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Delays, Controversy Muddle CMS’ Two-Midnight Rule for Hospital Patient Admissions
A new rule issued by the Centers for Medicare & Medicaid Services (CMS) is at the center of controversy fueled by competing interests and lack of clarity. And, for the fourth time since the two-midnight rule was introduced in the 2014 Hospital Inpatient Prospective Payment System, its implementation has been delayed. Hospitals and providers have until March 31, 2015, before auditors begin scrutinizing patient admission statuses for reimbursement determination.
The rule requires Medicare and Medicaid patients spending fewer than two midnights receiving hospital care to be classified as outpatient or under observation. Patients spending more than two midnights will be considered inpatient. Only physicians can make the determination, and the clock begins ticking the moment care begins.
The rule also cuts hospital inpatient reimbursement by 0.2%, because CMS believes the number of inpatient admissions will increase.
–Joanna Hiatt Kim, vice president of payment policy for the American Hospital Association
The rule pits private Medicare auditors (Medicare Administrative Contractors, MACs, and Recovery Audit Contractors, RACs), who have a financial stake in denying inpatient claims, against hospitals and physicians. It does little to clear confusion for patients when it comes time for them to pay their bills.
Patients generally are unaware whether they’ve been admitted or are under observation. But observation status leaves them on the hook for any skilled nursing care they receive following discharge and for the costs of routine maintenance drugs hospitals give them for chronic conditions.
Beneficiaries also are not eligible for Medicare Part A skilled nursing care coverage if they were an inpatient for fewer than 72 hours, and observation days do not count toward the three-day requirement. The two-midnight rule adds another “layer” to the equation, says Bradley Flansbaum, DO, MPH, FACP, a hospitalist and clinical assistant professor of medicine at NYU School of Medicine in New York City.
At the same time, hospitals now face penalties for patients readmitted within 30 days of discharge for a similar episode of care. Observation status offers a measure of protection in the event patients return.
The number of observation patients increased 69% between 2006 and 2011, according to federal data cited by Kaiser Health News, and the number of observation patients staying more than 48 hours increased from 3% to 8% during this same period.
“The concern is that [the two-midnight rule] sets an arbitrary time threshold that dictates where a patient should be placed,” says Joanna Hiatt Kim, vice president of payment policy for the American Hospital Association. The AHA opposes aspects of the rule and was involved in legislation to delay implementation.
“We feel time should not be the only factor taken into account,” Hiatt Kim adds. “It should be a decision a physician reaches based on a patient’s condition.”
Good Intentions
The rule states that hospital stays fewer than two midnights are generally medically inappropriate for inpatient designation. The services provided are not at issue, but CMS believes those administered during a short stay could be provided on a less expensive outpatient basis.
Dr. Flansbaum, a member of SHM’s Public Policy Committee, says the language of medical necessity that designates status is unclear, though CMS has given physicians the benefit of the doubt.
“We are looking for clear signals from providers for how we determine when someone is appropriately inpatient and when they’re observation,” he explains.
Although medical needs can be quantified, there are often other, nonmedical factors that put patients at risk and influence when and whether a patient is admitted. Physicians routinely weigh these factors on behalf of their patients.
“Risk isn’t necessarily implied by just a dangerous blood value,” Dr. Flansbaum says. “If something is not right in the transition zone or in the community, I think those [factors] need to be taken into account.”
Physicians are being given “a lot of latitude” in CMS’ new rule, he notes.
Clarification
In recent clarification, CMS highlighted exceptions to the rule. If “unforeseen circumstances” shorten the anticipated stay of someone initially deemed inpatient—transfer to another hospital, death, or clinical improvement in fewer than two midnights, for example—CMS can advise auditors to approve the inpatient claim.
Additionally, CMS will maintain a list of services considered “inpatient only,” regardless of stay duration.
But creating a list of every medically necessary service is an “administrative black hole,” says Dr. Flansbaum, though he believes that with enough time and clarity, compliance with the two-midnight rule is possible.
Kelly April Tyrrell is a freelance writer in Wilmington, Del.
A new rule issued by the Centers for Medicare & Medicaid Services (CMS) is at the center of controversy fueled by competing interests and lack of clarity. And, for the fourth time since the two-midnight rule was introduced in the 2014 Hospital Inpatient Prospective Payment System, its implementation has been delayed. Hospitals and providers have until March 31, 2015, before auditors begin scrutinizing patient admission statuses for reimbursement determination.
The rule requires Medicare and Medicaid patients spending fewer than two midnights receiving hospital care to be classified as outpatient or under observation. Patients spending more than two midnights will be considered inpatient. Only physicians can make the determination, and the clock begins ticking the moment care begins.
The rule also cuts hospital inpatient reimbursement by 0.2%, because CMS believes the number of inpatient admissions will increase.
–Joanna Hiatt Kim, vice president of payment policy for the American Hospital Association
The rule pits private Medicare auditors (Medicare Administrative Contractors, MACs, and Recovery Audit Contractors, RACs), who have a financial stake in denying inpatient claims, against hospitals and physicians. It does little to clear confusion for patients when it comes time for them to pay their bills.
Patients generally are unaware whether they’ve been admitted or are under observation. But observation status leaves them on the hook for any skilled nursing care they receive following discharge and for the costs of routine maintenance drugs hospitals give them for chronic conditions.
Beneficiaries also are not eligible for Medicare Part A skilled nursing care coverage if they were an inpatient for fewer than 72 hours, and observation days do not count toward the three-day requirement. The two-midnight rule adds another “layer” to the equation, says Bradley Flansbaum, DO, MPH, FACP, a hospitalist and clinical assistant professor of medicine at NYU School of Medicine in New York City.
At the same time, hospitals now face penalties for patients readmitted within 30 days of discharge for a similar episode of care. Observation status offers a measure of protection in the event patients return.
The number of observation patients increased 69% between 2006 and 2011, according to federal data cited by Kaiser Health News, and the number of observation patients staying more than 48 hours increased from 3% to 8% during this same period.
“The concern is that [the two-midnight rule] sets an arbitrary time threshold that dictates where a patient should be placed,” says Joanna Hiatt Kim, vice president of payment policy for the American Hospital Association. The AHA opposes aspects of the rule and was involved in legislation to delay implementation.
“We feel time should not be the only factor taken into account,” Hiatt Kim adds. “It should be a decision a physician reaches based on a patient’s condition.”
Good Intentions
The rule states that hospital stays fewer than two midnights are generally medically inappropriate for inpatient designation. The services provided are not at issue, but CMS believes those administered during a short stay could be provided on a less expensive outpatient basis.
Dr. Flansbaum, a member of SHM’s Public Policy Committee, says the language of medical necessity that designates status is unclear, though CMS has given physicians the benefit of the doubt.
“We are looking for clear signals from providers for how we determine when someone is appropriately inpatient and when they’re observation,” he explains.
Although medical needs can be quantified, there are often other, nonmedical factors that put patients at risk and influence when and whether a patient is admitted. Physicians routinely weigh these factors on behalf of their patients.
“Risk isn’t necessarily implied by just a dangerous blood value,” Dr. Flansbaum says. “If something is not right in the transition zone or in the community, I think those [factors] need to be taken into account.”
Physicians are being given “a lot of latitude” in CMS’ new rule, he notes.
Clarification
In recent clarification, CMS highlighted exceptions to the rule. If “unforeseen circumstances” shorten the anticipated stay of someone initially deemed inpatient—transfer to another hospital, death, or clinical improvement in fewer than two midnights, for example—CMS can advise auditors to approve the inpatient claim.
Additionally, CMS will maintain a list of services considered “inpatient only,” regardless of stay duration.
But creating a list of every medically necessary service is an “administrative black hole,” says Dr. Flansbaum, though he believes that with enough time and clarity, compliance with the two-midnight rule is possible.
Kelly April Tyrrell is a freelance writer in Wilmington, Del.
A new rule issued by the Centers for Medicare & Medicaid Services (CMS) is at the center of controversy fueled by competing interests and lack of clarity. And, for the fourth time since the two-midnight rule was introduced in the 2014 Hospital Inpatient Prospective Payment System, its implementation has been delayed. Hospitals and providers have until March 31, 2015, before auditors begin scrutinizing patient admission statuses for reimbursement determination.
The rule requires Medicare and Medicaid patients spending fewer than two midnights receiving hospital care to be classified as outpatient or under observation. Patients spending more than two midnights will be considered inpatient. Only physicians can make the determination, and the clock begins ticking the moment care begins.
The rule also cuts hospital inpatient reimbursement by 0.2%, because CMS believes the number of inpatient admissions will increase.
–Joanna Hiatt Kim, vice president of payment policy for the American Hospital Association
The rule pits private Medicare auditors (Medicare Administrative Contractors, MACs, and Recovery Audit Contractors, RACs), who have a financial stake in denying inpatient claims, against hospitals and physicians. It does little to clear confusion for patients when it comes time for them to pay their bills.
Patients generally are unaware whether they’ve been admitted or are under observation. But observation status leaves them on the hook for any skilled nursing care they receive following discharge and for the costs of routine maintenance drugs hospitals give them for chronic conditions.
Beneficiaries also are not eligible for Medicare Part A skilled nursing care coverage if they were an inpatient for fewer than 72 hours, and observation days do not count toward the three-day requirement. The two-midnight rule adds another “layer” to the equation, says Bradley Flansbaum, DO, MPH, FACP, a hospitalist and clinical assistant professor of medicine at NYU School of Medicine in New York City.
At the same time, hospitals now face penalties for patients readmitted within 30 days of discharge for a similar episode of care. Observation status offers a measure of protection in the event patients return.
The number of observation patients increased 69% between 2006 and 2011, according to federal data cited by Kaiser Health News, and the number of observation patients staying more than 48 hours increased from 3% to 8% during this same period.
“The concern is that [the two-midnight rule] sets an arbitrary time threshold that dictates where a patient should be placed,” says Joanna Hiatt Kim, vice president of payment policy for the American Hospital Association. The AHA opposes aspects of the rule and was involved in legislation to delay implementation.
“We feel time should not be the only factor taken into account,” Hiatt Kim adds. “It should be a decision a physician reaches based on a patient’s condition.”
Good Intentions
The rule states that hospital stays fewer than two midnights are generally medically inappropriate for inpatient designation. The services provided are not at issue, but CMS believes those administered during a short stay could be provided on a less expensive outpatient basis.
Dr. Flansbaum, a member of SHM’s Public Policy Committee, says the language of medical necessity that designates status is unclear, though CMS has given physicians the benefit of the doubt.
“We are looking for clear signals from providers for how we determine when someone is appropriately inpatient and when they’re observation,” he explains.
Although medical needs can be quantified, there are often other, nonmedical factors that put patients at risk and influence when and whether a patient is admitted. Physicians routinely weigh these factors on behalf of their patients.
“Risk isn’t necessarily implied by just a dangerous blood value,” Dr. Flansbaum says. “If something is not right in the transition zone or in the community, I think those [factors] need to be taken into account.”
Physicians are being given “a lot of latitude” in CMS’ new rule, he notes.
Clarification
In recent clarification, CMS highlighted exceptions to the rule. If “unforeseen circumstances” shorten the anticipated stay of someone initially deemed inpatient—transfer to another hospital, death, or clinical improvement in fewer than two midnights, for example—CMS can advise auditors to approve the inpatient claim.
Additionally, CMS will maintain a list of services considered “inpatient only,” regardless of stay duration.
But creating a list of every medically necessary service is an “administrative black hole,” says Dr. Flansbaum, though he believes that with enough time and clarity, compliance with the two-midnight rule is possible.
