The scariest thing about the superbug that killed six people at the National Institutes of Health in Bethesda last year is that such dangerous germs have become so common in U.S. hospitals that doctors viewed the outbreak as routine and saw no need to inform the public. The decision to keep the episode secret until last week has triggered a mild uproar, and deservedly so. A top Maryland health official conceded that the state, which was told of the problem in December, erred by neglecting to notify Montgomery County authorities. People who live or work near the sprawling NIH campus had a right to know that their neighbors at one of the world's most prestigious hospitals struggled desperately for months with an infection immune to antibiotics.
The final rule announced by Department of Health and Human Services Secretary Kathleen Sebelius Friday delays until Oct. 1, 2014 the compliance date for ICD-10 code implementation.
The rule finalizes a proposal to postpone for one year the date by which covered entities must comply with ICD-10 diagnosis and procedure codes.
The final rule for Meaningful Use Stage 2 was released late Thursday afternoon by the Department of Health and Human Services. In a step sure to please many stakeholders, HHS will delay the onset of MU Stage 2 criteria until 2014 to allow time for vendors to develop the necessary certified electronic health record technology.
The 672-page rule specifies the criteria that eligible professionals, hospitals, and critical access hospitals must meet to qualify for Medicare and/or Medicaid electronic health record incentive payments. It also specifies the Medicare payment adjustments that will be made for failing to demonstrate meaningful use of certified EHR technology.
The final rule reflects some give and take based on 6,100 "items of timely correspondence" received in response to the proposed rule released in March. In addition to delaying the onset of MU Stage 2 criteria, HHS finalized a special three-month EHR reporting period, rather than a full year, for providers attesting to either Stage 1 or Stage 2 in 2014 to allow time for providers to implement newly certified EHRs.
Despite complaints from the American Hospital Association and others, HHS stood its ground and will require stakeholders to provide patients with the ability to view, download, and transmit their health information on the Internet, as well as provide clinical summaries of care for each office visit.
Among the highlights of the final rule:
Core and menu objectives
Nearly all of the Stage 1 core and menu objectives are retained for Stage 2. Eligible professionals must meet the measure or qualify for an exclusion to 17 core objectives and three of six menu objectives. Eligible hospitals and CAHs must meet the measure or qualify for an exclusion to 16 core objectives and three of six menu objectives.
The "exchange of key clinical information" core objective from Stage 1 is replaced with a "transitions of care" core objective in Stage 2.
"Provide patients with an electronic copy of their health information" objective is replaced by a "view online, download, and transmit" core objective.
Clinical quality measures (CQM)
CQM data can be electronically submitted after the first year of demonstrating meaningful use. For the first year CQM data must be submitted via attestation.
Eligible professionals will submit nine CQMs from at least three of the National Quality Strategy domains. The rule recommends a core set of nine CQMs that focus on adult populations and controlling blood pressure. A core set of nine CQMs are also recommended for pediatric populations.
Eligible hospitals and CAHs will submit 16 CQMs from at least three of the National Quality Strategy domains.
Payment Adjustments
Medicare payment adjustments are required by statute to take effect in 2015.
Eligible professionals and hospitals that are meaningful EHR users in 2013 will avoid the 2015 payment adjustment.
Eligible professionals that are meaningful EHR users in 2014 will also avoid the adjustment if they demonstrate meaningful use at least three months before the end of the calendar year meet the registration and attestation requirement by Oct. 1, 2014.
Eligible hospitals that are meaningful EHR users in 2014 will also avoid the adjustment if they demonstrate meaningful use by the end of the fiscal year and meet the registration and attestation requirement by July 1, 2014.
Modifications to Medicaid EHR Incentive Program
Expands the definition of what constitutes a Medicaid patient encounter to include individuals enrolled in a Medicaid program, including Title XXI-funded Medicaid expansion encounters (but not separate Children's Health Insurance Programs encounters).
Specifies the look back period for patient volume to be the 12 months preceding attestation and not the previous calendar year.
Revises the definition of a children's hospital to include any separately certified hospital (freestanding or hospital within a hospital) that predominately treats individuals under age 21 that has been provided an alternative Medicare number in order to enroll in the Medicaid EHR Incentive Program.
Online Information Access & Reminders
Allows eligible hospitals and CAHs to withhold or remove information from online access if they believe substantial harm may arise from its disclosure online.
Lowers from 40 percent to 10 percent the percentage of images ordered by providers' inpatient or emergency departments which must be accessible through a certified EHR.
Requires providers to send patients reminders for preventive or follow-up care.
Texas's Health and Human Services Commission is seeking formal approval for new Medicaid fraud rules that doctors allege deny them due process and expand investigators' power to halt their funding. For months, HHSC's Office of the Inspector General has been increasingly relying on a federal rule—part of President Obama's healthcare plan—that allows the agency to freeze financing to any health provider accused of overbilling Medicaid. That means they can halt the flow of funding before they complete a full-fledged investigation, and often, providers say, before doctors are given any chance to defend themselves.
House Committee on Oversight and Government Reform Chairman Darrell Issa demanded all documents and communications between the IRS and President Barack Obama's White House after the healthcare overhaul law was signed into law in March 2010, in a letter released on Wednesday. Issa has challenged the Obama administration's authority to administer the healthcare law in states that are refusing to cooperate. The IRS is charged with distributing health insurance tax credits through the state exchanges. Issa argues that federally-created exchanges, set up in the resisting states, cannot deliver the tax credits.
Medicare Advantage is the private alternative to the traditional insurance program for seniors. It covers 11.7 million Americans. Some argue that it's less expensive than the public programs. Others say it's more expensive. It would be very hard for both of these things to be true. James Capretta and Yuval Levin made the case this week that Medicare Advantage plans are less expensive, citing an Aug. 1 study in the Journal of the American Medical Association. That research looks at what would happen if we implemented the Ryan-Wyden Medicare reforms (which are pretty similar to Romney's proposals) right away.