James Nennemann on Harkin Healthcare Reform Town Hall Today [Update]

RE: what to ask about new bill?

Ed,

I subscribe to your LinuxMedNews feed and appreciate you being a hub of info for OSS Medical Software. I am concerned about the development of a cartel system with certification and even more concerned that so many people are missing the boat when it comes to healthcare reform. Review the expenses of any small rural hospital (like the one I work at) and you will find all sorts of archaic uses of technology by government agencies. For instance, paying a company to act as a secure bridge between medicare and the hospital's billing department just to transmit billing info. Haven't these people ever heard of SSL? WebDAV? SSH?... and on? There are still some services we use that use a dial-up connection to transmit info!

Today at 4 p.m. central, Senator Tom Harkin (ed. toward bottom) will be holding a Town Hall meeting about health care reform at my facility. What are some talking points and questions to put to him? Are there some issues with the current bill that are in favor of or are against the OSS movement? How can we get more people to recognize that we don't need 100+ EMR software companies trying to re-invent the wheel?

Best regards,

-James Nennemann
Hamburg, IA
jnennemann@grapehospital.com

BWT - I hope to record the meeting in HD and post it publicly. I will send you a link if the recording comes out.

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My response:

James:

I think the most prudent thing for me to do is pass this inquiry on to lists of contacts who are active in reform in their various spheres of influence. I'll also post to my LinkedIn Medical Banking and Open Health Care groups, blog it at MBlog, etc. Thanks for the heads up.

I'd suggest using #HarkinHealthcare and #HealthcareReform as hashtags on twitter and identi.ca for any folks who tweet and/or post (does laconi.ca have a"cool post verb" yet?).

Best regards,

Ed Dodds

Evangelist, Strategist, Web Developer, Writer

collaboration communication convergence

Conmergence.com

http://www.conmergence.com

http://delicious.com/ed_dodds

http://www.linkedin.com/in/eddodds

http://www.facebook.com/ed.dodds

http://tinyurl.com/ed-dodds-resume

http://identi.ca/eddodds

http://twitter.com/ed_dodds

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Dr. Larry Ozeran response:

Hi James.

I received your email too late to send anything before your meeting, but thought I would send you some comments from one California community's perspective in case you have another opportunity. I am personally a trauma / general surgeon involved in Health IT for 20+ years and healthcare reform for 10+years (http://www.DrOzeran.com/policy.php). Our YSHC consortium includes both health providers (all types) and economic / education / workforce organizations. This is our message:

Washington is again considering temporary healthcare reform, and at great cost. Negotiating to the center of the proverbial table which is tilted heavily in favor of health insurers to the detriment of patients, providers and employers, has not worked in the past to lower cost, improve care, or insure more Americans. "Cost containment" for its own sake, whether Medicare's SGR, "managed" care, capitation, or "Pay for Performance", has not worked to contain costs. By ignoring our fundamental health system problems, past "reform" efforts have caused the American healthcare system to be the most expensive system in the world even as it leaves 15% of our population without good care.

To get true health system reform we must:

1) Get everyone in our nation's capitol to agree with Albert Einstein on two key points:
* "We can't solve problems by using the same kind of thinking we used when we created them."
* "Everything should be made as simple as possible, but not simpler."

2) Define the healthcare system that we want by identifying the principles necessary to make it effective and sustainable one actionable example: http://www.YubaSutterHealthcareCouncil.org

Please forward this message in the hopes that more Americans will seek to promote fundamental change to Congress and the White House.

Regards,

Larry

Dr. Larry Ozeran
Chair, Yuba-Sutter Healthcare Council

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James' follow on comments:

I just want to make it clear; there was no Tom Harkin present, just a staff member from a state office. The information I received was unclear on this point.

The talk was generally pointed at the finance side of things and the conversation never veered from 'how do we pay for changes'.

Thanks, fellows, for your input but as they say 'nothing to see here folks, please move along'

Best regards,

James N.

Banks say IT key to mortgage market (Update)

Posted by ED

Thought: what banks do re: mortgages will probably model how they approach healthcare

Research carried out for Capgemini, Unicredit and Efma for the 2009 World Retail banking report shows that banks see IT optimisation as the third most important (45%) opportunity in addressing the mortgage market over the next five years, with 36% saying that using remote channels is.

Thought #2: What banks are doing is trying to figure out what they've done

Dr. Johannes C. Scholtes, President and CEO, ZyLAB North America LLC wrote recently (Investigate or Investigated? The Credit Crisis is Turbo-Charging Enterprise Search):

At this moment, only two specialized applications in the enterprise search market exist that show growth potential: those that are used to investigate the fall-out of the credit crisis and those used by organizations as part of their defense against investigations that result from heir activities in the banking and financial industry. Although most of the economy is reeling and IT budgets are being slashed, enterprise search applications are one of the few areas where organizations are allocating investment resources.

Thought #3: A more pertinent question for banks may be what will they be doing in the future

This makes Alan Reiter's observations (Revolutionizing Money: Virtual Currency Gets Real) especially sobering:

We are witnessing a revolutionary financial trend: Virtual money. "Fake" online currency of gold, points, etc. -- is becoming real. Differences between real and virtual currency are diminishing. Currency "exchanges" have been established. Multiplayer virtual worlds will soon host government-licensed banks.

And the sins of real money, such as bank robberies and currency laundering, are infecting virtual money as well. Government taxing agencies, including the U.S. Internal Revenue Service, are exploring laws for virtual income. At least one government is concerned that virtual money could actually devalue "legitimate" money. I predict we will eventually consider some online currency at least as useful as traditional currency.

See also BusinessWeek's take at Virtual Currencies Gain in Popularity.

Thought #4 this will add a "virtual" blue ocean opportunity for peer to peer micro loan industry

Collateralized debt obligations (yes, of subprime fame) on virtual cash revenue streams are a possibility

Snippets from the Google Groups Cloud Computing Listserv As They Awaken to Medical Banking in the Cloud

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The Medical Banking Project agrees on the "cloudy" future of healthcare but argues banks (or their 3rd party suppliers) are the vendors with the greater exposure to security concerns, have the greatest history with online data delivery, etc.

Hopefully on this one occasion these resource pointers will not be considered "too spammy" for this listserv:

MBlog - Medical Banking Blogging - http://mblog.mbproject.org
International Journal of Medical Banking - http://www.mbproject.org/journal
Medical banking Project site - http://www.mbproject.org
LinkedIn Group - http://www.linkedin.com/e/gis/74285/183D9F20CD6D
7th National Medical Banking Institute ADVANCING HEALTH CARE REFORM BY CREATING A FEDERAL HEALTH BOARD - http://www.mbproject.org/stream.php

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Jeanne Morain:

With the due date for Electronic Medical Records provision of HIPAA coming in 2014 - The Healthcare Industry needs more innovative solutions around the implementation that is easier for those less technical to use. It will be very tempting for all of us technologist to jump on the opportunity - but we need to proceed with caution.

One of the biggest burdens faced by medical care professionals are the very systems we put in place to help make their jobs easier. The number one complaint I have heard when talking to the users in the medical industry is the amount of time needed for the electronic charting, syncing, loss of data etc taking away from continuity of care for their patients.

Centralizing this data is a HUGE savings for physicians. Universal Client computing came from understanding the impact of not applying the right technology for the right use case but also understanding the need that there has to offline capabilities as well as online to avoid negative outcomes. Tying together offline and online with solutions like application virtualization that can leverage local compute power by do bidirectional updates of data to the cloud over HTTP/HTTPs - or other hybrid based uses cases will go much farther then just espousing one technology over another.

We need to think both In and Out of the Cloud to have solutions that will work in the real world.....

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Jeanne Morain:

There are many uses in the healthcare industry where the Cloud can help but when implementing for those systems a bit of care needs to be taken. From the major hospitals I have worked with in the US and discussions in EMEA the following uses cases fair very well in the cloud:

1) Medical Billing - particularly when billing is done either in a foreign country or by a third party. Privacy laws in Europe around health information require the data to be kept in the country of origin. I have seen medical billing done successfully with VDI implementations for larger institutions but believe a CLoud implementation with EC2 (following proper SAS70 guidelines) would also be a viable solution.

2) Transcription services make sense as well - similar to medical billing.

Edge Cases Not Recommended 3) I am a large proponent of the Cloud and Virtual Desktops but there are edge cases that should wait until the technology is more mature like Critical applications required for 3D or 4D imaging used in diagnosis, in Emergency Medical areas like ER, Nurses Stations, ICU, etc that require access to vitals and charts, Pill dispensing stations that are locked. As someone that has provided technology for infrastructure for over a decade - I know too well how lives can be lost due to accidental patch or reboot on an individual basis now multiply that by 40 or a 100. The technology is not ready yet.

For the Optic Digital imaging diagnosis below - can you tell us where the graphics processing was done? Also did anyone chart the malpractice or misdiagnosis ratio of those films over traditional methods? At first blush the costs savings look great - but we are talking about eyesight and lives when we are talking about medical.

I have heard of issues with hospitals trying to implement Cloud based solutions in Emergency rooms. In one case the wireless network connection failed while a physician was trying to review films to remove a bullet from a patient. Although IT tried they could not fix it in enough time to save the patient.

The next example is a personal one - My family was impacted by a significant misdiagnosis of EchoCardiogram films for my husband's heart. The EchoCardiograms were misread by a Physician in India collaborating with the Physician in Phoenix. We were told that my husband's condition was graver then it was, asked if we wanted to participate in an experimental study for the greater good of man kind because his condition was not reparable (Supra Cristal VSD, Pulmonary Stenosis and a Patent Ductus Arterosis). At the time our childre were 6 and 11. We spent two days of hell planning for the worse. The second physician we spoke to the following week had a different opinion and referred us to Stanford. Stanford concurred with the second physician. He did have the VSD but did not have the other issues. Apparently the resolution on the remote display protocol was not clear enough for the Physician in India that read the Physician in Phoenix's file to get an accurate discern that what she was seeing was not a PDA but additional movement on the echo from the higher pressure shunting of the blood when the valves opened and closed. We never sued the doctors because it was a technology issue.

Had we have listened to the first doctor mentioned - chances are my husband would be dead given the morbidity rates of the experimental surgery or at best would have another 2 or so years left. Instead - he has a good prognosis.

Now I ask you - if that is your spouse, parent, child or YOU would you want the films processed at the server and streamed? I for one am glad we sought a second and third opinion from someone that used a local PC with high end video graphics cards.

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Khazret Sapenov :

I also know, that doctors use Amazon Mechanical Turk to process transcripts, thus reducing their HR burden.

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Sachin Duggal:

Yes - in fact you can use the cloud for making the supply and demand equalise. We did this for a diabetic retinopathy project where we connect doctors within certain regions to do diagnosis of eye images of patients who have been to clinics in different city or country. Thereby reducing the waiting time and giving dr's additional revenue streams.

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Jason Meiers:

Medical expenses are increasing everyday although the same medical processes have been around for a while with cloud computing do your think there is an opportunity to overhaul and simplfy high cost medical processes leverging infrastruture-as-a-service?

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Rajeev Gupta:

In healthcare its important to learn first and foremost the HIPAA regulations. Some of the clauses from what I understand require in simplified terms that the patient sensitive data be separated and/or encrypted from others and the machines be in a “cage”.

Having said that once you have the patient identifiable data separated from the actual data, you could use the cloud. I can see specially in claim processing, image processing or data mining that the cloud could be very useful.

Also since the “cloud” sits on the internet and a down internet can bring in a lot of liability to the end provider – I feel EMR would be a long shot.

Thanks

John Casillas on A Vision for eHealth Using Banks

Intro: Thank you Maureen and the entire team at the President’s Council, they deserve so much credit; Members and Sponsors.

Once a person visiting a restaurant in France was so taken by the entrée that she asked the Chef for the recipe. The following year she visited the same restaurant, ordered the same dish and asked for the Chef again. “I’ve tried it over and over again and its not coming out. What’s the missing ingredient?” The Chef replied, “madamme, after you follow the directions you must throw yourself into it”.

Today, during an unprecedented global crisis in banking and as our domestic healthcare systems strain under the weight of a growing underserved population, it may seem counter intuitive to link two ailing systems. But for those in banking and healthcare who have thrown themselves into the prospect of improving healthcare, a new vision of the future is emerging that is powerful, energizing and compelling! They have stumbled upon a missing ingredient in our national dialogue to improve healthcare – medical banking. And they realize there is simply too much at stake for banks not to be sitting at the table as we fix our healthcare system.

The recipe for economic disaster is a broken healthcare system. This was the central message of the President at last week’s healthcare summit. Thus all the things that drive the banking and financial services engine rely on healthy individuals and communities and a productive labor force. Dr. David Mirvis, who will be on our Federal Health Board panel today, researched this linkage and found that economies rise and fall based on the health of people in an article published in JAMA. Dr. Stephen Parente, who will also be on our panel today, wrote in our Dr. HSA Column that an economic stimulus pathway could be distributing using cards credited with $500 to be used for prescription drugs, adding that while he’s not very excited to see so much money being spent, if its going to happen anyway, let’s spend it smartly. Many see a clear link between healthcare and economic vitality so the real question is why wouldn’t banks be fully engaged, why wouldn’t banks use their resources in the national quest to fix healthcare.

We’ve all heard a common ingredient for success: “necessity is the mother of invention.” Perhaps it will be of necessity that we find healthcare using the rails of our banking complex to finally realize the national dream of real time data exchange between all the industry actors. When the dish is ready, we believe that banks can ramp healthcare onto a digital platform. Banking processes were at one time mired in paper too, and there is no question that the lessons they bring to the table, and in some cases their very systems and processes, in which they are highly invested, can fast forward our national eHealth strategy. Yet we don’t hear very much about this paradigm shift in the national process. We hear about spending billions of dollars to create a new digital system, but what about the digital system lying right under our nose?

Ultimately, our challenge is to forge a health-wealth view of the future, where banks join with fellow healthcare stakeholders to develop common solutions to help the uninsured and unbanked, to socialize better tools and information that families can use for their medical treatments, to help individuals get real time access to their healthcare records through online banking used by 55 million households in America and growing, and to enable community centers that President Obama is investing in with eligibility, funds and data transfer platforms that support far greater coordination of the finite healthcare assets in the community. Oh yes, we have a vital ingredient and a critical role in the national dialogue and don’t let anyone tell you otherwise.

Banks and financial services firms are teaming with health technology companies and others to create a new paradigm, starting with vastly improved administrative processes and moving up the value paradigm in phase 1, to automating workflows that remove the paper chase, leveraging the unique market position of the bank to process and capture payment data that improves revenue cycle decisioning through denial management or contract management routines that take up so much time in the business office, and finally moving to the top of the pyramid of value, to address the enterprise needs of the healthcare community. Different banks are evolving at different rates along this pyramid. As you do, know that the top contenders have found compelling prospects for profitability. As success stories come in, medical banking groups are following this strategic pathway, creating one of the nation’s most compelling “Green Tech” engines – another tie into the goals of the Obama Administration. Yes, we have a critical ingredient for the national dialogue to improve healthcare.

Moving to phase 2, we should align the immense annual investments in privacy and security in online banking with the unique data needs of each stakeholder. This calls for electronic integration of assets to liberate data so it can travel securely in real time. We’re all stirring this pot together – our own build-out of specialized banking platforms, NGA’s recent summit where former HHS Sec Leavitt called on leaders to “remember Argentina” and to invest in healthcare to stimulate the economy, John Halamka’s HISPC 11-state collaborative to normalize state laws that impede the flow of health data across state boundaries, WEDI’s leadership to move us toward the 5010, EHNACs program for clearinghouses, ABA’s HSA Council, TAWPIs new HPAS, HIMSS’ annual summit and much more – all of these efforts, in my view, are moving us towards greater data liquidity that at the end of the day will, and must, empower the consumer.

In phase 2, banks are embracing the power of their market position, reving up eHealth strategy, creating real time gateways with health IT partners, specializing card platforms to automate payment processing across stakeholders, leveraging online banking to support single-sign on for the consumer, giving families private access to health-wealth tools, and although Track 1 is a primary focus for many today, the recipes of the future belong to Track 2: innovations in medical consumerism.

So we ask you to apply yourselves diligently to the task of exploring how financial systems can align with the national process to improve healthcare; and this moves us to phase 3, examining how governance models, like the Federal Reserve, can spearhead common standards banks can use to empower business and consumers with mission-critical and family-critical tools…tools that hospitals can use to automate the routines in Phase 1, tools that health plans can use to reduce disbursement costs, tools that community care centers can use to access healthcare assets in real time, tools that will allow you and I to use a “healthcare ATM” just like we use the regular ATM, so if we travel abroad as a medical tourist or just across the country and we get ill, we have secure and private on demand access to our healthcare records and our financing resources at the swipe of a card. We can get this done!

Building an electronic medical banking community, the theme of our event, moves the President’s “Green Tech” agenda forward. Rationalizing the extreme paper chase in healthcare is core to modernizing our healthcare system. We’ve done good work digitizing the front door, sending the claim from the provider to the payor but the back door was left wide open and today, whenever you visit a care giver, a steady stream of paper follows you – almost all payment related. This mountain of paper invades our healthcare system, creating enormous barriers to efficiency, siloing data that needs to be securely liberated to improve healthcare at every point along the process and especially at point of service, where adverse drug events cause avoidable pain and loss.

Who will liberate this data? How will it happen? If you follow the trail, it leads through the banking world – a service is rendered, payments are processed. In this country, payments only move through banking systems. Thus banks can use their tremendous investments in information technology to ramp healthcare onto the on-demand paradigm that leads to better health programs for all the stakeholders. That is in large part what our educational program here is about. And what we need to do is understand how to add value to that data so it can address the unprecedented cash flow pressures our health care system is experiencing, not just from the economic downturn but because of the very complexity of our healthcare payment system. Today, I’m very proud to report success stories coming in from our members – one provider saving $4 million in 12 months after implementing a medical banking platform, another saving $660,000 and other stories that are catapulting medical banking into best practices. Yes, we have a Green Tech Message that is delivering compelling ROI and we need to spice up the national debate by making our voices heard. And I’m proud to say that that is what we can do at this Institute.

Sometimes when agonizing over problems you wake up to find solutions right under your nose. I want to suggest to you today that the medical banking build-out is inevitable. As banks linked with airline systems removed layers of inefficiency, enabling consumers with online tools, so medical banking is following a similar pathway, pushing paper out of the system, liberating data, fueling revenue cycles and decisioning; helping banks and their healthcare clients to gain a better view of the intrinsic value of the fundamental financial unit in healthcare, so taxed with myriad codes, and potentially unleashing $200 billion in credit from receivables that are wasting away on the books and records of our nation’s healthcare systems. Other industries have liquidated this asset. This is a mainstream practice except for healthcare, where the value of receivables is too often locked in a deep freeze. This will change in the new medical banking paradigm.

Now, do you remember how when growing up, Mom made you eat the peas? Some of you still don’t like peas because of that. Value should drive progress not legislative fiat. It may make sense to engage a legislative agenda at some point, but for now we’ve chosen to take our ideas to the marketplace and let the market decide. And they have. The 1100 employer strong Automotive Industry Action Group embraced medical banking as a strategy, helping us to create a new Tool Kit for Employers to diffuse medical banking practices in the marketplace, and we’re excited that LeapFrog and others are taking notice of our efforts. MBProject just aligned with NCPDP, the only group that is doing real time processing on a general basis, to cross-pollinate ideas with our banking members. The HFMA is here, a powerful healthcare group, and this is testimony to the power of our ideas. I look forward to hearing Bob Broadway tell us how we can help hospitals navigate one of the toughest times in the history of healthcare. As Obama said, we’re at that Thelma and Louise flashpoint in healthcare, where the car could go over the cliff. The medical banking community will not stand by idly and watch banking and healthcare crash burn. We’re in the game. Its Game On for Medical Banking!

