Medical Billing and Reviews - Health Care 2006

1

The Future of

Healthcare IT Is in the

Clouds

1

Milano Finanza

February 1999

Cellular Communications

International, Inc.

“A Smashing Victory”

Italia Oggi

April 2, 1994

Omnitel

Unitel*

Points assigned by

BAIN and Citibank

698.58

580.12

Investments pledged

Lit. 2 trillion

Lit. 1.5 trillion

Financial bid

Lit. 750 billion Lit. 707 billion

*Consortium led by Berlusconi

The HITECH Act

$50,000,000,000+Funding To

Revolutionize Healthcare I.T.

Grants

$10 Billion

Entitlements

$40 Billion

$25 Billion for Eligible

Professionals

$15 Billion for Hospitals

For HIEs, Rural Broadband,

Regional Extension Centers,

Education and Training,

Comparative Effectiveness

Research

Sections 3011-3016

Section 6001 and Titles I, XII

Sections 4101, 4102, 4201

USA

Germany

Italy

Israel

Health Care Costs

$ 7,900

$ 4,200 $3,100 $ 2,700

% GDP

17%

12%

10%

8%

Life Expectancy

78

80

82

82

Smokers

16%

22%

23%

20%

Obesity

34%

15%

10%

14%

Ambulatory Visits/

Capita

4

8

7

6

Gross National

Income/Capita

$47,000

$38,000

$31,000 $28,000

The Cost of Healthcare Is Destroying

The USA

6

Expenditure Disparities

Mayo Clinic

Cleveland Clinic

Johns Hopkins

Hospital

UCLA Medical

Center

Medicare Spending

$53,430

$55,330

$85,730

$93,840

Physician Visits

24

33

29

53

Days in Hospital

12

15

17

19

Hospital Beds

58

66

78

86

Source: The Dartmouth Atlas of Health Care 2008, as printed in Time Magazine June 29, 2009

End of Life Care Costs

Front page – New York Times, 9-18-06

Elyria Has 3 Times the Rate of

Angioplasties as Cleveland

Healthcare Wastes

•

57%

of patients must recount

medical or personal information

•

30%

of all U.S. healthcare costs go

to duplicative care

•

26%

of patients receive conflicting

information

Source: Markle Foundation, Robert Wood Johnson Foundation, Achieving Electronic

Connectivity in Healthcare, 2004

U.S. Adults Receive 55% of

0

20

40

60

80

Overall

Breast Cancer Hypertension

Asthma

Pneumonia

Hip Fracture Diabetes Mellitus

45

23

39

54

65

76

55

Overall

Breast Cancer

Hypertension

Asthma

Pneumonia

Hip Fracture

Diabetes Mellitus

McGlynn, June 26, 2003

Would You Fly Without a Checklist?

Would You Fly if a 747

Crashed Every 12 Hours?

Annual Deaths

Hospital Acquired Conditions

180,000

Lung Cancer

158,000

Breast Cancer

40,200

Pancreatic Cancer

36,800

Traffic Accidents

33,000

Prostate Cancer

32,000

AIDS

18,000

Total

318,000

“Adverse Events in Hospitals: National Incidence Among Medicare Beneficiaries”

70%

92%

64%

91%

Pneumonia

Heart Failure

2006

2003

2003

2006

Medicare Demonstration Project

Recommended Care

13

• The rate of death declined from

1.5%

to

0.8%

• Inpatient complications declined

from

11%

to

7%

Surgical Checklist

January 29, 2009

A Surgical Safety Checklist to Reduce

Morbidity and Mortality

0

2,0

4,0

6,0

8,0

16-18 months

1,4

7,7

Per 1000 Catheter Days

15

Catheter-Related Bloodstream

Infections in the ICU

eRX Is a “No-Brainer”

Source: Kaushal, R. et al, “Electronic Prescribing Improves Mediation Safety in Community-Based Office

Practices,” Journal of General Internal Medicine, 25(6): 530-6, February 26, 2010.

