HHS kicks off challenge to design a better medical bill

On May 9, 2016, HHS announced that registration was open for the “A Bill You Can Understand Design and Innovation Challenge,” an effort by the agency to encourage those working in health care or other relevant entities, such as digital information experts, to imagine a new form of the medical bill as well as a new medical billing process. The challenge was announced in the Federal Register.

Objectives

The challenge involves two objectives. First, HHS is asking participants to redesign the medical bill, “that is, making it more readable and easier for the consumer to understand.” In the second objective, HHS asked for a redesigning of the medical billing process. With respect to this objective HHS explained that “submissions could address any step in the consumer journey from the medical encounter to afterward.” This may include innovation relating to providing information at discharge about the process or developing a consolidation process, HHS noted. Overall, the agency predicted that the challenge would result in “conceptual solutions and frames that will help health systems and payers continue to make improvements in reducing the complexity of medical bills and improving the financial aspect of health from the patient’s perspective.” Specifically, HHS indicated that submissions should include: a design concept, a journey map or wireframe for the new patient process, and a written and video explanation.

Eligibility

Potential challenge contestants may be either: (1) a business or non-profit entity; or (2) an individual or team of “no more than five U.S. citizens or permanent residents of the United States who are 18 years of age or older at the time of entry.” Further, the entrants must meet the following requirements, participants must:

  • Register to participate pursuant to rules issued by CMS and the other requirements set forth in the Federal Register Notice;
  • Be incorporated and maintain a primary place of business in the U.S., if the participant is a private entity;
  • Not be a federal entity of an employee of the federal government who is working within the scope of their employment;
  • Not be employed by CMS or involved in any way of the judging or production of the challenge or an immediate family member of such an individual;
  • Not be a trustee, director, shareholder, employee, client, contractor, agent, representative, or affiliate of any entity involved with the production of the challenge; and
  • Not use certain other federal funding.

Prizes and dates

The agency is offering two prizes for those deemed the winners of the contest, each for $5000. One prize will be given for the most improved medical bill design and another will be awarded for the submission of the best transformational approach to the medical cost estimation and billing process.

Submissions were accepted by HHS starting on May 9, 2016, and will be accepted through August 10, 2016. The judging will occur between August 20, 2016, and September 10, 2016. The agency expects winners to be announced between September 25 and 28, 2016.

HHS describes the challenge, rules, eligibility, prizes, and relevant dates in more depth and provides a portal for enrollment on the challenge website.

What happens on social media doesn’t stay on social media, and other lessons learned at the #HCCAci

Social media was the issue of the day at the Health Care Compliance Association’s Compliance Institute (CI), which was held in Law Vegas, Nevada this year. Throughout the four-day event, health care compliance professionals tweeted, pinned, and “Instagram-ed” their way through the lectures, discussions, and networking events, while at the same time, ironically, learning a great deal about the growing popularity of social media and the dangers it may pose when it comes to your compliance program.

Even before the CI began, attendees were invited to follow the CI Pinterest page and begin to tweet and post pictures to Instagram using the hashtag #HCCAci. During the conference, social media savvy professionals were invited to network in a “Tweet Up” event; even after the conference was essentially over, participants let loose and posted pictures of their adventures in the City of Lights. As such, the role that social media plays in our current professional and personal realms was plain to see simply through the role it played at the CI this year alone.

At the general sessions that kicked off the conference both Dan Levinson, Inspector General (IG), and Leslie Caldwell, Assistant Attorney General of the Criminal Division of the Department of Justice (DOJ), noted that areas of health information security and privacy were among the most important areas to watch. In many of these arenas, according to Caldwell, the government is often behind the learning curve. As such, it would behoove compliance officers to look beyond the guidance put out by these agencies and into the future, with an eye to what new technologies are available and how they are being used.

Donald A. Sinko, Chief Integrity Officer at the Cleveland Clinic and a presenter at this year’s CI, once said that, “One of the greatest risks of social media is ignoring social media.” Presenters at breakout sessions at the CI took heed of that sentiment and focused many of their lectures and discussions on the role that social media and social media-related issues are playing in the compliance world. Most notably, Frank Ruelas, in a presentation “#HIPAA: How Social Media Impacts HIPAA Compliance,” drew lines between how many people use social media, for what purposes, and how those practices can lead to HIPAA breaches in the health care provider environment.

Ruelas encouraged audience members to volunteer their own stories about how social media affected their compliance officers, noting that it makes sense to think about social media–which is often driven by the youth population–and HIPAA together because HIPAA is a teenager itself. Ruelas concluded by urging compliance officers to “codify, illustrate, and judiciously enforce expectations” when it comes to social media use in the workplace in order to get closer to an effective compliance program. In a related presentation on emerging challenges in mHealth, David Holtzman and Web Hull, discussed how mobile health apps and wearables are playing a larger, and in some cases more concerning, role when it comes to health data privacy and security. As Hull put it, the biggest challenge concerning mHealth “is that what we are dealing with now is just the beginning.”

The second day of general sessions brought about a seeming round up of the issues discussed in the previous day’s general and breakout lectures from a somewhat surprising source. Cam Marston, a researcher of generational trends in the workplace and marketplace, spoke to the CI crowd about how individuals in different generations (baby boomers, “Gen Xers,” millennials, etc.) differ in terms of their backgrounds, the ways they were raised, how they act in the marketplace, and, most importantly, how their work attitudes and styles differ. The biggest gap between the generations with regard to work environment and marketplace is perhaps the issues involved with the advance of technology, including the growing popularity of the reliance on social media in our personal and professional lives.