We reached out to consumer groups too. Greg Scandlen, founder of Consumers for Health Care Choices, will share his ideas and I’m going to listen to him carefully. We need to listen to consumers, because our quest to build platforms that serve business will ultimately find critical mass in service to families. Banks know the power of scaling services for the masses, which they do everyday. As we collectively fine tune the vision in medical banking, new concepts will emerge of how to marry online banking, credit terminals, ATMs, branch systems, to personalized healthcare platforms that promote better lifestyles and better healthcare. Not only will this improve customer retention but banks may add three times more to the bottom line by creating a health-wealth portal, linked to online banking, based on an extrapolation of research done by Dr. Paul Whitman, here from California Lutheran University in Simi Valley.

We need to gather other chefs into the kitchen who don’t mind the heat. So we reached out to national leadership like the Mayo Clinic Health Policy Center. Bob Schmoldt, a leading national figure from Mayo, recently concluded a high level meeting in DC to fine tune the concept of a US Health Board. We’ll explore this area today and gain your valuable input. So you better plan on throwing yourself into this discussion, which we will document and provide to the White House Office for Health Reform.

Healthcare and banking groups are sharing ingredients, they are finding common ground to improve healthcare in increasingly powerful ways. When I first started talking about this in 1996, I was met with a field of bank stares. Yet convergence is vital to the national dialogue to improve healthcare. The Medical Banking Project has pioneered new ground; we’ve thrown ourselves into the healthcare dialogue with a critical ingredient and with our members, we are making great strides. All of you, top executives in your domains, must know that you are an integral part of the process, not a bystander. You should not accept the fact that everyone in healthcare is sitting around a table and leaving you out. You must be in the process, you must, if necessary, throw yourself into the process to fuel an electronic medical banking community that provides powerful and relevant services for our ailing healthcare system.

This is not a time sit back. I know there are groups that are struggling. I know that you are coming here trying to find your footing in this dynamic and complex area. I know its not easy. But I exhort you to move forward. Hold on and invest. Your ideas are far too compelling and you have a very good chance of being rewarded well for your efforts. You must not give up! Your participation is vital to the healthcare interests of our nation.

To help you, MBProject has created new tools:

Our Gold Seal program, is the essential underpinning of our movement. Its not just a technology platform that we need; we must build a platform of trust for business and consumers and bankers know that all too well. One slip up, and 58% of your customers will change banks. Your margin for error is almost non-existent. I encourage you, because even though today’s climate of low confidence is tough, consumers are still depositing funds into your accounts, using ATMs, credit cards and more. Let’s not throw the baby out with the bath water. Banks will continue to provide a central driving force in the evolution of healthcare solutions.

Our Dispute Resolution Initiative is a key tool that Sheila Schweitzer will discuss at our National Roundtable during lunchtime.

Our Medical Banking Tool Kit for Employers will be unveiled tomorrow where we’ll hear from Scott Sharland, Executive Director of the Automotive Industry Action Group; about their initiatives to manage fiscal stress, and how medical banking offers a key ingredient for their long term viability.

Our International Journal of Medical Banking, as Maureen discussed, provides a peer reviewed tool that helps to get the mental juices flowing to spur creative strategies linking banking and healthcare systems.

Our Executive Training Program, as announced by John English, a professor at Vanderbilt University, will address a growing need to train new medical banking talent and to foster critical leadership standards in this emerging area.

And there are more exciting programs being developed our Tool Shed. Tools that are being honed by an awesome cast of executives – our members – who are building common standards for creating a Green Economy, A Digital Economy, A Lean Economy; (a lean, green, stimulus machine)…they are building an electronic medical banking community. We urge you to become part of the process! Don’t sit aside when we need you to come to the table. We can’t educate you in medical banking in three days! This is much like drinking water from a fire hydrant. To get the recipe right, you need to be involved 12 months out of the year, you need to join MBProject and help us to make a difference!

In closing, I want to emphasize again that necessity is the mother of invention. What if one of the most important and critical ingredients for fixing our banking and healthcare crisis was to find common ways to help each other? What if two broken, elephantine systems, prodded by a dancing mouse, discovered new ways to heal themselves? Cleary, a healthy community supports a productive workforce that ultimately results in healthy deposits. Healthcare and banking leaders truly have much in common. There is good reason to invest in healthcare to energize the bottom line, and get the economy moving forward again. I believe we have an historic opportunity to influence the progress of our nation by throw ourselves into the creation of an electronic medical banking community. Towards this end, we offer this Institute to inform the national process, so that we can collectively build a healthy-wealthy future for our families and communities. Thank-you.

Presentation of awards

Medical Banking Project is driven by a mission: to convert digital savings into charitable resources. We do this by optimizing banking resources for healthcare. What gives life to our mission are the executives that have come into our process as members and leaders of our workgroups and councils. We want to acknowledge each of these leaders for their hard work. Each year, one or two people rise to the surface.

John Halamka on IT Spending: When Less Is More

Financial-services providers outspend the health-care industry on information technology, but they haven't made good use of all that data

When it comes to information technology spending, I've often been told companies in the health-care industry should behave more like banks.

During the decade I've been a chief information officer, IT operating budgets have been 2% of my organization's total budget. That proportion is typical for health care. During the same period, IT budgets for the financial-services industry have averaged 10% or higher.

Given the recent troubles of AIG (AIG), Lehman Brothers, Merrill Lynch, Washington Mutual, and others, you have to wonder whether those IT budgets represent money well spent.

Of course, financial-services firms have had great systems for handling such tasks as share trading, disaster recovery, and data storage. But did they have the business-intelligence tools and dashboards that could have alerted decision makers about the looming collapse of the industry?

Too Much Data

Did the financial-services industry have controls, risk analysis, or a memory of previous crises ranging from the Depression to the Japanese banking debacle to the collapse of Enron and WorldCom? Was it greed, irrational expectations, or too much data and not enough wisdom that brought down these institutions?

We in the health-care profession naturally take no delight in the financial industry's descent. At the same time, we're trying to make the most of our IT spending and make wise choices with the data we've amassed.

One of the challenges of being a doctor in the 21st century is information overload. More medical literature is published every year than a doctor can read in a lifetime. As electronic health records become more common, doctors can be overwhelmed with data gathered about each patient. They do not want to review hundreds of normal findings; they want to know the information that can be acted on to keep patients healthy. More

John Halamka to John Casillas: The purpose of my article was unrelated to banking or medical banking - it was to point out that we all need less data and more wisdom. I was asked the question yesterday - what is the advantage of medical banking as compared to a fully functional PHR like Google Health?

John Casillas to John Halamka: John,Touche. Yet people arent stuffing their money under the matress, they're depositing it. They are still using ATMs, credit cards and according to the last ABA report, online banking continues to grow. For all the hazards that we've encountered in investment banking, the commercial banking side of the house is operating as its always been, 24x7. Today, people still trust their banks to access the money instantaneously all over the world. We should not throw the baby out with the bath water. Most people, even and especially the uninsured, seek the ER when they are sick. Is the health care system broken? Yes. Do people still rely on it when they get sick. Yes. In medical banking, we find ourselves linking two broken systems - systems that represent the health and wealth of peoples and nations. Both have the potential to fundamentally transform our lives for the better. Linking tremendous investments in IT in banking to optimize healthcare isnt only good thinking, its actively being persued by mutiple muti-nationals and other companies - even governments. Needless to say, I wouldnt be too quick to erase the high levels of automation acheived in banking from my website or resume. Those levels of automation have produced outstanding improvements in how we manage our money today. And they will continue to do so as medical banking, mobile banking and even micro-banking evolve in the marketplace. Bottom line: our message is still the same. Banking systems have enormous potential to improve healthcare. And we have an historic opportunity to make this happen for our world, for our families. -from vacation in sunny California

Ed Dodds to John Casillas and John Halamka: Diebold ATMs infected with credit card skimming malware at ZDNet

Tools For Building An Electronic Medical Banking Community

The theme of our 2009 Medical Banking Institute, "Building An Electronic Medical Banking Community", wasn't an empty promise! Our Members have been very busy!

We are pleased to announce the creation of a new series of digital and educational tools for the growing medical banking community! These tools will do things like help assure the marketplace that medical banking organizations are meeting the highest standards of privacy, confidentiality and security, rationalizing costs in the healthcare revenue cycle, implementing medical banking programs that save time and money for groups that purchase healthcare and much more!

Make sure to check back often! More MBTools are being developed to increase the efficacy and efficiency of your operations! Send comments and suggestions to: mbtools@mbproject.org. We wish you every continued success engaging and developing medical banking programs!

Panel: Driving Medical Banking Into Everyday Practice - A New Tool Kit for Employers

Moderator:

John Casillas, Chair, Medical Banking Institute

Panel:

J. Scot Sharland, Executive Director, Automotive Industry Action Group (AIAG), Southfield, MI

June St. John, Chair, Education and Programming, Medical Banking Institute; Wells Fargo

Eric Booth, COO, The Leapfrog Group, Washington, DC

The role of an educational video

Interoperability

Security

Data-driven performance

Capitalizing A Whole New Industry

Moderator:

Kevin Lavender, Senior Vice President, Healthcare Finance, Firth Third Bank, Nashville, TN

Panel:

Harriett Flowers, Managing Director, Converge Capital, Dallas, TX

Raymond Falci, Managing Director, Cain Brothers & Company LLC, New York, NY

Keynote Panel - Banking on Better Healthcare

Moderator:

John Casillas, Chair, Medical Banking Institute

Panel:

Al Briand, Division Head, BNY Mellon Treasury Services Product Management and Strategic Development, New York, NY

Making the case for standards allowing for economies of scale and will determine the success of medical banking

Mentioned SWIFT and messages moving capabilities; they should be studied to see how they produced their standards

Paula Fryland, Senior Vice President and managing Director- Corporate Banking, PNC Bank, Louisville, KY

Local level:

Community involvement, community development

Boards members at community hospitals

Charitable giving - building facilities, fundraising

Financing:

Health NPOs liquidity markets have collapsed, banks have stepped up

New solutions:

Extending and/or customizing current products or services

Point of Sale technologies

Whole new solutions

Pete Wheeler, Wells Fargo

Leading by example to create knowledge dissemination

WF 281,000 employees; HSAs, wellness program

Huge deposit base, huge lending base, huge brokerage presence, huge mutual fund presence, huge geographic reach

As employees go to other companies they bring their knowledge of the medical banking options to others firms

John:

Global angst re: banks

PNC: Virtual wallet, healthcare 10s of millions of dollars in business investment, incredible opportunities in administrative transactions of hc, including noncredit products to build relationships

BNY Mellon: Can't count on certain aspects of traditional business so discovery of new opportunities must be explored; there must be a business case for them; friction (not seemlessness in transactions) means opportunity; consumer-centered healthcare; health custodians

WF: Opportunities coming from the synergies of combining 2 banks

Question from floor: quality rating on bonds

How will existing clearinghouse and transaction engines be tied together; current "RAILS" in place

How will XBRL and international standards impact -- bring as many players to the table to create and apply the standards

Economy of scale is THE DRIVER

Super-regional and community banks: Smaller banks have many healthcare related account; train a couple of SMEs first, build portfolios over time; attend conferences and be involved in groups active in the space

Will banks repeat their earlier investment in automation to accounts receivables

Health Wealth Portals? Convenience for either business or retail banks is important; cell phone convergence metaphor

How does hc impact your strategy? PHRs??? Wealthy individuals request new services; back office accounting of wealth management tools

How does the money saved by more efficient transaction being targeted to indigent care by hc orgs impact your banks? Banks have not recognized indirect benefits of their efficiencies investment in the communities they serve

TAKE AWAY: Economy of scale is THE DRIVER, standards are THE ENABLERS

Next Steps for Moving the Industry Forward

Maureen Turo, President, National Medical Banking Institute, VP, Healthcare Strategy, The Bank of New York Mellon Treasury Services Division, Pittsburgh, PA

Observations;

Comments from many on how many different constituencies are represented at the Institute and in MBProject

There needs to be a voice for Washington, DC

1) Task Force, Richard Mobley, Lead - 18 volunteers to climb the Hill

2) Ideas collected by the Mayo Clinic at the Institute will be compiled and emailed to attendees

Medical Banking Report provided on a quarterly basis at the MBP Portal

Deven McGraw on the Great Privacy Debate: Impact of ARRA 2009

deven@cdt.org

Health Privacy Resources

Health Privacy Project at Center for Democracy and Technology

Health IT and electronic health information exchange have tremendous potential to improve health care quality, reduce costs, and empower consumers
The public wants health IT – but also has significant privacy concerns
Failure to build foundation of trust is an obstacle to achieving greater health information exchange

Health Privacy Project at CDT

For years there was no progress on resolving the privacy and security issues raised by e-health
Project’s aim: Develop and promote workable privacy and security policy solutions for personal health information

Evolution of Federal Privacy Protections

Congress gives itself 3 years to enact privacy legislation

1999 – Proposed rules
2000 – Final rule
2002 – Regulatory changes
2003 – Effective for most

Era of Health Information Technology

Privacy was framed as the obstacle – but it wasn’t the only issue

Legislation moved furthest in 110th – but economic woes stalled progress

ARRA (Title XIII- HITECH)

Broke the privacy "logjam"
Most significant change to the healthcare privacy and security environment since the original HIPAA privacy rule
Not a change to everything about HIPAA – but some significant changes that will need to be addressed by many entities handling health care information
Most provisions require further regulatory clarification

Privacy and Security Provisions – Overview

Substantive changes to HIPAA statutory provisions and privacy and security regulations
Enhanced enforcement of HIPAA
Provisions to address health information held by some entities not covered by HIPAA
Misc: Administration/Studies/Reports/Educational Initiatives

Substantive HIPAA Changes

Breach notification requirement

Definition of breach
Safe harbor for “protected” data
Detailed requirements re: timing and content of notice; how provided to individual and HHS
Business Associates must notify covered entities

Strengthened individual right to restrict disclosures to health plans for payment and operations

Secretary guidance on minimum necessary
Use of limited data set where possible in interim
Discloser determines minimum necessary

Minimum necessary still does not apply to treatment

Accounting for disclosure requirements for entities using electronic health records

Requirement applies after standard and regulations are developed
Phased in over time
Covers only 3 years

Change with respect to how business associates comply

Patient right of electronic access

Can direct record to another entity or individual (PHR)

Changes to definition of marketing

Limited right to use information for marketing if the communication is paid for by an outside entity
Exceptions for treatment communications and communications about current drugs and biologics

Opt-out for fundraising communications

BA contracts required for RHIOs – and PHRs in some instances

Prohibition on “sale” of health records or protected health information

Exceptions

Public health
Research
Treatment of an individual
Sale of a facility/business
Payments to business associates
Copies to individuals
Designated by Secretary in regulations

HIPAA Enforcement

Business Associates accountable to authorities for compliance with some HIPAA privacy and security rules (+ new provisions)
Application of HIPAA criminal provisions to individuals
Ability to civilly enforce where violation qualifies as criminal but no criminal penalties pursued
Requirement to impose civil penalties in cases of willful neglect

Corrective action may still be pursued for lesser offenses

Tiered increase in civil monetary penalties
Distribution of % of civil penalties to individuals (penalties also go to OCR)
State AG civil enforcement
Secretary required to do periodic audits

Provisions for Entities not Covered by HIPAA

Temporary breach notification provisions for PHR vendors and internet applications

Breach definition
Same safe harbor for protected information
Enforced by FTC

Study by HHS & FTC with report to Congress on privacy and security recommendations for PHRs

Which agency should regulate?
Timeframe for regulations (no specific authority to regulate)

Misc. (Administration/Studies/Reports/Educational Initiatives)

Strengthened authority for ONC
New advisory committees on policy and standards
OCR public education initiative on uses of PHI and individual rights under HIPAA
Privacy Officers in each HHS region
Chief Privacy Officer within ONC - Not charged with HIPAA enforcement/oversight

Misc. (Studies/Reports/Educational Initiatives)

Annual report on enforcement
Study on implementation of the de-identification requirements
Study of HIPAA definition of psychotherapy notes with respect to inclusion of test data and materials used for evaluative purposes

Methodology for providing individuals with a % of civil monetary penalties
Report on best practices for disclosure of PHI for treatment purposes
Report on Impact of ARRA provisions on health care costs and adoption of EHRs

National Rountable: Medical Banking & The Health Data Ecosystem - Engineering A Revolution in Revenue Cycle Management

Moderator:

Sheila Schweitzer, Chairperson & CEO, CareMedic Systems, St. Petersburg, FL

Panelists:

Robert Nay, Director, BlueCross/Blue Shield of Florida, Health Options, Jacksonville, FL

Charlie Myers, Director of Operations, Special Programs and Support, Johns Hopkins Hospital and Health System, Baltimore, MD

Russell Taylor, Strategic Systems and Processes, Aetna, Inc. Middleton, CT

Laurie Holtsford, Director, Business Office Support, Community Health Systems, Brentwood, TN

Scott Hawig, Divisional CFO-Patient Revenue Management Organization, Duke University Health System, Durham, NC

Mayo Clinic Health Policy Center - Advancing Health Care Reform By Creating A Federal Health Board

Moderator:

Ceci Connolly, National Staff Writer, Washington Post, Washington, DC

Keynote Panel:

Robert K. Smoldt, Chief Administrative Officer Emeritus, Mayo Clinic, Rochester, MN

David M. Mirvis, MD, University of Tennessee Health Science Center, Memphis, TN

Murray N. Ross, Ph.D., Vice President, Kaiser Foundation Health Plan, Inc., Oakland, CA

Roy Ranthun, HSA Consulting Services, Silver Spring, MD

Stephen Parente, Ph.D., Associate Professor Finance, Carlson School of Management, University of Minnesota, MN

Study Documents:

US Health Board Proposal (PDF) | Enabling Legislation (PDF) | 2009 International Journal of Medical Banking

Robert Broadway on Pushing the Envelope Out for Good - Moving Healthcare Onto An Electronic Platform Using Banks

The Electronic Platform

15% fewer errors in electronic records study

Get on the same page

2015 is deadline for pay for performance based on new unified quality standards

Bankers sit on the boards on nonprofit community hospitals

2011 certified electronic health record

The Electronic Platform

Banking's e-commitment
Investment in technology
Transaction definition and standardization

The Banking System Electronic Platform

Universal Acceptance
Trust & confidence
Security

The Healthcare System Electronic Platform

Limited acceptance
Lack of understanding
Concerns for security
Many Systems

Elements of Electronic Processing In Healthcare

Clinical processing
Technology processing
Financial processing/(Accounting/Claims)
Customer/patients relations
E-health/web enabled

Clinical

EHR – Electronic health record
Nursing care
Physician care (Electronic order entry)
Other providers

Technology

Imaging (MRI, CT)
Radiation therapy
Laboratory
Monitoring – in-house and remote
Robotics

Opportunity for Banks External Processing

Eligibility
Connectivity
Billing transactions (claims)
Payment transactions (remittances)
Funds flow (cash)
Medical credit
Electronic data storage
Health savings accounts

John Casillas Opening Remarks Highlights

A Vision for eHealth Using Banks - Orientation and Awards

Greater secure data liquidity

Receivables locked in the medical paper chase

Medical Banking paradigm produces a lean, green, electronic stimulus machine

Necessity is the mother of invention

All participants at the MBI must throw yourselves into the process

Health Wealth paradigm

Historic opportunity

MBP creating tools

Inform the national process

Stuart M. Hanson on How Medical Consumerism and Medical Banking Align to Create Value

Presentation of White Paper: The Impact of Consumer Directed Healthcare on Providers

Consumer Directed Healthcare (CDH) typically combines a high deductible health insurance plan (HDHP) with a personal saving/spending account, from which medical expenses can be paid directly. Most common spending account plans are Health Savings Accounts and Health Reimbursement Arrangements.

