Friday, December 19, 2014

Omnibus Continues Tax Breaks for Blue Cross and Blue Shield Insurance & Ups Spending to Detect Healthcare Fraud and Abuse

The 2015 Fiscal Year Omnibus Appropriations Bill provides just over $1 trillion in discretionary spending in compliance with the Murray-Ryan budget agreement and funds the majority of the federal government through Sept. 30, 2015. 

Nongermane Riders
The New York Times reports that "Steve Ellis, vice president of Taxpayers for Common Sense, a nonprofit research group that tracks federal spending, said the bill bestowed favors on all sorts of constituencies.

“Authors of the bill and lobbyists behind these provisions know they are in there,” Mr. Ellis said. “But the public will not find out about most of them for weeks or months, if ever.” Congress supposedly forswore spending earmarks several years ago, after federal largess led to several scandals. But lawmakers can still steer money in less conspicuous ways."

One example of a nongermane rider that went into the bill without public debate provides relief to nonprofit Blue Cross and Blue Shield plans, which have special tax breaks that may have been threatened by provisions in the Affordable Care Act. While Blue Cross is not mentioned by name in the legislation, the deduction is only available to Blue Cross and Blue Shield plans. Blue Cross and Blue Shield have been lobbying Congress for a clarification since the Affordable Care Act was signed in 2010.

Fraud Prevention
The Committee on Appropriations executive summary also explains that the bill provides $1.484 billion for cap adjustment funding to prevent waste, fraud, abuse and improper payments in the Medicare, Medicaid and Social Security programs. This is a $560 million increase in funding from last year's level.

A significant portion of those funds, $672 million, are dedicated to the Health Care Fraud and Abuse Control program at the Centers for Medicare and Medicaid Services. That amount more than doubles the level enacted in fiscal year 2014. 
One reason for the increase is that preventing fraud creates a significant savings for the government. The latest data shows that for every $1 spent on fraud and abuse control, $8.10 is recovered by the Department of Treasury. That recovery ration is the highest three-year average return on investment in the entire 17-year history of the Health Care Fraud and Abuse Control program.

Further Information
For a more comprehensive discussion of nongermane riders passed in the Omnibus see this New York Times article, "In Final Spending Bill, Salty Food and Belching Cows are Winners." The Senate Committee on Appropriations executive summary of the bill can be found here.

Wednesday, December 17, 2014

CMS State Innovation Models Grants Awarded

The HHS announced Tuesday that a significant portion of the $665 million in available grants was awarded to health IT programs.The District of Columbia, 28 states, and three territories received grant money to fund local experiments in improving health care. The money is the second round of grants coming from CMS's State Innovation Models initiative. A breakdown of the awarded grants can be found at the initiative website

Politico reports that the selected health IT projects largely focus on improving data in electronic health records and systems. Part of the $100 million New York will receive will go toward better health IT, "including greatly enhanced capacities to exchange clinical data and an all-payer database." Overall, the state is looking to create a stronger, more integrated primary care workforce and delivery system. Colorado will receive up to $65 million over four years to integrate physical and behavioral health care in primary care and community mental health center. Part of the money will expand IT efforts including telehealth. The money will also assist in integrating public health, behavioral health and primary care sectors. Data analytics is a factor in the plans for Michigan and Iowa.

Friday, December 12, 2014

CMS Boosts Coverage for Telehealth

The Centers for Medicare & Medicaid Services released new rules that significantly broaden coverage for chronic care telehealth services.The rulemaking changes are inside the 1,185-page document detailing Medicare payments to physicians and other providers. The new rules also include seven new covered procedure codes for telehealth, including annual wellness visits, psychotherapy services, and prolonged services at physicians' offices.

Health Leaders Media reports, "The American Telemedicine Association, which had sought the expanded coverage for five years, notes that among the rules are provisions that will pay for remote chronic care management using the new current procedural terminology (CPT) code 99490, with a monthly unadjusted, non-facility fee of $42.60.

