Medical identity theft - fastest growing indentity crime in the U.S.

A NAHAM member found this article for us on bizjournals.com: Medical identity theft is fastest-growing identity crime in the U.S.

You may find the article here:

http://www.bizjournals.com/stlouis/blog/2015/03/medical-identity-theft-is-fastest-growing-identity.html?iana=ind_health&page=all

Medical identity theft has impacted over 2.3 million Americans. The ramp up in this type of identity theft makes it the fastest growing identity crime in the U.S.  The authors make note of the recent Anthem data breach and conclude that one in three Missourians are impacted by medical identity theft.

 

In February, Anthem, the nation’s second-largest health insurer, announced that its systems had been the target of a sophisticated external cyber-attack. This attack, one of the largest data breaches in U.S. history, impacted one in three Missourians, according to state officials. Since the breach involved health insurance information as well as Social Security numbers, the affected individuals are at true risk of medical identity theft.

 The two most common forms of medical identity theft?

The two most common include an individual posing as someone else in order to secure medical goods, prescriptions or services; or an individual billing someone else’s insurance, Medicare or Medicaid without their knowledge.

 

As with other types of identity theft, the victim often doesn't realize what has happened. But the risks associated with healthcare can be significant.

 

The affected person does not realize fraudulent activity has occurred. Electronic health records could be fraudulently changed, meaning anything from incorrect allergies to preexisting conditions. This could lead to a future misdiagnosis or inappropriate medical treatment.

Healthcare providers should take note.  There is a patient expectation that providers are proactive in guarding against identity theft.

Health care providers without effective security measures should take note: 48 percent of consumers said they would consider changing health care providers if their medical records were lost or stolen, according to the Ponemon Institute’s Fifth Annual Study on Medical Identity Theft. Consumers expect health care providers to be proactive in preventing and detecting medical identity theft. Forty percent say that if a breach occurs, it is important to receive immediate notification by the organization responsible for protecting their health care information.

So what is a provider to do?

 

While medical identity theft is most harmful to a consumer, organizations that handle personal health information (PHI) can suffer costly legal ramifications as well as a tarnished brand if they are the source of the data breach. To be less susceptible to these and other liabilities, cyberattack prevention and cyber insurance plans should be in place. While there are several components that make up an effective cybersecurity strategy, the following can be the key lines of defense against an attack or when facing ramifications:

 

• Encryption — Data at rest and data in motion should be encrypted to at least the levels recommended by HIPAA legislation. This will help minimize the risk that data is compromised.

 

• Data leak prevention (DLP) — Also known as data loss prevention, DLP is a data security technology that monitors data in use, in motion and at rest in order to detect potential data breaches in a timely manner and prevent them. A DLP system configured properly handles careless data leaks by internal sources as well as intentional data theft by external hackers or malware.

 

• Cyber insurance — Organizations that store or transmit personally identifiable information (PII) should review the insurance options for cyber protection. A variety of insurance policies cover things like the cost of fines, notification that PII has been compromised, liability and business interruption. Cyber policies vary greatly and an independent insurance consultant can help review the best coverage option.

 

Do you have any best practices or policies to share?  Please let us know.

 

Hospital Efforts to Improve Patient Satisfaction

Kaiser Health News reported earlier this month on hospital efforts to improve patient satisfaction.  See the report Hundreds Of Hospitals Struggle To Improve Patient Satisfaction, which also had a 4 minute air on National Public Radio.

The report notes the growing importance of patient satisfaction surveys, driving in large part by the prospects of pay levels from Medicare and some private insurers.

Since Medicare began requiring hospitals to collect information about patient satisfaction and report it to the government in 2007, these patient surveys have grown in influence.  For the past three years, the federal government has considered survey results when setting pay levels for hospitals. Some private insurers do as well.

Read the article in full and search for hospital patient satisfaction survey results.

Hospitals randomly survey former patients to learn about the quality of their stays. These surveys are collected and information from them is published by the U.S. Centers for Medicare & Medicaid Services, which also uses the results when setting Medicare pay rates.

Follow the link to the article above and use the imbedded tool to see how patients rated hospitals across the country on 11 topics and how each hospital compares with state and national averages. These scores reflect responses from patients who were discharged between January 2013 and December 2013. They include responses from adult patients and are not restricted to those on Medicare. 

