A group of health information technology vendors have formed an alliance to educate physicians about health IT incentives contained in the federal economic stimulus law. The Electronic Health Records Stimulus Alliance includes Allscripts-Misys Healthcare Solutions Inc., Cisco Systems Inc., Citrix Systems Inc., Dell Inc., Intel Corp., Intuit Inc., Microsoft Corp. and Nuance Communications Inc. The alliance is sponsoring a touring education program for doctors to inform them about the stimulus incentives. The program includes executive briefings, discussions, trade-show presentations, Webcasts and a Web site.
The Certification Commission for Healthcare Information Technology will put its 2009-2010 programs on hold and update its certification policies in light of guidance contained in the American Recovery and Reinvestment Act. CCHIT said it will defer the launch of its latest certification programs until it has reviewed the Office of the National Coordinator for Health IT's forthcoming standards and certification criteria. ONC will deliver a draft rule containing those items to the Health and Human Services Department by Aug. 26. CCHIT's certification cycle was set to begin July 1.
President Barack Obama last week signed the Fraud Enforcement and Recovery Act of 2009, which gives additional resources to law enforcement for fighting fraud and abuse and strengthens fraud laws and statutes.
Although the bill's primary function it to prevent the growing number of mortgage fraud cases, it also the most significant changes to the federal False Claims Act since 1986, according to the bill's co-sponsor Senator Chuck Grassley (R-IA). The changes to the False Claims Act can affect any organization that submits claims to the government for payment, including healthcare providers.
Specifically, the bill would extend the reach of the False Claims Act to include any false or fraudulent claim for government money or property, regardless of whether:
The claim is presented to a government official or employee
The U.S. Government has physical custody of the money
The defendant specifically intended to defraud the U.S. government
"If the bill becomes law, it is easier for the government and private whistleblowers to succeed in false claims act cases," said Claire Turcotte, a healthcare attorney with Bricker & Ecker LLP in West Chester, OH.
Not that False Claims cases have been particularly unsuccessful. In a press release, the bill's co-author, Senator Patrick Leahy (D-VT), called the False Claims Act the "one of the best civil tools available to root out fraud in government." Leahy also said from 2000-2008 the Justice Department recovered more than $15 billion in fraud using the False Claims Act.
According to Leahy, the bill redefines terms in the False Claims Act to more accurately reflect the intention of the law. In particular, the term "knowingly" has been redefined.
The new language specifically states intent is not a requirement of the False Claims Act and the prosecution only needs to show the violator did one of the following, in regards to information:
Had actual knowledge of the information
Acted in deliberate ignorance of the truth or falsity of the information
Acted in reckless disregard of the truth or falsity of the information.
Tim McCormack of Phillips & Cohen LLP said critics of FERA claim the change in language will unfairly expand the scope of the False Claims Act to cover innocent mistakes, but McCormack doesn't see it that way.
"The confusion on this point likely comes from the way that ‘knowing' is commonly defined in legal proceedings. A person can ‘know' that something is false in several ways. Obviously, a person who is actually aware that a claim is not true, ‘knows' that it is false. In addition, in legal terms, a person may ‘know' a claim is false if they suspect or should suspect it is not true and do nothing to confirm whether it is," McCormack said.
Basically what the bill does is protect the government from organizations that look the other way when they suspect a claim to be false in order to get out of any liability. The logic being if they do not investigate suspicious claims, they can always say they never knew about it.
The new language in FERA will put the onus on organizations to sniff out suspicious claims submitted to the government and investigate them. If irregular claims are not checked by organizations, they will be prosecuted as if they had intentionally submitted false claims.
One way to ensure an organization is protected against prosecution under the False Claims Act is to ensure it has a reliable compliance program, McCormack said. "The best way to steer clear of False Claims Act liability is to strive to submit truthful claims; scrupulously and promptly correct those inadvertently false claims that you later discover; and, listen when your employees raise compliance concerns."
UnitedHealthcare is the first national health plan to partner with the California Regional Health Information Organization and agree to pay for electronic health information services statewide. As part of the initiative, the exchange will deliver secure patient information to hospital emergency departments for UnitedHealthcare and PacifiCare of California private-sector HMO members.
The times, they are a-changing. For years the accreditation world has come to expect a treat every summer: new and revised National Patient Safety Goals from The Joint Commission.
