Borough President’s 9/11 Remembrance Day
CEO and President Joseph Stamm met with NYC Public Advocate Tish James on September 4, just nine days before New York State Democrats go to the polls to pick their nominee for Attorney General on September 13. The leading candidate for the post, PA James met with a handful of business leaders at the offices of The New York Board of Rabbis, hosted by Rabbi Joseph Potasnik.
The US Senate made history on August 28, when it unanimously passed a bill to honor former Egyptian President Anwar Sadat with the Congressional Gold Medal. As a member of the Sadat Gold Medal Commission behind the initiative, NYCHSRO/MedReview CEO Joseph B. Stamm joins with fellow advocates to celebrate the award.
The late Egyptian President Anwar Sadat is widely acknowledged as a visionary who, in partnership with the United States and late Israeli Prime Minister Menachem Begin, negotiated an unprecedented Mideast peace treaty in 1979. Sadat’s courageous action as the first Arab leader to visit Israel, address the Knesset and launch a peace initiative, culminated in Egypt’s official recognition of the State of Israel despite outspoken opposition by the Arab League and others around the world. In 1981, Sadat was assassinated for his role in making this peace.
The Sadat Gold Medal Commission is the joint initiative of prominent American Jewish leaders spearheaded by Ezra Friedlander, CEO of The Friedlander Group, and Shafik Gabr, founder of the Shafik Gabr Foundation. Gabr’s mission to enhance understanding and cooperation through global exchanges among emerging young Arab and Western leaders has earned worldwide recognition. Along with Friedlander, Gabr and Stamm, Commission members include Rabbi Elie Abadie, Isaac and Ivette Dabah, US Ambassador to Egypt H.E. Yasser Rada, Sol Goldner, Jack Avital, Andrew Friedman, Leon Goldenberg, Gil Kapen, Stanley Treitel, and Russell Taub.
As International Chairman of the Commission, Shafik Gabr expressed his satisfaction with the achievement.
“Advocating for this bill to become law allowed us to remind the Congress of the United States that great statesmen do exist and that honoring Sadat meets the criteria for a Congressional Gold Medal,” he said. “The Camp David Accords and the Peace Treaty between Egypt and Israel continue to serve the national security interests of the United States by preserving peace and serving as a foundation for partnership and dialogue in a region fraught with conflict and division.”
At the time of Sadat’s assassination, then-President Reagan encapsulated his high regard for the world leader.
“There are moments in history when the martyrdom of a single life can symbolize all that’s wrong with an age and all that is right about humanity. The noble remnants of such lives,” Reagan said, “can gain the force and power that endures and inspires and wins the ultimate triumph over the forces of violence, madness, and hatred.”
On behalf of the Commission, Chairman Gabr acknowledged the Congressional leaders who led the charge to grant the award.
“As an Egyptian who understands the importance of a strong Egyptian-American relationship that serves both countries’ national security, I would like to thank Senators Hatch and Cardin for introducing and ensuring the passage of this truly historical legislation,” he said. “The late President Sadat was a man ahead of his time. He was not only a voice for peace, but also a person whose courage, conviction and dedication to achieve peace regardless of any obstacles was immense. He had the wisdom to bring nations and peoples together, and he was a man of sincere belief of what peace can bring.
“It is my hope that other leaders around the globe would understand the importance of peace and what it brings to their people, their region and the world. As we mark the 40th anniversary of signing the Camp David Accords and celebrate the centennial of Anwar Sadat’s birth, I am appreciative of the US Senate for bestowing upon him this great honor,” Gabr concluded.
S.266 is a bipartisan bill introduced by Senators Orrin Hatch and Ben Cardin to honor former Egyptian President Anwar Sadat’s courageous effort in 1979 to achieve peace with the State of Israel. Seventy-one senators cosponsored the legislation, exceeding the minimum requirement of 67 to bring the bill to the floor for a vote. The Congressional Gold Medal is granted only by a legislative bill and is the highest award bestowed by the United States government.
In Memorium: Senator John McCain
NYCHSRO/MedReview joins with Americans across the political spectrum to remember US Senator John McCain of Arizona for his lifelong dedication through war and peace to his country and its democratic principles.