 

What's at stake with Affordable Care Act challenge in the Supreme Court?

The Supreme Court has already ruled on the Affordable Care Act based on an early constitutional challenge.  But the law is back at the Court based on a challenge that hinges on just four words in the 2012 law.

CNN provides an easy to understand primer on what's at stake this time around.  Find the article, "The latest Obamacare challenge: What you need to know" here.

The article explains that the law establishes the creation of exchanges "through which individuals can purchase competitively priced health insurance".  Sixteen states and the District of Columbia have set up their own exchanges. Folks living in the other 34 states must use the exchange run by the federal government.  And the law provides federal tax credits to income eligible individuals "to help offset the cost of the policies". 

Most of us remember all of this.  States set up their exchanges where you shop for your healthcare coverage.  Lots of governors or state legislatures chose not to create their own exchanges, so their citizens go to the exchange run by the federal government.  And because everyone is supposed to sign up if they don't have coverage elsewhere, the Affordable Care Act provided federal tax credits to help lower income individuals and families buy coverage. 

Simple enough.  Except, those bringing the case that is now before the Supreme Court say the law did not authorize those tax credits for those having to use the federal run exchange.  That's where the four words in the law passed by Congress comes in. 

A synopsis from the CNN article:

The health care law provides for the establishment of "exchanges" through which individuals can purchase competitively priced health insurance. It also authorizes federal tax credits to low- and middle-income Americans to help offset the cost of the policies. Currently 16 states plus the District of Columbia have set up their own exchanges; the remaining 34 states rely on exchanges run by the federal government. Those bringing the case say that the words "established by the State" in a subsection of the law make clear that subsidies are only available to those living in the 16 states that set up their own exchanges. If the court says the IRS rule is invalid, absent some kind of action by the states or Congress, more than 5 million individuals will no longer be eligible for the subsidies, shaking up the individual market.

So this time around the law in its entirety is not at stake.  But apparently the help through tax credits for 5 million individuals is at stake.  (CNN reports that in 2014, more than 5.3 million individuals selected an insurance plan through the federal exchange.)  We'll find out if Congress goofed or not.

Here is how CNN explains it:

Those challenging the law this time say: Congress limited the subsidies in order to encourage the states to set up their own exchanges. But when only a few states acted, the IRS tried to "fix" the law and wrote a rule allowing subsidies for those living in states with state-run exchanges as well as states with federally run exchanges.

The government, defending the law, says: the language at issue is a "term of art" and that Congress always intended the subsidies to be available to everyone. ... it was clear that some states would not establish their own exchanges.

There is a little technicality that is also interesting.  Challenges must have standing - that is to say that have to show that they are being harmed by the law.  The challengers in this case are residents of Virginia, one of the 34 states that did not create their own exchange.  So these Virginia residents don't get the tax credits.  Without the tax credits they can't afford health care coverage offered through the federal exchange.  So sounds like they want the tax credit.  Apparently not.  Remember the "individual mandate" part of the Affordable Care Act - if you don't get coverage, you get a penalty? 

As CNN explains:

The crux of their argument is that if it were not for the tax credits for premiums, they could not afford health insurance and thus would be exempt from the individual mandate to purchase health insurance.

 

 

 

 

 

 

Open Notes and Patient Portals?

Who manages patient access to their health records?  What technology are you employing?  Let us know. 

This article from Reuters made us want to hear from you.

The article posted Tuesday, February 24, "Patients, doctors see benefits of sharing medical records" may be found here.

It introduces the story of a patient who began using OpenNotes when her multiple sclerosis created increasing challenges for her to remember what happened at her last appointment and what follow-ups she was responsible for.

The article cites a new paper online in the British Medical Journal which demonstrates that patient access to their records, including physician notes, can lead to more collaboration between doctor and patient and more educated, engage healthcare consumers as patients.

One metric discovered: "After one year, 99% of patients wanted to continue accessing notes. Despite initial concerns among physicians about additional work, none decided to discontinue use."  And the age of the patient was not a factor in patients using portals to access their information.

Find more information on the study here.

What experiences have you had with managing patient access to their EHR information and the use of patient portals?

Let us here from you!

What are you seeing or reading about measles?

