The following
are articles, web
page content and other information we find
interesting to the healthcare professional.
They are listed below in the order shown. Click on the title or
scroll down and read them all. Please comment if you like.
* * * * * * * * * * * * * * * * * * * *
List of Older Articles
* * * * * * * * * * * * * * * * * * *
Tuesday April 25
SearchPointe Now Provides Chiropractor Background
Screening Online -- www.SearchPointe.com Helps Consumers Screen
Chiropractors' Credentials
ALPHARETTA, Ga.--(BUSINESS WIRE)--April 25,
2000--SearchPointe Inc. (www.SearchPointe.com)
announced today the launch of Chiropractor
Search(TM), the Internet's most comprehensive
source of professional background and credential
verification information on chiropractors.
The only nationwide service of its kind on
the Internet, Chiropractor Search features
detailed profiles on approximately 65,000
doctors of chiropractic (DCs) licensed to
practice in the United States. Chiropractor
Search is an important tool that helps health
care consumers research current and prospective
DCs prior to receiving treatment.
"Since chiropractic care is often not covered
by traditional medical insurance programs,
there is less likelihood that a provider's
credentials are being evaluated," said Matt
Connelly, SearchPointe's Director of Business
Development. "Coupled with the fact that
there are licensed chiropractors with sanctions
filed against him or her by the state's licensing
boards, it is important that consumers have
somewhere to turn in order to evaluate the
credentials of their chiropractor. Chiropractor
Search delivers that capability. SearchPointe
combines data from the Department of Health
and Human Services and the state chiropractic
licensing boards to provide a single, comprehensive
reference point to help consumers make more
knowledgeable decisions about their chiropractor."
Chiropractor Search enables visitors to search
for chiropractors by name or proximity. Based
on the visitor's preferences, Chiropractor
Search returns a list of chiropractors including
their name, office address and office phone
number. Additionally, visitors can select
chiropractors from the listing and view an
interactive map with the locations of selected
chiropractors(s) marked. Once a chiropractor
is chosen, Chiropractor Search displays a
profile, containing the chiropractor's background
information, including year of birth, gender
and chiropractic school attended. More importantly,
the status of license(s) and disciplinary
action data are available. SearchPointe's
visitors may also choose to activate an Alert
Service that notifies them via e-mail of
any change in the sanction status of a selected
chiropractor.
SearchPointe Inc. provides consumers with
online resources to help them make better
and more informed decisions about their professional
service providers. Through SearchPointe's
comprehensive databases, Doctor Search(TM)
and Chiropractor Search(TM), consumers can
access background and credential verification
information about certain health care providers
nationwide. SearchPointe(TM) has plans to
release additional search products on other
professional service providers throughout
the year. SearchPointe considers the protection
of its visitors' personal information a cornerstone
of its business practices. SearchPointe is
a subsidiary of ChoicePoint Inc. (NYSE:CPS
- news), a leading provider of decision-making
intelligence to businesses, individuals and
government agencies. For more information
about ChoicePoint visit www.choicepoint.net.
SearchPointe, Doctor Search, Chiropractor
Search and ChoicePoint are trademarks of
ChoicePoint Inc.
* * * * * * * * * * * * * * * * * * *
Out Of The Ashes 4/19/00
(Entrepreneur) Burnout. That's something only overworked
fast-track types experience, isn't it? A
homebased entrepreneur who has forsaken big
business for the slower, friendlier pace
of a self-guided career could not possibly
succumb to such a corporate malady, right?
Wrong. Burnout can-and does-affect homebased
entrepreneurs. But, avoiding burnout takes
preparation and forethought. Here are a few
tips to help you.
1. As you build or expand your homebased business,
make sure you don't neglect friends.
2. If you have a spouse, significant other,
children or even a pet, set aside a time
of day that belongs to them alone.
3. Join professional support organizations
that serve the dual functions of helping
you develop your business and giving you
a social outlet.
4. Take a vacation, even if it's just an extra-long
weekend at the beach, camping, or at your
favorite resort. And when you go, leave the
business at home.
5. Realize that it is natural for your initial
enthusiasm for your business to give way
to more pragmatic feelings, and don't be
alarmed.
6. Develop a nonbusiness-related hobby that
provides you with a creative outlet.
