “this has worked in the past” and makes sense “[g]iven all of the moving pieces that are involved with people without insurance, the use of false IDs, the need to try to obtain information for payment of services, the need to create correctly documented records of care, and that undocumented workers in these situations may not have coverage.”

OCR issued a short guide regarding law enforcement (see box, p. 9). It is important to note that, in addition to HIPAA’s federal requirements, under many state laws “mandatory reporting is triggered,” Ruelas says. Often this relates to “injuries as a result of a crime or injuries related to gunshot wounds, knife wounds, etc.,” he says.

If the patient is suspected, or confirmed, of being under the influence of an illegal substance, providers may contact law enforcement. “Typically if a person is suspected of being a danger to self or others, a report can be made” to law enforcement, adds Ruelas. “Many hospitals use this to alert police when a patient decides to leave against medical advice [and] is intoxicated. Because of the possibility that this person may try to operate a motor vehicle, this presents that basis for possible risk to others.”

Suspected or confirmed abuse can also trigger reporting to law enforcement, says Williams.

I have worked as a pediatric nurse for years, so I will emphatically say all child abuse should be reported immediately,” Williams says. “HIPAA permits reporting of child abuse and state law generally requires –– or at least permits –– good faith reporting of child abuse.”

Regarding adult abuse, neglect, or domestic violence situations under HIPAA, “a provider may report good faith beliefs of abuse to government authorities that are in a position to address the issue,” Williams says.

Reporting also occurs when required by state law, when a potential victim approves or is incapacitated and “the provider believes it is necessary to prevent harm.” The government agency accepting the report is required to attest that “the information will not be used against the patient” and “that immediate enforcement activity depends on [obtaining] the information,” she says.

Disclosures Must Be Entered in Logs

In addition, Ruelas reminds CEs that their “policies on how the staff is to respond” when law enforcement is involved should include “how this is to be reported both to authorities but also internally as well, such as to risk management or administration.”

And, as the Oregon law enforcement guide notes, disclosures need to be logged for the patient to obtain later. “The HIPAA Privacy Regulations require a hospital to give an accounting of certain disclosures, including disclosures to law enforcement made without patient authorization, upon the request of the patient,” it states.

However, there are also provisions that allow law enforcement to request a suspension of this “[a]ccounting for a time period specified by law enforcement if they provide a written statement that an [a]ccounting would be reasonably likely to impede the agency’s activities and specifying the time for which such a suspension is required.”


Kentucky looks at mobile driver licenses

We have reported on state initiatives on improved or modernized driver licenses. 

A NAHAM member of the Public Policy and Government Relations Committee shared this article, "Kentucky Holds Hearing on Mobile Driver Licenses," from SecureID News.  We note that because many in Patient Access use the driver license as the patient ID, this could have big implications.  What will you do if the driver license is electronic only - on a patient's smart phone?