Consumer Directed Healthcare Research Study

Objectives

Gain thorough understanding of impact of Consumer Directed Healthcare (CDH) trends on healthcare providers, financially & operationally
Ensure that feedback & findings were unbiased and broadly based

Research Methodology

Fifth Third engaged the Boundary Information Group
The research was conducted over a two month period: July – August 2008
The methodology consisted of a detailed one hour interview with CFOs, Patient
Accounting Directors and selected thought leaders from hospitals and physician groups from across the nation
Key findings of the research were compiled into a white paper “Impact of Consumer Directed Healthcare on Providers”
- Are providers seeing an impact on cash flow and operations from CDH?
- What Best Practices are providers pursuing to handle CDH?

CDH is a Growing Portion of $2 Trillion Market*

CDH plans grew by 43% in 2008. CDH plans will reach 14.9M accounts by January 2009
There is $5.3B value held in Health Savings Accounts which is expected to grow to $16B by 2010
Consumers spent over $250B on out of pocket healthcare expenses in 2008. $242B paid for by cash, check, credit, debit. The remaining $8B was paid by some form of Healthcare card
According to the US Census Bureau consumers will pay over $1000 annually in out-of-pocket healthcare related expenses by 2012 up from $800 today. The proportion of patient payments is projected to rise over the next few years from 15% to 21%

*Source: Consumer Driven Market Report, US Census, Celent, Forrester Research

Key Stakeholders:

Consumers: Provides economic incentives to manage their own care. Ability to build a medical nest egg.
Employers: Reduce benefit costs from lower premiums and FICA tax savings
Government: Proponents hope to drive down healthcare costs by stimulating market competition
Payers: Deliver high deductible health plans along with consumer tools such as quality and health information
Banks: Deliver Health Savings Accounts linked to a debit card. Offer online payment tools.
Providers: Must manage rising patient payment portion resulting from higher co-pays and deductibles. Less predictability in collections as responsible party becomes blurred further

What Does CDH Growth Mean for Providers?

Importance of financial arrangements at or before time of service increases Predictability of collections becomes less certain
New set of tools and processes are required to minimize negative financial impact of CDHP growth
POS Collection methods are stretched

According to a recent interview with a well respected industry expert: "In a nutshell, healthcare providers need to recognize that the tools they need today are not the tools they have from yesterday…they have to realize that they’re at a severe disadvantage unless they re-tool for this new patient responsibility paradigm … today many providers are basically bringing knives to a gunfight"

CDH Research Study: Key Findings

CDH Impact

Geographic Variability – but momentum building across all geographies
Providers Lack Processes, Tools, Resources
CDH Impact Far Greater Than Prior Experience with Self Pays
Result Could Include Higher Costs and Lower Revenues

Process Challenges

Negative Public Relations Impact
Lack of Price Transparency
Financial Complexity Demands More Experienced Staff

Technical Challenges

Legacy Systems are Challenged with “Consumer Debt” Issues
New Vendors are Emerging>
Providers Struggle with Limited IT Budgets
Providers Seeking Single Vendor Solutions

Recommendations for Providers

Assemble project team for examining current practices, evaluating options, making recommendations, and implementing new programs to adapt to CDHP growth trends and impact on your organization
Evaluate existing processes and tools in place today, especially against best practice conclusions from this analysis
Analyze method for managing commercial and governmental posting of EOB, ERA to speed posting process and potentially free up resources
Work with strategic banking partner to streamline revenue cycle activities as much as possible and to understand financial tools and options that are available
Determine suitability for new processes, tools, and/or possible upgrades to existing systems and capabilities
Prepare to implement new tools, software, staffing model, training programs, financial tools as needed

John Phalen and Nancy Vickroy on Privacy & Confidentiality - Building a Secure Platform for Growth

*The information contained in this presentation is not intended as and in no way constitutes legal or compliance advice. Please consult your General Counsel or Compliance Officer.

According to a TransUnion webinar asking re; Patient Safety Primary Concern, 12/12/08, n=42, What is your biggest identity theft concern? Medical safety 55%, Uncollectible patient debt 29%, Operational inefficiencies 10%, Patient dissatisfaction 7%

Red Flag Regulations

Proposed by financial regulatory bodies and the FTC
‘Final rule’ addendum to FACT Act, modifies sections 114, 315

Released on October 16, 2007; applies to:

All “users” of consumer reports (address discrepancy requirements)
Financial institutions and “creditors” (identity theft prevention program requirements)

Supplement including 26 examples of red flags

# # # #

Identity Theft Prevention Program

Identify Red Flags

Chose Red Flags that make sense in your environment
Identify departments that interact with individuals with covered accounts
Determine types of information gathered and how it is verified

Detect Red Flags

Develop procedures to detect Red Flags during life of account – pre-registration, registration, financial counseling, billing and collections
Implement identity verification at every step
Incorporate automated solutions to verify and authenticate identity information such as name, address and SSN

Respond to Red Flags

Responses will vary depending on risk of triggered Red Flag
Train staff in policies, procedures and responses to ensure consistent patient experience
Develop procedures for triggered Red Flag accounts for exception handling

Evaluate the program

Periodically evaluate for effectiveness and modify as needed
Track down known incidents of identity theft that occurred despite the program and monitor trends
Use data to make meaningful modifications over time

# # # #

Foster North on the Healthcare Transaction Marketplace

Primary Players, Market Position, Claims Processing Systems

High level over the healthcare transactions marketplace

Reliable industry resource guides, which are published annually, include summary information on all of the vendors and what they offer.

Healthcare Financial Managers Association has resources available including a guide

HIMSS (Healthcare Information and Management Systems Society) has a helpful guide available

Internet search engines

# # # #

The Medical Banking Arena is complicated:

Healthcare Revenue Cycle Process Overview

# # # #

Healthcare Revenue Cycle Management refers to an accounts receivable process beginning with scheduling and concluding with billing and collections: Scheduling, Pre-Registration, Registration / Admission, Encounter, Billing, Follow-Up, Collections

# # # #

# # # #

# # # #

Financial services and healthcare have come together in ways that neither industry could have expected: POS integration with credit card processing, Healthcare savings accounts – driving deposit growth, Medical lockbox services – enhanced receivables processing to facilitate posting

John English, Vanderbilt University, Highlighting 2 New Medical Banking Credential Programs

Medical Banking is now a recognized field of discipline!

Growing demand for executives that understand and can market and sell programs in this new field

Two levels of professional certification available

Medical Banking Professional (MBP) - strategic and treasury management 9 month online program

MBProject and the University of Missouri have collaborated to create a Medical Banking Executive Training Program. (Patricia Alafaireet, Director of Applied Health Informatics, School of Medicine, University of Missouri, Columbia, MO.)

9 month online training provides subject matter expertise

Involves a project of value to the industry and the employer

Objectives of Medical Banking Certification

To stimulate and disseminate the theory and principles of medical banking.
To help banks and healthcare groups to understand the value they can mutually bring to health and healthcare.
To provide tools and expertise that can drive improvements in marketing medical banking services.

6 modules

MBS: Professional Medical Banking Sales Program

Cross-industry Sales Training

An intensive day and a half executive training course to improve selling of medical banking services

Introduction to the fundamentals of medical banking

Market segmentation and size
A typology of medical banking convergence

Refine sales skills for medical banking

Videotaping and critical evaluation
Developing the sales presentation
Answering objections

Opening classes will be scheduled for July

Send inquiries to info@mbproject.org

7th National Medical Banking Institute, March 11-13, 2009, Nashville, TN

Nashville Airport Marriott Hotel
600 Marriott Drive
Nashville, TN 37214
615-889-9300
Fax: 615-889-9315

Updated: 03-03-2009

Wednesday - March 11, 2009
10:30 -1:00	Pre-Conference Registration
11:00 -12:00	President's Council Luncheon Meeting
Medical Banking Boot Camp
1:00 - 1:15	Introduction
	June St. John, Chair, Education and Programming Subcommittee, Medical Banking Institute; SVP, Healthcare Product Manager, Wachovia Treasury Services, Charlotte, NC Patricia Alafaireet, Director of Applied Health Informatics, School of Medicine, University of Missouri, Columbia, MO. MBProject and the University of Missouri have collaborated to create a Medical Banking Executive Training Program. We will be discussing the educational requirements for this program. ** NOTE: John English, Professor, Vanderbilt University, will provide an update on our training program.
1:15 - 1:45	Session 1: The Healthcare Transaction Marketplace: Primary Players, Market Position, Claims Processing Systems
	The healthcare revenue cycle will be reviewed by a senior executive. From this purview, we will look at the matrix of tools and digital techniques that have been developed to facilitate revenue cycle workflows in healthcare. This will set the stage for a better understanding of how banking systems can impact this area. Foster North, VP, CareMedic Systems, St. Petersburg, FL
1:45 - 2:45	Session 2: The Emerging Role of Banks In Health Data Processing
	The session will look at how banks have integrated their technologies and systems with the healthcare revenue cycle to reduce "friction" in the system. The basic medical banking platform will be explored, resulting ROI and a view towards how the platform could be adapted for greater efficiency in the future. Both batch/back end and real time systems will be presented. Specialized lockbox programs Richard Mobley, VP, Healthcare Services, BancTec, Irving, TX Real Time processing programs Bill Marvin, CEO, Instamed, Philadelphia, PA
2:45 - 3:15	BREAK
3:15 - 4:00	Session 3: Privacy & Confidentiality: Building a Secure Platform for Growth
	"Medical banking" represents a new industry that results from the adaptation of banking systems for healthcare. As hybrid innovations grow, more sensitive health data will flow through specialized medical banking channels and this creates a need for education, training and external affirmation of data privacy and security protocols. The Accreditation Review Council at MBProject oversaw the development of an online system of compliance assessment - the Gold Seal - that will be presented. The Accreditation Review Council believes that the Gold Seal will need to address a new series of compliancy measures for "credit-grantors" created under the FACTA regulations, commonly referred to as the "Red Flag Rules". Scheduled for enforcement in May 2009, these rules need to be evaluated to determine overall impact in medical banking programs. A White Paper by MBProject member TransUnion, which was accepted in the 2009 International Journal of Medical Banking, will be presented. Overview of MBProject's new Gold Seal Program: John Phelan, PhD, Healthcare Management & HIPAA Consultant, Milliman, Inc., Westlake Village, CA Presentation of White Paper - Red Flag Regulations: Exploring the Impact of New Identity Theft Regulations on Healthcare Providers: Nancy Vickroy, Director, Healthcare Product Marketing, TransUnion, Chicago, IL
4:00 - 4:45	Session 4: How Medical Consumerism and Medical Banking Align to Create Value
	As medical consumerism gathers increasing momentum in healthcare today, the need for point of service technologies is growing. This area significantly impacts management of the healthcare revenue cycle and because of this, medical banking programs are aggressively building tool sets to support the consumer. A study assessing this impact and the appropriate banking response was commissioned by Fifth Third Bank, (also accepted in the 2009 International Journal of Medical Banking), and will be presented. Presentation of White Paper - The Impact of Consumer Directed Healthcare on Providers: Stuart Hanson, VP, Healthcare Solutions & Wholesale Lockbox, Fifth Third Bank, Chicago, IL
5:30 - 8:30	Corporate Networking Suites Open -- BancTec Networking Suite -- WAUSAU Financial Systems Networking Suite
Thursday - March 12, 2009
7:30 - 8:30	Registration
8:30 - 8:45	Call To Order & Honorable Mention of Educational Grantor
	Maureen L. Turo, President, National Medical Banking Institute; VP, Healthcare Strategy, The Bank of New York Mellon Treasury Services Division, Pittsburgh, PA
8:45 - 9:00	A Vision for eHealth Using Banks - Orientation & Awards
	From MBProject's standpoint, 2008 was relatively quiet year. The credit crisis impacted growth plans yet it is the same crisis which re-focused banks and financial services firms on healthcare because it is an industry that compares favorably with others for future growth (note: Experian's $90 million acquisition of Search America). While using banking platforms to advance eHealth strategy is still an emerging concept, we see firms quietly building alliances and technologies that are convincingly changing the competitive landscape. Some industry veterans feel that medical banking represents the "next generation of health data management services" and given market indicators, it appears we are reaching a tipping point. John Casillas, Chair, Medical Banking Institute; Executive Director, The Medical Banking Project, Franklin, TN
9:00 - 9:30	Pushing the Envelope Out For Good - Moving Healthcare Onto An Electronic Platform Using Banks
	One of the most vibrant healthcare associations in America, the Healthcare Financial Management Association, has launched a new initiative to build a new payment system. This multi-year initiative, which found over 100 healthcare administrators and thought leaders including MBProject at a DC summit and reception at the French Embassy, finalized key building blocks that include creating a more responsive infrastructure for payment processing...thus rolling the red carpet out for banks to help. Robert Broadway, Chair, Healthcare Financial Management Association (HFMA); VP, Bethesda Healthcare System, Boynton Beach, FL
9:30 - 10:00	BREAK
10:00 - 12:00	Mayo Clinic Health Policy Center - Advancing Health Care Reform By Creating A Federal Health Board
	The nation's top healthcare CEO's and policy experts examine the potential role of a "Federal Health Board", similar in nature to the Federal Reserve, that could orchestrate affordable healthcare coverage for all Americans. Originally architected by the late Dr. Jerome Grossman of The Harvard/Kennedy School, the idea has gained increasing traction among industry leaders. Proceedings will be documented and provided to Congress and President-elect Obama's new administration. Moderator: Ceci Connolly, National Staff Writer, Washington Post, Washington, DC Keynote Panel: Robert K. Smoldt, Chief Administrative Officer Emeritus, Mayo Clinic, Rochester, MN David M Mirvis, MD, University of Tennessee Health Science Center, Memphis, TN Murray N. Ross, Ph.D., Vice President, Kaiser Foundation Health Plan, Inc., Oakland, CA Roy Ramthun, HSA Consulting Services, Silver Spring, MD Stephen Parente, Ph.D., Associate Professor Finance, Carlson School of Management, University of Minnesota, MN
12:00 - 1:30	LUNCH
12:20 - 1:20	NATIONAL ROUNDTABLE Medical Banking & The Health Data Ecosystem - Engineering A Revolution in Revenue Cycle Management
	National providers and payors describe the benefits and challenges of medical banking and what the future holds. We will examine critical path industry issues that are impeding movement of healthcare to a digital platform, as well as touch upon the whole idea of "real time adjudication" and how the panelists think this area could build out given the recent consumer push towards point of service processing. Moderator: Sheila Schweitzer, Chairperson & CEO, CareMedic Systems, St Petersburg, FL Panelists: Robert Nay, Director, Blue Cross/Blue Shield of Florida, Health Options, Jacksonville, FL Charlie Myers, Director of Operations, Special Programs and Support, Johns Hopkins Hospital and Health System, Baltimore, MD Russell Taylor, Strategic Systems and Processes, Aetna, Inc., Middletown, CT Laurie Holtsford, Director, Business Office Support, Community Health Systems, Brentwood, TN Scott Hawig, Divisional CFO—PRMO (Patient Revenue Management Organization), Duke University Health System, Durham, NC
1:30 - 2:45	CONCURRENT TRACKS
Track 1	Strategic Revenue Cycle Management
1.1	Linking Banking & Healthcare Systems - Part 1
	How are providers using medical banking platforms? What are the key ROI metrics? As these platforms move into best practices, what does the future hold for moving from a payment/remittance tool set to a business intelligence platform for healthcare? Moderator: Doug Bilbrey, EVP Sales & Marketing, The SSI Group, Inc., Mobile, AL Panelists: Charlie Myers, Director of Operations, Special Programs and Support, Johns Hopkins Hospital and Health System, Baltimore, MD Laurie Holtsford, Director, Business Office Support, Community Health Systems, Brentwood, TN Todd Slocumb, Chief Technology Officer, Revenue Management Solutions, Oklahoma City, OK Christine Smith, Product Manager-Remittance Solutions, WAUSAU Financial Systems, Mosinee, WI *Note: Todd Slocumb and Christine Smith are the new Workgroup Leader and Co-Leader (respectively) of MBProject's Workflow Automation Focus Group. They will be reporting out a listing of key industry issues developed at our 2008 Medical Banking Leadership Forum.
Track 2	Innovations in Medical Consumerism
2.1	UPDATE: HSA Adoption Issues
	How will Health Savings Accounts fare under the new Obama Administration? Will adoption issues increase? What are the regulatory and market factors that could impact HSA adoption? The panelists will review the regulatory environment in 2008 and future policy trends as well as present bi-annual research, hot off the AIS press, that the industry relies on for HSA metrics (number of HSAs, deposits, etc). In addition, a brand new survey of employers is being prepared -- more on that to be announced to the industry prior to the Institute! Moderator: Roy Ramthun, HSA Consulting Services, Silver Spring, MD Panelists: Tom Hricik, National Director of HSA Product Distribution, ACS HSA Solutions, Pittsburgh, PA Greg Scandlen, Fellow, Wheatland Institute; CEO, Consumers for Health Care Choices, Hagerstown, MD Todd Berkley, VP, Market Solutions, OptumHealth Financial Services, Salt Lake City, UT
2:50 - 3:30	The Great Privacy Debate
	A stunning on-the-ground look at how groups in Washington, DC are changing the ground rules for healthcare information technology systems. Devon McGraw, Executive Director, Health Privacy Project / Center for Democracy & Technology, Washington, DC
3:30 - 3:45	BREAK
3:45 - 5:00	CONCURRENT TRACKS
Track 1	Strategic Revenue Cycle Management
1.2	Linking Banking & Healthcare Systems - Part 2
	How are insurance carriers and health plans adjusting their strategy to promote greater adoption of electronic funds transfer and remittance management? Or are they? What are the ROI metrics for this side of the medical banking realm, and what does the future hold for moving more provider-customers to a digital paradigm for end-to-end claims processing? We will also look at the emerging area of real time payment processing during this session. Moderator: Rick Morrison, Vice President, WJM, Inc., Little Rock, AR Panel: Russell Taylor, Strategic Systems and Processes, Aetna, Inc., Middletown, CT Vince Marzula, Vice President & Product Group Manager, PNC Bank, Pittsburgh, PA (I) Greg Morris, President & CEO, TriHealix, Norwalk, CT Steven Lloyd, Vice President of Sales, Homeland Healthcare, Richardson, TX
Track 2	Innovations in Medical Consumerism
2.2	How Banks Can Support Personalized Healthcare Informatics
	MBProject has advanced the idea of using banking systems to speed consumer adoption and demand for personal healthcare records. How could this paradigm unfold? What banking activities are underway to support this dynamic? Is the PHR a stand alone application or does it need to be part of a broader consumer health IT play that meets multiple "health-wealth" needs? This panel will look at specific health IT programs, how they are being positioned and what banks can do to move this ball forward. Moderator: John Casillas, Founding Director, Medical Banking Project, Fanklin, TN Panelists: Paul D. Witman, Ph.D., Assistant Professor, Information Technology Management, School of Business, California Lutheran University, Simi Valley, CA Toby Rogers, EVP, Commercial Markets, DestinationRx, Chicago, IL Kumar Swaminathan, Industry Manager, Consumer Centric Healthcare, Sun Microsystems Inc., Menlo Park, CA Frank Convertino, Vice President, Sales & Channel Development, Centri Health, Los Angeles, CA
5:00	ADJOURN
6:30 - 9:00	BANCTEC NETWORKING & RECEPTION GALA Mingle with your colleagues and new acquaintances at the Medical Banking Project's ultimate gala event! Over the years this networking highlight has produced some of the industry's most talked about strategic alliances and partnerships. Don't miss this important opportunity to advance your business objectives in medical banking!
Friday - March 13, 2009
7:00 - 8:00	Registration
8:15 - 8:30	Orientation
	John Casillas, Chair, Medical Banking Institute; Executive Director, The Medical Banking Project, Franklin, TN
8:30 - 10:00	Keynote Panel - Banking on Better Healthcare
	In 2008, MBProject initiated a national dialogue in the form of a National Town Meeting called "Banking on Better Healthcare". Held in conjunction with The SSI Group User Meeting and attended by over 300 banking, healthcare and government executives, the national webcast examined how banks are engaging healthcare. The Keynote Panel comprised of senior banking executives will take up this issue again: why should banks specialize programs for healthcare? How are banks re-engineering existing systems to meet critical healthcare needs in America today, like reduced costs for transaction processing, point of service cash management/collections, implementation of programs to assist in the national build-out for an eHealth infostructure (electronic and personal healthcare records), and governance structures (like the "Health Fed" and its application for speeding adoption of standards, financing EMR infrastructure and fueling value and pricing transparency in healthcare). Moderator: John Casillas, Chair, Medical Banking Institute; Executive Director, The Medical Banking Project, Franklin, TN Panel: David Trotter, Executive Vice President, Head of Sales for Treasury Management at Wells Fargo, Charlotte, NC Al Briand, Division Head, BNY Mellon Treasury Services Product Management and Strategic Development, New York, NY Paula Fryland, Executive Vice President and Manager of PNC Healthcare, PNC Bank, Louisville, KY Ralph Bernstein, SVP and Senior Lead, U.S. Bank Healthcare Payments Solution, Minneapolis, MN
10:00 - 11:00	Capitalizing A Whole New Industry
	Launching an electronic medical banking community will take focused effort and investments, and today's investment banking and venture capital communities aren't sitting idly on the sidelines. Hear how key funding groups are capitalizing this brand new industry. Moderator: Kevin Lavender, Senior Vice President, Healthcare Finance, Fifth Third Bank, Nashville, TN Panel: Harriett Flowers, Managing Director, Converge Capital, Dallas, TX Raymond Falci, Managing Director, Cain Brothers & Company LLC, New York, NY
11:00 - 11:30	BREAK
11:30 - 12:30	Driving Medical Banking Into Everyday Practice - A New Tool Kit for Employers
	The nation's top automobile companies are reeling under the weight of healthcare costs and other environmental factors. The Medical Banking Project and the 1600 employer Automotive Industry Action Group formed a Joint Taskgroup for Value In Health over two years ago to orchestrate a "disruptive innovation" in healthcare, drafting a new "Medical Banking Tool Kit". The Tool Kit will be officially announced and a panel of team members will discuss why its critical for employers to adopt. Moderator: John Casillas, Chair, Medical Banking Institute; Executive Director, The Medical Banking Project, Franklin, TN Panelists: J. Scot Sharland, Executive Director, Automotive Industry Action Group (AIAG), Southfield, MI June St. John, Chair, Education and Programming, Medical Banking Institute; SVP, Healthcare Product Manager, Wachovia Treasury Services, Charlotte, NC Eric Booth, COO, The Leapfrog Group, Washington, DC
12:30 - 1:00	Next Steps for Moving the Industry Forward
	Maureen Turo, President, National Medical Banking Institute, VP, Healthcare Strategy, The Bank of New York Mellon Treasury Services Division, Pittsburgh, PA
1:00	ADJOURN

