Health Informatrix

CMS Has Updated the EHR Information Center with New Self-Service Options

2012-02-06T14:57:00.001-08:00

Following months of review and collective input, the ElectronicHealth Record (EHR) Information Center Interactive Voice Response (IVR) systemhas been enhanced to provide users with an increased number of options andservices to make accessing and reviewing data easier than ever before.

For eligible professionals (EPs), eligible hospitals or criticalaccess hospitals (CAHs), the revised functionality vastly improves theefficiency in obtaining the desired information, while also offering a morevaried amount of information and options for callers.

CMS is proud to announce that providers can now obtaininformation through an extensive IVR Self-Service option. Included in thisoption is a reinforced privacy protection module that requires your individualNational Provider Identifier (NPI), the last five digits of your TaxIdentification Number (TIN) and your EHR registration ID. Once accepted, thisnewly enhanced Self-Service tool allows you to:

Obtain registration status
Acquire attestation status
Review payment information
Check progress towards meeting the $24,000 threshold amount

Users may access these new options by following the stepsoutlined below:

Begin by dialing (888) 734 6433
Press 3 for Self Service
Enter the authentication elements

These options will be available on the IVR effective February16, 2012.

EHR Information Center Hours of Operation:

7:30 a.m. – 6:30 p.m. (Central Time) Monday through Friday, except federalholidays.

(Please note that GeneralInformation and Self-Service options may be reached via IVR 24 hours a day,except during periods of planned system maintenance or upgrades).

Supplementary information on the program may also be viewed byvisiting the FAQs section of the EHR Incentive Programswebsite, where users can search for any questions they have about the Medicareor Medicaid EHR Incentive Programs.

Want more information about the EHRIncentive Programs?

Make sure to visit the EHR Incentive Programs website for the latestnews and updates on the EHR Incentive Programs.

Stay Informed Via the CMS EHR Incentive Programs Listserv

2012-02-02T10:57:00.001-08:00

Congratulations on registering for the Medicare and MedicaidElectronic Health Record (EHR) Incentive Programs.

We want to invite you to join a free email service to receiveCMS' latest news on the EHR Incentive Programs. The CMS EHR Incentive Program listserv providestimely information on program requirements and changes in the EHR IncentivePrograms.

By subscribing to this listserv, you will receive earlynotification of new program developments, the availability of new resources,and the addition of any new Frequently Asked Questions that are publishedon the CMS EHR Incentive Programs' website.

Click here to join the listserv and visit the listserv section of the EHR Incentive Programswebsite to take a look at some of the recent messages we have sent. Weencourage you to let others know about the CMS EHR Incentive Program listserv,and to share its messages.

Note: Make sure to add cmslists@subscriptions.cms.hhs.gov to your approved senders list so thatthe EHR Incentive Programs listserv messages do not get caught in your spamfolder

Want more information about the EHRIncentive Programs?

Make sure to visit the EHR Incentive Programs website for completeinformation about the CMS Medicare and Medicaid EHR Incentive Programs.

New Functions of the EHR Information Center: More Options in the Call System

2012-01-30T12:31:00.001-08:00

CMS Has Updated the EHR Information Center with EnhancedFunctionality

CMS is proud to announce that after a review of collectedfeedback, enhancements and changes have recently been made to the EHRInformation Center Interactive Voice Response (IVR) system.

Among these caller-friendly revisions is a new feature to assistwith Hot Topics, including registration and attestation, as well as updatedPassword Reset menus. These improvements will enable eligible professionals(EPs), eligible hospitals, and critical access hospitals (CAHs) to obtaininformation about the EHR Incentive Program more easily and efficiently.

Directions for Calling the EHR InformationCenter

1. To contact the IVR, dial 1-888-734-6433 (primary number) or 888-734-6563(TTY number).

2. Take advantage of the new options from the main menu by doingthe following:

Press 1 for Hot Topics

For information on when registration begins, press 1.
For information on attestation, press 2.
For information on being a dually-eligible hospital, press 3.
For information on registration tips, press 4.
For information on payment time frames, press 5.
For information on important upcoming dates, press 6.
For information on the clinical quality measures (CQM) eReporting pilot, press 7.
For information on HPSA payments, press 8.

Press 2 for Information on NPPES and PECOS password resets

For EPs needing NPPES/PECOS password resets, press 1.
For eligible hospitals needing PECOS password resets, press 2.

Press 0 to speak with an information specialist.

For registration questions, press 1.
For all other questions, press 2.

Press # to repeat the menu

To listen to your available menu options, press #.

EHR Information Center Hours of Operation:

7:30 a.m. – 6:30 p.m. (Central Time) Monday through Friday, except federalholidays.

(General information isavailable on the IVR 24 hours a day, except during planned system maintenance.)

Program information can also be found on the FAQs section of the EHR Incentive Programswebsite, where users can search for any questions they have about the Medicareor Medicaid EHR Incentive Programs.

Want more information about the EHRIncentive Programs?

Make sure to visit the EHR Incentive Programs website for the latestnews and updates on the EHR Incentive Programs.

Proposed Delay of Stage 2 of Meaningful Use

2011-12-08T10:16:00.001-08:00

Proposed Meaningful Use Timeline Changes Encourage Adoption ofEHRs

In response to significant input from multiple stakeholders,expert testimony, and countless hours of review, analysis and deliberation, HHSannounced its intention to delay the start ofStage 2 meaningful use for the Medicare and Medicaid EHR Incentive Programs fora period of one year for those first attesting to meaningful use in 2011. CMS intends to proposesuch a delay in the Stage 2 meaningful use Notice of Proposed Rulemaking(NPRM), which is scheduled to be published in February 2012.

Why Did We Make this Decision?

Input from the vendor community and the provider community makes clear that thecurrent schedule for compliance with Stage 2 meaningful use objectives in 2013poses a challenge for those who are attesting to meaningful use in 2011.

The current timetable would require EHR vendors to design,develop, and release new functionality, and for providers to upgrade, implement,and begin using the new functionality as early as October 2012.

What are the Benefits to the ProposedDelay?

We believe that a proposed delay will be beneficial for several reasons:

We hope that this will give vendors added time to develop certified EHR technologies for Stage 2, as well as give providers additional time to implement new software and meet the new requirements of Stage 2.

We also intend to propose maintaining the current expectation for those first attesting to meaningful use in 2012, so that all providers attesting to meaningful use in 2011 or 2012 will begin Stage 2 in 2014.

We believe this provides an added incentive for providers to attest to meaningful use in 2011 and rewards early participants.

Under the Medicare and Medicaid EHR Incentive Programs,providers who attest early receive greater incentives. And now those providerswho first attest in 2011 are eligible for three payment years for meeting theStage 1 criteria, while those first attesting in 2012 can only have two paymentyears under Stage 1 criteria.

Are Medicaid Program Participants Affected?

Because Medicaid providers can receive an incentive payment for adopting,implementing, or upgrading to certified EHR technology in their first year of Medicaid EHR Incentive Program participation,Medicaid providers will still be able to attest to Stage 1 meaningful use forthe next two years (first for a 90-day period, then for a 365-dayperiod).

Therefore, mostMedicaid providers do not attest to Stage 2 requirements until 2014 at theearliest.

Want more information about the EHR Incentive Programs?

Make sure to visit the EHR Incentive Programs website for the latestnews and updates on the EHR Incentive Programs.

CMS has a New Data and Reports Web Page for the EHR Incentive Programs

2011-12-02T14:57:00.001-08:00

New Web Page Provides Medicare and Medicaid Electronic HealthRecord (EHR) Incentive Programs Payment and Registration Data

CMS has created a new web page where you can find Medicare andMedicaid EHR Incentive Program payment and registration data. The page includesup-to-date information about the programs through October 2011. The new webpage will be your resource for updates regarding the programs' registration,payment, and state Medicaid launches.

Overview of Content on the Data and ReportsPage

The web page includes the following information:

A Map that Illustrates a State Breakdown of Payments to Medicare and Medicaid Providers
A Map that Illustrates a State Breakdown of Registration by Medicaid and Medicare Providers
A Map that Illustrates a State Breakdown of Registration by Medicare Providers
A Map that Illustrates a State Breakdown of Registration by Medicaid Providers
Individual State Report of Registrants and Payments
Updates on State Launches of Medicaid EHR Program
List of Recipients of Medicare EHR Incentive Program Payments

You can use the maps to see how your state compares toothers in registration and payment totals for the EHRIncentive Programs.

October Highlights

Below are some highlights about the EHR Incentive Programs from data throughOctober 2011 that are now featured on the new page:

Over 135,000 Medicare and Medicaid providers have registered for the programs
Over $525 million in Medicare payments have been provided to eligible professionals and eligible hospitals
Over $710 million in Medicaid payment have been provided to eligible professionals and eligible hospitals

Want more information about the EHRIncentive Programs?

Make sure to visit the EHR Incentive Programs website for the latestnews and updates on the EHR Incentive Programs.

New Interactive Guide for EPs in the Medicare EHR Incentive Program

2011-12-01T10:09:00.001-08:00

Take a Look at CMS’ New Medicare EHR Incentive Program Guide forEligible Professionals (EPs)

CMS has created a new comprehensive tool, An Introduction to the Medicare EHR Incentive Program forEligible Professionals, to help guide EPs through all of thephases of the Medicare EHR Incentive Program—from eligibility and registrationto attestation and payment. Chapters provide information on:

EHR Incentive Program basics
How to participate (determining eligibility and registration)
Meaningful use and choosing measures
Attestation
Helpful resources on the Medicare and Medicaid EHR Incentive Programs

The guide is interactive. Users can click on sections of theTable of Contents to learn more about specific areas of the program.Interactive tabs are also included at the bottom of each page where users canjump from chapter to chapter. Additionally, each section provides readers withuser-friendly screen shots, charts, and links to the CMS website.

Note: If a user prefers a hard copydocument, the guide can also be printed. Links are written out and hyperlinkedthroughout the guide.

The guide can be found on the Educational Materials section of the EHRwebsite, along with several other helpful tools and resources for participantsin the Medicare and Medicaid EHR Incentive Programs.

Want more information about the EHRIncentive Programs?

Make sure to visit the EHR Incentive Programs website for the latestnews and updates on the EHR Incentive Programs.

Important Medicare & Medicaid EHR Incentive Programs Deadlines and Resources for Hospitals

2011-11-17T13:09:00.001-08:00

Reminderof Upcoming Deadlines and Helpful Resources for Eligible Hospitals andCAHs Participating in the EHR Incentive Programs

CMSwants to remind eligible hospitals and critical access hospitals (CAHs)of key registration and attestation dates for the EHR IncentivePrograms, and provide resources to help them successfully register andstart their path to payment for 2011.

Important Registration Details for Medicare and Medicaid

Medicare:November 30, 2011, is the last day for Medicare eligible hospitals andCAHs to register and attest to receive an incentive payment for Federalfiscal year 2011.
Medicaid: Each state has its own attestation deadlines. Please check with your State Medicaid agency to find out the last day you can attest.

Registration Resources
CMS has a number of resources to help providers successfully register for the EHR Incentive Programs, including:

A step-by-step Eligible Hospital and CAH Registration Guide for the Medicare and Medicaid programs
FAQs about registration and other EHR Incentive Programs topics
A video webinar to help guide eligible hospitals and CAHs through the registration process

Attestation Resources
CMS has an Eligible Hospital and CAH Attestation User Guide, which provides step-by-step instructions for login and completing attestation. CMS also has a Meaningful Use Attestation Calculator, which allows providers to see if they are able to meet all of the necessary meaningful use measures to successfully attest and qualify for an incentive payment.

Want more information about the EHR Incentive Programs?
Make sure to visit the EHR Incentive Programs website for the latest news and updates on the EHR Incentive Programs.

Update to State Medicaid Launches Message

2011-11-15T09:07:00.001-08:00

Updated Link for Montana Medicaid EHR Incentive Program Website

We apologize that our previous listserv message titled, "Arkansas, Delaware, Montana, New Jersey, New York, and North Dakota Launched Their Medicaid EHR Programs This Month" contained an incorrect link to the Montana Medicaid EHR Incentive Program website. The corrected link has been included in the message below.

Arkansas, Delaware, Montana, New Jersey, New York, North Dakota Launched Their Medicaid EHR Programs This Month

On November 7th, the Medicaid Electronic Health Record (EHR) Incentive Program launched in Arkansas, Delaware, Montana, New Jersey, New York, North Dakota. This means that eligible professionals (EPs) and eligible hospitals in these six states will be able to complete their incentive program registration. More information about the Medicaid EHR Incentive Program can be found on the Medicare and Medicaid EHR Incentive Program Basics page of the CMS EHR website.

If you are a resident of Arkansas, Delaware, Montana, New Jersey, New York, North Dakota, and are eligible to participate in the Medicaid EHR Incentive Program, visit your State Medicaid Agency website for more information on your state's participation in the Medicaid EHR Incentive Program. Click on a State below to access its website.

As of November 7th, 39 states have launched Medicaid EHR Incentive Programs and through October, 23 states have issued incentive payments to Medicaid EPs and eligible hospitals who have adopted, implemented, or upgraded certified EHR technology. CMS looks forward to announcing the launches of additional states' programs in the coming months.

For a complete list of states that have already begun participation in the Medicaid EHR Incentive Program, see the Medicaid State Information page on the CMS EHR website.

Want more information about the EHR Incentive Programs?

Make sure to visit the EHR Incentive Programs website for the latest news and updates on the EHR Incentive Programs.

Six New State Medicaid EHR Incentive Programs Launched in November

2011-11-14T06:23:00.001-08:00

Arkansas, Delaware, Montana, New Jersey, New York, North Dakota Launched Their Medicaid EHR Programs This Month

For a complete list of states that have already begun participation in the Medicaid EHR Incentive Program, see the Medicaid State Information page on the CMS EHR website.

Want more information about the EHR Incentive Programs?

Make sure to visit the EHR Incentive Programs website for the latest news and updates on the EHR Incentive Programs.

Alert: An Important EHR Incentive Program Deadline is Approaching

2011-11-08T11:00:00.001-08:00

November 30 is the Last Day for Eligible Hospitals and CriticalAccess Hospitals (CAHs) to Register and Attest for an Incentive Payment for FY2011

Eligiblehospitals and CAHs have 60 days after the end of the fiscal year to submittheir attestation for the Medicare Electronic Health Record (EHR) IncentiveProgram. The last day that eligible hospitals and CAHs can register and attestfor fiscal year (FY) 2011 is November 30, 2011. For eligible hospitals andCAHs, this means that they must successfully register and then attest todemonstrating meaningful use by this date in order to receive an incentivepayment for FY 2011. Note, in order to attest, you must havebegun your 90-day reporting period on or before July 3, 2011. Registration willbe open after November 30th for eligible hospitals and CAHs who wish to registerfor a 2012 payment.

CMSencourages eligible hospitals and CAHs not to miss the deadline to attest foran incentive payment for FY 2011.

RegistrationResources

To help eligible hospitals and CAHs with registration, CMS has created a Registration User Guide for Eligible Hospitals and CAHs.Additionally, eligible hospitals and CAHs can view the Medicare and Medicaid EHR Incentive Programs Webinar forEligible Hospitals and CAHs, which walks hospitals through the registrationprocess.

AttestationResources

CMS has a number of tools available to help eligible hospitals and CAHs preparefor attestation. They can use the CMS Eligible Hospital and CAH Attestation Worksheetto record their meaningful use measures and then use as a reference whenattesting for the Medicare EHR Incentive Program in CMS' web-based Registration and Attestation System. The Meaningful Use Attestation Calculator and Attestation User Guide for Eligible Hospitals and CAHscan also help with the attestation process.

LookingAhead

Wantmore information about the EHR Incentive Programs?

Make sure to visit the CMS EHR Incentive Programs website for thelatest news and updates on the EHR Incentive Programs.

ICD-10 Is No Laughing Matter, Duck Bites Aside

2011-11-03T05:02:00.000-07:00

November 1, 2011 — Physicians have gotten a few laughs from the new and voluminous set of diagnostic codes known as ICD-10, which distinguishes between being struck by a duck (W6162XA) and being bitten by a duck (W6161XA).

A new study by the healthcare research firm KLAS, however, suggests that physicians and other providers need to take ICD-10, more seriously. Only 9% of providers are more than halfway through the needed preparations to switch from the ICD-9 code set to the new one by the federal deadline of October 1, 2013. The rest, said study author Graham Triggs, are still in the early stage of doing their homework.

The consequences of not submitting claims to Medicare and other third-party payers with the new diagnostic codes when the deadline arrives are dire, said Triggs, a senior research manager at KLAS.

"If claims aren't compliant with ICD-10, they won't get paid," Triggs told Medscape Medical News. "It could put providers out of business."

More than 95% of providers surveyed by KLAS were hospitals and health systems, said Triggs. "My guess is that physicians in independent practices are even less prepared."