In theory, the NPSGs are regarded as a good and necessary concept, improving patient safety across the country and targeting challenging areas—but, constantly evolving, updated, added to, subtracted from, the NPSGs have presented a particularly frustrating challenge for accreditation coordinators.
In recent months, The Joint Commission has taken a different tactic with the NPSGs and looked at them with a fresh eye. Earlier, the organization announced that there would be no new goals in 2009—a breather of sorts—while the existing goals would be examined to see if they were working.
In February 2009, The Joint Commission announced that it would not factor survey findings on NPSG 8, medication reconciliation, into the organization's accreditation decision nor would these findings generate Requirements for Improvement or appear on its accreditation report, as The Joint Commission was reexamining the goal to "evaluate and refine the expectations for accredited organizations," according to an official statement.
At the time, speculation pointed to Universal Protocol that would soon receive similar treatment. As it turns out, the speculators were right: The Joint Commission has asked the field to review and comment on revisions to the 2009 NPSGs and 2009 Universal Protocol as part of this ongoing project to improve the NPSGs.
The Joint Commission has crafted revisions in the hopes of clarifying language and increasing relevancy to the settings where they are applied. Twenty-one pages of proposed revisions have been posted to The Joint Commission's Web site identifying standards and Elements of Performance proposed for revision or deletion.
"The proposed changes to critical results is more manageable," says Elizabeth Di Giacomo-Geffers, RN, MPH, CSHA, a healthcare consultant in Trabuco Canyon, CA, and former Joint Commission surveyor. "The most problematic standards have been medication reconciliation and Universal Protocol—The Joint Commission took action on medication reconciliation in February, and we anticipate more changes to medication reconciliation and Universal Protocol on the horizon. In short, the changes are good—they've deleted a lot and made the goals easier to follow."
Feedback will be gathered over a six-week period beginning May 12. Among the proposed changes: Eight NPSGs would be moved into the standards with some or all of their existing Elements of Performance. Ten others (including Universal Protocol) remain under the goals.
"There's a lot of movement from the NPSGs to the standards," says Di Giacomo-Geffers. "Some requirements are retained as NPSGs, some deleted, some moved to the standards… all have some rewording to be made simpler and more clear."
Earlier this month, the Centers for Medicare & Medicaid Services announced that it would not cover computed tomographic colonography or virtual colonoscopy. CMS said in a memo that while the "technology was promising," there was insufficient evidence on the performance of CT colonography in Medicare aged individuals to "conclude that screening CT colonography improves health benefits for asymptomatic, average risk Medicare beneficiaries."
Colorectal cancer is the third most common cancer among both men and women in the United States and accounted for nearly 50,000 deaths in 2008, according to the American Cancer Society. The majority of these deaths could be prevented by the early detection of colorectal cancer through screening, but only half of people age 50 or older, for whom the test is recommended, have received the screening. The reasons vary. Some people lack education about the importance of screening, others don't have health insurance coverage, and some just procrastinate or avoid taking the test because it is an invasive procedure and requires the unpleasant task of cleansing the colon.
Some experts believe that computed tomographic colonography or virtual colonoscopy, which is an imaging procedure that offers a detailed, cross-sectional, 2- or 3-dimensional view of the entire colon and rectum, could boost screening for colon cancer because it's less invasive than traditional colonoscopies. A traditional colonoscopy uses a thin tube equipped with a video camera that is pushed through the large intestine to view the lining. If a polyp is found, physicians can remove it by passing a wire loop through the colonoscope and using an electric current to cut the polyp from the wall of the colon. There is a higher risk of complications like bowel tears or bleeding, especially when a polyp is removed.
Although CT colonography still requires a bowel cleansing, it does not require sedation, has no recovery time, and usually takes about 10 to 15 minutes to complete. Patients with polyps or other abnormal test results would be referred for colonoscopy. Ideally they could receive the colonoscopy the same day to avoid the necessity of a second bowel preparation. Studies have shown that virtual colonoscopy detects about 96% of invasive colorectal cancer and has similar sensitivity compared with colonoscopy for large polyps.
One of CMS' chief concerns, however, is that CT colonography doesn't detect smaller polyps as well as other tests, and if a polyp is found, a regular colonoscopy would need to be performed anyway.
Did CMS make the right decision? Even gastroenterologists are split on the issue. CMS received comments opposing the decision from the American Cancer Society, the American College of Radiology, the American Gastroenterological Association, the Advanced Medical Technology Association, and UnitedHealthcare. CMS also received letters supporting the decision from the American College of Gastroenterology, the American College of Preventive Medicine, the American Society for Gastrointestinal Endoscopy, and American's Health Insurance Plans.