XBRL Part II Implementation: Are You Ready? Live Webinar March 18, 2009, 1:00pm to 3:00pm (ET)

Posted By ED

Note: XBRL has been mandated by the SEC for large organizations and will likely become part of the medical bank environment over time so I've provide this event pointer.

FEATURED SPEAKER LIST:

U.S. Securities and Exchange Commission
David Blaszkowsky
Director, Office of Interactive Disclosure

Bowne & Co., Inc.
Rob Blake
Senior Director of Interactive Services and founding member of XBRL.ORG

International Accounting Standards Committee Foundation
Kurt P. Ramin, CPA, MBA, CEBS
Chairman (Emeritus) of XBRL International
Advisor, IASCF

Ernst & Young LLP
Paul A. Penler
Executive Director, Auditing Tools and Techniques Global Assurance and Audit Practice

Summary: Implementation of The SEC's mandate to adopt XBRL-based financial reporting is now closer than ever. XML data tagging to makes it easier for internal controls, shareholders, investors, analysts, and the regulators to mine financial reports for data. Moreover, it helps provide an interactive data that is helpful in automating regulatory filings and business information processing. As the proposed timetable for the adoption of XBRL-based financial reporting is fast approaching, affected entities should be well-informed and use this format now or run the risk of not being able to fully utilize this feature rich reporting method.

The Knowledge Congress is producing a follow up to its highly successful webinar in September to discuss updates, the recent and the possible impact of XBRL in various financial reporting processes. Key experts and regulators are expected to speak at this event. The event will take place on March 18, 2009, 1:00pm to 3:00pm (ET). Click the button below to register in this event.

Course Level: Intermediate
Prerequisite: None
Method Of Presentation: Group-Based-Internet
Developer: The Knowledge Conference
Recommended CLE/CPE Hours: 1.75 - 2.0 (Please note, your State Bar or Accounting Board will make the final determination with respect to continuing education credit. If you are applying for CLE credit in Texas you must register 20 days before the event date.)
Advance Preparation: Print and review course materials
Course Code: 083817
Course Fee: $199 - $299 (Please click here for details)
NASBA Sponsor Number: 109004

We are an approved multi-event sponsor in the state of California. Our provider ID is: 14451. In Texas, Illinois, & Virginia, we submit programs for individual approval in advance. In New York, our programs are submitted immediately after the event live date and attendees are sent the approval codes once we receive them from the New York State Bar. All Other states: Once attendance is verified, attendees are emailed an official certificate of attendance which they submit to their respective State Bar Associations. Our programs are created with continuing education in mind and therefore are designed to meet the requirements of all State Bar Associations. If you have any questions, please email our CLE coordination: info@knowledgecongress.org

Important Notice:
Discounts apply for early registration. If you have a scheduling conflict and can't attend this live event on its scheduled date, you may want to order the full recording of the event for your review at your convenience.
Please email: info@knowledgecongress.org for any question or if you wish to order the recording.

For Group registrations please call 1.800.578.4370 for more info.

Unlimited Attendance Plans:
The Knowledge Congress has an extremely affordable benefit rich group preferred plan for companies that send multiple people to multiple webcasts. In addition to saving, you'll receive many exclusive benefits.

Policy Discussion at Workgroup for Electronic Data Interchange (WEDI)

By any measure, when you think back on healthcare legislation that has had a profound impact on American society, HIPAA rises to the top. A far reaching rule like that requires serious leadership and I’m proud to share the room with a few of those leaders. HIPAA is now a household word that means privacy and its recognition by the typical consumer is rivaled only by the Social Security Act that gave us Medicare. Truly, by any account, the story of HIPAA is remarkable.

In 1996, in the shadow of this major bill, I began to devote all of my energy on a side drama that has now gone main stream – the creation of a new and vibrant industry called medical banking. Anything good takes effort and driving this often misunderstood area has been anything but easy. A key story line in my work is the issue we’re discussing today – HIPAA’s impact on banks. Its occupied some portion of my time most everyday since 1996. Today, medical banking is raising a new generation of health care leaders from, of all places, banks. BNY Mellon, PNC, Wachovia-Wells Fargo, US Bank, Fifth Third and others are all taking their place at the table. New characters are writing chapters in the fascinating tale of HIPAA. Yet some people haven’t caught up, or even bothered to read the latest twist and turns in the plot, sort of like trying to read a book by starting in the middle.

Let’s start at the beginning to unwind the tale of HIPAA’s impact on banks. The year is 1996 – I wrote a little newsletter and sent it out to over 1,000 bank holding companies. It proposed that HIPAA could drive a new generation of banking services for healthcare but it only survived two printings because the issue wasn’t prominent. Fast forward to 1998, when I wrote a white paper called HIPAAs Impact On Lockbox Operations that pioneered new legal tests for assessing HIPAAs impact on banks and financial institutions. If you haven’t read it, I urge you to. It initiated a national discussion and debate about the questions being addressed today, questions that were answered between 2001 and 2004 by multiple federal agencies, a battery of attorneys and industry experts. Published by the International Association of Privacy Officers, the article caught the eye of LexisNexis who then published a 3-part sequel I wrote, considered a seminal piece on the topic, in Health Care Law Monthly and then contracted me to write Chapter 8, entitled Health Care Payment Systems, for their Treatise on Health Care Law.

Turning to the next chapter, the Healthcare Financial Management Association honored and appointed me as their lead advisor in medical banking. Much like a publisher that heralds a new book, Richard Clarke, CEO of HFMA, issued a wake-up call urging, no even insisting, that all healthcare groups read a white paper I wrote with Gail Sausser, an attorney who chaired the HFMA HIPAA@Work taskforce, that detailed HIPAA’s impact on bank-provider relations. Turning the pages further in this story, in 2003 and 2004, the National Committee on Vital and Health Statistics asked me to testify not once, but twice on this issue. I testified before AHIC more recently on the topic. If you haven’t read it, the testimony chronicles key factors in the development of medical banking policy.

Now if you’re anything like me, when I read a great story or come across a great book the first thing I ask is how did the author come up with that idea? At its core, the story of medical banking is shaped by this work on HIPAA’s impact on banks, interviews with 125 bankers in 1995 and Dr. Benn Konsynski’s work on inter-organizational systems, that shows how two adjacent industries upon reaching escalated levels of EDI adoption, inevitably form cross-industry bridges that remove systemic inefficiency. Taking the paper chase out of healthcare, I reasoned, is evolving into a banking issue. That was sort of like an intellectual awakening – an epiphany – and that really is how medical banking came to be. We pioneer new thinking around banking and healthcare and in this process HIPAA is a fundamental driver because its broad impact on the banking sector. Banks either must react or cease to offer some services in healthcare. From 2001-2005 in what many times seemed a field of blank stares and yawns, I created and promoted a vision of banks fully engaged to improve healthcare using systems that are secure, highly efficient and well-capitalized. A Deloitte survey of CIOs showed that banks routinely spend five times more than healthcare on technology. Why is that important? Its important because more healthcare groups are learning to harness bank technology for data processing.

Today, we’re witnessing Konsynski’s IOS theory in action as banks embrace healthcare, just like it proved out in other industries like SABRE in the airlines world and ASAP in the medical supply trade. Today you and I go to a website to buy our tickets, book our hotel rooms and cars – a direct result of close linkage between banks and the administrative process behind the airlines industry. The same industry dynamic, applied in banking and healthcare, will find consumers using online banking – a trusted portal for 55 million American homes – to do things like manage our investments in tax favored health savings accounts, research our care, receive reminders to fill our prescriptions and even request our healthcare records. This “health-wealth” portal of the future makes so much sense that one may well ask, why aren’t we doing this already? Medical banking is the tale of how this will come to pass.

If you believe in that kind of future then you need to draw lines back to where we were at in 1996 when HIPAA was passed. At that time I suggested that HIPAA’s impact on banks was broad because of that vision. In 2001, MBProject convened all the stakeholders to dialogue HIPAA’s impact and took our message now to over 30,000 banking and healthcare organizations, organizing 12 roundtables over 2 years and institutes – we’re now on our 7th Institute on March 11-13 in Nashville and you’re welcome to come – organizing a 15 month effort to create a Gold Seal accreditation standard for medical banking, defining the concept of a “bank-based health data clearinghouse”, carving it out of the body of law, and proposing and helping EHNAC to implement a bank clearinghouse accreditation program. This leads me to an interesting question: if this area really needs to be demystified, should we trust accreditation programs? MBProject certainly doesn’t believe this area needs to be demystified.

By 2003 we began a national tour targeting 10 stakeholders over 14 months with key experts like Tom Hanks, Stanley Nachimson and Alan Goldberg and organized national policy forums well followed in the media by CNBC, Health Data Management, Modern Healthcare and many others. We invited all the stakeholders and they came – FDIC, NACHA, ABA, OCR, Federal Reserve and many others. Today the US Treasury, DoD, CDC, major universities and some 60 firms are members of MBProject, and they’ve concluded that MBProject has already demystified HIPAA as evidenced by moving forward with their plans and strategies in medical banking. A growing number of banks are partnering, forming or acquiring their own clearinghouses and each are very serious about complying with HIPAA. So when I saw the title today – Demistifying HIPAA – I thought, didn’t we do that already? And then the second line caught my attention: “paving the way for banks”? Its common knowledge that the market has already paved the road; NCVHS, HHS and OCR have already weighed in on this issue. The road is paved, asphalted and marked. Banks, partnered with health IT firms and payors, aren’t waiting for next steps but running full throttle down a new medical banking highway, and not just in America but in Canada, Australia, Germany and other areas in the world. So maybe we should consider reframing this discussion but my next thought was reframe it to what? It seems like this story has already been told.

For argument’s sake let’s retell the story by going back to the middle of the book. The application of HIPAA on banks rests on 3 acid tests: 1. Does Section 1179 exempt banks from HIPAA? If it doesn’t we move onto the next test: 2. Does Section 1179 refer to payment data ONLY (dollars) or all payment-related functions (eligibility, authorization, remittance and even the claim)?; and finally, 3. When is a bank a clearinghouse under HIPAA? We found that framing the question in terms of trying to classify banks as BA vs. CH is redundant and I’ll explain that. We went through each test carefully, numerous times with numerous use cases and numerous stakeholders and here’s our summary:

Test number 1: How many people here believe that banks are 100% exempted from HIPAA? In a letter to HHS in 2004 NCVHS clearly states, and I quote, “For example, a small number of banks are clearinghouses as a result of services provided in addition to processing payments in their financial institution capacity, and are thus covered entities under HIPAA.” For those not following this area, the letter appears to raise unresolved questions but in reality, it was carefully worded to resolve far more than meets the eye. In fact, it carefully side-stepped a tense political drama to deliver a final verdict for acid tests number one, two and three, as we’ll see. If you haven’t read it I encourage you to go back and do so because NCVHS doesn’t even engage the debate but simply presumes HIPAA applies. End of story.

When you think about it, if HIPAA applies asymmetrically a bank-owned clearinghouse would be exempt and a non-bank owned clearinghouse would be covered, creating an uneven regulatory landscape that is inefficient and removes a blanket of data protection. In 2003 I argued in a letter to HHS and OCC for the symmetrical application of HIPAA across all market structures – not singling out banks or any other segment. I had delivered that message to AFECHT previously in 2002 and three days later the organization issued a letter to Secretary Thompson arguing against favorable treatment for banks. That was the right approach in our view and the market agreed with this conclusion. At our 2004 Institute three major banks publicly embraced this interpretation after much internal legal wrangling and analysis.

Section 1179, as Tom discussed, exempts consumer-initiated financial transactions like merchant and check processing. To their credit the banking industry, realizing this area was exposed, created FACTA’s Red Flag Rules (and PCI in the credit card arena) and now the healthcare industry is finding their world impacted by banking regulations. I suppose what’s good for the goose is good for the gander. We suggested, as did EPIC in 2004, that OMB implement a cross-industry group to review medical banking policy. Healthcare and banking do not live in isolation. As convergence broadens what one does will tend to impact the other. Thus the answer to the first test is “no”; banks aren’t 100% exempt from HIPAA.

The second test – does Section 1179 refer to payment data ONLY or all payment-related functions – is clarified in the guidance to the Privacy Rule drafted by Bill Braithewaite. What he wrote in 2001 is absolutely clear; I don’t think it needs to be demystified. Some argue that payment activities involve all of the claims transactions but the only way to reconcile the legislative intent of HIPAA and the guidance in the Privacy Rule is to specifically exempt consumer-initiated financial transactions not business-to-business transactions. This is clearly stated in the legislative record in no uncertain terms. The Privacy Rule guidance says moving diagnostic data through banking systems is only acceptable with a business associate contract in place. Thus the answer to the second test is to treat the term “payment activities” as movement of funds and not the movement of HIPAA transactions that have more data than this. In other words, if you exempt all HIPAA transactions you might as well exempt banks altogether and that’s an incorrect interpretation of the law. Whatever your view, NCVHS once again in 2004, makes it clear that covered entities should execute a business associate contract with their bank partners. Their advice is both sound and clear and if you look at the marketplace, its already complying or taking steps to do so.

The final test is “when is a bank a clearinghouse under HIPAA?” Talking about when a bank is a business associate vs. clearinghouse may be an interesting technical exercise but everyone involved in HIPAA knows the rule was drafted with the understanding that any HIPAA-CH is in fact already a business associate. That’s why the administrative regulations are different for clearinghouses; they don't need to do things like send privacy notices because obviously a clearinghouse has no direct relationship with the patient. So the real question is when is a bank a CH under HIPAA, because we already know that if a covered entity allows its business partner, bank or non-bank, to have access to protected health information they must execute a business associate contract. Thus a clearinghouse is presumed to always be a business associate; again, nothing to demystify here! We should also note that within the economic stimulus package the differentiation in terms of penalties between a CH and BA is blurring. Business associates will likely be penalized the same as clearinghouses! I think this is both unfortunate and difficult to apply. It undermines rather than leverages the underlining construct of HIPAA that in my opinion was a stroke of genius, pushing the privacy and security doctrines out into the marketplace in a very broad and sweeping way using the “covered entity-business association” principle. But I respect the work of many privacy groups and even the IOM has come out with a report suggesting we either scrap HIPAA or do an overhaul. We simply urge balance between privacy and functionality and privacy and safety.

So we turn to the issue of when is a bank a clearinghouse and here again, the law and NCVHS is abundantly clear. If a bank converts data to or from HIPAA transaction its a clearinghouse. That means it has federal obligations and not just contractual obligations and that could lead to fines for non-compliance but as we suggest even that may change under the Economic Stimulus plan. I want to add here that to suggest a BA or CH would be treated differently if there was evidence of unauthorized use of PHI is probably misleading. The Privacy Rule applies its penalties to individuals not companies. You don’t throw companies into jail, you throw people into jail. Today HIPAA penalties are the law of the land, whether BA, CH or a person walking down the street with unauthorized access to health data. Here again the story has already been told.

The third test then really revolves around function. Banks may be impacted in three areas: accounts payable and accounts receivable processing (at the lockbox or RDFI level) and point of service transaction processing to the extent HIPAA-regulated data conversion occurs. There may be other areas but one need only make this determination and you have your answer. Case settled.

In the interest of full disclosure, there are some outstanding policy issues having nothing to do with EDI. In 2003 I outlined new privacy rights in lending arrangements, published by the Banking Law Journal, that may become problematic until addressed. We alerted CMS and the marketplace in a press release on those issues and published opinions on the topic in our Medical Banking Road Map for America.

A few key facts related to this topic are important: first, less than 1% of remittance data flows through the ACH. This isn't a gaping risk area and its not growing; I’m not suggesting it isn’t important but its good to understand the magnitude of the topics we’re discussing; especially when talking about policy. Next, the average community bank that is processing payments from the ACH to the provider’s bank account may be business associates but the vast majority aren’t clearinghouses. Third, today no other industry outside of defense is as heavily invested in the Identity Theft Arms Race as banks. They simply cannot let the bad guys get your money, for if that happens just one time over 58% of all consumers will change banks according to a survey by Ponemon Institute. That unforgiving and small margin of error is a clear incentive for protecting both your confidentiality and money. Truth be told, the physical, technical and administrative safeguards banks are highly invested in are the most stringent prescribed in the Security Rule. Banks have layers of redundant safeguards to protect your confidentiality. We are convinced this engine of assurance can be harnessed to support national policy goals in healthcare through new medical banking innovations. Finally, even given today’s credit crisis, financial institutions have invested over half a billion dollars into health IT since 2001 and we see that trend growing. That’s new found money in health IT and its very important because most providers can’t afford to upgrade technology so banks partnered with health IT firms and payors can help to meet this critical need. For these and other reasons, banks should be a welcome stakeholder to improve healthcare for everyone.

In closing, every great story needs a great ending. I think the plot of medical banking, where there is an alliance between two industries that desperately need each other to be successful, is an inspiring story! HIPAA’s impact on banks is not a tale of mystery, in fact, there’s no mystery here whatsoever. I think the conclusion is crystal clear. That HIPAA has disclosed exciting and innovative ways for banks and healthcare to work together and that, working side-by-side through evolving cross-industry technologies, these groups have already paved a common destiny to improve healthcare. And that’s what the story of medical banking is all about. Thank-you!