A graduate of the US Naval Academy, McCain served as an officer from 1958 to 1981, including tours in Vietnam, and subsequently moved with his family to Arizona, where he embarked on his political career in the Republican Party. Following two terms in the House of Representatives, in 1987, he easily won his first of five senatorial campaigns, but in 2008 lost his presidential bid to the Democratic candidate, Barack Obama. He died on August 25, midway through his fifth term as Arizona’s senior Senator, succumbing to glioblastoma, a virulent brain cancer. It was the final heroic battle in a life marked by courage.
Senator McCain’s valor as an officer and naval aviator during the Vietnam War is legendary. Shot down and seriously injured during a key bombing mission over Hanoi, he endured six years as a prisoner of war, including episodes of torture that left him with lifelong disabilities. Despite the extreme abuse by his captors, the naval officer famously refused their offer of early release from the enemy prison, choosing to stay with his fellow POWs rather than accept special treatment.
His heroism and commitment to honor-above-self, even in the midst of battle, won McCain the life-long respect of his peers on both sides of the political divide. Indeed, his outspoken support of Israel through many contentious times is one more example of this lawmaker’s fierce loyalty and courage. As Prime Minister Benjamin Netanyahu said in a statement regarding the news of John McCain’s death, I will “always appreciate in my heart his strong friendship toward Israel and toward me personally. His consistent support for Israel flowed from his faith in the principles of democracy and freedom.”
NYCHSRO/MedReview CEO and President Joe Stamm also acknowledges the loss of this great American, whom he and his wife Anne have long admired. In 2014, when Congress honored the Stamms at the Jewish American Heritage celebration for their dedication to improving the quality and cost of healthcare for all Americans, Senator McCain himself presented the award at Mr. Stamm’s personal request.
“His leadership and voice will be missed,” states Stamm. “May his memory be a blessing.”
After a 26-year professional association, NYCHSRO/MedReview mourns the loss of George F. Bopp, BA, MPH, who passed away due to illness on August 19, 2018.
Mr. Bopp was part of the NYCHSRO/MedReview team since 1992, serving variously as a consultant and fulltime staff member with responsibility for expanding MIS operations and reporting methodology as well as enhancing data integrity programs, particularly in the ambulatory area, through the development of the Non-Institutional Claims Evaluation (NICE) program.
He joined NYCHSRO/MedReview after 25 years at Empire Blue Cross and Blue Shield. There, he supervised claims review, processing, and customer service for private and Medicare businesses and directed a physician services utilization review program to assess patterns of practice, including on-site office reviews. He developed EBCBS’s account data analysis and reporting division, with responsibility for the assurance of data integrity and the provision of data reports assessing utilization experience in relation to benefits coverage.
With an MPH degree from the New School University, he also taught systems and methods at Bloomfield College in NJ and conducted Health Care Reimbursement seminars at NYU Hospital’s resident intern training program.
NYCHSRO/MedReview’s CEO Joseph Stamm recalls his late friend and colleague with admiration.
“His contributions were many,” Stamm states. “He will be sorely missed.”
CEO Stamm Joins Mayor De Blasio in New York’s 2018 Israel Day Parade
As he does every year, Joseph Stamm attended the Israel Day Parade. This year MedReview’s chief executive had the honor of marching alongside his long-time friend, Mayor Bill de Blasio in New York’s annual “Celebrate Israel Parade,” which took place on June 3 and marked seven decades of Israel’s statehood
Other dignitaries at the head of the parade included NYS Governor Andrew Cuomo, Israeli Ambassador to the UN Danny Danon, Israeli Consul General, NYC Public Advocate Trish James and many City Council members, Assembly members and Congressman.
A thousand NYPD officers guarded the marchers and the throngs of supporters along the parade route.