Older Codes Said to Be Outdated, Lacking in Specificity

ICD-10 stands for the International Statistical Classification of Diseases, 10th Revision, which was developed by the World Health Organization. Like ICD-9, ICD-10 breaks down into 2 subsets: CM codes for diagnoses and PCS codes for procedures.

Physicians currently use Current Procedure Terminology (CPT) codes and those in the Healthcare Common Procedure Coding System (HCPCS) to document their services in office and outpatient settings. They will not switch from these codes to ICD-10 procedure codes, which are confined to inpatient treatment.

However, all physicians will need to make the leap from the ICD-9 diagnostic codes they use now to those of ICD-10. The new diagnostic codes are 3-7 characters in length, whereas their ICD-9 counterparts contain 5 at most. Then there is the difference in the sheer volume of codes — 68,000 for ICD-10 compared with 14,000 for ICD-9.

The Centers for Medicare and Medicaid Services (CMS) decreed the switch to ICD-10 in 2009 as part of implementing the Health Insurance Portability and Accountability Act (HIPAA). The rationale is that ICD-9, now 30 years old, contains outdated and obsolete terms, captures limited data about a patient's condition, and fails to describe current medical practice. Plus, its structure limits the number of new codes that can be coined.

With ICD-10, physicians will be able to document what ails a patient with far more specificity. ICD-9, for example, has a code for a malignant neoplasm of an arm, but ICD-10 offers 3 options: upper right arm, upper left arm, or unspecified arm.

Finally, a Code for Walking Into a Lamppost

Such multiple choices help explain why the new code set is almost 5 times larger than the old one. However, some may wonder whether the authors of ICD-10 got carried away in covering every base.

ICD-9, for example, recognizes that patients may seek treatment because they were bitten, and gives clinicians a few choices, such as dog, rat, snake, arthropod, unspecified animal, or human. ICD-10, in contrast, is a veritable zoo of bite codes — horse, cow, cat, pig, shark, dolphin, sea lion, alligator, macaw, parrot, and duck, to name just a few new kinds of jaws. And for each kind of bite, physicians can pick a code for an initial encounter, subsequent encounter, or sequela.

ICD-10 also describes the world of bumps and bruises in excruciating detail, with codes for walking into a wall versus a lamppost versus a piece of furniture. Ever been crushed between a sailboat and another kind of water craft? There's a code for that, too — V9114XA.

Some accident codes, however, defy the imagination, such as the famous V9107XA: burn due to water-skis on fire, initial encounter.

Develop a Master Plan and a Budget

Physicians may never need to look up the diagnostic code for a macaw bite, but they nevertheless must prepare to leave behind ICD-9 for ICD-10. There still is enough time to do so, according to Graham Triggs at KLAS.

Vendors of practice management and electronic health record (EHR) systems will perform much of the heavy lifting in the changeover because they need to incorporate the new codes in their software. Physicians should check in with their vendors and make sure they are on track with updating their programs to comply with ICD-10 along with the new Version 5010 HIPAA standards for electronic healthcare transactions, which take effect next year. Medical practices, of course, will need to buy the latest version of their practice management and EHR software and test it before going live with ICD-10 on October 1, 2013.

Even with software vendors doing their part on the tech end, physicians still have to invest sufficient time and money in training themselves and their staff — especially professional coders — on how to use the new diagnostic codes. Sources of that schooling range from software vendors to practice-management consultants to a network of ICD-10 trainers approved by the American Health Information Management Association (AHIMA).

All this preparation requires a master plan and somebody in charge of executing it. It also requires a budget. Besides spending money on software upgrades and training, practices should set aside some cash in the event that coding snags delay the payment of insurance claims. The Medical Group Management Association (MGMA) estimated in 2008 that a 3-physician practice would shell out a grand total of $84,000 to implement the new code set.

Physicians seeking further guidance on entering the ICD-10 era can find plenty of it on the Web sites of theMGMA, AHIMA, American Medical Association, their specialty medical society, or CMS.

We've Posted New FAQs to the EHR Website!

2011-10-28T15:24:00.001-07:00

Take a Look at the New Medicare and Medicaid EHR IncentivePrograms FAQs

We wantto keep you updated with the latest information about the Medicare and MedicaidElectronic Health Record (EHR) Incentive Programs. These new FAQs include information about clinicalquality measures (CQMs), meaningful use, attestation, and other Medicare andMedicaid EHR Incentive Programs topics.

Does a provider have to record all clinical data in their certified EHR technology in order to accurately report complete CQM data for the Medicare and Medicaid EHR Incentive Programs? Read the answer.
Do providers have to contribute a minimum dollar amount toward their certified EHR technology for the Medicare and Medicaid EHR Incentive Programs? Read the answer.
Where can I find a list of public health agencies and immunization registries to submit my data as required by the public health objectives for the EHR Incentive Programs? Read the answer.
Can two separate practices with two different TINs purchase a single certified EHR system and share it in order to participate in the Medicare and Medicaid EHR Incentive Programs? Read the answer.
For the Medicare and Medicaid EHR Incentive Programs, how should an eligible professional (EP), eligible hospital, or critical access hospital (CAH) that sees patients in multiple practice locations equipped with certified EHR technology calculate numerators and denominators for the meaningful use objectives and measures? Read the answer.
For the EHR Incentive Programs, how should an eligible hospital or CAH with multiple certified EHR systems report their CQMs? Read the answer.
Does the person who completes the registration for the EHR Incentive Programs need to be the same person who completes the attestation? Read the answer.
For the meaningful use objective “Capability to submit electronic syndromic surveillance data to public health agencies,” what is the definition of "syndromic surveillance"? Read the answer.

Wantmore information about the EHR Incentive Programs?Makesure to visit the CMS EHR Incentive Programs website for thelatest news and updates on the EHR Incentive Programs.

Big Medicare Pay Cut Would Shut Physician Doors to Patients

2011-10-27T14:41:00.001-07:00

October 27, 2011 — In yet another warning to lawmakers, a new survey of group practices shows that 51% will reduce the number of available appointment slots for new Medicare patients if Congress does not avert a 29.5% Medicare pay cut set for January 1.

Another 30.9% of group practices would stop seeing new Medicare patients altogether, according to the survey conducted by the Medical Group Management Association (MGMA). And 34.8% would reduce access to existing Medicare patients.

The MGMA says it intends to impress these findings on the Congressional Joint Select Committee on Deficit Reduction, the "super committee" tasked with recommending $1.5 trillion in savings that Congress must enact by December 23. Organized medicine is strenuously lobbying the super committee to repeal the sustainable growth rate (SGR) formula for physician reimbursement, which is triggering the scheduled reduction in 2012.

Physicians have faced SGR-mandated pay cuts each year since 2002. Except for a 4.8% reduction that went through in 2002, Congress has always postponed them, but postponement has caused them to accumulate to the point of catastrophe. Last year Congress voted no fewer than 5 times to stave off a reduction topping 20%.

Life on the edge of the SGR cliff has taken its toll on physicians. Sixty-five percent of respondents to the MGMA survey, released Monday, reported that they have delayed buying new clinical equipment and facilities because of the uncertainty over Medicare reimbursement. Roughly half said they have had to reduce charity care, the size of their administrative staff, and staff salaries and benefits.

"Our data reflects a dire Medicare environment for physician practices," said Susan Turney, MD, president and chief executive officer of the MGMA, in a press release. "The 5 short-term congressional patches last year substantially diminished practices' faith in Congress and the stability of the Medicare program. This time, practices are not waiting to implement tough business decisions. The SGR is a runaway train that threatens the future of Medicare."

A repeal of the SGR would not necessarily end the Medicare reimbursement crisis. Earlier this month, the Medicare Payment Advisory Commission (MedPac) recommended a "doc fix" for the SGR problem that would freeze reimbursement rates for primary care physicians for 10 years while cutting rates for specialists by 5.9% for 3 straight years, followed by zero growth over the next 7 years. Organized medicine has warned that these draconian measures, if approved by Congress, also would drive physicians out of Medicare and make it harder for seniors to get the care they need.

Find CMS at the AOA OMED Conference in Orlando, FL from Oct. 30 - Nov. 1

2011-10-27T11:58:00.001-07:00

CMS will be Presenting in the Exhibit Theater next to our Booth#322 To Help You Learn about the EHR Incentive Programs

Are youattending the American Osteopathic Association's Osteopathic Medical Conferenceand Exhibition beginning this Sunday, October 30th? CMS will be at Booth#322, next to the Office of the National Coordinator for Health InformationTechnology (ONC) exhibit. CMS and ONC are partnering to present information onthe Medicare and Medicaid EHR Incentive Programs and other HIT initiatives.

Representativesfrom CMS will be on-site to discuss your questions and listen to your EHR andHIT program experiences. You can even sign up for a chance to share your EHRstory by participating in a recorded discussion with CMS on Monday, October31st.

Therewill be computers and CMS staff available on-site to help guide providersthrough the EHR program registration and attestation processes. Educationalinformation and resources will be available at our booth to help yousuccessfully participate in the EHR Incentive Programs.

CMSwill also be holding two learning sessions on the EHR Incentive Programs at theExhibit Hall Theater near the CMS booth:

Sunday, October 30 at 2:45 p.m. - CMS: EHR Medicaid Presentation by John Allison
Monday, October 31 at 2:45 p.m. - CMS: EHR Medicare and ICD-10 Presentation by Michael Pierson and Ethan Moore

Wantmore information about the EHR Incentive Programs?

Make sure to visit the EHR Incentive Programs website for thelatest news and updates on the EHR Incentive Programs.

Sign up for CMS' CQM Webinar For Small-Practice Providers

2011-10-22T14:46:00.000-07:00

CMS is Holding a Second Webinar on the CQMs and the EHRIncentive Programs for Small-Practice Providers

Overview

What:Webinar- The CMS EHR Incentive Programs: Small-Practice Providers andClinical Quality Measures (CQMs)

When: October 25 from 1:00 – 2:30 p.m. EDT Why: To help small-practice providers successfully report CQMs How: Register online

TheCenters for Medicare & Medicaid Services (CMS) is holding a second webinaron CQMs and their importance in attesting to meaningful use for the EHRIncentive Programs. CMS hopes to help small-practice and rural providers becomemore knowledgeable in the topics below:

An overview of the CQMs
How to report CQMs during attestation
Why CQMs are included in the EHR Incentive Programs
Answers to many FAQs on the CQMs and the EHR Incentive Programs

Although,small-practice providers are the intended audience of this webinar, anyone iswelcome to join.

Thewebinar presentation, a document with over 300 questions and answersfrom the webinar held on August 30, and an informational CQM fact sheet will be provided toparticipants before the webinar as downloadable handouts.

Additionally,registrants will be given an opportunity to submit questions through theregistration site before the webinar that will be answered by CMS subjectmatter experts and posted to the CMS EHR website a few weeks after the webinarhas been completed.

Registration

Individuals can register online for the webinar. Aftersuccessfully registering, they will be sent a confirmation message with a linkto the webinar site. Space is limited, so interested participants should registernow to secure their place.

Wantmore information about the EHR Incentive Programs?

Make sure to visit the CMS EHR Incentive Programs website for thelatest news and updates on the EHR Incentive Programs.

Medicare Mailing eRx Pay-Cut Letters to Physicians

2011-10-20T15:52:00.000-07:00

October 18, 2011 — Physicians participating in Medicare should read their mail carefully over the next few weeks. There could be a letter warning them about a possible 1% pay cut next year because of their failure to meet the program’s e-prescribing requirements, the Centers for Medicare and Medicaid Services (CMS) announced today.

Anyone who opens such a letter may have enough time to beat a November 1 deadline to apply for a hardship exemption from the penalty, dubbed a "payment adjustment" by CMS.

Companies who process and pay Medicare claims on behalf of CMS began mailing out the letters Monday, said Michael Rapp, MD, JD, director of the Quality Measurement and Health Assessment Group in the CMS Office of Clinical Standards and Quality, during a conference call with providers today. The agency had intended to inform physicians about the e-prescribing penalty through a so-called Payment Adjustment Feedback Report that they could access at the CMS Web site, but the reports will not be ready to post until late November or early December. So CMS resorted to snail mail to get the word out, said Dr. Rapp.

The mailing should be completed by October 25, just days before the November 1 deadline to apply for an exemption from the penalty.

In addition, in the coming weeks Medicare help-desk personnel will telephone physicians who unsuccessfully attempted to comply with the eRx requirements to give them a head’s up about the penalty.

CMS will inform physicians only about the possibility of a penalty because the warning is based on a preliminary as opposed to a final analysis of claims data, said Molly MacHarris, a policy analyst in Dr. Rapp’s department at CMS, during the conference call.

Penalties Increase Over Time

In 2009, Medicare began paying bonuses to physicians and other clinicians who qualified as "successful" e-prescribers — that is, they reported electronically transmitting a certain number of prescriptions from their computer to a pharmacy computer. In 2011 and 2012, the bonus equals 1% of a clinician’s fee-for-service (FFS) charges. It drops to 0.5% in 2013, the last year of the incentive program.

Meanwhile, physicians who have not satisfied the complicated rules for e-prescribing this year face a 1% reduction in their FFS charges in 2012. The penalty increases to 1.5% in 2013 and 2% in 2014.

Not every physician is subject to the eRx penalty next year. Someone who was not licensed as of June 30, 2011, for example, need not do anything. Physicians who are subject to the penalty can apply for 1 of 6 exemptions, which cover situations such as practicing in a rural area that lacks high-speed Internet access. They can submit their exemption application at a CMS Web site called the Quality Reporting Communication Support Page. Medical groups participating in Medicare's Physician Quality Reporting System under the Group Practice Reporting Option must apply for a hardship exemption in writing. Either way, the deadline is November 1.

More information on the e-prescribing incentive program, and how to obtain an exemption, is available on the CMS Web site.

UPDATED: Are you Aware of the Registration Deadlines for the EHR Incentive Programs?

2011-10-19T11:57:00.001-07:00

Updated Message on Important Information on Registration for theEHR Incentive Programs

Thismessage is an updated version of the registration listserv message that wassent by CMS on October 4. This version of the message provides updated languageto help providers understand the difference in registration and attestationdates for the Medicare and Medicaid Electronic Health Record (EHR) IncentivePrograms.

CMSwants to remind eligible professionals (EPs), eligible hospitals, and criticalaccess hospitals (CAHs) of the key registration and attestation dates for theEHR Incentive Programs, and provide information to help them successfullyregister and start their path to payment for 2011.

ImportantRegistration Details for Medicare and Medicaid

Medicare - November 30, 2011, is the last day for Medicare eligible hospitals and CAHs to register and attest to receive an incentive payment for Federal fiscal year 2011.
Medicare - February 29, 2012, is the last day for Medicare EPs to register and attest to receive an incentive payment for calendar year 2011.
Medicaid - Each state may have different attestation deadlines. Please check with your State Medicaid agency to find out the last day you can attest.

WhenShould Providers Register?

CMS encourages providers to register for the Medicare and/or Medicaid EHRIncentive Program(s) as soon as possible to avoid payment delays. Please notethat not all states have launched a Medicaid EHR Incentive Program yet.EPs will not be able to complete their registration for the Medicaid EHRIncentive Program until their state's program has launched and that state'ssite has opened. Eligible professionals should check their state's status.

Note:Providers can register before they have a certified EHR and can also registerif they do not have an enrollment record in PECOS.

Registration ResourcesCMS has a number of resources to help providers successfully register for theEHR Incentive Programs:

Step-by-step registration guides, available on CMS' Registration page.
A number of FAQs about registration on the EHR Incentive Programs website.
Webinars on YouTube to help guide providers through the registration .process– one for EPs, and one for hospitals.

Wantmore information about the EHR Incentive Programs?

Make sure to visit the EHR Incentive Programs website for the latestnews and updates on the EHR Incentive Programs.

Meaningful Use: Attesting to the Data

2011-10-18T14:11:00.001-07:00

What Does Attestation for the EHR Incentive Programs Entail?

Over114,000 eligible professionals and hospitals have registered for the Medicareand Medicaid Electronic Health Record (EHR) Incentive Programs. As morehospitals move towards meeting meaningful use and attesting, the Centers forMedicare & Medicaid Services (CMS) wants to make sure everyone understandswhat attestation entails.

Inorder to attest, successfully demonstrate meaningful use, and receive anincentive payment under the Medicare EHR Incentive Program, eligible hospitalsmust indicate that they agree with several attestation statements.

Eligiblehospitals must agree that the information submitted:

is accurate to the knowledge and belief of the hospital or the person submitting on behalf of the hospital.
is accurate and complete for numerators, denominators, exclusions, and measures applicable to the hospital.
includes information on all patients to whom the measure applies.
for clinical quality measures (CQMs), was generated as output from an identified certified EHR technology.

Byagreeing to the above statements, the hospital is attesting to providing all ofthe information necessary from certified EHR technology, uncertified EHRtechnology, and/or paper-based records in order to render complete and accurateinformation for all meaningful use core and menu set measures except CQMs.