One article, "Measles May Be in U.S. to Stay, 15 Years After It Left" one of our members found here: By Anna Edney and Michelle Fay Cortez January 26, 2015 - http://www.businessweek.com/news/2015-01-26/measles-threatens-u-dot-s-dot-comeback-years-after-elimination-health

Here is a summary: 

Measles could once again become native in the U.S., as an outbreak in California linked to Disneyland has put a spotlight on a growing failure to vaccinate that’s helping the disease to spread.

While 94 percent of California kindergarteners were fully inoculated against the virus last school year, in some pockets of California, as much as a quarter of children are undervaccinated

 

This puts these children at risk of both contracting the disease and becoming a nexus of future spread.

Some facts cited in the article:

 

In 1990, 3 of every 1,000 children who got measles died from it.  

The virus is one of the most contagious pathogens known to man, and causes more serious complications in about three of 10 patients, according to the CDC.

 

It was declared eliminated in the U.S. in 2000

 

Outbreaks are instead started by people visiting from outside the U.S. or who return and bring it back.

The virus is highly contagious, spread through the air by coughing and sneezing. It is also insidious, with patients become infectious four days before the telltale rash appears.

The first vaccine became available in 1963, with the current combination shot approved in 1971. A single injection is 93 percent effective, rising to 97 percent for those who get both doses.

While the poor have long had lower rates of vaccination because of the cost, the number of unvaccinated children in other communities who don’t get their shots is growing because of worries vaccines are linked to autism. Doctors have debunked any such link.

Health experts fear "Re-establishing transmission": 

Re-establishing transmission would mean there is sustained chain of infection among U.S. citizens and the disease can no longer be considered eliminated. The CDC warned in 2012 that without high vaccination rates, measles could return.

Anthony Fauci, director of the U.S. National Institute of Allergy and Infectious Diseases, said measles re-establishing itself is less likely than the U.S. developing more frequent outbreaks from imported cases.

“You have parents who don’t allow their children to be vaccinated, and they’re clustered in certain areas,” Fauci said in an interview. The parents reinforce their philosophy of not wanting to get the kids vaccinated. So you have a cadre of kids who aren’t vaccinated and someone comes in from a foreign country that does have endemic measles, and you get outbreaks.’’

While there have been a few hundred cases at most documented in the U.S. each year since 2000, 2014 saw a sharp increase to 644 cases representing 23 outbreaks, the CDC said.

The largest outbreak last year occurred among non-vaccinated Amish communities in Ohio where 382 people caught measles. California took the runner-up title with 60 residents falling sick in just the first five months of the year.

 

 

 

 

Article on Medicare Alternative Payment Models

Medicare Unveils Alternative Payment Models

Find the source article here: Christopher Cheney, for HealthLeaders Media , January 27, 2015 - http://www.healthleadersmedia.com/print/HEP-312576/Medicare-Unveils-Alternative-Payment-Models

Here is the summary:

 

HHS officials highlight a three-year payment reform timeline, which calls for boosting fee-for-service Medicare reimbursements and increasing reimbursements linked to quality and value.

Federal officials have announced an accelerated effort to use payment reform as a mechanism to shift Medicare and the broader healthcare industry away from the fee-for-service model.

3-Year Timeline

A three-year payment reform timeline is expected to 1) boost the percentage of fee-for-service Medicare reimbursements based on alternative payment models (APM) and 2) to increase the percentage of all reimbursements linked to quality and value.

In the early phase of the payment reform initiative's implementation, APMs will be limited to three pathways: Medicare's existing accountable care organization efforts, the Pioneer ACO program and the Medicare Shared Savings Program; bundled payments; and payment models tied to patient-centered medical homes.

More ambitious value-based payment models are in the works, including episode-of-care payment for chronic illnesses and oncology care that will require providers to shoulder a significant level of cost risk.

The metrics are reported as follows -

 

The reform initiative calls for Medicare fee-for-service payments through APMs to rise from the current 20% level to 30% by the end of 2016. The percentage is slated to rise to 50% by the end of 2018.

It additionally calls for the percentage of Medicare payments that are linked to quality and value to reach 85% by 2016 and 90% by 2018. Existing Medicare quality and value linked payment programs include the Hospital Value-Based Purchasing (VBP) program and the Hospital Readmission Reduction Program (HRRP).

Marrying Value-Based Care Delivery With Value-Based Payment

HHS officials started foreshadowing the Medicare payment reform initiative in the fall.