John Casillas
Chair, Medical Banking Institute
Executive Director, Medical Banking Project
401 Pond View Court | Franklin, TN | 37064
Phone: 615.794.2009 Ext. 114| Fax: 615-468-7606
http://www.mbproject.org

IPayX Healthcare Improvement Webinar

Healthcare reform discussion moderated by Medical Banking Project’s John Casillas.

You need to attend the MBP webinars to get the meat on the bones rather than just the skeleton.

Simplifying The Business of Healthcare

Hospitals and Health Plans Join National Roundtable To Discuss Revenue Cycle Management

Contact:

John Casillas

Phone: 615.794.2009 Ext. 114| Fax: 615-468-7606

info@mbproject.org

Franklin, TN (January 8, 2009) The Medical Banking Project announced a National Roundtable - "Medical Banking & The Health Data Ecosystem: Engineering a Revolution in Revenue Cycle Management" - that will convene at the 7th National Medical Banking Institute in Nashville, TN, March 11-13, 2009 in Nashville, TN. Early bird registration expires on January 15, 2009.

"The Institute brings together diverse stakeholders from care providers, plans, banks, employers, consumer representatives, health IT firms, government and others, to discuss new ways to tackle fundamental challenges in health care,” said MBProject’s John Casillas. “For example, the Institute will demonstrate how medical banking can reduce infrastructure costs by over $35 billion annually, support real time payment and data transfers and offer a socially responsible "green" initiative that takes paper out of the system while reducing confusion around the payment process for patients. The core of this opportunity - reducing ‘friction’ in health claims and payment management - will be a key topic taken up by this national panel of experts."

Faculty for the National Roundtable includes:

Moderator:

Sheila Schweitzer, CEO & Chairperson, CareMedic, St. Petersburg, FL; Chair, Health Futures, President's Council

Panelists:

Lyman Sornberger, Executive Director, Cleveland Clinic, Cleveland, OH

Robert Nay, Director, Blue Cross/Blue Shield of Florida, Health Options, Jacksonville, FL

Charlie Myers, Director of Operations, Special Programs and Support, Johns Hopkins Hospital and Health System, Baltimore, MD

Russell Taylor, Strategic Systems and Processes, Aetna, Inc., Middletown, CT

Following the session, an industry panel will examine benefits of a medical banking platform from the health care provider's perspective, followed by another working session that will focus on benefits from the payor's perspective, including the adaption of banking systems for real time claims processing.

A concurrent track with two sessions focused on innovations in medical consumerism is also being offered. Atlantic Information Services, Wash, DC, will provide first quarter HSA statistics in a panel moderated by Roy Ramthun, former economic advisor to President Bush. The second session, supported by Sun Microsystems, will explore access to a personalized healthcare platform by online banking customers. A special study by Paul Whitman, PhD, (California Lutheran University) will demonstrate key financial benefits when moving consumers from off-line to online banking, suggesting that banks engaging new health IT tools for consumers could develop a competitive edge.

>> EARLY BIRD REGISTRATION (expires 1/15/09): http://www.mbproject.org/7mbi2009_registration.php

>> Full Agenda: http://www.mbproject.org/7mbi2009_agenda.php

>> Sponsorship Information: http://www.mbproject.org/7mbi2009_sponsorship.php

The Seventh National Medical Banking Institute convenes national leaders and entrepenuerial start-ups alike who are "building an electronic medical banking community", the theme of the event. A comprehensive and distinguished faculty from media, commerce, government and academia will present, including:

June St. John, Chair, Education and Programming Subcommittee, Medical Banking Institute; SVP, Healthcare Product Manager, Wachovia Treasury Services, Charlotte, NC

Patricia Alafaireet, Director of Applied Health Informatics, School of Medicine, University of Missouri, Columbia, MO.

Foster North, VP, CareMedic Systems, St. Petersburg, FL

Richard Mobley, VP, Healthcare Services, BancTec, Irving, TX

Bill Marvin, CEO, Instamed, Philadelphia, PA

John Phelan, PhD, Healthcare Management & HIPAA Consultant, Milliman, Inc., Westlake Village, CA

Nancy Vickroy, Director of Product Development & Management Healthcare Solutions, TransUnion, Chicago, IL

Nav Ranajee, VP, Healthcare Product Group, Fifth Third Bank, Chicago, IL

Maureen L. Turo, President, National Medical Banking Institute; VP, Healthcare Strategy, The Bank of New York Mellon Treasury Services Division, Pittsburgh, PA

John Casillas, Chair, Medical Banking Institute; Founding Director, The Medical Banking Project, Franklin, TN

Robert Broadway, Chair, Healthcare Financial Management Association (HFMA); VP, Bethesda Healthcare System, Boynton Beach, FL

Ceci Connolly, National Staff Writer, Washington Post, Washington, DC (I)

Robert K. Smoldt, Chief Administrative Officer Emeritus, Mayo Clinic, Rochester, MN (I)

Michael Johns, M.D., Chancellor, Emory University, Atlanta, GA; Co-Chair, The Blue Ridge Academic Healthcare Group (I)

Robert M. Crane, Senior Vice President, Research & Policy Development, Kaiser Foundation Health Plan, Inc. and Kaiser Foundation Hospitals, Oakland, CA (I)

Jeanne M. Lambrew, Deputy Director-elect, White House Office for Health Reform, Washington, DC; Senior Fellow, Center for American Progress; Associate Professor of Public Affairs, Lyndon B. Johnson School of Public Affairs, University of Texas (I)

Sheila Schweitzer, Chairperson & CEO, CareMedic Systems, St Petersburg, FL

Robert Nay, Director, Blue Cross/Blue Shield of Florida, Health Options, Jacksonville, FL

Charlie Myers, Director of Operations, Special Programs and Support, Johns Hopkins Hospital and Health System, Baltimore, MD (I)

Russell Taylor, Strategic Systems and Processes, Aetna, Inc., Middletown, CT

Doug Bilbrey, EVP Sales & Marketing, The SSI Group, Inc., Mobile, AL

Laurie Holtsford, Director of Business Office Support, Community Healthcare Systems, Franklin, TN (I)

Todd Slocumb, Vice President, Receivable Management Solutions, Edmond, OK

Christine Smith, Product Manager-Remittance Solutions, WAUSAU Financial Systems, Mosinee, WI

Roy Ramthun, HSA Consulting Services, Silver Spring, MD

Thomas Hricik, Principal and National Director, HSA Product Distribution, ACS, Pittsburgh, PA

Greg Scandlen, Fellow, Wheatland Institute; CEO, Consumers for Health Care Choices, Hagerstown, MD

Todd Berkley, VP, Market Solutions, OptumHealth Financial Services, Salt Lake City, UT

Steve Davis, Managing Editor, Inside Consumer Directed Care, Atlantic Information Services, Washington, DC

Devon McGraw, Executive Director, Health Privacy Project / Center for Democracy & Technology, Washington, DC

Rick Morrison, President, WJM, Inc., Little Rock, AR

Vince Marzula, Vice President, PNC Bank, Pittsburgh, PA

Bill Marvin, CEO, Instamed, Philadelphia, PA

Paul D. Witman, Ph.D., Ass’t Professor, Information Technology Management, School of Business, California Lutheran University, Simi Valley, CA

Toby Rogers, EVP, Commercial Markets, DestinationRx, Chicago, IL

Kumar Swaminathan, Industry Manager, Consumer Centric Healthcare, Sun Microsystems Inc., Menlo Park, CA

Vikram Kashyap, CEO, Canopy Financial, San Francisco, CA (I)

David Trotter, Executive Vice President, Division Head of Treasury Services, Wachovia, Charlotte, NC

Al Briand, Division Head, BNY Mellon Treasury Services Product Management and Strategic Development, New York, NY

Kevin Lavender, Senior Vice President, Healthcare Finance, Fifth Third Bank, Nashville, TN

J. Scott Sharland, Executive Director, Automotive Industry Action Group (AIAG), Southfield, MI

Leah Binder, CEO, The Leapfrog Group, Washington, DC

---------------------------------------------------

Many thanks to our sponsors!

EDUCATIONAL GRANTOR: BancTec

Platinum Sponsor: WAUSAU Financial Systems

Gold Sponsor: BNY Mellon

Silver Sponsors: TransUnion, Thelma-US, Metavante

Media sponsor: HealthcareFinanceNews

Organizational sponsor: Healthcare Information Management Systems Society (HIMSS)

CarevilleTV: Community Healthcare Clinics Can Provide Fertile Soil for Healthcare Improvements

I sat in on a gracious invite to moderate IPayX's Healthcare Improvement Webinar (positioned at MBProject as part of our "Banking on Better Healthcare Series" - see here), which collected opinions from participants for the Obama Healthcare Initiative. On the call sat a patient accounting executive from a world renoun academic health center, a large healthcare IT services firm and the IPayX team. It was small but the content was rich (see this SlideShare).

Douglas Braun, who runs IPayX, was able to describe the Obama healthcare plan in three bold strokes; (1) improve infrastructure; (2) expand coverage to all Americans; (3) improve prevention and public health. While we didn't get to the all important cost factor, we were able to hear a series of interesting observations, some from the Vice Chancellor of Health Affairs at Vanderbilt University, Dr. Harry Jacobson. Dr. Jacobson addressed the 2009 Medical Banking Leadership Forum, where some 55 banking and healthcare leaders attended to discuss the future of medical banking in a "credit-broken" economy. Some of his analyses were presented in the slide deck, comparing healthcare costs in the US versus other areas of the world. Looking at our healthcare "problematique" within a global context is very helpful, I believe, in forming constructive frameworks that could point to solutions.

Interestingly during the Forum, MBProject also focused on three key areas: (1) improving healthcare infrastructure and using those savings to expand coverage to more Americans (the mission of MBProject is to 'convert digital savings into charitable resources'); (2) how to extrapolate and capitalize on business intelligence running through medical banking platforms; and (3) implementing a personalized healthcare platform for increasingly sophisticated medical consumers - one that could include comparing healthcare resources in a community, educating consumers on wellness and prevention (a key issue arising in employer circles that talk about optimizing human capital), using a card-based system for managing a personal healthcare record and providing tools to better manage HSAs - a "health-wealth portal" play.

As I sat on the call and heard the opinions, (supplying many of my own), I saw more clearly that our areas of focus in the medical banking community align well with the stated objectives of the Obama Administration. We have much to offer former Senator Tom Daschle's (D-SD) new team as they sift through ideas...and a healthy dose of respect for the challenge that lies ahead that will require all stakeholder hands on deck.

One of my moments of clarity came from Obama's call for investing in communities. This is an agenda item for which we not only made a call for support among our bank members, noting that banks may be defined as good corporate citizens with access to credit (the latter being challenged today but still holding true), but an Action Plan called "Charitable Communities Network" and later rebranded to "CarevilleTV". After making an investment in this concept, that brings together so many of the community anchors and technologies that can support "healthier communities", I challenged banks to follow our lead in 2003. We got some bites but not enough to crank up the model and see if it really works...yet!

An article published by the The New York Times reads, reporting from Nashville,..."Although the number of uninsured and the cost of coverage have ballooned under his watch, President Bush leaves office with a health care legacy in bricks and mortar: he has doubled federal financing for community health centers, enabling the creation or expansion of 1,297 clinics in medically underserved areas." The IPayX webinar, this article, and our focus at MBProject lead me to a startling conclusion - that the community healthcare clinic setting should become an area of focus for the Obama Administration.

In the safety net setting we can test and deploy new technologies without the typical "game politic". We can get much done that is instructive to the greater healthcare establishment. I strongly believe that we must not race towards a digital economy in healthcare while leaving the safety net behind - nor should we! These "beacons of light" - community clinics dotting the American landscape - can serve a dual purpose to both help the underserved/unbanked as well as offering a critical testing and staging ground for the next generation of technology tools. Of course not all tools can evolve from this setting but my instincts tell me that many, many innovations can benefit from deployment in a real world, community clinic healthcare setting. My thoughts to Obama? Target this area with investment and a way to measure progress along the three critical fronts - cost, access and quality of care.

I have to admit, as I reasoned through these ideas during the IPayX call, and after having talked about CarevilleTV to my entrepenuerially-minded brother-in-law (and former pastor) over the holidays, the notion of moving forward on the Action Plan/Business Plan (yes, it is a self-sustaining business model) ignited once again. Along with other personal reasons involving the passing of my dear sister (see My Tribute here), I'd like to re-energize our "New Media Initiative" at MBProject. The idea was ahead of its time but that is no longer an excuse. We must push medical banking into the mainstream of our everyday community-oriented lives. CarevilleTV offers a plan to do just that. For more information on CarevilleTV (rebranded from CCN), see this.

John Casillas
johnc at mbproject.org
Chair, Medical Banking Institute
Executive Director, Medical Banking Project
401 Pond View Court | Franklin, TN | 37064
Phone: 615.794.2009 Ext. 114 | Fax: 615-468-7606
http://www.mbproject.org

Medical Banking Networking Group Launched on LinkedIn.com

Posted by ED

Medical Banking LinkedIn Group image

For those interested in using social networks to promote the latent integration of banking technology, infrastructure and credit with healthcare administrative and clinical operations, I have created a Medical Banking Networking Group on LinkedIn.com. The invite link is available here.

AHIP Board Backs Hill Reforms Plus 7

HealthWire reported today that AHIP is supporting the concept of a Federal Health Board among other policy goals.

The board of America’s Health Insurance Plans (AHIP) at a press conference in Washington today proposed 7 significant new health reform innovations as part of a package of ideas presented as a first-cut ‘comprehensive’ reform plan. While details were sketchy, a close reading of the new AHIP language shows it also endorses 13 out of 16 features of pending major Capitol Hill proposals.

The seven new health reform proposals from AHIP added to the mix include:

· Congress will set a specific target for reducing national health spending over a 5-year period (from a 6.6% to 4.7% increase)

· A new independent federal board (akin to the Federal Reserve) will develop a specific action plan for reducing health costs in the U.S.

· A national multi-payer online portal will give all providers a uniform method to communicate with all health plans on eligibility and benefits

· All payers will voluntarily adopt uniform national standards for quality, reporting and information technology versus today’s ‘piecemeal’ basis

· Small employers will under federal law be offered an “essential benefits plan” available nationwide and exempt from state mandates

· Emergency rooms will be replaced as a poor source of routine primary care for the uninsured by a planned and organized national system

· Low-income patients will get bankruptcy protection from medical claims under a system of tax credits tied to percentage of income spent

Medical Banking Offers Vision In Uncertain Financial Markets

By John Casillas, Founding Director, Medical Banking Project

In early October, sixty market leaders that are invested in the medical banking space met at a Leadership Forum in Nashville organized by the Medical Banking Project. Talk of the financial crisis quickly made its way into the dialogue with perhaps a unique wrinkle; namely, how will it impact Medical Banking?

Its important that leaders dialogue this issue to arrive at an understanding of market direction. The Leadership Forum provides the opportunity for members of MBProject to come together and discuss the current build-out of medical banking programs, isolating best practices and areas that require cooperation to move things along, like standards. Prior to beginning the session, a survey was handed out to capture opinions on the impact of the financial crisis on plans to implement medical banking programs.

Almost 80% of the delegates said that the financial crisis will not affect investment in medical banking programs over the next 12-18 months. The dollars earmarked for this activity have been budgeted and will more likely than not be placed into the segment. At that point, attendees breathed a collectively sigh of relief. We were all on the same page. Its still “game on” for medical banking.

I prepared a talk the night prior to challenge the leadership to stay focused. Taking a queue from Jack Welsh, former CEO of General Electric, I challenged leaders to not only create and articulate a vision, but to passionately own it, and to relentlessly drive it to completion. After the dust settles in the markets we still need to fix our healthcare system and in the basket of tools within our grasp to do that, medical banking offers a viable strategy to improve healthcare.

The remarks were received well. After an insightful review of the criticality of moving towards a real time system, comparing costs to other nations, by Dr. Harry Jacobsen, Co-Chancellor of Vanderbilt University and overseer of Vanderbilt Medical Center’s $2.5 billion budget, two panels followed discuss the current state of real time platforms and business intelligence in healthcare. This was followed by a talk by McCain advisor Dr. Steve Parente regarding his soon to be published paper entitled: The Next Step For Convergence of Healthcare and Financial Systems: The Potential of Medical Banking.

On day 2 of the Forum, the leadership broke up into work teams and methodically plodded out, through discrete action items, what the agenda will be for the medical banking industry in 2009.

Amidst a very serious crisis affecting financial markets, it should be clear that investment banking, and the bank on main street, are two very different structures. The paranoia has seeped through investment banking to affect main street banks, which are perfectly functional, as well as other industry segments. But the financial stability plan is largely a plan for investment banks, not commercial bankers. A new public relations program organized by the American Bankers Association is trying to get that point across to the American public.

Along these lines, I was asked to draft a column for the September issue of HFM to clearly outline the meltdown in financial markets and its impact on medical banking. In it I argue that although there a systems within healthcare and banking that are broken, there is still regularity and trust in both. We don’t tear down a house after a tornado has passed through if only the roof needs fixing. We still trust the foundation; we live in the house after its fixed. The two industries aren’t 100% broken and some leaders argue they need each other now more than ever before to pull through the crisis (see Martys blog).

In healthcare most of us trust that if something goes wrong we can get to the emergency room and receive care when we need it (although paying for it is another story). In banking, we routinely trust our funds transfer systems, ATM and branch networks, online banking and other areas. They operate 24 by 7 and will do so for a long, long time.

Let’s not throw the baby out with the bath water. Banking is a core requirement in our economy and the areas that are under attack today, although affecting the broader economy, didn’t start and won’t end by casting blame on commercial banks.

Leaders must drive medical banking to completion. In this we will realize the promise of EDI in healthcare. Another way of saying the same thing is we need medical banking to “convert digital savings into charitable resources”, our mission at MBProject, and those savings are needed in communities across America and around the globe. The potential for creative innovation using medical banking is very real. It can improve the quality of lives everywhere.

This has been a premise in medical banking since its inception and its more true today than when it was first conceived by the Medical Banking Project in 2001. Today, more voices are pointing towards the potential of medical banking to hasten needed and long lasting innovations in healthcare.

When the dust settles in banking, the worrisome troubles in healthcare will once again take center stage and as leaders, we must drive the medical banking programs we have articulated to completion. By doing so, we will show true leadership, be responsive to product innovations that can be profitable and productive for all the stakeholders and address critical issues that must be fixed in our healthcare system.

Can Bankers Save Doctors? (Can Doctors Save Bankers?) Part I and Part II

Martin Jensen, of the Healthcare IT Transition Group, www.HITtransition.com, delves into medical banking here and here.

Ignacio Valdes Editorializes on HIMSS response to HR 6898

Ignacio Valdes is the editor of Linux Med News and has been a proponent of open source in health care. He recently posted this notice of his editorial to the Open Source Working Group of the American Medical Informatics Association. It (and associate posts at LMN) may or may not be of interest:

"Health Information and Management Systems Society HIMSS has presented their response http://linuxmednews.com/PDFs/Final_HIMSS_Response_to_HR_6898.pdf to H.R. 6898 which favors open source software and Veterans Affairs VistA: '...The private sector makes significant investments in research and development for healthcare IT products. Healthcare IT is available via a competitive market in which vendors compete on the basis of price, quality, and functionality of a product. The development, routine updating, and provision of an open source "healthcare information system" is not the role of the federal government and such product development should remain in the private sector...'

I have penned a saucy little editorial response here: http://linuxmednews.com/1222727586/index_html

-- IV

A Medical Banking Addendum to the Financial Stability Plan Pending Before Congress

Creating lasting value for taxpayers by linking the 700 billion bail out plan to healthcare benefits

A pivotal feature of the current "bail out" plan is the perception of limited value for the American taxpayer. Clearly in the plan, taxpayer funds are at risk, however, the President, US Treasury and Federal Reserve all believe that a partial to full return of the 700 billion is possible.

