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CMS finalizes ‘flexibility’ in EHR meaningful use program
Physicians and hospitals will have more time to meet Stage 2 requirements under the federal government’s meaningful use program for the adoption of electronic health records.
Officials at the Centers for Medicare & Medicaid Services have been saying for months that they wanted to give physicians and hospitals greater flexibility in meeting the requirements of the EHR Incentive Programs, which offer bonuses for the "meaningful use" of certified EHR systems. The final rule cements a new timetable for Stage 2 of the program and allows providers to use older certified technology for longer, while vendors catch up with a backlog of demand.
Under the rule, the CMS officially extends Stage 2 of the program through 2016 for providers who were early adopters under the program, attesting to meaningful use in 2011 or 2012. Stage 3 of the meaningful use program will begin in 2017 for these providers, giving them an additional year to meet the more advanced requirements.
The rule also gives physicians more time to attest using older technology. Physicians can use the 2011 edition certified EHR technology or a combination of 2011 and 2014 edition certified product for the reporting period in 2014. All providers will be required to use 2014 edition certified products beginning in 2015.
But the American College of Physicians said the changes are "too little, too late."
Even with the increased flexibility to use older certified products, physicians will be able to attest for only Stage 1 until they have full access to 2014 edition certified technology, according to Dr. Peter Basch, chair of the ACP Medical Informatics Committee and the medical director for ambulatory EHR and health IT policy at MedStar Health in Washington. And that will impair their ability to prepare for Stage 2 attestation.
"Cut-over from their Stage 1 reporting configuration to their Stage 2 reporting configuration cannot be done overnight," Dr. Basch said. "Staffing and workflow changes take weeks, if not months, to accomplish."
And the new final rule does nothing to address other concerns raised by physicians. The American Medical Association has repeatedly called on the CMS to make more significant changes to the program, including lowering the threshold to earn incentives under the program. The AMA has urged the CMS to using a 75% pass rate as the standard for achieving meaningful use, as well as allowing physicians who meet 50% of meaningful use requirements to avoid financial penalties.
mschneider@frontlinemedcom.com
On Twitter @maryellenny
Physicians and hospitals will have more time to meet Stage 2 requirements under the federal government’s meaningful use program for the adoption of electronic health records.
Officials at the Centers for Medicare & Medicaid Services have been saying for months that they wanted to give physicians and hospitals greater flexibility in meeting the requirements of the EHR Incentive Programs, which offer bonuses for the "meaningful use" of certified EHR systems. The final rule cements a new timetable for Stage 2 of the program and allows providers to use older certified technology for longer, while vendors catch up with a backlog of demand.
Under the rule, the CMS officially extends Stage 2 of the program through 2016 for providers who were early adopters under the program, attesting to meaningful use in 2011 or 2012. Stage 3 of the meaningful use program will begin in 2017 for these providers, giving them an additional year to meet the more advanced requirements.
The rule also gives physicians more time to attest using older technology. Physicians can use the 2011 edition certified EHR technology or a combination of 2011 and 2014 edition certified product for the reporting period in 2014. All providers will be required to use 2014 edition certified products beginning in 2015.
But the American College of Physicians said the changes are "too little, too late."
Even with the increased flexibility to use older certified products, physicians will be able to attest for only Stage 1 until they have full access to 2014 edition certified technology, according to Dr. Peter Basch, chair of the ACP Medical Informatics Committee and the medical director for ambulatory EHR and health IT policy at MedStar Health in Washington. And that will impair their ability to prepare for Stage 2 attestation.
"Cut-over from their Stage 1 reporting configuration to their Stage 2 reporting configuration cannot be done overnight," Dr. Basch said. "Staffing and workflow changes take weeks, if not months, to accomplish."
And the new final rule does nothing to address other concerns raised by physicians. The American Medical Association has repeatedly called on the CMS to make more significant changes to the program, including lowering the threshold to earn incentives under the program. The AMA has urged the CMS to using a 75% pass rate as the standard for achieving meaningful use, as well as allowing physicians who meet 50% of meaningful use requirements to avoid financial penalties.
mschneider@frontlinemedcom.com
On Twitter @maryellenny
Physicians and hospitals will have more time to meet Stage 2 requirements under the federal government’s meaningful use program for the adoption of electronic health records.
Officials at the Centers for Medicare & Medicaid Services have been saying for months that they wanted to give physicians and hospitals greater flexibility in meeting the requirements of the EHR Incentive Programs, which offer bonuses for the "meaningful use" of certified EHR systems. The final rule cements a new timetable for Stage 2 of the program and allows providers to use older certified technology for longer, while vendors catch up with a backlog of demand.
Under the rule, the CMS officially extends Stage 2 of the program through 2016 for providers who were early adopters under the program, attesting to meaningful use in 2011 or 2012. Stage 3 of the meaningful use program will begin in 2017 for these providers, giving them an additional year to meet the more advanced requirements.
The rule also gives physicians more time to attest using older technology. Physicians can use the 2011 edition certified EHR technology or a combination of 2011 and 2014 edition certified product for the reporting period in 2014. All providers will be required to use 2014 edition certified products beginning in 2015.
But the American College of Physicians said the changes are "too little, too late."
Even with the increased flexibility to use older certified products, physicians will be able to attest for only Stage 1 until they have full access to 2014 edition certified technology, according to Dr. Peter Basch, chair of the ACP Medical Informatics Committee and the medical director for ambulatory EHR and health IT policy at MedStar Health in Washington. And that will impair their ability to prepare for Stage 2 attestation.
"Cut-over from their Stage 1 reporting configuration to their Stage 2 reporting configuration cannot be done overnight," Dr. Basch said. "Staffing and workflow changes take weeks, if not months, to accomplish."
And the new final rule does nothing to address other concerns raised by physicians. The American Medical Association has repeatedly called on the CMS to make more significant changes to the program, including lowering the threshold to earn incentives under the program. The AMA has urged the CMS to using a 75% pass rate as the standard for achieving meaningful use, as well as allowing physicians who meet 50% of meaningful use requirements to avoid financial penalties.
mschneider@frontlinemedcom.com
On Twitter @maryellenny
CDC: Time is running out to contain Ebola virus
Despite some signs of hope, the "window of opportunity" to contain and end the current Ebola virus outbreak in West Africa is shutting, causing the situation to worsen "significantly," according to officials at the Centers for Disease Control and Prevention.
"This is really the first epidemic of Ebola the world has ever known," Dr. Thomas Frieden, CDC director, said during a media briefing.
The prevailing belief, according to Dr. Frieden, is that the virus’s rapid spread is not due to mutation but instead to cultural and logistical obstacles.
"It’s not spreading in new ways, according to everything that we know," Dr. Frieden said. "It’s spreading through just two routes: people caring for other people ... and unsafe burial practices. ... That is really the Achilles’ heel. We know how it spreads; we know how to stop it. The challenge is to do that everywhere it is needed."
The Ebola virus is transmitted primarily through body fluids, but it also can be spread through contact with contaminated objects such as needles. Ebola is not spread through the air or by water.
Noting that rapid response is essential, and that data are lacking as to the actual numbers of those infected with the virus, Dr. Frieden outlined three key things that are needed to stem the epidemic: more resources; technical expertise in both health care management and logistics; and a coordinated global approach to ending the outbreak.
Dr. Frieden said it was a paradox that "the more the world isolates these countries, the harder it will be for them to control these outbreaks, the more cases there will be, and the less safe other countries will be. Like it or not, we’re connected."
The area currently experiencing outbreaks includes the countries of Guinea, Liberia, Sierra Leone, and Nigeria, with what Dr. Frieden said is a "dense, forested region that is the epicenter" located where the borders of all but Nigeria meet. The remote area is not serviced by radio or television and is rife with what Dr. Frieden called "misconceptions" about how the disease is transmitted.
"We can turn this around. Sometimes the problem can seem so large, it’s hard to get started, but we can chip away at the challenges, one by one," he said, inviting anyone with experience working in austere conditions, either as a health care provider or manager of an under-resourced facility, to consider volunteering his or her services, noting that the longer the crisis continues, the less stable the local communities will be.
In addition to nearly $20 million in aid from the U.S. Agency for International Development, for goods ranging from personal protection gear to resources for safer burials, the CDC will continue to support efforts by the World Health Organization (WHO) to contain the epidemic within the year, by deploying top CDC epidemic intelligence teams to help with tracking, treatment, and screening, he said.
The need for global coordination is not due to a lack of willingness from local officials and personnel to respond, according to Dr. Frieden.
"The countries are willing. In an Ebola treatment unit run by Doctors Without Borders, more than 90% of the staff are locals," Dr. Frieden said of one of the stops on his tour of West Africa. "Each of the presidents [of the affected countries] said the same thing to me: ‘Tell us what to do and we will do it. If we can’t do it, help us to do it. Teach us to care for Ebola patients and to manage the system more effectively.’ They need the world to work with them."
According to WHO, more than 1,400 patients have died of Ebola virus infection to date in this outbreak, making this the largest Ebola outbreak ever recorded. There are still "significant gaps in reporting in some intense transmission areas," and that the number of cases ultimately may top 20,000, according to WHO, which noted this outbreak has featured the infection and deaths of "an unprecedented number of health care workers."
There are no vaccines for Ebola approved by the Food and Drug Administration, although the National Institute of Allergy and Infectious Diseases currently is attempting to develop one.
As to treatments, ZMapp, a trio of monoclonal antibodies that was successfully used to treat two American health workers who were infected with Ebola, also has shown promise in a controlled trial with primates. According to ZMapp’s manufacturer, Mapp Biopharmaceuticals, the supply of the drug is currently exhausted and there is as yet no date for when more will be available.
On Twitter @whitneymcknight
Despite some signs of hope, the "window of opportunity" to contain and end the current Ebola virus outbreak in West Africa is shutting, causing the situation to worsen "significantly," according to officials at the Centers for Disease Control and Prevention.
"This is really the first epidemic of Ebola the world has ever known," Dr. Thomas Frieden, CDC director, said during a media briefing.
The prevailing belief, according to Dr. Frieden, is that the virus’s rapid spread is not due to mutation but instead to cultural and logistical obstacles.
"It’s not spreading in new ways, according to everything that we know," Dr. Frieden said. "It’s spreading through just two routes: people caring for other people ... and unsafe burial practices. ... That is really the Achilles’ heel. We know how it spreads; we know how to stop it. The challenge is to do that everywhere it is needed."