The article may be found at --

Two states have started piloting mobile driver licenses and at least five others want to explore putting the credentials on smartphones. Kentucky proposed legislation that would study the feasibility of mobile driver licenses this year but the bill died in committee. That didn’t stop legislators and other government officials from hosting a Joint Committee on Transportation hearing that discussed mobile driver licenses.
“The goal is to give the Commonwealth a background on the issue and the progress in other states,” says Chad Grant, vice president at Grant Consulting Group. HID Global executives testified at the hearing, giving officials information on the latest developments with placing the credentials on mobile devices.
The company talked about its proof of concept for a mobile driver license and what is involved with such a project, says Kathleen Carroll, vice president of corporate affairs at HID Global. Officials from the company also met with the Kentucky State Police to get some feedback on the idea of mobile driver licenses.
“When discussing a mobile driver’s license, there are four key stakeholders that should have significant input into any solution: citizens, law enforcement, federal authorities and state licensing authorities,” Carroll says.
States are looking at mobile driver licenses to increase security and convenience, Carroll says. Individuals have to carry around multiple IDs for different purposes – driver license, health care, work, etc. By placing identity on a mobile device individuals will only have to carry the smartphone.
“Because there is a secure trusted relationship between the state licensing authority and the citizen’s smartphone, new services can be added and the need to stand in long lines can be eliminated,” Carroll says. “Additionally, driver’s licenses built on a secure mobile technology platform will give citizens more control over their personal information allowing them to choose when and with whom they share their information, and as importantly, how much information they share.”
Law enforcement has concerns over mobile driver licenses, but Carroll explains how the system can make their jobs easier. “When appropriate, a secure mobile driver’s license platform would allow the authentication of a person’s ID from a safe distance by using Bluetooth technology to give law enforcement officers more time to determine if a traffic stop is routine or more complex,” she says.
The system could also help alleviate problems with counterfeiting licenses. During provisioning of the license to the smartphone, the system would establish a mutually authenticated channel between the provisioning service and the mobile device that ensures safe delivery of data. “A mobile credential would only be sent to a mobile device through a secure service by an authorized state licensing authority,” Carroll explains. “Likewise, during use of the credential, a mutually authenticated channel is established between the mobile device and the relying party application. This ensures a secure private transaction independent of Bluetooth, NFC or any other transport protocol.” -

Thursday, September 17, 2015

Deconstructing the FCC’s Declaratory Ruling on TCPA Regulations – What it Means for Healthcare Providers

The Federal Communications Commission (FCC) issued a Declaratory Ruling and Order on July 10, 2015, clarifying several exemptions under the Telephone Consumer Protection Act (TCPA) regulations common the healthcare organizations.  These were raised in a petition filed by the American Association of Healthcare Administrative Management (AAHAM) regarding the exemption from prior express consent of “healthcare-related messages”.  

The HIPAA exemption in the TCPA regulations currently extends to advertising and marketing calls to cell phone and residential landline phone numbers. Under the exemption, calls that deliver a healthcare message made by or on behalf of a “covered entity” or its “business associate,” as defined in HIPAA, do not require the prior express written consent of the party called. 

The FCC found that for calls subject to the HIPAA exemption, an individual’s voluntary provision of his or her cell telephone number to a healthcare provider constitutes prior express consent to be called on that number. The FCC had already ruled in a different proceeding that an individual’s provision of his or her cell phone number is “effectively an invitation to be contacted at that number”, as long as the calls or texts are limited in scope to the purpose the number was provided in the first place. The FCC extended that reasoning to calls and texts in the healthcare context.  It is important to note that only HIPAA-covered entities and their business associates can make healthcare calls subject to this exemption and calls must be within the scope of the consent given. 

The FCC also addressed situations where a patient is incapacitated and unable to provide a telephone number directly to a healthcare provider, while a third party intermediary may be able to provide a number.  The FCC ruled that where a party is unable to consent because of medical incapacity, prior express consent to make healthcare calls subject to HIPAA may be obtained from a third party.  Consent by a third party on behalf of an incapacitated party will end when the party is no longer incapacitated.  In such an instance, the provider must get prior express consent from the party being called. 

The FCC also clarified that certain free-to-end-user non-telemarketing healthcare calls are exempt from the prior express consent requirement.  The FCC found that such calls can provide vital, time-sensitive information that patients welcome, expect and often rely on to make informed decisions. 

The FCC found that acceptable calls that fall under this “free-to-end-user” call exemption include
·        Appointment and exam confirmations and reminders

·        Wellness check-ups

·        Hospital pre-registration instructions

·        Pre-operative instructions

·        Lab results

·        Post-discharge follow- up intended to prevent readmission; prescription notifications

·        Home healthcare instructions

It is important to note that the FCC made clear that healthcare calls related to accounting, billing, debt collection or containing other financial content are not part of this exemption. 

Also, the content of the exempt calls are still subject to HIPPA privacy rules.  The FCC said, "The information provided in these calls and texts “must not be of such a personal nature that it would violate the privacy of the patient if, for example, another person received the message.”

