Emergency Regulations proposed for Covered California Is It ? Jones Releases Emergency Rule Over Narrow Provider Networks

Are you one of the hundreds of thousands who accepted the incompetent design of 'The Affordable Care Act ?  You are not alone.

It has taken more than one year of operation for state health officials to recognize this current disaster. 

The affordable care act has delivered an empty promise, deception, and a boiler plate plan that gives  you a health insurance card...Good luck after that.

Sick patients require help and assistance. Those who are well and especially those who have an acute or chronic illness have many challenges in life, should not and cannot negotiate the web sites, and even when they do, much of it is incomprehensible.  

Haste in signing up due to arbitrary guidelines and enrollment dates add additional challenges for those still uninsured, and those who have discovered just how terrible their new plans are presents challenges for most.

Help may be on the way now that State Commissioner for Health Insurance, Dave Jones is responding to complaints from California Consumers.  Jones is the head of the California Managed Care programs.





California State Health Commissioner, Dave Jones

On Monday, the California Department of Insurance issued an emergency regulation that aims to address narrow provider networks in the state and improve residents' access to care, Capital Public Radio's "KXJZ News" reports. 

According to the state Department of Managed Health Care, several insurers, including Anthem, have violated state law by misleading consumers about the size of their provider networks  State Insurance Commissioner Dave Jones (D) said DOI has "received complaints from consumers across the state about long waiting times, about inaccurate directories of providers, about being charged out-of-network costs when there isn't an in-network provider. The list goes on and on and on" 

Details of Emergency Regulation

The emergency regulation requires insurers to:

• Adhere to new standards for appointment wait times (DOI release, 1/5);
• Offer an adequate number of physicians, clinics and hospitals to patients who live in certain areas;
• Provide an accurate list of in-network providers ("KXJZ News," Capital Public Radio, 1/5);
• Provide out-of-network care options for the same price as in-network care when the number of in-network providers is insufficient; and
• Report to DOI information about their networks and any changes.

The emergency regulation will go into effect after it has been reviewed by the Office of Administrative Law. According to a release, emergency regulations often go into effect more quickly than standard regulations (DOI release, 1/5).

According to Jones, he can bar insurers that do not comply with the regulation from selling insurance in the state next year 

Health Reform to 2014 and Beyond or Back to the Future

The More You Understand About the 2014 Changes,  The Better.

If you had not noticed.

I am retired from clinical practice, and  admit I miss seeing patients.  My career goals have changed as some of you have noticed.

During the last decade I became interested in health information technology and set out to communicate with fellow professionals.  Readers of Health Train Express and it's predecessor will see an evolution, beginning with electronic medical records, health information exchange, health reform, mobile health applications, remote monitoring, and telehealth. They all serve to integrate our health communications for providers and patients.

During the last 12 months I was diverted by the Affordable Care Act and  the promises of Accountable Care Act. The potential for these new paradigms are great, however the day to day activities of providers and hospitals will  increase their load, and without additonal reimbursements. Providers have been expected to make huge capital outlays for health IT, design,implement and use these new systems.  They are directed at reductions in reimbursements to allow the large growth in patient access.  i doubt whether there will ber an actual decrease in the gross outlays for health care.  However during the past two years there have been reports of a decrease in the rate of growth.

There are some key actions to implement changes:  These webinars are designed to address specific areas that will require action.

Understanding Payment Reform - Beyond Fee For Service 

In the past decade there were some pre-paid and capitated models. The new paradigm is to approach payments connected to outcomes.  How they will be measured is open to great debate, and the subject should be addressed actively and with transparency before changes are made to avoid a catastophe such as the Health.gov benefit exchanges.  Some of these issues may be addressed by a 'global fee to hospitals and providers and/or medical groups as part and parcel of integrated medical systems.

Understanding The 2014 EHR Incentive Program 

The webinar addresses objective information for non-acute providers,practice and clinics on how to prepare for 2014 changes to the CMS EHR Incentiviei Programs.

