|
Harry,
Amen to that!
It's in my plans only because I write our software. It's
a lot easier on a specialized system [a lot of things just don't
apply].
The opinions expressed here are my own and not necessarily the opinion of
LCMH.
Douglas M. Webb Computer System Engineer Little Company of Mary
Hospital & Health Care Centers [EMAIL PROTECTED]
"This electronic message may contain information that is confidential
and/or legally privileged. It is intended only for the use of the individual(s)
and entity(s) named as recipients in the message. If you are not an
intended recipient of the message, please notify the sender immediately,
delete the material from any computer, do not deliver, distribute, or copy this
message, and do not disclose its contents or take action in reliance on the
information it contains. Thank you."
----- Original Message -----
Sent: Tuesday, June 03, 2003 12:33
PM
Subject: RE: Transition paper
With all the talk about EDI I am continuously surprised that no
one talks
about what I think of as one of the open secrets of HIPAA
TCS--Most
providers, through their practice management systems are not
submitting EDI
at all, but rather, using a variety of 'HIPAA Compliant'
flat file or legacy
upgraded formats to clearinghouses who are converting
these flat files, (and
in some cases adding or correcting data content for
compliance), into an EDI
837. Many of these flat file formats are
proprietary to a clearinghouse
further locking a vendor into a specific
clearinghouse. Rather than
disintermediate the clearinghouses, HIPAA has
locked us further into working
with clearinghouses indefinitely since most
PMS vendors, particularly for
professional claims, have not added EDI to
their systems. So when someone
writes about "the wisdom of using EDI", most
of the PMS vendors I have
talked to have upgraded their systems for HIPAA
required content, but EDI is
not in their
plans.
Thanks,
Harry
Fox
-----------------------------------------------------
Harry D.
Fox
Vice President, e-Commerce
Coventry Health Care
6705 Rockledge
Drive, Suite 900
Bethesda , MD 20817
Work:
301-581-5797
Fax: 301-493-0720
Coventry Health
Care has a new look on the internet!
Visit http://www.coventryhealth.com <http://www.coventryhealth.com/>
-----Original
Message-----
From: David Frenkel [mailto:[EMAIL PROTECTED]
Sent: Tuesday,
June 03, 2003 11:39 AM
To: WEDI SNIP Transactions Workgroup
List
Subject: RE: Transition paper
Rachel,
You are
making some broad generalizations. It would be useful to at
least
cite some published metrics to support your conclusions. I can
mention that
one of the titans of US industry, Microsoft, continues to
expand its EDI
program on Microsoft OS platforms. One of Microsoft's
recent largest EDI
rollouts was for their Xbox product to get on the
shelves of another
industry titan Wal-Mart (which has pharmacies covered
under HIPAA). I can
site numerous other companies that are expanding
their EDI programs both on
mainframe and non-mainframe. I would
disagree about your concept of legacy
EDI only on mainframes. There
are many definitions of mainframes but the
mainstream concept of a
mainframe computer is an IBM 30xx and its variants
although there are more
inclusive definitions.
EDI is workable it is the older
'brittle' adjudication systems I think you
are referring to that are
causing the real
problems.
Regards,
David
Frenkel
Business Development
GEFEG USA
Global Leader in
Ecommerce Tools
www.gefeg.com <http://www.gefeg.com>
612-237-1966
-----Original Message-----
From: Rachel
Foerster [mailto:[EMAIL PROTECTED]
Sent: Tuesday, June 03, 2003 12:38
AM
To: WEDI SNIP Transactions Workgroup List
Subject: RE: Transition
paper
Miriam, with all due respect, while I agree that
for many industries and
large companies that have invested in a traditional
EDI infrastructure are
not walking away from it....they are NOT continuing
to invest more dollars
and resources into traditional EDI. Traditional EDI
is based on legacy
mainframe batch processing concepts, is much too
abstract and much too
brittle to support the 21st century's needs for
global interoperable
electronic business
messaging.
For the life of me I don't see why healthcare
should implement something
that other industries did 20-30 years ago
because it was the available
solution THEN simply because it worked BACK
THEN. It's not the foundation on
which to build for the 21st century and
for healthcare to continue down this
path, it will be spending tens of
billions of dollars to implement a
brittle, unworkable legacy capability
while the rest of the world has
moved
on.
Rachel
Rachel Foerster
Chief
Executive Officer
Rachel Foerster & Associates, Ltd.