Kelly April Tyrrell is a freelance writer in Wilmington, Del.
Senate passes 1-year SGR patch; delays ICD-10 until 2015
In a last-minute move, Congress averted a scheduled 24% cut to Medicare physician fees slated to start on April 1, while simultaneously delaying the move to the ICD-10 coding sets.
On March 31, the Senate voted 64 to 35 to approve H.R. 4302, a bill that replaces the scheduled cut called for by the Medicare Sustainable Growth Rate formula with a 0.5% fee increase through the end of 2014 and a pay freeze from Jan. 1, 2015 through March 15, 2015. The bill also bars the Health and Human Services (HHS) department from implementing ICD-10 until Oct. 1, 2015.
The House passed the same legislation on March 27. It now heads to the White House for President Obama’s signature.
At first glance, the bill looks like good news for physicians, who will get relief from both a hefty Medicare fee cut and a costly new regulatory requirement. But many physician organizations, led by the American Medical Association, have campaigned against the temporary patch, saying that it essentially stops the work to permanently repeal the SGR.
"It appears that an unprecedented, bipartisan agreement on Medicare reform is on the verge of being cast aside because elected leaders are unwilling to make tough choices to strengthen programs serving 50 million Americans," the AMA and more than 50 other medical societies wrote to congressional leaders before the House vote.
Several physician groups had endorsed a bipartisan legislative package that would have eliminated the SGR and replaced it with a combination of small fee increases and delivery system reforms. The hurdle to passing the legislation was finding a way to pay for it that would appeal to both Democrats and Republicans.
Recently, the House passed H.R. 4015, which would have funded the permanent SGR repeal package with a 5-year delay of the Affordable Care Act’s individual insurance mandate. But that bill is unlikely to be considered in the Democratic-controlled Senate. And an attempt by Sen. Ron Wyden (D.-Ore.) to move the permanent SGR repeal forward and pay for it using the savings from the end of the wars in Iraq and Afghanistan failed to gain enough votes in the Senate.
Before the March 31 vote, Sen. Wyden chided fellow lawmakers for continuing to pass temporary fixes to the SGR problem rather than replacing it and moving to a payment system that incentivizes quality improvement. "It can’t be ducked much longer," he said.
But Sen. Orrin Hatch (R.-Utah), who worked on the bipartisan bill to replace the SGR, said he objects to the funding mechanism that Sen. Wyden proposed. He said the 12-month SGR patch will give lawmakers more time to agree on how to pay for a permanent fix. "I’m not going to make the perfect the enemy of the good," he said on the Senate floor.
mschneider@frontlinemedcom.com
On Twitter @maryellenny
In a last-minute move, Congress averted a scheduled 24% cut to Medicare physician fees slated to start on April 1, while simultaneously delaying the move to the ICD-10 coding sets.
On March 31, the Senate voted 64 to 35 to approve H.R. 4302, a bill that replaces the scheduled cut called for by the Medicare Sustainable Growth Rate formula with a 0.5% fee increase through the end of 2014 and a pay freeze from Jan. 1, 2015 through March 15, 2015. The bill also bars the Health and Human Services (HHS) department from implementing ICD-10 until Oct. 1, 2015.
The House passed the same legislation on March 27. It now heads to the White House for President Obama’s signature.
At first glance, the bill looks like good news for physicians, who will get relief from both a hefty Medicare fee cut and a costly new regulatory requirement. But many physician organizations, led by the American Medical Association, have campaigned against the temporary patch, saying that it essentially stops the work to permanently repeal the SGR.
"It appears that an unprecedented, bipartisan agreement on Medicare reform is on the verge of being cast aside because elected leaders are unwilling to make tough choices to strengthen programs serving 50 million Americans," the AMA and more than 50 other medical societies wrote to congressional leaders before the House vote.
Several physician groups had endorsed a bipartisan legislative package that would have eliminated the SGR and replaced it with a combination of small fee increases and delivery system reforms. The hurdle to passing the legislation was finding a way to pay for it that would appeal to both Democrats and Republicans.
Recently, the House passed H.R. 4015, which would have funded the permanent SGR repeal package with a 5-year delay of the Affordable Care Act’s individual insurance mandate. But that bill is unlikely to be considered in the Democratic-controlled Senate. And an attempt by Sen. Ron Wyden (D.-Ore.) to move the permanent SGR repeal forward and pay for it using the savings from the end of the wars in Iraq and Afghanistan failed to gain enough votes in the Senate.
Before the March 31 vote, Sen. Wyden chided fellow lawmakers for continuing to pass temporary fixes to the SGR problem rather than replacing it and moving to a payment system that incentivizes quality improvement. "It can’t be ducked much longer," he said.
But Sen. Orrin Hatch (R.-Utah), who worked on the bipartisan bill to replace the SGR, said he objects to the funding mechanism that Sen. Wyden proposed. He said the 12-month SGR patch will give lawmakers more time to agree on how to pay for a permanent fix. "I’m not going to make the perfect the enemy of the good," he said on the Senate floor.
mschneider@frontlinemedcom.com
On Twitter @maryellenny
In a last-minute move, Congress averted a scheduled 24% cut to Medicare physician fees slated to start on April 1, while simultaneously delaying the move to the ICD-10 coding sets.
On March 31, the Senate voted 64 to 35 to approve H.R. 4302, a bill that replaces the scheduled cut called for by the Medicare Sustainable Growth Rate formula with a 0.5% fee increase through the end of 2014 and a pay freeze from Jan. 1, 2015 through March 15, 2015. The bill also bars the Health and Human Services (HHS) department from implementing ICD-10 until Oct. 1, 2015.
The House passed the same legislation on March 27. It now heads to the White House for President Obama’s signature.
At first glance, the bill looks like good news for physicians, who will get relief from both a hefty Medicare fee cut and a costly new regulatory requirement. But many physician organizations, led by the American Medical Association, have campaigned against the temporary patch, saying that it essentially stops the work to permanently repeal the SGR.
"It appears that an unprecedented, bipartisan agreement on Medicare reform is on the verge of being cast aside because elected leaders are unwilling to make tough choices to strengthen programs serving 50 million Americans," the AMA and more than 50 other medical societies wrote to congressional leaders before the House vote.
Several physician groups had endorsed a bipartisan legislative package that would have eliminated the SGR and replaced it with a combination of small fee increases and delivery system reforms. The hurdle to passing the legislation was finding a way to pay for it that would appeal to both Democrats and Republicans.
Recently, the House passed H.R. 4015, which would have funded the permanent SGR repeal package with a 5-year delay of the Affordable Care Act’s individual insurance mandate. But that bill is unlikely to be considered in the Democratic-controlled Senate. And an attempt by Sen. Ron Wyden (D.-Ore.) to move the permanent SGR repeal forward and pay for it using the savings from the end of the wars in Iraq and Afghanistan failed to gain enough votes in the Senate.
Before the March 31 vote, Sen. Wyden chided fellow lawmakers for continuing to pass temporary fixes to the SGR problem rather than replacing it and moving to a payment system that incentivizes quality improvement. "It can’t be ducked much longer," he said.
But Sen. Orrin Hatch (R.-Utah), who worked on the bipartisan bill to replace the SGR, said he objects to the funding mechanism that Sen. Wyden proposed. He said the 12-month SGR patch will give lawmakers more time to agree on how to pay for a permanent fix. "I’m not going to make the perfect the enemy of the good," he said on the Senate floor.
mschneider@frontlinemedcom.com
On Twitter @maryellenny
Senate passes 1-year SGR patch; delays ICD-10 until 2015
In a last-minute move, Congress averted a scheduled 24% cut to Medicare physician fees slated to start on April 1, while simultaneously delaying the move to the ICD-10 coding sets.
On March 31, the Senate voted 64 to 35 to approve H.R. 4302, a bill that replaces the scheduled cut called for by the Medicare Sustainable Growth Rate formula with a 0.5% fee increase through the end of 2014 and a pay freeze from Jan. 1, 2015 through March 15, 2015. The bill also bars the Health and Human Services (HHS) department from implementing ICD-10 until Oct. 1, 2015.
The House passed the same legislation on March 27. It now heads to the White House for President Obama’s signature.
At first glance, the bill looks like good news for physicians, who will get relief from both a hefty Medicare fee cut and a costly new regulatory requirement. But many physician organizations, led by the American Medical Association, have campaigned against the temporary patch, saying that it essentially stops the work to permanently repeal the SGR.
"It appears that an unprecedented, bipartisan agreement on Medicare reform is on the verge of being cast aside because elected leaders are unwilling to make tough choices to strengthen programs serving 50 million Americans," the AMA and more than 50 other medical societies wrote to congressional leaders before the House vote.
Several physician groups had endorsed a bipartisan legislative package that would have eliminated the SGR and replaced it with a combination of small fee increases and delivery system reforms. The hurdle to passing the legislation was finding a way to pay for it that would appeal to both Democrats and Republicans.
Recently, the House passed H.R. 4015, which would have funded the permanent SGR repeal package with a 5-year delay of the Affordable Care Act’s individual insurance mandate. But that bill is unlikely to be considered in the Democratic-controlled Senate. And an attempt by Sen. Ron Wyden (D.-Ore.) to move the permanent SGR repeal forward and pay for it using the savings from the end of the wars in Iraq and Afghanistan failed to gain enough votes in the Senate.
Before the March 31 vote, Sen. Wyden chided fellow lawmakers for continuing to pass temporary fixes to the SGR problem rather than replacing it and moving to a payment system that incentivizes quality improvement. "It can’t be ducked much longer," he said.
But Sen. Orrin Hatch (R.-Utah), who worked on the bipartisan bill to replace the SGR, said he objects to the funding mechanism that Sen. Wyden proposed. He said the 12-month SGR patch will give lawmakers more time to agree on how to pay for a permanent fix. "I’m not going to make the perfect the enemy of the good," he said on the Senate floor.
mschneider@frontlinemedcom.com
On Twitter @maryellenny
In a last-minute move, Congress averted a scheduled 24% cut to Medicare physician fees slated to start on April 1, while simultaneously delaying the move to the ICD-10 coding sets.
On March 31, the Senate voted 64 to 35 to approve H.R. 4302, a bill that replaces the scheduled cut called for by the Medicare Sustainable Growth Rate formula with a 0.5% fee increase through the end of 2014 and a pay freeze from Jan. 1, 2015 through March 15, 2015. The bill also bars the Health and Human Services (HHS) department from implementing ICD-10 until Oct. 1, 2015.
The House passed the same legislation on March 27. It now heads to the White House for President Obama’s signature.
At first glance, the bill looks like good news for physicians, who will get relief from both a hefty Medicare fee cut and a costly new regulatory requirement. But many physician organizations, led by the American Medical Association, have campaigned against the temporary patch, saying that it essentially stops the work to permanently repeal the SGR.
"It appears that an unprecedented, bipartisan agreement on Medicare reform is on the verge of being cast aside because elected leaders are unwilling to make tough choices to strengthen programs serving 50 million Americans," the AMA and more than 50 other medical societies wrote to congressional leaders before the House vote.
Several physician groups had endorsed a bipartisan legislative package that would have eliminated the SGR and replaced it with a combination of small fee increases and delivery system reforms. The hurdle to passing the legislation was finding a way to pay for it that would appeal to both Democrats and Republicans.