The Ebola virus is transmitted primarily through body fluids, but it also can be spread through contact with contaminated objects such as needles. Ebola is not spread through the air or by water.
Noting that rapid response is essential, and that data are lacking as to the actual numbers of those infected with the virus, Dr. Frieden outlined three key things that are needed to stem the epidemic: more resources; technical expertise in both health care management and logistics; and a coordinated global approach to ending the outbreak.
Dr. Frieden said it was a paradox that "the more the world isolates these countries, the harder it will be for them to control these outbreaks, the more cases there will be, and the less safe other countries will be. Like it or not, we’re connected."
The area currently experiencing outbreaks includes the countries of Guinea, Liberia, Sierra Leone, and Nigeria, with what Dr. Frieden said is a "dense, forested region that is the epicenter" located where the borders of all but Nigeria meet. The remote area is not serviced by radio or television and is rife with what Dr. Frieden called "misconceptions" about how the disease is transmitted.
"We can turn this around. Sometimes the problem can seem so large, it’s hard to get started, but we can chip away at the challenges, one by one," he said, inviting anyone with experience working in austere conditions, either as a health care provider or manager of an under-resourced facility, to consider volunteering his or her services, noting that the longer the crisis continues, the less stable the local communities will be.
In addition to nearly $20 million in aid from the U.S. Agency for International Development, for goods ranging from personal protection gear to resources for safer burials, the CDC will continue to support efforts by the World Health Organization (WHO) to contain the epidemic within the year, by deploying top CDC epidemic intelligence teams to help with tracking, treatment, and screening, he said.
The need for global coordination is not due to a lack of willingness from local officials and personnel to respond, according to Dr. Frieden.
"The countries are willing. In an Ebola treatment unit run by Doctors Without Borders, more than 90% of the staff are locals," Dr. Frieden said of one of the stops on his tour of West Africa. "Each of the presidents [of the affected countries] said the same thing to me: ‘Tell us what to do and we will do it. If we can’t do it, help us to do it. Teach us to care for Ebola patients and to manage the system more effectively.’ They need the world to work with them."
According to WHO, more than 1,400 patients have died of Ebola virus infection to date in this outbreak, making this the largest Ebola outbreak ever recorded. There are still "significant gaps in reporting in some intense transmission areas," and that the number of cases ultimately may top 20,000, according to WHO, which noted this outbreak has featured the infection and deaths of "an unprecedented number of health care workers."
There are no vaccines for Ebola approved by the Food and Drug Administration, although the National Institute of Allergy and Infectious Diseases currently is attempting to develop one.
As to treatments, ZMapp, a trio of monoclonal antibodies that was successfully used to treat two American health workers who were infected with Ebola, also has shown promise in a controlled trial with primates. According to ZMapp’s manufacturer, Mapp Biopharmaceuticals, the supply of the drug is currently exhausted and there is as yet no date for when more will be available.
On Twitter @whitneymcknight
Despite some signs of hope, the "window of opportunity" to contain and end the current Ebola virus outbreak in West Africa is shutting, causing the situation to worsen "significantly," according to officials at the Centers for Disease Control and Prevention.
"This is really the first epidemic of Ebola the world has ever known," Dr. Thomas Frieden, CDC director, said during a media briefing.
The prevailing belief, according to Dr. Frieden, is that the virus’s rapid spread is not due to mutation but instead to cultural and logistical obstacles.
"It’s not spreading in new ways, according to everything that we know," Dr. Frieden said. "It’s spreading through just two routes: people caring for other people ... and unsafe burial practices. ... That is really the Achilles’ heel. We know how it spreads; we know how to stop it. The challenge is to do that everywhere it is needed."
The Ebola virus is transmitted primarily through body fluids, but it also can be spread through contact with contaminated objects such as needles. Ebola is not spread through the air or by water.
Noting that rapid response is essential, and that data are lacking as to the actual numbers of those infected with the virus, Dr. Frieden outlined three key things that are needed to stem the epidemic: more resources; technical expertise in both health care management and logistics; and a coordinated global approach to ending the outbreak.
Dr. Frieden said it was a paradox that "the more the world isolates these countries, the harder it will be for them to control these outbreaks, the more cases there will be, and the less safe other countries will be. Like it or not, we’re connected."
The area currently experiencing outbreaks includes the countries of Guinea, Liberia, Sierra Leone, and Nigeria, with what Dr. Frieden said is a "dense, forested region that is the epicenter" located where the borders of all but Nigeria meet. The remote area is not serviced by radio or television and is rife with what Dr. Frieden called "misconceptions" about how the disease is transmitted.
"We can turn this around. Sometimes the problem can seem so large, it’s hard to get started, but we can chip away at the challenges, one by one," he said, inviting anyone with experience working in austere conditions, either as a health care provider or manager of an under-resourced facility, to consider volunteering his or her services, noting that the longer the crisis continues, the less stable the local communities will be.
In addition to nearly $20 million in aid from the U.S. Agency for International Development, for goods ranging from personal protection gear to resources for safer burials, the CDC will continue to support efforts by the World Health Organization (WHO) to contain the epidemic within the year, by deploying top CDC epidemic intelligence teams to help with tracking, treatment, and screening, he said.
The need for global coordination is not due to a lack of willingness from local officials and personnel to respond, according to Dr. Frieden.
"The countries are willing. In an Ebola treatment unit run by Doctors Without Borders, more than 90% of the staff are locals," Dr. Frieden said of one of the stops on his tour of West Africa. "Each of the presidents [of the affected countries] said the same thing to me: ‘Tell us what to do and we will do it. If we can’t do it, help us to do it. Teach us to care for Ebola patients and to manage the system more effectively.’ They need the world to work with them."
According to WHO, more than 1,400 patients have died of Ebola virus infection to date in this outbreak, making this the largest Ebola outbreak ever recorded. There are still "significant gaps in reporting in some intense transmission areas," and that the number of cases ultimately may top 20,000, according to WHO, which noted this outbreak has featured the infection and deaths of "an unprecedented number of health care workers."
There are no vaccines for Ebola approved by the Food and Drug Administration, although the National Institute of Allergy and Infectious Diseases currently is attempting to develop one.
As to treatments, ZMapp, a trio of monoclonal antibodies that was successfully used to treat two American health workers who were infected with Ebola, also has shown promise in a controlled trial with primates. According to ZMapp’s manufacturer, Mapp Biopharmaceuticals, the supply of the drug is currently exhausted and there is as yet no date for when more will be available.
On Twitter @whitneymcknight
FROM A CDC TELECONFERENCE
Hospitalist Ann Sheehy, MD, MS, FHM, Testifies Before Congress About Medicare
Twice in the past four months, Society of Hospital Medicine (SHM) member Ann Sheehy, MD, MS, FHM, found herself on Capitol Hill, testifying before Congressional committees focused on the U.S. healthcare system.
A physician at the University of Wisconsin (UW) School of Medicine and Public Health and a member of SHM’s Public Policy Committee, Dr. Sheehy was invited to speak about issues related to Medicare’s two-midnight rule, patient observation status, and the Recovery Audit Contractor (RAC) program.
These issues are “so important, and I am passionate about it,” Dr. Sheehy says. “I saw what was happening to patients and it just did not make any sense at all.”
Medicare’s two-midnight rule classifies most patients who stay in the hospital fewer than two midnights as outpatient or under observation. Observation status leaves patients on the hook for the costs of any chronic condition medications they receive in the hospital; additionally, patients under observation or considered outpatient are not eligible for skilled nursing facility (SNF) coverage.
SHM actively supports the Improving Access to Medicare Coverage Act, a bipartisan bill sponsored by Rep. Joe Courtney (D-CT) aimed at ensuring Medicare beneficiaries classified as under observation are considered inpatient for the purposes of accessing SNF care, even if their stay spanned fewer than two midnights.
At the Congressional hearings (watch video of the testimony at www.c-span.org/video/?319488-1/medicare-hospital-coverage committee and http://www.aging.senate.gov/hearings/admitted-or-not-the-impact-of-medicare-observation-status-on-seniors), Dr. Sheehy used her experience at UW Hospital and findings she and colleagues published in JAMA Internal Medicine to build a backstory around the issues. Based on the transcript of the testimony, Dr. Sheehy told the House Ways and Means Subcommittee on Health: “Because of our clinical work and extensive experience in the hospital setting, hospitalists have a firsthand view of what observation care looks like to patients, physicians, and hospitals.”
“Medicare policy, should be aligned with clinical realities and should also be rooted in allowing physicians to provide the care patients need.
—Ann Sheehy, MD, MS, FHM
She argues in her testimony that observation status harms the patient-physician relationship and does not make clinical sense.
For instance, the time of day a patient gets sick can impact their designation under the two-midnight rule. In one 2013 JAMA Internal Medicine publication [http://archinte.jamanetwork.com/article.aspx?articleid=1731964], Dr. Sheehy and colleagues found nearly half of UW Hospital patients would have been assigned observation status rather than inpatient under the two-midnight rule by virtue of the time they arrived at the hospital.
Additionally, Dr. Sheehy addressed the issue of the private contractors, or RACs, which were established under the Tax Relief and Health Care Act of 2006 to audit patient records for appropriate hospital status. Dr. Sheehy, in her testimony, said the RACs are aggressive and nontransparent in their audits. Additionally, the RACs are paid a percentage of the money they recover on Medicare’s behalf but are not held financially accountable for decisions that are subsequently appealed and overturned.
Nationally, roughly 40% of RAC audits are appealed, and 70% of these are overturned. Dr. Sheehy told the Congressional committee that at UW Hospital from Oct. 1, 2012 through Sept. 30, 2013, RAC audits determined that 21% of 299 patient charts had received improper payments. The hospital appealed 58 of the 63 audit decisions and had won each of them as of mid-May 2014.
Dr. Sheehy believes changes to the auditing programs enforcing observation rule compliance are necessary for the success of any observation reform, whether it comes through legislation or regulation. In her testimony closing, Dr. Sheehy told the House committee the two-midnight rule is not the answer to the need for observation status change. Medicare policy, she said, “should be aligned with clinical realities and should also be rooted in allowing physicians to provide the care patients need.”
