Flu Season Gets Worse, According to CDC Report

It appears that this Flu season may be worse than expected, according to a report from the Centers for Disease Control and Prevention (CDC).

NAHAM News previously reported a CDC warning about an early flu season in November (CDC Predicts a Bad Flu Season), but new data show that the numbers are getting worse. For the fourth week in a row, the share of people seeking treatment from health care providers for flu like symptoms rose. As of the week ending on December 29^th, twenty-nine (29) states had reported high levels of flu activity, and two child deaths were linked to the flu.

The CDC weekly flu report, which can be found here, reported that 5.6 percent of all outpatient doctor visits for the last week in December were flu related. This is up from 2.2 percent the previous month, and is well above last year’s season, which peaked at 2.2 percent.

While these numbers can seem troubling, the CDC is assuring citizens that the rates are still below the epidemic threshold, and are still below the 7.7 percent rate that was seen during the 2009 H1N1 flu pandemic.

Also promising, there has been no shortage of flu vaccinations reported this year. 

Study Shows Copying Common in EHR Notes

Electronic health records (EHRs) have long been touted as a transformative tool in medicine. The data can be shared easily between the patient and medical staff, medications can be automatically screened to ensure safety, and a doctor’s scribbles can be changed to easily read text. All of this good, however, is dependent upon the information in the EHR being accurate.

Many EHR systems allow users to copy and paste information, and according to one study, this can cause information to be incorrect or outdated. The study, done by a team at Case Western Reserve University School of Medicine, examined 2,068 progress reports for 135 patients in the ICU of a Cleveland hospital. The reports were created by 62 residents and 11 attending physicians, and were monitored over the course of five months using plagiarism detection software.

The team found that in 82% of the notes made by the residents and 74% of the notes made by attending physicians, 20% or more of the text was copied and pasted from pre-existing text from the patient’s records. These reports are used by internal hospital staff to monitor patient progress, but text containing a significant amount of pasted information may not be helpful. In one case, doctors of a patient who was released and then readmitted to the ICU couldn’t understand the previous progress reports. The pasted notes gave no clues as to the original diagnosis, and the new doctors had to call the diagnosing physician.

This study could signal that doctors are now using notes as more of a method to document billing then as a method to communicate with other health care staff.

The Reuters article can be found here.  

Healthcare Changes in the Fiscal Cliff Bill

On Monday night, the New Year came and went with the U.S. Senate still in session, debating a last minute compromise bill to avoid the so called “fiscal cliff.” The Senate ended up approving the bill about two hours later, on a vote of 89 to 9. The bill was then sent to the House of Representatives where members, after a day of party meetings, took up the bill at around 10:30pm eastern on January 1st. The bill passed the House, 257-167, and will be signed into law by President Obama.

The bill, known as the American Taxpayer Relief Act (ATRA), avoided the across-the-board spending cuts and tax hikes that were scheduled to go into effect, among other things.

One of the main provisions of the ATRA was to cancel out the massive automatic spending cuts known as sequestration. By doing this, the bill stops the 27% reduction in doctor Medicare reimbursement rates that would have been included in the sequestration cuts.  The ATRA also extends benefits on some outpatient services, extends the Medicare-Dependent Hospital (MDH) Program through Fiscal Year 2013, and extends the Low Volume Hospital Program through 2013.

The MDH Program provides funding for 200 rural hospitals through special Medicare rates resulting from high populations of Medicare patients. A hospital qualifies for the MDH Program if it is located in a rural area, has 100 beds or fewer, is not a "sole community hospital," and has at least 60 percent of inpatient days or discharges covered by Medicare. The Congressional Budget Office (CBO) estimates that this extension would cost approximately $100 million over 10 years.

The Low Volume Hospital program provides additional Medicare funding to hospitals in rural communities that are more than 15 road miles from another comparable hospital and have fewer than 1,600 Medicare discharges per year.

These extensions are offset by cuts in other healthcare spending. The current reduction in rates paid to hospitals for uncompensated care is extended by the bill, funding for the Medicare Improvement Fund is eliminated, and payments for end-stage renal disease treatments is modified. 

2013 Healthcare Reform Provisions

A new year means new provisions to be put in in place under the Affordable Care Act. There are four provisions slated to go into effect this year, three of them went into effect on January 1^st.

The first provision provides new funding to state Medicaid programs that choose to cover preventative services for patients at little or no cost. The program provides states with a 1 percentage point increase in federal matching payments to provide these services.

Another provision requires states to pay primary care physicians no less than 100% of Medicare payment rates in 2013 and 2014 for primary care services. The increase is fully funded by the federal government, and is a ramp up to Medicaid providers serving more patients in 2014.

