Don’t Rush Into eHRs

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Address Medical ID Theft

1-darrellpruitt

[By Darrell Pruitt; DDS]

Yesterday, an important message titled “Don’t Rush eHRs Without Addressing Medical ID Theft” was posted on ModernHealthcare.com by Martin Ethridgehill, a provider training specialist with Blue Cross and Blue Shield of New Mexico.

Link: http://www.modernhealthcare.com/apps/pbcs.dll/article?AID=/20090302/REG/303029965

Mr. Ethridgehill points out that if a patient’s electronic medical identity is stolen by someone for health insurance benefits, critical information about the patient can be imperceptibly altered, leading to accidental death in an emergency room for any number of reasons.  Furthermore, he points out that even if the real patient is aware that his or her record is tainted by a false patient’s data, it is very difficult to get the comingled record cleared up.

I have also read elsewhere that HIPAA actually impedes resolution of the nightmare because the Rule also protects the privacy of the false patient – prohibiting the real patient from examining his or her own health record.

Reasons to Go Slow 

Ethridgehill is particularly critical of the EHR industry which lately has downplayed the importance of patient privacy in order to sell dangerous products.  He gives these reasons for the need to slow down in the rush for interoperability:

  • “Adding safety and records mitigation protocols ensures patient safety as an ongoing concept and practice.”
  • “No industry would be allowed to operate, where the officials in charge of it stated that the market or other bodies would be responsible for creating safety procedures. Can you imagine if the auto industry stated, “We make cars, let the market figure out how to regulate safety”? I doubt that Congress or any other body would consider these people as remotely credible, yet I hear time and time again these statements being made in public and private forums by executives, lobbyists, and even so-called healthcare leaders.”
  • “For the public and providers to embrace a product that has no regulation, no built-in safeguards and obviously no importance to safety from the makers of these products, why would Congress expect the American public or healthcare providers to embrace a product or concept that involves the unregulated risk of injury, death, or staggering liability opportunities, let alone without any hope of remedy or proper relief?”

Conclusion

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Speaker: If you need a moderator or speaker for an upcoming event, Dr. David E. Marcinko; MBA – Publisher-in-Chief of the Medical Executive-Post – is available for seminar or speaking engagements. Contact: MarcinkoAdvisors@msn.com

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20 Responses

  1. Dear Dr. Marcinko or whom it may concern:

    I am writing in regards to the posting you made on MedicalExecutivesPost@HealthcareFinancials.com. The link/URL is below:

    https://healthcarefinancials.wordpress.com/2009/03/04/don%e2%80%99t-rush-ehrs/

    Despite your opinions of the subject regarding eHRs, you should know that your post is inacurrate and your source has misrepresented himself. Martin Ethridgehill is not an employee of Blue Cross and Blue Shield of New Mexico (BCBSNM) and has not been since February 2, 2009 – a month prior to his posting the article “Don’t Rush into eHRs.” To make matters worse, Mr. Ethridgehill’s opinions in his article are vastly different than that of BCBCNM.

    My company is in the process of determining which sort of action we should take in regards to this very public misrepresentation. In the meantime, however, I would like to request that you (or the website managers) remove your re-posting of “Don’t Rush into eHRs” from the Internet. If that is not possible, at least remove the reference to BCBSNM.

    I would appreciate a prompt response from you in regards to this matter.

    Sincerely,

    Ross Blackstone
    Health Care Service Corporation (Blue Cross and Blue Shield of Illinois, New Mexico, Oklahoma and Texas)
    901 S. Central Expressway
    Richardson, TX 75080
    Desk Phone: 972-766-1735
    Blackberry: 469-834-6843
    Fax: 972-766-1670
    E-mail: Ross_Blackstone@HCSC.net

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  2. Additional Readings, Posts, Opinions, Thoughts and Random Links of Interest

    Posted and available on the internet as of this day:

    Martin Ethridgehill:

    Link: Link: http://martinethridgehill.wordpress.com/2008/11/02/welcome/
    Link: http://health-information.advanceweb.com/editorial/Comments/Comments.aspx?CID=193146&URL=http%3A%2F%2Fhealth-information.advanceweb.com%2Feditorial%2Fcontent%2Feditorial.aspx%3FCC%3D193146
    Link: http://www.fiercehealthit.com/story/new-hampshire-emr-privacy-rule-struck-down/2008-03-17
    Link: http://www.linkedin.com/pub/dir/martin/ethridgehill
    Link:
    Link: http://www.govcentral.com/member/paradigmatic
    Link: http://www.healthinsurancecolorado.net/blog1/2007/08/10/medical-identity-theft/comment-page-1/
    Link: http://www.healthinsurancecolorado.net/blog1/2009/02/17/stimulus-aims-to-help-laid-off-workers-retain-health-insurance/
    Link: http://www.fightidentitytheft.com/blog/medical-identity-theft-protect-yourself
    Link: http://www.modernhealthcare.com/article/20090302/REG/303029965
    Link: http://www.fiercehealthcare.com/story/trend-identity-thieves-get-better-at-stealing-medical-records/2008-05-07
    Link: http://govhealthit.com/Articles/2009/01/20/Government-key-to-health-IDs.aspx
    Link: http://www.fiercehealthfinance.com/story/medical-identity-theft-challenge-just-beginning/2008-10-01
    Link: http://martinethridgehill.wordpress.com/2008/11/02/welcome/