"For us, it was more important to begin to specifically address chronic care," says Gary Capistrant, senior director of public policy at ATA. "The combination of the chronic care management code and being able to use it in conjunction with monitoring of those chronic conditions is a big step forward and a very substantial change for Medicare." Capistrant says the new rules also represent an acknowledgement by CMS that reimbursing for chronic care could prove to be cost effective.

"It's an important policy move. Whether it is sufficient, time will tell, but it is certainly a step in the right direction and an important initiative," he says. "There has been a lot of focus on primary care, even with the Medicare population. That may be the 80% of the people but it is only 20% of the problem. There's an increasing emphasis on looking at the 80% of the problem that is 20% of the people, and that is chronic and specialty care. They understand that the government is spending a huge amount for chronic care conditions and that there is a value managing those to reduce the overall expenditures."

Explore NAHAM AccessKeys

Coming in Mid-January:  NAHAM AccessKeys®
NAHAM is excited to announce the unveiling of a project more than two years in the making. Click here to read more about the NAHAM AccessKeys®.  Be sure to also register for the webinar taking place on January 14, 2015 at 2:00 pm. This webinar  will describe the creation of AccessKeys® and provide information about how to implement it in your facility.  

Be sure to renew your membership before January 1, 2015. AccessKeys® will be available to members only! 

Wednesday, November 26, 2014

NAHAM Webinar: Servant Leadership, Dec. 9th

Join Jeff Brossard, BSHA, CHAM,  for a presentation that will dig into the differences between management styles, with particular emphasis on servant leadership. 

Discover how servant leadership and mentoring, both co-workers and other leaders, can be an effective tool for generating high performing organizations. 

This webinar will include time for participant discussion, providing you with an opportunity to learn best practices. 

Tuesday, Dec. 9 at 2 p.m. EST

NAHAM members: FREE
Non-Members: $35  

All participants will receive 1 NAHAM contact hour. 

Register today!

Monday, November 24, 2014

Net Neutrality Impacts Healthcare IT

Modern Healthcare's  Darius Tahir explains why healthcare providers should be paying attention to net neutrality in the following article:

The techie term “net neutrality” likely isn't in the daily lexicon used by most senior healthcare executives. But it should be, and soon, argue those in healthcare technology who have been following the topic.

The wireless telecommunications industry's trade group, CTIA, for example, has been circulating a letter to healthcare organizations, asking their support to oppose regulation that would ensure continued net neutrality. But others argue healthcare benefits from net neutrality and should be lobbying for its continuance via a new Federal Communications Commission mandate.

Net neutrality means everyone sending data is treated the same by carriers like Verizon and others; no one can pay or be charged more for faster transmission speeds and none can be barred from sending data. The tool that net neutrality advocates want to use—Title II of the FCC’s authorization act—would essentially make internet traffic into a public utility.

The FCC is expected to rule either by year-end or early next year.

The debate on net neutrality has intensified as the amount of data being transmitted in videos and other usages has increased, leading some to argue that too much traffic is crossing a too-small network, slowing down performance.

Telehealth and electronic record data exchange are the two primary areas of healthcare that would suffer were internet service providers allowed to charge higher prices for faster transmission speeds, say those who back net neutrality.

“I don't think people realize how much net neutrality can affect health services,” said Mark Gaynor, an associate professor of health management and policy at St. Louis University and a long-time advocate for net neutrality.

President Barack Obama earlier this month put the spotlight on the issue when he called on the FCC to “implement the strongest possible rules to protect net neutrality.”

But he muddied the debate when it comes to healthcare by saying the rule, “can have clear, monitored exceptions for reasonable network management and for specialized services such as dedicated, mission-critical networks serving a hospital.”

But many critics of a net neutrality rule believe that allowing internet service providers to charge for a “fast lane” or “paid prioritization” would be helpful for innovation. Such pricing would allow data from paying content providers to move more quickly to consumers. Currently, they argue, many networks slow at peak times when everyone wants to view Netflix videos or use other heavy bandwidth applications, like online gaming.