Recently, the House passed H.R. 4015, which would have funded the permanent SGR repeal package with a 5-year delay of the Affordable Care Act’s individual insurance mandate. But that bill is unlikely to be considered in the Democratic-controlled Senate. And an attempt by Sen. Ron Wyden (D.-Ore.) to move the permanent SGR repeal forward and pay for it using the savings from the end of the wars in Iraq and Afghanistan failed to gain enough votes in the Senate.
Before the March 31 vote, Sen. Wyden chided fellow lawmakers for continuing to pass temporary fixes to the SGR problem rather than replacing it and moving to a payment system that incentivizes quality improvement. "It can’t be ducked much longer," he said.
But Sen. Orrin Hatch (R.-Utah), who worked on the bipartisan bill to replace the SGR, said he objects to the funding mechanism that Sen. Wyden proposed. He said the 12-month SGR patch will give lawmakers more time to agree on how to pay for a permanent fix. "I’m not going to make the perfect the enemy of the good," he said on the Senate floor.
mschneider@frontlinemedcom.com
On Twitter @maryellenny
In a last-minute move, Congress averted a scheduled 24% cut to Medicare physician fees slated to start on April 1, while simultaneously delaying the move to the ICD-10 coding sets.
On March 31, the Senate voted 64 to 35 to approve H.R. 4302, a bill that replaces the scheduled cut called for by the Medicare Sustainable Growth Rate formula with a 0.5% fee increase through the end of 2014 and a pay freeze from Jan. 1, 2015 through March 15, 2015. The bill also bars the Health and Human Services (HHS) department from implementing ICD-10 until Oct. 1, 2015.
The House passed the same legislation on March 27. It now heads to the White House for President Obama’s signature.
At first glance, the bill looks like good news for physicians, who will get relief from both a hefty Medicare fee cut and a costly new regulatory requirement. But many physician organizations, led by the American Medical Association, have campaigned against the temporary patch, saying that it essentially stops the work to permanently repeal the SGR.
"It appears that an unprecedented, bipartisan agreement on Medicare reform is on the verge of being cast aside because elected leaders are unwilling to make tough choices to strengthen programs serving 50 million Americans," the AMA and more than 50 other medical societies wrote to congressional leaders before the House vote.
Several physician groups had endorsed a bipartisan legislative package that would have eliminated the SGR and replaced it with a combination of small fee increases and delivery system reforms. The hurdle to passing the legislation was finding a way to pay for it that would appeal to both Democrats and Republicans.
Recently, the House passed H.R. 4015, which would have funded the permanent SGR repeal package with a 5-year delay of the Affordable Care Act’s individual insurance mandate. But that bill is unlikely to be considered in the Democratic-controlled Senate. And an attempt by Sen. Ron Wyden (D.-Ore.) to move the permanent SGR repeal forward and pay for it using the savings from the end of the wars in Iraq and Afghanistan failed to gain enough votes in the Senate.
Before the March 31 vote, Sen. Wyden chided fellow lawmakers for continuing to pass temporary fixes to the SGR problem rather than replacing it and moving to a payment system that incentivizes quality improvement. "It can’t be ducked much longer," he said.
But Sen. Orrin Hatch (R.-Utah), who worked on the bipartisan bill to replace the SGR, said he objects to the funding mechanism that Sen. Wyden proposed. He said the 12-month SGR patch will give lawmakers more time to agree on how to pay for a permanent fix. "I’m not going to make the perfect the enemy of the good," he said on the Senate floor.
mschneider@frontlinemedcom.com
On Twitter @maryellenny
Quitting Smoking During Substance Abuse Treatment
“Smoking tobacco causes more deaths among clients in substance abuse treatment than the alcohol or drug use that brings them to treatment,” according to the Substance Abuse and Mental Health Services Administration (SAMHSA). An 11-year study found that 51% of deaths in people in addictions treatment were tobacco related—a rate twice that found in the general population and nearly 1.5 times the rate of death by other addiction-related causes.
Substance abuse treatment programs often hesitate to incorporate smoking cessation therapies, fearing that patients will drop out entirely, says National Institute on Drug Abuse Director Dr. Nora D. Volkow. According to SAMHSA in a 2008 study, 63% of people who reported a substance use disorder also reported current tobacco use, compared with 28% of the general population.
So recent study findings from the National Institutes of Health bring good news: Helping smokers who are addicted to cocaine or methamphetamine to quit smoking won’t interfere with the substance abuse treatment.
Findings from the 10-week trial were published in the December 2013 issue of Journal of Clinical Psychiatry. In the study, 538 adults being treated for cocaine or methamphetamine dependence who were also interested in quitting smoking were assigned to treatment as usual or treatment as usual with smoking cessation treatment. If assigned to the concurrent treatment, participants received weekly individual smoking cessation counseling and extended release bupropion (300 mg/d) during weeks 1 to 10. During postquit treatment (weeks 4-10), participants in the concurrent arm also received a nicotine inhaler and contingency management for smoking abstinence.
The researchers found no significant treatment effects on stimulant-use outcomes or on attendance. Participants assigned to the concurrent treatments had significantly better outcomes for drug-free days at the 6-month follow-up (P < .05) and significantly better outcomes in remaining smoke free (P < .001).
“These findings,” said Theresa Winhusen, PhD, lead author on the study, “coupled with past research, should reassure clinicians that providing smoking-cessation treatment in conjunction with treatment for other substance use disorders will be beneficial to their patients.”
“Smoking tobacco causes more deaths among clients in substance abuse treatment than the alcohol or drug use that brings them to treatment,” according to the Substance Abuse and Mental Health Services Administration (SAMHSA). An 11-year study found that 51% of deaths in people in addictions treatment were tobacco related—a rate twice that found in the general population and nearly 1.5 times the rate of death by other addiction-related causes.
Substance abuse treatment programs often hesitate to incorporate smoking cessation therapies, fearing that patients will drop out entirely, says National Institute on Drug Abuse Director Dr. Nora D. Volkow. According to SAMHSA in a 2008 study, 63% of people who reported a substance use disorder also reported current tobacco use, compared with 28% of the general population.
So recent study findings from the National Institutes of Health bring good news: Helping smokers who are addicted to cocaine or methamphetamine to quit smoking won’t interfere with the substance abuse treatment.
Findings from the 10-week trial were published in the December 2013 issue of Journal of Clinical Psychiatry. In the study, 538 adults being treated for cocaine or methamphetamine dependence who were also interested in quitting smoking were assigned to treatment as usual or treatment as usual with smoking cessation treatment. If assigned to the concurrent treatment, participants received weekly individual smoking cessation counseling and extended release bupropion (300 mg/d) during weeks 1 to 10. During postquit treatment (weeks 4-10), participants in the concurrent arm also received a nicotine inhaler and contingency management for smoking abstinence.
The researchers found no significant treatment effects on stimulant-use outcomes or on attendance. Participants assigned to the concurrent treatments had significantly better outcomes for drug-free days at the 6-month follow-up (P < .05) and significantly better outcomes in remaining smoke free (P < .001).
“These findings,” said Theresa Winhusen, PhD, lead author on the study, “coupled with past research, should reassure clinicians that providing smoking-cessation treatment in conjunction with treatment for other substance use disorders will be beneficial to their patients.”
“Smoking tobacco causes more deaths among clients in substance abuse treatment than the alcohol or drug use that brings them to treatment,” according to the Substance Abuse and Mental Health Services Administration (SAMHSA). An 11-year study found that 51% of deaths in people in addictions treatment were tobacco related—a rate twice that found in the general population and nearly 1.5 times the rate of death by other addiction-related causes.
Substance abuse treatment programs often hesitate to incorporate smoking cessation therapies, fearing that patients will drop out entirely, says National Institute on Drug Abuse Director Dr. Nora D. Volkow. According to SAMHSA in a 2008 study, 63% of people who reported a substance use disorder also reported current tobacco use, compared with 28% of the general population.
So recent study findings from the National Institutes of Health bring good news: Helping smokers who are addicted to cocaine or methamphetamine to quit smoking won’t interfere with the substance abuse treatment.
Findings from the 10-week trial were published in the December 2013 issue of Journal of Clinical Psychiatry. In the study, 538 adults being treated for cocaine or methamphetamine dependence who were also interested in quitting smoking were assigned to treatment as usual or treatment as usual with smoking cessation treatment. If assigned to the concurrent treatment, participants received weekly individual smoking cessation counseling and extended release bupropion (300 mg/d) during weeks 1 to 10. During postquit treatment (weeks 4-10), participants in the concurrent arm also received a nicotine inhaler and contingency management for smoking abstinence.
The researchers found no significant treatment effects on stimulant-use outcomes or on attendance. Participants assigned to the concurrent treatments had significantly better outcomes for drug-free days at the 6-month follow-up (P < .05) and significantly better outcomes in remaining smoke free (P < .001).
“These findings,” said Theresa Winhusen, PhD, lead author on the study, “coupled with past research, should reassure clinicians that providing smoking-cessation treatment in conjunction with treatment for other substance use disorders will be beneficial to their patients.”
Military's top doc: Iraq lessons saved lives in Boston
Dr. Jonathan Woodson fielded emails in his Pentagon office last April from nervous colleagues in Boston. His fellow vascular surgeons there wanted to know if more attacks were coming in the Marathon bombings. "When you work at the Pentagon, everyone thinks you have total situational awareness," said Dr. Woodson, assistant secretary of defense for health affairs.
His former colleagues, however, wanted tips on how to care for bombing victims, and knew that military surgeons like Dr. Woodson had answers. Before President Obama tapped him in 2010 to become the military’s top doctor and oversee the Pentagon’s $50 billion–plus medical budget, he’d scrubbed in on battlefield cases in Kosovo, Iraq, and Afghanistan, in addition to performing his vascular surgery and administrative duties at Boston University and Boston Medical Center.
"We’ve been dealing with [improvised explosive device] injuries for over a decade," said Dr. Woodson, a brigadier general in the U.S. Army Reserve. "I had trained some of the folks who worked on the bombing victims, and they knew what my techniques were."
The back-and-forth about the Boston attacks highlights how important it is for military and civilian physicians to cross-pollinate. In the past, "there’s always been a cadre of usually academic surgeons and physicians who maintain contact with the military. I think [it] is very important to formalize these connections. One of my strategic imperatives is to make sure we invest in partnerships [with] academic medical centers and key professional organizations" so that war innovations make it into civilian practice, and, in turn, are remembered for future conflicts.
"There’s the potential for this expertise to be lost," said Dr. Woodson, There’ve been many innovations in recent years, including the recognition that extensive fasciotomies can save badly damaged limbs.
At the start of Operation Iraqi Freedom in 2003, Dr. Woodson was in northern Kuwait running a makeshift U.S. military hospital out of a commandeered Kuwaiti facility. "As the troops went over the berm, we were taking the first wave of casualties," performing surgery in full chemical-attack gear. "Luckily, the incoming Scud missiles weren’t very accurate. It was a humbling experience," he said.
A young soldier was helicoptered in with a crushed leg after a hit to his armored vehicle. "We did an interposition graft to repair the popliteal artery," and, because of severe swelling, extensive fasciotomies to prevent compartment syndrome; the soldier still had his leg when he was airlifted out. Although not standard practice at the time, that case and others like it quickly demonstrated "the benefit of doing four-compartment fasciotomies early on to preserve limbs. Fasciotomies are now [used routinely] to address these injuries."
Tourniquets – which "prior to this conflict had a very bad reputation" – have proved their worth in recent battles as well, a lesson that helped save lives in Boston. Likewise, the military has learned the value of temporary vascular shunts when there’s no time for a definitive repair. "We [also] came to understand very early on the need for aggressive blood replacement," he said.