NYCHSRO/MedReview’s growth projections for 2018 got a significant boon just before the New Year with our certification as a HITRUST healthcare organization. The Health Information Trust Alliance, comprised of IT and security personnel of major organizations nationwide, grants this certification to entities who have demonstrated that all necessary security is in place to protect any personal healthcare information coming over the transom, electronically or otherwise. Notification of our HITRUST status followed a yearlong effort by two dozen staffers under the direction of SVP of Operations Spencer Young and CTO Dan McNamara to meet the rigorous demands. In March, on the heels of this success, CTO McNamara joined a trio of IT experts for a panel discussion on “AI for Cyber Defense” at the invitation of Darktrace, a noted San Francisco-based cybersecurity solutions provider for healthcare, biotech and pharma.
Since the advent of HIPPA in 1996 and the coining of the term PHI—protected health information—the business of healthcare in the technological age has been hit by continuing waves of regulations concerning the secure transfer and storage of patient information and medical records, including payment history. These regulations govern how we share such information down to the minutest identifiers, such as zip codes; vehicle and license numbers; web addresses; biometric identifiers such as finger, eye, and voiceprints; and any unique identifying number, characteristic or code except the unique code assigned to code the data. You read that correctly: new code configured to disguise existing code. The reality is beyond Orwellian.
In fact, HITRUST certification is the highest security clearance granted within the healthcare industry and related cloud-based businesses, including Amazon. “The HITRUST Alliance leads the charge,” states CTO McNamara. “It’s the gold standard.”
To achieve the title, a dedicated team from MedReview’s IT bullpen had to build and test complex new infrastructure while a second team from the executive suites, with a critical assist by WeCARE Program Director Debra Rush-Murphy, wrote and rewrote policies and procedures to ensure compliance. The infrastructure team alone included eight staff, two of whom were new hires specifically brought in to achieve and maintain HITRUST compliance.
“Our tech team supports, configures and manages IT—from the workings of the keyboard on your desk to corporate security,” McNamara explains. “Reviewers, human resources, operations, clerical staff, chief officers—every end user at MedReview had to change the way they work. On-site third-party assessors went through our documentation to confirm that we had implemented mandatory password requirements, PHI clean-desk policies and other controls. HITRUST impacts every employee, no matter their job,” the CTO states.
Moreover, as rigorous as the requirements are, the Alliance moved the goal line just as MedReview was rounding to the finish. Ten days before our due date, the Alliance issued new controls, including rewritten versions of the original 180 plus 80 more. “We had to redo it all from scratch,” McNamara states, “but our process had been so orderly we completed our updates in a month.”
SVP Young also commented on the rigor of the twelve-month application process. “The HITRUST Alliance did not conceive the designation with small or medium-sized businesses like ours in mind,” he said. “At times, we had to work backwards, figuring out how we did a task step by step in order to write procedures, or acquire new hardware because our infrastructure did not support their requirements.”
One of the most significant upgrades mandated under HITRUST rules was the creation of a disaster recovery site off premises, which must function as an exact duplicate of the security infrastructure at Water Street. “We had to run tests to ensure that if one site crashes, all current data is saved at the other site, and vice versa,” Young explains. We had to bring down the entire system intentionally and bring it back up again. And, we had to achieve a specific minimum score to pass.”
NYCHSRO/MedReview succeeded in scoring very high marks with only minor findings that were easy to correct. Nevertheless, the work continues, as HITRUST certification is renewable biennially via the identical steps, plus any new specifications. “We start the application process all over again in 2019,” states McNamara.
Still, he is undaunted.
“We have built a really robust security program and we work hard to maintain it, so it will never be as difficult again,” he asserts. “It’s turned us into a security-first organization. We are exemplary to other organizations big and small. We are doing a better job at security than some major hospitals and financial institutions.”
An added bonus for all this work, notes MedReview’s CTO, is the well-earned allure our HITRUST status provides in the marketplace. His invitation to speak on Darktrace’s expert panel is one such example. The exclusive event moderated by Nicole Eagan, CEO of Darktrace and winner of the World Economic Forum Technology Pioneer Award, addressed security challenges in the healthcare sector and the use of artificial intelligence on the “frontlines of the battle” to detect ransomware and cyber threats. McNamara’s co-panelists were IT directors for Metropolitan Pathologists in Colorado and Country Life Vitamins in New York.
“As a customer, MedReview uses Darktrace technology as a way to incorporate machine learning into our own cyber defense efforts,” says McNamara. “This enables us to remain on the cutting edge as we maintain HITRUST requirements without employing additional staff.”