Attestingto CQM Data's Validity

CMSconsiders information to be accurate and complete for CQMs to the extent thatit is identical to the output that was generated from certified EHR technology.In other words, the hospital is only attesting that what was put in theattestation module is identical to the output generated by its certified EHRtechnology. Therefore, the numerator, denominator, and exclusion informationfor CQMs must be reported directly from information generated by certified EHRtechnology.

CMS,through meaningful use, does not require any data validation. Eligiblehospitals are notrequired to provide any additional information beyond what is generated fromcertified EHR technology in order to satisfy the requirement for submitting CQMinformation, even if the reported values include zeros. If a hospital hasconcerns about the accuracy of its output, the hospital can still attest butshould work with its vendor and/or the Office of the National Coordinator for Health InformationTechnology to improve the accuracy of the individual product and/orthe level of accuracy guaranteed by certification.

CMSrecommends that hospitals print out or save an electronic copy of the CQMreport used at attestation from their certified EHR. The eligible hospitalshould retain this copy for its records so that the hospital can show itsnumbers in the event of an audit. Upon audit, this documentation will be usedto validate that the hospital accurately attested and submitted CQMs.

For more informationabout the Medicare and Medicaid EHR Incentive Programs, please visit the CMS EHR website, and see the Frequently Asked Questions page for answers onvarious topic areas of the programs.

AMA to Medicare: Begin Paying for Care Coordination in 2012

2011-10-14T03:55:00.001-07:00

October 12, 2011 — An influential committee of the American Medical Association (AMA) has issued a challenge to Medicare: If you are serious about the patient-centered medical home, show us the money in 2012.

That group, the AMA/Specialty Society Relative Value Scale Update Committee (RUC), is asking the Centers for Medicare and Medicaid Services (CMS) to start paying separately for certain care coordination services for the chronically ill:

telephone consults with patients;
education and training for patient self-management performed by nonphysicians;
medical team conferences, regardless of whether the patient is present; and
anticoagulation management.

Right now, such services are generally considered rolled into, and reimbursed under, evaluation and management (E&M) services, epitomized by office visits with established patients. In addition, such services all involve care that does not hinge on a face-to-face encounter between physicians and patients. Organized medicine has long complained that although Medicare pays for the work that occurs in the exam room, it does not adequately compensate physicians for what they do once the patient walks out the door.

The new healthcare reform law aims to solve this payment problem through the medical home, which consists of clinician teams, usually lead by physicians, that will receive a monthly fee for care coordination on top of fee-for-service reimbursement. CMS is testing the medical home concept through pilot projects.

RUC, however, wants quicker, broader action. In a letter to CMS last week, RUC Chair Barbara Levy, MD, asked the agency to begin reimbursing care coordination services for the chronically ill next year on a short-term, piecemeal basis until a more comprehensive approach, such as the medical home, is in place. By doing so, Dr. Levy says, CMS would demonstrate that it "is prepared to incentivize care coordination and foster delivery reform."

While boosting Medicare spending up front, separately reimbursed care coordination services will pay for themselves by eliminating unnecessary office visits, trips to the emergency department, hospitalizations, and prescriptions, she added.

CMS can ignore RUC's recommendations. However, the agency is in the habit of listening to them. It relies heavily on the AMA committee for input when, every 5 years, it updates the relative value units that make up the resource-based relative value scale, which is used by CMS to price physician services.

Codes Already Exist, but Go Unreimbursed

RUC's proposal to CMS is couched in the words and numbers of Current Procedural Terminology (CPT) codes, which are developed and maintained by the AMA for reporting services and procedures performed by physicians. CMS has officially adopted this code set as the means to bill Medicare and Medicaid for physician services.

However, just because the AMA creates a CPT code for a particular service does not guarantee that Medicare and Medicaid will necessarily reimburse it. Case in point are CPT codes 99363 and 99364 for anticoagulation management. The AMA's CPT editorial panel created them in 2007, using 99363 for the first 90 days of such therapy and 99364 for each subsequent 90-day period. In her letter to CMS, Dr. Levy noted that the agency had calculated the reimbursement for the 2 codes ($41 per month for 99363, and $14 per month for 99364), but never authorized paying for them, reasoning that managing someone's warfarin regimen was bundled into E&M reimbursement. RUC is asking CMS to begin paying for these codes on their own.

Other care coordination services listed in the RUC letter also come with codes already on the books:

Education and training for patient self-management, CPT codes 98960 to 98962: These apply to sessions conducted by nonphysicians such as a registered nurse on a physician's staff.
Telephone services, CPT codes 99441 to 99443 and 98966 to 98968: These codes are designed for telephone conversations initiated by an established patient that do not originate from a related E&M service within the previous 7 days or lead to an E&M service or procedure within the next 24 hours, or at the soonest available appointment. The first set of codes is for telephone conversations between patients and physicians. When another kind of clinician takes the call, the second set of codes applies.
Medical team conferences, CPT codes 99366 to 99368: The 99366 code pertains to nonphysicians who confer together with the patient or family members; 99368 is for such nonphysician conferences when patient and family are absent. The 99367 code describes team meetings that include a physician, but not a patient or family members.

Someday, "One Big Code" for Care Coordination

The RUC recommendation to pay for care coordination on a piecemeal basis until the medical home model is in place drew nods of approval from domains of organized medicine beyond the AMA.

"These are short-term fixes, but they recognize the value of work done outside the face-to-face visit, which has not been properly paid for," Lori Heim, MD, who chairs the primary care payment valuation task force of the American Academy of Family Physicians, said in an interview with Medscape Medical News. "[The RUC proposal] could be a real game-changer."

Likewise, Shawn Martin, director of government relations for the American Osteopathic Association, called the RUC recommendations an interim step toward a "comprehensive payment model."

"We're pretty pleased," Martin told Medscape Medical News. "Compensation for services outside the face-to-face visit is a core element of the medical home. Ultimately, you will have one big code for an undefined set of services."

Six New State Medicaid EHR Incentive Programs Launched

2011-10-13T11:55:00.000-07:00

California, Maine, Maryland, Massachusetts, Utah, and Vermont Launched Their Medicaid EHR Programs This Month

On October 3rd, the Medicaid Electronic Health Record (EHR) Incentive Program launched in California, Maine, Maryland, Massachusetts, Utah, and Vermont. This means that eligible professionals (EPs) and eligible hospitals in these six states will be able to complete their incentive program registration at the state level and receive incentive payments. More information about the Medicaid EHR Incentive Program can be found on the Medicare and Medicaid EHR Incentive Program Basics page of the CMS EHR website.

If you are a resident of California, Maine, Maryland, Massachusetts, Utah, or Vermont, and are eligible to participate in the Medicaid EHR Incentive Program, visit your State Medicaid Agency website for more information on your state's participation in the Medicaid EHR Incentive Program. Click on a State below to access its website.

As of October 3rd, 33 states have launched Medicaid EHR Incentive Programs and through September, 22 states have issued incentive payments to Medicaid EPs and eligible hospitals who have adopted, implemented, or upgraded certified EHR technology. CMS looks forward to announcing the launches of additional states' programs in the coming months.

For a complete list of states that have already begun participation in the Medicaid EHR Incentive Program, see the Medicaid State Information page on the CMS EHR website.

A new FAQ has been posted on Medicaid patient volume Q: For the Medicaid EHR Incentive Program, can a non-hospital based eligible professional (EP) include their in-patient encounters for purposes of calculating Medicaid patient volume even if the patient is included in the eligible hospital's patient volume for the same 90-day period?

A: Read the answer.

Want more information about the EHR Incentive Programs?

Make sure to visit the EHR Incentive Programs website for the latest news and updates on the EHR Incentive Programs.

Seniors aren't familiar with and don't use Medicare Star ratings for plan selection

2011-10-12T04:34:00.000-07:00

Few seniors are familiar with the Medicare Star Quality Ratings for Medicare plans from the Centers for Medicare & Medicaid Services and even those who do know about them rarely use the information to help select their Medicare plan.

These are the findings of a recent Harris Interactive survey conducted for Kaiser Permanente aimed at finding how familiar Medicare beneficiaries are with the CMS rating system.

"Evaluating a Medicare plan can be challenging,” said Jed Weissberg, MD, senior vice president, Hospitals, Quality and Care Delivery Excellence, Kaiser Permanente. “There are many things to consider, but quality should be at the top of any consumer's list. Educating consumers about and encouraging them to use the Medicare Star Quality Ratings helps to ensure that Medicare beneficiaries are receiving only the best available care."

But the survey showed the annual ratings are not used regularly by seniors to help them make their MA plan selections. Only 18 percent of Medicare-eligible seniors said that they are familiar with the rating system and, of that group, less than one-third have used the system to select their health plan. Even more significantly, only 2 percent of respondents were aware of how their current plans rates.

"As health services providers, it is our responsibility to maintain the highest levels of quality," said Weissberg, in a press release detailing the survey results. "We urge seniors to hold their Medicare providers accountable by taking advantage of the Medicare Star Quality Ratings and selecting plans that meet and exceed quality standards."

One roadblock to seniors becoming more familiar of the star ratings is that most don’t know where to turn to find ratings information. Among the 483 Medicare-aged people questioned for the survey, less than 30 percent knew where to find the information.

Medicare Payment Advisory (MedPac) searching for alternative benefit models for Medicare beneficiaries

2011-10-11T11:44:00.000-07:00

The Medicare Payment Advisory Commission (MedPAC) is exploring alternative benefit models for Medicare beneficiaries as policymakers seek to rein in spending, but the models so far that the panel is considering rely primarily on various approaches to cost-sharing.

Some commission members urged at its Oct. 7 meeting that researchers develop models to incorporate benefit designs that would encourage changes in unhealthy beneficiary behavior, such as controlling weight or diabetes.

MedPAC wants to reform Medicare’s current fee-for-service benefit design because it has no limit on responsibility for sharing costs, different categories of care setting require various levels of cost-sharing, and premiums for supplemental coverage are often expensive and mask overall healthcare costs.

For the alternative benefit designs, all three would have a cap of $5,000 on out-of-pocket expenses. One model would have a $500 deductible and co-insurance package; another would have a $750 deductible with prices set for medical services; and the third would have a $500 deductible with the same medical service expenses, said Scott Harrison, a MedPAC principal policy analyst. The three would require co-payments.

Only the model with coinsurance would have higher average cost-sharing at $1,550 than what currently exists. Another model would have cost sharing that is similar to current and the other would have somewhat lower average cost-sharing of $1,150. Researchers used 2009 Medicare data to develop the models.

Glenn Hackbarth, MedPAC chairman and an independent consultant, said that supplemental coverage that beneficiaries purchase and how that interacts with their benefits is a critical element. Many seniors on a fixed income purchase Medigap insurance plans to help them cover deductibles and other expenses not covered by Medicare’s fee-for-service benefits. But the protection of the supplemental coverage also enables seniors to use more services.

“If we were able to have a potential source of savings that could offset some of the costs of the expansion of the benefit package and limit to the extent to which people supplement it, then they would not incur such cost sharing,” he said.

Scott Armstrong, MedPAC member and president and CEO of Group Health Cooperative, said the panel should consider how to create more value with Medicare benefits. For example, generic statins could require no co-pay compared with brand names.

“We can look at different models of benefit designs that do more than rejigger the out-of-pocket costs with a cap but actually invest in higher value services that change utilization patterns over time,” he said. Some employers offer such designs, and many employees in the boomer generation are familiar with them.

If the panel is unable to develop a value-based benefit design, Michael Chernew, commission member and healthcare policy professor at Harvard Medical School, said that co-pay design would be important.” It can incent beneficiaries if the most expensive treatment doesn’t add any extra value,” he said.

In November, the commission staff will add more demographic data and supplemental coverage information to its models to determine how the design changes would affect beneficiaries.

Co-branded Aetna, CVS Medicare Part D plan to hit 43 states

2011-10-10T09:37:00.001-07:00

Aetna and CVS/pharmacy announced last week a co-branded Medicare prescription drug plan available in 43 states and Washington, DC, in a deal that will leverage the retail base of more than 7,200 CVS and Long Drug stores across the country.

The announcement comes as Aetna continues to seek more ways to broaden its product lines, as well as build a strong business in the Medicare market. In June, the company acquired the Medicare supplement business of Genworth Financial, a book of business that brought 145,000 new members to the company.

“This important growth opportunity comes at a time when the Medicare population is anticipated to increase as ‘Baby Boomers’ reach age 65,” said Aetna Chairman, Presdient and CEO Mark Bertolini at the time of the Genworth deal. “Medicare supplement is expected to be a fast-growing product in the coming years as individuals seek peace of mind for out-of-pocket costs and employers look for added retiree coverages.”

The same can be said of seniors looking for Medicare Part D coverage to help them with the cost of prescription drugs. The Part D product will offer beneficiaries who fill their prescriptions at CVS with in-network savings that include $3 co-pays for generic drugs and will save $10 on copayments for non-preferred generic and preferred brand prescriptions.

“With 75 percent of the U.S. population in the markets in which CVS/pharmacy operates living within 3 miles of a CVS drugstore, Medicare beneficiaries will have convenient access to the prescription drugs they need through this plan,” said John Chomeau, head of Aetna Medicare, in a press release announcing he deal.

For CVS, the deal builds upon the relationship betwee its parent company, CVS Caremark, and Aetna. Last summer, Aetna inked a 12-year pharmacy benefits management services deal with CVS Caremark. Aetna’s PBM business is substantial, comprising more than 9.7 million customers and members who represent about $9.5 billion in drug spending each year.

The announcement of the new Part D plan comes just a couple or weeks ahead of the Medicare open enrollment period, which this years runs from Oct. 15 to Dec. 7.

Medicare Payment Advisory Commission (MedPAC) approves SGR repeal proposal

2011-10-08T10:45:00.001-07:00

The Medicare Payment Advisory Commission (MedPAC) voted Thursday to approve the sustainable growth rate (SGR) proposal it issued last month. Medical groups are already expressing their displeasure.

MedPAC’s approved recommendation repeals the SGR for an estimated cost of $200 billion. To cover that cost MedPAC suggests a 10-year Medicare payment rate freeze for primary care physicians and cuts to payments for specialists by 5.9 percent each year for three years followed by a seven-year payment freeze. Some of the other offsets come from durable medical equipment, hospitals and Medicare benefits to seniors.

Prior to MedPAC’s Thursday vote, a slew of medical organizations, including the American Medical Association (AMA), the American College of Cardiology, the American College of Emergency Physicians, the American College of Physicians, the American College of Surgeons and the American Psychiatric Association, sent the commission a letter urging a revision of the commission’s September proposal.

“We share your concern that the SGR is undermining patient and physician confidence in the Medicare program and appreciate the Commission’s effort to present a comprehensive plan intended to improve the prospects for SGR repeal,” read the letter dated Oct. 3. “Unfortunately, however, we cannot support this plan in its present form because it retains many of the SGR’s flaws, undermines physicians’ ability to participate in payment and delivery reforms and calls for payment rates that the Commission itself has previously said could reduce Medicare beneficiaries’ access to medical care.”

As news of MedPAC’s vote in favor of its proposal got out, medical groups began announcing their displeasure.

“The recommendation voted on today by MedPAC flies in the face of their previous recommendations to stop harmful physician cuts that threaten access to care for patients,” said Peter Carmel, MD, president of the AMA in a statement. “There is already a 20 percent gap between Medicare payment updates and the cost of providing healthcare to seniors. Many physicians may also face upcoming payment penalties related to electronic prescribing, health information technology and quality reporting programs. Adding additional physician payment cuts to this mix will leave many physicians unable to care for Medicare patients or make the investments needed to participate in new models of care that can increase coordination and reduce costs.”

“The proposal is not an acceptable or sustainable solution to the SGR and does nothing to promote quality or resource stewardship,” said Jack Lewin, MD, CEO of the American College of Cardiology in a statement. “Looming primary care shortages require focused solutions, we agree. But this proposal somewhat misaligns the interests of primary and specialty doctors, rather than focusing on incentives to work together to improve quality, efficiency, coordination of care, and outcomes.”

Offering a less strident perspective, the National Coalition on Health Care (NCHC) said in a statement that while some of MedPAC’s offsets may shift more costs onto providers, businesses, health plans and beneficiaries, the proposal is essentially a good thing.

“MedPAC has produced an honest attempt to cut the Gordian knot of federal health policy and end the SGR. Whether or not MedPAC’s shared sacrifice approach is the right one, at least MedPAC has gotten serious about addressing provider payment. It is long past time that our elected leaders do the same,” said NCHC President and CEO John Rother in his statement.

“If we’re ever going to rein in the health costs strangling our nation’s consumers, businesses and public institutions, we must redesign provider payment to encourage the highest-value care for patients. MedPAC’s proposal should spur the Congress and the Administration to get to work,” he concluded.