The final provision that was effective on New Year’s Day establishes a national pilot program on payment “bundling”.  Under payment bundling, hospitals, doctors, and providers are paid a flat rate for an episode of care rather than the current fragmented system where each service or test or bundles of items or services are billed separately to Medicare. For example, instead of a surgical procedure generating multiple claims from multiple providers, the entire team is compensated with a “bundled” payment that provides incentives to deliver health care services more efficiently while maintaining or improving quality of care.

Under a fourth provision of the Affordable Care Act, effective on October 1, 2013, states will receive two more years of funding to continue coverage for children not eligible for Medicaid. This is provided under the existing Children’s Health Insurance Program, or CHIP, plan.

Also, as NAHAM News has written before, open enrollment for state health insurance exchanges will begin this year for coverage beginning on January 1, 2014.  

Ensuring Patient ID Online

Although patient identification has long been an issue within the hospital community, a new push in the conversion to electronic health records (EHRs) has added new challenges and solutions. Some organizations, like the Department of Defense (DoD) are already verifying the identity of their patients and other authorized users of their online system, MyHealtheVet. The DoD, however, has the luxury of a Veterans Administration database that includes all military personnel that would be accessing the system.

What health systems without pre-existing user databases should do is still up in the air. Privacy and security experts have not yet decided which methods of ensuring patient identity online are most effective and easiest to use. No matter the conclusion, however, most agree that it will still be necessary to verify patient credentials like a driver’s license, passport, or biometric identifier before allowing that patient to access their records online. 

Some states are implementing programs allowing access to partial records. Indiana’s State Department of Health, for example, has an online vaccination portal which allows parents to verify their children and view online immunization records. A parent must be registered by their child’s healthcare provider, and all access requests are monitored by a separate system.

Other businesses, such as identity card company Gemalto, are suggesting the use of SmartCards for patients. These cards, similar to the federal government’s Common Access or “CAC” cards, will contain a chip with biometric information about the user.

A federal policy committee has provided three guidelines that should be followed when thinking about enabling online access. The access should require a username and password at the minimum, with the option for additional security if the user chooses. The protection should not be so difficult that it discourages patients from participating, and providers should look to the Office of the National Coordinator for Health Information Technology (ONC) for guidance on identification methods. While this guidance has not yet been provided, a team within the National Institute of Standards and Technology has directed the agency to work with the ONC in setting up best practices.

You may find the original article from the Government Health IT website here. 

Hospitals Get Creative to Limit Medicare Readmissions

Since October, Medicare has been calculating the number of Medicare patients readmitted to hospitals within 30 days of their discharge. This data is kept for the new Value Based Purchasing Program, a part of health care reform (HCR) that penalizes hospitals with high rates of readmission by withholding a part of their reimbursement money.

The program has begun to change the payment structure of Medicaid away from government payments to hospitals per procedure, and towards payments for the overall wellness of the patients. These changes are a welcomed change by many patients, and even by some health care professionals who believe that this is the way hospitals will be paid in the future.

As a result, some hospitals have been employing new techniques to ensure that patients are able to care for themselves at home. According to an article in the Waco (TX) Tribune, some hospitals in Texas will have a nurse call the patient at home to follow up on their recovery and ask if there is anything the patient needs. Others will automatically schedule a follow up appointment with the patient’s doctor. Still others may send health care professionals to the patient’s home to ensure a smooth transition.

Many hospitals employ a discharge questionnaire that asks questions such as “will there be a friend or family member to assist you at home,” “Are you able to get to the pharmacy,” and “do you understand any changes in medication?” While these questionnaires have been in place for a while in many hospitals, some have tweaked the questions in an effort to prevent readmissions.

The program, combined with the resulting changes in hospital procedure, mark a significant change in hospital culture. This change will be important over time, as penalties for readmissions only escalate in the coming years. 

CDC Predicts a Bad Flu Season

The Centers for Disease Control and Prevention (CDC) warned the public earlier this month to be prepared for a bad year of the flu. The CDC found that this year’s flu season got underway in late November, the earliest start since 2003. The CDC also warns that the strain being seen this year tends to be more severe than in the past.

Normally, a spike in flu like symptoms is not expected until late December, but the CDC reported that the season kicked off the week of November 24^th. During that week, about 2.2% of doctor visits were for flu-like symptoms.

The flu is expected to be especially bad in the south, where five states are seeing outbreaks. These states include Tennessee, Mississippi, Alabama, Louisiana, and Texas. Meanwhile, Georgia and Missouri are reporting moderate levels of this year’s strain.

The best tool against infection is still vaccination. The vaccine that is available this year is well equipped to handle the flu, according to the CDC, and officials there believe the vaccine will be effective. So far, 123 million doses of the vaccine have been distributed, and 112 million of those have been administered.

This year, unlike past years, there is not expected to be any shortage of vaccines, so everyone should be able to get a vaccine if they want one. The CDC especially recommends vaccinating vulnerable groups including children, pregnant women, and healthcare workers.

You can view the Denver Post article here, and the CDC report here.