    Ross Blackstone:

    Video: http://www.youtube.com/watch?v=IuHBnNiYvcU
    Link: http://www.linkedin.com/pub/0/750/5b2
    Link: http://www.facebook.com/people/Ross-Blackstone/739369364
    Link: http://www.mindcontrolforums.com/news/doyoubelieve-governmentmindcontrol.htm
    Link: http://www.siacinc.org/documents/Press%20Releases/Glen%20Mowrey%20Award%2010-07.doc

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  3. Dear Mr. Ross Blackstone, BCBS Representative for Several States,

    Thank you, Mr. Blackstone, for your interest.

    At the moment, I see no reason to change a single word of what I posted. After all, how do I know you are who you say you are? How do I know you represent BCBS?

    It looks like you may have to get an attorney involved in order to change my mind, so I suggest you just drop it if you don’t want to attract even more attention to this issue, but by all means, have it your way. This could be interesting. Did you really not anticipate resistance to ad–hoc censorship?

    Finally, what is so bad about Mr. Ethridgehill’s opinions, if he is really who he says he is? I think you should offer more information, hire a lawyer or disappear.

    PS: One more thing, Mr. Blackstone, bring a ladder and a sack lunch.

    Darrell K. Pruitt; DDS

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  4. Now let’s get silly. BCBS talked the publishers of ModernHealthcare.com into removing Martin Ethridgehill’s comments.
    ——————————————-
    http://www.modernhealthcare.com/article/20090306/REG/303069960

    Writer’s opinions don’t reflect organization’s views
    Posted: March 6, 2009 – 5:59 am EDT

    In response to “Don’t rush EHRs without addressing medical ID theft”:

    The author [Martin Ethridgehill} is not an employee of Blue Cross and Blue Shield of New Mexico. He has not been an employee since Feb. 2. His opinions do not reflect the views and opinions of our organization.

    Becky Kenny
    Media relations specialist
    Blue Cross and Blue Shield of New Mexico
    Albuquerque
    _________________
    Editor’s note: Per editorial policy, the letter in question has been removed from our Web site as the author did not properly identify himself.
    ……………………………….

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  5. Gross anatomy – Coming soon to a forum near you

    In the next part, I will dissect for you another trapped dinosaur called BCBS-opotamus. It could get messy, so dress appropriately. Wear old shoes.

    As I am writing this, the monster is stumbling and flailing – slinging snot all over the place while carelessly crushing unprepared PR consultants left and right in an attempt to scramble out of a slippery hole a former employee dug for grins.

    Here’s the exciting thing about being one of the few at the event horizon: Hardly anyone has noticed the thread so far, and the harder BCBS struggles, the more attention the story will acquire. I humbly request that you be a good sport and share the tale with friends to give it a really swell start… or not.

    Here is a brief introduction:

    BCBS, in its famous cost-cutting ways, hired cost-effective, but unprepared second-tier PR consultants to shut up a man named Martin Ethridgehill who once worked for BCBS of New Mexico until a little more than a month ago. The exciting and truly confounding problem that has created panic at BCBS nationwide is the nature of the comment that Ethridgehill posted on ModernHealthcare.com.

    Its title is “Don’t rush EHRs without addressing medical ID theft” – Ethridgehill’s cautionary statement that medical ID theft is dangerous and that the nation should be careful in its rush to adopt paperless healthcare practices. Sounds like good advice. Right?

    Here’s my favorite twist in the real-time lesson:

    BCBSNM does not want any part of Ethridgehill’s side of the argument. Now, students, imagine you are the PR consultant who is called into the VP’s office at 9:05 AM tomorrow morning and told to hard-sell the counter-point that although it is counter-intuitive, recklessness in adopting eHRs is actually healthier for BCBSNM clients, as well as their growing number of imposters.

    If you want to read ahead, and actually prepare for tomorrow’s lesson for once in your easy educational career, go to the Medical Executive-Post thread, “Don’t Rush Into eHRs.”

    https://healthcarefinancials.wordpress.com/2009/03/04/don%e2%80%99t-rush-ehrs/

    You signed up for advanced studies in social networking (not for credit). That is what you paid for, friends. That is what I deliver.