In addition to addressing the arbitrary time cutoff, Dr. Sheehy made the case that the two-midnight rule puts short-stay, acutely ill patients at a disadvantage, may add cost and waste to the healthcare system, and is challenging for providers, who must estimate patient time of stay upon patient hospitalization.
But, Dr. Sheehy believes meaningful change is possible and hopes her testimony is helpful in the endeavor.
“Our understanding is that [Ways and Means committee members] were going to draft legislation out of the hearing, and we hope we have comprehensively addressed [patient] observation and the auditing programs that enforce it,” she says. “Hopefully, we provided the backstory and evidence for a comprehensive bill everyone can get behind.”
For SHM, Dr. Sheehy’s testimony demonstrates that hospitalists are taking leadership when it comes to critical issues that impact patients, physicians, and hospitals.
“The hearings shows the strength of hospital medicine as a specialty and a movement in healthcare: Hospitalists and SHM are not standing on the sidelines when it comes to flawed Medicare policies such as the two-midnight rule and observation care in general,” says SHM President Burke Kealey, MD, SFHM, medical director of hospital specialties at HealthPartners Medical Group in St. Paul, Minn. “These policy discussions are critical to the care our patients receive. Congress is clearly interested in listening to the hospitalist perspective. Dr. Sheehy represented the nation’s 44,000 hospitalists with the expertise, confidence, and compassion that are hallmarks of the specialty.”
Kelly April Tyrrell is a freelance writer in Wisconsin.
Twice in the past four months, Society of Hospital Medicine (SHM) member Ann Sheehy, MD, MS, FHM, found herself on Capitol Hill, testifying before Congressional committees focused on the U.S. healthcare system.
A physician at the University of Wisconsin (UW) School of Medicine and Public Health and a member of SHM’s Public Policy Committee, Dr. Sheehy was invited to speak about issues related to Medicare’s two-midnight rule, patient observation status, and the Recovery Audit Contractor (RAC) program.
These issues are “so important, and I am passionate about it,” Dr. Sheehy says. “I saw what was happening to patients and it just did not make any sense at all.”
Medicare’s two-midnight rule classifies most patients who stay in the hospital fewer than two midnights as outpatient or under observation. Observation status leaves patients on the hook for the costs of any chronic condition medications they receive in the hospital; additionally, patients under observation or considered outpatient are not eligible for skilled nursing facility (SNF) coverage.
SHM actively supports the Improving Access to Medicare Coverage Act, a bipartisan bill sponsored by Rep. Joe Courtney (D-CT) aimed at ensuring Medicare beneficiaries classified as under observation are considered inpatient for the purposes of accessing SNF care, even if their stay spanned fewer than two midnights.
At the Congressional hearings (watch video of the testimony at www.c-span.org/video/?319488-1/medicare-hospital-coverage committee and http://www.aging.senate.gov/hearings/admitted-or-not-the-impact-of-medicare-observation-status-on-seniors), Dr. Sheehy used her experience at UW Hospital and findings she and colleagues published in JAMA Internal Medicine to build a backstory around the issues. Based on the transcript of the testimony, Dr. Sheehy told the House Ways and Means Subcommittee on Health: “Because of our clinical work and extensive experience in the hospital setting, hospitalists have a firsthand view of what observation care looks like to patients, physicians, and hospitals.”
“Medicare policy, should be aligned with clinical realities and should also be rooted in allowing physicians to provide the care patients need.
—Ann Sheehy, MD, MS, FHM
She argues in her testimony that observation status harms the patient-physician relationship and does not make clinical sense.
For instance, the time of day a patient gets sick can impact their designation under the two-midnight rule. In one 2013 JAMA Internal Medicine publication [http://archinte.jamanetwork.com/article.aspx?articleid=1731964], Dr. Sheehy and colleagues found nearly half of UW Hospital patients would have been assigned observation status rather than inpatient under the two-midnight rule by virtue of the time they arrived at the hospital.
Additionally, Dr. Sheehy addressed the issue of the private contractors, or RACs, which were established under the Tax Relief and Health Care Act of 2006 to audit patient records for appropriate hospital status. Dr. Sheehy, in her testimony, said the RACs are aggressive and nontransparent in their audits. Additionally, the RACs are paid a percentage of the money they recover on Medicare’s behalf but are not held financially accountable for decisions that are subsequently appealed and overturned.
Nationally, roughly 40% of RAC audits are appealed, and 70% of these are overturned. Dr. Sheehy told the Congressional committee that at UW Hospital from Oct. 1, 2012 through Sept. 30, 2013, RAC audits determined that 21% of 299 patient charts had received improper payments. The hospital appealed 58 of the 63 audit decisions and had won each of them as of mid-May 2014.
Dr. Sheehy believes changes to the auditing programs enforcing observation rule compliance are necessary for the success of any observation reform, whether it comes through legislation or regulation. In her testimony closing, Dr. Sheehy told the House committee the two-midnight rule is not the answer to the need for observation status change. Medicare policy, she said, “should be aligned with clinical realities and should also be rooted in allowing physicians to provide the care patients need.”
In addition to addressing the arbitrary time cutoff, Dr. Sheehy made the case that the two-midnight rule puts short-stay, acutely ill patients at a disadvantage, may add cost and waste to the healthcare system, and is challenging for providers, who must estimate patient time of stay upon patient hospitalization.
But, Dr. Sheehy believes meaningful change is possible and hopes her testimony is helpful in the endeavor.
“Our understanding is that [Ways and Means committee members] were going to draft legislation out of the hearing, and we hope we have comprehensively addressed [patient] observation and the auditing programs that enforce it,” she says. “Hopefully, we provided the backstory and evidence for a comprehensive bill everyone can get behind.”
For SHM, Dr. Sheehy’s testimony demonstrates that hospitalists are taking leadership when it comes to critical issues that impact patients, physicians, and hospitals.
“The hearings shows the strength of hospital medicine as a specialty and a movement in healthcare: Hospitalists and SHM are not standing on the sidelines when it comes to flawed Medicare policies such as the two-midnight rule and observation care in general,” says SHM President Burke Kealey, MD, SFHM, medical director of hospital specialties at HealthPartners Medical Group in St. Paul, Minn. “These policy discussions are critical to the care our patients receive. Congress is clearly interested in listening to the hospitalist perspective. Dr. Sheehy represented the nation’s 44,000 hospitalists with the expertise, confidence, and compassion that are hallmarks of the specialty.”
Kelly April Tyrrell is a freelance writer in Wisconsin.
Twice in the past four months, Society of Hospital Medicine (SHM) member Ann Sheehy, MD, MS, FHM, found herself on Capitol Hill, testifying before Congressional committees focused on the U.S. healthcare system.
A physician at the University of Wisconsin (UW) School of Medicine and Public Health and a member of SHM’s Public Policy Committee, Dr. Sheehy was invited to speak about issues related to Medicare’s two-midnight rule, patient observation status, and the Recovery Audit Contractor (RAC) program.
These issues are “so important, and I am passionate about it,” Dr. Sheehy says. “I saw what was happening to patients and it just did not make any sense at all.”
Medicare’s two-midnight rule classifies most patients who stay in the hospital fewer than two midnights as outpatient or under observation. Observation status leaves patients on the hook for the costs of any chronic condition medications they receive in the hospital; additionally, patients under observation or considered outpatient are not eligible for skilled nursing facility (SNF) coverage.
SHM actively supports the Improving Access to Medicare Coverage Act, a bipartisan bill sponsored by Rep. Joe Courtney (D-CT) aimed at ensuring Medicare beneficiaries classified as under observation are considered inpatient for the purposes of accessing SNF care, even if their stay spanned fewer than two midnights.
At the Congressional hearings (watch video of the testimony at www.c-span.org/video/?319488-1/medicare-hospital-coverage committee and http://www.aging.senate.gov/hearings/admitted-or-not-the-impact-of-medicare-observation-status-on-seniors), Dr. Sheehy used her experience at UW Hospital and findings she and colleagues published in JAMA Internal Medicine to build a backstory around the issues. Based on the transcript of the testimony, Dr. Sheehy told the House Ways and Means Subcommittee on Health: “Because of our clinical work and extensive experience in the hospital setting, hospitalists have a firsthand view of what observation care looks like to patients, physicians, and hospitals.”
“Medicare policy, should be aligned with clinical realities and should also be rooted in allowing physicians to provide the care patients need.
—Ann Sheehy, MD, MS, FHM
She argues in her testimony that observation status harms the patient-physician relationship and does not make clinical sense.
For instance, the time of day a patient gets sick can impact their designation under the two-midnight rule. In one 2013 JAMA Internal Medicine publication [http://archinte.jamanetwork.com/article.aspx?articleid=1731964], Dr. Sheehy and colleagues found nearly half of UW Hospital patients would have been assigned observation status rather than inpatient under the two-midnight rule by virtue of the time they arrived at the hospital.
Additionally, Dr. Sheehy addressed the issue of the private contractors, or RACs, which were established under the Tax Relief and Health Care Act of 2006 to audit patient records for appropriate hospital status. Dr. Sheehy, in her testimony, said the RACs are aggressive and nontransparent in their audits. Additionally, the RACs are paid a percentage of the money they recover on Medicare’s behalf but are not held financially accountable for decisions that are subsequently appealed and overturned.
Nationally, roughly 40% of RAC audits are appealed, and 70% of these are overturned. Dr. Sheehy told the Congressional committee that at UW Hospital from Oct. 1, 2012 through Sept. 30, 2013, RAC audits determined that 21% of 299 patient charts had received improper payments. The hospital appealed 58 of the 63 audit decisions and had won each of them as of mid-May 2014.
Dr. Sheehy believes changes to the auditing programs enforcing observation rule compliance are necessary for the success of any observation reform, whether it comes through legislation or regulation. In her testimony closing, Dr. Sheehy told the House committee the two-midnight rule is not the answer to the need for observation status change. Medicare policy, she said, “should be aligned with clinical realities and should also be rooted in allowing physicians to provide the care patients need.”
In addition to addressing the arbitrary time cutoff, Dr. Sheehy made the case that the two-midnight rule puts short-stay, acutely ill patients at a disadvantage, may add cost and waste to the healthcare system, and is challenging for providers, who must estimate patient time of stay upon patient hospitalization.
But, Dr. Sheehy believes meaningful change is possible and hopes her testimony is helpful in the endeavor.