Charging those users more allows for more efficient usage of limited bandwidth, and provides an incentive to internet service providers to build more network infrastructure, which would accommodate more usage down the road. That position is partially supported by a July 2014 draft paper produced by two FCC officials, which use a model to show that overall market efficiency is improved if broadband providers are allowed to charge for fast lanes.

Billionaire internet entrepreneur Mark Cuban argued, in a post on his personal blog, that this debate has particular relevance to healthcare.

Hypothetically, he said, an emergency surgeon might want to access an internet application for a surgery—and finds that she can't get enough bandwidth for the service to work because “TV and movie services … swamp bandwidth.”

A net neutrality rule, he suggested, encourages that situation for two reasons: because it prevents the investment that would make a bigger network for everyone; and because it prevents high-priority data from jumping to the front of the line.

Cuban also doesn't believe Obama's exception for hospitals—which might put it at the front of the queue—would do much good, writing, “First in line in a traffic jam is still slow and buffering.”

Also opposing neutrality, Verizon has argued in a letter (PDF) to the FCC, that classifying internet traffic under Title II is not legally permissible, and an attempt to do so would invite legal challenges.

The push-and-pull over net neutrality has left the FCC's decision uncertain. The Washington Post reported on Nov. 11 that FCC chair Tom Wheeler had rejected Obama's call to reclassify internet traffic to Title II and he was looking to “split the baby” between internet service provider and net neutrality advocate concerns.

Most opponents of formal net neutrality believe that classifying internet traffic under Title II would result in onerous new requirements for internet providers, as the section was designed for older types of networked communication.

Jot Carpenter, the vice president of government affairs for CTIA, said in an interview that the rules would slow new innovations for wireless providers. The exception proposed by Obama, he said, would introduce confusion for the providers.

In those instances, he said, they would have to approach the FCC and see whether their intended idea—whether a formal partnership with a content provider or an economic arrangement—fell under the hospital exception. Carpenter derided that as the “Mother, may I?” approach to governance, which he argued is bad for innovation.

It's also unclear what might fall under the exception, Kerry McDermott, the vice president of public policy and communications for the Center for Medical Interoperability and a former FCC official said. Which hospital data would apply? Would other healthcare data apply?

Because of that perspective, Carpenter and CTIA have been circulating a letter to healthcare groups arguing that proposed reclassification would increase regulatory uncertainty for mobile health, which they argue is too young to withstand the shock.

While Carpenter declined to name which stakeholder groups had been contacted, a draft copy of the letter obtained by Modern Healthcare includes comments from the Healthcare Information and Management Systems Society. It's not possible to attribute specific comments on the letter to the organization. As of press time, HIMSS had not responded to inquiries regarding the letter. And Carpenter wouldn't discuss when the letter would be officially released, or with which signatories.

But Gaynor and others are anxious about the negative effects of allowing providers to charge higher prices to content providers.

“I don't want to see small companies that are trying to innovate be locked out by bigger companies that have more money and can pay for faster service,” Gaynor said.

Carpenter rejects that argument. “I don't know that there's any evidence to suggest that these startups would be prevented from reaching their customers or gaining critical mass in the marketplace or gaining notice. Paid placement isn't always an evil,” he said, citing Google's early history as an example.

And facing a toll might also hurt efforts to encourage interoperability, Gaynor continued. The healthcare system is hoping to encourage more data sharing, often through Health Information Exchanges. A charge for faster service provides a disincentive to sharing overall, and in particular hurts HIEs – which are non-profit and often struggle to find the proper business model under current conditions.

Innovation might be hurt in another way, Gaynor and his co-authors argued in a July 2013 paper in the Journal of the American Medical Informatics Association. Some internet service providers own or are closely associated with healthcare services; Verizon, for example, has a virtual visits telehealth service, as well as an Apple HealthKit competitor called Converged Health Management. If internet service providers are allowed to discriminate between content providers, they might favor their own, Gaynor writes.

That argument also attacks the FCC officials’ paper, which assumes that broadband internet service providers are not vertically integrated with a content provider.