Our rising profile as a HITRUST healthcare company provides another boon to MedReview’s bottom line.
“We had been working for five years to win a DSRIP contract with one of New York’s largest and most prestigious medical centers. Their decision-making process includes a risk assessment, and after receiving our official notice, I let them know that we are HITRUST certified,” says CTO McNamara. “The person on the other end said, ‘That’s all you had to tell us.’ Our new contract came through shortly after.”
NYCHSRO/MedReview Celebrates Two Historic Achievements: Client Activity in All 50 States and Beyond plus Round-the-Clock Operations
This time last year, NYCHSRO/MedReview announced the imminent expansion of our business to all fifty states, British Columbia, Puerto Rico and the Virgin Islands and, with it, the expansion of our full-floor of offices at 199 Water Street to a second office suite at 80 Pine Street—reflecting the company’s burgeoning client base and workforce. One year later, CEO/President Joseph Stamm is pleased to announce that now MedReview not only is operational throughout the US, as forecast in 2017, but that the company’s growth spate continues unabated through first quarter 2018.
As he marks his 43rd year at the helm of the organization, Mr. Stamm speaks with a well-earned sense of accomplishment. “It is been a longtime dream of mine to see the map of the US all in yellow, signifying MedReview’s activity throughout the American continent. This year, with the backing of the Board, my dream is reality,” he declares. “What began as a citywide business is now nationwide and beyond.”
Indeed, with this dream fully realized, Mr. Stamm has announced the achievement this quarter of yet another milestone: MedReview’s giant leap into yet a third new office complex—this one, a newly constructed 100-person call center in the Philippines. As of press time, it is already up and running 24/7 with 45 operators fielding patient precertification requests on behalf of United Health Care and other clients. Built to MedReview’s stringent specifications, the call center is under the direction of EVP/CFO Helen Mutchler, a 36-year veteran of this organization and a native of the Philippines who travels there frequently to visit family from her home in the New York area.
“There is a twelve hour time difference between New York and the Philippines, so even when our offices here are closed at night and on weekends, our call center in the Philippines is fully staffed and fielding queries round the clock,” CEO Stamm explains. “Our goal is to provide the most cost-effective and efficient service possible to our clients. Now patients from anywhere can get answers to questions or expedite a request anytime, day or night.”
The Grab for Dollars: Decoding the Upcoding MedReview’s Case Study in Endoscopic Drainage
A 62-year-old male hospitalized for a duodenal ulcer with hemorrhage required a colonoscopy as part of his workup. During the procedure, the endoscopist noted that there was fecal material blocking the scope’s field of view and used the endoscope’s irrigation system to flush the material out of the way. Upon the patient’s discharge, the hospital added to its diagnostic and procedural coding for this case the code for “therapeutic lavage and drainage of the colon.” This DRG carried a charge of $71,000, or $35,000 more than the bill would have been without the upcoding.
“It is routine during a colonoscopy to lavage with water when visualization is impaired. Scopes have built-in water irrigation systems for just this reason,” states Seth Lewin, MD, Chief Medical Officer at MedReview. “Irrigation during endoscopy to better visualize the bowel in order to obtain an accurate diagnosis is routine and should not be billed as if it were a treatment separate and distinct from the diagnostic endoscopy.”
NYCHSRO/MedReview denied the additional coding for endoscopic lavage and drainage, reducing the billable DRG amount to $36,000. The hospital doctors appealed, but the reviewers upheld our original coding.
“Attempts such as this to obtain enhanced payment for patient care are far from uncommon,” notes Dr. Lewin. “In this instance, the effect of the upcoding was to nearly double the billed amount. MedReview recently reported a similar case in which the hospital coded administration of daily eye drops to a patient each morning as if it were an operative procedure, increasing the DRG payment by $2500. In the current instance of upcoding for therapeutic lavage and drainage of the colon, the cost impact was fourteen times as great and was equally and absolutely unjustifiable.”
ORIGINAL BILL: $71,000.00
RECODED BILL: $36,000.00
CLIENT SAVINGS: $35,000.00