“Our understanding is that [Ways and Means committee members] were going to draft legislation out of the hearing, and we hope we have comprehensively addressed [patient] observation and the auditing programs that enforce it,” she says. “Hopefully, we provided the backstory and evidence for a comprehensive bill everyone can get behind.”
For SHM, Dr. Sheehy’s testimony demonstrates that hospitalists are taking leadership when it comes to critical issues that impact patients, physicians, and hospitals.
“The hearings shows the strength of hospital medicine as a specialty and a movement in healthcare: Hospitalists and SHM are not standing on the sidelines when it comes to flawed Medicare policies such as the two-midnight rule and observation care in general,” says SHM President Burke Kealey, MD, SFHM, medical director of hospital specialties at HealthPartners Medical Group in St. Paul, Minn. “These policy discussions are critical to the care our patients receive. Congress is clearly interested in listening to the hospitalist perspective. Dr. Sheehy represented the nation’s 44,000 hospitalists with the expertise, confidence, and compassion that are hallmarks of the specialty.”
Kelly April Tyrrell is a freelance writer in Wisconsin.
Clear Identification Needed for Hospitalists in Medicare
In recent months, numerous articles have come out targeting high-billing physicians—looking for smoking guns in recently released 2012 Medicare fee-for-service physician claims data. These data include both the amount each individual physician billed and the amount Medicare paid on average for services performed by all physicians treating Medicare beneficiaries.
Many physician groups, including the AMA, criticized the data release as having significant limitations, including clinical and billing practice realities that confound the layperson’s understanding of the data’s implications. Still, there is much physicians can learn by exploring this information, particularly those in a still-growing field like hospital medicine (HM).
There is no clear method to identify hospitalists within these data. Hospitalists are dispersed throughout their respective board certifications—internal medicine, family practice, pediatrics. The designations come directly from the Medicare specialty billing code; the code associated with the largest number of services becomes that provider’s de facto specialty. For the majority of providers, this will correspond with their board certification and their professional identity. A hospitalist’s unique practice is lost within these general identifiers.
However, the contours of that unique practice may provide some tools to identify hospitalists, albeit roughly, within the data and in the absence of a specialty billing code. Things like practice location and commonly billed Healthcare Common Procedure Coding System (HCPCS) codes can help sketch the boundaries of the field. Certainly, any classification methodology will have its share of imperfections and may exclude individuals who would otherwise identify as hospitalists. Regardless, such an exercise could identify trends in hospital medicine while providing a better understanding of the field as a whole.
HM does not have the traditional hallmark signifiers—board certification and Medicare specialty billing code—used by many specialties and subspecialties to frame their fields and to classify and compare physicians. The Medicare specialty billing code is a unique code applied to Medicare billing claims that tells Medicare exactly how the provider would like to be identified.
Because of its relative specificity and ready accessibility, the Centers for Medicare and Medicaid Services (CMS) uses the specialty billing code to create specialty comparison groups in pay-for-performance programs. Under the value-based payment modifier, hospitalists are compared against outpatient internal medicine or family medicine physicians, which makes them seem all the more expensive and less efficient.
SHM has been attuned to this particular issue since the early days of the physician value-based payment modifier. For nearly two years, SHM has repeatedly admonished CMS to compare hospitalists against other hospitalists in order for a pay-for-performance scheme to fairly and reasonably evaluate quality and efficiency. CMS acknowledged that many specialties and subspecialties may be masked within the current listing of Medicare specialty billing codes but yielded only so far as to say that aggrieved specialties can apply for their own code. SHM, for its part, applied for a specialty billing code for hospitalists in May 2014.
SHM has been actively exploring the data and looking at ways to identify hospitalists within this Medicare data. There’s an inherent value to this sort of self-reflection—it explains who we are and where we have been.
More importantly, it helps inform where we are going.
Joshua Lapps is SHM’s government relations manager.
In recent months, numerous articles have come out targeting high-billing physicians—looking for smoking guns in recently released 2012 Medicare fee-for-service physician claims data. These data include both the amount each individual physician billed and the amount Medicare paid on average for services performed by all physicians treating Medicare beneficiaries.
Many physician groups, including the AMA, criticized the data release as having significant limitations, including clinical and billing practice realities that confound the layperson’s understanding of the data’s implications. Still, there is much physicians can learn by exploring this information, particularly those in a still-growing field like hospital medicine (HM).
There is no clear method to identify hospitalists within these data. Hospitalists are dispersed throughout their respective board certifications—internal medicine, family practice, pediatrics. The designations come directly from the Medicare specialty billing code; the code associated with the largest number of services becomes that provider’s de facto specialty. For the majority of providers, this will correspond with their board certification and their professional identity. A hospitalist’s unique practice is lost within these general identifiers.
However, the contours of that unique practice may provide some tools to identify hospitalists, albeit roughly, within the data and in the absence of a specialty billing code. Things like practice location and commonly billed Healthcare Common Procedure Coding System (HCPCS) codes can help sketch the boundaries of the field. Certainly, any classification methodology will have its share of imperfections and may exclude individuals who would otherwise identify as hospitalists. Regardless, such an exercise could identify trends in hospital medicine while providing a better understanding of the field as a whole.
HM does not have the traditional hallmark signifiers—board certification and Medicare specialty billing code—used by many specialties and subspecialties to frame their fields and to classify and compare physicians. The Medicare specialty billing code is a unique code applied to Medicare billing claims that tells Medicare exactly how the provider would like to be identified.
Because of its relative specificity and ready accessibility, the Centers for Medicare and Medicaid Services (CMS) uses the specialty billing code to create specialty comparison groups in pay-for-performance programs. Under the value-based payment modifier, hospitalists are compared against outpatient internal medicine or family medicine physicians, which makes them seem all the more expensive and less efficient.
SHM has been attuned to this particular issue since the early days of the physician value-based payment modifier. For nearly two years, SHM has repeatedly admonished CMS to compare hospitalists against other hospitalists in order for a pay-for-performance scheme to fairly and reasonably evaluate quality and efficiency. CMS acknowledged that many specialties and subspecialties may be masked within the current listing of Medicare specialty billing codes but yielded only so far as to say that aggrieved specialties can apply for their own code. SHM, for its part, applied for a specialty billing code for hospitalists in May 2014.
SHM has been actively exploring the data and looking at ways to identify hospitalists within this Medicare data. There’s an inherent value to this sort of self-reflection—it explains who we are and where we have been.
More importantly, it helps inform where we are going.
Joshua Lapps is SHM’s government relations manager.
In recent months, numerous articles have come out targeting high-billing physicians—looking for smoking guns in recently released 2012 Medicare fee-for-service physician claims data. These data include both the amount each individual physician billed and the amount Medicare paid on average for services performed by all physicians treating Medicare beneficiaries.
Many physician groups, including the AMA, criticized the data release as having significant limitations, including clinical and billing practice realities that confound the layperson’s understanding of the data’s implications. Still, there is much physicians can learn by exploring this information, particularly those in a still-growing field like hospital medicine (HM).
There is no clear method to identify hospitalists within these data. Hospitalists are dispersed throughout their respective board certifications—internal medicine, family practice, pediatrics. The designations come directly from the Medicare specialty billing code; the code associated with the largest number of services becomes that provider’s de facto specialty. For the majority of providers, this will correspond with their board certification and their professional identity. A hospitalist’s unique practice is lost within these general identifiers.
However, the contours of that unique practice may provide some tools to identify hospitalists, albeit roughly, within the data and in the absence of a specialty billing code. Things like practice location and commonly billed Healthcare Common Procedure Coding System (HCPCS) codes can help sketch the boundaries of the field. Certainly, any classification methodology will have its share of imperfections and may exclude individuals who would otherwise identify as hospitalists. Regardless, such an exercise could identify trends in hospital medicine while providing a better understanding of the field as a whole.
HM does not have the traditional hallmark signifiers—board certification and Medicare specialty billing code—used by many specialties and subspecialties to frame their fields and to classify and compare physicians. The Medicare specialty billing code is a unique code applied to Medicare billing claims that tells Medicare exactly how the provider would like to be identified.
Because of its relative specificity and ready accessibility, the Centers for Medicare and Medicaid Services (CMS) uses the specialty billing code to create specialty comparison groups in pay-for-performance programs. Under the value-based payment modifier, hospitalists are compared against outpatient internal medicine or family medicine physicians, which makes them seem all the more expensive and less efficient.
SHM has been attuned to this particular issue since the early days of the physician value-based payment modifier. For nearly two years, SHM has repeatedly admonished CMS to compare hospitalists against other hospitalists in order for a pay-for-performance scheme to fairly and reasonably evaluate quality and efficiency. CMS acknowledged that many specialties and subspecialties may be masked within the current listing of Medicare specialty billing codes but yielded only so far as to say that aggrieved specialties can apply for their own code. SHM, for its part, applied for a specialty billing code for hospitalists in May 2014.
SHM has been actively exploring the data and looking at ways to identify hospitalists within this Medicare data. There’s an inherent value to this sort of self-reflection—it explains who we are and where we have been.
More importantly, it helps inform where we are going.
Joshua Lapps is SHM’s government relations manager.
New Pain Research Database
With the launch of the Interagency Pain Research Portfolio (IPRP), the public and clinicians can now gather information from more than 1,200 federally funded research projects. The database is the brainchild of the NIH and the Interagency Pain Research Coordinating Committee (IPRCC).
The IPRCC is made up of 6 government agencies and was created by the HHS to foster collaboration across the government with the goals of advancing a fundamental understanding of pain and improving pain-related treatment strategies. The Office of Pain Policy at the National Institute of Neurological Disorders and Stroke (NINDS) manages the database.
Research projects are categorized into 2 tiers of topic areas. Tier 1 is broad: basic, translational, and clinical research. Tier 2 comprises 29 specific topics that, according to IPRP, are “uniquely relevant to pain and meaningful to the broad range of agency missions and the needs recognized by the pain research community.”
The database will be “an important tool,” said Linda Porter, PhD, policy advisor for pain at NINDS, as a “research portfolio in which contributions from federal agencies and departments reflect their unique missions and the populations that they serve."
With the launch of the Interagency Pain Research Portfolio (IPRP), the public and clinicians can now gather information from more than 1,200 federally funded research projects. The database is the brainchild of the NIH and the Interagency Pain Research Coordinating Committee (IPRCC).
