Enrollment of Young Adults in Healthcare Exchanges

The Obama Administration announced Monday that young adults comprise nearly a quarter of the health plan enrollees. The Administration hopes to reach the goal that 38-40% of enrolled individuals will be young adults by the end of the enrollment period on March 31. 

The enrollment of 18-35 year olds is seen as crucial to the success of the healthcare plans. Politico reports that without young adult enrollment healthcare premiums could rise considerably and the healthcare market could become unstable. 

Despite doubts from some insurance companies, director of the Office of Health Reform of HHS, Mike Hash, expressed confidence that the newest numbers would result in "an appropriate mix" of young, healthy registrants and those with more expensive healthcare needs. Another senior official explained that a Kaiser Family Foundation report showed that only a quarter of the enrollees needed to be young adults to avoid the so-called death spiral to unstable healthcare markets. 

Hidden Costs of Duplicate Patient Records

A recent article by Patricia Consolver, Minimizing Duplicate Patient Records to Maximize Cash Flow, highlighted the relationship between a reduction in duplicate patient records and increases in revenue cycle efficiency. A 2008 RAND Corporation study found that the average duplicate patient record is 8 percent. In addition to the inherent risks to patient safety, duplicate and incorrect patient identifications have the potential to impair downstream financial activities such as delayed payments, appeals, and denials. 

The costs associated with duplicate records also include instances of repetitious lab and diagnostic tests that were performed, but documented in a duplicate record. Insurance companies often deny claims for repetitive tests. This results in care that the hospital will not be reimbursed for and cannot collect. 

Texas Health Resources, a 13-hospital system that serves over 1 million patients per year, implemented a four-step process during the transition to EHRs that resulted in a duplicate patient record rate of 0.36 percent. 

The Four-Step Process

1. Scrubbing the existing MPI
2. Identifying and selecting the correct patient records
3. Educating key stakeholders on avoiding duplicate creation
4. Monitoring performance

Education was necessary to ensure the EHR did not devolve to the state of MPI's duplicate records. Texas Health Resources education efforts were focused on both registration and medical record department employees. These courses emphasized the importance of using a full, legal name and the ways that duplicate records affect downstream activities in several areas of the hospital's operations. Data integrity teams were created to monitor the records and focus new education efforts on common mistakes that needed to be corrected. 

The implementation of similar systems is being evaluated at hospitals across the country as Meaningful Use requirements become effective. 

Affordable Care Act and Emergency Rooms: Enrollment Opportunity and Visits

NPR and Kaiser Health News reported Tuesday that California hospitals are beginning to provide emergency room patients with information on signing up for health insurance plans, expanded Medicaid programs, and possible subsidies to lower the cost of health insurance for those who qualify. Hospitals such as O’Connor Hospital are hiring more staff dedicated to health benefits and insurance coverage to reach out to the 5,000 uninsured patients their emergency department treats each year.

Benefits coordinators Araceli Martinez reports more uninsured patients view health insurance as an affordable possibility after Martinez provides them with information on coverage options. However, most uninsured that pass through her door find the process of purchasing insurance on their own for the first time daunting and confusing. About half of poor uninsured adults are unaware that they would qualify for Medicaid.

There is an economic motivation for hospitals to sign patients up. Increasing the number of patients with private insurance increases reimbursement rates. This is especially appealing at a time when hospitals are facing Medicare cuts. The expansion of Medicaid allows hospitals to receive payment retroactively for medical treatments if the patient enrolls in Medicaid. The retroactive payments may be applied to treatment received up to three months prior to the patient’s enrollment.

Jim Dover, president and CEO of O’Connor Hospital, explains that dedicating resources to enrolling patients in healthcare insurance plans is also a worthy goal because the newly insured patients “don’t have to come to the ER for common problems.” This is a common argument for increasing Medicaid enrollment.

The argument came under fire recently when Science published a study that concluded emergency room visits increased with the expansion of Medicaid. The study found that people recently enrolled in Medicaid went to the emergency room 40-percent more frequently than others, even when the conditions could be treated less expensively in a doctor’s office.

"Increasing coverage and seeing people use more medical care isn't necessarily a bad thing," said Dr. Renee Hsia, an associate professor of emergency medicine at University of California San Francisco and a health policy researcher who wasn't involved in the study but reviewed it for Science. "The outcome that we desire is not that we don't have people going to see their doctors anymore. The outcome is that we have people who feel protected from (financial problems and) seeking care when they feel they need it."

Sources for this Blog:

Kaiser Health News, “Emergency Rooms Are Front Line for Enrolling New Obamacare Customers” 

NPR, “California Hospital Workers Pitch Obamacare to ER Patients” 

Kaiser Health News, “Medicaid Expansion Boosted Emergency Room Visits in Oregon, Study Finds”

Associated Press story in Seattle Times, “Study finds Medicaid expansion drove up ERvisits”

CMS Revises Hospital Accreditation Program Requirements "Medications Management" Language

The Centers for Medicare and Medicaid Services (CMS) revised the language for Joint Commission standards of Conditions of Participation. The agency explained the revisions, published on Dec. 19, 2013, were issued to maintain uniformity within the Leadership and Medication Management chapters applicable to hospitals and critical access hospitals. 

The revisions remove the term "polysaccharide" from the list of vaccines requiring a specific order from a doctor to administer to a patient for both hospitals and critical access hospitals. The revisions also removes "inpatient hospital care" from the element of performance criterion specifying the types of services required to be provided to patients by critical access hospitals. 

The prepublication notice applicable to hospitals is available here. The prepublication notice applicable to critical access hospitals is available here. 

Study Finds Copy-Paste Function in Electronic Health Records Leads to Medicare Fraud

A report released by the Department of Health and Human Services (HHS) Wednesday outlined more flaws in the government oversight of adopting electronic health records. This is the second report issued by the HHS that specifically criticizes the CMS oversight of the federal program created to convert paper patient records to an electronic format. 

The report specifically points to the lack of clear "program integrity practices" to provide guidelines on the proper use of copy-paste, or cloning function, in updating electronic health records and recording new office visits and treatments. Doctors and hospitals use the feature to reduce the time it takes to input patient data. Many say that without this function the health practitioners would drown in the patient input process, to the detriment of the treatment quality for their patients. 

However, the report finds that widespread indiscriminate use of the cloning function may lead to the input of more extensive treatment and tests than actually occurred. This, in turn, leads to doctors overcharging Medicare for care that was not actually provided. There is also concern that without proper oversight this type of fraud may grow exponentially in the coming years with the implementation of electronic health records nationwide. 

The report issued by the Office of the Inspector General for the Health and Human Services Depart is available here.

Media coverage of the report is available at:

• New York Times, "Report Finds More Flaws in Digitizing Patient Files."