    D. “Scoop” Pruitt

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  6. Part two – Gross anatomy

    PR consultants Ross Blackstone and Becky Kenny are cost-effective appendages of BCBSNM. Let’s open them up.

    After I submitted my description of Martin Ethridgehill’s comment to the Medical Executive-Post, in which he urges caution in the adoption of eHRs, I was a little surprised that they picked it up. I’m glad they did.

    https://healthcarefinancials.wordpress.com/2009/03/04/don%e2%80%99t-rush-ehrs/

    Even as I was working on my article, I recognized that it was weak, and I almost didn’t offer it. If Ethridgehill’s warning about the danger of medical ID theft hadn’t been written by someone who I assumed was employed by BCBS, I would not have considered the comment he posted on ModernHealthcare.com significant enough to note. Even though he made excellent points, they weren’t unprecedented.

    It turns out that Ethridgehill misrepresented himself as a current employee of BCBS, so he had no right to speak on their behalf. But his deception is hardly the exciting part of the story. As I noted at the end of the last lesson, BCBS evidently does not agree with Ethridgehill’s cautionary advice. A week after Ethridgehill posted his comment on ModernHealthcare.com, and a couple of days after I posted mine about his on ME-P, BCBS noticed the taboo advice, panicked and sent second-tier PR specialists to put out the fires. The wonder team was poorly equipped.

    Whistleblowers – employed, formerly employed and unemployed

    Have you ever considered what makes a hero? I think this entertaining, under-the-radar crisis, which has BCBS public relations firefighters tripping over trails of smoke, confirms that Ethridgehill is an unwanted whistleblower. His courage reminds me of Justen Deal’s short-lived rebellion against Kaiser Permanente a couple of years ago. The difference is, Deal emailed to thousands of his co-workers his well-considered concerns about Kaiser’s ethics – immediately before he lost his job. Ethridgehill took up the whistle after already losing his.

    Even though both Deal and Ethridgehill’s issues concerned downsides to eMRs, here’s the difference in their investments: Ethridgehill pretended to be someone he wasn’t. It would have been better if he had said he is a “former” provider training specialist with Blue Cross and Blue Shield of New Mexico. It would not have hurt his credibility as much as lying. Justen Deal on the other hand, liked working for Kaiser, and is still friends with many who work there.

    Nevertheless, both whistleblowers have my admiration for standing up to the largest and most powerful healthcare entities in the nation. It is wonderful that American citizens can still speak freely without being hounded by the government, even though big businesses can and do wreck troublemakers’ careers without trial and jury. Deal is still my favorite hero. He sacrificed something he loved for ideals he valued… for others.

    Within four days of the appearance of Martin Ethridgehill’s smoldering comment on ModernHealthcare.com, and two days following my description of the (false) BCBS policy, BCBS sent Ross Blackstone and Becky Kenny who clumsily stirred the embers in a traditional, professional way as if old-school rules were still in effect.

    As far as I can tell, Blackstone was the first to the scene when on March 5, he politely requested that the publisher of ME-Post and I retract my comment concerning Ethridgehill:

    https://healthcarefinancials.wordpress.com/2009/03/04/don%e2%80%99t-rush-ehrs/#comment-3134

    ———————————–

    “Dear Dr. Marcinko or whom it may concern [including Darrell K. Pruitt DDS]:

    I am writing in regards to the posting you made on MedicalExecutivesPost@HealthcareFinancials.com. The link/URL is below:

    https://healthcarefinancials.wordpress.com/2009/03/04/don%e2%80%99t-rush-ehrs/

    Despite your opinions of the subject regarding eHRs, you should know that your post is inacurrate [sic] and your source has misrepresented himself. Martin Ethridgehill is not an employee of Blue Cross and Blue Shield of New Mexico (BCBSNM) and has not been since February 2, 2009 – a month prior to his posting the article “Don’t Rush into eHRs.” To make matters worse, Mr. Ethridgehill’s opinions in his article are vastly different than that of BCBCNM.

    My company is in the process of determining which sort of action we should take in regards to this very public misrepresentation. In the meantime, however, I would like to request that you (or the website managers) remove your re-posting of “Don’t Rush into eHRs” from the Internet. If that is not possible, at least remove the reference to BCBSNM.

    I would appreciate a prompt response from you in regards to this matter.

    Sincerely,

    Ross Blackstone
    Health Care Service Corporation
    (Blue Cross and Blue Shield of Illinois, New Mexico, Oklahoma and Texas)
    901 S. Central Expressway
    Richardson, TX 75080
    Desk Phone: 972-766-1735
    Blackberry: 469-834-6843
    Fax: 972-766-1670
    E-mail: Ross_Blackstone@HCSC.net

    ———————————

    So far, so good. Right? I have previously noted that in today’s PR industry, the only thing worse than an embarrassing video on the Internet is to have nothing on the Internet at all. BCBSNM has provided us with examples of both.