Steve Kraus, a partner at venture capitalist firm Bessemer Venture Partners, agrees with Gaynor’s argument. “The whole premise of telemedicine would fall down,” he said, if startups suffer lagged performance.

He argued that the net neutrality debate is particularly relevant to healthcare: first, patients and providers often need speed in making care; and second, because the data being moved in healthcare – like medical records, genomics, and video – is often so large.

Kraus's colleagues agree, and are worried about the large telecommunications firms potentially giving themselves an unfair advantage, noting that both Verizon and AT&T have been investing heavily in healthcare.

Virtual visits firm American Well also feels strongly about net neutrality. In an interview, the firm's senior vice president of consumer markets, Mike Putnam, said that he believes paid prioritization would decrease healthcare access and cause the firm to pass on costs to the consumer.

Seth Ginsburg, the president of non-profit Global Healthy Living Foundation, has been advocating for net neutrality in Capitol Hill—and actually retained a lobbyist to do so, the only purely healthcare entity registered in the Senate's lobbying database to list net neutrality as an interest.

Ginsburg’s organization, which helps patients with conditions like rheumatoid arthritis, believes that paying tolls for faster service would harm its relationship with patients. The organization is a nonprofit, and can’t afford to pay a toll; and yet it also communicates time-sensitive information, concerning drug safety for example, to its patients. Allowing a fast lane would put the organization in a bind.

Ginsburg is contemplating complementing his firm's lobbying efforts by adding the voices of his patients, who he said are in all 50 states. He has seen a lack of healthcare interest in the political half of the debate. He suspects it's due to the other large healthcare IT issues on the docket, like meaningful use and the ICD-10 code switch.

Thursday, November 20, 2014

CMS Names Niall Brennan First Chief Data Officer

The Centers for Medicare & Medicaid Services (CMS) today announced the formation of the Office of Enterprise Data and Analytics (OEDA) which will be led by Niall Brennan, the agency’s first Chief Data Officer (CDO), and tasked with overseeing improvements in data collection and dissemination as the agency strives to be more transparent. OEDA will help CMS better harness its vast data resources to guide decision-making and develop frameworks promoting appropriate external access to and use of data to drive higher quality, patient-centered care at a lower cost.

CMS collects a wealth of data that is critical to decision making for the agency and other stakeholders in the nation’s health care system. CMS generates data administering the Medicare, Medicaid and CHIP programs. In addition, new responsibilities, including stewardship of the EHR Incentive Programs, more expansive quality measurement programs, and the establishment of the Health Insurance Marketplaces, have expanded the scope of data that CMS collects. As CMS works to shift the focus from volume of services to better health outcomes for patients, coordinating care, and spending dollars more wisely, the need for CMS to analyze data across its multiple programs and provide greater access to this data, whether in granular or aggregate form, will only intensify.

“It’s clear how much data transparency will help the country improve outcomes, control costs and aid consumer decision making,” said CMS Principal Deputy Administrator Andy Slavitt. “This appointment signals to the industry that there is no turning back from the health care data agenda. Niall Brennan will help make sure CMS leads the way.”

The creation of this new post and the data and analytics office  builds on the steps CMS has taken in recent years to better harness its data resources both internally and externally. CMS is now routinely analyzing claims data in real time and applying predictive analytics to proactively identify fraud and abuse and track key metrics such as hospital readmissions. Accountable Care Organizations and State Medicaid agencies receive monthly near real-time feeds of Medicare data to support care coordination. CMS has launched the Virtual Research Data Center to facilitate lower cost access to CMS data for researchers and federal grantees. CMS has also released numerous public use datasets; the most notable releases to date include the release of data on hospital charges and physician utilization in 2013 and 2014.

“Our commitment to transparency is matched by our commitment to keeping personal information safeguarded. We can't expect to advance health outcomes unless we also ensure that our policies and practices around data privacy are leading the way,” said Slavitt. “We look forward to building on the success of recent releases, providing a clearer picture of the health care delivery system.”