The IPRCC is made up of 6 government agencies and was created by the HHS to foster collaboration across the government with the goals of advancing a fundamental understanding of pain and improving pain-related treatment strategies. The Office of Pain Policy at the National Institute of Neurological Disorders and Stroke (NINDS) manages the database.
Research projects are categorized into 2 tiers of topic areas. Tier 1 is broad: basic, translational, and clinical research. Tier 2 comprises 29 specific topics that, according to IPRP, are “uniquely relevant to pain and meaningful to the broad range of agency missions and the needs recognized by the pain research community.”
The database will be “an important tool,” said Linda Porter, PhD, policy advisor for pain at NINDS, as a “research portfolio in which contributions from federal agencies and departments reflect their unique missions and the populations that they serve."
With the launch of the Interagency Pain Research Portfolio (IPRP), the public and clinicians can now gather information from more than 1,200 federally funded research projects. The database is the brainchild of the NIH and the Interagency Pain Research Coordinating Committee (IPRCC).
The IPRCC is made up of 6 government agencies and was created by the HHS to foster collaboration across the government with the goals of advancing a fundamental understanding of pain and improving pain-related treatment strategies. The Office of Pain Policy at the National Institute of Neurological Disorders and Stroke (NINDS) manages the database.
Research projects are categorized into 2 tiers of topic areas. Tier 1 is broad: basic, translational, and clinical research. Tier 2 comprises 29 specific topics that, according to IPRP, are “uniquely relevant to pain and meaningful to the broad range of agency missions and the needs recognized by the pain research community.”
The database will be “an important tool,” said Linda Porter, PhD, policy advisor for pain at NINDS, as a “research portfolio in which contributions from federal agencies and departments reflect their unique missions and the populations that they serve."
Global Health Cooperation
Pandemics are not territorial, which is the reason the U.S., Canada, and Mexico have adopted a set of principles and guidelines on how the 3 governments will share information during health emergencies “of mutual interest,” according to HHS. At the 67th World Health Assembly in Geneva, Switzerland, on May 20, 2014, HHS Secretary Kathleen Sebelius, Canada’s Minister of Health Rona Ambrose, and Mexico’s Secretary of Health Mercedes Juan signed a Declaration of Intent, formally adopting the guidelines.
The declaration calls for the countries to share public communications plans, statements, and other communications products related to health emergencies prior to public release and to apprise other appropriate authorities within their respective governments when the declaration is invoked. “This declaration will help our countries work together on the essential task of communicating more effectively on public health issues,” said Minister Ambrose.
The agreement supports the requirements of the International Health Regulations, which call for neighboring countries to develop accords and work together on shared public health issues. It also supports the underlying principles of the 2012 North American Plan for Animal and Pandemic Influenza, which builds on lessons learned during the H1N1 influenza pandemic.
In a similar collaborative vein, the U.S. and European Union (EU) have joined to battle the complex, daunting concern of antimicrobial resistance. In May 2014, they released the first progress report of the Transatlantic Taskforce on Antimicrobial Resistance (TATFAR), which summarizes advances made during the first implementation period of 2011 to 2013.
The goal of TATFAR is to improve cooperation in 3 key areas. First, appropriate therapeutic use of antimicrobial drugs in medical and veterinary communities; second, prevention of health care- and community-associated drug-resistant infections; and third, strategies for improving the pipeline of new antimicrobial drugs.
This collaboration is detailed and multifaceted. For instance, the FDA and the European Medicines Agency (EMA) have staff assigned to work in the other agency, allowing “candid, rapid, and confidential exchange of information regarding practices and policies that affect product labeling and other regulatory issues,” the report says.
Because the global problem continues to escalate, the task force has been renewed for at least 2 more years. Work on the original TATFAR recommendations continues, along with 1 new recommendation: Establish a joint working group of experts to study the transmission to man of antimicrobial resistance from the use of antimicrobial drugs in animals.
Forthcoming projects include a report summarizing the strategies hospitals should include as part of their programs to improve antimicrobial prescribing practices and a joint publication comparing the results of the U.S. and EU point prevalence surveys used to estimate the burden of hospital-associated infections. The partners have also synchronized public awareness campaigns, such as the U.S. campaign Get Smart: Know When Antibiotics Work, coordinated with the EU campaign European Antibiotic Awareness Day.
The full report is available at http://www.cdc.gov/drugresistance/tatfar/report.html.
Pandemics are not territorial, which is the reason the U.S., Canada, and Mexico have adopted a set of principles and guidelines on how the 3 governments will share information during health emergencies “of mutual interest,” according to HHS. At the 67th World Health Assembly in Geneva, Switzerland, on May 20, 2014, HHS Secretary Kathleen Sebelius, Canada’s Minister of Health Rona Ambrose, and Mexico’s Secretary of Health Mercedes Juan signed a Declaration of Intent, formally adopting the guidelines.
The declaration calls for the countries to share public communications plans, statements, and other communications products related to health emergencies prior to public release and to apprise other appropriate authorities within their respective governments when the declaration is invoked. “This declaration will help our countries work together on the essential task of communicating more effectively on public health issues,” said Minister Ambrose.
The agreement supports the requirements of the International Health Regulations, which call for neighboring countries to develop accords and work together on shared public health issues. It also supports the underlying principles of the 2012 North American Plan for Animal and Pandemic Influenza, which builds on lessons learned during the H1N1 influenza pandemic.
In a similar collaborative vein, the U.S. and European Union (EU) have joined to battle the complex, daunting concern of antimicrobial resistance. In May 2014, they released the first progress report of the Transatlantic Taskforce on Antimicrobial Resistance (TATFAR), which summarizes advances made during the first implementation period of 2011 to 2013.
The goal of TATFAR is to improve cooperation in 3 key areas. First, appropriate therapeutic use of antimicrobial drugs in medical and veterinary communities; second, prevention of health care- and community-associated drug-resistant infections; and third, strategies for improving the pipeline of new antimicrobial drugs.
This collaboration is detailed and multifaceted. For instance, the FDA and the European Medicines Agency (EMA) have staff assigned to work in the other agency, allowing “candid, rapid, and confidential exchange of information regarding practices and policies that affect product labeling and other regulatory issues,” the report says.
Because the global problem continues to escalate, the task force has been renewed for at least 2 more years. Work on the original TATFAR recommendations continues, along with 1 new recommendation: Establish a joint working group of experts to study the transmission to man of antimicrobial resistance from the use of antimicrobial drugs in animals.
Forthcoming projects include a report summarizing the strategies hospitals should include as part of their programs to improve antimicrobial prescribing practices and a joint publication comparing the results of the U.S. and EU point prevalence surveys used to estimate the burden of hospital-associated infections. The partners have also synchronized public awareness campaigns, such as the U.S. campaign Get Smart: Know When Antibiotics Work, coordinated with the EU campaign European Antibiotic Awareness Day.
The full report is available at http://www.cdc.gov/drugresistance/tatfar/report.html.
Pandemics are not territorial, which is the reason the U.S., Canada, and Mexico have adopted a set of principles and guidelines on how the 3 governments will share information during health emergencies “of mutual interest,” according to HHS. At the 67th World Health Assembly in Geneva, Switzerland, on May 20, 2014, HHS Secretary Kathleen Sebelius, Canada’s Minister of Health Rona Ambrose, and Mexico’s Secretary of Health Mercedes Juan signed a Declaration of Intent, formally adopting the guidelines.
The declaration calls for the countries to share public communications plans, statements, and other communications products related to health emergencies prior to public release and to apprise other appropriate authorities within their respective governments when the declaration is invoked. “This declaration will help our countries work together on the essential task of communicating more effectively on public health issues,” said Minister Ambrose.
The agreement supports the requirements of the International Health Regulations, which call for neighboring countries to develop accords and work together on shared public health issues. It also supports the underlying principles of the 2012 North American Plan for Animal and Pandemic Influenza, which builds on lessons learned during the H1N1 influenza pandemic.
In a similar collaborative vein, the U.S. and European Union (EU) have joined to battle the complex, daunting concern of antimicrobial resistance. In May 2014, they released the first progress report of the Transatlantic Taskforce on Antimicrobial Resistance (TATFAR), which summarizes advances made during the first implementation period of 2011 to 2013.
The goal of TATFAR is to improve cooperation in 3 key areas. First, appropriate therapeutic use of antimicrobial drugs in medical and veterinary communities; second, prevention of health care- and community-associated drug-resistant infections; and third, strategies for improving the pipeline of new antimicrobial drugs.
This collaboration is detailed and multifaceted. For instance, the FDA and the European Medicines Agency (EMA) have staff assigned to work in the other agency, allowing “candid, rapid, and confidential exchange of information regarding practices and policies that affect product labeling and other regulatory issues,” the report says.
Because the global problem continues to escalate, the task force has been renewed for at least 2 more years. Work on the original TATFAR recommendations continues, along with 1 new recommendation: Establish a joint working group of experts to study the transmission to man of antimicrobial resistance from the use of antimicrobial drugs in animals.
Forthcoming projects include a report summarizing the strategies hospitals should include as part of their programs to improve antimicrobial prescribing practices and a joint publication comparing the results of the U.S. and EU point prevalence surveys used to estimate the burden of hospital-associated infections. The partners have also synchronized public awareness campaigns, such as the U.S. campaign Get Smart: Know When Antibiotics Work, coordinated with the EU campaign European Antibiotic Awareness Day.
The full report is available at http://www.cdc.gov/drugresistance/tatfar/report.html.
Happy Anniversary, Operation Live Well!
It’s been a good year for Operation Live Well (OLW). The program, which launched in May 2013, focuses on giving service members and veterans the tools, resources, and inspiration they need to live healthful lifestyles. Since then, the achievements have mounted. Among them:
• Quit Tobacco—Make Everyone Proud averaged 28,000 visits to the website and 320 smoking cessation chats per month.
• Thanks to Go for Green, a color-coded food rating system, 72% of soldiers report eating more quality foods than they did before joining the U.S. Army.
• Nearly 84% of surveyed Defense Logistics Agency employees shopped at the farmers market at McNamara HQC.
• FitPick vending machines took in more than $14,000 in healthful food sales in less than 2 months at the Naval Submarine Base New London in Groton, Connecticut.
