Member Spotlight
Q and A with Dave Cheli, Co-Chair of HIMSS’ Financial Systems Newsletter Workgroup
Dave Cheli serves as Chief Information Officer for Gateway EDI, a national healthcare clearinghouse. He has over 17 years of experience in healthcare information technology, with extensive knowledge of EDI (Electronic Data Interchange), HIPAA, software development methodologies and project management. He is an active participant with HIMSS, serving as the Advocacy Liaison of the Midwest Gateway Chapter and actively participates on the HIMSS Financial Systems Education Committee.
1. What makes integration of clinical and financial systems such a "hot" topic for today's healthcare organizations?
One of the main drivers is consumerism. This movement is increasingly placing higher demands from the public for integrated and reliable data that they can use to take more control of their healthcare.
2. How will Financial Edge aim to reach all the varied stakeholders impacted by the role of financial systems in healthcare, including clearinghouses, providers, payors, vendors and consultants? Why is this multi-perspective approach important?
One of the important goals of Financial Edge is to educate the diverse audience about efforts that have existed for quite some time, with the intent on leveraging what currently exists and minimizing duplication. As an example, there currently exists a healthcare electronic infrastructure operated by clearinghouses; there is an accrediting body for it called EHNAC. While these efforts have been around for quite sometime, there still seems to be efforts underway that are “reinventing the wheel.”
3. Shifting gears a bit, how did you become involved with your local HIMSS chapter-- the Midwest Gateway Chapter?
I actually contacted the president of the board a few years back and it so happened that they were looking to transition in a new advocacy liaison. The president asked if I’d be interested in participating on the board and I agreed since I was already involved in advocacy efforts with HIMSS-AFEHCT. From there, I moved into the role of president, which was a very good learning experience for me. This year, I am once again serving as the advocacy liaison.
4. As advocacy liaison for your local HIMSS chapter, why do you believe it is critical for healthcare IT stakeholders to advocate for legislation (local and federal) in& support of healthcare IT, as a way to transform our healthcare system?
I strongly feel that healthcare IT can make a very positive impact on our healthcare system and that our legislators play a key role in moving healthcare IT initiatives forward. Most importantly, healthcare IT stakeholders should be providing concise, accessible, educational messages on these complex issues and the benefits that healthcare IT can offer. These messages should be aimed at helping our legislators, who juggle many other priority issues, to more quickly grasp the essence and importance of our issues, thereby allowing them to more confidently incorporate healthcare IT in the various legislations they’re involved in. Advancing this is one of my goals as advocacy liaison for the Midwest Gateway Chapter.
5. Finally, tell us about your musical career.
I play jazz saxophone and am involved in the jazz education scene. Jazz is an art form that I fell in love with as a kid and has stayed with me. I actually have a degree in jazz performance. Prior to my career in healthcare IT, I spent several years as a professional musician, traveling around the country and ended up spending five months on a cruise ship. Since then, I’ve stayed active as a part-time performer in the St. Louis area, primarily playing in a fairly avant-garde jazz group, hitting the coffee shops and other beatnik venues.
Congress Passes Physician Medicare Payment Fix
By Diana Manos, Healthcare Finance News Senior Editor
After a series of failed attempts to stall a 10.6 percent Medicare physician pay cut, Congress has approved a veto-proof fix. The new law, when enacted, will halt the July 1 pay cut for the rest of 2008 and provide a 1.1 percent pay increase in 2009. The House previously passed the Medicare Improvements for Patients and Providers Act of 2008 by a wide margin in June with enough votes to overturn a veto long-threatened by President Bush.
Call for Participation: Financial Edge
Share your feedback on this first issue of Financial Edge. Let us know what you’d like to see in future issues and if you’d like to participate in planning and developing newsletter content. Contact Pam Matthews, CPHIMS, HIMSS Senior Director, Healthcare Information Systems or Nancy Vitucci, HIMSS Manager, Publications.
