Government Speak

healthcare reformMy Comments: Many of us remember a simpler time, not just in politics but in medicine. As we grow older, we tend to interact more and more with the world of health care providers, who have a language all their own. The following comes from the June 2015 internet magazine published by MDPreferred.

Doctors and hospitals are reimbursed by Medicare and Medicaid for their services to elderly and poor patients. The reimbursement is regulated by the CMS. This is the lead agency in the government’s daily battle to control the ruinous rise in healthcare costs. Their primary regulatory weapons in this war are the formulas and principles they set to determine how much government money flows to healthcare providers.

Because these regulations, once in place, become the law of the land, annual proposed changes are closely watched and analyzed by the healthcare industry. Government speak has raised the use of clever acronyms to an art form. The names of agencies, programs and initiatives are often determined by how cute their acronym will be. Here is just a sampling of the alphabet soup that permeates medical journals and government entities:

HHS – United States Department of Health and Human Services – the cabinet level department of the U.S. government that is charged with protecting the health of Americans and providing essential human services.

HCFA – Health Care Financing Administration – the former name of the government agency within HHS that manages Medicare and Medicaid now known as CMS

CMS — The Centers for Medicare & Medicaid Services — the federal agency with HHS that administers the Medicare program and works with state governments to manage Medicaid which provides subsidized healthcare services for the poor and also administers SCHIP and HIPAA

HQSRR – Hospital Quality and Safety Reporting Requirements–part of Medicare’s reimbursement formula that is designed to move physician and hospital reimbursement toward a payment model that rewards quality over quantity

PQRS –Physician Quality Reporting System – a CMS program initiated in 2006 described as a “pay-for-reporting” incentive that pays physicians a bonus for reporting quality data

EPIP – Electronic Prescribing Incentive Program – another CMS initiative designed to move doctors toward electronic prescription technology and devices that minimize miscommunications and adverse drug interactions

SCHIP – State Children’s Health Insurance Program – a program that provides matching funds to states for health insurance for uninsured children in families of modest incomes that are too high to qualify for Medicaid…now more commonly known as CHIP.

HIPAA – Health Insurance Portability and Accountability Act of 1996 –The Act has two primary parts…Title I of the act lays out regulations that protect the health insurance coverage for workers and their families who have lost their jobs or are changing jobs. Title II of the act establishes national standards for electronic health care transactions and governs very strict privacy rules for the handling of personal healthcare records and information.

EHRs – Electronic Health Records – government mandated digital records that will replace paper records of our health history including doctor visits, test results, medications, diseases and disabilities. There are still many issues to address including privacy concerns and hardware and software standards that allow the transfer and sharing of records from one healthcare entity to another.

NCHIT – National Coordinator for Health Information Technology – The government Czar charged with making EHRs happen.

APIs – application programming interfaces – pieces of software code that give patients access to their medical information on their smart phones and other mobile devices

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