Entrepreneur.com
* * * * * * * * * * * * * * * * * * * *
InfoGlide's XML Similarity Search Engine(TM)
Applied To First Notice of Loss Fraud Detection -
Stopping Fraud Before a Claim Is Paid
AUSTIN, Texas, March 5 /PRNewswire/ -- The XML Similarity
Search Engine(TM) has
now been implemented to fight fraud at first
notice of loss -- before an insurance claim
is paid.
Virtually all insurance fraud technologies
"pay and chase," paying fraudulent claims
and then chasing criminals after fraud is
discovered. Insurance fraud has been estimated
at over $20 billion per year by the prestigious
Conning & Associates, a leading insurance
industry authority.
InfoGlide CEO Jay Valentine noted: "The
'Holy Grail' of insurance fraud detection
is the ability to stop fraud before a claim
is paid. InfoGlide has proven that fraud
can be discovered before a claim is paid.
We have implemented the world's largest first
notice of loss system, with astounding results."
InfoGlide implemented a fraud detection system
searching 11 databases, each in different
formats, with over 30,000 new "claims"
or identity incidents per day. The $20 billion
client had over 7 million records, which
had to be cross-searched.
The system was fully implemented in 6 days.
By applying InfoGlide XML Similarity Search,
fraud can be dramatically reduced by cross-searching
NICB Suspicious Claims databases, downloaded
ISO data, internal claims files and SIU files.
In one example, Special Investigations Unit
personnel brought in their own 'personal
case files' and integrated these for cross-search.
The XML Similarity Search Engine quickly
identified hundreds of claims that were about
to be paid to fraudulent providers.
In one very dramatic example, a major midwestern
insurer identified a claim that had been
approved for payment -- to a medical provider
serving time in Federal prison. InfoGlide
downloaded the Sanctioned Doctors Database
from the Internet to identify doctors sanctioned
by the Federal government. Cross-searching
the insurer's claims with this downloaded
data, InfoGlide discovered that the insurer
was continuing to pay this doctor in prison.
The Similarity Search Engine showed that
this insurance firm had previously paid this
prison bound doctor $187,000.
Valentine noted, "We see insurers every
day who are paying millions of dollars to
known fraudulent doctors, attorneys, and
medical providers. These fraudulent providers
know that if they change all their identifiers,
they can become invisible to most link charting/visualization
systems. Even when these people change all
their identifiers to avoid detection, the
XML Similarity Search Engine finds them and
quickly flags the claim before it is paid."
Stopping fraud at first notice of loss has
been impossible because it requires that
many databases, sometimes 20 or 30, be cross-searched
instantly when a claim arrives. Many attributes
or fields have to be weighted and scored.
Since each database is often in very different
format, an insurer has to "scrub" the data-modify
all the fields so they look precisely the
same. Unfortunately, this removes all the
good fraud clues.
The XML Similarity Search Engine searches
and scores virtually any data without any
scrubbing or reformatting. Even if an insurance
fraud perpetrator changes his/her name, address,
phone number, Tax ID number, or any of hundreds
of other identifiers, the XML Similarity
Search Engine finds them and flags them for
the claims department.
Four of the top 10 United States property
and casualty insurance firms have implemented
the XML Similarity Search Engine for advanced
fraud protection.
* * * * * * * * * * * * * * * * * * * *
Want a Practice Web Site? Stop. Now, Call
Your Lawyer
Potential e-Health Legal Snares Are Legion
By Bonnie Darves
WebMD Business Columnist
Feb. 7, 2000 (Portland, Ore.) -- It's wow, it's cool,
everybody's doing it -- and if you do it
without adequate legal guidance, it could
get you in a whole lot of trouble. It's that
tantalizing entity, your practice's own Internet
web site.
Just be careful what you wish for, say many
physicians who've hopped onto the web wave
-- and wiped out after running a ruinous
legal riptide.
Facing pressure from staff -- and not wanting
to be viewed by patients as being behind
the times -- physicians in growing numbers
are establishing some type of presence for
their practices on the Internet -- from setting
up limited-focus web sites, containing little
more than basic practice profiles, to participating
in large "co-op" sites with other
physicians or health care entities.
Unfortunately, many physicians venturing
onto the 'Net don't realize the potential
legal risks they're facing by participating
in such ventures, according to e-health law
experts.