Welcome to Financial Edge
Financial Edge, HIMSS’ financial systems eNewsletter, is your source for the latest issues and emerging trends focused on financial systems and related technologies within healthcare delivery.
Keep Financial Edge Coming to You:
Financial Edge is provided to readers at no charge, but only to those readers who sign up to receive the online publication. To permanently subscribe to this complimentary information source from HIMSS, click here.
Published the third Tuesday of each month, Financial Edge is for HIMSS members, providers, payors, clearinghouses, vendors, consultants and anyone involved in connecting clinical and financial systems.
Through monthly topics, news briefs, guest editorials, member profiles and tools and resources, Financial Edge will provide an understanding of the trends and changes in financial systems, the value and benefits of financial and clinical systems integration as well as inform readers on ways to contribute and participate in the industry and within HIMSS.
In addition to Financial Edge, HIMSS offers other financial systems resources, such as white papers, fact sheets and FAQs. Click here for a complete list.
Medical Banking—The Proverbial “Paper Chase” Goes Digital
by John Casillas
Are we witnessing a paradigm shift in the making? The fall of the Berlin Wall was a stunning game changer that brought new challenges by integrating two economies into a unified Germany. In 2001, HIPAA’s Privacy Rule levied a broad impact on standard banking services for healthcare, toppling a wall between banking and healthcare and opening up a door to new “hybrid” service models. Today, capital-rich, high value administrative centers of excellence (banks) are reaching deep into capital-poor, processing deficient healthcare organizations to transform the proverbial “paper chase” into a digital platform. We call this multi-faceted movement “medical banking.”
A good case study of what could happen as banks integrate with healthcare is the airline industry. Linking the ticketing system with a banking network (SABRE) allowed people to book flights without a travel agent. This well-studied “inter-organizational system” (IOS), defined by Benn Konsynski, PhD, in 1992, changed the competitive paradigm among airlines. Likewise, medical banking could fundamentally change how healthcare stakeholders interact.
A new “bank infomediary” will move us much closer to a real time world in healthcare. Things like payment at the counter or on-demand healthcare records can flourish in this new ecosystem. New banking investments in health information technology are re-scoping boundaries and shifting the bank’s role from money changer to data processor. Banks are moving more and more health data to providers, plans and consumers. This budding area, while linked to consumer-driven healthcare, goes much deeper into the very fabric of our healthcare infrastructure.
Data confirming the effectiveness of medical banking is scarce. It is a new area and the success stories need to be verified. MBProject will contribute future articles to the Financial Edge newsletter that catalogue this extraordinary journey—linking these two conservative industries. Look for future articles to address topics such as the convergence of banking and healthcare, privacy and security and public trust.
Click here for more information on the MBProject.
John Casillas founded the Medical Banking Project, a member-driven forum, to research, document and facilitate "medical banking™," a term he coined to denote "the latent integration of banking technology, infrastructure and credit resources with healthcare administrative operations." In addition, he founded the National Medical Banking Institute, an educational arm of the MBProject, to advance cross-industry understanding of the scope of change made possible by engaging the bank healthcare stakeholder. Mr. Casillas is an authority in medical banking subject matter and provides technical assistance to policy makers, banks, healthcare administrators, lawyers and othersEHNAC Accreditation for Electronic Health Networks
The Electronic Healthcare Network Accreditation Commission (EHNAC), an independent not-for-profit accrediting agency, grew out of the 1993 Workgroup for Electronic Data Interchange (WEDI). A need was identified at that time for the healthcare transactions industry to have a self-governing body that would develop operational standards for the industry. EHNAC began accrediting electronic health networks in 1995.
Lee Barrett serves as the Executive Director of EHNAC, and Financial Edge had the opportunity to talk with him about his organization.