Presumably the payback funds (original principal and profits) will go into a general account. We believe this creates the feeling of paying for the broken heater at home - it needs fixing but it sure doesnt feel good when the money leaves our hands.

For this reason, I suggest linking the bail out plan to a healthcare benefit for the uninsured. This could help to solve the perception issue of value.

In this model, a means test could be efficiently applied to qualifying individuals. This "community care platform" could be supervised by a commission appointed by Congress to oversee the appropriate transfer of "bail out" principal and profits to community healthcare benefits.

I further recommend that a percentage of the profits be used to fund President Bush's previous call that every American have a personal healthcare record in 10 years. This could have a lasting impact on the quality of care for every taxpayer after the profits have dried up.

Linking the financial stability plan with a healthcare benefit is a message that could resonate well with the American taxpayer. Changing the perception of value by showing a concrete return may turn this intensely negative issue into a positive.

John Casillas
johnc at mbproject.org
Founding Director
Medical Banking Project
www.mbproject.org
(615) 794-2009

The Rise of the Bank Infomediary in Health Care

John Casillas, www.hfma.org

Privacy and security regulations and the rise of consumer-driven health care are changing the role of banks in health care.

At a Glance

Banks are evolving in four key areas that collectively comprise the rise of a “bank infomediary”:

Efficient administrative processing
Medical Internet
Health information broker
Community care platform

Medical Banking Goes Green

Institute shows how banks and healthcare are teaming to move paper out of the system and create compelling opportunities for "on-demand" health data services

Contact: Evelyn Marquez Sanchez
615-794-2009
info@mbproject.org

Franklin, TN (August 13, 2008) The Medical Banking Project's Seventh National Medical Banking Institute highlights the benefits of "Building An Electronic Medical Banking Community," the theme of the event. The 3-day Institute will be held in Nashville, TN, March 11-13, 2009 and will feature Keynote speeches from the Chair of the Healthcare Financial Management Association, the Executive Director of the Automotive Industry Action Group and other VIPs.

“We’re energized about our mission to convert digital savings into charitable resources by linking banking and healthcare systems,” said John Casillas, MBProject founder and chair of the Institute. “It rids the system of a lot of paper and that’s a ‘green message’ that we haven’t stressed enough. Translated into everyday language, medical banking systems can save 2 million trees and avoid using 103 million gallons of gas every year. It's good for the environment.”

“Banks want to move paper out of the financial system and so the medical banking movement really fits this initiative,” said Maureen Turo, president of the Medical Banking Institute and Vice President of Healthcare Strategy at The Bank of New York Mellon. “As we look at industries where we can re-engineer our systems to make an impact, healthcare is a primary target.”

“Finding smart ways to effectively link and digitize cross-industry workflow is essential,” said June St. John, Chair of Education and Programming for the Medical Banking Institute and SVP, Healthcare Product Manager at Wachovia Treasury Services. “We organized this institute to highlight opportunities for banks to help electronify the paper chase in healthcare. The Institute's educational programming is timely and addresses a critical need in healthcare today - creating the potential for quantum leaps in efficiency for all the stakeholders – payors, providers, employers, banks and consumers.”

Some of the key features of the Institute include:

BancTec Networking Reception & Gala provides a venue for high value interactions and networking for our guests.

Payor, provider, bank and large employer panels will connect the dots and explain how new medical banking systems can benefit their operations.
The Joint Taskgroup for Value In Health, a collaborative of MBProject and the Automotive Industry Action Group (AIAG), convened executives from the financial services, healthcare, automotive industry and State Government to create a "Medical Banking Tool Kit for Employers" that will be highlighted at the session.
The 2009 International Journal of Medical Banking will feature prominent thought leadership and will be distributed at the event.
More to be announced soon…

Educational Grantor: BancTec

BancTec helps clients around the world simplify the process of managing their information. Specifically related to healthcare, BancTec’s RemitCycle 360 information platform exchange provides a HIPAA-compliant payment system that processes Electronic Remittances (835 transactions) and facilitates processing explanation of benefits (EOBs) and money transactions from health insurers to healthcare providers electronically. Implementing the RemitCycle 360 system improves collections, materially reduces administrative expense and dramatically improves bill to post. To learn more, please visit www.BancTec.com

Make plans to attend ASAP! Registration is available at: www.mbproject.org/7mbi2009_registration.php

Sponsorship opportunities are available at: www.mbproject.org/7mbi2009_sponsorship.php

White Papers are still being accepted for publication in the 2009 International Journal of Medical Banking. Please see the manuscript guidelines at: www.mbproject.org/7mbi2009_whitepapers.php.

About the Medical Banking Project...

MBProject is a pioneering authority that coined the term “medical banking” to denote the emerging global convergence of banking and healthcare systems to improve health costs, quality and access. Our educational forums, workgroups and pilot programs showcase visionary ideas and initiatives that inform policy, commerce and academia. Supported by a diverse constituency, MBProject conducts research and outreach that defines and facilitates medical banking, and this supports our mission to convert digital savings into charitable resources. Our work demonstrates how banks can improve healthcare programs for consumers, care givers, health plans and employers. For more information please go to: www.mbproject.org.

Open standard gains new ground in financial reporting

May 14, 2008, By Grant Gross, IDG News Service\Washington Bureau, IDG, NYTimes.com

The U.S. Securities and Exchange Commission has taken a major step toward requiring publicly traded companies to submit their reports to the agency in an interactive data format, with backers saying the change will make financial reports easier to analyze.

All three SEC members voted to publish a proposal that would require public companies to file reports in eXtensible Business Reporting Language, or XBRL, a programming language related to XML that's being developed by a nonprofit consortium of about 450 companies. Under the proposal, which still needs final approval from the SEC after a public comment period, the transition from text and HTML reports to XBRL would take three years, with about 500 of the largest U.S. and foreign companies required to start filing XBRL reports after Dec. 15.

The International Journal of Medical Banking White Paper Submission Requirements

Requirements:

1. The paper must be related to issues that directly affect the medical banking industry

2. The paper must not be a self-promoting or advertising piece

3. Preference is given to original pieces of research

4. The text should be double-spaced and include an abstract, list of milestones and/or deliverables if applicable and the significance of the work.

5. Submissions must be in electronic format (MS Word) and submitted to info@mbproject.org.

6. When submitting a white paper please include: company name, author(s) and contact information including email addresses. We are seeking white papers in the following areas:

Information privacy, confidentiality and security that focuses on cross-industry issues in banking and healthcare
Identity management technology that applies to medical banking programs
Community coalition building, community programs & awareness that can be applied to medical banking constituencies
Treasury and cash management programs targeting healthcare
Card-based platforms and technologies that link healthcare and banking systems
New credit programs for healthcare, both consumer and commercial
Consumer-driven healthcare technology tools and platforms
Open source healthcare programs linking banking and healthcare systems
Electronic and Personal Healthcare Records programs linked to banking systems
Bank-assisted RHIO programs
Independent Health Record Banks/Trusts
Banking opportunities in medical tourism
Man-made and/or disaster preparedness involving medical banking systems
Community care platforms linking consumers with healthcare programs in the local area using automated eligibility and funds transfer platforms

The 2nd edition of the Journal will be distributed to attendees of the 7th National Medical Banking Institute tentatively scheduled to occur in New Orleans, LA in April 2009. If you have any questions please feel free to contact MBProject offices by email using: journal@mbproject.org.

FRONTLINE Travels To Five Countries In Search Of a Universal Health Care System That Could Work In The U.S.

Posted by John Casillas (from the PR)

FRONTLINE teams up with T.R. Reid, a veteran foreign correspondent for The Washington Post, to find out how five other capitalist democracies--United Kingdom, Japan, Germany, Taiwan and Switzerland--deliver health care and what the United States might learn from their successes and their failures. In Sick Around the World, airing Tuesday, April 15, 2008, at 9 P.M. ET on PBS (check local listings), Reid turns up remarkable differences in how these countries handle health care--from Japan, where a night in a hospital can cost as little as $10, to Switzerland, where the president of the country tells Reid it would be a "huge scandal" if someone were to go bankrupt from medical bills.

Reid's first stop is the U.K.--a system very different from ours, where the government-run National Health Service is funded through taxes. According to Whittington Hospital CEO David Sloman, "Every single person who's born in the U.K. will use the NHS ... and none of them will be presented a bill at any point during that time." Reid is surprised to find the system often dismissed as "socialized medicine." The U.K. is now trying free-market tactics like "pay-for-performance," where some doctors are paid more if they get good results controlling chronic diseases like diabetes, and patient choice, in which hospitals compete head to head. While such initiatives have helped reduce waiting times for elective surgeries, the London Times' medical correspondent Nigel Hawkes tells Reid the NHS hasn't made enough progress. "We're now in a world in which people are much more demanding, and I think that the NHS is not very effective at delivering in that modern, market-orientated world."

Reid reports next from Japan, the world's second largest economy and the country boasting the best health statistics. The Japanese go to the doctor three times as often as Americans, have more than twice as many MRIs, use more drugs, and spend more days in the hospital, yet Japan spends about half as much per capita as the United States. Reid finds out the secrets of the nation's success: By law, everyone must buy health insurance--either through an employer or a community plan--and unlike in the U.S., insurers cannot turn down a patient for a pre-existing illness, nor are they allowed to make a profit.

Reid's journey then takes him to Germany, the country that invented the concept of a national health care system. For it's 80 million people, Germany offers universal health care, including medical, dental, mental health, homeopathy and spa treatment. Professor Karl Lauterbach, M.D., a member of the German parliament, describes it as "a system where the rich pay for the poor and where the ill are covered by the healthy. It is ... highly accepted by the population." As they do in Japan, medical providers must charge standard prices which are negotiated with the government every year. As a consequence, physicians in Germany earn between half and two-thirds as much as their U.S. counterparts.

Taiwan researched many health care systems before settling on one where the government runs the financing, but Reid finds the delivery of health care is left to the market. Taiwanese health care offers medical, dental, mental and Chinese medicine, with no waiting time and for less that half of what we pay in the United States. Every person in Taiwan has a "smart card" containing all of his or her relevant health information, and bills are paid automatically. But what Reid finds is that the Taiwanese spend too little to sustain their health care system. According to Princeton's Tsung-Mei Cheng, who advised the Taiwanese government, "As we speak, the government is borrowing from banks to pay what there isn't enough to pay the providers."

Reid's final destination is Switzerland, a country whose health care system suffered from some America's problems until, in 1994, the country attempted a major reform. Despite a huge private insurance business, a law called LAMal was passed, which set up a universal health care system that, among other things, restricted insurance companies from making a profit on basic medical care. Today, Swiss politicians from the political right and left enthusiastically support universal health care. Pascal Couchepin, the president of the Swiss Federation, argues: "Everybody has a right to health care. ... It is a profound need for people to be sure that if they are struck by destiny ... they can have a good health system."

Sick Around the World is a FRONTLINE co-production with Palfreman Film Group. The film's correspondent is T.R. Reid. The writers are Jon Palfreman and T.R. Reid. The producer and director is Jon Palfreman. FRONTLINE is produced by WGBH Boston and is broadcast nationwide on PBS. Funding for FRONTLINE is provided through the support of PBS viewers. Major funding for FRONTLINE is provided by The John D. and Catherine T. MacArthur Foundation. Additional series funding is provided by the Park Foundation. Additional funding for Sick Around the World is provided by The Colorado Health Foundation, The Commonwealth Fund and The Colorado Trust. FRONTLINE is closed-captioned for deaf and hard-of-hearing viewers and described for people who are blind or visually impaired by the Media Access Group at WGBH. FRONTLINE is a registered trademark of WGBH Educational Foundation. The senior producer is Raney Aronson. The executive producer of FRONTLINE is David Fanning.

A New Medical Banking Ecosystem

Franklin, TN (April 3, 2008) Delegates conclude a 3 day meeting today with senior officials in banking and healthcare at the 6th National Medical Banking Institute. Calling attention to natural and man-made disasters, like the subprime mortgage crisis, MBProject’s founder John Casillas asked attendees “yet today, aren’t we faced with an even more compelling man-made disaster as we experience a ground swell in the rising costs of healthcare?” He challenged attendees to rally behind medical banking as a national strategy to mitigate a “financial tsunami” that is leaving more families destitute and undercutting national productivity. He asked leaders to build a “new medical banking ecosystem” to address an impending crisis in healthcare.

Other keynotes included an industry summary by Booz Allen Hamilton, a review of data privacy issues by the Joint Commission, (which issued a new report on quality measurement and data reporting), a review of ONC efforts to build a national healthcare information network by Jodi Daniel, senior advisor at ONC, and an industry panel entitled: Are Medical Banking Systems Ready for Prime Time?”. Today’s talks will feature an industry panel (Converting “Cybercondriacs” to HIT Wizards”) moderated by David Harris, a partner at PricewaterhouseCoopers who chairs the HSA Workgroup at MBProject. The panel features Microsoft HealthVault program, a personal healthcare record service, Best Doctors and OptumHealthBank. Dr. Paul Grundy from IBM, who chairs the Patient Centered Primary Care Collaborative, will introduce bank delegates to the new Medical Home concept and seek their participation to change the healthcare payment systems.

A series of new industry announcements by MBProject Members were announced during the day, including:

Fifth Third Bank announced a new partnership with GHN-Online and Revenue Management Solutions (RMS) to launch a new business intelligence platform for the healthcare industry.
GHN-Online released a new healthcare reimbursement scorecard that measures “the average number of payment days for a clean claim from payors, extracted from the payors remittance advice reports.” The firm further announced a new relationship with Revenue Managements Solutions (RMS) to provide a “comprehensive claims processing and remittance solution for healthcare banking.”
E-Duction announced that it has now processed over 1,000,000 “variable payroll deductions” using a “guaranteed issue credit, zero percent interest and automatic payment via payroll deductions that traditional credit cards don’t offer”. In a separate announcement, the firm announced that an independent market research firm rated users of the program and found that 81% are “highly satisfied”.
The Bank of New York Mellon and The SSI Group, Inc., announced a new healthcare services alliance that will “enhance a range of end-to-end claims processing solutions” for healthcare clients. This includes “new lockbox services for patient and commercial insurance payments, conversion of paper transactions to electronic remittance advices (ERAs), establishment of ERAs and reassociation of ERAs with electronic payments, providing the industry an all-payer solution.”
The Bancorp Bank announced that it is “aggressively pursuing a variety of strategies” in healthcare through 120 established relationships with a variety of clients nationwide; and listed its bank as one of the “Top 50” Origination Depository Financial Institutions (ODFIs) and one of the “Top 5” HSA Administrators in the nation.
PNC announced that it is the first bank in the nation to receive EHNAC accreditation for its health care clearinghouse, lockbox and e-commerce operations. PNC was noted for its “extremely robust systems, policies and procedures” and a data center and disaster recovery documentation that was cited as “the best ever seen” by the independent site consultant.
TransUnion announced a new patent for its Healthcare Revenue Cycle Platform (HRCP), “an ASP-based technology platform that determines, in real time, patient eligibility for financial assistance at point of registration.” Among other functions, the platform “pursues multiple financial assistance opportunities concurrently, providing significant labor savings to hospitals; reducing staff time spent gathering data and filing forms.”

A main focus of the Institute was on emerging privacy and security frameworks. MBProject announced a new medical banking “Gold Seal” standard “that instills public trust” among medical banking constituencies, “a key cornerstone for a new medical banking ecosystem”. A pilot program conducted by the Working Capital Solutions division of the Bank of New York Mellon and Milliman was previously announced. An afternoon session reported out industry results to attendees.

The complete press releases will be posted on the Institute Agenda at www.mbproject.org by April 11, 2008.

About the Medical Banking Project...
MBProject is a pioneering authority that coined the term “medical banking™” to denote the emerging global convergence of banking and healthcare systems to improve health costs, quality and access. Our educational forums, workgroups and pilot programs showcase visionary ideas and initiatives that inform policy, commerce and academia. Supported by a diverse constituency, MBProject conducts research and outreach that defines and facilitates medical banking™, and this supports our mission to convert digital savings into charitable resources. Our work demonstrates how banks can improve healthcare programs for consumers, care givers, health plans and employers. For more information please go to http://www.mbproject.org or contact Evelyn Marquez Sanchez, 615-794-2009,
info@mbproject.org

Overview of Players and Their Roles in the Emerging Medical Banking Industry

Note: I'm not able to attend the MBI this year but I'm going to blog from notes on the hope that this will still be of value to the MBlog readership. - ED

Presenter: Doug Bilbrey, EVP, The SSI GROUP, Inc., Mobile, AL, 800-880-3032, doug.bilbrey@ssigroup.com

During the Medical Banking Boot Camp, Doug's presentation discussed the Players in the Medical Banking field: Providers (Institutional, Professional, Ambulatory Care Centers), Payers (Commercial, Governmental, Fiscal Agents), Vendors (HIS, PMS, RIS/PACS; EDI; Analytical / Revenue Recovery; Document Management {OCR/ICR}; Decision Support {Financial, Clinical}; Clinical Systems; Adjudication Systems), Trade Associations (HIMSS, HBMA, RBMA, MGMA, HFMA, RSNA, ECT...; Cooperative Exchange ), Collections Companies (NCO, Chamberlain Edmonds, Regional / Local ), Consultants, Banks (Consumer, Commercial), Employers, Politicians, Government, Consumers

Discussing the The Bad and The Ugly of Healthcare Fiscal Management, Doug noted:

$300 billion of collected funds goes to processing bills, claims and payments; bad debt; and other transactions each year.
60% of claims paid are paper, average cost of $8 each
Approximately 1 in 5 claims submitted is delayed or denied
- 96% must be submitted more than once!
Bad debt expense ranges between $40 to $60 billion
- 80-90% of consumer self-payments goes uncollected
- on average, 50% of commercial payments

Further, he pointed out that 14 percent of all claims submitted to payers are denied and that this is important when one considers that denials represent 11 percent of a provider’s gross charges.

On "Why Do Claims Get Denied?" he reported:

Coordination of benefits	25%
Patient not eligible	15%
No authorization	5%
Medical Record requested	11%
Untimely filing	11%
Additional info pending	9%
Non-covered Service	7%
Benefits expired	6%
Billing Errors	1%
Contract Review	.03%

Regarding the Cost of Collections, he listed these factors: Patient Balances, Statement Generation/Processing, A/R Aging, Small Balance Write-offs, and Unbilled or Missed Charges

Among Industry Pressures on Providers, he cited: Reimbursement from Payers (CMS, Commercial), Higher Deductibles, Philosophical/Cultural (“We’re here to take care of sick people”), Requirements Complexities (Coding, Billing, Collections and follow-up), Human Resources (Finding them, Keeping them, Incentives ), Legal (Liability), Outpatient Centers (Highly compensated services, Hospitals left holding the bag), Infrastructure (Physical Plant, Technology), and Community Perception

Industry Pressures on Payers faced include: Operational Costs (FTE’s, Payments), Inefficient Processing Mechanisms (Telephonic, Paper), Membership Satisfaction, Community Demands (On-line access, PHR, Provider Tools, and Integrated Delivery Systems)

Industry Pressures on Employers relate to: Costs (Company, Employee, Dependants), Employee Retention, Employee Recruitment, and Enrollment

While Industry Pressures on Consumers comes from all of the above as well as Access to Healthcare, Affordability, and Bombardment of R/X Ads (Do I have this? Should I take this? What are the consequences?)

Meanwhile Political Pressures will focus on Election 2008 (The Economy, Cost of Living {Fuel Costs, Inflation}), Access to Healthcare (Real or Perceived); Fallout (What new pressures will be levied on system? {Fixed Prices?, Additional/Stricter Requirements?}, Who Pays for This?)

Solutions need to recognize Patient Access/The Genesis of The Claim and the Potential Impact

Patient Access is Key since 45 – 55 Percent of all billing errors originate in Patient Access, Patient Access has one of the highest levels of turnover within a provider organization due in part to the Tremendous Pressure placed of Patient Access Staff (Consent Forms, Benefit Verification, Copay and Deductible Collection, Advanced Beneficiary Notice, Advanced Directive and "Do all this in 10 minutes or less") Improved Processes can affect outcome for Patients, Providers, Payers and the Entire System

How Might Banks Help?