Free Preventive benefits for Medicare Patients

2011-10-07T12:44:00.000-07:00

The Centers for Medicare & Medicaid Services (CMS) reported Thursday that nearly 20.5 million people with Medicare have had a free Annual Wellness Visit or received other preventive services with no deductible or cost sharing this year, thanks to funding through the Affordable Care Act.

In addition, nearly 1.8 million people with Medicare have received discounts on brand-name drugs in the Medicare Part D coverage gap, also known as the "donut hole," between January and August of this year. The total value of discounts to people with Medicare in the donut hole is nearly $1 billion through August of this year, with an average savings of $530 per beneficiary.

“Thanks to the Affordable Care Act, more people with Medicare are getting preventive services like mammograms for free,” said HHS Secretary Kathleen Sebelius in a statement. “The new healthcare law is also making prescription drugs more affordable for millions of seniors and people with disabilities.”

Some of the free preventive services available to people with Medicare include:

• Mammograms and cervical cancer screenings

• Annual Wellness Visit

• Cholesterol and other cardiovascular screenings

• Colorectal and prostate cancer screenings

The rising number of people who are taking advantage of preventive benefits and prescription drug discounts comes as people with Medicare are beginning to review their plan options for next year. The web-based Medicare Plan Finder is now available to help beneficiaries, their families, other caregivers, and senior program advocates look at all local drug and health plan options that are available for the 2012 benefit year. The annual enrollment period begins earlier this year than last year, on Oct. 15, and runs through December 7.

Every person with a Medicare Advantage or a Part D drug plan will also see better value in those plans for the second year. Average Part D drug plan premiums will remain virtually unchanged in 2012. Those in the Part D coverage gap will continue to be able to get discounts on covered brand name drugs. People with Medicare will get deeper discounts in the years ahead until the gap is closed in 2020.

On average, Medicare Advantage premiums will be four percent lower in 2012 than in 2011, and plans project enrollment to increase by 10 percent. All beneficiaries will have access to Medicare-covered preventive services with zero cost-sharing, including the Annual Wellness Visit, bone-mass measurement, colon cancer screenings and diabetes screenings, as well as influenza and pneumococcal vaccines.

Medicare Payment Advisory Commission (MedPac) recommends New 'Doc Fix'

2011-10-07T04:35:00.000-07:00

October 6, 2011 — The Medicare Payment Advisory Commission (MedPac) today voted 15 to 2 to recommend a "doc fix" for the Medicare reimbursement crisis that organized medicine views as the makings of another crisis.

The MedPac plan, which requires Congressional approval, would repeal the hated sustainable growth rate (SGR) formula for setting physician reimbursement and avert an SGR-triggered pay cut of 29.5% on January 1. To offset the estimated $300 billion price of this "doc fix," as it is called on Capitol Hill, MedPac recommends freezing reimbursement rates for primary care physicians for 10 years while cutting rates for specialists by 5.9% for 3 straight years, followed by zero growth during the next 7 years.

Pinching Medicare rates this way would raise roughly $100 billion toward financing the doc fix. MedPac comes up with another $235 billion in proposed cuts to Medicare Part D drug plans, post–acute care facilities, hospitals, laboratories, suppliers of durable medical equipment, Medicare Advantage plans, and other providers, along with reduced benefits for seniors.

The commission recommended this package of measures despite dire warnings from organized medicine that the proposed cut-and-freeze approach to rates would drive many of their members out of Medicare and jeopardize access to care for seniors. Medical societies have routinely predicted the same scenario if SGR-triggered pay cuts were to take effect.

In an October 3 letter to MedPac, the American Medical Association (AMA) and 42 other medical societies pointed out that since 2001, Medicare reimbursement rates have increased by 4%, but practice costs have grown 6 times as fast, at 24%. The commission's reimbursement proposal, they argued, would put physicians further in the hole as practice costs continue to rise, making it harder for them to invest in the kind of care coordination, chronic disease management, and quality improvement envisioned in healthcare reform.

Compounding the payment cuts proposed by MedPac are other Medicare policies that could reduce physician reimbursement, according to the medical societies. Some of those could take the form of penalties for not reporting quality measures to the Centers for Medicare and Medicaid Services or for not adopting electronic health record technology, both of which require physician investment.

Peter Carmel, MD

The medical societies have argued that instead of asking physicians to make unreasonable sacrifices, Congress could finance a doc fix with other budget offsets already identified by the Congressional Budget Office, the Senate "Gang of Six," and the presidential deficit reduction commission.

Another Rift Between Primary Care Physicians and Specialists

Organized medicine was quick to repeat its criticism of the MedPac plan after today's decision.

"The AMA strongly opposes the Medicare physician payment recommendation voted on today by MedPAC," said AMA President Peter Carmel, MD, in a press release. "Offsetting part of the cost of [the SGR formula] repeal through drastic cuts and long-term freezes to physicians falls far short of what is needed to preserve patients' access to care. The recommendation voted on today by MedPAC flies in the face of their previous recommendations to stop harmful physician cuts that threaten access to care for patients."

Dr. Jack Lewin

Jack Lewin, MD, chief executive officer of the American College of Cardiology, said the MedPac proposal "is not an acceptable or sustainable solution to the SGR and does nothing to promote quality or resource stewardship."

"Looming primary care shortages require focused solutions, we agree," Dr. Lewin said in a press release. "But this proposal somewhat misaligns the interests of primary and specialty doctors, rather than focusing on incentives to work together to improve quality, efficiency, coordination of care, and outcomes."

Dr. Lewin's remarks reopen a traditional rift between primary care physicians and their specialist kin about who is getting a fair shake in Medicare reimbursement policy. The MedPac plan places most of the financial sacrifice on specialists, because the services subject to 3 straight years of cuts account for 92% of Medicare spending on physician services.

The MedPac proposal could become fodder for the Congressional Joint Select Committee on Deficit Reduction, the so-called super committee, which is tasked with recommending $1.5 trillion in savings that Congress must enact by December 23. Organized medicine is lobbying the super committee to repeal the SGR formula, but not pay for it MedPac-style.

Deadline Reminder for CMS eRx Program Hardship Exemption

2011-10-05T13:24:00.000-07:00

The Deadline to Request a Hardship Exemption for the eRx Incentive Program is November 1, 2011

The Centers for Medicare & Medicaid Services (CMS) would like to remind eligible professionals and group practices that the deadline to request a hardship exemption for the 2012 Medicare Electronic Prescribing (eRx) Incentive Program adjustment is November 1, 2011.

Eligible professionals and group practices should determine if they are subject to the 2012 eRx payment adjustment by reviewing the MLN Article SE1107. If you believe that you may be subject to the 2012 eRx payment adjustment, you should determine if you meet any of the hardship exemption categories specified by CMS in the 2011 Medicare Electronic Prescribing (eRx) Incentive Program Final Rule.

In addition, a Quick Reference Guide is available to help you understand the changes that the eRx Final Rule made to the 2011 Medicare eRx Incentive Program. As a result of changes to the program, eligible professionals and group practices have until November 1, 2011 to submit a significant hardship exemption request and rationale.

Exemption Requirements

Please note, to be considered for an exemption under the significant hardship exemption category “Eligible professionals who register to participate in the Medicare or Medicaid Electronic Health Record (EHR) Incentive Programs and adopt Certified EHR Technology,” an eligible professional must:

1. Have registered for either the Medicare or Medicaid EHR Incentive Program (for instructions on how to register for one of the EHR Incentive Programs, please visit the Registration and Attestation page of the EHR Incentive Programs website; and

2. Providers have to show that they adopted certified EHR technology no later than October 1, 2011, and provide identifying information about the certified EHR technology. Please note that in order to qualify for an exemption to the 2012 eRx payment adjustment under this significant hardship exemption category, it is not necessary that an eligible professional receive an incentive payment under the Medicare or Medicaid EHR Incentive Program.

Registration Details

Eligible professionals wishing to register for the Medicaid EHR Incentive Program in states that have not yet launched their respective programs may initiate the registration process at the CMS Registration and Attestation System and obtain a registration number, even though they will not be able to successfully complete registration. If a State has not launched its Medicaid EHR Incentive Program, the State name will not appear in the drop-down menu for eligible professionals to select. However, a registration number is assigned even if registration is not successfully completed.

In order to initiate registration for the Medicaid EHR Incentive Program, please visit the registration site and follow the instructions to begin the registration process. Obtaining a CMS EHR Incentive Programs registration number, even if the registration is not successfully completed, suffices for the purposes of applying for a significant hardship exemption for the 2012 Medicare e-Prescribing payment adjustment.

To request an exemption, individual eligible professionals must submit their hardship exemption requests through the Quality Communications Support Pageand group practices participating under the group practice reporting option (GPRO) must submit hardship exemption requests via a letter to CMS.

Please remember that CMS will review these requests on a case-by-case basis. All decisions on significant hardship exemption requests will be final.

For additional information and resources, please visit the eRx page on the CMS website, and see the new FAQ.

Want more information about the EHR Incentive Programs?
Make sure to visit the EHR Incentive Programs website for the latest news and updates on the EHR Incentive Programs.

Are you Aware of the Registration Deadlines for the EHR Incentive Programs?

2011-10-05T09:20:00.001-07:00

Important Updates on Registration for the EHR Incentive Programs

CMS wants to remind eligible professionals (EPs), eligible hospitals, and critical access hospitals (CAHs) of the key registration dates for the Electronic Health Record (EHR) Incentive Programs, and provide information to help them successfully register and start their path to payment for 2011.

Important Registration Dates to Remember

November 30, 2011– Last day for eligible hospitals and CAHs to register and attest to receive an incentive payment for Federal fiscal year 2011.
February 29, 2012– Last day for EPs to register and attest to receive an incentive payment for calendar year 2011.

When Should Providers Register?

CMS encourages providers to register for the Medicare and/or Medicaid EHR Incentive Program(s) as soon as possible to avoid payment delays. Please note that not all states have launched a Medicaid EHR Incentive Program yet. Providers will not be able to complete their registration for the Medicaid EHR Incentive Program until their state's program has launched and that state's site has opened. Providers should check their state's status.

Note: Providers can register before they have a certified EHR and can also register if they do not have an enrollment record in PECOS.

Registration Resources

CMS has a number of resources to help providers successfully register for the EHR Incentive Programs:

Step–by–step registration guides, available on CMS' Registration page
A number of FAQs about registration on the EHR Incentive Programs website
Webinars on YouTube to help guide providers through the registration process– one for EPs, and one for hospitals.

Want more information about the EHR Incentive Programs?

Make sure to visit the EHR Incentive Programs website for the latest news and updates on the EHR Incentive Programs.

Lawsuit against New MEDICAID Plans filed by Washington DC ER Docs

2011-10-03T11:53:00.001-07:00

Emergency physicians in Washington state have filed a lawsuit against a state plan to limit payment for Medicaid visits to three "non-emergency" visits to emergency departments each year. The plan would also classify more than 700 diagnoses as "non-emergent," including chest pain, abdominal pain, miscarriage and breathing problems.

"This list of non-emergent diagnoses puts patients in danger and unfairly targets the poor and those in most need of care," said Stephen Anderson, MD, president of the Washington Chapter of the American College of Emergency Physicians in a press release announcing the lawsuit. "We understand that our state Medicaid office is working with 19 other states to develop this policy. If this plan goes into effect, other states will certainly follow suit."

The Washington State Health Care Authority (HCA) announced its new payment rules for the 2011-2013 biennium late last month and also its new policy on non-emergency use of ERs, which was mandated under the budget passed by the state legislature.

According to HCA, the state spent around $98 million for nearly 328,000 fee-for-service ER visits last year. The legislature estimated that limiting ER use for non-emergency care could save the state $35 million a year.

The policy is set to begin Oct. 1 and the first three-visit limit period will run through June 30, 2012. Medicaid recipients who reach their third visit will be notified by letter and warned that additional non-emergency visits will be the client’s financial responsibility. Additional mailings will target the program’s high utilizer patients, including those who exceeded three visits last year.

“This is a realistic strategy to change clients’ behavior and improve patient care as well as assure taxpayers that we are addressing the state’s continuing financial crisis,” said Doug Porter, HCA director. “Non-emergency issues and chronic conditions should be treated by a primary care provider, not by an expensive visit to hospital Emergency Rooms.”

But the Washington Chapter of the American College of Emergency Physicians doesn’t see it that way. It said the basis for the lawsuit is multi-factorial and adds that the state:

has not implemented a rulemaking process that included stakeholder comments; yet the plan is being forced on hospitals and providers with no warning;
has violated the requirements that this be a collaborative process as outlined by the legislature;
has violated the requirements that this be a list of non-emergent diagnoses as outlined by the state legislature;
has misconstrued the ability to bill patients for services. Federal law prevents physicians from meeting Medicaid requirements for billing patients through EMTALA, and state law blocks hospitals from billing under charity requirements; and
is violating the federal Prudent Layperson standard by applying it to managed care patients.

"The average number of emergency visits for Medicaid patients affected by this requirement is about 4.5 visits per year, not the 30 plus that the state eludes to," added Anderson. "Physicians in the state have offered to work with state officials to come up with a list of truly non-emergent conditions. We truly want to work together to help reduce healthcare costs, but we must protect patients from harm."

But Jeffery Thompson, MD, Medicaid’s Chief Medical Officer, said the state did seek the input of hospitals and providers across the state as it worked to refine the list of more than 700 non-emergency billing codes.

In addition, the three-visit limit would not apply in the following situations:

Children placed by the department in out-of-home care with foster parents, relatives or other caregivers
Clients delivered to the Emergency Room by ambulance, police or EMTs.
Visits for mental health diagnoses or for clients seeking detoxification services
Visits that result in an inpatient admission, emergency surgery or admission for observation.

The program also created an exception to the rule process by which hospitals can appeal non-emergency billings on the grounds of special circumstances.

“In point of fact, 97 percent of our clients can live very comfortably with this three-visit limit,” said Thompson. “The small number who exceed that limit are responsible for scores of visits – and most of them are for chronic conditions and complaints of pain – visits that usually end with a narcotics script. Providers and clients should recognize that the Emergency Room is not the place to treat non-emergencies and chronic conditions. These will be handled more cost-effectively and improved care by primary care providers.”

Thompson also noted that some groups, prior to the current lawsuit, raised concerns that the new rules will endanger the health of Medicaid members, though he feels these opponents have also used scare tactics to make their point.

“For example, they have pointed out that a code for ‘chest pains’ still is on the list,” he said, “but they don’t point out that the code is chest pains not related to a cardiac event.”

Plans may see recurring turnover among expanded Medicaid recipients

2011-10-03T09:11:00.001-07:00

Medicaid managed care and other health plans should prepare for anticipated churn of members who will likely fall into and out of eligibility of expanded Medicaid and subsidized coverage once health insurance exchanges launch in 2014.

Health reform expands the number of individuals who are eligible for Medicaid coverage or helps them afford other plans via tax credits or subsidies for with incomes between 133 percent and 400 percent of the federal poverty level.

“The paradigm is shifting to keeping people enrolled in coverage,” said John Kaelin, senior vice president for health reform at UnitedHealth Group. But extending coverage will also include some cost-sharing for enrollees who experience even modest income gains.

“We have to put strategies, policies and products in place to manage for people moving around to the degree that their income fluctuates,” Kaelin added at a recent conference sponsored by America’s Health Insurance Plans.

For example, he said that at the top end of Medicaid – around $14,000 in annual income – a member pays no premium nor shares any costs. However, earning just slightly more, at 140 percent of the poverty level or about $15,200, the individual is faced with having to pay $40 to $50 a month for health coverage, and depending on the plan, share some costs to use the health system despite subsidies.

“That could be big shock,” Kaelin said. Individuals may question whether they want to stay enrolled when it will cost so much relative to limited earnings.

Health plans might consider affordability and price points related to this population and develop user-friendly products to communicate and educate about premiums, deductibles and co-pays. Plans could provide simulators that enable customers to make informed decisions, he said.

As customers move between Medicaid and the exchange plans because of job losses or gains, members may want to keep the same physician instead of changing with each plan. Therefor, the provider network will be a critical component, and providers who overlap in Medicaid and exchange plans could enable seamless coverage, Kaelin said.

Michael Nardone, principal for Health Management Associates and former Pennsylvania Medicaid director said states will also need to take people moving between health plans into consideration in order to smooth the transition between Medicaid and other programs. To ensure continuity of coverage, states could provide an essential health benefit option and network requirements for exchange plans, as well as encourage or require existing Medicaid plans to participate in the exchange. However, CMS has not yet defined what the essential health benefit will look like.

Some state Medicaid policies, such as those focused on quality improvement, could transfer to insurance exchanges, especially if the state is looking to be an active purchaser or do selective contracting with specific health plans when they establish their exchanges, Nardone said.