    In a simple Internet search, one can easily discover that Ross Blackstone is a former Sacramento TV news reporter looking for work. Like other effective and modern public relations consultants, Blackstone has a strong Internet presence, and that is in his favor. However, if I had been his advisor, I would have discouraged him from posting his home-made montage of news clips he calls “Ross Blackstone Reporter Resume” on YouTube. Apart from lacking the minimum level of professional quality that someone would willingly pay for, the subject matter is so corny that I honestly thought Blackstone was putting all of us on.

    Blackstone’s video resume, without introduction or explanation, suddenly opens with a wide shot of him in winter clothes standing on the side of a snow-covered hill. The viewer knows that the wind is blowing hard because not only can one see Blackstone’s hair blowing, but it was picked up heavily in the audio. Blackstone reports:

    “Because this snow melts every day and then refreezes every night, [he almost slips] this terrain can get pretty slippery. It may not look like it, but that slope over there is very steep, that’s why all the crews are attached to this tether line for their safety.”

    I think I figured out what Blackstone was marketing here: His courage. Even though it’s nothing like reporters in Iraq dodging bullets, it is clear to viewers that Blackstone is not tethered to the safety line.

    Abruptly, the scene suddenly changes – once again without warning or explanation (or the expense of an editor). The only thing consistent with the mountain scene is the bald reporter’s voice in a residential neighborhood. This time, we discover that it’s an investigative report:

    “The school is also investigating the possibility that students have been changing grades for years now. They do not consider the computer system still vulnerable though. They say they’ve changed all the passwords.”

    I encourage readers to view the whole video for themselves. I cannot do it justice.

    The clip guaranteed to make humorless, traditional executives (other than BCBS) shake uncontrollably takes up most of the video resume. It is a story about a ten year old girl who was evidently tortured by the devil and his angels before mysteriously reappearing in her home speechless, dehydrated and disoriented. The fact that nobody heard a door to the garage that always squeaks when it is opened seems to be the link between reality and the spiritual world. It is a truly incredible piece of sensational footage one should avoid.

    (Let me get more serious for a moment. After watching the clip, I sincerely hope someone from California Department of Social Services was sent to investigate that incident. It was very unusual, and the child was taken away in an ambulance. Someone will have to contact Ross Blackstone to get more details about time and location).

    In response to Ross Blackstone’s request that I change my article, I invited him to provide more information, hire an attorney or disappear. He chose to disappear.

    ModernHealthcare.com yields to Beck Kenny of BCBSNM – no questions asked: A traditional, obsolete standard of journalism.

    While Blackstone was dealing with ME-P, the other firefighter, Becky Kenny, successfully persuaded ModernHealthcare.com to retract Ethridgehill’s comment from their website. She is a media relations specialist with BCBSNM, and that is all I know. I couldn’t find out anything about her on the Internet. She is either very new at PR work and has no idea about what she is in for, or she is traditional… way too traditional. Either way, she is easy prey. On the one hand, she is a deer on the interstate and her feelings have probably never been hurt, and on the other hand, she is a traditional part of a slow-moving dinosaur whose feelings have probably never been hurt.

    When I discovered that she had her way with ModernHealthcare.com, I immediately submitted the following to be posted on ME-P to send good ol’ boys this message: You can no longer hide.

    ——————————————-

    Now let’s get silly. BCBS talked the publishers of ModernHealthcare.com into removing Martin Ethridgehill’s comments.

    ——————————————-

    http://www.modernhealthcare.com/article/20090306/REG/303069960

    Writer’s opinions don’t reflect organization’s views
    Posted: March 6, 2009 – 5:59 am EDT

    In response to “Don’t rush EHRs without addressing medical ID theft”:

    The author [Martin Ethridgehill} is not an employee of Blue Cross and Blue Shield of New Mexico. He has not been an employee since Feb. 2. His opinions do not reflect the views and opinions of our organization.

    Becky Kenny
    Media relations specialist
    Blue Cross and Blue Shield of New Mexico
    Albuquerque
    _________________

    Editor’s note: Per editorial policy, the letter in question has been removed from our Web site as the author did not properly identify himself.
    ……………………………….
    Advertisement | Your Ad Here [Dell intel]
    ………………………………..

    D. “Newton” Pruitt’s first Law of Spam, March 6, 2009: Freedom of speech is inversely proportional to ad space income.

    ME-P posted my copy of Becky Kenny’s demand to ModernHealthcare.com, but without the note about the ad space that appeared below the article that was paid for by Dell Computer. Yea, “Dell” as in “Dell Hell” and Jeff Jarvis – another rebel who lacks respect for tradition.

