Obama wins 6-3 in Supreme Court battle

Yesterday, (Thursday 25 June 2015) the Supreme Court ruled 6 to 3 in favor of upholding federal subsidies in the contentious King v. Burwell case, which addressed whether the wording of the Affordable Care Act intended the State to subsidize insurance premiums in states with Health Exchanges that were not federally implemented or controlled.

One of the three dissenters, Scalia, said that "Words no longer have meaning if an Exchange that is not established by a State is 'established by the state." His approach rested on the literal interpretation of the wording of the Act.

In contrast, Chief Justice Roberts (one of the six that voted in favor of the administration) said things less literal for him. "In every case we must respect the role of the Legislature and take care not to undo what it has done. A fair reading of legislation demands a fair understanding of the legislative plan. Congress passed the Affordable Care Act to improve health insurance markets, not destroy them. If at all possible we must interpret the Act in a way that is consistent with the former and avoids the latter."

ICD-10, 1-2-3

When ICD-10 hits on October 1st, many will be swamped or swept away by the tsunami. The news is full of articles about what practices can do before the dreaded date to prepare for the impact. But what should practitioners do on October 2nd? And 3rd? Now, there's a question.

The first three months following ICD-10 transition will be the most painful, and carry the majority of this dramatic learning curve. Six months in, ICD-10 coding will be almost second nature. Getting through that initial transition period will inevitably be traumatic, but there are steps you can take now to minimize the pain later.

Here are three suggestions...

High Deductible Health Plans and Your Bottom Line 

Ever-tightening budgets mean that employers are increasingly moving toward adoption of low-premium High Deductible Health Plans (HDHP) in efforts to reduce ongoing costs. HDHP are attractive to employers, as the larger part of the financial burden, the High Deductible part of HDHP, falls on their employees, making them much more affordable.

This is a mixed blessing. Employees still get the health benefits they need, but with 2015 deductibles starting at around $1300 for single plans and $2600 for family plans, when someone falls ill and it comes time to actually use the health plan, some patients find the high deductible forms an insurmountable barrier to treatment. In short, that high deductible is just too much of an up-front cost. And this in turn means that some patients are electing to skip minor treatments.

Are You Coming to NAATP 2015?

Sigmund Software is! As long time supporters of this important addiction treatment event we will be there in force this year, exhibiting at Booth 116. We invite everyone to stop by and see what we have to offer.

The NAATP (National Association of Addiction Treatment Providers) conference this year is being hosted at the prestigious Omni La Costa Spa and Resort in Carlsbad, CA., between May 16 and 18 inclusive.

This beautiful resort is worthy of a visit just for the scenery. Our team is in the air as this is being typed, and they will be on the ground ready to meet, greet, and answer questions. If you will be here for this conference, they look forward to seeing you.

Concierge Medicine: A hedge against Medicare/Medicaid reductions? 

Ever increasing costs and ever more regulatory controls are adding ever more pressure to many practices already seeing reductions in their Medicare and Medicaid reimbursement levels. This pressure has in turn led many practices to seek alternatives revenue streams, and one increasingly popular source of revenue in particular: Concierge medicine.

In this business model a practice is not dependent on payers, insurance companies, or Medicare incentive payments. In fact, many concierge doctors don't even accept insurance payments or patients. Rather, in concierge medicine, doctors set fixed monthly or annual fees. For payment of this flat fee, patients receive unlimited access to their doctor. Occasional co-pays balance things when needed, but in the course of regular business everybody wins. The practice receives a steady and independent source of income. Patients receive the healthcare they need with a simplified payment structure, often at a lower cost than through a health plan, one which makes their health costs far more manageable and worry-free.

ICD improvements mean faster reimbursements.

In 2012 the ChiroCode Institute joined forces with the American Chiropractic Association (ACA) to forge an amalgam of their coding manuals, respectively the ChiroCode Deskbook and the ACA Chiropractic Coding and Compliance Manual. Since then, the partnership has flourished. The most current resource, titled the ICD-10 Coding for Chiropractic (Chirocode ICD-10 Coding Resource Endorsed by ACA) is currently available on the ACA web site at a member price of $119. Non-members pay $129.

ChiroCode Premium members can save themselves a further $10 by purchasing instead through the ChiroCode site, where the price is $109.

The manual promises to be valuable reading for chiropractors, offering a comprehensive list of relevant ICD-10-CM codes for Chiropractic, along with practical tools and advice on converting codes between ICD-9-CM and ICD-10-CM. The book promises to be a complete guide to understanding ICD-10-CM and also offers 'Other aids you need for a painless transition'.