• U.S. Navy and Marine Corps Public Health Center’s 2014 Crews Into Shape challenge found 80% of surveyed participants increased their daily physical activity.
• In the 2014 Weight Loss Wars contest, the Missile Defense Agency lost collectively more than 3,000 pounds.
The website highlights some of OLW’s demonstration projects, partners, and other initiatives (See App Corner). For the special anniversary compilation, visit http://www.health.mil/Military-Health-topics/Operation-Live-Well/OLW-Anniversary.
It’s been a good year for Operation Live Well (OLW). The program, which launched in May 2013, focuses on giving service members and veterans the tools, resources, and inspiration they need to live healthful lifestyles. Since then, the achievements have mounted. Among them:
• Quit Tobacco—Make Everyone Proud averaged 28,000 visits to the website and 320 smoking cessation chats per month.
• Thanks to Go for Green, a color-coded food rating system, 72% of soldiers report eating more quality foods than they did before joining the U.S. Army.
• Nearly 84% of surveyed Defense Logistics Agency employees shopped at the farmers market at McNamara HQC.
• FitPick vending machines took in more than $14,000 in healthful food sales in less than 2 months at the Naval Submarine Base New London in Groton, Connecticut.
• U.S. Navy and Marine Corps Public Health Center’s 2014 Crews Into Shape challenge found 80% of surveyed participants increased their daily physical activity.
• In the 2014 Weight Loss Wars contest, the Missile Defense Agency lost collectively more than 3,000 pounds.
The website highlights some of OLW’s demonstration projects, partners, and other initiatives (See App Corner). For the special anniversary compilation, visit http://www.health.mil/Military-Health-topics/Operation-Live-Well/OLW-Anniversary.
It’s been a good year for Operation Live Well (OLW). The program, which launched in May 2013, focuses on giving service members and veterans the tools, resources, and inspiration they need to live healthful lifestyles. Since then, the achievements have mounted. Among them:
• Quit Tobacco—Make Everyone Proud averaged 28,000 visits to the website and 320 smoking cessation chats per month.
• Thanks to Go for Green, a color-coded food rating system, 72% of soldiers report eating more quality foods than they did before joining the U.S. Army.
• Nearly 84% of surveyed Defense Logistics Agency employees shopped at the farmers market at McNamara HQC.
• FitPick vending machines took in more than $14,000 in healthful food sales in less than 2 months at the Naval Submarine Base New London in Groton, Connecticut.
• U.S. Navy and Marine Corps Public Health Center’s 2014 Crews Into Shape challenge found 80% of surveyed participants increased their daily physical activity.
• In the 2014 Weight Loss Wars contest, the Missile Defense Agency lost collectively more than 3,000 pounds.
The website highlights some of OLW’s demonstration projects, partners, and other initiatives (See App Corner). For the special anniversary compilation, visit http://www.health.mil/Military-Health-topics/Operation-Live-Well/OLW-Anniversary.
Answering subpoenas poses legal, privacy risks
Receiving a subpoena for information or testimony can make any physician feel nervous and apprehensive. The official-looking notices often arrive as certified mail, have a stamped deadline, and include an attorney’s signature. But immediately fulfilling a subpoena without first assessing the request could land doctors in trouble.
"Understandably, many physicians don’t recognize that no judge has reviewed the propriety of a subpoena," said Michael J. Schoppmann, a New York–based health law attorney. "Most judges are not even aware of the subpoena. There’s an assumption by the physician that it has been vetted by the court and, in many cases, that is not true. With good intentions, we find physicians getting into trouble out of a desire to be compliant."
Before answering a subpoena, physicians should evaluate where the request originated, the status of the case, and who is involved, legal experts say. Frequently, a request for patient information or records is objected to by the patient’s attorney, said Michael J. Sacopulos, a medical liability defense attorney. Physicians should ensure record requests are authorized by the patient or a court order.
"Let’s say you’re not going to court, but they want information," Mr. Sacopulos said. "You have HIPAA issues at play. You still have an independent duty to safeguard patient information."
Mr. Schoppmann recommends physicians contact the judge affiliated with the case and request guidance about how to proceed. The judge may deny the request because the records are inappropriate or allow the subpoena to proceed.
"It’s great protection because if we get an order from the court, that (shields the doctor) from the litigants later saying, ‘We did not want you to release those records,’ " Mr. Schoppmann said.
In other instances, physicians may be subpoenaed to discuss a patient’s condition or treatment in a third-party case. For example, a patient who is suing an insurance carrier or third-party over a vehicle accident. Doctors have a responsibility to offer honest and unbiased testimony about their patient’s medical condition, said Steven Fitzer, a medical malpractice defense attorney in Tacoma, Wash. However, physicians shouldn’t provide opinions on medical matters unrelated to their expertise.
"A family practice doctor should offer thoughts and opinions and facts that are within his or her specialty," Mr. Fitzer said. "If [the doctor] regularly treats people who have whiplash and cervical strain, you can talk about that. But the family practice doctor shouldn’t be talking about neck surgery unless you do neck surgeries." Physicians should also consider and address how their involvement with a case may affect their relationship with patients. Often, patients view their doctor as their supporter and expect their alliance during a third-party lawsuit. "Patients sometimes misunderstand that the role of the doctor in a deposition is to call it the way he or she sees it, not to be an advocate for the patient," he said.
Be wary of subpoenas for information or records that stem from a malpractice case in which the doctor is a named defendant, Mr. Sacopulos noted. In such instances, a plaintiff’s attorney may request details about a patient visit or ask about a doctor’s role in treating the patient. But the attorney could really be fishing for more physicians to sue.
"They may have sued one or two physicians, but the statute of limitations has yet to run out," Mr. Sacopulos said. "They’ll sue one or two, then depose others to see if they can’t get some finger pointing and increase the litigation."
In addition, plaintiffs’ attorneys may hope that the subpoenaed physician makes statements to further enhance their case against another doctor, without hiring them as an expert witness.
"My advice would be if you are requested to offer testimony in a case that you are not a party to, you immediately contact your liability carrier," Mr. Sacopulos said. "Your medical malpractice carrier will most often provide an attorney for a deposition, even though you’re not a party."
Physicians should not let attorneys intimidate them with subpoenas or excessive demands for information. Some lawyers request thousands of pages of documents in a short timeframe and pressure the physician to comply, Mr. Schoppmann said. Other attorneys try to convince physicians to speak with them over the phone about the request and to provide patient information verbally.
Ensure that the scope, the timing, and the overall content of the request are appropriate before responding, Mr. Schoppmann stresses. "The subpoena has to be reasonable," he said. "Step back and do not respond unduly aggressively. You could be subject to criticism later if you respond to an inappropriate subpoena. We want right, rather than quick."
Receiving a subpoena for information or testimony can make any physician feel nervous and apprehensive. The official-looking notices often arrive as certified mail, have a stamped deadline, and include an attorney’s signature. But immediately fulfilling a subpoena without first assessing the request could land doctors in trouble.
"Understandably, many physicians don’t recognize that no judge has reviewed the propriety of a subpoena," said Michael J. Schoppmann, a New York–based health law attorney. "Most judges are not even aware of the subpoena. There’s an assumption by the physician that it has been vetted by the court and, in many cases, that is not true. With good intentions, we find physicians getting into trouble out of a desire to be compliant."
Before answering a subpoena, physicians should evaluate where the request originated, the status of the case, and who is involved, legal experts say. Frequently, a request for patient information or records is objected to by the patient’s attorney, said Michael J. Sacopulos, a medical liability defense attorney. Physicians should ensure record requests are authorized by the patient or a court order.
"Let’s say you’re not going to court, but they want information," Mr. Sacopulos said. "You have HIPAA issues at play. You still have an independent duty to safeguard patient information."
Mr. Schoppmann recommends physicians contact the judge affiliated with the case and request guidance about how to proceed. The judge may deny the request because the records are inappropriate or allow the subpoena to proceed.
"It’s great protection because if we get an order from the court, that (shields the doctor) from the litigants later saying, ‘We did not want you to release those records,’ " Mr. Schoppmann said.
In other instances, physicians may be subpoenaed to discuss a patient’s condition or treatment in a third-party case. For example, a patient who is suing an insurance carrier or third-party over a vehicle accident. Doctors have a responsibility to offer honest and unbiased testimony about their patient’s medical condition, said Steven Fitzer, a medical malpractice defense attorney in Tacoma, Wash. However, physicians shouldn’t provide opinions on medical matters unrelated to their expertise.
"A family practice doctor should offer thoughts and opinions and facts that are within his or her specialty," Mr. Fitzer said. "If [the doctor] regularly treats people who have whiplash and cervical strain, you can talk about that. But the family practice doctor shouldn’t be talking about neck surgery unless you do neck surgeries." Physicians should also consider and address how their involvement with a case may affect their relationship with patients. Often, patients view their doctor as their supporter and expect their alliance during a third-party lawsuit. "Patients sometimes misunderstand that the role of the doctor in a deposition is to call it the way he or she sees it, not to be an advocate for the patient," he said.
Be wary of subpoenas for information or records that stem from a malpractice case in which the doctor is a named defendant, Mr. Sacopulos noted. In such instances, a plaintiff’s attorney may request details about a patient visit or ask about a doctor’s role in treating the patient. But the attorney could really be fishing for more physicians to sue.
"They may have sued one or two physicians, but the statute of limitations has yet to run out," Mr. Sacopulos said. "They’ll sue one or two, then depose others to see if they can’t get some finger pointing and increase the litigation."
In addition, plaintiffs’ attorneys may hope that the subpoenaed physician makes statements to further enhance their case against another doctor, without hiring them as an expert witness.
"My advice would be if you are requested to offer testimony in a case that you are not a party to, you immediately contact your liability carrier," Mr. Sacopulos said. "Your medical malpractice carrier will most often provide an attorney for a deposition, even though you’re not a party."
Physicians should not let attorneys intimidate them with subpoenas or excessive demands for information. Some lawyers request thousands of pages of documents in a short timeframe and pressure the physician to comply, Mr. Schoppmann said. Other attorneys try to convince physicians to speak with them over the phone about the request and to provide patient information verbally.
Ensure that the scope, the timing, and the overall content of the request are appropriate before responding, Mr. Schoppmann stresses. "The subpoena has to be reasonable," he said. "Step back and do not respond unduly aggressively. You could be subject to criticism later if you respond to an inappropriate subpoena. We want right, rather than quick."
