Friday, April 29, 2016

CMS backs away from two-midnight rule

A NAMAH member shared this with NAHAM News, found in Modern Healthcare (Monday, April 18). 

The CMS will not continue to impose an inpatient payment cut to hospitals under the two-midnight rule following ongoing industry criticism and a legal challenge. It will provide a onetime bump to hospitals to offset the cuts. 

The original rule may be found in the CMS Fact Sheet: Two-Midnight Rule.

The agency imposed the cut because it estimated the two-midnight policy would increase Medicare spending by approximately $220 million because of an expected increase in inpatient admissions. 

Hospitals will also see a temporary increase of 0.6% in fiscal 2017. That would make up for the 0.2% reduction to the rates the past three years.

This addition, plus other increases outlined in the proposed rule, will result in a net increase of approximately $539 million to hospital inpatient prospective payment systems providers in 2017.

The decision to drop the proposed cut came after a September ruling in Shands Jacksonville Medical Center v. Burwell. A federal judge partially sided with the American Hospital Association and scores of other hospitals around the country, ordering HHS to better justify the cut and re-open the policy to comments.

As reported by Modern Healthcare, hospitals had challenged a 0.2% reduction for inpatient services meant to offset estimated costs to Medicare associated with the two-midnight rule. The rule directs CMS payment contractors to presume hospital stays are appropriately billed as inpatient admissions rather than outpatient observation visits if they span two midnights.

The policy was intended to reverse a trend toward higher rates of observation stays, which experts attributed to defensive billing practices by hospitals wary of having their admissions challenged by Medicare's audit contractors.

Even though September's ruling didn't outright demand the CMS rescind the pay cut, the agency felt it was the best thing to do given the industry's apprehension.

CMS explains its adjustment in its Fact Sheet: Hospital Inpatient Prospective Payment System (IPPS) and Long Term Acute Care Hospital (LTCH) Proposed Rule Issues for Fiscal Year (FY) 2017 -

"CMS is proposing to take action regarding the -0.2 percent adjustment it implemented in the FY 2014 IPPS/LTCH PPS final rule to account for an estimated increase in Medicare expenditures due to the Two Midnight Policy.  Specifically, in the FY 2014 IPPS/LTCH PPS final rule, CMS estimated that this policy would increase expenditures and accordingly made an adjustment of -0.2 percent to the payment rates.  CMS believes the assumptions underlying the -0.2 percent adjustment were reasonable at the time they were made.  Additionally, CMS does not generally believe it is appropriate in a prospective payment system to retrospectively adjust rates.  However, in light of recent review and the unique circumstances surrounding this adjustment, for FY 2017, CMS is proposing to permanently remove this adjustment and also its effects for FYs 2014, 2015, and 2016 by adjusting the FY 2017 payment rates.  The impact of this proposal is to increase FY 2017 payments by approximately 0.8 percent."

Monday, April 25, 2016

Help Inform the Department of Health and Human Services’ (HHS) Measurement of Interoperability

The ONC asking for your input on ways to measure the progress toward a future where health information is flowing between providers and patients to supports a health system that provides better care, smarter spending, and healthier people. The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) declares it a national objective to achieve the widespread exchange of health information through the use of interoperable certified electronic health records and directs HHS to establish metrics in consultation with you – the health IT community – to see if that objective has been met.

The Federal Health IT Strategic Plan is a collaboration with over 35 federal partners and the public which focuses federal offices that use or influence the use of health information technology on person-centered care, advancement of science, and overall health. The central theme of the Strategic Plan is ensuring health data flows seamlessly and securely to create a learning-based, person-centered health system.

Similarly, the Nationwide Interoperability Roadmap was an effort by the Office of the National Coordinator for Health Information Technology (ONC) in collaboration with the private sector, states, and federal partners to identify near-term actions to advance an interoperable health system.

Combined with the recent announcements of private sector market leaders to make EHR information flow more efficiently, these efforts all help to support the flow of health information when and where it is needed for patient care. (See our 3/1/16 post “Health Groups Aim to Make Medical Records Easier to Access” here.)

The ONC is issuing a request for information for your thoughts on how to measure interoperability and ensure HHS is keeping pace with the objectives laid out in the Roadmap and the Federal Health IT Strategic plan to measure the broad health information ecosystem, including individuals and non-health settings. Specifically, the ONC is asking for input on:

1.       What populations and elements of information flow should we measure?
2.      How can we use current data sources and associated metrics to address the MACRA requirements?
3.      What other data sources and metrics should HHS consider to measure interoperability more broadly?