Exempt calls are subject to these FCC imposed limitations
1)     Calls must be free to the end user;

2)     Calls must be made by or on behalf of a healthcare provider;

3)     Calls can only be made or sent to the cell phone number provided by the patient;

4)     Calls or texts must state the name and contact information of the healthcare provider;

5)     Calls or texts must be “concise” (one minute or less for voice calls and 160 characters or less for text messages);

6)     Healthcare providers may only make one exempt call or send one exempt text per day (per recipient), with a weekly limit of three total calls or texts (per recipient); and

7)     Healthcare providers must offer recipients an opportunity to opt out of receiving these types of calls or texts, and honor those opt outs immediately

The exclusive method for opting out of text messages is for the recipient to reply with the word “STOP”.  Recipients must be given this instruction.

Did the FCC address your questions regarding your system’s practices?  Do you have any specific practices you are still not sure about?  Let us hear from you.  Chances are other NAHAM members are have the same questions and are finding answers.

The FCC’s Declaratory Ruling and Order may be found at its webpage using this address: https://www.fcc.gov/document/tcpa-omnibus-declaratory-ruling-and-order.

A “NAHAM TCPA Checklist” as well as a longer version of this blog, NAHAM’s “Deconstructing the FCC’s Declaratory Ruling on TCPA Regulations – What it Means for Healthcare Providers”, may be found on the NAHAM webpage using this address: www.naham.org.



Friday, September 11, 2015

Congressional Quarterly reports on efforts to create Medicare "Smart Cards"

Congressional Quarterly's CQ News reported "Medicare 'Smart Cards' Pitched as Fraud Prevention" in a report written by Alan K. Ota, September 10, 2015.

Two Illinois Republicans, Representative Peter Roskam and Senator Mark S. Kirk are pushing a plan aimed at replacing traditional Medicare cards with smart cards containing computer chips to guard against fraud and identity theft.

Roskam's proposal, H.R. 3220, the Medicare Common Access Card Act, would create a test program to distribute Medicare common access cards to store personal and health-related data. CQ News reports it is expected to draw broad support as a stand-alone bill or as an add-on to other legislation, as the congressional Republicans hunt for ways to curb the growth of Medicare spending.  This would be encouraging for moving the bill through the important Ways and Means Committee of the U.S. House of Representatives.

Congressman Roskam is quoted as saying that allowing health providers to scan the proposed smart cards would “help close the gap on the more than $1 billion lost every week to false claims.”

On the Senate side, Senator Kirk has offered a similar pilot-program proposal,  S. 1871,also dubbed the Medicare Common Access Card Act.  The Senate legislation has the support of Florida Republican Senator Marco Rubio and Oregon Democrat Senator Ron Wyden, ranking member on Senate Finance. CQ News reports that Wyden called the new cards “a constructive tool” and said he was discussing the issue with Senate Finance Committee Chairman, Utah Republican Senator Orrin Hatch.

The proposals by Roskam and Kirk have support from the Secure ID Coalition, a six-member industry group representing makers of electronic identification cards.

CQ News reports that a recent General Accountability Office study found $60 billion in improper Medicare payments in 2014 that “either were made in an incorrect amount or should not have been made at all.” CQ News also reports that the Centers for Medicare and Medicaid Services estimated that improper payments made up about 12.7 percent of all Medicare fee-for-service payments in fiscal 2014, and the article quotes Paul Van de Water, a senior fellow at the Center on Budget and Policy Priorities, as predicting that the proposal could help curb Medicare fraud by patients but, it would have a limited effect preventing fraudulent reimbursement claims by health care providers.

It is expected that the new Medicare cards would be similar to identification cards issued to employees of the Defense Department and some other federal agencies, which are used to enter government buildings.  The legislation would require the Department of Health and Human Services to provide the smart cards in three areas with a “high risk of fraud and abuse” and further directs the Department to determine the scope of personal and health-related data stored on the chips, along with appropriate privacy protection measures.  The legislation would also encourage participation in the pilot program by those Medicare beneficiaries who say their personal and health-related data has been compromised.