Trusted Delivery Mechanisms (PHR, Financial Transactions, Infrastructure); Connections between Payers, Providers, and other Banks; LockBox (Remits, Claims ???, Eligibility Rosters ???) Banks Are Uniquely Positioned (Patient Access {Credit Card Processing, Upfront Collections of Co-Pay and Deductibles}, Claim Processing {Value Added Services [Clearinghouses, Claim Warehousing, Data Archival]}; Remittances (ERAs, Lock Box {Paper to ERA}, All Payer Capabilities), and Providers Need and Will Use These Services

Interview with Maureen Turo, VP, Healthcare Market Specialist, Bank of New York Mellon

Posted by John Casillas

The Medical Banking Project convened a multi-stakeholder group among its membership to develop health data privacy and security criteria that is uniquely focused on the regulatory requirements and market expectations in the medical banking segment. After 15 months of regulatory review, industry outreach and feedback, the Accreditation Review Council (ARC) at MBProject formalized a new "Gold Seal Standard" for medical banking constituencies. The program, which will be placed into production in the May-June timeframe, was announced recently.

We caught up with Maureen Turo, VP, Healthcare Market Specialist, Bank of New York Mellon Treasury Services Division in Pittsburgh, PA to discuss the new Gold Seal program. BNY Mellon was involved in the first pilot program, administered by Milliman, to vet out the issues related to application of the Gold Seal.

Tell us about what you do at The Bank of New York Mellon...

The Bank of New York Mellon Corporation is a global financial services company focused on helping clients manage and service their financial assets. We operate in 34 countries and serve more than 100 markets.

Within The Bank of New York Mellon’s Treasury Services group, I am part of a team dedicated to providing solutions to the healthcare sector. We offer a full suite of services that help healthcare providers better manage their working capital – the technical expression we use is, “address inefficiencies in the revenue cycle.” Some specific examples of what we do include: helping healthcare providers electronically post claim payments to reduce accounts receivable days outstanding; collect and reconcile patient payments at the point of service; identify and analyze denial data; simplify the patient refund process; streamline short-term investing of working capital, and much more.

Why did you get involved in the MBProject Gold Seal standard program?

Healthcare is obviously in need of significant attention. Improvements are going to take collaboration among banks, vendors, payers, and providers. The MB Project provides thought leadership on many different fronts for medical banking with privacy and security accreditation being one of them.

Based on our experience in providing healthcare treasury services and our rigorous attention to regulations and rules, we knew we could provide valuable feedback from the perspective of a financial institution. This multi-disciplined/stakeholder involvement allows MB Project ideas to be improved upon and vetted with numerous industry participants. We were also interested in seeing a cost-effective, valuable accreditation program developed that would meet the needs of banks involved in the program while taking into account the regulatory oversight already governing the financial industry.

Tell us a little about the pilot program. We understand that as many as 23 subject matter experts were interviewed?

Overall, the pilot ran very smoothly! Numerous subject matter experts had to be identified and engaged in the pilot because privacy and information security touch such a wide range of areas in the bank. We found by taking the time upfront to identify the right subject matter experts, we were able to quickly go through the online program modules and answer the questions related to our use of the various identified best practices. At the end of the pilot, we were also able to suggest improvements to the methodology and some of the questions used in the Gold Seal accreditation program.

As the first anticipated recipient of the Gold Seal standard, what are your intended benefits from the program? Do you think these will be achieved?

From the project’s perspective, we think the main benefits of a program like this are threefold:

It provides a cost-effective, independent assessment of a recipient’s compliance in processing healthcare data (under HIPAA) and their adherence to related operational privacy and security standards using a common set of best practices criteria.
It can complement or supplement a recipient’s existing internal evaluations, as well as other external evaluations such as a SAS70 Type II audit.
It conveys to healthcare providers that recipients understand the privacy risk associated with handling health information and attests to their use of best practices to protect that data.

At The Bank of New York Mellon, we certainly think we can derive all three benefits from this Gold Seal program. In fact, we see having a third party like the Medical Banking Project offering and promoting this program as being key to our realizing the benefits we expect to derive from accreditation. I don’t think there’s any question about healthcare providers and their patients continuing to demand protection for health-related information. By providing appropriate levels of accreditation, the project is taking an important step forward to provide assurance to healthcare stakeholders that financial institutions take their responsibilities seriously.

Gold Seal Standard Highlights Public Trust In Medical Banking Domain

A 15 month effort and recent pilot program culminate in the industry’s first health data privacy and security accreditation for medical banking constituencies

Franklin, TN (March 13, 2008) Just weeks before the Sixth National Medical Banking Institute to be held April 1-3, 2008 in Marietta, GA, the Medical Banking Project (MBProject), an authoritative pioneer in the formation of the medical banking industry, announced the creation of the first "Gold Seal Standard" for health data privacy and security for medical banking constituencies. The first version was created after a 15-month multi-stakeholder effort by MBProject members, and highlights the research firm's ongoing efforts to assure the highest standards of quality for emerging medical banking programs.

"We urged leaders to adopt a program that instills public trust in medical banking programs in 2001," said MBProject founder John Casillas. The Institute has strong roots in the national movement to implement HIPAA compliance among medical banking constituents. The first two Institutes held in 2002 and 2003 were 100% focused on privacy and security of health data, policy issues and operating areas where the two industries converge. In recent weeks federal and commercial groups have announced the creation of privacy frameworks that will be explored at the Institute. "We have increasing support from employers, banks, financial services firms, healthcare and IT firms and others, marking that it's time to implement this critical program," said Casillas.

Industry surveys suggest that banks are global leaders in the area of public trust. "Banks have considerable and ongoing investments in technology, processes and controls to ensure the bad guys don't get our money," said Casillas. "The Gold Seal program recognizes that medical banking is a new industry, and that the convergence of systems calls for a supplemental review to assure that the uncompromising standards and controls used by banks to secure our money will be used to thwart those who want to inappropriately access our health data." The program adds criteria outlined in HIPAA to existing banking regulations and controls, and is designed to adapt to additional federal, state and commercial privacy frameworks as they evolve.

MBProject called on its members to form a new "Accreditation Review Council" at the 2007 Institute, leading to a 15-month R&D effort isolating banking and healthcare regulations and related accreditation programs. The Council reached out to government and industry groups as it formed its framework. By January 2008, both the criteria and an accreditation methodology were adopted by the Council and readied for a pilot program.

The two-day pilot was conducted by John Phelan, PhD, an expert at Milliman, Inc., a global consulting and actuarial firm that works with a range of organizations on HIPAA compliance, and BNY Mellon Working Capital Solutions, a division of The Bank of New York Mellon. To meet the pilot criteria, BNY Mellon's healthcare team gathered 23 internal subject matter experts who would be impacted by the program. A post-pilot survey of the experts was conducted to assess the effectiveness of the new program. BNY Mellon and Milliman will present the results at the April Institute.

"The pilot was a successful and critical step in an accreditation program that demonstrates the financial service industry's commitment to assuring the highest security and confidentiality of personal health information," Phelan said.

"The work of the Council is a key foundation for building a medical banking ecosystem that will improve healthcare in America and around the world. We're excited about their work and eager to support the Gold Seal among our constituencies," said Casillas.

To learn more about the Institute or to register, please go to:

>> Institute Homepage & Agenda: http://www.mbproject.org/6mbi2008.php

>> Registration: http://www.mbproject.org/6MBI2008_registration.php

Many thanks to our Sponsors:

>> Educational Grantor: BancTec, Inc.

>> Platinum Sponsor: ACS, Inc.

>> Gold Sponsor: OptumHealthBank

>> Silver Sponsors: The Bank of New York Mellon; Fifth Third Bank; PNC Bank; Teleperformance

>> Media Sponsors: Healthcare Finance News, Future Healthcare

About the Medical Banking Project...
MBProject is a pioneering authority that coined the term “medical banking™” to denote the emerging global convergence of banking and healthcare systems to improve health costs, quality and access. Our educational forums, workgroups and pilot programs showcase visionary ideas and initiatives that inform policy, commerce and academia. Supported by a diverse constituency, MBProject conducts research and outreach that defines and facilitates medical banking™, and this supports our mission to convert digital savings into charitable resources. Our work demonstrates how banks can improve healthcare programs for consumers, care givers, health plans and employers. For more information please go to: http://www.mbproject.org. Contact: Evelyn Marquez Sanchez, 615-794-2009, info@mbproject.org

Pilot Updates At The Medical Banking Project

Posted by John Casillas, Executive Director, MBProject (adapted from the latest Medical Banking Report, Vol. 5 No. 1, Jan-Feb, 2008)

I just want to take a moment to thank all of the members of MBProject who are working in our different areas. We know its not easy given today’s busy schedule to convene with fellow stakeholders to tackle industry issues. We greatly appreciate your time and support. I believe that as we continue to work through the various areas, you will have an impact in the industry for the better. If you’re not involved in a workgroup and would like to be, please call me to discuss. Many thanks again.

Dispute Resolution Initiative

Leadership: Sheila Schweitzer, CEO & Chairperson, CareMedic

Launched after a recommendation by David Harris, Partner, PricewaterhouseCoopers, and an affirmative vote was taken at our last Leadership Forum in Franklin (Nov 07), the workgroup is creating an approach for rationalizing the myriad denial codes in claims processing. As many denial codes as possible, derived from data provided by the SSI Group and CareMedic, are being mapped into a standard matrix. A recommendation and work product is scheduled for presentation at the April Institute. We hope to enlist all of our members to adopt the standard and thus influence the industry towards this matrix. The work product is being placed into production by Sun Microsystem and will appear as a free resource on the public MBProject website.

HSA Deductible Engine Use Case

Leadership: Doug Spence, COO, Foresight

After rallying around a model to procure the current deductible at point of service that was presented at the November Franklin Leadership Forum, MBProject was tasked with finding a client of United Healthcare that would support a pilot program and provide a control group of out-of-network physicians and employees. The concept was taken to our Joint Taskgroup for Value In Health (see more on this group below) and ArvinMeritor accepted the call. In fact, the CEO of ArvinMeritor has indicated full support for the project. The workgroup is now awaiting logistics for implementing a deductible data exchange-prototype with United Healthcare to test the concept further. MBProject member Tim Murray, CEO of ICSGlobal has indicated that his group can implement the prototype. Foresight has also offered assistance. Note that United Healthcare’s Exante Bank (rebranded to OptumHealth Bank) funded this use case. The process is proceeding slower than we’d like, probably characteristic of a major systems change in strategy. Started in November of 2006, milestones included funding, visiting Mount Carmel Healthcare System in Columbus, OH, to discuss a pilot program (Spence and Casillas), meeting face-to-face with the technical staff at United Healthcare and of course funding for the organization and implementation of Phase 1 of the project (development of the industry requirements document now posted in the membership research portal).

Accreditation Review Council

Leadership: John Casillas, MBProject

After nearly 15 months of effort, ARC has examined the major rules in banking and healthcare that pertain to health data privacy and security, as well as assessed all relevant accreditation programs. We continue to add information to this process. At the Franklin Leadership Forum, John Phelan, PhD, Milliman presented a summary of the work and the approach ARC is taking to create an accreditation program that will be accessible via an online compliance tool.

Following the presentation, in late January, a pilot program was conducted at the Working Capital Solutions division of The Bank of New York Mellon. Some 23 subject matter experts (SMEs) were asked to participate during the two-day program managed by Dr. Phelan and Ken Kabala, VP, Senior New Business Development Manager, BNY Mellon. A post-pilot survey was conducted, seeking reaction from the SMEs which was positive and informative. ARC is now reviewing recommendations to improve the program. We intend to unveil the “Gold Seal” program at the April Institute.

Joint Taskgroup for Value in Health

We are very pleased to announce that Jim Patterson, Director of Total Health Management at ArvinMeritor, has agreed to direct our Joint Taskgroup. ArvinMeritor is a tier one automobile supplier with some 8,000 employers in over 20 countries. We also asked Brad Kirkpatrick, Vice President of Marketing at Best Doctors, to co-direct this effort. Brad has been involved in working with employer groups and provides an important perspective to the effort. Finally, we plan to make another leadership announcement - an executive from one of our bank members - pertaining to this work effort at the April Institute or before. We believe these three individuals will help to move the work effort along in a positive direction. The Joint Taskgroup is preparing a program for May 6 in Detroit, where we will hear opinions from some of the largest employers on the planet (GM, Ford, Chrysler, others) about how they envision partnering with banks to optimize human capital.

HSA Preventive Drug Listing Workgroup

Leadership: Roy Ramthun, CEO, HSA Consulting, LLC

MBProject is entering a Memorandum of Understanding (MOU) with the National Council for Prescription Drug Programs (NCPDP) to govern our exchanges. A few years back, John Casillas spoke with former CMS Chief Mark McClellan about language in the Medicare Modernization Act (MMA) that created a “fourth type of clearinghouse” - a Part D sponsor - which could be a bank. It was picked up in the media (see CNBC interview with Casillas and Dan Rother, AARP at: http://www.mbproject.org/tour_media_6.php). Originally, we didn’t envision this to be a medical banking area until Forbes published an article by McClellan’s senior advisor (“Banks: The New HMOs”) advocating bank-PBM partnerships to support the new $400 billion Part D program. We decided to organize a focus group in this area. Our first phase will focus on making a formal recommendation to the IRS for “preventive drugs”, as this isn’t clearly specified in the HSA rules and is a source of agitation in the HSA/HDHP arena. Roy Ramthun is helping to steer the group, comprised mostly of health plans and PBMs. The group is currently awaiting feedback from legal to ensure the workgroup can meet without running afoul of the law.

Medsphere and Tolven to 'Surround, Supplement, and Renew' VistA

Posted by ED

Ignacio Valdes [ivaldes@hal-pc.org], editor of Linuxmednews.com, sent a pointer and some comments out to the American Medical Informatics Association Open Source Workgroup which might be of interest to those in the Medical Banking industry. Tolven participated in a recent Medical Banking Project event.

Medsphere and Tolven announced ( article here ) at the annual HIMSS show that they will form a new partnership to "Surround, Supplement, and Renew" VistA as a viable platform for forward thinking health care organizations. The announcement is loaded with buzz-words, but a close read implies that Medsphere is attempting to reach out to other providers to include them in their currently non-existent ecosystem.

This has potentially very interesting ramifications for VistA which has been languishing for nearly a decade. I believe it is a race to save the patient with renewed and collective investment versus being overwhelmed into irrelevance by the blistering pace of other, newer technology. This should be a STAT! page to the entire VistA community that more effective collaboration will be required to save this valiant trialblazer.

Link to article: http://linuxmednews.com/1204042379/index_html

A New Medical Banking Ecosystem [Update]

Franklin, TN (December 6, 2007) Global delegates will convene at the Sixth National Medical Banking Institute on April 1-3, 2008 in Marietta, GA, to discuss best practices and case studies in the convergence of banking and healthcare systems. The theme of the event "A New Medical Banking Ecosystem" offers a view of the future of a healthcare system that is much more tightly linked with everyday banking," said John Casillas, founder of the Medical Banking Project and chair of the Institute. "This is an exceptional journey and we're receiving overwhelming confirmation in the marketplace that medical banking both works and is growing."

A new "International Journal of Medical Banking" will be launched at the event, further documenting industry growth. "Medical banking is a global phenomenon," said BP Fulmer, president of the Institute and Executive Director of Commercial EDI Services for ACS. "Its got a long tail wind and our prognosis for the future is high growth as medical banking systems seek to offer greater value in the marketplace."

Organized by the Medical Banking Project, both the Institute, peer reviewed by the President's Council, a panel of leading banking and healthcare experts, and the Journal, featuring an editorial advisory board of commercial executives, academicians and employer-based medical officers, offers a uniquely engaging and authoritative venue for gaining critical insights into medical banking convergence.

The Institute hosts three educational tracks, a new "Medical Banking Boot Camp", an advanced topics program and a members-only room for pilot updates, voting and more. Tracks include:

The Hybrid Revenue Platform: chaired by the Healthcare Financial Management Association (HFMA). The track will feature the evolution of health data management across banking and healthcare systems a pivotal technical axis in the build out of medical banking services. The sessions will focus on rationalizing the "extreme paper chase" in healthcare for institutions and everyday consumers too. Batch and real time systems will be showcased. In addition, a new "Dispute Resolution Initiative" at MBProject will convene leadership and seek attendee comments on industry recommendations to simplify the use of denial codes in the claims payment process.

Privacy & Adoption of E/PHRs: chaired by the Health Information Management Systems Society (HIMSS). The track will unveil new banking programs that support health information exchanges. Presentations will feature how consumers can start a "care clipping" service through local banks. Other models that will be presented include Health Record Trusts and a framework for bank-supported RHIOs. A critical debate will examine privacy and security of data in banking systems. A global consumer survey will be referenced that found that banks are the most trusted entity for digital identity in today's emerging electronic world.

Value-Centered Medical Consumerism: chaired by PricewaterhouseCoopers. The track will examine the evolution of consumer health IT services through case studies and presentations. We will feature the convergence of B2B and B2C platforms, the evolution of consumer tools that support a value-centered approach for healthcare and systems migration towards the online banking platform/format to speed adoption of consumer engagement in healthcare.

A new "Medical Banking Boot Camp" will help organizations that need staff training in the complex area of medical banking. The course provides a unique primer for executives who are forming strategy in new medical banking services. A certificate of completion will be issued to those completing the course.

Two new programs have also been announced:

Room A: Advanced Topics in Medical Banking; will include "A Medical Banking Gold Seal" for privacy and security accreditation, a Medical Banking Tool Kit for Employers and "Your Medical Banking Avatar: New Dimensions of Consumerism Using Web 2.0."
Room B: Members Only - Reserved for members of MBProject to review pilot programs and to vote on 2007-2008 initiatives.

The event, organized by MBProject, is open to the public. Online registration is now available at http://www.mbproject.org/6MBI2008_registration.php. Early registration is strongly recommended. A full agenda in addition to white paper and keynote selections will be posted online at http://www.mbproject.org.

Top tier sponsorship programs are also available. To receive a Sponsorship Guide call Evelyn Marquez at 615-794-2009 or email the MBProject staff at info@mbproject.org.

About the Medical Banking Project
MBProject is a pioneering authority that coined the term "medical banking" to denote the emerging global convergence of banking and healthcare systems to improve health costs, quality and access. Our educational forums, workgroups and pilot programs showcase visionary ideas and initiatives that inform policy, commerce and academia. Supported by a diverse constituency, MBProject conducts research and outreach that defines and facilitates medical banking, and this supports our mission to convert digital savings into charitable resources. Our work demonstrates how banks can improve healthcare programs for consumers, care givers, health plans and employers.

For more information please go to: http://www.mbproject.org or contact Evelyn Marquez Sanchez at 615-794-2009 or info@mbproject.org

Semantic Interoperability on Steriods

Posted by ED

<note>RE: Our friend John Hardin -

Dear Members and C.O.M.B.A.T. Advisory Board,

We received sad news this morning and I felt it was important that you hear it from me. John Hardin, a good friend and confidant, passed away on Friday night. We have few details right now but I talked to his wife, Meggan, this morning and she wanted to relay how much John enjoyed working with our members at MBProject and how much he believed in our cause.

As you may know, John presented at our 3rd National Medical Banking Institute and was instantly recognized with an unusually gifted talent in the area of open source technology. In fact, John was a open source warrior, holding key positions in a number of open source organizations to advance the cause (OASIS, OMG). His final position was at Sun Microsystems, an open source advocate, where he managed B2B initiatives. Most recently, John wrote an analysis of how an innovation in UDEF, created at Lockheed, could facilitate semantic interoperability of medical records. You can find this analysis in our last issue of The Medical Banking Report, July/August 2007, Vol. 4 No. 3.