In Ruelas’ social media discussion, one compliance officer in the audience mentioned that one of her employees was found to be taking pictures, that were perhaps in violation of HIPAA, and posting them on Snapchat, an image messaging app and social media outlet. She explained that in order to truly understand the problem she had asked younger people in her family to help explain Snapchat to her and had obtained the app for herself and started using it in an effort to understand how it functions. In this way, we can see how it possible to bridge the divide caused by social media use and embrace its existence in a health care setting. Ruelas explained to his audience, social media “runs through the veins” of its users and, therefore, assuming that they will not use it at work without having policies that explicitly prohibit or explain proper use of it is not a good avenue to go down.

As the role of social media takes up more of our lives, it takes more of our work as well. As such, it is promising to see how compliance professionals are embracing it as both a tool for their own networking and knowledge spreading and recognizing it as a potential outlet for compliance issues in the workplace. Although what happens in Vegas may stay in Vegas, what happens on social media is for the world to see, and, as such, compliance professionals should be on notice of that.

BCBS highlights increase in certain diseases, costs for newly insured

Individuals who have health insurance coverage thanks to the Patient Protection and Affordable Care Act (ACA) (P.L. 111-148) have a higher prevalence of certain diseases, a greater propensity to use medical services, and are more costly to cover according to an investigation of claims between 2014 and 2015. A Blue Cross Blue Shield (BCBS) report revealed these trends after comparing the health status, use of medical services, and corresponding costs of those enrolled in individual coverage before and after the implementation of the ACA. BCBS also compared this data to that of individuals with employer-based coverage.

Use of services

The data collected by BCBS highlighted the facts those individuals who enrolled in BCBS plans in 2014 and 2015 utilized medical services, on average, more than those who had coverage prior to 2014. Comparing these groups, the data revealed that those with coverage post-ACA implementation had inpatient admissions that were 84 percent higher, outpatient visits that increased by 48 percent, and medical professional services that grew by 26 percent. When comparing newly enrolled individuals use of medical services with individuals who received coverage through their employer, inpatient, outpatient, and medical professional services increased by 38 percent, 10 percent, and 10 percent, respectively.

Prevalence of disease

BCBS analyzed data collected in the first nine months of 2015, which showed that the newly enrolled BCBS beneficiaries experienced higher rates of hypertension, diabetes, coronary artery disease, and depression. BCBS predicted that if it were able to collect data for the full year, the higher prevalence among the new enrollees would be even more pronounced. Further, the study found that the newly enrolled also had a higher prevalence of HIV and Hepatitis C. Specifically, the new enrollees had rates of HIV at 41 and Hepatitis C at 24 per 10,000. Individuals enrolled pre-ACA implementation had HIV at 12 and Hepatitis C at 10 per 10,000; individuals with employer-sponsored coverage had rates of 11 per 10,000 for both diseases.

Medical costs

BCBS identified an increase of 12 percent, or a jump from $501 to $559, when it came to the average monthly medical costs of individuals who were enrolled in BCBS plans after the ACA took effect. While the report noted that this could be a result of several factors including increases in medical services, underlying medical cost inflation also played a role. In that same time, medical costs for those with employer coverage increased by 8 percent, from $422 to $457.

Going forward

In the conclusion of the study, BCBS called the analysis “the first comprehensive, in-depth look at the medical needs and costs of caring for individuals enrolled in health insurance coverage with the expanded access and broader benefits called for under the ACA.” Further, these findings indicated, according to BCBS, that health insurers, medical professionals, and consumers need to work in conjunction to determine how to best utilize health care services. BCBS also noted that it would be emphasizing the importance of primary care and medical adherence to consumers. The company also announced it would be “expanding patient-focused care programs that emphasize prevention, wellness, and coordinated care so that individuals can get healthy faster and stay healthy longer.”

E&C, Ways and Means subpoena Burwell after ‘yearlong effort to obtain information’

Representatives from the House Energy and Commerce Committee and the House Ways and Means Committee issued subpoenas requiring that HHS Secretary Sylvia Burwell produce certain documentation regarding the Basic Health Program, which is part of the Patient Protection and Affordable Care Act (ACA) (P.L. 111-148), by April 12, 2016. According to the committeesannouncements of the subpoenas, Chairmen and Reps. Fred Upton (R-Mich) and Kevin Brady (R-Texas) are behind these issuances and have lead a yearlong effort to obtain the information sought on the subpoenas.

Specifically, according to the Energy and Commerce Committee, “the committees have been seeking to understand the facts that led the [A]dministration’s decision to fund the Basic Health Program without a congressional appropriation.” The Ways and Means Committee’s press release added that, “the committee leaders have been concerned that the [A]dministration is making payment subsidies to insurance companies under section 1402 [of the ACA] without a legal appropriation from Congress.” According to the Ways and Means representatives, these types of expenditures equal more than $5 billion now and will exceed $170 billion in the next 10 years.

Subpoenas

Specifically, the subpoena issued by the Ways and Means Committee required Burwell to produce the following before the committee by April 12, 2016: (1) current and previous iterations of the Health Reform Tracker, which is “also known as the ‘Big Ugly Table;’” (2) all HHS or other agencies’ documents relating to the apportionment of funds for the Basic Health Program; (3) all documents and communications relating to the Office of Management and Budget’s consideration or grant of any request of apportionment of these funds; (4) the final memorandum of understanding between the IRS and CMS with regard to payments pursuant to the Basic Health Program and all documents and communications relating to this memorandum. The subpoena from the Energy and Commerce committee requests the same information to be presented on the same day.

Timeline

According to the committees’ announcements, the issuance of the subpoena is the culmination of a yearlong effort to obtain this information from HHS. Further, the committees claim that HHS has failed to respond to each of the request for information in this area. Each committee accompanied its announcement with a timeline of attempts to request the information dating back to June of 2015.