What role would these cards play in improving positive patient identification?  Are these cards a model for government-issued photo IDs?  Let us know your thoughts.

Thursday, September 10, 2015

What to expect from trend in hospitals' purchasing physician practices

Kaiser Health News posted an article "When The Hospital Is Boss, That's Where Doctors' Patients Go" and poses the question with competing answers:

Why did hospitals binge-buy doctor practices in recent years?

To improve care coordination, lower costs and upgrade patient experiences, say hospitals.

To raise costs, gain pricing power and steer patient referrals, say skeptics.

Researchers at Stanford University looked into this, using 2009 CMS data.  This summary of findings by KHN caught our eye (emphasis added) -

Ownership by a hospital “dramatically increases” odds that a doctor will admit patients there instead of another, nearby hospital, they found. Worse, from the viewpoint of reformers, it boosts chances that patients will go to higher-cost, lower-quality hospitals.

The findings were published in August by the National Bureau of Economic Research.

In terms of the trend in hospitals purchasing physician practices, the article puts it this way -

Doctors are the hospital’s sales force, although they don’t like to think of it that way. Without doctors there are no admissions and no revenue to pay hospitals’ huge fixed expenses.

So hospitals have long been interested in owning physician practices, including a spurt of acquisitions in the 1990s in which many lost money and a renewed boom in the last decade as the Affordable Care Act promised to squeeze costs.

We thought the increased admissions was interesting from a patient access perspective.  From a public policy perspective, consider this -

“If these results are valid, then there are large implications,” said Martin Gaynor, a health economist at Carnegie Mellon University who was not involved in the study. “Hospital acquisitions of physician practices could disadvantage rival hospitals and harm competition.”

It is important to note that the data used in the Stanford study is pre-Affordable Care Act, so new data based on a new healthcare regime may yield different results different interpretations -

The health law encourages doctor-hospital collaboration in groups called accountable care organizations that put participants on the hook for financial and quality results.

ACOs are supposed to reduce incentives for hospitals to gobble market share, raise prices and slight quality — the kind highlighted by the Stanford paper.

Tuesday, August 18, 2015

Hospital wait times, noise levels and other information posted online through Yelp

See the Washington Post article: "You can now look up ER wait times, hospital noise levels and nursing home fines on Yelp" by Lena Sun (August 5, 2015).

The article reports on the emphasis being put on healthcare services by Yelp, with the help of ProPublica, a nonprofit news organization based in New York.

ProPublica compiled the information from its own research and the Centers for Medicare and Medicaid Services. The data is for 4,600 hospitals, 15,000 nursing homes, and 6,300 dialysis clinics in the United States, and it will be updated quarterly.

What's the big deal?  According to the article: "Much of the information about hospitals, for example, is available on Medicare's Hospital Compare Web page. But Yelp executives say the information is sometimes difficult to find and hard to sift through."

This data will be in addition to the Yelp star rating system based on consumer reviews: "Consumers have always been able to review medical businesses using Yelp's star-rating system. Those ratings will continue to be based on consumer reviews. What's different now is the additional data that will pop up."

How are hospitals reacting?  Let us know your thoughts.

See the Washington Post article: "How hospitals hope to boost ratings on Yelp, HealthGrades, ZocDoc and Vitals" by Lena Sun (June 3, 2015).

See how one "reputations manager" is addressing the online data, "after several months of reviewing comments in real time on nearly a dozen Web sites, including Healthgrades.com, ZocDoc.com and Google Plus, as well as Facebook and Twitter".

So to answer the question What's the big deal? consider this point about expectations:

"But putting hospitals and doctors into the online rating world is fraught with possible problems. For one, patients and doctors have widely differing expectations."

"When patients are asked to rate how doctor quality should be measured, clinical outcomes, such as getting cured of a disease, rarely come up, said Lisa Suennen, who advises health-care companies. Patients talk about whether a doctor or nurse was kind to them, or whether their experience was fast and convenient. It’s assumed that the doctor is going to treat their illness or condition."