Receiving a subpoena for information or testimony can make any physician feel nervous and apprehensive. The official-looking notices often arrive as certified mail, have a stamped deadline, and include an attorney’s signature. But immediately fulfilling a subpoena without first assessing the request could land doctors in trouble.
"Understandably, many physicians don’t recognize that no judge has reviewed the propriety of a subpoena," said Michael J. Schoppmann, a New York–based health law attorney. "Most judges are not even aware of the subpoena. There’s an assumption by the physician that it has been vetted by the court and, in many cases, that is not true. With good intentions, we find physicians getting into trouble out of a desire to be compliant."
Before answering a subpoena, physicians should evaluate where the request originated, the status of the case, and who is involved, legal experts say. Frequently, a request for patient information or records is objected to by the patient’s attorney, said Michael J. Sacopulos, a medical liability defense attorney. Physicians should ensure record requests are authorized by the patient or a court order.
"Let’s say you’re not going to court, but they want information," Mr. Sacopulos said. "You have HIPAA issues at play. You still have an independent duty to safeguard patient information."
Mr. Schoppmann recommends physicians contact the judge affiliated with the case and request guidance about how to proceed. The judge may deny the request because the records are inappropriate or allow the subpoena to proceed.
"It’s great protection because if we get an order from the court, that (shields the doctor) from the litigants later saying, ‘We did not want you to release those records,’ " Mr. Schoppmann said.
In other instances, physicians may be subpoenaed to discuss a patient’s condition or treatment in a third-party case. For example, a patient who is suing an insurance carrier or third-party over a vehicle accident. Doctors have a responsibility to offer honest and unbiased testimony about their patient’s medical condition, said Steven Fitzer, a medical malpractice defense attorney in Tacoma, Wash. However, physicians shouldn’t provide opinions on medical matters unrelated to their expertise.
"A family practice doctor should offer thoughts and opinions and facts that are within his or her specialty," Mr. Fitzer said. "If [the doctor] regularly treats people who have whiplash and cervical strain, you can talk about that. But the family practice doctor shouldn’t be talking about neck surgery unless you do neck surgeries." Physicians should also consider and address how their involvement with a case may affect their relationship with patients. Often, patients view their doctor as their supporter and expect their alliance during a third-party lawsuit. "Patients sometimes misunderstand that the role of the doctor in a deposition is to call it the way he or she sees it, not to be an advocate for the patient," he said.
Be wary of subpoenas for information or records that stem from a malpractice case in which the doctor is a named defendant, Mr. Sacopulos noted. In such instances, a plaintiff’s attorney may request details about a patient visit or ask about a doctor’s role in treating the patient. But the attorney could really be fishing for more physicians to sue.
"They may have sued one or two physicians, but the statute of limitations has yet to run out," Mr. Sacopulos said. "They’ll sue one or two, then depose others to see if they can’t get some finger pointing and increase the litigation."
In addition, plaintiffs’ attorneys may hope that the subpoenaed physician makes statements to further enhance their case against another doctor, without hiring them as an expert witness.
"My advice would be if you are requested to offer testimony in a case that you are not a party to, you immediately contact your liability carrier," Mr. Sacopulos said. "Your medical malpractice carrier will most often provide an attorney for a deposition, even though you’re not a party."
Physicians should not let attorneys intimidate them with subpoenas or excessive demands for information. Some lawyers request thousands of pages of documents in a short timeframe and pressure the physician to comply, Mr. Schoppmann said. Other attorneys try to convince physicians to speak with them over the phone about the request and to provide patient information verbally.
Ensure that the scope, the timing, and the overall content of the request are appropriate before responding, Mr. Schoppmann stresses. "The subpoena has to be reasonable," he said. "Step back and do not respond unduly aggressively. You could be subject to criticism later if you respond to an inappropriate subpoena. We want right, rather than quick."
Fee schedule: Medicare gives details on care coordination pay, SGR cut
Starting Jan. 1, 2015, Medicare will pay physicians about $42 for certain care management services outside of the face-to-face office visit, according to a new government proposal.
The proposed rule for the 2015 Medicare Physician Fee Schedule, released on July 3, offers details on how officials at the Centers for Medicare & Medicaid Services (CMS) plan to roll out the new chronic care management services payments that begin in 2015. The proposal also expands telehealth services offered by Medicare and makes changes to the Open Payments program.
CMS proposes to pay $41.92 for a new G-code for chronic care management services provided to patients with two or more chronic conditions that are expected to last at least a year. The code could be billed only once a month for each patient.
To bill for the code, physicians would have to offer some type of 24/7 access, continuity of care, care management for chronic conditions including medication reconciliation, creation of a patient-centered care plan, management of care transitions including visits to the hospital and emergency department, and coordination with community-based services.
In the 2015 Physician Fee Schedule, CMS is also proposing to require that physicians use certified electronic health record technology.
The American Academy of Family Physicians (AAFP), members of which would benefit from the coding change, applauded CMS for proposing the care management code. But the AAFP said the benefit of the code would be overshadowed were Congress to allow the scheduled cut to the Medicare Sustainable Growth Rate (SGR) formula to go into effect on April 1, 2015.
The fee schedule proposal reiterates that physicians will face a 20.9% across-the-board fee cut next year if Congress does not repeal or postpone the SGR.
"The AAFP welcomes the new code but we also look to a day when policies designed to strengthen primary medical care are not undermined by drastic cuts to the underlying foundation on which all payment is based," Dr. Reid Blackwelder, AAFP president, said in a statement.
The proposed fee schedule also seeks to add annual wellness visits, psychoanalysis, psychotherapy, and prolonged evaluation and management services to the list of telehealth services that can be furnished to Medicare beneficiaries under the telehealth benefit.
Medicare also proposes to redefine screening colonoscopy to include anesthesia. With this proposed change, Medicare beneficiaries would not have to pay coinsurance on the anesthesia portion of the procedure when it is provided separately by an anesthesiologist.
CMS is also planning to make changes to the Open Payments program, which requires drug and device manufacturers to report on the payments and transfers of value made to physicians and teaching hospitals.
Agency officials want to completely exclude reporting on continuing medical education payments made by industry. Under the current framework, CMS excluded most CME reporting, if the event met the accreditation or certification requirements of five organizations. However, the proposal would broaden that provision to include any CME event in which the industry provides funding but is not involved in selecting or paying speakers. If finalized, the changes would take effect in 2015.
mschneider@frontlinemedcom.com
On Twitter @MaryEllenNY
Starting Jan. 1, 2015, Medicare will pay physicians about $42 for certain care management services outside of the face-to-face office visit, according to a new government proposal.
The proposed rule for the 2015 Medicare Physician Fee Schedule, released on July 3, offers details on how officials at the Centers for Medicare & Medicaid Services (CMS) plan to roll out the new chronic care management services payments that begin in 2015. The proposal also expands telehealth services offered by Medicare and makes changes to the Open Payments program.
CMS proposes to pay $41.92 for a new G-code for chronic care management services provided to patients with two or more chronic conditions that are expected to last at least a year. The code could be billed only once a month for each patient.
To bill for the code, physicians would have to offer some type of 24/7 access, continuity of care, care management for chronic conditions including medication reconciliation, creation of a patient-centered care plan, management of care transitions including visits to the hospital and emergency department, and coordination with community-based services.
In the 2015 Physician Fee Schedule, CMS is also proposing to require that physicians use certified electronic health record technology.
The American Academy of Family Physicians (AAFP), members of which would benefit from the coding change, applauded CMS for proposing the care management code. But the AAFP said the benefit of the code would be overshadowed were Congress to allow the scheduled cut to the Medicare Sustainable Growth Rate (SGR) formula to go into effect on April 1, 2015.
The fee schedule proposal reiterates that physicians will face a 20.9% across-the-board fee cut next year if Congress does not repeal or postpone the SGR.
"The AAFP welcomes the new code but we also look to a day when policies designed to strengthen primary medical care are not undermined by drastic cuts to the underlying foundation on which all payment is based," Dr. Reid Blackwelder, AAFP president, said in a statement.
The proposed fee schedule also seeks to add annual wellness visits, psychoanalysis, psychotherapy, and prolonged evaluation and management services to the list of telehealth services that can be furnished to Medicare beneficiaries under the telehealth benefit.
Medicare also proposes to redefine screening colonoscopy to include anesthesia. With this proposed change, Medicare beneficiaries would not have to pay coinsurance on the anesthesia portion of the procedure when it is provided separately by an anesthesiologist.
CMS is also planning to make changes to the Open Payments program, which requires drug and device manufacturers to report on the payments and transfers of value made to physicians and teaching hospitals.
Agency officials want to completely exclude reporting on continuing medical education payments made by industry. Under the current framework, CMS excluded most CME reporting, if the event met the accreditation or certification requirements of five organizations. However, the proposal would broaden that provision to include any CME event in which the industry provides funding but is not involved in selecting or paying speakers. If finalized, the changes would take effect in 2015.
mschneider@frontlinemedcom.com
On Twitter @MaryEllenNY
Starting Jan. 1, 2015, Medicare will pay physicians about $42 for certain care management services outside of the face-to-face office visit, according to a new government proposal.
The proposed rule for the 2015 Medicare Physician Fee Schedule, released on July 3, offers details on how officials at the Centers for Medicare & Medicaid Services (CMS) plan to roll out the new chronic care management services payments that begin in 2015. The proposal also expands telehealth services offered by Medicare and makes changes to the Open Payments program.
CMS proposes to pay $41.92 for a new G-code for chronic care management services provided to patients with two or more chronic conditions that are expected to last at least a year. The code could be billed only once a month for each patient.
To bill for the code, physicians would have to offer some type of 24/7 access, continuity of care, care management for chronic conditions including medication reconciliation, creation of a patient-centered care plan, management of care transitions including visits to the hospital and emergency department, and coordination with community-based services.
In the 2015 Physician Fee Schedule, CMS is also proposing to require that physicians use certified electronic health record technology.
The American Academy of Family Physicians (AAFP), members of which would benefit from the coding change, applauded CMS for proposing the care management code. But the AAFP said the benefit of the code would be overshadowed were Congress to allow the scheduled cut to the Medicare Sustainable Growth Rate (SGR) formula to go into effect on April 1, 2015.