In November, the Centers for Medicare & Medicaid Services released details about developing and optimizing APMs, linking fee-for-service payments to quality and value, Medicare ACO and bundled payment projects, and PCMH models.

 

A primary goal of the Medicare payment reform initiative is to develop and enhance the alignment between value-based healthcare delivery and value-based healthcare payment models.

Read the article here: http://www.healthleadersmedia.com/print/HEP-312576/Medicare-Unveils-Alternative-Payment-Models

Medicare Spending on Children Results is Good for Income, New York Times Reports

Recently, Margot Sanger-Katz wrote the following article outlining a study that showed providing government health care to children correllated with a boost in future earnings that may result in the government recouping some of the funds used to provide the medical care with income taxes.

The article follows:

"When advocates talk about the advantages of government health care, they often talk about a moral obligation to ensure equal access. Or they describe the immediate health and economic rewards of giving people a way to pay for their care.

Now a novel study presents another argument for the medical safety net, at least for children: Giving them health coverage may boost their future earnings for decades. And the taxes they pay on those higher incomes may help pay the government back for some of its investment.

The study used newly available tax records measured over decades to examine the effects of providing Medicaid insurance to children. Instead of looking at the program’s immediate impact on those children and their families, it followed them once they became adults and began paying federal taxes.

People who had been eligible for Medicaid as children, as a group, earned higher wages and paid higher federal taxes than their peers who were not eligible for the federal-state health insurance program. And the more years they were eligible for the program, the larger the difference in earnings.

“If we examine kids that were eligible for different amounts of Medicaid over the course of their childhood, we see that the ones that were eligible for more Medicaid ended up paying more taxes through income and payroll taxes later in life,” said Amanda Kowalski, an assistant professor of economics at Yale and one of the study’s authors.

The results mean that the government’s investment in the children’s health care may not have cost as much as budget analysts expected. The study, by a team that included economists from the Treasury Department, was able to calculate a return on investment in the form of tax revenue.

The return wasn’t high enough to pay the government back for its investment in health insurance by the time the children reached age 28, when the researchers stopped tracking the subjects. By that age, the Treasury had earned back about 14 cents for every dollar that the federal and state governments had spent on insurance. But it did suggest that, if the subjects’ wages continued to follow typical trajectories as they aged, the federal government would earn back about what it spent on its half of the program by the time the children reached 60 — about 56 cents on the dollar, calculated using a formula that took into account the time value of money.

The split in spending between the federal and state governments for Medicaid varies by state, but, on average, federal taxpayers pay 57 cents of each dollar. There may also be some return on investment for states that collect income taxes, but the researchers didn’t measure that.

Here’s what that means in real numbers: The average person in the study with no Medicaid earned a total of $149,000 by age 28. For each year a person was eligible for Medicaid, that income went up by $250, and the taxes the person paid went up accordingly.

“What’s exciting about this is how good the outcome variables that they can look at,” said Janet Currie, a professor of economics and public affairs at Princeton. A few studies have tracked the health outcomes of children who were eligible for Medicaid over time, including one Ms. Currie wrote, but the study’s measures of economic outcomes are new.

The new paper was made possible by a series of policy changes throughout the 1980s and 1990s that slowly expanded Medicaid to cover more and more American children. The changes essentially happened in two phases: First, the federal government allowed the program to include older children, and then individual states approved expansion to those groups. The slow, state-by-state spread of the policy enabled the researchers to compare children who were eligible for Medicaid with a control group of similar children of the same age and family income level who were not eligible for the program. The study looked at children who were eligible for Medicaid, even though not every eligible child actually signed up.

Ms. Currie said that earlier studies of children’s health outcomes also suggest that children with serious illnesses often go on to be sick as adults as well — meaning they are more likely to miss work or have limited career options. Medicaid supports and funds a lot of important preventive health care for very young children. She said the lesson could be that “an ounce of prevention is worth a pound of cure.”

Now that the earlier expansions have had a chance to spread, nearly every low-income child in the country is eligible for Medicaid, and more than a third of all American children are currently enrolled in either Medicaid or a closely related federal-state program, called the Children’s Health Insurance Program.

“If this is right, then we’re going to be seeing a lot more impact for the kids that are born now and in the future,” said Judy Solomon, a vice president for health policy at the left-leaning Center on Budget and Policy Priorities."