    In my mind, recognition of the ad is important because I suspect that it was fear of advertisement income loss, if not the advertisers themselves, that traditionally pressured ModernHealthcare.com to remove Ethridgehill’s comment without offering the rest of the story you read here. I like to think that the editor of ME-P left off the reference to Dell because its relevance to the censorship was unclear.

    D. Kellus Pruitt DDS

    —————————————————-

    Coming up in Lesson 8: Defenseless Dinosaurs, government mandates and public relations

    As a preview, here is the teaching case that highlights the next lesson: BCBSTX public relations department failed to explain their employer’s NPI number qualification to clients before selling “freedom-of-choice” dental benefits policies. Insurance companies are restricted from using such deceptive policies by state law – just like they are prohibited in most states from guaranteeing their providers’ fillings like Delta Dental, I think.

    If you decide you want to prepare for the next lesson (Right! Like that’s going to happen), you can read ahead at

    https://healthcarefinancials.wordpress.com/2008/08/25/the-npi-and-one-dds%e2%80%99s-opinion/

    Wear old shoes.

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  7. Hello:

    First, my name is Martin Ethridgehill, and I am deeply concerned with the tone and language of comments posted by others here.

    Second, I wrote the article because I believe that the healthcare industry as a whole has a great deal of room for improvement and did not in ANY WAY indicate that any single company was more, or less, involved in any negative activity. The reaction both hurt and surprised me because I was not commenting on ANY company, just discussing concepts regarding Medical Identity Theft and how information is utlized from silo’d and non-silo systems.

    What I have learned from this experience is that more attention was posted toward me, than in the facts of trying to bring attention to shortcoming in healthcare information technology.

    While one post refered to me as a whistle blower let me set the record straight – what I am is a concerned citizen and user of healthcare services who would like to see are: [1] information technology improvement, [2] improved systems security, and [3] a system of medical records correction, all of which work together as normal systems of operations.

    Finally, I had written the article prior to leaving BCBSNM, but was posted afterwards. As a result of the postings here, I continue to ensure that writtings CLEARLY indicate my own opinions and not those of any other person or entity. At no point did I indicate that I represented any BCBS entity, nor authorize public release of information from former employers.

    Martin Ethridgehill

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  8. “I would like to set the record straight on a few points made by several people in this blog.”

    – I have not written publically on behalf of ANY employer, nor do I comment specifically about any company.

    – I AM a former employee of BCBSNM, and am concerned with being identified as as a CURRENT employee – which is NOT the case. I appreciate the efforts of the BCBS employees to assist with correcting the information regarding employment status – as I feel they would receive more assistance than I would with this request.

    – I had thought I had CLEARLY indentified this when I made the original posting about the healthcare industry as a whole, and not any one company as many have twisted in this blog thread..

    To clear up a term that was used in the original posting, when I reference “patient profiles” I am referring to any means of profiling a patient for healthcare delivery and tracking: —– that means when verifying a health ID card, any use of claims data for informatics, entries made by the patient themselves in online repositories, when providers use EMR/EHR [paper or electronic], etc.

    In other words —– any means of creating a historical record of treatment/interactions/visitations for a specific individual person – and that I have deep reservations when it come to how successful electronic records will be with regard to mitigation and remediation when Medical Identity Theft [or some other negative impacting interaction] has been identified. This can include things such as simple transposition errors when manually typing/scanning paper records into an electronic system.

    I have been blogging and posting for months now about the issues with Medical Identity Theft – and appreciate the reception and inclusion from various editors, newspapers, electronic magazines, and even the owner of this blog.

    I do not believe in the concept of the “healthcare industry”, since people are not parts, but I believe that as a consortium of players, healthcare in general has a long way to go with meeting the President and Congress in addressing deep-seated concerns from a great many sources and avenues.”

    Martin Ethridgehill

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  9. I am indeed saddened if you were hurt by the circumstances caused by BCBSNM, Mr. Ethridgehill. In my defense, I was answered with silence from BCBSNM, whose leaders could have stepped forward on your behalf if they cared about you. Instead they sent inept PR hacks. From my experience, it is easy for me to conclude that nobody at BCBS ever accepts accountability, and they also don’t mind leaving former employees hanging.

    I sincerely wish you luck, Mr. Ethridgehill. You are an innocent casualty who was only trying to do the right thing. Whistleblower or not, you improved the quality of healthcare in the nation as well as saved taxpayers money by urging caution in the adoption of eHRs. You said what needed to be said, and I am indebted.

    D. Kellus Pruitt; DDS

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  10. Darrell and Martin,

    Could not agree with you more.

