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RBS (REGULATORY BUDGET SENTINEL)

INDUSTRY REMAINS SLUGGISH TO MAKE ICD-10 PLANS
By: Nicola Crean, CHS Marketing Coordinator

Crossing over to ICD-10 codes has been one of the many new changes to come within the health care industry. The U.S. Department of Health and Human Services decided to extend the implementation deadline to October 2014 in order to provide all entities of the healthcare industry with additional time to prepare for the new set of codes to be activated.

“We have heard from many in the provider community who have concerns about the administrative burdens they face in the years ahead,” HHS secretary Kathleen Seblius said last fall when the deadline was officially postponed. “We are committing to work with the provider community to reexamine the pace at which HHS and the nation implement these important improvements to our health care system.”

Even with the 12-month time extension, it appears that many professionals within the medical industry are still refusing to make progress towards crossing over to ICD-10. Several studies have demonstrated that there is a lack of understanding about the codes within the industry, in addition to hospitals, physician and others failing to make plans on how the codes will be implemented.

The Medical Group Management Association, MGMA, released the results of a survey earlier this month that analyzed over 1,200 practices with a total of 55,000 physicians across the U.S. The survey looked to gather information regarding what strategies were being used to tackle the ICD-10 deadline and how they were working.

 “A successful transition to ICD-10 requires coordination between providers and their vendor, clearinghouse and health plan trading partners,” said Susan L. Turney MD, MS, FACMPE, FACP, MGMA president and CEO, according to a MGMA press release. "It is proving to be one of the most complex and expensive changes our health care system has faced in decades."

The study’s results showed that a mere 4.8 percent of respondents report that they have made significant progress towards meeting the 2014 deadline. Even worse, a total of 55.4 percent of individuals say that they have not even begun the process of transitioning to ICD-10. 

“Our data suggest that many practices are in the dark in terms of moving forward with ICD-10 as this coordination has not yet occurred,” Turney said. “Without the necessary software changes and testing, practices will have no confidence that they will be paid for the care they deliver to their patients after Oct. 1, 2014.”

MGMA survey results demonstrated that there are three specific areas that are a major source of concern for these practices. The cost of converting to ICD-10 and adjusting to the changes in how information is documents are the top two concerns for practices. Following closely in third is the potential for a loss of revenue due to clinician’s loss of productivity as they navigate through the new codes. 

Although these concerns are certainly understandable, the industry as a whole is struggling with how to overcome these types of inevitable obstacles that will be faced in the coming months. How to combat these challenges will be something the industry must overcome together.

"Like much of family medicine, the ICD-10 transition process is a team sport," said Kent Moore, AAFP’s senior strategist for physician payment. "All team members -- both clinical and nonclinical -- must remain active and have a role to play in a successful implementation."

Since the HHS has been vocal about not providing any more time after the October 2014 deadline, the medical industry as a whole must be realistic about the coming changes. Hospitals, physicians, insurance companies and all others have no choice, but to have a plan in place before it is too late.

SKIPPING BREAKFAST LEADS TO LONG-TERM HEALTH COMPLICATIONS

By: Nicola Crean, CHS Marketing Coordinator

Breakfast is often regarded as the most important meal of the day. Getting up and starting your day with a healthy meal seems to be the practical thing to do. However, many Americans continue to skip this part of their day and often do not eat until lunch time.

Regardless of busy schedules or any other reason used to explain skipping breakfast, experts stress that it is important to provide your body with fuel early on in the day. Waiting to eat till the afternoon can impact the individual’s weight, energy level and even overall health in the long run.

“When you skip breakfast, you may feel ravenous later and be tempted to reach for a quick fix - such as vending machine candy or doughnuts at the office,” said Katherin Zeratsky, RD from Mayo Clinic in a CNN article.

Skipping breakfast will leave your body thirsty for energy, which often leads to consuming unhealthy snacks and eating big meals throughout the day. Large dinners will not provide your body with enough time to metabolize the meal thus resulting in weight gain.

A study published in the American Journal of Clinical Nutrition followed 46,000 women for six years. All of these women were relatively healthy and free of diabetes at the beginning of the study. As time passed, researchers found that women that who failed to consume breakfast had a higher chance of suffering from type 2 diabetes then those who ate breakfast.