The fee schedule proposal reiterates that physicians will face a 20.9% across-the-board fee cut next year if Congress does not repeal or postpone the SGR.
"The AAFP welcomes the new code but we also look to a day when policies designed to strengthen primary medical care are not undermined by drastic cuts to the underlying foundation on which all payment is based," Dr. Reid Blackwelder, AAFP president, said in a statement.
The proposed fee schedule also seeks to add annual wellness visits, psychoanalysis, psychotherapy, and prolonged evaluation and management services to the list of telehealth services that can be furnished to Medicare beneficiaries under the telehealth benefit.
Medicare also proposes to redefine screening colonoscopy to include anesthesia. With this proposed change, Medicare beneficiaries would not have to pay coinsurance on the anesthesia portion of the procedure when it is provided separately by an anesthesiologist.
CMS is also planning to make changes to the Open Payments program, which requires drug and device manufacturers to report on the payments and transfers of value made to physicians and teaching hospitals.
Agency officials want to completely exclude reporting on continuing medical education payments made by industry. Under the current framework, CMS excluded most CME reporting, if the event met the accreditation or certification requirements of five organizations. However, the proposal would broaden that provision to include any CME event in which the industry provides funding but is not involved in selecting or paying speakers. If finalized, the changes would take effect in 2015.
mschneider@frontlinemedcom.com
On Twitter @MaryEllenNY
ICD-10 delayed: Proceed with caution, experts say
When it comes to ICD-10 readiness, invest in low-cost, high-impact steps that will benefit the October 2015 switch to a new code set, but will also improve the general health of the medical practice.
Now that implementation of ICD-10 has been delayed a full year, "I’d avoid spending too much money at this stage," said Robert Tennant, senior policy adviser at the Medical Group Management Association (MGMA).
Practical steps include checking claims already paid under ICD-9 to see whether the documentation was sufficient to assign an ICD-10 code. In the case of a sprained wrist, for example, make sure the documentation includes whether the injury was to the left or right wrist, Mr. Tennant said.
Consider dual coding – coding the same claims in both ICD-9 and ICD-10 – for some most commonly used codes, Mr. Tennant advised. If you "go through the clinical documentation improvement exercises, you will produce a better quality medical record and that can help the practice in a number of ways even if ICD-10 never goes forward."
Other low-cost, high-impact steps include reaching out to clearinghouses to request reports on the practice’s top diagnosis codes, the top pended or rejected claims, and the most frequently used unspecified codes.
"That should really focus the practice in on those claims that are the most problematic," he said.
One tough decision is when to upgrade software. Upgrade too early and the practice could lose money if there’s another delay. Wait too long and the practice risks being unprepared for the compliance date, according to Mr. Tennant.
He advised finding out when the vendor will be ready with upgrades and how long it will take them to install the software and provide training. Use that to build an implementation timeline.
"It’s such a tightrope that practices have to walk," Mr. Tennant said.
Dallas-based pediatrician Joseph Schneider has been helping physicians prepare for ICD-10 in his role as chair of the Texas Medical Association’s Practice Management Services Council. The association’s official policy is that the move to ICD-10 should be scrapped, but the group is urging physicians and hospitals to prepare anyway.
Dr. Schneider said smaller practices should check in with payers, vendors, and clearinghouses now, but save significant investments and training for next year.
"If you’re in a small physician practice, probably doing not very much between now and December might be a pretty good strategy," he said. "From January forward, you have to start your engines and get everything ready."
But larger practices and health systems don’t have the luxury of waiting, he said.
Dr. George Abraham, who is part of a six-physician practice in Worcester, Mass., was ready for ICD-10 to take effect this year. His practice spent more than $25,000 preparing for the scheduled switch and had done some initial testing of systems when the delay was announced.
Now the practice faces an additional expenditure on upgrades and refresher courses for coders and physicians.
"After everything, poof, it’s gone in a puff of smoke because everything came to a standstill when ICD-10 got suspended for a year," said Dr. Abraham, governor of the Massachusetts chapter of the American College of Physicians.
"It will be déjà vu all over again come summer of next year. We’ll be doing the same thing in preparation for ICD-10 being rolled out in October 2015."
Most health plans won’t begin end-to-end testing of claims until next year, Dr. Abraham said, and that’s worrisome because it may not provide enough time to work out potential glitches.
"A delay in claims being processed is our biggest anxiety," he said. "A delay in payments will lead to a severe cash flow crunch."
When it comes to ICD-10 readiness, invest in low-cost, high-impact steps that will benefit the October 2015 switch to a new code set, but will also improve the general health of the medical practice.
Now that implementation of ICD-10 has been delayed a full year, "I’d avoid spending too much money at this stage," said Robert Tennant, senior policy adviser at the Medical Group Management Association (MGMA).
Practical steps include checking claims already paid under ICD-9 to see whether the documentation was sufficient to assign an ICD-10 code. In the case of a sprained wrist, for example, make sure the documentation includes whether the injury was to the left or right wrist, Mr. Tennant said.
Consider dual coding – coding the same claims in both ICD-9 and ICD-10 – for some most commonly used codes, Mr. Tennant advised. If you "go through the clinical documentation improvement exercises, you will produce a better quality medical record and that can help the practice in a number of ways even if ICD-10 never goes forward."
Other low-cost, high-impact steps include reaching out to clearinghouses to request reports on the practice’s top diagnosis codes, the top pended or rejected claims, and the most frequently used unspecified codes.
"That should really focus the practice in on those claims that are the most problematic," he said.
One tough decision is when to upgrade software. Upgrade too early and the practice could lose money if there’s another delay. Wait too long and the practice risks being unprepared for the compliance date, according to Mr. Tennant.
He advised finding out when the vendor will be ready with upgrades and how long it will take them to install the software and provide training. Use that to build an implementation timeline.
"It’s such a tightrope that practices have to walk," Mr. Tennant said.
Dallas-based pediatrician Joseph Schneider has been helping physicians prepare for ICD-10 in his role as chair of the Texas Medical Association’s Practice Management Services Council. The association’s official policy is that the move to ICD-10 should be scrapped, but the group is urging physicians and hospitals to prepare anyway.
Dr. Schneider said smaller practices should check in with payers, vendors, and clearinghouses now, but save significant investments and training for next year.
"If you’re in a small physician practice, probably doing not very much between now and December might be a pretty good strategy," he said. "From January forward, you have to start your engines and get everything ready."
But larger practices and health systems don’t have the luxury of waiting, he said.
Dr. George Abraham, who is part of a six-physician practice in Worcester, Mass., was ready for ICD-10 to take effect this year. His practice spent more than $25,000 preparing for the scheduled switch and had done some initial testing of systems when the delay was announced.
Now the practice faces an additional expenditure on upgrades and refresher courses for coders and physicians.
"After everything, poof, it’s gone in a puff of smoke because everything came to a standstill when ICD-10 got suspended for a year," said Dr. Abraham, governor of the Massachusetts chapter of the American College of Physicians.
"It will be déjà vu all over again come summer of next year. We’ll be doing the same thing in preparation for ICD-10 being rolled out in October 2015."
Most health plans won’t begin end-to-end testing of claims until next year, Dr. Abraham said, and that’s worrisome because it may not provide enough time to work out potential glitches.
"A delay in claims being processed is our biggest anxiety," he said. "A delay in payments will lead to a severe cash flow crunch."
When it comes to ICD-10 readiness, invest in low-cost, high-impact steps that will benefit the October 2015 switch to a new code set, but will also improve the general health of the medical practice.
Now that implementation of ICD-10 has been delayed a full year, "I’d avoid spending too much money at this stage," said Robert Tennant, senior policy adviser at the Medical Group Management Association (MGMA).
Practical steps include checking claims already paid under ICD-9 to see whether the documentation was sufficient to assign an ICD-10 code. In the case of a sprained wrist, for example, make sure the documentation includes whether the injury was to the left or right wrist, Mr. Tennant said.
Consider dual coding – coding the same claims in both ICD-9 and ICD-10 – for some most commonly used codes, Mr. Tennant advised. If you "go through the clinical documentation improvement exercises, you will produce a better quality medical record and that can help the practice in a number of ways even if ICD-10 never goes forward."
Other low-cost, high-impact steps include reaching out to clearinghouses to request reports on the practice’s top diagnosis codes, the top pended or rejected claims, and the most frequently used unspecified codes.
"That should really focus the practice in on those claims that are the most problematic," he said.
One tough decision is when to upgrade software. Upgrade too early and the practice could lose money if there’s another delay. Wait too long and the practice risks being unprepared for the compliance date, according to Mr. Tennant.
He advised finding out when the vendor will be ready with upgrades and how long it will take them to install the software and provide training. Use that to build an implementation timeline.
"It’s such a tightrope that practices have to walk," Mr. Tennant said.
Dallas-based pediatrician Joseph Schneider has been helping physicians prepare for ICD-10 in his role as chair of the Texas Medical Association’s Practice Management Services Council. The association’s official policy is that the move to ICD-10 should be scrapped, but the group is urging physicians and hospitals to prepare anyway.
Dr. Schneider said smaller practices should check in with payers, vendors, and clearinghouses now, but save significant investments and training for next year.
"If you’re in a small physician practice, probably doing not very much between now and December might be a pretty good strategy," he said. "From January forward, you have to start your engines and get everything ready."
But larger practices and health systems don’t have the luxury of waiting, he said.
Dr. George Abraham, who is part of a six-physician practice in Worcester, Mass., was ready for ICD-10 to take effect this year. His practice spent more than $25,000 preparing for the scheduled switch and had done some initial testing of systems when the delay was announced.
Now the practice faces an additional expenditure on upgrades and refresher courses for coders and physicians.
"After everything, poof, it’s gone in a puff of smoke because everything came to a standstill when ICD-10 got suspended for a year," said Dr. Abraham, governor of the Massachusetts chapter of the American College of Physicians.
"It will be déjà vu all over again come summer of next year. We’ll be doing the same thing in preparation for ICD-10 being rolled out in October 2015."
Most health plans won’t begin end-to-end testing of claims until next year, Dr. Abraham said, and that’s worrisome because it may not provide enough time to work out potential glitches.
"A delay in claims being processed is our biggest anxiety," he said. "A delay in payments will lead to a severe cash flow crunch."
