Medicare Is Faulted on Shift to Electronic Records


From the New York Times

November 29, 2012

By 

The conversion to electronic medical records — a critical piece of the Obama administration’s plan for health care reform — is “vulnerable” to fraud and abuse because of the failure of Medicare officials to develop appropriate safeguards, according to a sharply critical report to be issued Thursday by federal investigators.

The use of electronic medical records has been central to the aim of overhauling health care in America. Advocates contend that electronic records systems will improve patient care and lower costs through better coordination of medical services, and the Obama administration is spending billions of dollars to encourage doctors and hospitals to switch to electronic records to track patient care.

But the report says Medicare, which is charged with managing the incentive program that encourages the adoption of electronic records, has failed to put in place adequate safeguards to ensure that information being provided by hospitals and doctors about their electronic records systems is accurate. To qualify for the incentive payments, doctors and hospitals must demonstrate that the systems lead to better patient care, meeting a so-called meaningful use standard by, for example, checking for harmful drug interactions.

Medicare “faces obstacles” in overseeing the electronic records incentive program “that leave the program vulnerable to paying incentives to professionals and hospitals that do not fully meet the meaningful use requirements,” the investigators concluded. The report was prepared by the Office of Inspector General for the Department of Health and Human Services, which oversees Medicare.

The investigators contrasted the looser management of the incentive program with the agency’s pledge to more closely monitor Medicare payments of medical claims. Medicare officials have indicated that the agency intends to move away from a “pay and chase” model, in which it tried to get back any money it has paid in error, to one in which it focuses on trying to avoid making unjustified payments in the first place.

Late Wednesday, a Medicare spokesman said in a statement: “Protecting taxpayer dollars is our top priority and we have implemented aggressive procedures to hold providers accountable. Making a false claim is a serious offense with serious consequences and we believe the overwhelming majority of doctors and hospitals take seriously their responsibility to honestly report their performance.”

The government’s investment in electronic records was authorized under the broader stimulus package passed in 2009. Medicare expects to spend nearly $7 billion over five years as a way of inducing doctors and hospitals to adopt and use electronic records. So far, the report said, the agency has paid 74, 317 health professionals and 1,333 hospitals. By attesting that they meet the criteria established under the program, a doctor can receive as much as $44,000 for adopting electronic records, while a hospital could be paid as much as $2 million in the first year of its adoption. The inspector general’s report follows earlier concerns among regulators and others over whether doctors and hospitals are using electronic records inappropriately to charge more for services, as reported by The New York Times last September, and is likely to fuel the debate over the government’s efforts to promote electronic records. Critics say the push for electronic records may be resulting in higher Medicare spending with little in the way of improvement in patients’ health. Thursday’s report did not address patient care.

Even those within the industry say the speed with which systems are being developed and adopted by hospitals and doctors has led to a lack of clarity over how the records should be used and concerns about their overall accuracy.

“We’ve gone from the horse and buggy to the Model T, and we don’t know the rules of the road. Now we’ve had a big car pileup,” said Lynne Thomas Gordon, the chief executive of the American Health Information Management Association, a trade group in Chicago. The association, which contends more study is needed to determine whether hospitals and doctors actually are abusing electronic records to increase their payments, says it supports more clarity.

Although there is little disagreement over the potential benefits of electronic records in reducing duplicative tests and avoiding medical errors, critics increasingly argue that the federal government has not devoted enough time or resources to making certain the money it is investing is being well spent.

House Republicans echoed these concerns in early October in a letter to Kathleen Sebelius, secretary of health and human services. Citing the Times article, they called for suspending the incentive program until concerns about standardization had been resolved. “The top House policy makers on health care are concerned that H.H.S. is squandering taxpayer dollars by asking little of providers in return for incentive payments,” said a statement issued at the same time by the Republicans, who are likely to seize on the latest inspector general report as further evidence of lax oversight. Republicans have said they will continue to monitor the program.

