3 min read
Ahh, Halloween. A time for eagerly knocking on strangers’ doors, consuming copious amounts of candy, and if you’re a parent of young children like some of us at Moxe, perhaps looking through the recycling bin to figure out how you’re going to transform your daughter’s ballerina costume into a passable purple ninja (she insists that’s what she wanted to be all along).
October 31 just wouldn’t feel like Halloween without some spooky stories, too. So, for all of our friends in healthcare IT, we’d like to share some of the scariest headlines we’ve come across in 2023. Step aside, The Legend of Sleepy Hollow.
- The Fax is Still King in Healthcare--and it's Not Going Away Anytime Soon
We wish this 2023 headline was an April Fool’s joke. The author says about fax machines, “. . .until someone comes up with a more secure and prolific method for transmitting patient information and prescription requests, the aging systems aren't going anywhere.” Maybe it’s time to consider Moxe?
- Fax As An On-Ramp for Interoperability
Scott Turicchi, the CEO of the world’s largest digital fax provider, makes a case for digital cloud fax. Digital cloud fax enables unstructured documents to be converted to structured documents, from which discrete data elements can then be extracted. While we agree that digital cloud fax is superior to traditional fax, it doesn’t come close to delivering what other interoperability solutions, like Moxe’s Release of Information, can. Digital cloud fax replaces a technology, but it doesn’t transform processes. It still requires requestors to manually request information and staff to manually pull and then transmit that information. It does little to reduce the mounting administrative burden in healthcare of fulfilling requests for information.
- CMS’s Final RADV Rule Announces No Extrapolation Methodology, No FFS Adjuster
As if all the acronyms aren’t scary enough! In short, this article talks about CMS’ decision to not apply the fee-for-service (FFS) adjuster, which historically has allowed “for permissible threshold errors emanating from third-party provider medical record documentation”, to Medicare Advantage Organizations (MAO) during risk adjustment data validation (RADV) audits. RADV audits determine whether medical information and diagnoses submitted for risk adjustment purposes are fully supported by a patient’s medical record. In the authors’ (and our) view, “Reliance on provider medical record documentation practices has an inherent risk of some level of incompleteness, inconsistency, and error that makes extrapolation of audit results legally and equitably inappropriate. The FFS adjuster operates to offset any impact of erroneous diagnosis codes in Medicare Part A and B data used to calculate an allowable level of payment error for risk adjustment modeling.” Perhaps the scariest element of this news story for our provider partners: “Now having settled on not applying the FFS Adjuster, CMS will extrapolate audit findings to which MAOs are subject beginning with payment year 2018, estimating potential recoveries of $4.7 billion by 2032.”
- Healthcare Spending Will be One-Fifth of the Economy within a Decade
This headline is chilling and motivating to our Moxe team. It’s exactly why we were founded: to address what we see as one of the greatest challenges of our time: making healthcare more affordable. According to the article, “national health expenditures (NHE), are projected to climb from $4.4 trillion, or $13,413 per person, in 2022 to $7.2 trillion, or $20,425 per person, in 2031. Relative to the size of the economy, NHE is projected to climb from 17.4% of gross domestic product (GDP) in 2022 to nearly 20% by 2031 as rising healthcare costs will outpace the growth in the economy.” Moxe is doing everything in our power so that we can look back at this headline in 10 years and say: we proved them wrong! But, we know we cannot tackle this massive problem alone. It will take countless stakeholders in the healthcare ecosystem committing themselves to reducing the administrative burden in healthcare and thinking creatively and strategically about how we are going to drive down costs.
- Traditional Medicare lags MA in utilization, efficacy: study
This article highlights some of the major findings of a recently published white paper by Harvard Medical School and cloud-based healthcare data aggregation service Inovalon. In short, there are some scary care utilization differences between patients enrolled in Medicare Advantage (MA) and traditional, fee-for-service Medicare. In his summary of the white paper findings the author notes, “While people who enrolled in MA plans saw stable utilization in the first two years, those who enrolled in fee-for-service Medicare instead saw utilization increase by 35%, according to the report.” The good news is that MA seems to be making a meaningful difference in providing more cost effective care without sacrificing care quality. The scary part? Traditional Medicare participants still make up just under half—about 49%—of Medicare-eligible patients.
In order to move more patients away from traditional fee-for-service plans like Medicare, the secure, efficient exchange of actionable data is paramount. In our quest to help drive down healthcare costs while contributing to care quality, Moxe wants to be anywhere there is a need for this type of data.
As pumpkins pop up on front porches and we prepare for Halloweeen, we’ll keep an eye on the scary headlines. They help keep us focused on the important work ahead: making the healthcare system work for all of us. Here’s to smarter healthcare and the lighter side of this spooky season: candy, costumes, and jack-o-lanterns.
Ready for more on Moxe?
Check out this article in Health Data Management about how payers and providers can use clinical and claims data to get a more complete picture of patient health.