Ideas -
Promotion - Innovation
Voice: 847-872-8070
email: <mailto:[EMAIL PROTECTED]> [EMAIL PROTECTED]
<http://www.rfa-edi.com/> http://www.rfa-edi.com
-----Original
Message-----
From: Miriam Paramore
[mailto:[EMAIL PROTECTED]
Sent: Monday, June 02, 2003
2:47 PM
To: WEDI SNIP Transactions Workgroup List
Subject: RE:
Transition paper
Dr. Feahr, Peter et al,
With all
due respect, my 2 cents.
EDI is still the backbone of
most of the sexy e-commerce that is running
other industries --
manufacturing, retail, etc. Even those that are
implementing cool XML
and web stuff still have an EDI backbone under the
covers.
Healthcare needs the backbone that has proven successful
in other industries
and that is why I don't think HIPAA is barking up the
wrong tree. To try
and create consensus in a non-X12 standard --
after it took a decade to get
it for X12 -- would simply have us asking the
same questions a decade from
now about what is wrong with that
standard.
Best Regards,
Miriam J. Paramore (Co-Founder and
President of HAWK)
President & CEO
PCI: e-commerce for
healthcare
9001 Shelbyville Road
iTRC Building
Louisville, KY
40222
502-429-8555
www.hipaasurvival.com
===========================================
This email contains
confidential information intended only for the named
addressee(s). Any use,
distribution, copying or disclosure by any other
person is strictly
prohibited.
-----Original Message-----
From: Christopher Feahr
[mailto:[EMAIL PROTECTED]
Sent: Monday, June 02, 2003 1:41 PM
To: WEDI
SNIP Transactions Workgroup List
Subject: Re: Transition
paper
(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
Christopher J. Feahr,
O.D.
Optiserv Consulting (Vision Industry)
Office: (707)
579-4984
Cell: (707) 529-2268
<http://Optiserv.com> http://Optiserv.com
<http://VisionDataStandard.org> http://VisionDataStandard.org
-----
Original Message -----
From: [EMAIL PROTECTED] <mailto:[EMAIL PROTECTED]>
To: WEDI SNIP Transactions <mailto:[EMAIL PROTECTED]>
Workgroup
List
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]
---
The WEDI
SNIP listserv to which you are subscribed is not moderated. The
discussions
on this listserv therefore represent the views of the
individual
participants, and do not necessarily represent the views of the
WEDI Board
of Directors nor WEDI SNIP. If you wish to receive an official
opinion, post
your question to the WEDI SNIP Issues Database at
http://snip.wedi.org/tracking/.
These listservs should not be used for
commercial marketing purposes or
discussion of specific vendor products and
services. They also are not
intended to be used as a forum for personal
disagreements or unprofessional
communication at any time.
You are currently subscribed to
wedi-transactions as: [EMAIL PROTECTED]
To unsubscribe from
this list, go to the Subscribe/Unsubscribe form at
http://subscribe.wedi.org or send a blank
email to
[EMAIL PROTECTED]
If
you need to unsubscribe but your current email address is not the same
as
the address subscribed to the list, please use the
Subscribe/Unsubscribe
form at http://subscribe.wedi.org
---
The WEDI SNIP listserv to which you are subscribed is not
moderated. The
discussions on this listserv therefore represent the views
of the individual
participants, and do not necessarily represent the views
of the WEDI Board
of Directors nor WEDI SNIP. If you wish to receive an
official opinion, post
your question to the WEDI SNIP Issues Database
at
http://snip.wedi.org/tracking/.
These listservs should not be used for
commercial marketing purposes or
discussion of specific vendor products and
services. They also are not
intended to be used as a forum for personal
disagreements or unprofessional
communication at any time.
You are currently subscribed to
wedi-transactions as:
[EMAIL PROTECTED]
To
unsubscribe from this list, go to the Subscribe/Unsubscribe form at
http://subscribe.wedi.org or send a blank
email to
[EMAIL PROTECTED]
If
you need to unsubscribe but your current email address is not the same
as
the address subscribed to the list, please use the
Subscribe/Unsubscribe
form at http://subscribe.wedi.org
---
The WEDI SNIP listserv to which you are subscribed is not
moderated. The
discussions on this listserv therefore represent the views
of the individual
participants, and do not necessarily represent the views
of the WEDI Board
of Directors nor WEDI SNIP. If you wish to receive an
official opinion, post
your question to the WEDI SNIP Issues Database
at
http://snip.wedi.org/tracking/.
These listservs should not be used for
commercial marketing purposes or
discussion of specific vendor products and
services. They also are not
intended to be used as a forum for personal
disagreements or unprofessional
communication at any time.
