An advocacy message from our CEO...
As we continue to expand physician advocacy efforts as an organization, I wanted to share some recent activity that further illustrates our commitment to delight our clients and make a difference in the healthcare industry. On May 7, 2018 I had the pleasure of meeting with CMS Director Seema Verma at her office in Washington, DC. It was a very cordial meeting and I walked away impressed by the fellow Hoosier’s shared passion to make a difference in healthcare. The meeting covered a variety of topics:
- Director Verma’s recently announced MyhealthEData Initiative.
- Discrepancies in denial patterns with MAC Intermediaries.
- Use of artificial intelligence and machine learning in clearing the backlog of appeals.
- The replacement of PECOS and Credentialing platform for physician credentialing.
- Pricing transparency and the responsibility of the providers/payers.
On the MyhealthEData initiative, it was clear to me that Director Verma was extremely passionate about this broad and challenging initiative designed to give patients total control over their own medical records. It is her belief that if the patients were in charge of the records, and those records were easily accessible from mobile devices, the cost and quality of care would be positively impacted. We had an engaging conversation on the challenges associated with collecting and accessing disparate HIS, EMR, and other proprietary sources of data, as well as the challenges of creating a secure database to maintain these records. She is very interested in driving this discussion and empowering patients to have control of their own medical records. We offered to assist her, and had interesting discussions on an additional initiative she was just launching, which centered on Medicare recipients’ use of technology. We shared with her the response rates and usage patterns associated with our texting efforts. Again, we offered our services to help serve on this committee.
We also shared a ZP-generated report that identified a wide range of differences in MAC’s initial and final rates. This was of interest to CMS, as this not only increases our costs in getting resolution, but CMS incurs additional costs in process denials and responding to appeals of potentially inappropriate denials. She asked that we further drill into the data in an effort to identify patterns that could be easily identified. We are in the process of working with the BI department to share this data with the CMS Integrity Committee.
On October 26, 2017 I also met with Demetrios Kouzoukas (Principal Deputy Administrator & Director of the Center of Medicare) and other department personnel. We were told that CMS recently executed contracts with outside contractors to build a brand new enrollment system to replace PECOS.In discussing the appeal process, I recommended the use of machine learning and AI in an effort to process these appeals more consistently and in a timely manner. We extended an invitation to bring in some of our portfolio companies from Meridian Street Capital (our venture capital arm).
Contractors include Solutions by Design and Booze Allen. We discussed inconsistencies between MACs and stressed using a one “standard approach.” Demetrious commented that this would also handle the Medicaid enrollment on behalf of individual states. Additionally, it would be revamped to help in the evolving enrollment requirements for ACO’s. Director Verma confirmed this was still an ongoing project.
The last issue addressed was price transparency. It was clear that transparency in the costs of healthcare was an important initiative to CMS, as well as HHS Director Azar. While Director Verma was initially discussing this for Medicare recipients it was clear she believes that this transparency should be for all healthcare costs, including commercial plans. We spent a little time expressing the concerns we had with CMS’ involvement in the contractual relationship between our clients and private payors. She understood our concerns, but was resolve in her belief that greater price transparency will reduce costs.
In closing, these discussions will benefit our industry going forward, and we welcome the opportunity to help drive conversations that make a difference in the delivery of healthcare.
T. Scott Law
Founder and CEO – Zotec Partners