There were many different factors that participated to women developing this disease. The study concluded that a lack of breakfast and BMI did play a role in approximately 1,500 women reporting that they had been diagnosed with type 2 diabetes.

"Most of these negative factors were abbreviated when breakfast was consumed, compared with breakfast-skippers," said Heather Leidy, PhD, assistant professor in the department of nutrition and exercise physiology at the University of Missouri, in an article published in the Science Daily. "Targeting that behavior could lead to a reduction in obesity."

More research continues to examine how skipping breakfast will affect the body. A similar study that was conducted at Harvard examined 26,000 men for 16 years. Just like the study in the American Journal of Clinical Nutrition, the Harvard researchers saw that skipping breakfast negatively impacted people’s health. Those who eliminated breakfast from their diet were overall at a higher risker for cardiovascular disease compared to the rest of the population.

"If they ate late at night persistently or consistently, they had a significant increase in risk.  This was over and above their usual risk of cardiovascular disease, diabetes, hypertension, obesity and family history," Dr. Keith Churchwell said during a discussion of the Harvard study published on WKRN’s website. "Many of us tend to go through the rest of the day and don't really take into consideration [that] we should be on a better schedule in terms of what we eat and we should avoid late night eating.”

Overall, experts agree that it is necessary to eat in the morning to get the metabolism moving and to provide the body with energy at the beginning of the day. The benefits of eating breakfast also have to do with what is being ingested. Fast-food breakfast and other foods typically have a high fat or sugar content.

Instead, consuming foods that are high in fiber and rich in protein is the best option, according to an article on Boston.com. This type of food will leave the individual feeling full quicker then unhealthy options. Eating breakfast may make some feel hungrier for lunch sooner, but this is a sign the metabolism is stimulated and the body is active.

"For a very long time we thought that light is the cue that resets the brain clock," says Satchin Panda, an associate professor in the Regulatory Biology Laboratory at the Salk Institute, said in an article in published on NPR. "But slowly we are learning that actually its food that's the biggest cue to reset the clock."

With food having such an impact on how the body operates throughout the day, it becomes increasingly important to be aware of what you are putting in your body and when you are eating. The benefits of eating breakfast should be taken into consideration by all individuals, especially since it is an easy lifestyle change to make.

THERE ARE SOME BEHAVIORS YOU JUST CAN'T REGULATE.

By: Chacko Kurian

Regulations depend on carrots and sticks. If you don’t pay your taxes, there will be serious consequences – the stick. If you buy a home with a home loan, we’ll let you take the interest payment deduction on your taxes – the carrot. The HITECH Act has a number of sticks associated with the security of Protected Health Information (PHI). We at CHS will be addressing the issue of security of PHI in forthcoming articles. There is, under some circumstances, one link in the security chain that no regulation can affect -the uninformed behavior of the user. This article addresses one method where cyber criminals make unwitting users partners in a security breach.

Prior to founding Apple Computers, the Steves (Wozniak and Jobs) could be found ripping off Ma Bell using a blue box to make long distance phone calls (domestic and international) for free. The subculture that reveled in this activity called “phreaking” was probably the progenitor of the subculture of hackers who, today, like to hack computer systems just because they’re there. There is the story of Steve Woz(niak) actually making a “phreak” phone call to the Vatican and asking to speak to the Pope while pretending to be Henry Kissinger with a think German accent. These are the guys who later found legal ways to take your money.

Before the age of digital telephone switching systems, telephone switches reset trunk (long distance) lines with a tone at a specific frequency – 2600Hz. This meant that the trunk line was disconnected at one end and available for dialing at the other end. The dialing was also accomplished by tones at preset multiple frequencies. How did one get those frequencies? Legend has it that the 2600Hz frequency was discovered by accident by Joe Engressia, known among phreakers as ‘Joybubbles’, at the age of 7! He was apparently able to whistle at that frequency and so attach himself to the dialing end of an available long distance line.

But how does one progress from knowing that you could get a trunk line to using it to make free long distance calls. In 1954, the then undivided Bell System published an article in the Bell System Technical Journal about the basics of signaling using multi-frequency tones. This piece of information by itself was of little use. The second and final piece of the puzzle was published, again courtesy of Ma Bell, in the November 1960. Bell System Technical Journal in an article called “Signaling systems for control of telephone switching”. This article published the actual multi-frequency tones used to control the switches. From that information to the creation of the reputed “Blue Box” that became a clandestine product was a short step. With one of these boxes, anybody was able pick up a phone and make free long distance calls.