In her letter in response, which has not been made public, Ms. Sebelius dismissed the idea of suspending the incentive program, arguing that it “would be profoundly unfair to the hospitals and eligible professionals that have invested billions of dollars and devoted countless hours of work to purchase and install systems and educate staff.” She said Medicare was trying to determine whether electronic records had been used in any fraudulent billing but she insisted that the current efforts to certify the systems and address the concerns raised by the Republicans and others were adequate.

The report also takes to task another federal agency that certifies the software systems used to qualify for the Medicare incentive payments, saying it should do more to ensure the systems’ reports are accurate and meet the “meaningful use” criteria.

Medicare has not audited any of the $3.6 billion payments it has made to date, according to the report, which faults the agency for its lack of prepayment review and reliance on self-reporting after money has been spent.

In their written response to the report, federal officials said they agreed with some of the inspector general’s recommendations that they clarify what hospitals and doctors need to do to qualify for the payments. But Marilyn Tavenner, the acting administrator for Medicare, strongly disagreed with the idea that the agency should do more to ensure payments are appropriate before writing a check.

Requiring an audit before paying hospitals and doctors “could significantly delay payments to providers,” she said, and these reviews “would also impose an increased upfront burden on providers.” Ms. Tavenner said Medicare took some steps to make sure providers were eligible for the payments but “does not believe prepayment audit is necessary at this juncture.” Medicare maintains that it has systems in place to verify the information being submitted.

Medicare has developed plans to audit payments it has made since the program started in 2011 and says it expects to issue additional guidance for hospitals and doctors.

The other federal agency, the Office of the National Coordinator for Health Information Technology, agreed with the inspector general’s recommendations and said officials were already working to improve the process of certifying systems.

The inspector general said Medicare should be able to review at least some payments before they were made to determine whether the hospitals and doctors actually qualified. The investigators suggest identifying a small number of providers where the information provided was inconsistent and conducting a review or audit.

 

GOP Politician’s Outrageous Father-to-Son Lesson: Women “Rape So Easy” #wtfnews


Wisconsin rep. endorsed by Paul Ryan blames women for being so darn rape-able.
October 11, 2012  |

Clearly it’s not as simple as “no means no.”

A Wisconsin freshman representative is watching his re-election chances plummet as his comments that “some women rape easy” begin to circulate in the media, fueling another round of outrage over the GOP’s seeming blatant ignorance about women’s health and safety.

State Rep. Roger Rivard (R-Rice Lake) made the statement last December, explaining that as a young boy his father had scared him into pre-marital sex by telling him that “some women rape easy,” which is apparently bro-talk for the widespread phenomenon of women consenting to sex at night only to turn around the next morning and cry rape. The comments are drawing attention now, almost ten months later, because Rivard is in a tight race against Democratic challenger Stephen Smith over the state representative seat and because Rivard has been endorsed by GOP Vice Presidential candidate Paul Ryan.
Rivard has complained that his comments were taken out of context since they were first published in a local town newspaper, The Chetek Alert, after the representative commented on the case of a high school senior being charged with sexual assault for having sex with a girl under 18, which is the legal age for consent in Wisconsin.
Rivard attempted to clarify his words to the Milwaukee Journal Sentinel yesterday:
“[My father] also told me one thing, ‘If you do (have premarital sex), just remember, consensual sex can turn into rape in an awful hurry,’ ” Rivard said. “Because all of a sudden a young lady gets pregnant and the parents are madder than a wet hen and she’s not going to say, ‘Oh, yeah, I was part of the program.’ All that she has to say or the parents have to say is it was rape because she’s underage. And he just said, ‘Remember, Roger, if you go down that road, some girls,’ he said, ‘they rape so easy.’
“What the whole genesis of it was, it was advice to me, telling me, ‘If you’re going to go down that road, you may have consensual sex that night and then the next morning it may be rape.’ So the way he said it was, ‘Just remember, Roger, some girls, they rape so easy. It may be rape the next morning.’
“So it’s been kind of taken out of context.”
Doesn’t sound like it’s been taken out of context at all. The explicit point of his words is that women can’t be trusted (with sex, but really why with the vote either?) and that rape is not a real form of violence but actually just a false claim that could ensnare any God-fearing, unsuspecting young man who momentarily falls victim to the Sirens’ cries.
Rivard’s supporter Paul Ryan was able to avoid uttering one of these women-hating, rape-denying slips last night during the vice presidential debate. But other members of the GOP, most notoriously Todd Akin, have been recently caught issuing similar statements, such as the idea that no “legitimate rape” can result in pregnancy because a woman’s body has a way of dealing with these types of things. These comments sparked outrage not only for being offensive, but also for betraying a clear lack of knowledge about the basic anatomy of women’s bodies–a scary ignorance for a lawmaker in an era when medical care is increasingly regulated and decided by the government.
Both these comments also display a clear inability to talk about sexual consent in a meaningful way. How else, after all, could a fun romp in the sack turn into one of the most psychologically and physically damaging experiences a woman can have a mere eight hours later? The confusion and struggle to discuss consent is unsurprising, given the fact that adolescent sexual education is nearly non-existent. Changing that won’t be possible until we have lawmakers who are willing to support the idea that teenagers (who will soon grow into adults) should be informed about not only how sex biologically works, but how it can be navigated in a way that is physically and emotionally consensual.
Since that’s looking like it may be a long-time coming in this political climate, we can at least thank Akin for assuring us that none of the next generation’s ignorance-fueled rapes will result in any babies.