The public comment period closes on June 3, 2016. View and download the request for information here and view the original posting here

Thursday, April 21, 2016

What Yelp Can Tell You About a Hospital That Official Ratings Can’t

Yelp is home to reviews on everything from restaurants to salons, and now hospitals too. If you've ever taken the time to give Yelp your two cents about a hospital, you'll be happy to know that someone's listening and that they've deemed the crowdsourced information not only useful — but unique.

In what is believed to be the first large-scale analysis of such data, researchers from the University of Pennsylvania looked at 17,000 Yelp reviews of 1,352 hospitals from consumers. The researchers found that the Yelp reviews provide more and broader information than the stalwart U.S. government created survey that costs millions of dollars to implement every year.

The Hospital Consumer Assessment of Healthcare Providers and Systems Survey or HCAHPS has been used since 2006 and involves asking discharged patients questions about their stays. It consists of 11 categories ranging from communication with medical staff, to staff responsiveness, pain management, and hospital hygiene.

Yelp offers consumers the ability to rate hospitals on a scale of one to five stars and write a review to accompany that rating. The U-Penn researchers used natural language processing to take apart the narratives and put them into buckets that were similar to the categories used by the HCAHPS. They gave as an example a post that had words such as "pain," "nurse," "medication," "gave" and how that might be assigned to the pain category.

Their paper, published in the April issue of Health Affairs, found that Yelp reviews encompassed only about seven of the 11 categories covered by the HCAHPS.

But, the data still proved surprising. The Yelp reviews had information about 12 additional categories that weren't addressed in the government survey. Those include the cost of the hospital visit, insurance and billing, ancillary testing, facilities, amenities, scheduling, compassion of staff, family member care, quality of nursing, quality of staff, quality of technical aspects of care, and specific type of medical care.

For positive reviews they included caring doctors, nurses and staff; comforting; surgery/procedure and peri-op; and labor and delivery. And for negative reviews, they included insurance and billing and cost of hospital visit.

The publication of the paper comes at a key time for Yelp when the social media site is trying to transform itself from a social, whimsy, and casual review website to a more serious player in other consumer domains.

The original article by  Ariana Eunjung Cha can be found at the following address:

Monday, April 18, 2016

Studies Find High Rates Of Errors In Medical Billing

In 2013, the America Medical Association estimated that 7.1% of paid claims in 2013 contained an error and a 2014 NerdWallet study found mistakes in 49% of Medicare claims. Groups that review bills on patients' behalf, including Medical Billing Advocates of America and CoPatient, put the error rate closer to 75% or 80%.

To that end, experts suggest reviewing medical bills closely before paying them. "Don't pay it until you understand it," said Sara Taylor, health solutions and strategies manager for benefits administrator Aon Hewitt.

For some consumers, spotting and correcting medical billing problems is getting easier. A forthcoming Aon Hewitt survey of 800 large and mid-size employers found that 45 percent offer advocacy services to help workers manage their health-care benefits; 43 percent are considering adding those services within five years.

Often, billing errors result in an out-of-pocket cost that's bigger than expected, either from a charge that shouldn't be there or a coding error that affected how your insurer processed the claim. Or, a bill is sent before payment is received from an insurer.

For those patients who do not have access to health concierge and patient advocacy services, asking for an itemized detailed statement is the best option. For those patients who are facing a big or complex bill, hiring a billing advocate is a solution.

Typically, review of the bill is free, with the service taking a cut of whatever savings it successfully secures for you. (MBAA takes a 25 percent cut; CoPatient, 35 percent.) Outsourcing the process can also save you time spent trying to get the bill corrected.

However, waiting too long to pay (or officially dispute) a medical bill is not recommended. Some providers are fast to take action on unpaid balances — resulting in 20 percent of consumers having an unpaid medical debt on their credit report, according to a 2014 Consumer Financial Protection Bureau study. The average amount owed: $579.

The original article by Kelli Grant can be found at the following address:

Thursday, April 14, 2016

Health IT Interoperability Remains Elusive

To assess the state of HIT, Modern Healthcare conducted a survey in 2015, known as the 25th annual Modern Healthcare Survey of Executive Opinions on Key Health Information Technology Issues. The results on interoperability of EHRs were disappointing. Only 11% of respondents to the survey said their organizations were able to routinely exchange electronic patient information with other providers across the country.

That meager showing comes 11 years after President George W. Bush created the Office of the National Coordinator for Health In-formation Technology with a mandate to implement a “nationwide interoperable health information technology infrastructure.

Only 17% of respondents to the 2015 survey indicated their hospitals and physician offices can move patient records around their home states. Just 21% reported they can exchange records within their regions. In contrast, 21% of respondents said they aren't exchanging electronic information at all, either within or outside of their organizations.