Dr. Jonathan Woodson fielded emails in his Pentagon office last April from nervous colleagues in Boston. His fellow vascular surgeons there wanted to know if more attacks were coming in the Marathon bombings. "When you work at the Pentagon, everyone thinks you have total situational awareness," said Dr. Woodson, assistant secretary of defense for health affairs.
His former colleagues, however, wanted tips on how to care for bombing victims, and knew that military surgeons like Dr. Woodson had answers. Before President Obama tapped him in 2010 to become the military’s top doctor and oversee the Pentagon’s $50 billion–plus medical budget, he’d scrubbed in on battlefield cases in Kosovo, Iraq, and Afghanistan, in addition to performing his vascular surgery and administrative duties at Boston University and Boston Medical Center.
"We’ve been dealing with [improvised explosive device] injuries for over a decade," said Dr. Woodson, a brigadier general in the U.S. Army Reserve. "I had trained some of the folks who worked on the bombing victims, and they knew what my techniques were."
The back-and-forth about the Boston attacks highlights how important it is for military and civilian physicians to cross-pollinate. In the past, "there’s always been a cadre of usually academic surgeons and physicians who maintain contact with the military. I think [it] is very important to formalize these connections. One of my strategic imperatives is to make sure we invest in partnerships [with] academic medical centers and key professional organizations" so that war innovations make it into civilian practice, and, in turn, are remembered for future conflicts.
"There’s the potential for this expertise to be lost," said Dr. Woodson, There’ve been many innovations in recent years, including the recognition that extensive fasciotomies can save badly damaged limbs.
At the start of Operation Iraqi Freedom in 2003, Dr. Woodson was in northern Kuwait running a makeshift U.S. military hospital out of a commandeered Kuwaiti facility. "As the troops went over the berm, we were taking the first wave of casualties," performing surgery in full chemical-attack gear. "Luckily, the incoming Scud missiles weren’t very accurate. It was a humbling experience," he said.
A young soldier was helicoptered in with a crushed leg after a hit to his armored vehicle. "We did an interposition graft to repair the popliteal artery," and, because of severe swelling, extensive fasciotomies to prevent compartment syndrome; the soldier still had his leg when he was airlifted out. Although not standard practice at the time, that case and others like it quickly demonstrated "the benefit of doing four-compartment fasciotomies early on to preserve limbs. Fasciotomies are now [used routinely] to address these injuries."
Tourniquets – which "prior to this conflict had a very bad reputation" – have proved their worth in recent battles as well, a lesson that helped save lives in Boston. Likewise, the military has learned the value of temporary vascular shunts when there’s no time for a definitive repair. "We [also] came to understand very early on the need for aggressive blood replacement," he said.
Dr. Jonathan Woodson fielded emails in his Pentagon office last April from nervous colleagues in Boston. His fellow vascular surgeons there wanted to know if more attacks were coming in the Marathon bombings. "When you work at the Pentagon, everyone thinks you have total situational awareness," said Dr. Woodson, assistant secretary of defense for health affairs.
His former colleagues, however, wanted tips on how to care for bombing victims, and knew that military surgeons like Dr. Woodson had answers. Before President Obama tapped him in 2010 to become the military’s top doctor and oversee the Pentagon’s $50 billion–plus medical budget, he’d scrubbed in on battlefield cases in Kosovo, Iraq, and Afghanistan, in addition to performing his vascular surgery and administrative duties at Boston University and Boston Medical Center.
"We’ve been dealing with [improvised explosive device] injuries for over a decade," said Dr. Woodson, a brigadier general in the U.S. Army Reserve. "I had trained some of the folks who worked on the bombing victims, and they knew what my techniques were."
The back-and-forth about the Boston attacks highlights how important it is for military and civilian physicians to cross-pollinate. In the past, "there’s always been a cadre of usually academic surgeons and physicians who maintain contact with the military. I think [it] is very important to formalize these connections. One of my strategic imperatives is to make sure we invest in partnerships [with] academic medical centers and key professional organizations" so that war innovations make it into civilian practice, and, in turn, are remembered for future conflicts.
"There’s the potential for this expertise to be lost," said Dr. Woodson, There’ve been many innovations in recent years, including the recognition that extensive fasciotomies can save badly damaged limbs.
At the start of Operation Iraqi Freedom in 2003, Dr. Woodson was in northern Kuwait running a makeshift U.S. military hospital out of a commandeered Kuwaiti facility. "As the troops went over the berm, we were taking the first wave of casualties," performing surgery in full chemical-attack gear. "Luckily, the incoming Scud missiles weren’t very accurate. It was a humbling experience," he said.
A young soldier was helicoptered in with a crushed leg after a hit to his armored vehicle. "We did an interposition graft to repair the popliteal artery," and, because of severe swelling, extensive fasciotomies to prevent compartment syndrome; the soldier still had his leg when he was airlifted out. Although not standard practice at the time, that case and others like it quickly demonstrated "the benefit of doing four-compartment fasciotomies early on to preserve limbs. Fasciotomies are now [used routinely] to address these injuries."
Tourniquets – which "prior to this conflict had a very bad reputation" – have proved their worth in recent battles as well, a lesson that helped save lives in Boston. Likewise, the military has learned the value of temporary vascular shunts when there’s no time for a definitive repair. "We [also] came to understand very early on the need for aggressive blood replacement," he said.
IHS Takes Aim at HIV
In 2010, American Indians and Alaska Natives (AIANs) accounted for < 1% of the estimated 47,500 new cases of human immunodeficiency virus (HIV) infection in the U.S. However, that proportion is misleading. When population size is taken into account for 2011, AIANs ranked fifth in rates of HIV/AIDS (acquired immunodeficiency syndrome) diagnoses. And the rate of AIDS diagnosis for this group has been higher than that for whites since 1995, according to the Centers for Disease Control and Prevention (CDC).
Also, AIANs diagnosed with HIV/AIDS die sooner: Between 2003 and 2007, only 81% lived longer than 36 months after being diagnosed. In 2010, HIV infection was the ninth leading cause of death among AIAN men and women aged 25 to 34 years.
Race and ethnicity are not, by themselves, risk factors for HIV infection, the CDC says. American Indian and Alaska Natives also have high rates of Chlamydia trachomatis infection, gonorrhea, and syphilis—sexually transmitted diseases are a warning signal of contracting or spreading HIV. Substance abuse is another risk factor: Current illicit drug use is higher among AIANs (12.8%) than in other races or ethnicities.
Lack of access to appropriate health care is another crucial factor, especially in the extremely poor AIAN communities, where between 2002 and 2004 about twice the national average was living in poverty. An estimated 1 in 5 AIAN adults living with HIV/AIDS at the end of 2009 were unaware of their infection. And while 75% of those who found out they were living with HIV in 2010 were linked to medical care within 3 months, this was the lowest proportion of any group surveyed.
Effective prevention interventions, the CDC says, must be tailored to the population. But the AIAN population comprises 562 federally recognized tribes and at least 50 state-recognized tribes, with different culture, beliefs, practices, and languages. Further, at the time of AIDS diagnosis, more AIANs lived in rural areas and may have been less likely to be tested for HIV because of limited access to testing. They also may have been less likely to seek testing because of concerns of confidentiality in a small and close-knit community. More than half of AIANs who responded to the Behavioral Risk Factor Surveillance System survey during 1997-2000 said they had never been tested for HIV.
The Indian Health Service (IHS) created a video to promote testing, “Facing HIV/AIDS in Native Communities,” available at http://www.ihs.gov/hivaids. Promotional materials include radio public service announcements, and training kits. Information on reaching out through social media and other emerging technology can be found at http://www.aids.gov/using-new-media.
“We have shown the positive impact of focused HIV/AIDS screening, education, treatment, and prevention in a group of IHS facilities,” says IHS Chief Clinical Consultant for Infectious Diseases Dr. Jonathan Iralu. “Now is the time to offer the opportunity to have an ‘AIDS Free Generation’ to all American Indian and Alaska Native communities that we serve.”
In 2010, American Indians and Alaska Natives (AIANs) accounted for < 1% of the estimated 47,500 new cases of human immunodeficiency virus (HIV) infection in the U.S. However, that proportion is misleading. When population size is taken into account for 2011, AIANs ranked fifth in rates of HIV/AIDS (acquired immunodeficiency syndrome) diagnoses. And the rate of AIDS diagnosis for this group has been higher than that for whites since 1995, according to the Centers for Disease Control and Prevention (CDC).
Also, AIANs diagnosed with HIV/AIDS die sooner: Between 2003 and 2007, only 81% lived longer than 36 months after being diagnosed. In 2010, HIV infection was the ninth leading cause of death among AIAN men and women aged 25 to 34 years.
Race and ethnicity are not, by themselves, risk factors for HIV infection, the CDC says. American Indian and Alaska Natives also have high rates of Chlamydia trachomatis infection, gonorrhea, and syphilis—sexually transmitted diseases are a warning signal of contracting or spreading HIV. Substance abuse is another risk factor: Current illicit drug use is higher among AIANs (12.8%) than in other races or ethnicities.
Lack of access to appropriate health care is another crucial factor, especially in the extremely poor AIAN communities, where between 2002 and 2004 about twice the national average was living in poverty. An estimated 1 in 5 AIAN adults living with HIV/AIDS at the end of 2009 were unaware of their infection. And while 75% of those who found out they were living with HIV in 2010 were linked to medical care within 3 months, this was the lowest proportion of any group surveyed.
Effective prevention interventions, the CDC says, must be tailored to the population. But the AIAN population comprises 562 federally recognized tribes and at least 50 state-recognized tribes, with different culture, beliefs, practices, and languages. Further, at the time of AIDS diagnosis, more AIANs lived in rural areas and may have been less likely to be tested for HIV because of limited access to testing. They also may have been less likely to seek testing because of concerns of confidentiality in a small and close-knit community. More than half of AIANs who responded to the Behavioral Risk Factor Surveillance System survey during 1997-2000 said they had never been tested for HIV.
The Indian Health Service (IHS) created a video to promote testing, “Facing HIV/AIDS in Native Communities,” available at http://www.ihs.gov/hivaids. Promotional materials include radio public service announcements, and training kits. Information on reaching out through social media and other emerging technology can be found at http://www.aids.gov/using-new-media.
“We have shown the positive impact of focused HIV/AIDS screening, education, treatment, and prevention in a group of IHS facilities,” says IHS Chief Clinical Consultant for Infectious Diseases Dr. Jonathan Iralu. “Now is the time to offer the opportunity to have an ‘AIDS Free Generation’ to all American Indian and Alaska Native communities that we serve.”
In 2010, American Indians and Alaska Natives (AIANs) accounted for < 1% of the estimated 47,500 new cases of human immunodeficiency virus (HIV) infection in the U.S. However, that proportion is misleading. When population size is taken into account for 2011, AIANs ranked fifth in rates of HIV/AIDS (acquired immunodeficiency syndrome) diagnoses. And the rate of AIDS diagnosis for this group has been higher than that for whites since 1995, according to the Centers for Disease Control and Prevention (CDC).
Also, AIANs diagnosed with HIV/AIDS die sooner: Between 2003 and 2007, only 81% lived longer than 36 months after being diagnosed. In 2010, HIV infection was the ninth leading cause of death among AIAN men and women aged 25 to 34 years.
Race and ethnicity are not, by themselves, risk factors for HIV infection, the CDC says. American Indian and Alaska Natives also have high rates of Chlamydia trachomatis infection, gonorrhea, and syphilis—sexually transmitted diseases are a warning signal of contracting or spreading HIV. Substance abuse is another risk factor: Current illicit drug use is higher among AIANs (12.8%) than in other races or ethnicities.