"Physicians, on the other hand, go straight to the clinical. The cancer is gone. Or the person can walk again. They don’t even talk about the other stuff, Suennen said. The two groups “are really disconnected.”

Consider this: The healthcare system featured in the Washington Post article reported about two negative reviews a day. (A score of 3 or lower, out of 5). Some days there would be none. Then there was a week with seven negative reviews, all for doctors who hadn’t been rated before.

"One scored 1.9 out of 5 because the patient waited more than 45 minutes and had only a few minutes with the doctor. Another review complained about a rude receptionist. Most negative ratings have to do with wait times and scheduling."

The article discussed how a system may push out positive comments and how the Cleveland Clinic has developed its own rating system in addition to the patient satisfaction survey required by Medicare.

"Even the Cleveland Clinic, one of the country’s most prominent medical centers, felt the digital pressure. It rolled out its own doctor rating site in April for more than 1,550 doctors. Responses are drawn from a patient satisfaction survey required by Medicare, which many hospitals use internally to target areas for improvement."

"Unlike some sites that rely on one or two reviews, Cleveland Clinic displays only ratings for doctors who have been reviewed by at least 30 patients. Ratings — one to five stars — are updated weekly and include negative as well as positive comments."

And consider this strategy of creating 37 categories, including office staff and bedside manner. “If someone writes that ‘Dr. Smith seems very smart but he only spent 3 minutes with me,’ ” the doctor scores a 5 for competency but maybe 3 on beside manner.

Monday, August 3, 2015

Notice Act presented to President - written notice to be required for observation status of more than 24 hours

The Notice of Observation Treatment and Implication for Care Eligibility (NOTICE) Act, introduced as H.R. 876 on February 11 of this year, made a quick run through the legislative process, having passed the House on March 16 after committee consideration and passing the Senate on July 27.  It is now waiting the President's signature. This action follows close on the heels of the CMS proposed changes to the two-midnight rule.

Becker's Hospital Review posted "9 things to know about the Notice Act on July 29".  Follow the link to the original article written by Erin Marshall.  The text follows:

1. The legislation calls for hospitals to provide written notice to patients who are in the hospital under observation status for more than 24 hours. Hospitals would need to provide notification no later than 36 hours after the time observation status begins.

2. The written notice must include why the patient was not admitted to the hospital and the financial implications of observation status, including subsequent eligibility for coverage for a skilled nursing facility.

3. Medicare does not cover skilled nursing facility stays unless the patient was admitted as an inpatient for a minimum of three nights. In some cases, physicians reclassify people as inpatients when more than observation is needed. Medicare patients who are not reclassified have to either forgo SNF care or pay for it themselves, regardless of the length of their hospitalization.

4. Medicare Part A pays for inpatient stays. If you are hospitalized on observation status, payment by Medicare is under Part B, which covers physician and outpatient services. Patients without Part B coverage are often left with the bill for observation status, even though there was not a perceptible difference in the type or level of care they received in the hospital.

5. If the NOTICE Act is signed into law by President Obama, hospitals across the nation will have to comply within 12 months.

6. A number of states, including Connecticut, Maryland, New York, Pennsylvania and Virginia, already require hospitals to give patients notice about observation care.

7. There were an estimated 1.5 million observation stays among Medicare beneficiaries in 2012. The number of observation stays increased 100 percent from 2001 to 2009, likely because of financial pressure on hospitals to reduce potentially preventable readmissions of inpatients within 30 days.

8. Under the NOTICE Act, hospitals would be required to notify patients about observation status, but patients can only change that status by swaying a physician or the hospital to do so. Yale-New Haven (Conn.) Hospital CEO Marna Borgstrom noticed that after learning they were under observation care, many patients left the hospital against medical advice.

9. The NOTICE Act is separate from CMS' two-midnight rule, for which it recently proposed updates as part of the 2016 Hospital Outpatient Prospective Payment System and Ambulatory Surgical Center Payment System proposed payment rule.