 

Laura Gottesdiener is a freelance journalist and activist in New York City.

 

Missouri Republicans Pass Two Anti-Abortion Bills Allowing Employers And Doctors To Deny Women Birth Control


 

March 31, 2012
By Stephen D. Foster Jr.

Missouri is now the top contender for the title of most insane and most anti-women conservative state in America. On Thursday, Missouri Senate and House Republicans passed two bills that could cripple women’s access to abortion and contraception. One bill allows employers to deny coverage for contraception and abortion services for religious reasons and the other bill gives doctors, nurses, and pharmacists the same power.

According to St. Louis Today:

“The Senate passed a bill that would let employers deny health insurance coverage for birth control for employees who cannot prove a medical need for it.” On the same day, the House “passed a bill that would shield health care workers from participating in anything that conflicts with their conscience.”

In other words, an employer can grill a woman about why she needs contraception, and if she doesn’t give a satisfactory reason, it won’t be covered. And if a woman needs an emergency abortion or is raped and needs an abortion, the medical staff can refuse to help her.

Republican Senator John Lamping and House Republican Tim Jones are the sponsors of the bills. Lamping says “employers today have the right to offer whatever benefits they want,” and that his bill would somehow exempt employers from the new health care laws found in the Affordable Care Act and the new contraception coverage rules set forth by the Obama Administration. Meanwhile, Jones says his legislation is about religious freedom and not the reproductive rights of women.

Jones and Lamping are damned liars. These bills are all about denying women rights over their reproductive health. Lamping’s bill gives employers free reign over what women are doing in their private sex lives. Employers have no right to interfere in what a female employee does with her own body. How exactly is an employee supposed to know if a woman is telling the truth about what the contraceptives are for? Demand a doctor note? Have access to medical records? And what happens if the female employee is lying to protect her own privacy? Will she be wrongly fired for making her own decisions regarding her uterus? That’s exactly why this bill is dangerous. Employers have no right to know what a woman does with her sex organs. It violates the privacy and personal liberty of women and doctor/patient confidentiality.

Jones’ bill is just as dangerous and perhaps even more so. Not only could this bill allow doctors and pharmacists to deny women contraception, it allows doctors and nurses to refuse medical care to women who need an abortion. So if a woman needs an emergency abortion because of a life threatening ectopic pregnancy, medical personnel can turn their collective backs on her while precious time is wasted that could be used to save her life. This bill is a ‘Let Women Die’ bill and Jones knows it.

These bills are being passed under the excuse of religious freedom, but this is clearly not about religious freedom. It’s about eliminating women’s rights and destroying privacy and personal liberty. It’s about the conservative hatred of independent women who make their own choices without the permission of men. Republicans are disgracing Missouri and if these two bills actually become law, the state should henceforth be known among women as ‘Misery’.