Lack of access to appropriate health care is another crucial factor, especially in the extremely poor AIAN communities, where between 2002 and 2004 about twice the national average was living in poverty. An estimated 1 in 5 AIAN adults living with HIV/AIDS at the end of 2009 were unaware of their infection. And while 75% of those who found out they were living with HIV in 2010 were linked to medical care within 3 months, this was the lowest proportion of any group surveyed.
Effective prevention interventions, the CDC says, must be tailored to the population. But the AIAN population comprises 562 federally recognized tribes and at least 50 state-recognized tribes, with different culture, beliefs, practices, and languages. Further, at the time of AIDS diagnosis, more AIANs lived in rural areas and may have been less likely to be tested for HIV because of limited access to testing. They also may have been less likely to seek testing because of concerns of confidentiality in a small and close-knit community. More than half of AIANs who responded to the Behavioral Risk Factor Surveillance System survey during 1997-2000 said they had never been tested for HIV.
The Indian Health Service (IHS) created a video to promote testing, “Facing HIV/AIDS in Native Communities,” available at http://www.ihs.gov/hivaids. Promotional materials include radio public service announcements, and training kits. Information on reaching out through social media and other emerging technology can be found at http://www.aids.gov/using-new-media.
“We have shown the positive impact of focused HIV/AIDS screening, education, treatment, and prevention in a group of IHS facilities,” says IHS Chief Clinical Consultant for Infectious Diseases Dr. Jonathan Iralu. “Now is the time to offer the opportunity to have an ‘AIDS Free Generation’ to all American Indian and Alaska Native communities that we serve.”
Testing now is critical to ICD-10 readiness
Still not prepared for the switch over to ICD-10? Experts say there’s still time to catch up before the Oct. 1 compliance date.
In an ideal world, physicians, their coders, and office staff would have already fully assessed the cost of transitioning to ICD-10, would have undergone training about how to improve clinical documentation and appropriate use of the new diagnosis codes, and would have internally tested their upgraded software. That would leave more than half a year to complete external testing with health plans to ensure that they get paid in October.
The reality? Few are on track to meet those milestones on time.
"Everybody is behind, not just practices," said Robert Tennant, senior policy adviser at the Medical Group Management Association (MGMA). For a practice to be ready for ICD-10, the "key trading partners have to be ready and our surveys are indicating that they are not," he said.
Those partners include practice management software vendors, electronic health record (EHR) vendors, clearinghouses, and private and public payers.
So does that mean another ICD-10 delay is likely? The Centers for Medicare and Medicaid Services says no.
Part of the reason may be that health plans, which are investing money in upgrading their own systems, are pushing the agency to move forward on time. They are signaling to the government that they don’t want another delay, Mr. Tennant said.
The MGMA is advising its members to prepare for an Oct. 1 launch of ICD-10. But Mr. Tennant said he’s not entirely convinced that the CMS will stick to the date if much of the health care industry is unprepared to make the switch.
"Claims have to be paid," he said. "The system cannot grind to a halt because practices that aren’t paid can’t see patients."
Start with training
Assuming that most physician offices have assessed which parts of their practice management and EHR systems need to be upgraded, and have determined the cost for upgrades and training, it’s time to get familiar with the new diagnosis coding system.
Coders and billers will need the most training on the new coding methodology, but doctors still need to get familiar with the level of documentation that’s need for their most frequently used codes. In general, the new system calls for great specificity, though it’s not an absolute rule.
For instance, the classification for asthma has changed from ICD-9 to ICD-10. Physicians will need to provide more specific documentation about the severity level (moderately persistent, severely persistent, etc.) for their coders to select the appropriate ICD-10 code, according to Kathryn DeVault, a coding expert at the American Health Information Management Association (AHIMA).
"The good news is that as different as ICD-10 and ICD-9 are, they are similar," Ms. DeVault said. "If there’s a familiarity or comfort level working with ICD-9, it’s a natural transition to ICD-10."
While there are some significant changes, especially related to orthopedic codes, for many subspecialties the differences will be minimal, she said.
Ms. DeVault recommended having the practice manager or lead coder identify the top 20 diagnosis codes for every physician in the practice and build some education around those frequently used codes.
She cautioned doctors not to skimp on the time and money needed to thoroughly train themselves and their staffs. "The key here is to do it right and do it right the first time," she said.
Check the books
Physicians and their staff also need to evaluate their current cash flow and revenue cycle, including the age of account balances, billing lag time, and other issues that may result in delayed or denied claims, said Asia Blunt, practice management strategist at the American Academy of Family Physicians. Correct those problems now, she said, then reevaluate between April and August.
Experts at the AAFP are recommending that physicians put aside a cash reserve, if possible, to cover expenses during the first 3 months of the transition in case large numbers of claims are denied. (See below for more tips on planning for the worst.)
Testing with vendors, payers
Internal and external testing is also key. Before Oct. 1, practices should have completed end-to-end testing of their upgraded systems, ensuring that everything works smoothly from the time they code a claim to when they receive payment from the health insurer.
Practices can begin internal testing as soon as they have upgraded their software. But external testing will depend on when clearinghouses and health plans are ready.
The CMS will provide the first testing opportunity March 3-7. The agency will hold a national ICD-10 testing week allowing practices and clearinghouses to submit claims using the new coding system. Practices will receive an acknowledgement that the claims were either accepted or rejected by the system. Practices must register in advance through their local Medicare Administrative Contractor (MAC) website to test. Find your local MAC here.
But this type of front-end testing is only a first step, Mr. Tennant said. Front-end testing determines whether the claim contains an ICD-10 code and if it is in the right place and the right format. But practices will need to conduct further testing with payers to determine if the code they used is appropriate and whether they will get paid.
For instance, when submitting a claim for a sprained ankle under ICD-10, the coder might specify right or left ankle, or leave it as unspecified. Depending on the health insurer’s policy around the code, the insurer could pay the claim, reject it, or hold or "pend" it while seeking additional information. The complicating factor, Mr. Tennant said, is that each health insurer has different coding policies and those policies have yet to be released for ICD-10.
"It’s very frustrating for everybody," Mr. Tennant said.
To minimize the impact, Mr. Tennant recommended identifying the payers responsible for the majority of your claims. Keep in contact with them about the release of their payment policies and testing schedules, he said.
"Be aggressive in your outreach to those plans," he said.
Contingency plans
Just in case a worst-case scenario develops, Mr. Tennant offered the advice on ICD-10 contingency plans:
• Research back-up options for practice management systems and clearinghouses. If the vendors aren’t providing a clear answer on when they will be ready to offer upgrades and testing, start researching alternatives. Ask colleagues if they have vendors that are prepared for the transition.
• Don’t rely on one coder. Train more than one staff member on how to use the new coding system. That way, if the chief coder leaves 3 weeks before the compliance date, someone else can step in.
• Limit vacations around the Oct. 1 compliance date. This is not a time to operate short staffed.
• Don’t wait around for health plans to start ICD-10 testing. Start with context testing. Take a subset of high-dollar, high-volume ICD-9 claims that have already been paid by the health plan and practice coding them in ICD-10. Similarly, begin to code claims in parallel in both ICD-9 and ICD-10 and move them through your internal workflow. In both of these testing approaches, check if the documentation provided is sufficient to identify the best ICD-10 code. If not, it’s time for more training.
• Ensure you have enough cash to operate in case claims are rejected or delayed. Setting aside cash reserves is a good move. Consider postponing major capital investments for a few months before and after Oct. 1. Obtaining a line of credit to cover a few months of operating expenses is another option.
• Submit as many of claims as possible with ICD-9 codes before Oct. 1.
Free ICD-10 resources
• ICD-10 guide with checklists and timelines (CMS).
• Sample letter to gauge vendors’ ICD-10 readiness (AHIMA).
• Cost calculator and ICD-10 timeline (AAFP).
• Twelve step transition plan, white papers, and practice tool (AMA)
mschneider@frontlinemedcom.com
On Twitter @maryellenny
Still not prepared for the switch over to ICD-10? Experts say there’s still time to catch up before the Oct. 1 compliance date.
In an ideal world, physicians, their coders, and office staff would have already fully assessed the cost of transitioning to ICD-10, would have undergone training about how to improve clinical documentation and appropriate use of the new diagnosis codes, and would have internally tested their upgraded software. That would leave more than half a year to complete external testing with health plans to ensure that they get paid in October.
The reality? Few are on track to meet those milestones on time.
"Everybody is behind, not just practices," said Robert Tennant, senior policy adviser at the Medical Group Management Association (MGMA). For a practice to be ready for ICD-10, the "key trading partners have to be ready and our surveys are indicating that they are not," he said.
Those partners include practice management software vendors, electronic health record (EHR) vendors, clearinghouses, and private and public payers.
So does that mean another ICD-10 delay is likely? The Centers for Medicare and Medicaid Services says no.
Part of the reason may be that health plans, which are investing money in upgrading their own systems, are pushing the agency to move forward on time. They are signaling to the government that they don’t want another delay, Mr. Tennant said.
The MGMA is advising its members to prepare for an Oct. 1 launch of ICD-10. But Mr. Tennant said he’s not entirely convinced that the CMS will stick to the date if much of the health care industry is unprepared to make the switch.
"Claims have to be paid," he said. "The system cannot grind to a halt because practices that aren’t paid can’t see patients."
Start with training
Assuming that most physician offices have assessed which parts of their practice management and EHR systems need to be upgraded, and have determined the cost for upgrades and training, it’s time to get familiar with the new diagnosis coding system.
Coders and billers will need the most training on the new coding methodology, but doctors still need to get familiar with the level of documentation that’s need for their most frequently used codes. In general, the new system calls for great specificity, though it’s not an absolute rule.
For instance, the classification for asthma has changed from ICD-9 to ICD-10. Physicians will need to provide more specific documentation about the severity level (moderately persistent, severely persistent, etc.) for their coders to select the appropriate ICD-10 code, according to Kathryn DeVault, a coding expert at the American Health Information Management Association (AHIMA).
"The good news is that as different as ICD-10 and ICD-9 are, they are similar," Ms. DeVault said. "If there’s a familiarity or comfort level working with ICD-9, it’s a natural transition to ICD-10."
While there are some significant changes, especially related to orthopedic codes, for many subspecialties the differences will be minimal, she said.
Ms. DeVault recommended having the practice manager or lead coder identify the top 20 diagnosis codes for every physician in the practice and build some education around those frequently used codes.
She cautioned doctors not to skimp on the time and money needed to thoroughly train themselves and their staffs. "The key here is to do it right and do it right the first time," she said.
Check the books
Physicians and their staff also need to evaluate their current cash flow and revenue cycle, including the age of account balances, billing lag time, and other issues that may result in delayed or denied claims, said Asia Blunt, practice management strategist at the American Academy of Family Physicians. Correct those problems now, she said, then reevaluate between April and August.
Experts at the AAFP are recommending that physicians put aside a cash reserve, if possible, to cover expenses during the first 3 months of the transition in case large numbers of claims are denied. (See below for more tips on planning for the worst.)
Testing with vendors, payers
Internal and external testing is also key. Before Oct. 1, practices should have completed end-to-end testing of their upgraded systems, ensuring that everything works smoothly from the time they code a claim to when they receive payment from the health insurer.
Practices can begin internal testing as soon as they have upgraded their software. But external testing will depend on when clearinghouses and health plans are ready.