1. What products does EHNAC offer the healthcare industry?
Our products, which we call programs, address entities that process real-time and batch transactions, such as:
- Healthcare Network Accreditation Program (HNAP): focused on electronic health networks (EHNs)
- Financial Services Accreditation Program (FSAP): focused on financial institutions for both their EHN and lockbox
- Payor Clearinghouse Accreditation Program (PCAP): focused on payors with electronic gateway/frontend capabilities for their trading partners
- e-Prescribing Accreditation Program (ePAP): focused on e-prescribing and PBM entities for the EHN
2. Tell us about EHNAC’s accreditation process and the aspects of an organization you look at.
The accreditation process addresses four major areas, listed below with sample criteria for each:
- Business Practices
- Identify protected health information (PHI); treat as confidential data in all documents
- Customer service benchmarks, including defined levels of service and escalation procedures
- Improved Response Times
- Transaction turnaround response time measurements and monitoring
- Maintain high levels of systems availability
- Security Infrastructures
- Disaster recovery, business continuity and contingency plans
- Intrusion detection and response
- HIPAA Privacy & Security
- Efficient Transaction Processing
- Capability to handle generally-accepted industry standard formats including, but not limited to, HIPAA-mandated transactions
- Audit trails for transaction processing integrity
The accreditation process is almost totally electronic; we provide all of our documentation and processes on our Web site to make it as easy as possible for entities seeking EHNAC accreditation. The process is also consultative; our site reviewers will provide recommendations to assist an organization in addressing business areas they determine may benefit from other improvements. Our site reviewers have 20+ years of experience in the industry.
3. What should healthcare organizations expect from companies that are EHNAC accredited?
EHNAC is a third-party, objective, nationally recognized source that provides regular, comprehensive and objective evaluation and establishes metrics and benchmarks for accredited entities. Companies accredited through EHNAC demonstrate a commitment to improving/enhancing business processes, employee training and their products and services, as well as identifying security and business risk exposures and implementing risk controls.
4. What are the future plans for EHNAC?
EHNAC is working on several major initiatives. We’re currently in beta development for our Third Party Administrator (TPA) Accreditation Program; we anticipate launching this by Q108. We’re working with a joint industry collaborative, including CCHIT, to assist in developing accreditation criteria/standards for healthcare information exchanges (HIEs). And, we’re developing a reciprocal program with CAQH CORE to accept our accreditation status towards CORE certification, and for those that have achieved CORE certification to be credited toward their EHNAC accreditation.
HIMSS’ Role on NUBC/NUCC Committees
The National Uniform Billing Committee (NUBC) and the National Uniform Claim Committee (NUCC) are voluntary organizations created to develop a standardized data set for use by both the institutional and non-institutional healthcare communities. These standardized data sets are used to transmit claim and encounter information to and from all third-party payors. The NUBC is chaired by the American Hospital Association (AHA) and the NUCC is chaired by the American Medical Association (AMA). Criteria for membership on these committees includes a national scope and representation of a unique constituency affected by healthcare EDI, with an emphasis on maintaining or enhancing the provider/payor balance. Each committee member is intended to represent the perspective of the sponsoring organization and the applicable constituency.
Kathy Ochal-Thompson, Revenue Cycle Product Manager at Siemens Medical Solutions, represents HIMSS on both the NUBC and the NUCC. Her role is to offer HIMSS’ perspective on relevant issues to both these committees.
Ms. Ochal-Thompson uses the HIMSS NUBC and NUCC listservs to communicate and solicit input on topics relevant to HIMSS and its stakeholders. To sign up to participate in these listservs, please contact Holly Gaebel, Coordinator, Business Information Systems, HIMSS.
Advocacy/Regulatory/Compliance Update
7th Annual National Health IT Advocacy Day on Capitol Hill
U.S. Rep Allyson Schwartz (D-PA) encourages support for healthcare IT legislation during the National Health IT Week Capitol Hill Press Conference on June 10.
More than 300 individuals from 46 states gathered in the nation’s capital on June 10-11 for HIMSS’ 7th Annual Advocacy Day—held in conjunction with National Health IT Week. Advocacy Day activities supported raising awareness and garnering national support for the ongoing transformation of healthcare using healthcare IT and management systems.