Here is an example of how it could help.

Remembering the good old days

I grew up in the 60's. Black and white TV, moon landings, JFK. I remember waiting for the TV to warm up, and I remember watching the white dot until it disappeared when the set was turned off. Then came the 70's, with bigger TV sets and bigger hair, both in psychedelic color. The 80's introduced MTV, the 90's the Internet, and from then on it has been a roller coaster that gets faster every day. But I still remember that massive TV set in the corner.

Nowadays, I have a 48" flat screen LED TV attached to my wall. I can control it through my iPhone. I can surf the Internet, check email, or watch videos from my computer. Nice. No way would I go back to black and white cathode ray technology. 

I think most of us feel the same: Nostalgia is fine, but it should be kept in a rose-tinted box until we want to look at it again. Modern technology offers far better picture quality and viewing convenience. So why, oh why, is everyone so resistant to change?

National Council 2015

The annual conference dedicated to behavioral health, NATCON, will this year be held between April 20th and 22nd at the Gaylord Palms Convention Center, Orlando, Florida. Featuring keynotes from industry thought leaders, TED style talks, and a daily film festival, the conference has a lighter side too, with cookery lessons, a spa, Zumba, Ping Pong, airbrush tattoos and even a retro gaming arcade.

This and many other attractions are sure to offer something for everyone.

What is NATCON? We will let them speak for themselves.

Working With Self-Diagnosing Patients

A recent survey on behalf of the Astellas Innovation Debate determined that 75% of medical practitioners had noted a 'marked increase' in the number of self-diagnosing patients during the last twelve months. Many of these, 21%, presented at their doctor's office armed with supporting data from a growing range of health apps and smart devices. Some even carried folders full of graphs and printouts to support their arguments. Some saw that as helping their doctors. Others saw it as a declaration of war, with their doctor on the opposing side. The numbers of self-diagnostic patients are likely to increase as the number of available devices grow, and the various supporting platforms all see corresponding growth in the numbers of healthcare apps in their respective stores.

This issue will also continue to grow.

Six Months to ICD-10

With only six months to go, many industry leaders believe another delay to the implementation date for ICD-10 to be unlikely. October 1st seems to be a lock. The only remaining obstacle is the impending congressional vote to reconfirm the date, and if that goes through without issue, as many state senators expect it will, then October 1st it indeed is. Ready or not.

Many that were preparing for ICD-10 placed their preparations on hold on April 1, 2014, when the deferment brought about by the Protecting Access to Medicare Act was signed, pushing back the ICD-10 date by a year. The mixed message sent by that act has some still thinking ICD-10 will eventually just go away. This now appears highly unlikely.

Sigmund Software Has A New Home

Sigmund Software move to Lee FarmSigmund Software is pleased to announce the new location of its corporate headquarters at Lee Farm Corporate Park in Danbury, CT. Our successful growth and market demand for our services and software solutions has facilitated the transition to a much larger office space with state of the art amenities and technological capabilities. We would like to welcome you to our new home:

Sigmund Software, LLC
Lee Farm Corporate Park
83 Wooster Heights Road, Suite 210
Danbury, CT 06810

2016 HHS Budget Highlights

The Department of Health and Human Services (HHS) budget for 2016 runs to 158 pages. Available in full as a PDF from the HHS web site it covers the entire spectrum of healthcare expense and was presented at a recent press conference by Secretary Sylvia M. Burwell. At 158 pages the entire budget is far too complex to analyze in a blog post, so here is a handy graphic, provided by the HHS, which breaks out the gross overall percentages.

Are Patient Portals Good Investments?

A core requirement for Meaningful Use Stage 2 is the provision of patient access to personal health data. This is commonly achieved using a dedicated web site, known as a patient portal. OK. We can do that. Ah. But there is a catch. Just providing such access is insufficient. Patients must be shown to be actually using the patient portal. That's a different animal.

There is no way to force anyone to visit any web site. If there were, we could all be Internet millionaires. Yet if the required percentage of patients do not Visit, Download and Transmit (there are percentage requirements for each) their personal health data, then MU incentive payments will not be issued, since the criteria has, in the eyes of the issuing authority, not been met. Tricky.

Patient Assessment and Progress Notes with AURA EHR from Sigmund Software


Leverage flexible Content Management Controls in AURA to develop organizationally defined instrumentation that has intelligence.

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Custom User Interfaces with Administrative Dashboards in the AURA EHR from Sigmund Software



Enjoy greater controls over the vital signs of your organization with personalized custom administrative Dashboards from AURA.

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