An ICD-10 GEMS Crosswalk Overview

GEMS is a term which most providers are not familiar. CMS on it's web site offers these white papers. 

• 2013 General Equivalence Mappings - Diagnosis Codes and Guide [ZIP, 583KB]
• 
  

     The compressed zip files contain 3 white papers.

     The Dxgem file addresses specifics of conversion from ICD9 to ICD10.

MDs Everywhere's Vice-President of Development, Doug Salas explains the impact of 14,000 ICD codes expanding to 70,000 will have on documenting

Understanding HIPAA Requirements and Safety Measures 

HIPAA has been around since the mid 1990'. Providers have always known the standards of ehtical private confidentiality.  HIPAA was designed for others, institutions who deal with large amounts of patient health and financial data.  Penalties and fines are impressively high and the law has been enforced agains several large hospitals and other custodians of health records.

Recording and Archived:  (In case  you cannot attend the webinar at it's schedule time) At the time of registration you will receive a link and a date, which can be downloaded to an Outlook  .ics file.

All of the webinars will be archived for later viewing

Health Software Vendors

Software and hardware age quickly in health care. Software and hardware evolve, change and become obsolete quickly in the course of five years. Much changed during this 1/2 decade as providers and hospitals geared up for the HIT revolution.

Just ten years ago (2004) EMRs were very few and only 10-25% of providers or hospitals had any type of electronic health record.   The concept of health information exchanges and interoperability were still seminal ideas. Mobile health applications were few.

Following the HITECH Act the progress has been staggering. On the one hand it stimulated the adoption of EHRs, on the other hand in a rush to capture the incentive and avoid penalties, users were coerced to obtain inadequate electronic systems which were not tested for ethnology or true user functionality.  Many were and still are a barrier to efficiency and do not instill confidence in physicians by patients when providers faces are embeded in their display, which minimized face-to-face contact.  Transference as most providers realize is a key component of patient reassurance and compliance.  Score two big negatives for the current generation of EMRs.

Many providers have invested in EMRs, some already had EMRs which were compliaint enough to be CCHIT certified for interoperability (necessary to use HIX (health information exchanges) to exchange data with diverse EMRs.  Some were able to be upgraded to satisfy Meaningful Use, Stage I.

However many of these pre-existing systems are now insufficient to be further upgraded due to the increasing complexity of reporting metrics to CMS and Health Insurers.  Now faced with ACOs (Accountable Care Organizations the EMR and HIX face the challenge of further requirements.

For some the time as come to upgrade their EMR even though it may be only five to ten years old.

There have been many reports about physician dissatisfaction with first, or second generation systems. Offerings are divided between small practice, medium size practices, and large enterprise integrated health systems.

Perhaps a measure of change can be found in a report from MarketWatch of the Wall Street Journal.  I find the WSJ to be a reliable source of change in markets as they measure financial changes early on.

EPIC has been the leading software vendor for large enterprise systems.  This year however KLAS has ranked athenahealth as the top vendor replacing EPIC as rated by thousands of health care providers across the U.S., athenahealth is now rated #1 in the following categories:

-- 2013 Best in KLAS Overall Software Vendor

-- 2013 Best in KLAS Overall Physician Practice Vendor

-- 2013 Best in KLAS Practice Management Service, athenaCollector(R), for the 1-10 and 11-75 physician segments

-- 2013 Best in KLAS Patient Portal, athenaCommunicator(R)

The old guard of HIT leaders is finally being displaced by more nimble, innovative models designed for health care's future - not for its past," said Jonathan Bush, chairman and CEO, athenahealth

Health IT in Asia at Health 2.0 India

Read more about it at Health Train Express including these topics of interest

• Designing an improved patient experience for a Billion people

• Trending – Startups, Funding and Accelerating Health 2.0

• Health 2.0 in the village

• Quantified self, wearable sensors and trackers

• Mobile health in real life

• Rise of big data and better decisions

• Pharma and better outcomes

• C-Level executives unplugged

• Unmentionables amplified – Sex, Sport & Rock n’ Roll

Visit Health Train Express to learn more........