Pennsylvania worked with some health plans to use pay for performance that crosses private plans and Medicaid. “I think there is some potential leverage there that states can build on,” Nardone said.

Exchanges, as envisioned, hold some potential technical solutions to these challenges, as they could serve to simplify the enrollment process while encouraging health plans, states and the Centers for Medicare & Medicaid Services to work together.

One example is the single point of entry or “no wrong door,” in which customers who enter the exchange portal are directed to the program for which they qualify, Kaelin said. Another is pre-populating forms to promote initial and ongoing enrollment, especially when Medicaid members “fall off because they don’t recertify or there is some paperwork snafu,” Nardone added.

CMS has News to Share about the EHR Incentive Programs

2011-09-30T08:37:00.000-07:00

CMSwill be at the AHIMA Conference later this week, new EHR videos are now up onthe CMS YouTube channel, and updated EHR Incentive Programs' payment andregistration numbers are available online.

AHIMAConference

Are you attending the 2011 AHIMA Convention and Exhibit, which takes place fromSeptember 30 – October 6 in Salt Lake City, Utah? CMS will be at booth #1631,and will have representatives from the CMS EHR Incentive Programs on-site toprovide information about the programs and hear your participation stories.Attendees are encouraged to visit the booth and get the resources they need tosuccessfully participate in the EHR Incentive Programs.

Videos

CMS has posted new videos to the CMS, including:

An overview video, titled EHR: Delaware Meaningful Use Recognition Ceremony, where providers participating in the Medicare EHR Incentive Program were honored.
An overview video, titled EHR: Cherokee Nation Receives Medicaid EHR Incentive Payment, where Dr. Woitte and the Cherokee Nation were honored for participating in the Medicaid EHR Incentive Program and for being the first tribe to receive an incentive payment.

UpdatedRegistration and Payment Numbers

As of August 31, 2011, more than 90,000 providers have registered for the EHRIncentive Programs, and more than $652 million has been received in incentivepayments for both the Medicare and Medicaid programs. If you have not alreadydone so, take a look at CMS' Educational Materials page on the EHR websiteto find helpful information about eligibility, registration, meaningful use,and attestation.

Wantmore information about the EHR Incentive Programs?

Make sure to visit the EHR Incentive Programs website for thelatest news and updates on the EHR Incentive Programs.

North Carolina Blues, Allscripts to hook up 750 docs with EHRs

2011-09-30T04:54:00.000-07:00

Blue Cross and Blue Shield of North Carolina (BCBSNC) is collaborating with health technology company Allscripts to roll out electronic health records to more than 750 North Carolina physicians, including more than 150 physicians in 39 free clinics, allowing them to connect to the statewide health information exchange.

BCBSNC will cover 85 percent of EHR cost for eligible independent practices and 100 percent for eligible free clinics, including training and support for participating practices.

The new initiative, called the North Carolina Program to Advance Technology for Health (NC PATH), also provides training and ongoing support for the practices to implement the certified EHR technology, and work towards achieving meaningful use status and becoming patient-centered medical homes.

"This alliance with Allscripts puts our state on a path to better health outcomes driven by high standards," said Brad Wilson, BCBSNC president and CEO. "By providing more than 750 physicians with this technology and support, they are better able to coordinate care – an important step toward improving our healthcare system."

As part of the program, participating practices receive support for their efforts toward earning PCMH recognition, which has shown results in enhancing healthcare quality and managing costs. BCBSNC, working with the NC Area Health Education Centers (NC AHEC) Regional Extension Center programs, will help practices identify quality improvement opportunities in order to achieve PCMH status. In addition, BCBSNC is working with the North Carolina Health Information Exchange (NC HIE) to create a program to enable all participating providers to connect to the HIE.

"North Carolina is taking real action and leading the charge toward more effective, more efficient healthcare," said Glen Tullman, CEO of Allscripts. "Electronic health records are a critical part of a future that provides Americans with more affordable, higher quality care. Collaborations like this one that expand the reach of technology are a step in the right direction."

Cost and use of EHR technology

BCBSNC is investing $15 million into the NC PATH program with Allscripts sharing in the cost, continuing its support of North Carolina healthcare initiatives. The investment allows BCBSNC to cover 85 percent of the software and setup costs for 600 physicians in eligible independent practices and 100 percent of the costs for 39 eligible free clinics over the next five years, eliminating the largest barrier of entry for utilization of EHR technology.

Participation in NC PATH will help physicians meet key provisions of the HITECH Act, including:

Adoption of certified EHR technology to support 'meaningful use' requirements.
Eligibility for up to $44,000 in 'meaningful use' EHR incentive payments under the HITECH Act. This is in addition to the BCBSNC subsidy.
NC AHEC Regional Extension Center support in achieving meaningful use well in advance of the 2015 deadline, which avoids potential reduced Medicare reimbursements.
Practices that implement meaningful use certified EHR technology show improvements in the quality of provided care, reduced medical errors and reductions in redundant or unnecessary care, which helps to rein in medical costs.

CMS will Pay $20 per Patient Monthly Medical-Home Fee

2011-09-29T13:00:00.000-07:00

September 29, 2011 — The Centers for Medicare and Medicaid Services (CMS) put a price tag on the much-discussed medical-home concept when it unveiled a plan yesterday to strengthen primary care through new test models for delivering and paying for services.

Physicians participating in the Comprehensive Primary Care Initiative (CPCI) will receive a monthly care-management fee on top of their usual Medicare fee-for-service reimbursements during a 4-year trial run. CMS will initially pay clinicians an average of $20 per Medicare beneficiary per month in the first 2 years. Actual payments will range from $8 to $40 per month because of risk-adjustments based on patients' claims histories and medical status. The agency also will adjust care-management fees up or down to reflect geographic differences in costs.

Richard Baron, MD, director of the Seamless Care Models Group at the CMS Innovation Center, said at a briefing today that the care-management fees are 40% to 50% more than Medicare invests now in primary care.

The care-management fee drops to $15 in the third and fourth years of the CPCI based on the CMS assumption that physicians will become more efficient in this work. In addition, the agency wants to "shift reliance to accountable forms of payment" such as shared savings, which kick in during year 2. Under a shared-savings arrangement, physicians attempt to come under budget in caring for a group of Medicare patients while meeting quality standards. If they succeed, they receive a slice of the savings.

Private Insurers Needed to Make Plan Work

CMS states that the CPCI, an outgrowth of healthcare reform, builds on and extends the patient-centered medical-home concept that many primary care physicians view as the salvation of their specialty. In this delivery model, primary care physicians are financially rewarded for care-management chores — such as talking to a patient's family members or managing specialty referrals — that typically go unreimbursed in traditional fee-for-service Medicare. Medical homes emphasize prevention, patient and caregiver engagement, continuity of care, easy access, and the use of electronic health record (EHR) software to help make it all happen.

CMS is inviting private insurers to participate in the CPCI as well and either pay care-management fees to physicians or support them with embedded care managers, health educators, or pharmacists. Getting these insurers to sign up is critical for the initiative's success, according to the agency. Medicare alone cannot motivate physicians to switch to a new care model.

"Having a majority of a practice's payers supporting enhanced primary care will ensure that a practice can implement a more consistent and comprehensive approach to treating patients," the agency stated in a solicitation for insurers to apply. "Without that majority, practices risk not having enough sustained support to provide the services we are seeking."

Private insurers have until January 17, 2012, to submit an application to participate. CMS will then choose insurers in 5 to 7 markets and recruit 75 primary care practices in each one to come aboard. The agency expects to begin selecting the practices by the spring of 2012 and start paying them under CPCI by the summer.

"We believe that participating practices, depending on the degree of (private) insurance participation, may see a 30% to 50% increase in their gross revenue," said Dr. Baron. The boost in pay, he said, will enable them to invest in the staffing and information technology needed for this "new business model of primary care."

CMS Innovation Center Director Richard Gilfillan, MD, added today that by giving primary care physicians more time and resources to care for patients, healthcare costs will eventually stabilize, patients will be healthier and happier, "and doctors will be more fulfilled."

CMS to start Appeal Process for EHR Incentive

2011-09-28T06:44:00.000-07:00

The Centers for Medicare and Medicaid Services (CMS) intends to establish an appeals process for the Medicare electronic health record (EHR) incentive program.

CMS, to that end, has awarded a $2.25 million contract to Provider Resources Inc., of Erie, Pa., to help develop the administrative appeals process, and evaluate and promote the infrastructure to support it.

Provider Resources, which provides analysis and education about program integrity and healthcare quality, will also support CMS with problem identification and system solutions for the appeals process, according to a Sept. 22 notice in Federal Business Opportunities.

The vendor will also work with CMS and other partners to conduct outreach about the appeals process.

CMS said in August that it is working to come up with the policy and procedures for an appeal process for Medicare providers participating in the EHR incentive program.

Bipartisan Group to equip with 48 million Medicare enrollees with SmartCards

2011-09-26T12:52:00.001-07:00

A bipartisan group of lawmakers has introduced legislation that would equip the nation’s 48-million-and-counting Medicare enrollees with smartcards, thus improving access to healthcare and saving an estimated $30 billion a year in fraud and waste.

The proposed legislation comes as three other lawmakers are petitioning the Government Accountability Office to evaluate the Centers for Medicare & Medicaid Services’ Medicare eligibility system, saying it sometimes takes far too long to determine beneficiary eligibility.

The Medicare Common Access Card Act of 2011, sponsored by Sens. Mark Kirk (R-Ill.), Ron Wyden (D-Ore.) and Marco Rubio (R-Fla.) in the Senate and Reps. Jim Gerlach (R-Pa.), Earl Blumenauer (D-Ore.) and John Shimkus (R-Ill.) in the House, would create a two-stage process for the smartcard program. The first stage would consists of a number of pilot programs to embed microchips in Medicare identification cards, while the second would expand those programs nationwide.

The pilot programs would study the smartcards’ ability to improve quality and access to care and accuracy of Medicare and reduce the likelihood of identity theft, waste, fraud and abuse.

The Department of Justice has estimated the cost of Medicare fraud at $60 billion per year, while the Office of Management and Budget said more than $48 billion in improper payments were made by Medicare in 2010. Supporters of the smartcard proposal say it would reduce fraud and improper payments by authenticating providers, patients and services at the point of care. Under the current process, Medicare generally pays all claims, then tries to recoup fraudulent payments after they’ve been made.

The enhanced cards would not display Social Security numbers and would require a PIN for verification. Under the proposal, healthcare providers would also be issued with cards with biometric security features, and both the providers and the patient would have to insert their cards into a reader at the point of care to confirm that services were rendered.

The program is modeled on the Common Access cards now used by some 20 million Department of Defense personnel and Military Health System enrollees.

“Building on the smartcards already issued to all Americans in uniform, we can offer seniors more protection for their identities while reducing fraud and waste in the strained Medicare system,” Sen. Kirk said in a press release issued by the six lawmakers. “By removing a senior's social security number from the front of the card and including the security upgrades used on the cards of our troops, this secure Medicare Common Access Card will also help end Medicare's current 'pay then chase' policy that allows so much fraud and waste.”

The proposal has received support from the Secure ID Coalition, a group of four companies that offer identity protection services like smartcards, and the AARP. The SIDC has launched a website,www.UpgradeTheCard.org.

“This innovative bill will protect our nation’s seniors by issuing them an upgraded, secure Medicare card similar to the identity credential used by the Department of Defense, known as the Common Access Card. Based on a smart card platform – a proven, tested, and trusted technology used throughout government – the modernized Medicare card will also help to protect our senior’s privacy and security by taking the Social Security number off of the front of the Medicare card. This is a basic privacy protection seniors have been demanding for years, and it’s about time they were heard,” said Kelli Emerick, the SIDC’s executive director, in a press release.

Officials estimate the new program would cost $19 per person in cards and readers if enacted on a nationwide basis.

The smartcard program could aid the Medicare eligibility system called into question on Sept. 22 by Republican Sens. Richard Burr (North Carolina), Tom Coburn (Oklahoma) and Orrin Hatch (Utah). In a letter sent to CMS, the three lawmakers cited “concerns about recurring problems with” CMS’ HIPAA Eligibility Transaction System (HETS).

The senators said some healthcare providers and beneficiaries have complained of long wait times in trying to confirm eligibility, as well as a lack of telephone access to CMS.

“If HETS is failing to serve providers and seniors – whether due to increased transaction volume because of the new Medicare beneficiaries aging into the program or to mismanagement and neglect – Congress deserves to know the facts … in order to help CMS make the necessary course corrections before the problem becomes more acute,” the letter read.

Humana to acquire Medicare Advantage HMO MD Care

2011-09-26T07:58:00.001-07:00

By:

Chris Anderson

Humana Inc. announced today an agreement to acquire Southern California’s MD Care, a Medicare Advantage HMO with approximately 15,000 members.

When completed the deal will add to Humana’s existing book of MA business in California where it has more than 200,000 members. MD Care’s 2010 revenue was $155 million. Terms of the agreement were not disclosed

“As Humana continues growing its Medicare business in the western U.S., MD Care offers an opportunity to expand our Medicare footprint and the suite of products and services we offer in California,” said Thomas J. Liston, senior vice president of senior products for Humana in a press release announcing the deal.

Four-year-old MD Care currently offers Medicare beneficiaries a choice of Medicare Advantage plans that serve as an alternative to traditional fee-for-service Medicare. MD Care’s medical plans include two Medicare Advantage plans including a special needs plan, and Medicare Part D insurance for prescription drug coverage. MD Care’s market area includes all of Los Angeles County and Orange County; and select zip codes San Bernardino County and Riverside County.

According to company information, MD Care’s medical delivery model focuses on preventive care, health maintenance and access to health services, which are safe, evidence-based and quality driven.

The transaction is subject to both federal and state regulatory approvals and is expected to close in late 2011. Humana’s acquisition of MD Care is not expected to materially impact the company’s financial earnings this year.

States choose diverse paths to expand Medicaid managed care

2011-09-26T04:10:00.001-07:00

By:

Mary Mosquera, Senior Editor

New York, North Carolina and Texas are examples of how states take different paths to expand and improve Medicaid managed care, including medical home models, new services and health plan competition. Regardless of the tools, managed care is fast approaching as the primary method to deliver health care to low income populations.

New York has the largest Medicaid program in the country based on its annual budget of $53 billion and serves 5 million New Yorkers, about 25 percent of the state’s population, according to Jason Helgerson, Medicaid director in the Office of Health Insurance Programs, New York State Department of Health.

The state has gravitated to managed care on a voluntary basis but left individuals with complex and chronic conditions in its fee-for-service program, “sort of a halfway point to real managed care for the entire population but not going into those higher cost areas. That has changed in the last few months,” he said at a recent briefing sponsored by the Kaiser Family Foundation.

A Medicaid redesign team in New York “put the state on a three-year glide path to get out of fee-for-service in our state,” Helgerson said

New York wants to expand the mandatory managed care umbrella to the dual eligible population, who drive 36 percent of the total Medicaid budget, to bring them into integrated and coordinated care. “We have a number of small programs, but they haven’t grown to sufficient size yet,” he said. The state has also mandated that managed long-term care will take effect in April 2012.

New York has 820,000 Medicaid patients in medical homes and pays a bonus to physicians who meet National Committee for Quality Assurance (NCQA) accreditation standards. Most of those patients are in low-income health plans. “We’re gearing up for the move which includes identifying very specific performance measures that we’re going to hold plans accountable for,” Helgerson said. "We’re now looking at outcomes of those members to see if that extra payment of millions of dollars is seeing a return on investment."

To use managed care effectively, states have “to structure the contractual relationship, provide the right financial incentives and have the right checks in the system to ensure getting the outcomes you want,” Helgerson said.

Elsewhere, North Carolina has expanded its pioneering Community Care of North Carolina (CCNC) Medicaid medical home model across all the state’s 100 counties and serves 1 million Medicaid recipients. CCNC, established as a not-for-profit organization, has 14 provider networks that develop care management and coordination practices, and an informatics center to collect and analyze claims data for quality purposes.

North Carolina plans to add incentive-based upon metrics to further drive quality, said Dr. Craigan Gray, director, medical assistance division, North Carolina Department of Health and Human Services. For example, pharmacy services will fill more generic prescriptions based on tiered reimbursement. CCNC has also added a pregnancy medical home model, with measures to improve clinical outcomes.

“We’ll pay the obstetrician a little more. It’s data and claims driven, and there is surveillance through in-office chart review to make sure they meet the quality outcome metrics,” he said.

“But that does not measure the collateral benefit that we receive from this program from getting healthier kids and avoiding the later costs that Medicaid would undoubtedly bear from being very low birth weight,” Gray said.

The medical home model in North Carolina has demonstrated enough cost savings and quality improvements to attract the attention outside of Medicaid of several large employers within the state. These organizations, including the manager of North Carolina’s health plan for state workers, Blue Cross and Blue Shield, have engaged CCNC as an option to their health coverage. The overwhelming majority of primary care providers in North Carolina participate in CCNC.

