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As I lead Sentry through this new ERA of Healthcare Technology requirements, speed, efficiency, robust feature functionality and constant evolution of the solutions through innovation are essential.  Please see the case study article featured on IBM’s website 

Drug CEOs Switch Tactics on Reform  

Pharmaceutical Companies Join Health-Care Overhaul, Hoping to Influence Where Costs Are Cut

By JONATHAN D. ROCKOFF

Drug-company executives are aiming to prevent steep cuts in prescription prices by joining the effort to overhaul the U.S. health-care system.

Their approach contrasts sharply with their behavior 15 years ago, when they helped defeat President Bill Clinton’s reform efforts from the outside. “This is not the 1990s, when the industry was playing defense,” says John Lechleiter, Eli Lilly & Co.’s chief executive. “We’re playing offense. We’re at the table.”  click here for more

The AP (5/22, Neergaard) reported, “Inching closer to a swine flu vaccine, the government is beginning to analyze two candidates for the key ingredient to brew one. The Centers for Disease Control and Prevention hopes to deliver one or both to vaccine manufacturers by the end of next week so scientists can begin the months-long process of producing shots.” The US “set aside $1 billion for crucial testing of the first pilot doses and stockpiling of key vaccine ingredients” on Friday. CDC scientists also “unveiled the most detailed genetic examination yet of the novel virus, finding that the new swine flu may have been circulating undetected in pigs for years.”
According to the Los Angeles Times (5/23, Kaplan), “an analysis of more than 50 strains of the H1N1 influenza virus at the center of the global outbreak has concluded that they are closely related and can be fought with a single vaccine.” The findings “could boost the likelihood that the US will move forward with an H1N1 vaccine that would be offered separately from the seasonal flu vaccine.” Sanofi Pasteur announces $190 million swine flu vaccine contract with US. For more click here.

What’s a Shared nothing database??? That’s the first question I asked myself when I heard about it.

My CIO came into my office one day and said,”in order to meet your product expectations we need to build a massively scalable distributed database with a shared-nothing architecture”.  

I said to myself, Ha! Tech-guys, he’s looking for money for his department again… You know, everything with them needs to sound so dramatic!  It turns out, it was the most insightful look into the future I’ve ever seen.

Check this link out if you want to learn more about what I am talking about.

http://www.sentryds.com/Products/Datanex/Components/QDC/

Many families are concerned about the Swine Flu (AKA H1N1 Flu).  The CDC has many resources that are available to provide you the information needed to prepare what needs to be done and not worry.

What is Swine Influenza?

Swine Influenza (swine flu) is a respiratory disease of pigs caused by type A influenza virus that regularly causes outbreaks of influenza in pigs. Swine flu viruses cause high levels of illness and low death rates in pigs. Swine influenza viruses may circulate among swine throughout the year, but most outbreaks occur during the late fall and winter months similar to outbreaks in humans. The classical swine flu virus (an influenza type A H1N1 virus) was first isolated from a pig in 1930. 

Link

http://www.cdc.gov/h1n1flu/key_facts.htm

Washington Post: Ads Against Health Care Overhaul Cite Problems In Canada And Britain (Washingtonpost.com)  This story was written by Dan Eggen.

The television ads that began airing last week feature horror stories from Canada and the United Kingdom: Patients who allegedly suffered long waits for surgeries, couldn’t get the drugs they needed, or had to come to the United States for treatment.

“Before government rushes to overhaul health care, listen to those who already have government-run health care,” intones Rick Scott, founder of a group called Conservatives for Patients’ Rights. “Tell Congress to listen, too.”

Scott, a multimillionaire investor and controversial former hospital chief executive, has become an unlikely and prominent leader of the opposition to health-care reform plans that Congress is expected to take up later this year. While disorganized Republicans and major health-care companies wait for President Obama and Democratic leaders to reveal the details of their plan before criticizing it, Scott is using $5 million of his own money and up to $15 million more from supporters to try to build resistance to any government-run program. Click on link for full story.

http://www.cbsnews.com/stories/2009/05/11/politics/washingtonpost/main5005823.shtml?source=RSSattr=Politics_5005823

By ELIANE ENGELER and MARI YAMAGUCHI, Associated Press Writers Eliane Engeler And Mari Yamaguchi, Associated Press Writers   – Sun May 17, 3:43 pm ET

GENEVA – Health experts are looking very closely at the spread of swine flu among people in Spain, Britain and Japan, a WHO official said Sunday as Japan reported a one-day explosion of over 70 new cases, mostly among teenagers.

