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(Please forgive the cross-posting to "business
issues", but I think it belongs there too)
Dear Peter,
Thank you again for this thoughtful and evenly
balanced statement of the problem and proposed solutions. I would offer a
few comments, however, on your new 6.18 section that answer's Rachel's
question "Is legal relief of any type just treating symptoms and not the
illness?"
First, we need to keep in mind that we have 2
problems to solve: the deadline and the original cost/inefficiency problem that
TCS was intended to mitigate. I agree that the deadline problem is
tricky... but it's also completely artificial. Give me a few hours with
the Federal register and a pail of White-Out and I can make that problem
disappear! The administration can stick to its guns and derail the
healthcare industry right before an election year... or it can
maintain the status quo while we ALL (providers included) take a deep breath and
a second look at the ORIGINAL problems TCS was intended to fix. In my
view, this is a no-brainer for President
Bush's Administration.
"Managed Legal Relief" is by far the most detailed
and intelligent proposal I have seen for averting the Certain Disaster of
obeying the law and/or the Tragedy of entirely calling off our noble
effort to remove cost/error from healthcare.
At the same time, however, we MUST address the
questions that Rachel and I and many others are raising about the wisdom of
using EDI as the standard in an industry as important and as fragmented as
healthcare. There are only two positions that I can imagine us adopting
with respect to the present Rule and EDI:
1. EDI is a good and workable concept for our
industry... today... and people just need to get more serious about
implementation. OR
2. EDI is physically incapable of
removing net cost or improving net efficiency in healthcare...
that both it and the regulatory process that is presently driving it
are, in fact, ADDING cost/complexity to an industry already
overburdened with its core mission of delivering care.
Does anyone in healthcare anticipate true ROI
from the existing Transaction Rule... even for the billions we have already
invested in EDI? What about ROI for EDI-development dollars spent over
the next couple years? These questions must be
answered WHILE we struggle with the self-inflicted problem of the
deadline. Until a few weeks ago, it was considered "in very bad taste" to
openly criticize the federal government's plan or suggest it will not accomplish
its stated objective. If I'm really the only guy in the country who thinks
EDI is barking up the wrong tree and that pouring additional development
dollars into it would be a BAD idea in Q4 of 2003... then I guess I'll
have to shut up and go back to being an eye doctor. If you think I'm
on the right track, however... but simply believe we'd never be able to
execute such a dramatic course change in such a short time... then I ask you to
remember two concepts: TRAIN WRECK and ELECTION YEAR. There is
plenty of motivation here for a dramatic course change!
I think it would be very helpful to step WAY back
from HIPAA for a moment and ask ourselves, "What is the most sensible course of
action for ALL industry stakeholders and for our Patients... from this
moment forward?"
Best regards,
-Chris
----- Original Message -----
Sent: Sunday, June 01, 2003 8:04 PM
Subject: Re: Transition paper
I would like to thank those who have sent comments.
Three so far have been to the listserv; so I would like to answer those in the
listserv format.
A. To David Frenkel, who asked if I had tested
the conclusions of the paper in Washington (see below).
David,
thanks for your comments. I always find your emails must reading.
My expectation is that the concept of administrating the implementation using
status information linked to legal relief may not be intuitively attractive to
HHS. I thought it needed to be said anyway. Although it is a small
amount of work now, it stands the better chance of controlling the delay such
that we would not face it anew, say, a year from now. I would hope the
give it close examination. Saying that, I have very high regard for HHS
and CMS administration and will contentedly go along with the outcome.
The paper also has other value, including:
-
description of the risk we are facing
- description of the
causes of the risk, c.f. 6.7
- discussion of, as WEDI asked,
what it means to be compliant; c.f 1.3, 5.1.2, 5.1.4, 6.1, and 6.2
- description of the criteria for waiver of penalty; c.f.
2.3-2.6.
B. To Susan Hollabaugh, who asked, since we are
proposing to gather information anyway, why not get the underlying or internal
status information that in most cases is driving the pace of
implementation. Thanks, Susan, for bringing up a great point. I
have added a new paragraph 6.17 to the paper should it ever go out with
another new version. The paragraph is reprinted below.
C.
To Rachel Forster who complimented me by including a reference to the paper
along with the WEDI and AHA letters and with Kepa's 3rd essay on market
forces. Rachel, I agree heartily with the potential for new technology
but am not so sure about its relevance to today's problem. I have
added a new paragraph, 6.18, quoted below, on this and some related
subjects.
Again, thanks you all for even reading the paper. It is
an entertaining subject.
Peter
Peter Barry
Peter T Barry
Company
Independent Consulting Health Care and Information
Systems
Ozaukee Bank Building
1425 West Mequon Road
Mequon Wisconsin
53092
(414) 732 5000 (national
cell)
[EMAIL PROTECTED]
-------------------------------------------------------------------------------------------
New
paragraphs added to the paper:
6.17 Why just gather the status between
trading partners?