To be able to win this questionable prize, the phreaker required two pieces of information and they were found in two locations, but once they were combined, the information became quite powerful. Today – cybercriminals put two pieces of information discovered from different locations together to achieve their nefarious goals..

Spear Phishing is the technique by which pieces of information stolen from different locations are put together, by cybercriminals, to steal your identity, your money and anything of value. How does this work? Unlike the shot gun approach taken by those Nigerian scam artists who send out millions of emails, the Spear Phisher is looking for prey with a small email blast to very targeted prospects. All they need to start the process is one piece of information – your email address and sometimes your name. They don’t need anything like a credit card number, the password to your on-line bank account or your social security number– well, not yet. The attack is quick and over in less than a day, before security and software companies have an opportunity to react.

A typical Spear Phishing attack starts with an email that comes to you and looks something like this, courtesy of the Microsoft Safety and Security center

Remember they already have your email address and sometimes your name so the “Hello” salutation is not so innocuous. It looks very familiar but the highlighted items should make you suspicious. If you examine the links you will find that they link to unsecured and unfamiliar sites as shown below:

Once you click on the link and enter the information they’re asking for, they’ve got you.

Another variation of this technique is to send you an email making you an offer that sounds reasonable on the surface, but requires you to open an attachment with the details of the offer. Again, once you open that attachment, they’ve got you. What happens behind the scenes is that the attachment has a robot program that can do almost anything that they want it to do. It can install a keystroke logger and send your internet banking or credit card passwords to the cybercriminal. It can give control of your computer over to the cybercriminal and so enable more of these schemes to be run from your computer. The possibilities are endless.

Sometimes the Spear Phisher makes the email look like its coming from your boss – again remember he has email addresses and names. The email may require you to give up password and other authentication information in order to perform a “security audit” or an “account verification”.

Key to making this criminal endeavor work is that it requires your participation to either provide the missing information or open the attachment. So the best defense it to verify the email by contacting the sender by phone or alternate method if the email looks suspicious. A good antivirus program installed on your computer can help too.Remember for the scheme to work it requires your participation.

We might as well brace for a number of these email attacks. Recently Epsilon, a division of Alliance Data suffered an illegal entry on its client’s email databases. This is the company that processes marketing communications for loyalty programs like Marriott Rewards, Citibank Advantage and many other large organizations. Imagine the rich information for cybercriminals that email addresses, names and loyalty program associations can provide. If you belong to the Marriott Rewards program like I do, expect an incredibly valuable offer to come to you via email. Do not open the attachment even though the logo looks almost right and the text has only one or two spelling mistakes.

There’s lots of regulations coming from Washington DC these days, but I don’t think they can think one up for this.

CHS SOFTWARE UPDATE

CHS Software you may want to use

Often, we at CHS, are guilty of not informing you of products or features that we have implemented over the past year that you may want to use. This year we have rounded out our individual enrollment, billing and administration offering with a full cycle product. If you sell individual policies or sell voluntary products in addition to your regular employer sponsored group health offerings, this may interest you.

"Full Cycle" in this context means the following:
i) taking the application for enrollment of the individual/family on the web, after getting their responses to qualifying/underwriting questions,
ii) enrolling them in the plan of choice,,
iii) billing their credit card or bank account at the appropriate frequency, i.e. monthly, quarterly, semi-annually or annually,
iv) applying the payments received against the appropriate invoices
v) disbursing premium/commission and other payments to carriers, brokers/agents and other suppliers
vi) updates to Accounts Receivable, Accounts Payable and General Ledger without manual intervention after set-up.

We would like to say that all of the above happens "automatically" (a grossly over-used word) but it doesn't. It happens with minimal, but appropriate, human intervention. For example, there are checks and balances in place to make sure that premium billing adjustments owing to changes in family composition or product choices are made accurately. The web enrollment product, CHS iCoverNow, has to be customized with your logo, color palette, questions and response logic. Users of our product like it. It has allowed them to grow into areas where they couldn't before. We believe that this will interest administrators of individual health plans who sell to the public at large and may become a valuable tool in the context of health care reform.