The swine flu epidemic is already expected to dominate the World Health Organization’s annual meeting, a five-day event that begins Monday in Geneva and involves health officials from the agency’s 193 member states.

WHO Director-General Dr. Margaret Chan will reveal experts’ recommendations on the production of a swine flu vaccine sometime at the meeting. Pharmaceutical companies are ready to begin production, but many decisions have to be made first — such as how much vaccine to make, how it should be distributed and who should get it.

Some experts say there’s no question that a swine flu vaccine must be produced but WHO needs to discuss the issue with its members.

As of Sunday, the swine flu virus — which WHO calls the A (H1N1) virus — has sickened at least 8,480 people in 40 countries, killing 75 of them, mostly in Mexico.

Go to link for full article http://news.yahoo.com/s/ap/20090517/ap_on_he_me/med_swine_flu

By TOM MURPHY | AP Business Writer

    1:52 PM CDT, May 14, 2009

INDIANAPOLIS - The chief executive of drugmaker Eli Lilly and Co. warned Thursday that a proposed public health insurance plan would be a “slippery slope” toward government-run health care that stifles his industry.

John Lechleiter told a U.S. Chamber of Commerce luncheon audience in Washington, D.C., that there are no examples worldwide of “a robust private health insurance market coexisting with a government plan that’s open to all.”

Lechleiter also said in a Webcast of the speech that a “wave of defensive consolidations” that has swept through big drug companies is contributing to what he termed an innovation crisis in the life sciences sector.

President Barack Obama has called for an overhaul of the U.S. health care system to cover the uninsured and rein in costs. Obama and many Democrats in Congress say a government insurance option as part of this would help keep the private insurance industry honest. Click link to see article 

http://www.chicagotribune.com/news/local/wire/chi-ap-apfn-lillyceo-healthc,0,2141262.story

US prescription drug use fell in 2008, study says

By MARLEY SEAMAN

NEW YORK (AP) - Prescription drug use in the U.S. fell lastyear, although total spending on drugs increased as prices rose sharply on brand-name products, pharmacy benefits manager Medco Health Solutions said Wednesday.

Medco said the overall decline in prescriptions was the first in a decade. The company, which handles drug benefits covering about 60 million people, said total prescription use was down because few new drugs were launched last year, former blockbuster drugs like Zyrtec became available without a prescription, and some drugs faced safety issues that led to decreased use.

Those factors had a bigger impact on prescriptions than the recession, the company said.   For more info click

http://channels.isp.netscape.com/news/story.jsp?floc=&idq=/ff/story/0001%2F20090513%2F1443650370.htm&sc=1310

How the Deficit Reduction Act Affects Hospitals
New Challenges in Medicaid Billing Require Additional Diligence
The Deficit Reduction Act of 2005 brings some significant challenges to hospitals with regards to their Medicaid billing practices.  As of the second quarter in 2009, most states are beginning to require that the 11 digit National Drug Code (NDC) for all Medicaid physician administered drugs be included on bills that are submitted for payment.
Background
The Deficit Reduction Act requires all state Medicaid Agencies to collect rebates from drug manufacturers for all outpatient drugs.  Prior to the DRA, most state Medicaid agencies didn’t receive specific 11 digit NDC numbers for drugs administered in hospital or other ambulatory care settings, which meant that Medicaid couldn’t go back to drug manufacturers and receive financial rebates for the drugs that were utilized in those settings.  Section 6002 of the Deficit Reduction Act sought to save money for Medicaid by collecting this information from each and every ambulatory care provider to enhance the financial rebates it receives from drug manufacturers.
Several types of claims that now require a full 11 Digit NDC include:
•    All physician-administered drugs in an office/clinic setting (including 340B drugs)
•    Claims from certified dialysis treatment centers
•    Outpatient hospital claims and institutional outpatient crossovers (including 340B drugs)
•    Professional crossover claims

It should be noted that 11 Digit NDCs are manufacturer specific, and this is important due to how these rebates will be processed.