Still, an overwhelming majority of respondents (71%) were optimistic they'll be able to exchange a “core data set” of patient information nationally by the end of 2017 in keeping with a goal set in the ONC's “interoperability road map” released in January 2015. And 72% of those taking our survey opined that achieving nationwide interoperability would be of either high value (23%) or moderate value (49%) to their organizations. The road map signaled a shift in emphasis by federal health IT policymakers away from EHR adoption and toward health information exchange.

The original article by Joseph Conn can be found at the following address:

Monday, April 11, 2016

Electronic Health Records: Top 10 Healthcare Milestone of the Past 40 Years

In a recent article, Modern Healthcare named the top healthcare milestones of the past 40 years.  The top 10 milestones include electronic medical records, as called for by President George W. Bush in his 2004 State of the Union address. President Bush called for universal, portable, electronic health records within a decade.

On April 26, 2004, President George W. Bush formally launched the federal drive to widely disseminate health information technology to improve patient care. The next day, by executive order, Bush created the Office of the National Coordinator for Health Information Technology within HHS. A few days later, HHS Secretary Tommy Thompson named Dr. David Brailer the first ONC leader.

Bush said the ONC should work with private sector healthcare organizations as well as all federal agencies with a hand in healthcare. The goal of the newly-created ONC was to begin work on a national HIT strategy to promote the adoption and use of interoperable electronic health records to enhance clinical decision-making, improve quality, lower costs, reduce errors, improve coordination of care and ensure the privacy and security of patient data.

However, the Bush years of the ONC did not provide funding for the agency. Instead, the ONC was financed by reshuffling HHS' administrative funds. Despite this, adoption of EHRs has tripled in the first 10 years of the ONC and the concept health information exchange is now commonplace.

The second era of the ONC is the big-money Obama era starting with the 2009 American Recovery and Reinvestment Act, with its $2 billion for ONC grant programs. The incentive payment program for adoption of EHRs has paid out $21.6 billion so far.

There are critics of the strong federal role in HIT development, calling the EHR incentive program a market-disrupting “Frankenstein.”

Ross Koppel, a professor of sociology at the University of Pennsylvania medical school, said federal policymakers erred in thinking that “more HIT equals better care and safer care. That assumption has been defeated by their desire to push the technology long before it was ready.” What has resulted, he said, “is a captured market in which vendors create inferior products that the clinicians are obliged to purchase.”

Yet, EHR has still come a long way. Before the ONC, caveat emptor ruled for EHR buyers. Today, virtually all EHR systems sold are tested and certified against a list of functional criteria developed by the ONC. Before the ONC and the EHR incentive program, fewer than 4% of nonfederal U.S. hospitals had EHR systems with computerized physician-order entry. Today, 90% of hospitals have CPOE. Previously, less than 20% of office-based physicians had any kind of an EHR; today, more than 78% do.

Though ONC has had several previous directors and initiatives, Dr. Karen DeSalvo, the current Coordinator, succinctly sums up the ONC’s overarching goal: “Everyone is trying to solve these same three issues—capturing data, freeing it appropriately and then putting it to use.”

The original article by Joseph Conn can be found at the following address:

Thursday, April 7, 2016

U.S., Canada Issue Joint Alert On 'Ransomware' After Hospital Attacks

The United States Department of Homeland Security (DHS), in collaboration with Canadian Cyber Incident Response Centre (CCIRC), released this Alert on March 31, 2016, to provide further information on ransomware, specifically its main characteristics, its prevalence, variants that may be proliferating, and how users can prevent and mitigate against ransomware.

DHS defines ransomware as “a type of malware that infects computer systems, restricting users’ access to the infected systems. Ransomware variants have been observed for several years and often attempt to extort money from victims by displaying an on-screen alert. Typically, these alerts state that the user’s systems have been locked or that the user’s files have been encrypted. Users are told that unless a ransom is paid, access will not be restored. The ransom demanded from individuals varies greatly but is frequently $200–$400 dollars and must be paid in virtual currency, such as Bitcoin.”

The Alert comes in response to an increasing number of ransomware attacks on the systems of healthcare organizations. In the past month, five organizations have reported being hit by computer viruses.

Targets so far include various Prime Healthcare Services hospitals, Hollywood Presbyterian Medical Center, King's Daughters' Health Hospital, and the MedStar Health system.

A spike in ransomware use by hackers goes back to 2012, when such attacks estimated profits of $33,000 a day for the hackers.

That has led to a proliferation of ransomware variants, said the statement from the United States-Computer Emergency Readiness Team and the Canadian Cyber Incident Response Center.