“This is truly engaging the power of the Medicaid program to improve the standard of care across the state,” Gray said.

Texas plans to grow its STAR Medicaid managed care program throughout the state by March 2012 from just large metropolitan areas, in part to be prepared for the anticipated spike in individuals eligible for Medicaid under health reform.

Medicaid growth in general is outpacing infrastructure, and states are going to have to respond, said Joe Vesowate, deputy director of managed care operations, Medicaid and CHIP divisions, Texas Health and Human Services Commission.

Care coordination is a cornerstone, along with adding services to support that, such as a pharmacy benefit.

In March 2012, Texas Medicaid will add a managed care dental program for its children’s insurance program and expand to most parts of the state its STAR Plus managed care program for acute and long-term services for the disabled and chronically ill.

A critical characteristic underlying the expansion of managed care and controlling costs is Texas’ competitive procurement for healthcare services. ”The key is having these competitive relationships, good business environment and the right number of managed care organizations for the capacity,” Vesowate said.

An Important EHR Incentive Program Deadline is Approaching

2011-09-23T12:27:00.000-07:00

October 3 is the Last Day for Eligible Professionals to Begintheir 90-Day Reporting Period for 2011

Thelast day that eligible professionals (EPs) can begin their 90-day reportingperiod in calendar year (CY) 2011 for the Medicare EHR Incentive Program isOctober 3, 2011. For EPs, this means that they must begin their consecutive90-day reporting period by October 3 in order to attest to meeting meaningfuluse and be eligible to receive an incentive payment for CY 2011.

For EPswho have already completed their reporting period, CMS has a number of toolsavailable to help prepare for attestation. EPs can use the CMS Eligible Professional Attestation Worksheet torecord their meaningful use measures to have as a reference when attesting forthe Medicare EHR Incentive Program in CMS' web-based Registration and Attestation System. The Meaningful Use Attestation Calculator and Attestation User Guide for Eligible Professionalscan also help EPs to successfully attest to meeting meaningful use.

CMSencourages EPs not to miss the opportunity to participate in the Medicare EHRIncentive Program this year. Begin your reporting period by October 3rd to geton the path to payment for CY 2011.

LookingAhead

Take a look at all of the other EHR Incentive Program important dates that arecoming up by going to our CMS Medicare and Medicaid EHR Incentive ProgramsMilestone Timeline, or reviewing the “Important Dates” section ofthe EHR Incentive Programs’ Overview page.
Wantmore information about the EHR Incentive Programs?Makesure to visit the CMS EHR Incentive Programs website for the latestnews and updates on the EHR Incentive Programs.

Only 15 Percent of Healthcare Executives are "Very Familiar" with ACOs

2011-09-23T03:56:00.000-07:00

By:

Chris Anderson

The 2011 Accountable Care Organization (ACO) Readiness Study released recently by Beacon Partners shows that only 15 percent of healthcare executives are “very familiar” with ACOs. Nonetheless, more than half surveyed said they are moving ahead with plans for ACOs.

“Clearly, there is still a lot of confusion and uncertainty surrounding ACOs, but most healthcare organizations understand that they need to move forward with an ACO strategy,” says Kevin Burchill, director at Beacon Partners in a press release. “This is most likely due to the fact that many C-level executives are optimistic regarding the potential benefits that an ACO model will provide to their organization.”

The study found that 62 percent of healthcare executives were “somewhat familiar” with ACOs and – even though there was still a high level of uncertainty and many didn’t have a high level of familiarity with the ACO concept – 92 percent of respondents said they are either in development or in the pre-planning stages for their own ACO. This marks a significant jump from a study by Beacon released earlier this year that showed only 47 percent of healthcare organizations were in the planning and development stages.

Healthcare organizations are going to need to becoming much more conversant in exactly what an ACO is and what its benefits are in order to successfully promote the concept, Burchill noted.

“It’s crucial for the industry to improve upon their communication of an ACO’s structure, rules and benefits, otherwise there will continue to be some level of negativity surrounding ACOs,” he said.

Other findings in the report include:

45 percent of those surveyed have not committed money from their operating budgets to ACO planning efforts and 27 percent are unsure what their budget is for ACO planning
49 percent of respondents named their CEO as the person responsible for ACO development
53 percent of respondents have not yet created a department or executive role to develop an ACO
44 precent of respondents have no plans to hire personnel to handle ACO development, and another 25 percent plan to reallocate existing personnel
48 precent of respondents are unsure as to how an ACO will affect their organization
31 percent of respondents listed undefined rules and confusion of ACO structure as their top concern in the market, followed by high start-up costs (17 precent) and regulatory issues (14 precent)

“Perhaps none of this should be surprising given that ARRA and PPACA regulations have challenged providers to move forward without the benefit or clarification of final rules and regulations,” Beacon noted in the report’s executive summary. “Nor should it surprise that this confusion has also led to uncertainty about how to communicate ACO developments to their patients.”

Materials from CMS' National Provider Calls Now Available Online

2011-09-22T08:58:00.000-07:00

Take a Look at the Transcripts, Presentations, and Audio Filesfrom Two National Provider Calls on the EHR Incentive Programs

Materialsfrom two of this summer’s National Provider Calls are now online!

CMS’ NationalProvider Call on July 14, 2011, “Medicare & Medicaid EHR Incentive Program Basics forEligible Professionals,” provided basic information on the IncentivePrograms for eligible professionals, and answered the following questions:

Who is eligible?
How much are the incentives and how are they calculated?
How does one get started?
What are major milestones regarding participation and payment?
How does one report on meaningful use?
Where can helpful resources be found?

CMS’National Provider Call on August 18, 2011, “Medicare & Medicaid EHR Incentive Program:Understanding Meaningful Use,” provided information about themeaningful use requirements of the EHR Incentive Programs, and covered thefollowing topic areas:

Defining "meaningful use"
The requirements for Stage 1 of meaningful use (2011 and 2012)
Attestation for meaningful use
Goals of the Meaningful Use Objectives Specification Sheets

Stage 1 EHR Meaningful Use Specification Sheets for Eligible Professionals
Stage 1 EHR Meaningful Use Specification Sheets for Eligible Hospitals

Question & answer session

Materialsfrom these calls are now available, and include each of the call’spresentations, transcripts, and audio recordings. Materials from both of thesecalls can be found under the Presentations for Providers section on the Educational Materials page of the CMS EHRWebsite.

Wantmore information about the EHR Incentive Programs?

Make sure to visit the Medicare and Medicaid EHR Incentive Programs websitefor the latest news and updates on the EHR Incentive Programs.

CMS will create ACO claims, provider database

2011-09-22T02:29:00.001-07:00

The Centers for Medicare and Medicaid Services will create a database containing the health information of Medicare beneficiaries who receive treatment with providers participating in an accountable care organization.

CMS said it will use the data collection to support policy activities and reimbursement for its programs to bundle payments and share savings.

Besides Medicare beneficiaries, the database will contain personally identifiable information about certain individuals participating in the ACOs, including healthcare sole proprietors, providers, key leaders and managers of ACOs and contact persons.

Some of the information could be patient claims number, which could incorporate a Social Security Number, address and date of birth, or ACO eligibility and contact records, including the home address of a key leader or manager; or ACO participant tax identification number, according to an announcement in the Sept. 19 Federal Register. The database will become effective Oct. 19. The public may comment on it until then.

Federal agencies must report when they intend to establish a new system with personally identifiable information and assure safeguards against its disclosure for other than its stated uses, including determining the eligibility of ACO applicants, to meet quality and other reporting requirements, under the Privacy Act.

“Relevant HHS personnel, and any CMS contractors, grantees and consultants assisting them, will use personally identifiable information from this system on a ‘need to know’ basis,” the notice said.

The Medicare Shared Savings Program aims to reward quality care and takes steps toward paying for quality and efficient care by promoting accountability for a patient population and coordinates inpatient and ambulatory services and encourages investment in health IT and redesigning care processes. Under the Pioneer ACO Model, up to 30 provider organizations will test alternative payment models that include escalating financial accountability and arrangements based on outcomes in quality and patient experience.

The programs are designed to carry out new delivery and reimbursement provisions under the Patient Protection and Affordable Care Act.

Providers seek vendor help with ACOs

2011-09-21T11:39:00.000-07:00

By: Mike Miliard

As health organizations begin to feel their way toward accountable care models, a new report from KLAS explores how providers and vendors are putting the pieces together, finding varying levels of confidence in IT solutions' integration ability.

For the new report, titled "Accountable Care: Providers Forge the ACO Trail," KLAS interviewed 197 providers at 187 organizations to get a picture of how they're approaching accountable care – and how health IT tools are helping (or hindering) their efforts.

The accountable care organization (ACO) is a care delivery model where groups of healthcare providers take collective responsibility for managing patients' long-term continuum of care. ACOs that cut care costs without missing quality targets receive a portion of the savings.

While only a third of providers surveyed by KLAS plan to pursue a formal Medicare ACO designation, the majority agree that accountable care is the way of the future.

"Accountable care will touch every aspect of an organization," said Jason Hess, author of the report. "Its changes have the potential of turning the healthcare world upside down – from patient care to administration to revenue cycle management to IT infrastructure. The internal challenges appear endless. Unfortunately, planning an ACO is further complicated by the fact that the final government rules have not yet been published."

There are no one-stop shops for providers' ACO IT needs, says Hess, especially since each ACO will be different. Many providers are looking to leverage a combination of technology solutions to fill in the gaps and meet ACO requirements. That said, providers see some vendors are more prepared than others – with the most integrated rising to the top.

Top-tier healthcare vendors Cerner and Epic currently lead the way in provider confidence as being most ACO-ready, according to the KLAS report. Despite a few integration and offering gaps, Cerner has already integrated many of the IT pieces needed to complete an ACO puzzle and is taking a proactive approach to working with individual needs of interested providers.

Epic is also perceived as being close to ACO-ready, the survey finds, with gaps found primarily in their analytic capabilities and their ability to share data with non-Epic systems.

The KLAS report also examines provider perceptions of ACO readiness for Allscripts (Eclipsys), CPSI, GE Healthcare, McKesson, MEDITECH, QuadraMed and Siemens.

"Providers describe a variety of planned HIT purchases for their ACO projects - including data warehousing and analytics, HIE and patient portals," said Hess. "Vendors whose offerings integrate best with providers' in-house systems will top the selection lists going forward."

To learn more about this report, visit KLASresearch.com/reports.

Obama Deficit Plan Has Medicare Provider, Beneficiary Cuts

2011-09-20T13:21:00.000-07:00

September 19, 2011 — A deficit-reduction plan unveiled by President Barack Obama today would wring $248 billion in savings from Medicare over 10 years, in part by cutting special payments to rural physicians and hospitals, requiring prior authorization for expensive imaging services, and reducing support for teaching hospitals.

Another $72 billion in savings would come from Medicaid and other healthcare programs.

In all, the president's plan would trim the deficit by more than $3 trillion through a mix of spending cuts and tax hikes that follow the so-called Buffet Rule (suggested by billionaire Warren Buffett): People making more than $1 million should not have lower tax rates than the middle class. Obama's proposed surgery on the deficit comes on top of roughly $1 trillion excised by the federal debt-ceiling deal in August.

The new proposal will become fodder for Congress and its newly appointed Joint Select Committee on Deficit Reduction, also known as the "super committee." That bipartisan group was tasked by the debt-ceiling legislation to find $1.5 trillion in additional savings that Congress must enact by December 23. Given that Congressional Republicans, who control the House and have enough votes in the Senate to filibuster, have announced stony opposition to tax increases, the Obama plan faces a tough, if not impossible, going.

President Barack Obama called for new deficit cuts of $3.0 trillion.
Nicholas KAMM/AFP/Getty Images

However, the president has signaled he will play hardball on the tax issue. He warned today that he would veto any deficit-reduction package that reduces Medicare benefits for seniors but fails to "raise serious revenues" from the wealthiest Americans and biggest corporations.

"We are not going to have a one-sided deal that hurts the folks who are most vulnerable," Obama said today.

Program Cuts Called Modest

The Obama administration characterizes the $320 billion in cuts to Medicare and Medicaid as both modest and necessary for the long-term viability of the programs. Physicians would feel their nick in a number of ways:

Medicare traditionally has paid physicians and hospitals in underserved rural areas a little extra, but these payments "may be greater than necessary to ensure continued access to care," according to the Obama administration. It therefore wants to end an "add-on payment" for physicians and hospitals in certain low-population states in 2013.
The dramatic growth of Medicare spending for imaging services has led some experts to question whether such scans are always necessary or reasonably priced. Accordingly, the Obama administration would require prior authorization for the most expensive imaging services, beginning in 2013, along with lower reimbursement for them.
As part of an initiative to reduce improper Medicare payments, the administration would penalize providers who fail to update their enrollment information.
Residency training programs could experience pain under a proposal to reduce Medicare subsidies for teaching hospitals, saving $9 billion over 10 years. The subsidies exist because teaching hospitals, by their very nature, are less efficient, and are therefore costlier to operate. However, the administration believes current subsidy payments exceed the extra costs that these hospitals incur by training residents.

The quest for Medicaid savings would target high prescribers. The government wants to require states to track Medicaid drug claims for signs of waste, fraud, and abuse, and prevent it from happening in the first place.

Deductibles, Premiums Would Increase for Some Beneficiaries

Medicare belt-tightening in the president's proposal affects beneficiaries, as well as providers:

Beneficiaries who are already paying higher Medicare Part B and Part D premiums on account of their high income would pay 15% more beginning in 2017.
The annual deductible for Medicare Part B would increase by $25 in 2017, 2019, and 2021 for new beneficiaries. The idea here is to motivate seniors to seek "high-value healthcare services"; that is, good care at a lower price.
Also in 2017, beneficiaries would begin to owe a $100 copayment for home-health episodes with 5 or more visits that are not preceded by a hospital stay.
The government has determined that seniors who purchase MediGap policies to pay for costs not covered by Medicare — copays, for example — tend to use more healthcare services, driving up Medicare spending. The administration proposes to add a hefty surcharge to Medicare Part B premiums in 2017 whenever beneficiaries buy a MediGap policy that subjects them to little if any cost-sharing. Presumably, the surcharge would discourage seniors from obtaining such generous MediGap policies.

To apply the brakes even more to Medicare spending, Obama today reiterated an earlier proposal to strengthen a creation of the new healthcare reform law, the Independent Payment Advisory Board (IPAB). The job of the IPAB is to counsel Congress on how to slow down Medicare spending if it exceeds growth-rate targets set by the law. If Congress does not implement what the IPAB recommends, it must come up with its own cost-cutting plan, or else let the Department of Health and Human Services devise one.

In 2018, the IPAB target is growth in the gross domestic product plus 1%. Obama wants to make it gross domestic product growth plus 0.5%.

The American Medical Association and other medical societies view the IPAB with hostility because it represents an additional threat to physician revenue. Many Congressional Republicans have advocated repealing the IPAB, saying that it will ration healthcare for seniors, even though the Affordable Care Act prohibits the board from increasing beneficiary premiums or cost-sharing, or restricting benefits.

Deficit-Reduction Math Factors in Doc Fix

The American Medical Association quickly identified at least one thing it liked about the administration's deficit-reduction plan: Obama's numbers assume passage of a "doc fix" to the Medicare reimbursement crisis created by the program's sustainable growth rate formula for setting physician pay. That formula will trigger a 29.5% reduction in Medicare rates on January 1 unless Congress acts to avert it.

Current federal budget projections assume this massive reduction will occur. Repealing the sustainable growth rate and freezing Medicare rates for 10 years would cost $300 billion, which is an amount that must be factored into deficit-reduction math, the Obama administration said. "Failure to do so simply masks the worsening long-run deficit."

In a press release today, American Medical Association President Peter Carmel, MD, commended the president for recognizing that deficit reduction must take sustainable growth rate repeal into account.

Medicare Payment Advisory Commission (MedPac) doc fix doesn't impress

2011-09-20T04:04:00.000-07:00

By:

Stephanie Bouchard

The Medicare Payment Advisory Commission is proposing to fix the Sustainable Growth Rate by sharing the cost of repealing the SGR among physicians, other health professionals, providers in other sectors and beneficiaries. The response from those in the industry has been less than supportive.

MedPAC, a body that advises Congress on Medicare payment policy, presented a draft of its proposal last week. In it, MedPAC said its SGR repeal would cost about $200 billion. To pay for its repeal plan, MedPAC suggests instituting a 10-year payment rate freeze for primary care physicians and three years of reduced payments at 5.9 percent each for specialists followed by a seven-year payment freeze. It also recommends offsets totaling about $235 billion. Those offsets would come from cuts to Medicare Part D drug plans (32 percent); post-acute care facilities (21 percent); Medicare benefits to seniors (14 percent); hospitals (11 percent); laboratories (9 percent); durable medical equipment (6 percent); Medicare Advantage (5 percent); and others (2 percent).