What’s Involved in Complying with the DRA?
Outpatient bills for services that include drugs are normally indicated by the presence of a “J-Code”.  “J-Codes” are Level II HCPCs codes that begin with the letter “J” and are mapped by the Center for Medicare and Medicaid Services to specific NDCs.  Hospitals use an NDC code to purchase drugs from a drug wholesaler or manufacturer, but they identify administrations of those drugs using a Charge Description Master, or set of proprietary codes that’s loosely mapped to specific NDCs.  All three of these different code sets must be in sync or serious over reporting or under reporting of utilization will occur.
In addition to matching up several different code sets, there are added complications at each stage of the mapping process.  Several common and show-stopping
1.    There can be more than one NDC purchased for a single drug (for instance, a brand drug and a generic, or different types of generics), and the difference between NDCs is important.  Because Medicaid will go back to each individual manufacturer for rebates on that manufacturer’s drugs, an NDC change is a critical point in the process.   In the event of a manufacturer triggered audit, a hospital will be required to prove that they bought the exact amounts of the drug they reported to Medicaid.
2.    CDM to NDC mapping tables are hard to maintain, often aren’t maintained regularly, and many Hospital Information Systems (HIS) can’t manage the complex interactions that regularly exist between multiple CDM codes that relate to multiple NDCs.
3.    CDM to J-Code tables are hard to maintain due to the fact that these tables are updated quarterly, and there can often be more than one CDM that should be mapped to the same J-Code.
4.    Billing systems and pharmacy systems are often poorly connected and drugs that should be billed are left off of claims or claims include drugs that were never administered.
5.    A patient’s status and insurance class at the time of administration is key and can affect compliance.  This status often changes over the course of a patient’s care within a hospital.
6.    Billing units can be incorrectly calculated by the billing system and/or pharmacy systems involved, resulting in inaccurate reporting.
7.    Some states require COG reporting or other details that need to be submitted along with the NDC code.  These need to be accurately calculated and determined and can introduce additional complexity.

What Does Compliance to the DRA Look Like?
Compliance with the Deficit Reduction Act means that a hospital can tie its purchases to dispensations for all Medicaid outpatients.  Challenges include providing a visible, auditable, repeatable, and reasonable process for allocating different drugs purchased to patients that flow through the hospital pharmacy.
Because pressure will come to bear from drug manufacturers to substantiate the specific NDCs that are being reported by hospitals, inquiries will likely be triggered after each state submits its rebate requests to each manufacturer.   These inquiries will likely focus on comparing the pharmacy purchases a hospital has made to the electronic claims adjudicated to Medicaid.  Identification of drugs that were purchased but not reported, or drugs that were reported but never purchased will be gaps that draw attention
What’s the Solution?
The DRA reporting process is complicated and involves several different steps requiring conversions between several disparate numbering systems.  The only way to ensure accuracy is to invest in tools that clearly identify and illuminate all steps of the process.
Hospitals should look for technology tools that include the following features:
1.    Operate under electronically enforced, written, clearly specified Policies and Procedures.  A documented policy and procedure becomes a crucial tool in the event of an audit.
2.    Provide built in support for key coding schemes used for pharmacy procurement (NDCs), pharmacy billing (CDMs), and financial adjudication of claims (J-Codes/HCPC Codes).
3.    Automatically update mapping tables and crosswalk tools to reflect changes in the regulatory environment, procurement practices, or administration.
4.    Electronically provide instant access to a comprehensive “two or three clicks” audit trail that ties all steps of the process flow together.
5.    In the event a hospital employs a bedside barcoding system, the system should take this information into account and be able to provide formulary updates back to the barcoding system.
Strategies to Avoid
The following strategies will leave your facility open to a time consuming, expensive audit that will find inaccuracies
•    Manual workarounds or “patches” to existing systems that don’t incorporate all of the critical compliance components.
•    Refusing to submit claims to Medicaid that might include drug codes.  Most states don’t allow for these types of selective billing practices.
•    Attempting a “Best of Breed” integration involving multiple systems.  This type of integration will cost a significant sum of money, still presents significant challenges during an audit, and often fails to deliver on the promise of tight integration, often requiring poorly documented manual processes.