•

2 in 5

handwritten prescriptions

had errors

• Prescription errors reduced from

43%

to

7%

with e-prescribing

Cornell Medical College

•

75%

reduction in allergic drug

reactions and excessive dosages

•

45%

reduced in the average time

spent in the ICU

Kaiser eRX and Safety

Source: Clinical Information: Achieving the Vision, 2002; Kaiser Permanente

Physician Benefits of eRX

•

50%

of office phone calls are

related to prescriptions

1

• eRX can generate time savings of

1 hour

per nurse and

30 minutes

per file clerk per day

2

1. The Physician’s eHealth Report, November/ December 2004

2. Rhode Island Electronic Prescribing Project

The HITECH Act

$50,000,000,000+Funding To

Revolutionize Healthcare I.T.

Grants

$10 Billion

Entitlements

$40 Billion

$25 Billion for Eligible

Professionals

$15 Billion for Hospitals

For HIEs, Rural Broadband,

Regional Extension Centers,

Education and Training,

Comparative Effectiveness

Research

Sections 3011-3016

Section 6001 and Titles I, XII

Sections 4101, 4102, 4201

Medicaid Is at the Center

of Healthcare

The MITA Business Architecture, May 8,

2010

2011

2012

2013

2014

2015

2016

2017

ARRA

Medicaid

ARRA

Medicaid

ARRA

Medicaid

ARRA

Medicaid

ARRA

Medicaid

ARRA

Medicaid

ARRA

Medicaid

ARRA

Medicaid

ARRA

Medicaid

ARRA

Medicaid

Bonus

$63,750

$63,750

$63,750 $63,750 $63,750 $63,750

ARRA Medicare

ARRA Medicare

ARRA Medicare

ARRA Medicare

ARRA Medicare

ARRA Medicare

Bonus

$44,000

$44,000

$39,000 $24,000

Penalty

-1%

-2%

-3%

ePrescribing

ePrescribing

ePrescribing

ePrescribing

ePrescribing

ePrescribing

ePrescribing

ePrescribing

ePrescribing

ePrescribing

Bonus

2%

1%

1%

0.5%

Penalty

-1%

-1.5%

-2%

PQRI

PQRI

PQRI

PQRI

PQRI

PQRI

PQRI

PQRI

PQRI

PQRI

Bonus

2%

1%

0.5%

0.5%

0.5%

Penalty

-1.5%

-2%

-2%

Total Annual Penalties

Total Annual Penalties

Total Annual Penalties

Total Annual Penalties

-1%

-1.5%

-2%

-2.5%

-4%

-5%

Bonuses and Penalties for

Eligible Professionals

1. American Recovery and Reinvestment Act of 2009

2. Assumes 30% of patient volume is in underserved areas or communities 3. Assumes Medicare Part B revenues exceeds $25,000

15 Core

Objectives

20 Objectives to Accomplish Stage 1 MU*

5 of 10 Menu

Objectives

1 Core Objective

Requires

Satisfying 6 of 44

Clinical Quality

Measures

*Meaningful Use

15 Core

Objectives

20 Objectives to Accomplish Stage 1 MU*

5 of 10 Menu

Objectives

1 Core Objective

Requires

Satisfying 6 of 44

Clinical Quality

Measures

*Meaningful Use

15 Core

Objectives

20 Objectives to Accomplish Stage 1 MU*

5 of 10 Menu

Objectives

1 Core Objective

Requires

Satisfying 6 of 44

Clinical Quality

Measures

*Meaningful Use

Clinical Quality Measures Numerators / Denominators

NQF 0013

Hypertension: Blood Pressure

Measurement 1/1No exclusions

NQF 0028

Preventive Care and Screening Measure Pair: a. Tobacco Use Assessment, b. Tobacco Cessation Intervention 1/1 for a 1/1 for b No exclusions NQF 0421

Adult Weight Screening and

Follow-Up 2/2Possible exclusions

NQF 0018

Controlling High Blood Pressure 1/1

No exclusions

NQF 0027

Smoking and Tobacco Use Cessation,

Medical Assistance 2/2No exclusions

NQF 0061

Diabetes: Blood Pressure

Management 1/1Possible exclusions

Core Objectives

C01 CPOE for Medication Orders 30%

C02 Drug Interaction Checks Enable function

C03 Maintain Problem List 80%

C04 Permissible Prescriptions 40%

C05 Active Medication List 80%

C06 Medication Allergy List 80%

C07 Record Patient Demographics 50%

C08 Record Vital Signs 50%

C09 Record Smoking Status 50%

C10 Clinical Quality Measures-CQMs (from within this Objective you must choose six measures)