Some variants of ransomware encrypt not just the files on the infected device but also the contents of shared or networked drives, according to US-CERT/CCIRC. These variants render the users' files useless until criminals receive a ransom.

One variant, called Locky, has infected computers belonging to healthcare facilities and hospitals in the U.S., Germany and New Zealand, the cybersecurity organizations warned.

It propagates through spam e-mails that include malicious Microsoft Office documents or compressed attachments (e.g., .rar, .zip).

US-CERT recommends that users and administrators take some of the following preventive measures to protect their computer networks from ransomware infection.

·         Employ a data backup and recovery plan for all critical information. Perform and test regular backups to limit the impact of data or system loss and to expedite the recovery process. Ideally, this data should be kept on a separate device, and backups should be stored offline.
·         Use application whitelisting to help prevent malicious software and unapproved programs from running. Application whitelisting is one of the best security strategies as it allows only specified programs to run, while blocking all others, including malicious software.
·         Keep your operating system and software up-to-date with the latest patches. Vulnerable applications and operating systems are the target of most attacks. Ensuring these are patched with the latest updates greatly reduces the number of exploitable entry points available to an attacker.
·         Maintain up-to-date anti-virus software, and scan all software downloaded from the internet prior to executing.

For more tips and suggestions, visit the official Alert (TA16-091A) here.

The original article by Joseph Conn can be found at the following address:

Monday, April 4, 2016

Why Patients Still Need EMTALA

Recently, hospitals have been coming under scrutiny for violations of the federal Emergency Medical Treatment and Active Labor Act (EMTALA). This past December, Bon Secours St. Francis agreed to pay a $100,000 civil penalty to settle allegations that it violated EMTALA by improperly transferring the two gunshot victims, even though it had the capacity to treat them. The benefits of the transfer did not outweigh the risks and unnecessarily placed their health at further risk, according to HHS' Office of the Inspector General.

EMTALA, known as the patient anti-dumping law, was signed into law 30 years ago in response to national outrage over a surge in community hospitals transferring unstable emergency patients—including women in labor—to public hospitals and academic medical hospitals, largely for financial reasons.

EMTALA requires Medicare-participating hospitals to screen patients for emergency medical conditions and provide stabilizing treatment, regardless of their ability to pay. Hospitals with specialized capabilities must accept appropriate transfers to provide stabilizing treatment. The law does not require providers to continue treating patients once they are stable, nor does it generally apply after someone is admitted as an inpatient.

Hospitals found in violation of the law potentially face a $50,000 civil fine per incident, and can be barred from the Medicare and Medicaid programs. The law also gives dumped patients or their families the right to sue the provider.

The unfunded mandate signed into law by President Ronald Reagan sharply reduced cases of hospitals refusing to treat ED patients without insurance. Experts blame poor communication and inadequate training for most of the remaining incidents.

EMTALA—whose basic requirements are posted on the walls of every hospital ED—is widely credited with sharply reducing the number of cases of hospitals dumping or avoiding uninsured or underinsured patients.

Despite the law's positive impact, about 200 complaints a year are found to have merit. While that represents a tiny fraction of the more than 136 million annual emergency department visits in the U.S., there's broad agreement that the law continues to play an important role.

Yet, EMTALA is resented by hospital administrators and some physicians for its failure to finance its mandate. Experts say there are a variety of reasons why violations of the law continue to occur. Factors include pressure on hospitals to improve their finances, poor staff training, flawed systems and processes, communication mishaps, growing challenges in getting specialty physicians to be on-call to the ED, and a lack of inpatient beds and community resources for serving mentally ill patients.

The impetus for EMTALA was an epidemic of patient transfers that were widely seen as inappropriate and dangerous for patients, including pregnant women in labor being turned away from emergency rooms. Studies showed that in the early 1980s, there were about 250,000 transfers a year from private hospitals to public or Veterans Health Administration hospitals.

But EMTALA is no guarantee of appropriate emergency care. From 2002 to 2015, the CMS conducted 6,035 investigations of EMTALA complaints against hospitals and physicians—an average of 431 a year, according to a new study in the Western Journal of Emergency Medicine. The CMS found violations in 2,436 of the complaint cases it surveyed in conjunction with state agencies—an average of 174 a year.

To keep their Medicare certification, hospitals found in violation must submit a corrective plan, which the CMS reviews and approves. The agency then forwards those cases to the OIG for possible civil monetary penalties.

Of the cases referred to the OIG from 2002 to 2015, 192 resulted in settlements, including eight by physicians, according to the study. The most common citations were for failure to screen (75%) and stabilize (42.7%) for emergency conditions. Patients were turned away from hospitals for financial reasons in 15.6% of cases.