"Physicians are largely unaware of the
legal implications of developing or participating
in medical web sites," Reece Hirsch,
co-chair of Davis Wright Tremaine's e-health
law practice, tells WebMD. "They should
understand that if they are making [the site]
part of their practice, they need to observe
the same standard of care that they do in
their 'normal' practice."
What kinds of problems may physicians face
in "e-practice"? Not surprisingly,
they're related to the same ones they face
in their physical practices. For example,
if e-mail becomes a regular method of physician-patient
communication, certain professional liability
issues may arise if the physician handles
that communication improperly. Then, of course,
there are the well-recognized issues of patient
confidentiality and medical record privacy.
The following are some additional key areas
of potential liability that physicians should
keep in mind when they consider establishing
or participating in web sites.
Jurisdiction issues and advertising laws. An "online" physician who practices
in just one state risks violating laws in
states and even municipalities well beyond
that state's borders. In fact, several court
cases have been filed in recent months accusing
physicians of exactly this. Hirsch notes,
however, that those cases typically involve
web sites that engage in either interactive
communications or sales of goods and services
-- not sites that "are merely passive
information postings."
Nonetheless, Hirsch tells WebMD, physicians
who respond to any type of query via their
web sites should take extra precautions.
"If a physician basically uses the site
as a marketing tool, but receives e-mails
from potential patients who are out of state,
[the physicians] need to be careful about
establishing a physician-patient relationship
in a state in which they're not licensed,"
he says, because there can be "a fine
line between just posting general information
and providing individualized, real medical
advice."
That doesn't mean a physician shouldn't respond
to a query from out of state, but rather
that she or he should ensure that the site
-- and even the particular page -- includes
appropriate disclaimers in a prominent place.
"They need to make it clear that they're
providing general medical information, and
that it's not intended to be medical advice,"
Hirsch says. The primary issue, he says,
is that physicians must be able to distinguish
the point when providing user-specific information
constitutes creating a physician-patient
relationship.
The potential risks of violating advertising
laws can be similarly "muddy,"
according to Hirsch, who is based in San
Francisco. "A web site is basically
advertising, even though physicians don't
think of it that way. So anything you say
on the site must be said with the same care
you would put into an advertisement"
for the practice.
For example, a specialist who claims certain
success rates for a particular procedure
may run afoul of state advertising laws if
the claims can't be properly substantiated.
In California --which has recently enacted
strict Internet advertising laws -- it wouldn't
be unheard of, Hirsch says, for the "attorney
general to show up at the office and say,
'Where is the support for that statement
on success rates?' And if you can't produce
concrete evidence, you could be charged with
false advertising."
Professional liability considerations. In the medical malpractice arena, late
or inadequate e-mail communication can be
just as risky as failing to respond promptly
and diligently to patients' phone calls or
in-person queries.
In several medical malpractice cases, physicians
have been found negligible for not responding
promptly to phone calls or messages from
patients -- and courts may soon apply the
same standards to e-mail communications,
Hirsch says.
"Physicians who make e-mail a part of
their practice can't just allow e-mail messages
to stack up and not respond to them, if they've
established that line of communication with
their patients." At the very least,
physicians should set the ground rules for
e-mail use, he says, making sure, for example,
that patients understand that e-mail should
not be used for emergency communications.
"It's OK to be less responsive if you
tell patients what the policy is," Hirsch
says, but it might be a better bet to put
that policy in writing.
Fraud and abuse considerations. As far as the Internet is concerned, the
application of federal fraud and abuse laws
is still "relatively uncharted,"
Hirsch tells WebMD. But however unexplored,
this area is fraught with potential risk
for physicians whose web sites involve advertising
or other relationships that could affect
Medicare or Medicaid patients.
For example, if a medical practice web site
establishes an advertising relationship with
a drug company, and the payment for the ads
is based on "click-throughs" to
the advertiser's site, those relationships
could prove problematic if the advertiser
-- such as a pharmaceutical company -- provides
an item or service covered by a federal health
care program. That's because the federal
anti-kickback statute forbids providers from
offering payment or receiving remuneration
for either purchasing such items or referring
patients to such items or services.
"The laws are complicated, so you can't
make a broad statement, but it's a definite
risk area and physicians have to at least
think about advertising relationships,"
Hirsch says, and have those relationships
reviewed by legal counsel if they aren't
sure whether a potential violation exists.