What do you think? Does the increased number of patients who would be willing to have a virtual colonoscopy screening outweigh concerns that the test is good, but not quite as good as a traditional colonoscopy? When colorectal cancer is found early and treated, the 5-year relative survival rate is 90%, according to statistics by the Centers for Disease Control and Prevention. That is a pretty powerful statistic in support of making colorectal cancer screenings as accessible as possible.
Note: You can sign up to receive HealthLeaders Media IT, a free weekly e-newsletter that features news, commentary and trends about healthcare technology.
New Jersey hospitals could lose $97 million in federal funds next year and more than $500 million over the next five years–prompting even more Garden State hospital closings and layoffs–under a new Medicare payment rules proposed to take effect in October, according to a New Jersey Hospital Association analysis.
NJHA examined three provisions under CMS' 2010 inpatient prospective payment proposed rule, which would take effect Oct 1 and could cost the nation's hospitals $11 billion by 2014.
The proposed rule makes several changes, including two behavioral offsets that reduce payments to hospitals to adjust for variables in coding and classification of claims and another that would eliminate capital funds distributed under the graduate medical education system.
The NJHA analysis determined that an "operating behavioral offset" would cut annual market basket adjustments for New Jersey hospitals from 2.1% to 0.2%–an approximately $77 million loss next year and $409 million over the next five years. In addition, the "capital behavioral offset" would be reduced from an anticipated increase of 1.2% to a cut of 0.7%, representing a $6.1 million loss statewide next year and $31 million by 2014.
Existing capital indirect medical education funding would be eliminated entirely under the proposed rule, a loss of $14 million next year and $71 million by 2014.
"This is more devastating financial news for hospitals in our state," says NJHA President and CEO Betsy Ryan. "New Jersey already has seen nine hospitals close in the last two years, and more will surely follow if we continue to chop away at the payments they receive for taking care of patients."
The proposed rules change was introduced on May 1, and will be finalized on Aug. 1.
NJHA also raised concerns about the expiration in 2011 of the imputed wage index floor–which gives New Jersey hospitals a minimum reimbursement level for treating Medicare patients to compensate for the high labor costs in the region. It also requires changes in hospitals' payments to be budget-neutral on a statewide basis–if one hospital sees its payments increase, other hospitals would sustain cuts of the same amount. As much as $44 million in Medicare funds could be vulnerable to this shift next year.
An updated version of the Minimum Data Set (MDS) 3.0 Draft Item Set appeared on CMS' Web site May 7 and an initial analysis revealed significant changes from the previous draft.
Some key changes featured in the updated MDS 3.0 draft include:
The MDS 2.0 two-column coding format for activities of daily living self-performance and support provided, which was omitted from the previous draft, is included in the updated version.
The updated MDS 3.0 draft requires the start and end dates of therapy to be recorded. This allows an Other Medicare Required Assessment (OMRA) to be completed closer to the start or end date of therapy services, adjusting the resource utilization group category so the payment rate is more accurate.
The requirement that the Brief Interview for Mental Status, Resident Mood Interview (PHQ-9), Interview for Daily Preference, Interview for Activity Preference, and Pain Assessment Interview be conducted the day before, day of, or day after the assessment reference date is omitted from the updated MDS 3.0 draft.
The look back period for active diseases was reduced from 30 days to 7 days.
The updated MDS 3.0 draft clearly states the reverse staging of pressure ulcers should not be used.
Section N, Medication, of the updated MDS 3.0 draft includes a section for insulin.
The updated MDS 3.0 draft includes a section for the Care Area Trigger (CAT) Summary (Section V). CATs will replace Resident Assessment Protocols (RAP) as the new tools for organizing MDS information about a resident's health problems and functional status.
CMS plans to release the final MDS 3.0 in October of this year and implement the new assessment system on October 1, 2010. Although items may be added, revised, or dropped before the final MDS 3.0 is released, the updated MDS 3.0 draft gives providers a good indication of what the final version will include.
If current federal healthcare reform efforts fall flat in Congress, businesses in 2019 could find their health costs doubled and 65.7 million people could end up uninsured under a worst-case scenario, according to projections from researchers at the Urban Institute in Washington.