The CMS will provide the first testing opportunity March 3-7. The agency will hold a national ICD-10 testing week allowing practices and clearinghouses to submit claims using the new coding system. Practices will receive an acknowledgement that the claims were either accepted or rejected by the system. Practices must register in advance through their local Medicare Administrative Contractor (MAC) website to test. Find your local MAC here.
But this type of front-end testing is only a first step, Mr. Tennant said. Front-end testing determines whether the claim contains an ICD-10 code and if it is in the right place and the right format. But practices will need to conduct further testing with payers to determine if the code they used is appropriate and whether they will get paid.
For instance, when submitting a claim for a sprained ankle under ICD-10, the coder might specify right or left ankle, or leave it as unspecified. Depending on the health insurer’s policy around the code, the insurer could pay the claim, reject it, or hold or "pend" it while seeking additional information. The complicating factor, Mr. Tennant said, is that each health insurer has different coding policies and those policies have yet to be released for ICD-10.
"It’s very frustrating for everybody," Mr. Tennant said.
To minimize the impact, Mr. Tennant recommended identifying the payers responsible for the majority of your claims. Keep in contact with them about the release of their payment policies and testing schedules, he said.
"Be aggressive in your outreach to those plans," he said.
Contingency plans
Just in case a worst-case scenario develops, Mr. Tennant offered the advice on ICD-10 contingency plans:
• Research back-up options for practice management systems and clearinghouses. If the vendors aren’t providing a clear answer on when they will be ready to offer upgrades and testing, start researching alternatives. Ask colleagues if they have vendors that are prepared for the transition.
• Don’t rely on one coder. Train more than one staff member on how to use the new coding system. That way, if the chief coder leaves 3 weeks before the compliance date, someone else can step in.
• Limit vacations around the Oct. 1 compliance date. This is not a time to operate short staffed.
• Don’t wait around for health plans to start ICD-10 testing. Start with context testing. Take a subset of high-dollar, high-volume ICD-9 claims that have already been paid by the health plan and practice coding them in ICD-10. Similarly, begin to code claims in parallel in both ICD-9 and ICD-10 and move them through your internal workflow. In both of these testing approaches, check if the documentation provided is sufficient to identify the best ICD-10 code. If not, it’s time for more training.
• Ensure you have enough cash to operate in case claims are rejected or delayed. Setting aside cash reserves is a good move. Consider postponing major capital investments for a few months before and after Oct. 1. Obtaining a line of credit to cover a few months of operating expenses is another option.
• Submit as many of claims as possible with ICD-9 codes before Oct. 1.
Free ICD-10 resources
• ICD-10 guide with checklists and timelines (CMS).
• Sample letter to gauge vendors’ ICD-10 readiness (AHIMA).
• Cost calculator and ICD-10 timeline (AAFP).
• Twelve step transition plan, white papers, and practice tool (AMA)
mschneider@frontlinemedcom.com
On Twitter @maryellenny
Still not prepared for the switch over to ICD-10? Experts say there’s still time to catch up before the Oct. 1 compliance date.
In an ideal world, physicians, their coders, and office staff would have already fully assessed the cost of transitioning to ICD-10, would have undergone training about how to improve clinical documentation and appropriate use of the new diagnosis codes, and would have internally tested their upgraded software. That would leave more than half a year to complete external testing with health plans to ensure that they get paid in October.
The reality? Few are on track to meet those milestones on time.
"Everybody is behind, not just practices," said Robert Tennant, senior policy adviser at the Medical Group Management Association (MGMA). For a practice to be ready for ICD-10, the "key trading partners have to be ready and our surveys are indicating that they are not," he said.
Those partners include practice management software vendors, electronic health record (EHR) vendors, clearinghouses, and private and public payers.
So does that mean another ICD-10 delay is likely? The Centers for Medicare and Medicaid Services says no.
Part of the reason may be that health plans, which are investing money in upgrading their own systems, are pushing the agency to move forward on time. They are signaling to the government that they don’t want another delay, Mr. Tennant said.
The MGMA is advising its members to prepare for an Oct. 1 launch of ICD-10. But Mr. Tennant said he’s not entirely convinced that the CMS will stick to the date if much of the health care industry is unprepared to make the switch.
"Claims have to be paid," he said. "The system cannot grind to a halt because practices that aren’t paid can’t see patients."
Start with training
Assuming that most physician offices have assessed which parts of their practice management and EHR systems need to be upgraded, and have determined the cost for upgrades and training, it’s time to get familiar with the new diagnosis coding system.
Coders and billers will need the most training on the new coding methodology, but doctors still need to get familiar with the level of documentation that’s need for their most frequently used codes. In general, the new system calls for great specificity, though it’s not an absolute rule.
For instance, the classification for asthma has changed from ICD-9 to ICD-10. Physicians will need to provide more specific documentation about the severity level (moderately persistent, severely persistent, etc.) for their coders to select the appropriate ICD-10 code, according to Kathryn DeVault, a coding expert at the American Health Information Management Association (AHIMA).
"The good news is that as different as ICD-10 and ICD-9 are, they are similar," Ms. DeVault said. "If there’s a familiarity or comfort level working with ICD-9, it’s a natural transition to ICD-10."
While there are some significant changes, especially related to orthopedic codes, for many subspecialties the differences will be minimal, she said.
Ms. DeVault recommended having the practice manager or lead coder identify the top 20 diagnosis codes for every physician in the practice and build some education around those frequently used codes.
She cautioned doctors not to skimp on the time and money needed to thoroughly train themselves and their staffs. "The key here is to do it right and do it right the first time," she said.
Check the books
Physicians and their staff also need to evaluate their current cash flow and revenue cycle, including the age of account balances, billing lag time, and other issues that may result in delayed or denied claims, said Asia Blunt, practice management strategist at the American Academy of Family Physicians. Correct those problems now, she said, then reevaluate between April and August.
Experts at the AAFP are recommending that physicians put aside a cash reserve, if possible, to cover expenses during the first 3 months of the transition in case large numbers of claims are denied. (See below for more tips on planning for the worst.)
Testing with vendors, payers
Internal and external testing is also key. Before Oct. 1, practices should have completed end-to-end testing of their upgraded systems, ensuring that everything works smoothly from the time they code a claim to when they receive payment from the health insurer.
Practices can begin internal testing as soon as they have upgraded their software. But external testing will depend on when clearinghouses and health plans are ready.
The CMS will provide the first testing opportunity March 3-7. The agency will hold a national ICD-10 testing week allowing practices and clearinghouses to submit claims using the new coding system. Practices will receive an acknowledgement that the claims were either accepted or rejected by the system. Practices must register in advance through their local Medicare Administrative Contractor (MAC) website to test. Find your local MAC here.
But this type of front-end testing is only a first step, Mr. Tennant said. Front-end testing determines whether the claim contains an ICD-10 code and if it is in the right place and the right format. But practices will need to conduct further testing with payers to determine if the code they used is appropriate and whether they will get paid.
For instance, when submitting a claim for a sprained ankle under ICD-10, the coder might specify right or left ankle, or leave it as unspecified. Depending on the health insurer’s policy around the code, the insurer could pay the claim, reject it, or hold or "pend" it while seeking additional information. The complicating factor, Mr. Tennant said, is that each health insurer has different coding policies and those policies have yet to be released for ICD-10.
"It’s very frustrating for everybody," Mr. Tennant said.
To minimize the impact, Mr. Tennant recommended identifying the payers responsible for the majority of your claims. Keep in contact with them about the release of their payment policies and testing schedules, he said.
"Be aggressive in your outreach to those plans," he said.
Contingency plans
Just in case a worst-case scenario develops, Mr. Tennant offered the advice on ICD-10 contingency plans:
• Research back-up options for practice management systems and clearinghouses. If the vendors aren’t providing a clear answer on when they will be ready to offer upgrades and testing, start researching alternatives. Ask colleagues if they have vendors that are prepared for the transition.
• Don’t rely on one coder. Train more than one staff member on how to use the new coding system. That way, if the chief coder leaves 3 weeks before the compliance date, someone else can step in.
• Limit vacations around the Oct. 1 compliance date. This is not a time to operate short staffed.
• Don’t wait around for health plans to start ICD-10 testing. Start with context testing. Take a subset of high-dollar, high-volume ICD-9 claims that have already been paid by the health plan and practice coding them in ICD-10. Similarly, begin to code claims in parallel in both ICD-9 and ICD-10 and move them through your internal workflow. In both of these testing approaches, check if the documentation provided is sufficient to identify the best ICD-10 code. If not, it’s time for more training.
• Ensure you have enough cash to operate in case claims are rejected or delayed. Setting aside cash reserves is a good move. Consider postponing major capital investments for a few months before and after Oct. 1. Obtaining a line of credit to cover a few months of operating expenses is another option.
• Submit as many of claims as possible with ICD-9 codes before Oct. 1.
Free ICD-10 resources
• ICD-10 guide with checklists and timelines (CMS).
• Sample letter to gauge vendors’ ICD-10 readiness (AHIMA).
• Cost calculator and ICD-10 timeline (AAFP).
• Twelve step transition plan, white papers, and practice tool (AMA)
mschneider@frontlinemedcom.com
On Twitter @maryellenny
Expanded Disability Pay for Patients With TBI
The VA has developed new regulations that could make getting additional disability pay easier now for some veterans who have traumatic brain injury (TBI) in addition to Parkinson disease, certain types of dementia, depression, unprovoked seizures, or certain diseases of the hypothalamus and pituitary glands.
The new regulations, which took effect in January, were born of a 2008 Institute of Medicine report, Gulf War and Health, Volume 7: Long-Term Consequences of Traumatic Brain Injury. That report was based on a consensus by a National Academy of Sciences committee of experts, which found “sufficient evidence” to link moderate or severe levels of TBI with the other illnesses. The committee noted that even mild TBI is associated with adverse consequences, including memory loss, Alzheimer-like dementia, and seizures.
According to the new regulations if veterans with service-connected TBI also have 1 of the 5 associated illnesses, the second illness will be considered service-connected in the calculations of disability compensation. Eligibility for expanded benefits will depend on the severity of the TBI and the time between the injury causing the TBI and the onset of the second illness. However, veterans can still file a claim to establish direct service connection for those conditions even if they don’t meet the time and severity standards in the new regulation.
Service members who are within 180 days of discharge can file a predischarge claim for TBI online at http://www.eBenefits.va.gov. Veterans who have questions or want to file new disability claims can also use the eBenefits website. The published final rule is available at http://www.regulations.gov.
The VA has developed new regulations that could make getting additional disability pay easier now for some veterans who have traumatic brain injury (TBI) in addition to Parkinson disease, certain types of dementia, depression, unprovoked seizures, or certain diseases of the hypothalamus and pituitary glands.
The new regulations, which took effect in January, were born of a 2008 Institute of Medicine report, Gulf War and Health, Volume 7: Long-Term Consequences of Traumatic Brain Injury. That report was based on a consensus by a National Academy of Sciences committee of experts, which found “sufficient evidence” to link moderate or severe levels of TBI with the other illnesses. The committee noted that even mild TBI is associated with adverse consequences, including memory loss, Alzheimer-like dementia, and seizures.
According to the new regulations if veterans with service-connected TBI also have 1 of the 5 associated illnesses, the second illness will be considered service-connected in the calculations of disability compensation. Eligibility for expanded benefits will depend on the severity of the TBI and the time between the injury causing the TBI and the onset of the second illness. However, veterans can still file a claim to establish direct service connection for those conditions even if they don’t meet the time and severity standards in the new regulation.