Ethical and legal reasons. Finally, physicians should be careful about
lending their names or endorsements to medical
web sites. Hirsch acknowledges that this
isn't a significant issue for most providers
-- "those who aren't celebrity e-doctors
like Dr. Dean Adell" -- but he says
the situation can get sticky if physicians
"blur the line between their professional
practices and business. Basically, if you're
lending your professional name to a site,
and that site endorses a certain provider,
then it looks as if you are making a professional
recommendation."
Before you go online, go over your practice's
potential liability exposure with your lawyer
to be sure your "cyberpractice"
will evolve in compliance with the fast-changing
climate of health care regulation.
© 2000 Healtheon/WebMD.
* * * * * * * * * * * * * * * * * * * *
Medicare: Federal Report Reveals 'Exorbitant'
Spending
From The American Health Line
Feb. 7, 2000 (Washington) -- Despite recently cutting
benefits and raising premiums, some Medicare
HMOs are spending "exorbitant"
amounts on administrative costs, including
parties, gifts, and tickets to sporting events,
according to reports from the HHS inspector
general's office.
USA Today reports that in one study, researchers
uncovered $4.7 million in "questionable
administrative costs" among nine Medicare
HMOs -- one insurer spent $249,283 on food,
gifts, and alcoholic beverages; four HMOs
spent $106,490 for sporting events and theater
tickets and one spent $25,057 to lease a
luxury box at a sports arena. Another HMO
spent $37,303 on wine, flowers, and other
gifts for customers, insurance brokers, and
employees.
HHS Inspector General June Gibbs Brown said,
"We don't think any reasonable person
would believe that Medicare should pay for
sporting event tickets, gift baskets, or
holiday parties."
Another study of 232 plans reveals "wide
discrepancies in how much is set aside to
administer Medicare HMOs, which often offer
more benefits to the elderly and disabled
than traditional Medicare." For every
dollar the government pays Medicare HMOs,
some spend as little as 3% running their
plans, while others spend up to 32%. Brown
said, "The administrative costs for
some Medicare managed care plans are clearly
exorbitant." To combat spending, the reports recommend
a 15% cap on administrative spending.
The American Association of Health Plans
questioned whether the reports "fairly
capture the reasons for the wide disparity
in spending." Susan Pisano of AAHP explained
that "small insurers might be spending
to expand into underserved rural areas,"
while "some plans had to spend more
to meet new federal regulations."
But Pisano added that the reports of extravagant
spending on gifts and entertainment are "unfounded."
She added, however, "If [the government]
is correct, then having those kinds of costs
passed on to Medicare is wrong" (Appleby,
2/4).
© 2000 by National Journal Group, Inc.
* * * * * * * * * * * * * * * * * * * *
Health Issues
A Simple Solution To Rising Health Care Costs
Today, most health care is paid for by third parties
-- employers or government programs. Some
experts say the third-party payer system
is the root cause of medical cost inflation,
since consumers have no incentive to shop
for the best prices or limit their use of
services to what is medically necessary,
and few physicians compete in pricing their
services.
However, an innovative new concept is cutting
costs for some patients' care by half. The
concept is known as "paying cash."
Cash is the basis for SimpleCare, begun in
1997 by two Seattle, Wash., physicians squeezed
on payments by managed care companies to
the point that their practice was losing
money.
The doctors, Vern S. Cherewatenko and David
McDonald, decided to substantially lower
their fees if patients paid cash at the time
of the visit. That would allow them to avoid
managed care companies and lower their administrative
costs.
Under managed care, if Dr. Cherewatenko spent
10 minutes treating an insured patient suffering
a cold, the doctor's staff would submit a
$79 bill to the patient's health maintenance
organization.
The HMO would only pay $43 for that service
-- but Cherewatenko incurred about $20 in
administrative expenses to collect the HMO
payment, so he would net $23.
However, his overhead cost for that patient
is $30, so he actually lost $7.
Now, he charges a patient $35 instead of
$79 if the patient pays by check or credit
card, thus earning $5 instead of losing $7.
To promote SimpleCare nationwide, Cherewatenko
started the American Association of Patients
and Providers. Members of the group slash
their regular fees from 30 percent to 50
percent.
Since 89 percent of health care costs are
small claims under $2,000, SimpleCare could
reduce the nation's health care bill if widely
implemented.
Source: Tyler Chin, "Making Managed
Care Simple," American Medical News,
November 15, 1999.
* * * * * * * * * * * * * * * * * * *
Will Grow Consulting