John chaired our Planning & Design Subcommittee for the C.O.M.B.A.T. Initiative. He architected the design for a medical banking platform that could be used by banks for provisioning healthcare records, fully incorporated in MBProject's response to ONCHIT's RFP in 2005. His work defined "C .O.M.B.A.T. Version 1", and we formally recognized his efforts by awarding him with MBProject's Person of The Year Award in 2006. John introduced MBProject to General Motors, Walt Disney, and the Automotive Industry Action Group, paving the way for the formation of our Joint Taskgroup for Value In Health. His contributions in the new arena of medical banking will be memorialized in our website.

I will personally miss our stimulating and encouraging talks about how to link open source to medical banking, align the stakeholders and how small unknowns can create a "disruptive" force in healthcare that can have ripple effects all over the world for the better. I would be most appreciative if you joined with me in extending our sincerest condolences to the Hardin family during this time of loss. He is survived by his wife, Meggan, and his two sons who live in Kansas City.

Sincerely,
John Casillas
Chair, Medical Banking Institute
Executive Director, Medical Banking Project

John Hardin's colleague from SUN, David Lee Todd, adds this post.</note>

This article was written by MBProject Member, John Hardin, Product Manager, B2B Platforms, Sun Microsystems, Inc. John was MBProject’s “Person of the Year Award” in 2006 due to his work in the Planning & Design Subcommittee of MBProject’s C.O.M.B.A.T. Initiative. This article appeared originally in The Medical Banking Report, July/August 2007 Vol. 4, No. 3

As the stage is being set for widespread adoption of clinical record document sharing capabilities, sometimes referred to as Regional Healthcare Information Organizations (RHIOs) or Healthcare Information Exchanges (HIEs), there is a growing number of standards that are competing to provide the payload document formats. These standards include the Continuity of Care Record from ASTM, the HL7 CDA and the XDS-Medical Summary from IHE, among others. Additionally, the interview published by Health-IT World. The article provides excellent insight to many of the issues and opportunities associated with EHR.

As adoption grows, the number of disparate formats creates a lack of interoperability across platforms and applications. If your E.H.R. application produces a CCR as output to share information about a patient, but the care provider that you are sharing with uses an E.H.R. that accepts / produces a HL7 CDA format, then the two can’t communicate electronically. This then creates the requirement for a mapping, transformation and integration project to link the two documents, translating from one to the other and back again. Multiply this times the size of the medical industry, even in a single region, and the result is such a lack of interoperability that the applications become ineffective at sharing data, and the entire objective of the build out becomes difficult to meet.

Some collaboration between these groups is happening, however, there may still be a condition where we don’t have a single standard.... Obviously, this is a problem across all of IT, encompassing most software applications and nearly every industry. It has single-handedly spawned the entire Integration software industry, and complex frameworks are being built to facilitate the processes of transformation and delivery of documents that are different in format, and use different terms to name the data elements. A further difficulty arises as each of those standards bodies improve on or change from one version of the document format to the next. These changes can break the mapping and transformation code, which then require more development to stay current. This is an exponentially increasing problem, which won’t be solved until either every software application that needs to exchange data uses the same formats, or a bridging solution can be implemented to cross the gap between formats.

The problem has a simple explanation: different names for the same data concepts, and is closely related to the formation of ontologies or taxonomies. The solution is termed Semantic Interoperability. The Universal Data Element Framework (UDEF) proposes to solve this problem by adding an attribute, in the form of an alphanumeric tag, to every data element in each format. This would provide a common identifier for each data element concept in each document, which can then be programatically analyzed and matched, then transformed, by software. This will be a major change from the mostly human-based analysis, coding, testing and implementation effort that characterizes current integration projects. Also of note is the fact that the UDEFID’s are alphanumeric, allowing them to also provide bridges across language translations (from English to Korean, for example).

Continue reading "Semantic Interoperability on Steriods"

Medical Banking Careers at McKesson

By MBProject Member, BP Fulmer, Executive Director, Commercial EDI, ACS, Inc., The MEDICAL BANKING REPORT, July/August 2007, Vol. 4, No.3

About a month ago one of my colleagues sent me an email entitled, “Looks like Medical Banking is legitimate.” Obviously, the title caught my eye. My immediate thought was, “Of course it is.” So I opened the email and discovered that not only is Medical Banking a legitimate endeavor it is now being recognized by one of the worlds largest and most successful healthcare companies in the world as a corporate function with a career path.

That company is McKesson. The email I read included a link to their human resources list of open positions. It listed medical banking positions and acknowledged that McKesson is creating a “medical banking” unit. The listing heralds that medical banking is becoming a formalized corporate function and an emerging career.

A couple weeks later I had the opportunity of having breakfast with Jim Bodenbender, Vice President and General Manager of McKesson. I asked him about this bold move to create a special operating unit inside Relay Health devoted exclusively to the development and pursuit of medical banking products and market opportunities.

Convergence Highly Likely for Online Banking and eHealth

The MEDICAL BANKING REPORT, July/August 2007, Vol. 4, No.3

When it comes to the growth of online banking there is one factor that stands above all the others: Public Trust. According to a survey by Ponemon Institute, a think tank that advances responsible information management practices in business and government, 57% of consumers said if there was one privacy breach at their bank, they’d stop all online services. That’s a pretty small margin for error.

The survey (sponsored by Watchfire in April 2005) had 2,328 responses (17.2% response rate) and was conducted with a cross segment of customers from Wachovia, PNC, US Bank, Washington Mutual, National City and Citigroup.

The statistic isn’t entirely surprising. What banking service isn’t inextricably bound to Public Trust? It is much like the air that a banker breathes. Without Public Trust all bets are off that a bank will succeed.

This is one reason why banks today are locked into an Identity Theft Arms Race. No one likes to be compromised.

Privacy vs safety a paramount concern

Posted by ED for JC

The referenced TriCities.com article articulates with great clarity where the focus of the privacy debate should be: Privacy vs. Safety. We should expect our health data to be treated with the utmost of privacy and confidentiality...but to the detriment of our own safety? Some privacy wonks say that HIPAA protects no one. Really?

Yes, HIPAA permits covered entities to use our data without authorization for "TPO" - treatment, payment and operations. Thus if one is unconscious and can't sign a consent form, its ok to look at that person's record. If a third party (payor) is responsible for payment, its ok to send a claim without patient consent. This seems safe to me, especially because HIPAA has mechanisms in place (through BAA contract) that requires that any entity receiving the data use it for the specific purpose intended (payment of a claim, for instance). It also requires a minimum necessary standard. Only the minimum amount of data (not the 130 page medical record) can be supplied for payment of a claim, unless required.

Some privacy groups say this standard isn't adequate. They say that anytime anyone accesses our data it must be accompanied with a signed consent form. Even in the area of public health, where breakouts are monitored and patient data must be accessed quickly, some privacy groups contend that if a person doesn't want their data shared, it shouldn't. Should privacy be placed above public safety? Isn't this the key question? Within this context, what does VA Tech teach us?

This is a difficult debate but simple common sense can get us beyond many issues. Its easy to crusade behind an "I'm-for-the-small-guy" mask. I identify with the underdog too. I just want that underdog to be safe. I want to be safe. And by the way, I AM the underdog. Aren't most of us?

I'm ok with hospitals having my data for TPO, but the privacy groups want to force hospitals and others to go through hoops when my life is in danger. They want me to get behind the idea that HIPAA doesn't go far enough. Perhaps there are changes that could be made and as an underdog, I'm open to that possibility. But we must be careful not to create an environment that makes all of us less safe, shouldn't we?

There is a delicate balance between privacy and safety. Perhaps we should err on the side of safety. I'm interested in how some privacy groups justify their position in light of VA Tech. This is an acid test. To use VA Tech for political purposes is immoral, to be sure, but for testing standards it provides a meaningful and absolutely necessary exercise.

---
John Casillas
Chair, Medical Banking Institute
Executive Director, Medical Banking Project
320 Main St., Ste. 230
Franklin, TN 37064
v: 615.794.2009, ext. 3
f: 615.794.1481
http://www.mbproject.org

MBProject Members in Good Standing

Posted by ED

as of August 13, 2007

<ed.note>I post this because I think some folks may still be laboring under a misperception that the MBP isn't serious about changing the paradigm.</ed.note>

ABN Amro

ACS, Inc.

ACS EDI Gateway, Inc.

Azima Healthcare Services, Inc.

Best Doctors, Inc.

Canadian Medical Association - Practice Solutions

CareGain, Inc.

CareMedic Systems, Inc.

Centers for Medicare & Medicaid Services

Claimtrust, Inc.

Conmergence

ConnectYourCare

Edifecs, Inc.

E-Duction

eGistics, Inc.

eTransX, Inc.

Exante Financial/UnitedHealthcare

Fifth Third Bank

First Horizon Merchant Services

Fiserv Health, Inc.

Foresight Corporation

Genpass Card Solutions

HealthFusion, Inc.

ICSGlobal, Ltd.

Information Technology, Inc.

Insight Healthcare Financial, Inc.

InstaMed

MaxSurge Healthcare Solutions, Inc.

McKesson

McKesson Transaction Solutions Hub

Mellon Financial Corporation

Office of Civil Rights

PFPC

PNC Bank

PNC Financial Service Group

PricewaterhouseCoopers, LLP

Private MD Secure Records Online

QHR

Remettra

RemitStream Solutions

Revenue Management Solutions

Sanofi-Aventis U.S., LLC

SearchAmerica, Inc.

Starbourne Communications Design

Sun Microsystems, Inc.

The SSI Group, Inc.

US Bank

US Treasury Department

Veterans Health Administration

Visa U.S.A., Inc.

Wachovia, NA

Walt Disney Company

Walt Disney Corporate IT

Wausau Benefits

Will Healthcare Bank on Banks?

Posted by ED

Aug 14, 2007 By Gary Baldwin, HealthLeadersMedia.com

If John Casillas is correct, one day we'll use financial Web sites for more than paying bills and checking balances, like some 53 million Americans already do. We'll be paying physicians and checking cholesterol scores. Casillas is the founder of the Medical Banking Project, a Franklin, TN-based think tank. Since 2001, he has been working toward an unusual goal. The very term "medical banking" begs for a definition. "It is merging two different worlds," Casillas says. "I want to optimize banking systems to provide better healthcare."

MBProject, WEDI and Uptake of 835s (electronic healthcare remittance advice) in the healthcare industry

Posted by ED

John Casillas writes:

WEDI (Workgroup for Electronic Data Interchange) recently testified before NCVHS, an HHS Advisor (National Committee on Vital and Health Statistics) about the uptake of 835s (electronic healthcare remittance advice) in the healthcare industry. The testimony refers to two groups: providers and payers.

In 2001, MBProject estimated that electronic remittance management can save up to $35 billion in annual healthcare costs by reducing the sheer volume of payments-related paperwork (think of the trail of paper that follows you when you leave the hospital). "Ramping" the current paper-based process to a digital environment using the X12N 835 is part of the process...and challenge.

Here is the testimony, taken from a survey WEDI conducted in which MBProject and many others helped to design.

835 Survey Summary

The following summaries represent the workgroups analysis of the responses to the survey. There were a total of 34 respondents to the survey. The respondents were representative of the payer, provider and vendor community. There was an extremely small response to this survey due to the limited length of time the survey was available to the public. It may be beneficial to open this survey again to expand the survey respondent base.

Payer

Findings

There was an extremely small response to the 835 survey.
100% of the payers are able to exchange the 835
This survey expanded the transaction list to the payers about acknowledgment transactions, 100% stated they utilize the 997 while only 50% utilize the TA1
There was representation from all sectors with the majority being Medicaid
The majority of payers utilize in-house staff for 835 implementation.
The majority of 83% COB claims appear not to be electronic.
Average costs for implementing 835 ranged from ‘No Cost to ‘More than $5 Million’.
When asked about the FTE count for implementation – the common answer was either unsure or no cost.
When asked about benefit – the payers were split between, not sure, slight benefit to no benefit
The majority of the respondents agreed with the modifications described by the survey with the exception of new wording of situational usage rules, 50% of the payers disagreed.
Open comments included a note concerning the lack of a filed for ‘remittance number’ as assigned by the payer.
100% of the payers still utilize paper to communicate remittance advice

BENEFIT opportunities

When polled the majority of payer respondents did not agreed there is a benefit to moving to version 5010. The Task Group feels strongly that there are not enough responders to make this as a final conclusion.
The 5010 837 provides additional rules and requirements that may benefit the industry, specifically for coordination of benefits and secondary/tertiary payment information

Provider (835 Survey Summary cont.)

Findings

Small number of providers responded overall – however, the providers represented the largest respondents of this survey accounting for almost 50% of the total survey.
Most provider organizations are able to conduct 835 transactions , of the other transactions the 837 institutional and professional were the highest utilized by providers.
43.8% of the providers reported they were able to utilize concurrent versions of the X12 standard.
Coordination of benefit (COB) claims volume ranges from less than 10% to 25% of total claims volume.
Most providers were able to auto post 50+ of the claim payments from the 835.
62.5% of providers could not submit COB claims utilizing data received in the 835 Healthcare Remittance Advice.
Costs of upgrading software can be significant ranging from ‘No Cost’ to ‘Greater than 1,000,000’.
There were no Open comments of note:

BENEFIT opportunities

When polled the majority of providers stated they were unsure if there were benefits to migrate to the 5010 837. This may be due to lack of exposure to the 5010 documentation.
From the responses of the survey, providers appear to be paper based for COB.
When asked about the proposed changes the majority of providers either agreed with the modification or had no opinion. This may be due to the lack of exposure to the 5010 documentation.
The 5010 835 provides additional rules and requirements that may benefit the industry, specifically to increase the use the 835 for electronic coordination of benefits claims and

*Vendor (**835 Survey Summary cont.)*

Findings

Small number of vendors responded.
Representation from all sectors.
The overwhelming majority of the Vendors’ report their software is capable of receiving/sending the 835 today.
When asked about acknowledgements, 75% were capable of utilizing the 997 while only 58% utilized the TA1
83% of the vendor’s have customers that have implemented the 835 when asked what percentage of their customer base – 50% of the vendors report less than half of their customer base have actually implemented.
When asked 80% of the vendor’s customers have implemented an automated AR posting utilizing the 835
100% of the vendors listed federal/state regulatory mandates as the reason to provide a solution followed by customer demand
75% stated they would not charge for the upgrade from 4010A1 to 5010.
The majority of vendors were not able to answer to the investment their company would make to address the migration from the 4010A1 to the 5010 version. Two vendors did list a significant investment of more than 5 million dollars.
Overwhelmingly the Vendors agreed with most changes proposed in the version 5010 835,
58.4% of the vendors stated there would be some form of benefit to migrate from version 4010A1 to 5010.
Open comments of note:

One of the best things would be to provide examples of each 837 and resulting 835 combination. We still have not run across every possible combination of 837/835 and have no real way to ensure our software will "do the right thing".BENEFIT opportunities

BENEFIT opportunities

58.4% when polled saw some level of benefit of migration from version 4010 to 5010 837.
The benefit for vendors is minimal without customer demand whether driven by the industry or by federal mandate.
The vendors agreed with the suggested modifications, it appeared that these respondents may have been more exposed to the information. This may be a good indication of the value of the changes.

On average less than 50% of the respondents stated some type of benefit, while the remaining were either unsure or stated no benefit. The 835 transaction is exchanged by 80% of the respondents, however, when compared to the responses of utilization 835 COB claim payment the average fell significantly to 50% or less – with most between 10% - 25%. There may be potential benefit to electronic COB utilization with the version 5010 835.

The findings of this survey demonstrate there are improvements between the versions 4010A1 and the 5010 which may benefit the healthcare industry, potentially concerning coordination of benefit claims electronically. When surveyed the respondents agreed with the changes being made as documented within the survey questions, except for the technical improvements, where most had no opinion. There is concern that the lack of access to the 5010 documentation may have been a factor where the technical improvements where concerned. The survey responses may have been more robust if the documentation were available.

Due to the lack of responses and short time frame of this survey, it may be beneficial to open this survey to the public for a longer period of time.

The “Futures” of Medical Banking -- A Systems View

By Ed Dodds, a Systems Architect at <Conmergence />

Occasionally John Casillas and I have chats about possible content for MBlog, the Medical Banking blog, and the various technological factors which are developing in parallel to the field of medical banking. One of my major themes (you'd have to ask him if he's convinced yet) is that once one buys the premise of the distributed, digital enterprise there is really only one business domain – data. Every distinction people perceive is imposed by legal contrivance, legacy tradition and personal interest. If you buy this premise then the “bit” of the argument is that just because healthcare and finance (and indeed any other business) have been done in a particular manner, this is no real predictor of how they will function in the future.

The intersection of two technologies, XML and IP (extensible markup language and internet protocol) mean that just about any information source can be digitized and delivered anywhere. While not perfect technologies, they provide an interconnectivity platform which makes convergence and interoperability more possible now than at any previous time. Some of the developments that these technologies will enable and that will likely intersect medical banking are:

Collaborative intelligence tools:

Semantically informed proprietary and open source blogs, opensearch, portals, wikis ( think “web 2.0” ) will be coupled with “Z” models ( Zecco, Zillow, Zopa – think “finance 2.0” ) and global, mobile “intelligent mobs” (both actual and virtual, like Facebook, IndyMedia, MySpace, SecondLife) empowering consumer driven healthcare, class warfare and class action suits.

Corporate hierarchy consolidation pressure:

The adoption of open standards and balanced scorecards, compensation metrics and disclosure via universal charts of accounts and extensible business reporting language due to the SEC and media attention on C-suite fraud, insider trading, and hedge fund regulation will encourage per-worker productivity gains. Globalization and green politics will drive the adoption of work over IP, results-only work environments and long-lived transaction technologies will foster new financial instruments. Where standards exist, mergers happen. In the domain of data, this type of consolidation often requires the merger of infrastructure alone.

Cybersecurity:

Terrorism fuels the political discourse but methamphetamine addiction-inspired identity theft rings are the actual cause of many current woes. Medical banking is already caught in the cross-winds of a digital ID storm as more consumers seek convenience for things like accessing money, healthcare records and even traveling through airports. The perfect storm is forming as “paper to digital” conversion gathers momentum, (much data leaving our shores using poor data encryption practices), and new technologies make this data ubiquitous. Business is off shoring, down-salarying IT functions, and thumb drives are literally as cheap as sand.

Ubiquitous global broadband connectivity (via 3G/4G, airship/dirigibles, broadband-in-gas, broadband over power lines, cable, DSL, Fiber to the home, fixed wireless, ISDN, Ultra Wide Band, WiFi, WiMax, satellite, etc.) means virtual medical tourism, distance medical education, remote disease sensing from automobile and home healthcare servers, laptops and smart phones will be able to offer voluntarily provided de-identified PHI to the medical banking data grid. Unified communications (email, H.323, IM, IVR, SIP, VOIP, etc.) as well as contactless payments, mobile payments and smart cards will also deluge data centers, which always seem to be located on or near fault lines, fires or floods.

Today, emerging technologies that are transforming political fault lines provide ample content for John and I to discuss. Sifting through it all to discover how transaction costs in healthcare can be rationalized using medical banking principles has become a hot topic. We can envision a sea of opportunity as technological convergence is manifested through new commercial programs that bring ever increasing value to our healthcare system using banks. From a technology head, medical banking has a long life span, many tentacles and a very promising future indeed.

Conmergence is a strategy consultancy facilitating convergence and enabling the distributed, digital enterprise. Dodds edits the Medical Banking Project's MBlog.

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MBProject, WEDI and Uptake of 835s (electronic healthcare remittance advice) in the healthcare industry

835 Survey Summary

Payer

Findings

BENEFIT opportunities

Provider (835 Survey Summary cont.)

Findings

BENEFIT opportunities

Vendor (835 Survey Summary cont.)

Findings

BENEFIT opportunities

The “Futures” of Medical Banking -- A Systems View

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*Vendor (**835 Survey Summary cont.)*