Service members who are within 180 days of discharge can file a predischarge claim for TBI online at http://www.eBenefits.va.gov. Veterans who have questions or want to file new disability claims can also use the eBenefits website. The published final rule is available at http://www.regulations.gov.
The VA has developed new regulations that could make getting additional disability pay easier now for some veterans who have traumatic brain injury (TBI) in addition to Parkinson disease, certain types of dementia, depression, unprovoked seizures, or certain diseases of the hypothalamus and pituitary glands.
The new regulations, which took effect in January, were born of a 2008 Institute of Medicine report, Gulf War and Health, Volume 7: Long-Term Consequences of Traumatic Brain Injury. That report was based on a consensus by a National Academy of Sciences committee of experts, which found “sufficient evidence” to link moderate or severe levels of TBI with the other illnesses. The committee noted that even mild TBI is associated with adverse consequences, including memory loss, Alzheimer-like dementia, and seizures.
According to the new regulations if veterans with service-connected TBI also have 1 of the 5 associated illnesses, the second illness will be considered service-connected in the calculations of disability compensation. Eligibility for expanded benefits will depend on the severity of the TBI and the time between the injury causing the TBI and the onset of the second illness. However, veterans can still file a claim to establish direct service connection for those conditions even if they don’t meet the time and severity standards in the new regulation.
Service members who are within 180 days of discharge can file a predischarge claim for TBI online at http://www.eBenefits.va.gov. Veterans who have questions or want to file new disability claims can also use the eBenefits website. The published final rule is available at http://www.regulations.gov.
From Medic to Nurse: Getting Credit for Field Experience
The Department of Health and Human Services (HHS) is helping veterans with medical skills and experience transition from the military to medicine. Department of Health and Human Services Secretary Kathleen Sebelius recently announced $2.8 million in grants and plans to award academic credit for prior military training and experience. In a partnership with the U.S. Army, Navy, and Air Force, HHS Health Resources and Services Administration (HRSA) will align accreditation requirements for nursing programs with enlisted medical training so medics and corpsmen can receive academic credit for military health care service. Award recipients will also develop career ladders that include academic and social supports, career counseling, mentors, and links with veteran service organizations and community health systems. Over 4 years, the grants will enable more than 1,000 veterans to obtain baccalaureate nursing degrees.
Through the Nurse Education, Practice, Quality and Retention (NEPQR): Veterans’ Bachelor of Science Degree in Nursing (VBSN) program, 9 institutions have been awarded funding: University of Alabama at Birmingham; Jacksonville University in Florida; Florida International University in Miami; University of South Florida in Tampa; Davenport University in Grand Rapids, Michigan; State University of New York in Stony Brook; University of Texas at Arlington; Hampton University in Virginia; and Shenandoah University in Winchester, Virginia.
The College of Nursing and Health Sciences at Texas A&M University in Corpus Christi has already started working to turn veterans into nurses. With funding from the NEPQR program, the college established the eLine Military program, an online bachelor of science in nursing training program offered to Texas residents who are veterans or military personnel and have prior medical experience. Now it is working with the Medical Education and Training Command in San Antonio, Texas, which has been designated as the central site for all health care-related training for the Tri-Service. The Texas project will focus on bridging the gap between enlisted training and academic coursework, improving the documentation of health care training, and working with other key stakeholders, such as state licensure boards.
The HRSA will give funding priority to nursing schools that offer proveteran learning environments, recruit and support veterans interested in pursuing nursing careers, and facilitate academic credit for enlisted health care training.
“Veterans know the value of working in teams and have a strong commitment to service,” said HRSA Administrator Mary K. Wakefield, PhD, RN. “And these are just the skills and talents our health care delivery system needs right now.”
For more information, visit http://bhpr.hrsa.gov/nursing.
The Department of Health and Human Services (HHS) is helping veterans with medical skills and experience transition from the military to medicine. Department of Health and Human Services Secretary Kathleen Sebelius recently announced $2.8 million in grants and plans to award academic credit for prior military training and experience. In a partnership with the U.S. Army, Navy, and Air Force, HHS Health Resources and Services Administration (HRSA) will align accreditation requirements for nursing programs with enlisted medical training so medics and corpsmen can receive academic credit for military health care service. Award recipients will also develop career ladders that include academic and social supports, career counseling, mentors, and links with veteran service organizations and community health systems. Over 4 years, the grants will enable more than 1,000 veterans to obtain baccalaureate nursing degrees.
Through the Nurse Education, Practice, Quality and Retention (NEPQR): Veterans’ Bachelor of Science Degree in Nursing (VBSN) program, 9 institutions have been awarded funding: University of Alabama at Birmingham; Jacksonville University in Florida; Florida International University in Miami; University of South Florida in Tampa; Davenport University in Grand Rapids, Michigan; State University of New York in Stony Brook; University of Texas at Arlington; Hampton University in Virginia; and Shenandoah University in Winchester, Virginia.
The College of Nursing and Health Sciences at Texas A&M University in Corpus Christi has already started working to turn veterans into nurses. With funding from the NEPQR program, the college established the eLine Military program, an online bachelor of science in nursing training program offered to Texas residents who are veterans or military personnel and have prior medical experience. Now it is working with the Medical Education and Training Command in San Antonio, Texas, which has been designated as the central site for all health care-related training for the Tri-Service. The Texas project will focus on bridging the gap between enlisted training and academic coursework, improving the documentation of health care training, and working with other key stakeholders, such as state licensure boards.
The HRSA will give funding priority to nursing schools that offer proveteran learning environments, recruit and support veterans interested in pursuing nursing careers, and facilitate academic credit for enlisted health care training.
“Veterans know the value of working in teams and have a strong commitment to service,” said HRSA Administrator Mary K. Wakefield, PhD, RN. “And these are just the skills and talents our health care delivery system needs right now.”
For more information, visit http://bhpr.hrsa.gov/nursing.
The Department of Health and Human Services (HHS) is helping veterans with medical skills and experience transition from the military to medicine. Department of Health and Human Services Secretary Kathleen Sebelius recently announced $2.8 million in grants and plans to award academic credit for prior military training and experience. In a partnership with the U.S. Army, Navy, and Air Force, HHS Health Resources and Services Administration (HRSA) will align accreditation requirements for nursing programs with enlisted medical training so medics and corpsmen can receive academic credit for military health care service. Award recipients will also develop career ladders that include academic and social supports, career counseling, mentors, and links with veteran service organizations and community health systems. Over 4 years, the grants will enable more than 1,000 veterans to obtain baccalaureate nursing degrees.
Through the Nurse Education, Practice, Quality and Retention (NEPQR): Veterans’ Bachelor of Science Degree in Nursing (VBSN) program, 9 institutions have been awarded funding: University of Alabama at Birmingham; Jacksonville University in Florida; Florida International University in Miami; University of South Florida in Tampa; Davenport University in Grand Rapids, Michigan; State University of New York in Stony Brook; University of Texas at Arlington; Hampton University in Virginia; and Shenandoah University in Winchester, Virginia.
The College of Nursing and Health Sciences at Texas A&M University in Corpus Christi has already started working to turn veterans into nurses. With funding from the NEPQR program, the college established the eLine Military program, an online bachelor of science in nursing training program offered to Texas residents who are veterans or military personnel and have prior medical experience. Now it is working with the Medical Education and Training Command in San Antonio, Texas, which has been designated as the central site for all health care-related training for the Tri-Service. The Texas project will focus on bridging the gap between enlisted training and academic coursework, improving the documentation of health care training, and working with other key stakeholders, such as state licensure boards.
The HRSA will give funding priority to nursing schools that offer proveteran learning environments, recruit and support veterans interested in pursuing nursing careers, and facilitate academic credit for enlisted health care training.
“Veterans know the value of working in teams and have a strong commitment to service,” said HRSA Administrator Mary K. Wakefield, PhD, RN. “And these are just the skills and talents our health care delivery system needs right now.”
For more information, visit http://bhpr.hrsa.gov/nursing.
Centers for Medicare & Medicaid Services Modify Physician Quality Reporting System
Only 27% of eligible providers participated in the Physician Quality Reporting System (PQRS) in 2011—roughly 26,500 medical practices and 266,500 medical professionals, according to the Centers for Medicare & Medicaid Services (CMS).
“A lot of physicians have walked away [from PQRS] feeling like there are not sufficient measures for them to be measured against,” says Cheryl Damberg, senior principal researcher at RAND corporation and professor at the Pardee RAND Graduate School in Santa Monica, Calif.
Encouraging more participation from hospitalists has been the goal of the Society of Hospital Medicine (SHM) for the last several years, says Gregory Seymann, MD, SFHM, clinical professor and chief in the division of hospital medicine at University of California San Diego Health Sciences and chair of SHM’s Performance Measurement and Reporting Committee (PMRC).
“The committee has tried to champion it the best we can, making sure the measures that are there and in development meet the needs of the specialty,” Dr. Seymann says.
In just one year, the SHM committee managed to increase hospitalist reportable measures in PQRS from a paltry 11—half of which were only for stroke patients—to 21, which now includes things like diabetes exams, osteoporosis management, documentation of current medications, and community-acquired pneumonia treatment.
For Comparison’s Sake
For the first couple of phases of PQRS reporting, very few measures were relevant to hospitalists, Dr. Seymann says. The committee worked to ensure that more measures were added and billing codes modified to include those used by the specialty. Hospital medicine is relatively new, not officially recognized by the American Board of Medical Specialties (ABMS), and hospitalists serve a unique role. Most hospitalists are in internal medicine, family medicine, or pediatrics, but they aren’t doing what the average primary care doctor does, like referral for breast cancer or colon cancer screening, Dr. Seymann adds. Additionally, they aren’t always the provider performing specific cardiac or neurological care.
Hospitalists’ patients usually are in the hospital because they are sick. They may have chronic disease or more complex medical needs (e.g. osteoporosis-related hip fracture) than the average population seen by a non-hospitalist PCP.
If hospitalists are compared to other PCPs, as is the plan in the Physician Value-Based Payment Modifier, it “looks like our patients are dying a lot more frequently, we’re spending a lot of money, and we’re not doing primary care,” Dr. Seymann explains.
New Brand, New Push
PQRS is not new; it is the rebranding of CMS’ Physician Quality Reporting Initiative (PQRI), launched in 2006. But changes to the program are part of a national push to improve healthcare quality and patient care while reimbursing for performance on outcome- and process-based measures instead of simply for the volume of services provided. Each year, CMS updates PQRS rules.
This year is the last one in which providers will receive a bonus for reporting through PQRS. Beginning next year, practitioners that don’t meet the reporting requirements for 2013 will incur a 1.5% penalty—with additional penalties for physicians in groups of 100 or more from the value-based payment modifier. This year also serves as the performance year for 2016, when a 2% penalty for insufficient reporting will be assessed.
In early December 2013, the Centers for Medicare & Medicaid Services (CMS) published the 2014 Physician Fee Schedule and, with it, the final rules for the PQRS. Although many physicians and specialist groups believed the measures included in PQRS in previous years were too limited, CMS has added the additional reporting methodology of qualified clinical data registries (QCDR), which can include measures outside of the PQRS—a marked shift from previous policies.
The rule change, Damberg says, should take some energy out of the discussion surrounding the program and allow more physicians to participate.
“From CMS’ perspective, they want doctors delivering the recommended care and they want doctors to be able to report it out easily,” Damberg says.
Moving Forward
In 2014, providers can submit measures through the new QCDR option, or submit PQRS-identified measures through a Medicare qualified registry, through electronic health records, through the group practice reporting option (GPRO), and through claims-based reporting (though this last option is expected to be phased out over time).