Healthcare IT advocates participated in two days of training sessions and panel discussions on privacy and security, interoperability and the successes of the Nicholas E. Davies Award recipients, in addition to meeting with Congressional leaders and their staffers. Collectively, the advocates delivered handouts to all 540 congressional offices (this includes five delegates offices) and visited 199 members of Congress and their staff.
Jim Gaddis of HIMformatics, LLC found attending his first Advocacy Day to be a “very enlightening” experience. “Most of the folks we met with were very interested in what we had to say,” Mr. Gaddis said. “Some were very informed about healthcare IT, while others were not as well informed, but they all inquired as to how we saw healthcare IT improving the industry and the lives of their constituents.” He added that during his Advocacy Day Team’s Hill visits, they had a chance to discuss how CCHIT and ONC have affected the industry, how physicians perceive EMRs and where the return on investment is for healthcare IT systems—topics that could “impact legislators’ thinking about bills they are voting on.”
Also attending his first Advocacy Day, Kenneth Stensvold, IT Unit Manager, at the Mayo Clinic and Programs Director of the Minnesota Chapter of HIMSS, recognized the importance of healthcare IT professionals meeting with their local and national legislators to advocate for support of healthcare IT. “Our legislators cannot hope to keep on top of the vast changes happening in our industry, so we need to help them focus on the important issues,” Mr. Stensvold said. He added that although he and his Advocacy Day Team were pressed for time, they did discuss the $118 million for healthcare IT proposed in the President’s Fiscal Year 2009 Health Information Technology Budget Request for the Department of Health and Human Services.
Visit HIMSS’ Advocacy and Public Policy Center for more information on HIMSS advocacy initiatives, including efforts to promote healthcare IT and management systems funding and legislation.
HIMSS Launches New Financial Systems Task Force and Workgroups
HIMSS is looking for volunteers interested in participating in the new financial systems task force and workgroups launching this month.
- Revenue Cycle Task Force: This task force will develop a white paper on RCM and the life cycle of the patient encounter. Topics may include best practices, the impact of real time processing and metric performance measures.
- Financial Edge Workgroup: This workgroup will support HIMSS’ new financial systems eNewsletter. Work efforts include identifying authors and content and monitoring the newsletter performance scorecard. Visit Financial Edge.
- Public Policy Workgroup: This workgroup will support HIMSS activities by responding to public comment periods, participating in industry calls, such as with CMS, and supporting industry testimonies/other public presentations focused around financial systems.
Participation in these groups is open to all active HIMSS members. Work activities are conducted through monthly, one-hour conference calls. If you are interested in participating or have any questions, please contact Holly Gaebel. These workgroups and task force are supported by HIMSS Staff Liaisons Pam Matthews, CPHIMS, Senior Director, Healthcare Information Systems, and Holly Gaebel, Coordinator, Business Information Systems.
Nominations for HIMSS Board and Nominating Committee Due by August 1
Nominations for positions on the HIMSS Board of Directors and the Nominating Committee are due by August 1. Nominees must be a Regular or Life Member or the senior executive representative of an Organizational Member who have achieved and maintained advanced* membership status. Please send all nominations to:
H. Stephen Lieber, President/CEO
HIMSS
230 East Ohio Street, Suite 500
Chicago, IL 60611-3269
executive@himss.org
*Click here to obtain further information on the advancement process and/or access the application.
Upcoming Events
Privacy Symposium Summer 2008: Privacy in Transition—An Executive Education Program on Privacy and Data Security Policy and Practice
August 18 – 21
Harvard University, Cambridge, MA
Click here for more details.
The Sixteenth National HIPAA Summit at Harvard—Special Edition
Healthcare Privacy and Security Training and Professional Certification
(Collocated for the first time with Privacy Symposium Summer 2008)
August 18 - 21
Harvard University, Cambridge, MA
Click here for more information.
2008 HIMSS Public Policy Forum
October 28, 2008
National Press Club—Washington, DC
Watch HIMSS’ Advocacy and Public Policy Center for more details.