“While we fully appreciate the need to correct problems in the Medicare payment system for physicians, we are deeply concerned that this MedPAC outline to address the so-called 'doc fix' disproportionately targets the (skilled nursing facility) sector – and the net impact of these proposed Medicare cuts would place seniors' care at deep risk, jeopardize jobs across America and further destabilize the nation's second largest health facility employer," said Alan G. Rosenbloom, president of the Alliance for Quality Nursing Home Care in a statement.

“… As we have in the past, we will continue to insist today that the U.S. Congress should make its Medicare funding decisions based upon the complete set of funding variables and economic realities facing skilled nursing facilities, our patients and our workforce,” he added. “This MedPAC outline inherently fails to recognize these realities."

Organizations representing physicians are balking at the proposed cuts and freezes to physician payment rates. In a statement, the American College of Surgeons praised MedPAC for recognizing the need to eliminate the SGR but the organization criticized the commission for undervaluing the role of physicians.

“Unfortunately, while the MedPAC recommendations being considered do eliminate the SGR, they fail to meet the goal of quality and further jeopardize access to care,” reads ACS’ statement. “The recommendations do not value the role all physicians have in the continuum of care and would have a devastating impact on access to surgical care.”

“We do not believe that cuts are the answer,” ACS’ statement continues. “We believe that a replacement of the SGR needs to be created that leverages quality, bends the cost curve, pays down the SGR debt and incentivizes value in the future. Over the next several years, the cost of caring for the frail and elderly will place an enormous strain on the country's healthcare resources. As a result, the ACS supports redesigning the delivery system to meet this critical demand by applying a shared savings model centered around quality and value incentivizing all physicians to adopt better practices.”

Follow HFN associate editor Stephanie Bouchard on Twitter @SBouchardHFN.

Removal of Online Malpractice Data Sparks Outcry

2011-09-19T11:50:00.001-07:00

September 17, 2011 — Journalists and consumer groups are calling on a federal agency to reverse its decision to remove a public data file on payments in medical malpractice cases and clinician disciplinary actions from the National Practitioner Data Bank (NPDB)Web site.

The Health Resources and Services Administration (HRSA), which operates the NPDB, removed the file from the Web site on September 1 after news organizations such as the Kansas City Starmanaged to use it to identify physicians frequently accused of malpractice who went undisciplined by state medical boards. The NPDB data does not include physician names or addresses, but journalists have traced the data to individuals by piecing it together with other data sources.

"Federal law mandates that information about individual physicians remains confidential," HRSA spokesperson Martin Kramer told Medscape Medical News. "We have a responsibility to make sure federal law is being followed."

Individual researchers can still access the malpractice data by contacting the NPDB, and HRSA may post it online again after the agency figures out how to prevent clinicians, patients, and healthcare organizations from being outed. That deliberation will take at least 6 months, according to HRSA.

In the meantime, a group called Investigative Reporters & Editors has posted a copy of the file — downloaded from the NPDB Web site in August — on its own Web site.

The IRE along with the Society of Professional Journalists and the Association of Health Care Journalists sent a letter to HRSA Administrator Mary Wakefield on September 15 asking her to repost the so-called Public Use Data File on the NPDB Web site.

"The Public Use (Data) File...provided invaluable information about the functioning of state medical boards and hospital disciplinary systems," the letter stated. "Reporters for years have used the data to identify flaws in their states' regulatory systems that have led to patient harm. As a result of these stories, states have enacted new legislation and medical boards have taken steps to investigate problem doctors."

The journalism associations also said they disapproved of an intimidating letter that HRSA sent to Kansas City Star reporter Alan Bavley about a story that he was researching with the help of NPDB information about a much-sued neurosurgeon. That news story was published on September 3.

AMA Applauds Removal of Online Malpractice Data

Other groups that have demanded the reposting of the malpractice data include Consumer Union, the publisher ofConsumer Reports; and the watchdog group Public Citizen. The groups wrote in separate letters to HRSA that its decision to take the information off the NPDB Web site runs counter to a push for more transparency within the Department of Health and Human Services and other government agencies.

One group that applauded HRSA's action is the American Medical Association (AMA), which considers the NPDB an unreliable source of information about the overall qualifications of physicians.

"The AMA has long opposed public access to the National Practitioner Data Bank and welcomes the decision to stop posting its public data file online to prevent breaches of physician confidentiality in the future," AMA President Peter Carmel said in a written statement. "Duplicate entries, inaccurate data, and inappropriate information in the NPDB provide, at best, an incomplete and haphazard indicator of a physician's competence or quality."

Congress created the NPDB in 1986 to give hospitals, insurers, state medical boards, and other government entities a way to check up on physicians, dentists, and other licensed healthcare professionals. The Public Use Data File contains information reported to the NPDB on such matters as:

Payments in medical malpractice cases (settlements as well as jury awards)
Adverse actions on licensure, clinical privileges, and membership in professional societies
Adverse actions taken by the Drug Enforcement Administration
Exclusion from Medicare and Medicaid
Criminal convictions

In the past, the online file had been updated quarterly, but Public Citizen complained in its letter to HRSA that, earlier this year, updates "have not been posted in a timely fashion."

Medicaid plans can expect more fraud, overpayments scrutiny

2011-09-19T06:37:00.000-07:00

By: Mary Mosquera, senior editor

Medicaid health plans will need to pay more attention to waste, abuse and fraud as federal and state agencies step up scrutiny to cut incorrect payments and reduce costs.
Medicaid plans can expect to increase screening of hired or contracted professionals brought into their healthcare networks, inspect for overpayments and recoveries, and work with new fraud investigations by the states.
“State fines and penalties have concentrated on Medicaid contract compliance but not regulatory compliance,” said Stuart Freedman, compliance director of Molina Healthcare of Washington, at a Sept. 15 conference sponsored by America’s Health Insurance Plans.
The health reform law also makes provisions for more anti-fraud activities related to Medicaid. As part of that, the Health and Human Services Department released Sept. 14 its final rule to develop a Medicaid recovery audit contractor (RAC) program, similar to one for Medicare, which will rely on states to procure contracts to establish a system to detect fraud and handle overpayments.
Nobody knows how much fraud is in the healthcare system, said Louis Saccoccio, executive director of National Health Care Anti-Fraud Association and a former prosecutor. In 2010, HHS estimated $70 billion in improper payments, including fraud, in Medicare and Medicaid.
“If you’re in the fraud business and you’re looking for an area where you can potentially make a lot of money, health care has it. There are organized crime or enterprise crime groups, not just Mafia, that want to get in on it,” he said.
Earlier this month, an interagency fraud strike force under HHS and the Justice departments broke up Medicare scam operations in eight cities, resulting in charges against 91 individuals, including physicians, whose schemes involved $295 million in false billing.
Saccoccio said it’s important for Medicaid managed care plans to develop a relationship with their state Medicaid fraud control units to go after fraud and share information.
Information sharing and data analysis are especially important because there is not an all-claims database for health care like in the property and casualty lines of insurance.
“You need to be sharing data with investigators, and the investigators need to be talking with you. Data analytics is critical, and once you get information from the tools you are using, you need to share that information,” Saccoccio said.
Among anti-fraud tools, he recommended using:
Predictive modeling, which is more effective than fraud detection systems because the perpetrators are becoming more sophisticated
Geographic data to identify members who travel often and great distances to see particular providers
Social networking sites to help with investigations
Subscriber pictures and thumbprints on Medicaid cards for identification, better security around enrollees’ identity
The Centers for Medicare & Medicaid Services is continually intensifying its efforts to reduce incorrect payments througha varied of initiatives including increasing law enforcement efforts against fraud, applying sophisticated methods and technology to root out suspicious activities before payments go out the door and sharing information with states, other federal agencies and healthcare fraud units.
While most of these tools have been targeted at rooting out Medicare fraud, CMS will now also target Medicaid fraud, said Dr. Peter Budetti, CMS deputy administrator and director for the Center for Program Integrity.
“We will always be doing pay and chase. Our law enforcement colleagues say we can’t prosecute our way out of this. We have to prevent this. We want to get those guys when they’re at $30,000, not $300 million,” he said.
Freedman offered a number of controls that managed care plans should establish, measure and report to reduce the risk of fraud, including:
standards or code of conduct and policies in place about how the organization conducts business and communicate it with partners, contractors and employees.
governing authority or board of directors that tackles issues, with a committee that deals with compliance, and an organization compliance officer with a direct line to the president or CEO.
training and education, including basic employee training, ongoing and advanced training as rules change, and specialized training for those who handle claims and provider network areas.
audit and monitoring of compliance plan, including reporting audits to board and re-audit after correcting any problems. Engage leadership about what keeps them up at night and what might reduce the risk and monitor that.
discipline and screening-Even with credentialing process, frequently check employees, network providers and contractors. Establish policies to address fraudulent activity.
detection and corrective action. Employ investigative log to track detection through correction. Build rules-based edits into the front end of the system to assure claims accuracy before payment.

CMS puts on steam to meet 5010, ICD-10 deadlines

2011-09-18T15:10:00.000-07:00

All of a sudden, the Centers for Medicare and Medicaid Services (CMS) is putting pressure on the healthcare industry to comply with the Jan. 1, 2012 deadline for switching to the HIPAA 5010 transaction set and the Oct. 1, 2013 deadline for the changeover to the ICD-10 diagnostic code set.

CMS is doing this in the most benign manner by providing a series of "widgets" to help the industry make the transitions. Essentially a series of project management timelines for large providers, small providers, payers, and vendors, these widgets can be printed out as PDFs, downloaded to a desktop or mobile device, or shared via websites.

While the timelines start where providers should have been on Jan. 1, 2011, they also include goals for three months, two months, and one month before the 5010 deadline. Of course, unless a hospital or a practice has already completed internal testing and started external testing by now, it is behind on that timeline.

Under the ICD-10 plan, CMS envisions that by early next year, healthcare systems will begin training their staffs and be ready to start internal testing. They are supposed to start external testing in fall 2012. The following spring, CMS says, they should conduct intensive training for their coders. In summer 2013, they should complete external testing and begin the transition from ICD-9 to ICD-10 so they'll be ready to switch over entirely to ICD-10 by October.

CMS also has taken a couple of other steps to prepare for these major administrative changes. Last week, the agency selected 3M's ICD-10 Code Translation Tool to convert its own systems, applications and reports to the new codes. And it also recently declared a HIPAA 5010 Testing Week.

One could interpret all of this activity as a signal that CMS is not planning to postpone its deadlines. On the other hand, it could be an acknowledgment that the industry isn't coming to heel fast enough.

White House Declares National Health IT Week

2011-09-15T14:38:00.001-07:00

Celebrate National Health IT Week by Making EHRs Part of YourPractice

In a proclamation on Monday, President Obamadeclared the week of September 11 – 17 as National Health InformationTechnology Week.

In hisproclamation, President Obama spoke about how health IT connects doctors andpatients to more complete and accurate health records and how tools like EHRsand electronic prescriptions help patients and providers make safer, smarterdecisions about health care. By providing financial incentives to thoseproviders who successfully meet meaningful use of certified EHRs, CMS hopes toencourage providers and hospitals to adopt this technology.

Providersare already beginning to see the benefits of using EHRs. Recently, CMSinterviewed providers at a Delaware Meaningful Use Recognition Ceremony on howEHRs are positively affecting their practices. Dr. Jerome Abrams, a doctor ofFamily Medicine from Delaware, whose practice successfully attested to meetingmeaningful use, said that EHRs have allowed his practice “to captureinformation on patients a lot more efficiently and a lot more completely.”

Over90,000 providers and hospitals have registered for the Medicare and MedicaidEHR Incentive Programs, and over $652 million has been paid to providers andhospitals that have successfully demonstrated meaningful use.

If youare interested in learning more about the Medicare and Medicaid EHR IncentivePrograms or would like to find resources to help you register and attest tomeeting meaningful use, visit the CMS EHR website.

Wantmore information about the EHR Incentive Programs?Makesure to visit the Medicare and Medicaid EHR Incentive Programs websitefor the latest news and updates on the EHR Incentive Programs.

Judge Blocks Florida 'Gag Law' on Physicians’ Gun Questions

2011-09-15T13:11:00.001-07:00

September 14, 2011 — A federal judge in Miami, Florida, today issued a preliminary injunction against a Florida law that prohibits physicians from asking patients if they own a gun, saying that it infringes on their constitutional right to free speech.

The Florida law, enacted earlier this year, bans inquiries regarding firearms ownership, recording the answers in a patient's chart, "unnecessarily harassing" gun owners, or turning away patients who refuse to answer gun questions. There is an exception for questions about firearms if a clinician believes "that this information is relevant to the patient's medical care or safety, or the safety of others." However, critics say physicians are afraid of claiming this exception because the criteria for relevance are not spelled out.

Medical societies in Florida that challenged the law in federal court counter that they are obliged to broach the subject of guns so they can counsel patients about safe-storage practices and prevent accidental shootings, especially of children. The American Medical Association had supported the Florida physicians in their lawsuit.

In her ruling today, which blocks enforcement of the Florida statute, US District Court Judge Marcia Cooke wrote that the case "concerns one of our Constitution's most precious rights — the freedom of speech." Cooke stated that Florida physicians were "self-censoring themselves" out of fear that they would be disciplined for supposedly violating the law.

"Plaintiffs’ injury," she wrote, "is their chilled free speech."

The National Rifle Association (NRA) had lobbied on behalf of the law, which it deems a defense of the Second Amendment right to bear arms. It views an antigun agenda behind firearm questions from physicians and claims some have harassed gun owners and dropped at least one as a patient.

Cooke, however, ruled that the litigation before her did not involve the Second Amendment because physician questions and statements about gun ownership do not interfere with anyone owning firearms. She also noted that the state legislature had relied heavily on anecdotal information about gun conversations between physicians and patients as opposed to "studies, research, and statistics."

Medscape Medical News contacted the NRA and asked to speak to Marion Hammer, the group's lobbyist in Florida, about the judge's ruling. An NRA spokesperson said Hammer would issue a comment once she had finished studying the decision.

The Florida medical societies and individual physicians who had sued the state in federal court over the law applauded Cooke's ruling.

"Pediatricians simply want to do what they do best: Protect children," said Lisa Cosgrove, MD, president of the Florida chapter of the American Academy of Pediatrics, in a press release. "We hope that now we will be able to get back to working with parents to maintain their guns, pools and poisons to keep kids safe."

"Reversing this law is essential in order to preserve the sanctity of the doctor-patient relationship by keeping the government out of the exam room," added Stuart Himmelstein, MD, a governor of the Florida chapter of the American College of Physicians.

CMS Releases Medicaid RACs Final Rule

2011-09-15T09:19:00.001-07:00

In February, the Centers for Medicare and Medicaid Services (CMS) delayed its expected April 1 implementation of the Medicaid recovery audit contractors (RACs) final rule until an unspecified time later this year.

That unspecified date became Wednesday: CMS released its Medicaid RACs final rule.

The new initiative, modeled after the Medicare RAC program, aims to fight waste and fraud in Medicaid and will save taxpayers an estimated $2.1 billion over the next five years, according to a press release from the Department of Health and Human Services (HHS). About $900 million will be returned to states.

“Today we are building on an already successful program that targets improper payments in our healthcare programs and recovers those dollars, making Medicare and Medicaid more reliable and responsible,” HHS Secretary Kathleen Sebelius said today's press release. “We simply can't afford to see even one penny of our healthcare dollars wasted and expanding this program will help us reach that goal."

The rule itself implements section 6411 of the Affordable Care Act and provides guidance to individual states related to federal/state funding of state start-up, operation, and maintenance costs of Medicaid RACs, and the payment methodology for state payments to Medicaid RACs, according to the rule.

Editor's note: Click here to access the Medicaid RACs final rule.

Organized Medicine Defends Top Pay for US Physicians

2011-09-13T13:21:00.001-07:00

September 13, 2011 — Several leaders of organized medicine have responded to a new article reporting that US physicians charge more and earn more than their international colleagues by saying that higher pay is necessary to draw the best candidates to the profession.

"If you want to attract the best and the brightest, you need to pay them enough," said Kevin Bozic, MD, MBA, a spokesperson for the American Academy of Orthopaedic Surgeons, in an interview withMedscape Medical News.

"It's why people in the Middle East, when they have a serious illness, come to the Mayo Clinic or the Cleveland Clinic," added William Jessee, MD, president of the Medical Group Management Association. "The feeling is...the expertise is here. The compensation has attracted the best and the brightest."

An article published in the September issue of Health Affairs found that US primary care physicians and orthopaedic surgeons charge higher fees than their counterparts in Australia, Canada, France, Germany, and the United Kingdom. In addition, US primary care physicians generally earn about a third more than their peers in these 5 countries, whereas US orthopaedists earn anywhere from 36% to 187% more, write political scientist Miriam Laugesen, PhD, who teaches at the Mailman School of Public Health of Columbia University in New York City, and Sherry Glied, PhD, a former Mailman colleague who now is the assistant secretary for planning and evaluation in the US Department of Health and Human Services.