    One of the supposed pillars of health care reform is modernizing our antiquated health records system. This means pouring billions of dollars into the current generation of electronic medical records (EMRs), despite both the flaws, and the myriad of reasons why doctors are so resistant to go digital.

    In an excellent piece, noted below, orthopedic surgeon Scott Haig MD points to why electronic records are not likely to save money, and worse, can further balloon health spending. The major reason is the physician payment system.

    Link: How the widespread adoption of electronic medical records can raise health care costs – 2009-03-12 14:00:00-04

    “The slightly embarrassing financial reality of EMR,” writes Dr. Haig, “is that large, mechanized medical operations like hospitals, clinics and big multi-doctor practices stand to make quite a bit of money by adopting them — given our current convoluted system of paying for health care. Two clear factors make EMR a money-winner: improved billing and internal cost control.”

    Indeed, EMRs make it very easy to “upcode,” or easily pick a diagnosis or service level that will pay more money. A simple click of the button can blur a diagnosis from “urinary tract infection,” to “pyelonephritis,” for instance, increasing the complexity, and the subsequent reimbursement, of the visit.

    Or, consider this example, where a patient can “go to the doctor with a sore knee and for some reason he is examining your ears. It might be that you have a very thorough doctor who is ruling out a rare ear-knee syndrome. More likely, the EMR program he bought is reminding him that notes on the chart about just few more body parts will kick your visit up into a higher-paying code.”

    Of course, this is not unlike the simple e-macros and e-templates that some surgeons, internists and others have been using for years.

    So, be careful when you hear that digital records can cut costs. With the current generation of systems geared towards gamming the flawed physician payment system, it’s unlikely that EMRs will save any money at all.

    Ann

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  11. One more note: Speaking of gamming, how about “Pay-for-Clicks.” I would like to add that in my opinion, paying physicians to use eMRs rather than paying them to do things that actually cure patients is wrong in oh so many ways.

    D. Kellus Pruitt; DDS

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  12. Dear ModernHealthcare,

    Here are Wall Street Journal blog guidelines taken directly off their website.

    “We welcome thoughtful comments from readers. Please comply with our guidelines. Our blogs do not require the use of your real name.”

    Submitted FYI; for your consideration.

    Ann Miller; RN, MHA
    [Executive Director]
    ME-P

    Like

  13. Hello Ann,

    I really enjoyed reading your comments about EMR’s perhaps NOT being a real cost-saver across the board.

    One of the things that I have tried to bring to the table across multiple channels is the divergence between “Healthcare Reform” and “Insurance Reform”.

    It has been my pleasure to have met truly outstanding physicians and nurse’s – and I have wondered how complicated paperwork systems and byzantine rules they are forced to follow in order to recieve payment may actually COMPLICATE what should be simple billing and payment systems.

    Nationally the debate is being called “Healthcare Reform” when it seems that the proper terminology should be “Insurance Reform”.

    I have not personally experienced a single case of bad healthcare, but I have had to deal with insurance companies … I would like to know that quality of service, where value recieved is balanced for value expensed, is what drives businesses – where I feel that I am valued for more than the monthly insurance premiums that I pay.

    I understand that healthcare needs funding to survive, monery is needed to pay for services and supplies – I totally get it.

    However, that being said, it is MY personal opinion better value should have ALWAYS been derived from the monthly premium that people are forced to pay in order to recieve medical services.

    Healthcare recieved should never be compared to insurance premiums paid – insurance is a necessary evil in order to obtain servies that do have value … But it certainly makes the cost of healthcare more affordable than without.

    I wish that people did not have to worry about pre-existing conditions and I am disgusted by the arguments that limitations are necessary to control costs. Whose costs – the insurance companies?

    In truth a great many more people would recieve care, certainly less expensive than ER and Urgent Care, if they were not EXCLUDED. With 64 milllion uninsured and millions more UNDER-insurered, it seems THAT is a diluting pool of people who could help share the costs – except that insurance companies would make less profit.

    Too many people are too quick to pull the blame game by stating that some doctors upcode, or internally commit fraud. Let’s first start by making it easier for them to get back to TREATING patients and spending less times fighting for every nickle and dime from non-patient sources.

    These comments are my own, I do not share credit with any other sources – and do not directly reflect on any company or entity.

    Martin Ethridgehill

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  14. I always enjoy reading you, Martin.

    You bring convincing information about timely issues concerning health insurance that, in all fairness, should be made available to all Americans who want proof of the need for change. What you are suggesting is nothing short of transparency in the healthcare industry. You’re a good man. You’re a leader.

    No wonder BCBS attempted to shut you up using cost-effective, expendable (and naive) PR personnel like Ross Blackstone and Becky Kenny. I noticed that not a single official with BCBS of New Mexico offered to explain why they think it is much better for their clients to speed ahead with eHR adoption. Why are they so shy? Accountability is a real weakness in a few leaders of disrespectful and greedy insurance firms in the nation. Even our grandchildren know that by now – or will learn soon enough.