This paper only proposes to gather the status between
trading partners. It does not propose to gather information on internal
projects of a covered entity even though internal information might be highly
indicative of eventual progress. But internal information might be
unnecessarily intrusive, more subjective, and gathering it would definitely
burden the industry. Instead, this paper proposes to index only the more
objectively defined status on EDI exchange. It is simpler, oriented to
results rather than project steps, and does not burden the
industry.
6.18 Is legal relief of any type just treating symptoms and
not the illness?
One line of discussion is that this paper, the WEDI
letter, AFEHCT and AHA testimony, Drs. Braithwaite's and Fusile's report, and
Dr. Zubeldia's essay on market forces represent Band-Aids, that they do not
address the underlying problem. The underlying problem is variously
suggested to be (1) that government fiat is unworkable, (2) it places undue or
inequitable demand on smaller entities, (3) it ignores the financial plight of
providers, (4) it is high distraction from a Medicare/Medicaid funding crisis,
and (5) it is too complex, cumbersome, and costly to implement. It is
frequently suggested that EDI technology is old and problems would be much
less if more modern technology were used instead.
I view all these
points as interesting topics for discussion. They are more than
philosophic discourse, but they do not address the present problem of October
16th; so they completely miss the point. Since there is no way the
industry can meet the deadline, the government has only two possible
actions: (1) abandon the effort, or (2) give relief from the
deadline. Abandonment is defeatist, ignores the excellent gains and
potential good that will come of the present effort, and would cause its own
heavy costs and dislocation. It is also politically infeasible. So
the only viable course is to provide legal relief. The central thesis of
this paper is that the relief should be linked with status information to
enable effective administration.
Peter
Peter Barry
Peter T
Barry Company
Independent Consulting Health Care and Information
Systems
Ozaukee Bank Building
1425 West Mequon Road
Mequon Wisconsin
53092
(414) 732 5000 (national
cell)
[EMAIL PROTECTED]
---------------------------------------------------------------
Peter,
Have
you tested the political waters in Washington with your conclusions?
There seems to be bigger distractions in Congress in regards to Medicare drug
benefits and diminishing Medicare reimbursements. On top of all this
next year is a presidential election. It is already well known that most
hospitals in the US are already having financial problems and there appears to
be little effort to alleviate this regardless of the HIPAA
issues.
Regards,
David Frenkel
Business Development
GEFEG
USA
Global Leader in Ecommerce
Tools
www.gefeg.com
612-237-1966
-----------------
Forwarded
Message:
Subj: RE: Transition Paper
Date: 5/30/2003 9:16:27 PM Central
Daylight Time
From: [EMAIL PROTECTED]
To:
[EMAIL PROTECTED]
Sent from the Internet
(Details)
Peter,
I found your paper full of great ideas
and I am circulating it within my own organization. I do have one
concern regarding the gathering of status information.
I work for a
provider organization and we do use a clearinghouse but our clearinghouse only
knows what our status is with them. However, there are many steps that lead up
to the point of even submitting claims to our clearinghouse to test.
1)status of our PMS HIPAA upgrade,
2) our competence level with the
IGs
3)status of our payer surveys and the collection and review of
Companion Guides
4)data gathering related to the requirements laid out in
the companion guides
5) completion of a gap analysis and all the other
countless things I have forgotten to mention.
If our CH uploads
information regarding our HIPAA status with them to the Data Gathering
Website, it would not be a true reflection of where we (the provider) are in
the implementation efforts. If we are trying to determine how ready the
industry is then it seems to me we need to know this type of information as
well.
For example, we have done a Work Flow Inventory, a Gap Analysis,
modified many of our Patient Registration Forms to collect new date, developed
a comprehensive training program to train staff to collect the new data,
developed materials to explain to patients why we are asking all these new
questions, begun testing with a third party organization (prior to sending to
our CH), etc...
We are in a very different place than many of the
other providers that submit to the same CH that we use, but the CH does not
record or store this type of detail.
If we are going to take the time
to gather industry wide detail on where we are, don't we need to know this
type of information? Would the Clearinghouses be expected to gather this type
of information about their providers?
Susan
-----Original
Message-----
From: [EMAIL PROTECTED]
[mailto:[EMAIL PROTECTED]
Sent: Thursday, May 29, 2003 1:44 PM
To:
WEDI SNIP Transactions Workgroup List
Subject: Transiion Paper
Attached
is an updated copy of the Transition paper I presented at the WEDI conference
last week. This builds on WEDI positions, but it does not in any way
represent anyone's opinion by my own, errors and all. If it is useful to
you, you may freely distribute it.
Besides its recommendations,
it may offer helpful description of the transition problem and business
strategies to deal with it. It also addresses the contest between
technical perfection and general conduct of business, the latter prevailing to
my thinking.
Peter
Peter Barry
Peter T Barry
Company
Independent Consulting Health Care and Information
Systems
Ozaukee Bank Building
1425 West Mequon Road
Mequon Wisconsin
53092
(414) 732 5000 (national
cell)
[EMAIL PROTECTED]
---
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