Registries themselves are not new, but they can cost millions of dollars to establish and as much as a million a year to maintain. They typically contain more clinical depth and specificity than claims data, and numerous studies show the use of registries leads to improved patient outcomes.
“We don’t know how many [existing] registries are going to qualify to become these qualified clinical data registries,” says Tom Granatir, senior vice president for health policy and external relations at ABMS. “It’s going to take some time for these registries to evolve.”
Qualified clinical data registries must be in operation for at least one year to be eligible for certification by Medicare. They must include performance data from other payers beyond Medicare. Not only must QCDRs be capable of capturing and sending data, they must also provide national benchmarks to those who submit and must report back at least four times per year.
Granatir believes the QCDR rule, which allows QCDR’s to report measures beyond those included in the PQRS program, will help increase participation and will lead to more practice-based measures, but he fears it may exclude some important nuances of day-to-day patient care.
“The whole point [of quality measure reporting] is to create more public transparency…but if you have measures that are not relevant to what is actually done in practices, then it’s not a useful dataset,” he says.
Ideally, Damberg says, PQRS and other performance measures should enable physicians to do what they do better.
“I think this is really going to raise the stakes for [hospitalists] if they want to control their destiny,” Damberg says. “I think they have to get really engaged in this game and take a pro-active role in looking at where the quality gaps are and how can they better benefit patients. That’s the ultimate goal.”
Kelly April Tyrrell is a freelance writer in Wilmington, Del.
Only 27% of eligible providers participated in the Physician Quality Reporting System (PQRS) in 2011—roughly 26,500 medical practices and 266,500 medical professionals, according to the Centers for Medicare & Medicaid Services (CMS).
“A lot of physicians have walked away [from PQRS] feeling like there are not sufficient measures for them to be measured against,” says Cheryl Damberg, senior principal researcher at RAND corporation and professor at the Pardee RAND Graduate School in Santa Monica, Calif.
Encouraging more participation from hospitalists has been the goal of the Society of Hospital Medicine (SHM) for the last several years, says Gregory Seymann, MD, SFHM, clinical professor and chief in the division of hospital medicine at University of California San Diego Health Sciences and chair of SHM’s Performance Measurement and Reporting Committee (PMRC).
“The committee has tried to champion it the best we can, making sure the measures that are there and in development meet the needs of the specialty,” Dr. Seymann says.
In just one year, the SHM committee managed to increase hospitalist reportable measures in PQRS from a paltry 11—half of which were only for stroke patients—to 21, which now includes things like diabetes exams, osteoporosis management, documentation of current medications, and community-acquired pneumonia treatment.
For Comparison’s Sake
For the first couple of phases of PQRS reporting, very few measures were relevant to hospitalists, Dr. Seymann says. The committee worked to ensure that more measures were added and billing codes modified to include those used by the specialty. Hospital medicine is relatively new, not officially recognized by the American Board of Medical Specialties (ABMS), and hospitalists serve a unique role. Most hospitalists are in internal medicine, family medicine, or pediatrics, but they aren’t doing what the average primary care doctor does, like referral for breast cancer or colon cancer screening, Dr. Seymann adds. Additionally, they aren’t always the provider performing specific cardiac or neurological care.
Hospitalists’ patients usually are in the hospital because they are sick. They may have chronic disease or more complex medical needs (e.g. osteoporosis-related hip fracture) than the average population seen by a non-hospitalist PCP.
If hospitalists are compared to other PCPs, as is the plan in the Physician Value-Based Payment Modifier, it “looks like our patients are dying a lot more frequently, we’re spending a lot of money, and we’re not doing primary care,” Dr. Seymann explains.
New Brand, New Push
PQRS is not new; it is the rebranding of CMS’ Physician Quality Reporting Initiative (PQRI), launched in 2006. But changes to the program are part of a national push to improve healthcare quality and patient care while reimbursing for performance on outcome- and process-based measures instead of simply for the volume of services provided. Each year, CMS updates PQRS rules.
This year is the last one in which providers will receive a bonus for reporting through PQRS. Beginning next year, practitioners that don’t meet the reporting requirements for 2013 will incur a 1.5% penalty—with additional penalties for physicians in groups of 100 or more from the value-based payment modifier. This year also serves as the performance year for 2016, when a 2% penalty for insufficient reporting will be assessed.
In early December 2013, the Centers for Medicare & Medicaid Services (CMS) published the 2014 Physician Fee Schedule and, with it, the final rules for the PQRS. Although many physicians and specialist groups believed the measures included in PQRS in previous years were too limited, CMS has added the additional reporting methodology of qualified clinical data registries (QCDR), which can include measures outside of the PQRS—a marked shift from previous policies.
The rule change, Damberg says, should take some energy out of the discussion surrounding the program and allow more physicians to participate.
“From CMS’ perspective, they want doctors delivering the recommended care and they want doctors to be able to report it out easily,” Damberg says.
Moving Forward
In 2014, providers can submit measures through the new QCDR option, or submit PQRS-identified measures through a Medicare qualified registry, through electronic health records, through the group practice reporting option (GPRO), and through claims-based reporting (though this last option is expected to be phased out over time).
Registries themselves are not new, but they can cost millions of dollars to establish and as much as a million a year to maintain. They typically contain more clinical depth and specificity than claims data, and numerous studies show the use of registries leads to improved patient outcomes.
“We don’t know how many [existing] registries are going to qualify to become these qualified clinical data registries,” says Tom Granatir, senior vice president for health policy and external relations at ABMS. “It’s going to take some time for these registries to evolve.”
Qualified clinical data registries must be in operation for at least one year to be eligible for certification by Medicare. They must include performance data from other payers beyond Medicare. Not only must QCDRs be capable of capturing and sending data, they must also provide national benchmarks to those who submit and must report back at least four times per year.
Granatir believes the QCDR rule, which allows QCDR’s to report measures beyond those included in the PQRS program, will help increase participation and will lead to more practice-based measures, but he fears it may exclude some important nuances of day-to-day patient care.
“The whole point [of quality measure reporting] is to create more public transparency…but if you have measures that are not relevant to what is actually done in practices, then it’s not a useful dataset,” he says.
Ideally, Damberg says, PQRS and other performance measures should enable physicians to do what they do better.
“I think this is really going to raise the stakes for [hospitalists] if they want to control their destiny,” Damberg says. “I think they have to get really engaged in this game and take a pro-active role in looking at where the quality gaps are and how can they better benefit patients. That’s the ultimate goal.”
Kelly April Tyrrell is a freelance writer in Wilmington, Del.
Only 27% of eligible providers participated in the Physician Quality Reporting System (PQRS) in 2011—roughly 26,500 medical practices and 266,500 medical professionals, according to the Centers for Medicare & Medicaid Services (CMS).
“A lot of physicians have walked away [from PQRS] feeling like there are not sufficient measures for them to be measured against,” says Cheryl Damberg, senior principal researcher at RAND corporation and professor at the Pardee RAND Graduate School in Santa Monica, Calif.
Encouraging more participation from hospitalists has been the goal of the Society of Hospital Medicine (SHM) for the last several years, says Gregory Seymann, MD, SFHM, clinical professor and chief in the division of hospital medicine at University of California San Diego Health Sciences and chair of SHM’s Performance Measurement and Reporting Committee (PMRC).
“The committee has tried to champion it the best we can, making sure the measures that are there and in development meet the needs of the specialty,” Dr. Seymann says.
In just one year, the SHM committee managed to increase hospitalist reportable measures in PQRS from a paltry 11—half of which were only for stroke patients—to 21, which now includes things like diabetes exams, osteoporosis management, documentation of current medications, and community-acquired pneumonia treatment.
For Comparison’s Sake
For the first couple of phases of PQRS reporting, very few measures were relevant to hospitalists, Dr. Seymann says. The committee worked to ensure that more measures were added and billing codes modified to include those used by the specialty. Hospital medicine is relatively new, not officially recognized by the American Board of Medical Specialties (ABMS), and hospitalists serve a unique role. Most hospitalists are in internal medicine, family medicine, or pediatrics, but they aren’t doing what the average primary care doctor does, like referral for breast cancer or colon cancer screening, Dr. Seymann adds. Additionally, they aren’t always the provider performing specific cardiac or neurological care.
Hospitalists’ patients usually are in the hospital because they are sick. They may have chronic disease or more complex medical needs (e.g. osteoporosis-related hip fracture) than the average population seen by a non-hospitalist PCP.
If hospitalists are compared to other PCPs, as is the plan in the Physician Value-Based Payment Modifier, it “looks like our patients are dying a lot more frequently, we’re spending a lot of money, and we’re not doing primary care,” Dr. Seymann explains.
New Brand, New Push
PQRS is not new; it is the rebranding of CMS’ Physician Quality Reporting Initiative (PQRI), launched in 2006. But changes to the program are part of a national push to improve healthcare quality and patient care while reimbursing for performance on outcome- and process-based measures instead of simply for the volume of services provided. Each year, CMS updates PQRS rules.
This year is the last one in which providers will receive a bonus for reporting through PQRS. Beginning next year, practitioners that don’t meet the reporting requirements for 2013 will incur a 1.5% penalty—with additional penalties for physicians in groups of 100 or more from the value-based payment modifier. This year also serves as the performance year for 2016, when a 2% penalty for insufficient reporting will be assessed.
In early December 2013, the Centers for Medicare & Medicaid Services (CMS) published the 2014 Physician Fee Schedule and, with it, the final rules for the PQRS. Although many physicians and specialist groups believed the measures included in PQRS in previous years were too limited, CMS has added the additional reporting methodology of qualified clinical data registries (QCDR), which can include measures outside of the PQRS—a marked shift from previous policies.
The rule change, Damberg says, should take some energy out of the discussion surrounding the program and allow more physicians to participate.
“From CMS’ perspective, they want doctors delivering the recommended care and they want doctors to be able to report it out easily,” Damberg says.
Moving Forward
In 2014, providers can submit measures through the new QCDR option, or submit PQRS-identified measures through a Medicare qualified registry, through electronic health records, through the group practice reporting option (GPRO), and through claims-based reporting (though this last option is expected to be phased out over time).
Registries themselves are not new, but they can cost millions of dollars to establish and as much as a million a year to maintain. They typically contain more clinical depth and specificity than claims data, and numerous studies show the use of registries leads to improved patient outcomes.
“We don’t know how many [existing] registries are going to qualify to become these qualified clinical data registries,” says Tom Granatir, senior vice president for health policy and external relations at ABMS. “It’s going to take some time for these registries to evolve.”
Qualified clinical data registries must be in operation for at least one year to be eligible for certification by Medicare. They must include performance data from other payers beyond Medicare. Not only must QCDRs be capable of capturing and sending data, they must also provide national benchmarks to those who submit and must report back at least four times per year.
Granatir believes the QCDR rule, which allows QCDR’s to report measures beyond those included in the PQRS program, will help increase participation and will lead to more practice-based measures, but he fears it may exclude some important nuances of day-to-day patient care.
“The whole point [of quality measure reporting] is to create more public transparency…but if you have measures that are not relevant to what is actually done in practices, then it’s not a useful dataset,” he says.
Ideally, Damberg says, PQRS and other performance measures should enable physicians to do what they do better.
“I think this is really going to raise the stakes for [hospitalists] if they want to control their destiny,” Damberg says. “I think they have to get really engaged in this game and take a pro-active role in looking at where the quality gaps are and how can they better benefit patients. That’s the ultimate goal.”
Kelly April Tyrrell is a freelance writer in Wilmington, Del.