    Let me assure you that I sincerely admire your courage, and I understand if you would rather not comment about BCBS’s unfair business practices. Therefore, I wish to expound on one of your thoughts in ways that you possibly can’t.

    You write: “I have wondered how complicated paperwork systems and byzantine rules they are forced to follow in order to recieve payment may actually COMPLICATE what should be simple billing and payment systems.”

    I also must routinely fight to get paid what insurers owe on my dental patients’ bills (their clients) – long after my work has left the office attached to satisfied customers who were mislead by insurance reps. Surely someone in the new administration who is responsible for cutting wasteful spending in healthcare is aware that strategically delayed payments by insurers add billions of dollars in unproductive expense to providers’ overhead, as well as unearned profits to insurers – even before hyperinflation begins.

    Now that the US Treasury is printing lots more dollars to help the economy, if inflation is not successfully kept in check by the “Excuse Me” Fed, who do you think will benefit the most from delayed payments to doctors during times of double-digit inflation? Insurance companies or patients?

    For example, what happens when there is a foul-up with the NPI number at NPPES (it happens), delaying payment to a provider? I personally think it should be obvious to most people that tyrannical powers are using HIPAA to delay and deny payment to providers for not only profit, but as ransom for control of doctor-patient relationships. In my opinion, the crowning achievement will be nationwide, full implementation of P4P, or Play for Performance.

    But then, I should warn readers that some think I’m a conspiracy nut, so I guess that gives at least a few readers a hard choice of who to believe: BCBS officials, who do not say enough, or D. Kellus, who says perhaps just too damn much.

    Did you know that BCBS of Texas routinely and knowingly [allegedly] commits fraud with numerous employers in the Fort Worth, Texas area – including the US government?

    Here is the case:

    BCBS representatives in my area are selling dental insurance benefits packages to employers – promising that under the contractual terms of their plan, employees are free to see any dentist they please as long as the dentist has a current Texas dental license. That is a premeditated lie that has increased BCBSTX officials’ bonus checks for years.

    Here is what BCBSTX sales reps fail to disclose to large employers in my neighborhood: If a dentist does not have an NPI number, BCBSTX will not process that dentist’s claims. However, the requirement of an NPI number is not mentioned in any BCBSTX sales literature that I have ever seen.

    In addition, I have spoken to former and soon-to-be former patients who were not told anything about the NPI number. Unfortunately for me, dental patients tend to follow their insurance, and BCBSTX clients often choose other dentists in town who have NPI numbers rather than waste their benefit package – purchased by an human resources official who has no idea the company, or even the US government, is getting ripped off. The ten digit number simply does nothing to improve the level of quality of dental care in Texas. In fact, the HIPAA requirement harms Texans.

    I have lost several satisfied patients because of transparent [alleged] fraud by BCBSTX hiding behind HIPAA. My business, like other dentists’ businesses across the state, has suffered real damage because of capricious and unfair rules. I sincerely think there is a class action lawsuit somewhere in the middle of the BCBSTX-NPI mess, not only from Texas dentists, but from their patients as well. It is harmful to patients to break up dental homes. Now that the riches from the tobacco industry have been drained for the public good, let’s go after some dental insurance companies.

    Changing dentists causes fillings

    It was during the first day of the 2008 National Dental Benefits Conference in ADA Headquarters in Chicago that Maxwell H. Anderson DDS, the dental affairs advisor for DDPA, located in Oak Brook Illinois, announced that by data mining their proprietary dental claims over 11 years, Delta uncovered evidence-based information revealing that clients who change dentists regularly are likely to receive more fillings than those who enjoy dental homes where they are content with long-term, continuous care.

    Dr. Anderson told the audience of about a hundred dentists and dental industry representatives that “The greatest hazard to teeth is changing dentists.”

    (See “Dental Managed Care Survey – Delta Dental Plans Association”)

    https://healthcarefinancials.wordpress.com/2008/08/28/dental-managed-care-survey/

    I intend to scorch the soul of BCBSTX if given the opportunity. I hope this lesson will be something other dental insurance companies will remember before instituting their own NPI requirements on unsuspecting customers.

    Thanks for giving me this opportunity to talk about your former employer. You cannot get into any trouble for anything I say. And neither can I.

    D. Kellus Pruitt DDS.

    Like Martin Ethridgehill, these comments are my own, and I accept full responsibility for them.

    Like

  15. ME-P

    Let me say that I am very thankful that Medical Executive-Post has been so patient with my caustic opinions for about six months now, and I hope our relationship continues for years if that is their wish as well.