C11 Clinical Decision Support Rule 1

C12 Electronic Copy of Health Information

50%

C13 Clinical Summaries 50%

C14 Electronic Exchange of Clinical Information

1 test

C15 Protect Electronic Health 1 risk

Menu Objectives

M01 Drug Formulary Checks Enable function

M03 Patient Lists 1 report

M04 Patient Reminders 20%

M07 Medication Reconciliation 50%

M09 Immunization Registries Data Submission

1 test

Checklist

Objectives for Stage 1 MU

Rules-Based Engines

• Measures are

added

each year

• Measures are

adjusted

from year

to year

• Measures are

retired

26

Imagine MD Provides 4 Real-Time

Levels of Assurance of MU

1. MU Indicators

2. Patient level compliance dashboard

3. Provider level compliance dashboard

4. Dashboards provide necessary steps

to achieve compliance for each MU

objective

Real-Time Meaningful Use Dashboard

Multiple Language Capability

English

Italian

Russian

Page Code with place holders User Preferred Language P h r a s e Code LanID1 (English) LanID2 (German) L a n I D 2 (Portuguese)

1 Personal Details Persönliche Angaben Detalhes pessoais 2 Show History Historie anzeigen Mostrar Histórico 3 MRN MRN MRN

4 Status Status Status

5 Primary Provider Primary-Anbieter Provedor primário

Phrases Data Table

Page Display Engine

Multiple Language Capability

Prescription

Code

Personal ID

Note for Pharmaceutical

Association

Exceptions

Data of

Filings

Type of Prescription

Transmission to

Central Repository

Prescription

Diagnosis and ICD 9-CM

Code

Electronic Interconnection of

Doctors

Regulatory Reference – Mandatory Data To Be Transmitted

Electronically

Progetto Tessera Sanitaria Web Services per la

Trasmissione dei Certificati di Malattia all’INPS

Linkem Overview

42MHz of frequency spectrum 84MHz of frequency spectrum

License holder of 84MHz of spectrum

covering 80% of the population and

42MHz of spectrum covering the

remaining 20%

Over €190 million of capital funded to

date

FOR MORE INFORMATION PLEASE

VISIT OUR WEBSITE:

WWW.LINKEM.COM









Brescia

Key to Icons:

 Location of TI DSLAMs

 Linkem customers who do not have access to DSL

 Linkem customers who have access to DSL, but have reported

 DSLAM which is nearing saturation

 DSLAM which has reached full saturation

Brescia

39

Key to Icons:

 Location of TI DSLAMs

 Linkem customers who do not have access to DSL

 Linkem customers who have access to DSL, but have reported

 DSLAM which is nearing saturation

 DSLAM which has reached full saturation

Latina

Key to Icons:

 Location of TI DSLAMs

 Linkem customers who do not have access to DSL

 Linkem customers who have access to DSL, but have reported

 DSLAM which is nearing saturation

 DSLAM which has reached full saturation

Latina

41

Key to Icons:

 Location of TI DSLAMs

 Linkem customers who do not have access to DSL

 Linkem customers who have access to DSL, but have reported

 DSLAM which is nearing saturation

 DSLAM which has reached full saturation

Avezzano

Key to Icons:

 Location of TI DSLAMs

 Linkem customers who do not have access to DSL

 Linkem customers who have access to DSL, but have reported

 DSLAM which is nearing saturation

 DSLAM which has reached full saturation

Avezzano

Avezzano

44

Key to Icons:

 Location of TI DSLAMs

 Linkem customers who do not have access to DSL

 Linkem customers who have access to DSL, but have reported

 DSLAM which is nearing saturation

 DSLAM which has reached full saturation

WiMAX “Dish” for WiFi in

Outdoor “Dish”

47

The Future of

Healthcare IT Is in the

Clouds

47