The researchers, using their Health Insurance Policy Simulation Model, estimated how coverage and cost trends could change between now and 2019. They looked at three scenarios: worst case where growth is slow for incomes but high for healthcare costs; intermediate case where incomes grow somewhat faster, but healthcare costs remain slower; and best case where there is full employment and faster income growth but slower growth in healthcare costs.
However, no matter which scenario occurs, business owners likely will face huge strains and millions would end up losing their insurance, according to the analysis, which is included in the report, Health Reform: The Price of Failure, published by the Robert Wood Johnson Foundation. Even under the intermediate case scenario, 62.2 million individuals could be uninsured, and 53.1 million could be uninsured under the best case scenario.
Individuals and families would see healthcare costs dramatically jump. In addition, total individual and family spending on premiums and out-of-pocket costs could increase 68% by 2019 in the worst-case scenario. Even under the best case scenario, healthcare costs still could increase at least 46%.
Businesses could see their healthcare costs double within 10 years. The amount that employers pay for premiums could more than double--from $429.8 billion in 2009 to $885.1 billion in 2019. Even with the best-case economic conditions, employer spending on health insurance premiums would increase 72%. The percentage of individuals covered by employer insurance could drop from 56.1% in 2009, to as low as 49.2% by 2019.
Spending on government insurance programs could double. In the worst case scenario, spending on Medicaid and the state Children's Health Insurance Program (SCHIP) could increase from $251.2 billion this year to $519.7 billion in 2019, as more people are priced out of private insurance and become eligible for government programs.
At the same time, public programs could be hit hard. For instance, Medicaid and the SCHIP "would increase substantially" from the current rate of 16.5% of the population to 20.3% by 2019.
John Holahan, PhD, director of the Health Policy Research Center at the Urban Institute, wrote in his blog about the projections that "it seems to me that while enacting reform in a bad economy will be politically tough, it’s the cost of failure that the nation really can’t afford."
Nearly 10 years ago, the Institute of Medicine released its report To Err Is Human: Building a Safer Health System, which put a spotlight on problems surrounding patient safety. Last week, a panel of providers and policymakers who initially experienced firsthand the impact of that report—which estimated that upward of 98,000 people died each year in hospitals due to medical errors—had a chance to reflect how the report exceeded or fell short of expectations during the intervening years at a meeting of the National Patient Safety Foundation Annual Congress outside of Washington.
Lucian Leape, MD, one of the authors of the report and an adjunct professor of health policy at the Harvard School of Public Health, said the early publicity over the report "really took us very much by surprise."
Overall, there were three messages to the report:
This is a serious problem
It's not bad people but bad systems
This needs to be a national priority
"Unfortunately number three never happened, and that's the big disappointment," he said.
In the healthcare reform area, patient safety should be an important issue in the debate, but federal attention has not been there, said James Guest, who is president of Consumers Union. "I think it's critically important that in addition to access, in addition to cost savings, and in addition to other factors, patient safety really ought to be front and center in health reform."
Last week, Consumer's Union issued a report that said as many as 100,000 people still may be dying in hospitals because of medical errors. "There's really a dichotomy here," Guest said. At the macro level, many hospitals have "poured their heart and soul" into quality improvement efforts addressing patient safety. But at a macro level, the data and direction has not been there to address patient safety concerns.
Overall, more transparency and accountability are needed, Guest said. In places where hospitals are required to be more transparent with data reporting—such as in states requiring disclosure of hospital-inquired infections, they may face "some pressure and incentive to really do some things to make a difference," he said.
The IOM report also signaled the appearance of patient- and family-centered care in a new light, said James Conway, senior vice president with the Institute for Healthcare Improvement.
However, in his home state of Massachusetts, 10 patients died last year because of medication errors. "We have so much more work to do. And unfortunately, the news isn't shocking," Conway said.
One of the problems is that while great stories are told about individuals addressing patient safety concerns, "we don't have a collective urgency," to make changes now, Guest said.
For instance, more than 15% of the nation's CEOs in an American College of Healthcare Executives survey, said they don't go to sleep at night worrying about quality and safety as part of their first three priorities. "That's an enormous place where we need to go."
Carolyn Clancy, MD, the head of the Agency for Healthcare Research and Quality, said the IOM report "gave us a brilliant roadmap . . . but that roadmap needs to be updated periodically."
One area where she thinks the nation has "fallen down a bit" is establishing and updating "a national reporting system that right now would let us know across the nation how we're doing," she said. "There's still a lot of sensitivity about being transparent about all of this."