    I would like to point out to readers, and especially to BCBS attorneys, that on two occasions in my last comment, ME-P felt it was necessary to insert the qualifier “[alleged]” whenever I clearly stated that it is my opinion that BCBSTX continues to commit fraud against not only Texas dentists and their patients, but also employees of the US government.

    Let me make this perfectly clear to everyone: It is my personal opinion, and not necessarily ME-P’s, that Blue Cross and Blue Shield of Texas is a fraudulent company that uses unfair business practices. BCBSTX clearly lies in order to sell dental insurance policies. Even if the attorney general of Texas chooses to look the other way, I know for a fact that hat is against the law in Texas.

    Come and get your whoopin’, BCBS. Give me your best shot, please. Let’s see if we can make the evening news. Then prepare to pay dearly.

    Or you can continue to be silent, Bluie. And I will take you apart piece by piece just to show my friends how it’s done.

    Here’s an idea: Why don’t you send a couple more PR experts like Blackstone and what’s-her-name? They’re fun to mess with.

    D. Kellus Pruitt; DDS

    Like

  16. WHAT GALL?

    ModernHealthcare had an interesting poll question listed on their website recently. It asked:

    “Should physician practices require patients to sign agreements of mutual privacy that bar patients from posting comments or ratings of the practices online?”

    Link: http://www.modernhealthcare.com/apps/pbcs.dll/section?category=mpfront

    This is indeed ironic considering that MH apparently capitulated to the BCBX-TX request to remove a First Amendment covered personal opinion from a former representative, and one investigative reporter – Martin Ethridgehill.

    Docs, if you can’t stand the heat; please get out of the kitchen.

    Barry

    Like

  17. You Don’t Say …

    Acknowledging that the body of scientific evidence on the efficacy of health IT still is rather scant, national health IT coordinator Dr. David Blumenthal is anticipating a flood of new research as a result of the federal stimulus that encourages wide adoption of electronic health records.

    Read more here: http://www.fiercehealthit.com/story/blumenthal-more-research-needed-health-it-effectiveness/2009-09-21?utm_medium=nl&utm_source=internal

    Nice job reoprting Dr. Pruitt and the ME-P.

    Linda

    Like

  18. If Dr. David Blumenthal is “anticipating a flood of new research as a result of the federal stimulus that encourages wide adoption of electronic health records,” I’m sure that is exactly what he’ll get with the right funding and the right kind of science.

    I remember in 2005, when the Bush administration needed a study to show that 77 billion will be saved by converting from paper health records to eHRs. He called on the Rand Corporation to get in touch with imaginative HIT vendors to produce the scientific results he needed. It’s just that easy if the money is right and the science is patriotic.

    D. Kellus Pruitt; DDS

    Like

  19. EHRs falling short of promises

    “EHR Systems Falling Short in Improving Patient Safety,” by Greg Slabodkin for HalthDataManagement.com , July 18, 2014.

    http://www.healthdatamanagement.com/news/EHR-Systems-Falling-Short-in-Improving-Patient-Safety-48438-1.html

    “Peter Pronovost, M.D., senior vice president for patient safety and quality, and director of the Armstrong Institute for Patient Safety and Quality at Johns Hopkins Medicine, argues that ‘the federal government and healthcare organizations have spent hundreds of billions of dollars on health information technology with little to show for it.’”

    He continues: “The promised improvements in safety have not been realized and productivity has decreased rather than increased. Moreover, the usability of most HIT is poor.”

    Darrell Pruitt DDS

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  20. More Docs Report Quality Data and e-prescribe, but Many Prefer Penalty

    The CMS paid out more than $380 million in incentive payments through its physician-quality reporting system and electronic-prescribing incentive programs, but more than 400,000 providers accepted pay cuts rather than participate. The agency issued a new report on the programs, late Thursday. The numbers come as the CMS and physicians prepare for the Physician Quality Reporting System, or PQRS, to be rolled into what’s intended to be a more cohesive approach to quality reporting and incentives under the recently enacted legislation repealing and replacing Medicare’s sustainable growth-rate formula.

    Physicians have long complained of a disjointed and overlapping array of reporting requirements, leading many to conclude that the financial bonuses and penalties tied to them aren’t worth the trouble. Nearly 470,000 physicians and other eligible professionals got a 1.5% reduction in 2015 payments based on their PQRS data, while almost 50,000 eligible professionals saw a reduction in 2014 through the e-prescribing program. In both cases, the most common reason for getting dinged was declining to participate: 98% of PQRS reductions and about 80% of e-prescribing adjustments.

    Source: Darius Tahir, Modern Healthcare [4/24/15]
    http://www.amazon.com/Dictionary-Health-Information-Technology-Security/dp/0826149952/ref=sr_1_5?ie=UTF8&s=books&qid=1254413315&sr=1-5

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