You are currently subscribed to
wedi-transactions as: [EMAIL PROTECTED]
To
unsubscribe from this list, go to the Subscribe/Unsubscribe form at
http://subscribe.wedi.org or send a blank
email to
[EMAIL PROTECTED]
If
you need to unsubscribe but your current email address is not the same
as
the address subscribed to the list, please use the
Subscribe/Unsubscribe
form at http://subscribe.wedi.org
---
The WEDI SNIP listserv to which you are subscribed is not
moderated. The
discussions on this listserv therefore represent the views
of the individual
participants, and do not necessarily represent the views
of the WEDI Board
of Directors nor WEDI SNIP. If you wish to receive an
official opinion, post
your question to the WEDI SNIP Issues Database
at
http://snip.wedi.org/tracking/.
These listservs should not be used for
commercial marketing purposes or
discussion of specific vendor products and
services. They also are not
intended to be used as a forum for personal
disagreements or unprofessional
communication at any time.
You are currently subscribed to
wedi-transactions as: [EMAIL PROTECTED]
To
unsubscribe from this list, go to the Subscribe/Unsubscribe form at
http://subscribe.wedi.org or send a blank
email to
[EMAIL PROTECTED]
If
you need to unsubscribe but your current email address is not the same
as
the address subscribed to the list, please use the
Subscribe/Unsubscribe
form at http://subscribe.wedi.org
---
The WEDI SNIP listserv to which you are subscribed is not
moderated. The
discussions on this listserv therefore represent the views
of the individual
participants, and do not necessarily represent the views
of the WEDI Board
of Directors nor WEDI SNIP. If you wish to receive an
official opinion, post
your question to the WEDI SNIP Issues Database
at
http://snip.wedi.org/tracking/.
These listservs should not be used for
commercial marketing purposes or
discussion of specific vendor products and
services. They also are not
intended to be used as a forum for personal
disagreements or unprofessional
communication at any time.
You are currently subscribed to
wedi-transactions as: [EMAIL PROTECTED]
To
unsubscribe from this list, go to the Subscribe/Unsubscribe form at
http://subscribe.wedi.org or send a blank
email to
[EMAIL PROTECTED]
If
you need to unsubscribe but your current email address is not the same
as
the address subscribed to the list, please use the
Subscribe/Unsubscribe
form at http://subscribe.wedi.org
Email
Confidentiality Notice: The information contained in this transmission
is
confidential, proprietary or privileged and may be subject to
protection
under the law, including the Health Insurance Portability and
Accountability
Act (HIPAA). The message is intended for the sole use
of the individual or
entity to whom it is addressed. If you are not
the intended recipient, you
are notified that any use, distribution or
copying of the message is
strictly prohibited and may subject you to
criminal or civil penalties. If
you received this transmission in
error, please contact the sender
immediately by replying to this email and
delete the material from any
computer.
---
The WEDI SNIP listserv
to which you are subscribed is not moderated. The discussions on this listserv
therefore represent the views of the individual participants, and do not
necessarily represent the views of the WEDI Board of Directors nor WEDI SNIP.
If you wish to receive an official opinion, post your question to the WEDI
SNIP Issues Database at http://snip.wedi.org/tracking/.
These listservs should not be used for commercial marketing purposes or
discussion of specific vendor products and services. They also are not
intended to be used as a forum for personal disagreements or unprofessional
communication at any time.
You are currently subscribed to
wedi-transactions as: [EMAIL PROTECTED]
To
unsubscribe from this list, go to the Subscribe/Unsubscribe form at http://subscribe.wedi.org or send a blank
email to [EMAIL PROTECTED]
If
you need to unsubscribe but your current email address is not the same as the
address subscribed to the list, please use the Subscribe/Unsubscribe form at
http://subscribe.wedi.org
---
The WEDI SNIP listserv to which you are subscribed is not moderated. The discussions on this listserv therefore represent the views of the individual participants, and do not necessarily represent the views of the WEDI Board of Directors nor WEDI SNIP. If you wish to receive an official opinion, post your question to the WEDI SNIP Issues Database at http://snip.wedi.org/tracking/. These listservs should not be used for commercial marketing purposes or discussion of specific vendor products and services. They also are not intended to be used as a forum for personal disagreements or unprofessional communication at any time.
You are currently subscribed to wedi-transactions as: [EMAIL PROTECTED]
To unsubscribe from this list, go to the Subscribe/Unsubscribe form at http://subscribe.wedi.org or send a blank email to [EMAIL PROTECTED]
If you need to unsubscribe but your current email address is not the same as the address subscribed to the list, please use the Subscribe/Unsubscribe form at http://subscribe.wedi.org
|