One possible explanation for the earnings gap, write Dr. Laugesen and Dr. Glied, is a "broader US income structure." That is, "the share of income received by people in the top 1% of the US income distribution far exceeds the corresponding share in the comparison countries." As a result, physicians here occupy a lower rung on the income ladder than they do elsewhere, and alternative career paths are more lucrative, exerting upward pressure on physician pay.

"Their earnings reflect the cost of drawing highly skilled people to the profession in an economy where the rewards for skilled individuals are higher than elsewhere," the study authors write. That is also the line of reasoning taken up by Dr. Jessee and Dr. Bozic.

Greater Reward for Physician Skill and Time

The research by Dr. Laugesen and Dr. Glied set out to explain why the United States spends substantially more on physician services than other countries. That differential, they write, is far greater than the difference in total healthcare spending.

The authors focused on physician fees paid by both public and private payers for primary care office visits and hip replacements. They found that US primary care physicians received 27% more from public payers and 70% more from private payers for a standard office visit with an established patient. The fee differential for hip replacement was even higher, at 70% more with US public payers and 120% more with private ones.

Higher US practice costs do not fully account for higher fees because "net incomes vary about as much as fees do," according to the authors. Rather, higher fees also reflect greater rewards "for the skill and time of physicians."

In turn, higher physician income here does not appear to stem from a higher volume of services. And when the authors factored out what US physicians need to earn to pay off a heavier burden of educational debt, they found that US physicians still come out ahead financially.

These relationships lead Dr. Laugesen and Dr. Glied to conclude that "higher fees, rather than higher practice costs, volumes, or tuition expenses, are the main driver of higher US spending" on primary care office visits and hip replacements.

The authors restated that point in the study’s abstract, writing that higher fees are the main drivers of "higher US spending, particularly in orthopaedics." That wording led a number of leaders of organized medicine to protest that physicians should not take the rap for runaway health costs across the board, because physician services represent just a portion of them: 1 in 6 dollars, according to the American Medical Association.

"We question the conclusion that physician payment rates are driving our nation's healthcare costs," said American Medical Association President Peter Carmel, MD, in a statement.

In an email to Medscape Medical News, Dr. Laugesen explained that the study abstract's comment on "higher US spending" refers only to physician services.

"We Undervalue Primary Care"

In another set of comparisons, the authors found that US primary care physicians earn 42% of what orthopaedic surgeons earn, which is a wider gap than that in the 5 other countries (in Germany, primary care physicians receive nearly two thirds of an orthopaedic surgeon's income). Dr. Laugesen and Dr. Glied said policy makers in all countries need to consider how this pay differential pulls medical students toward specialty fields, as opposed to primary care.

Glenn Stream, MD, president-elect of the American Academy of Family Physicians, agrees. "The difference shows how much we undervalue primary care," Dr. Stream told Medscape Medical News.

The pay differential also caught the eye of the Medical Group Management Association's Dr. Jessee, who is a pediatrician.

"Primary care should be the cornerstone of our healthcare system," he said. "But economically, it's not in [anyone's] best interest to enter primary care."

Dr. Laugesen received financial support from the Robert Wood Johnson Foundation, and Dr. Glied received a grant from the Commonwealth Fund. This article was written before Dr. Glied's employment with US Department of Health and Human Services and does not reflect its official views.

Health Aff. 2011;30(9):1647-1656. Abstract

Will Debt Panel Tackle Medicare, Social Security?

2011-09-12T15:29:00.000-07:00

By Donna Smith

WASHINGTON (Reuters) Sep 08 - A new congressional "super committee" will face tough choices on politically popular government health and retirement programs as it tries to draft a plan to reduce deficits by at least $1.2 trillion over a decade.

The panel has until November 23 to make recommendations that the Senate and House of Representatives are to vote on by December 23.

Here are some questions and answers on Medicare, Medicaid and Social Security -- the biggest items in the federal budget not subject to annual appropriations by Congress.

WHAT'S THE PROBLEM?

In just one decade, the number of Americans drawing Social Security retirement benefits will jump to 71 million from about 55 million now. Spending for the popular government program will rise to $1.3 trillion from $726 billion this year.

At the same time, spending for the Medicare healthcare program for the elderly will rise to $966 billion by 2021 from $555 billion this year, according to the nonpartisan Congressional Budget Office. Federal spending for the Medicaid health program for the poor is projected to increase to $561 billion in 10 years up from $273 billion.

WILL THE COMMITTEE TACKLE THESE PROGRAMS?

That is the big question for financial markets as well as conservative and liberal groups who will be closely following deliberations. These programs are enormously popular among voters, but they are the largest items in the federal budget next to defense spending.

It is too early to say whether the six Democrats and six Republicans on the panel will address those programs. On the eve of the first meeting, Senator John Kerry, one of the Democrats on the committee, was asked about details of what would be addressed and said: "I think we'll all have a better sense after we get going tomorrow."

Many analysts believe the panel will leave Social Security for another time. Meanwhile Democrats have made clear they will not make concessions on Medicare and Medicaid as long as Republicans refuse to consider raising revenues by reducing tax breaks and loopholes or other tax increases.

WHY NOT TACKLE THESE ISSUES?

Compromising on basic party principles ahead of the November 2012 presidential and congressional election will be difficult if not impossible for panel members.

Republicans are campaigning for smaller government and want tax reforms to finance lower individual and corporate tax rates, not to cover the cost of existing programs. Democrats want to protect these programs for the elderly and poor and are railing against Republican proposals to privatize Medicare and limit federal oversight of Medicaid.

Most likely it will be left to voters next year to decide how the financial stresses facing these programs will be addressed. Senator Jon Kyl, a Republican member of the committee, Tuesday acknowledged the political realities facing the panel telling reporters that it would be "very, very hard" for committee members to "compromise our principles."

COULD THE COMMITTEE OFFER SWEEPING CHANGES?

The panel is being called the "super committee" because the August agreement that provided an increase in the $14.3 trillion debt ceiling gave it broad authority to seek at least $1.2 trillion in deficit reduction over the next 10 years.

They need to be worried about next year's elections. Disgust over the partisan vitriol that dominated the debt ceiling debate is fueling an anti-incumbent sentiment among voters that could upset both Republicans, who control the House, and Democrats, who control the Senate.

Meanwhile, financial market volatility over the debt crisis in Europe and nervousness about the lackluster U.S. economy could also spur panel members to take bold action.

WHAT COULD THEY DO?

It is unlikely the committee could undertake broad reform of Medicare, Social Security, Medicaid and the tax code by November 23. But they could propose some cost cutting measures as a down payment for bigger savings later on. It would be politically difficult, but it might help ease financial market concerns about U.S. debt.

If the panel does decide to tackle Social Security, raising the retirement age, which is set to rise to 67 under current law, is a possibility. Also raising the Medicare eligibility age, currently at 65, is also under consideration.

An idea that gained traction during debt limit negotiations was changing the annual inflation adjustment the government uses to calculate program benefits. Instead of the Consumer Price Index, a different measure would be used that takes into account consumers shifting choices when confronted with higher prices.

The CQM Webinar Presentation is Now Online

2011-09-09T14:00:00.001-07:00

View the Presentation from the August 30 CQM Webinar

OnAugust 30, CMS held a webinar to discuss the clinical quality measures (CQMs)and how to successfully report them during Stage 1 of meaningful use for theMedicare and Medicaid Electronic Health Record (EHR) Incentive Programs.

A PDFof the webinar presentation is now available online. Go to the Spotlight and Upcoming Event Section of theMedicare and Medicaid EHR Incentive Programs website to download thispresentation.

Thepresentation includes information on:

An overview of the CQMs
How to report CQMs during attestation
Why CQMs are included in the EHR Incentive Programs

Thewebinar also included an hour-long question-and-answer session with CMS subjectmatter experts. In the coming weeks, a transcript with all of these questionsand answers, along with a video of the webinar, will be made available online.

CMSplans to host another CQM webinar soon. Stay tuned for updates on how you canjoin this informational session.

Want more information about the EHR Incentive Programs? Make sure to visit the Medicare and Medicaid EHR Incentive Programs websitefor the latest news and updates on the EHR Incentive Programs.

Health Care Lobbyists Want Debt Committee to Fail

2011-09-08T13:48:00.001-07:00

By Tim Reid and Anna Yukhananov

WASHINGTON (Reuters) Sep 06 - The powerful healthcare industry hopes a congressional "super committee" tasked with slashing America's debt will fail and is lobbying instead for automatic spending cuts that will kick in if the panel deadlocks.

Much of the health sector believes the spending cuts, which will be triggered if the committee fails to find at least $1.2 trillion in savings over 10 years, will be less draconian than any deficit-reduction deal, according to lobbyists and healthcare groups interviewed by Reuters.

Under the trigger mechanism -- a process called sequestration -- automatic spending cuts of $1.2 trillion will begin in 2013. But programs such as the Medicaid healthcare program for the poor and the Social Security retirement program are totally protected from cuts, while Medicare, the healthcare program for the elderly, would face only a 2% cut to providers.

Chris Jennings, a former healthcare adviser to Democratic President Bill Clinton, said: "Virtually all healthcare stakeholders would prefer the sequester to take place rather than worry about the near inevitability of the super committee coming up with a package of deeper and broader cuts."

Mark Hayes, who lobbies on behalf of healthcare clients and is the former chief health counsel and health policy director for the Senate Finance Committee, said healthcare companies would actively push for the automatic spending cuts.

"The message will be communicated to their members of Congress, through all the usual channels including letters, town hall meetings, phone calls and personal meetings," he told Reuters.

The bipartisan committee, made up of six Republican and six Democratic lawmakers, was formed as part of an August deal to raise the U.S. debt limit. It meets for the first time on Thursday and must report by late November, but if it fails to reach agreement, or if Congress does not endorse its plan, the automatic cuts are triggered.

The healthcare industry has one of the most powerful lobbying forces in the United States.

Between 1999 and August 2011, the 12 lawmakers on the super committee collectively received more than $9.2 million in campaign contributions from the healthcare industry, according to a Reuters analysis of Federal Election Commission data compiled by watchdog group OpenSecrets.org.

"Sequestration is the devil you know and the super committee is the devil you don't," said Max Richtman, president and CEO of the National Committee to Preserve Social Security and Medicare, an advocacy group with 3.5 million members and supporters.

Richtman said he had spoken with some lobbyists who were planning on targeting Republican members of the committee to tell them not to "cave in" on their stance not to raise taxes. His organization was not planning to follow this strategy, however.

By persuading the Republicans not to compromise on taxes, "that will lead to stalemate" and thus the triggers, Richtman said. "They are talking about ways to induce stalemate.

"A lot of provider groups and healthcare groups would take a 2% cut to providers, no cuts to Medicaid and would find that much easier to live with."

One former Obama administration official told Reuters: "If I were a Democrat on the super committee I would not be too scared of the triggers."

But Republicans could be less susceptible to the healthcare industry's lobbying effort because the automatic spending cuts would pose a greater threat to the defense industry, a sector the party has traditionally championed.

Half of the $1.2 trillion in cuts will come from the defense budget.

As a result, the pressure is on Republican members of the committee to strike a deal, said Steve Bell, a former Republican staff director of the Senate Budget Committee who now works at the Bipartisan Policy Center, an independent Washington-based think tank.

"If a sequestration were to occur, in my judgment programs that the Republicans have tried to support, especially in national security, would be hurt more profoundly than safety net programs the Democrats have tried to support. Therefore there is much less incentive for most Democrats to give on entitlements or anything fundamental."

Some lobbyists contacted by Reuters agreed that many healthcare officials -- in addition to Democrats generally -- would rather see sequestration, but that actively lobbying for super committee failure was difficult.

"You cannot say to these members, 'don't do a deal,'" one lobbyist said on condition of anonymity. "But you can say that 2% is enough, this is how I would like the 2% to be cut.

"If you lobby the committee, your message is that we have already given almost $500 billion under President Obama's healthcare reforms. You go to the committee and say we have already given a lot, and more cuts will cause job losses."

Joe Baker, president of the Medicare Rights Center, said lobbyists for the big entitlement programs will be warning the super committee members about the political dangers of cutting Medicare, Medicaid and Social Security.

But he cautioned: "If you don't get a deal, sequestration might be fine for Medicaid, Medicare and Social Security but it deals a heavy blow to discretionary programs, that could include housing, transportation and meals, that many seniors and people with disabilities rely upon."

Board Certification Varies With Demographics, Education

2011-09-07T12:21:00.001-07:00

September 6, 2011 — Specific demographic and educational factors are associated with board certification of physicians. These include race and education debt, according to a study published in the September 7 issue of JAMA.

Certification by an American Board of Medical Specialties member board is an important credential, and it is becoming increasingly common. Previous studies have shown better outcomes in patients who are in the care of board-certified physicians, and health maintenance organizations, hospitals, and insurance plans use board certification as an evaluation tool for physicians.

Donna B. Jeffe, PhD, and Dorothy A. Andriole, MD, both from Washington University School of Medicine, St Louis, Missouri, investigated how demographic, medical school, and graduate medical education were associated with American Board of Medical Specialties board certification. They conducted a retrospective study of a national cohort of 42,440 medical students who graduated from US medical schools between 1997 and 2000. Participants were followed up through March 2, 2009.

Of the participants, 37,054 (87.3%) were board certified. The researchers found that board certification was associated with first-attempt passing scores in the highest tertile (compared with those who failed on the first attempt) on US Medical Licensing Examination Step 2 Clinical Knowledge. This trend held true in all physician categories. The lowest adjusted odds ratio (AOR) was found in emergency medicine (87.4% vs 73.6%; AOR, 1.82; 95% confidence interval [CI], 1.03 - 3.20). The highest was found for radiology (98.1% vs 74.9%; AOR, 13.19; 95% CI, 5.55 - 31.32).

Participants who self-identified as underrepresented racial/ethnic minorities had a lower likelihood of being board-certified — a trend that held for every physician category except family medicine. The percentage in pediatrics was 83.5% (vs 95.6% of whites; AOR, 0.44; 95% CI, 0.33 - 0.58). In other nongeneralist specialties, the percentage was 71.5% (vs 83.7% in whites; AOR, 0.79; 95% CI, 0.64 - 0.96).

Increased debt also had an effect. Among obstetrics/gynecology specialists, every $50,000 stepped increase in debt was associated with a lower likelihood of board certification (AOR, 0.89; 95% CI, 0.83 - 0.96) compared with those who had no debt. The reverse was true among family medicine specialists (ie, family practitioners with higher educational debt were more likely to be board certified; AOR, 1.13; 95% CI, 1.01 - 1.26).

The authors noted that the observational nature of the study makes it impossible to assign causal associations, and longer follow-up times may increase the rates of board certification. The results also cannot be applied to osteopathic physicians or students at international medical schools.

"Nevertheless, our findings can inform an understanding of factors contributing to US medical school graduates' advancement along the medical education continuum to board certification, an outcome of interest for medical school graduates, their patients, and the relevant professional organizations involved in undergraduate medical education, [graduate medical education], and board certification," the authors write.

The study was supported by the National Institutes of Health National Institute of General Medical Sciences. The authors received travel funds from the National Institutes of Health for meeting attendance. One author received an honorarium and travel reimbursement from the University of Cincinnati supporting a lecture on MD-PhD programs and their graduates.

JAMA. 2011;306:961-970.

Hear the Experts Discuss the EHR Incentive Programs

2011-08-31T12:51:00.001-07:00

Register Now for the Medicare & Medicaid EHR IncentivePrograms National Provider Call: Registration and Attestation for EligibleProfessionals

Hearthe Experts Discuss the EHR Incentive Programs

Date:Friday, September 9

Time:1:30-3:00 p.m. ETAgenda:During the call, CMS experts will discuss the following topics:

Path to Payment
Highlights of Registration and Attestation Processes
Third Party Proxy
Troubleshooting
Helpful Resources

Therewill also be a Q&A session where experts will address your questions andconcerns.

Registration:Register now for this informative session.Registration will close at 1:30 p.m. on September 8, or when available spacehas been filled. No exceptions will be made, so please register early.

PresentationMaterials: The presentation will be available prior to the call on the presentations section of the CMS EHR website.

Note: Hospital-basedeligible professionals (EPs) may not participate. An EP is consideredhospital-based if 90 percent or more of the EP's services are performed in ahospital inpatient or emergency room setting. Medicaid EPs must meet patientvolume criteria, providing services to those attributable to Medicaid or, insome cases, needy individuals. Visit the CMS EHR Incentive Program website for more information, includingMedicaid patient volume requirements.

Wantmore information about the EHR Incentive Programs?Make sure to visit the EHR Incentive Programs website for the latestnews and updates on the EHR Incentive Programs.