Johnson Memorial Corp. laid off 55 staff members, reduced the hours of 49 others and will file for bankruptcy protection as it prepares to merge with Eastern Connecticut Health Network. The corporation, which runs the ailing Johnson Memorial Hospital, agreed to sell the hospital's assets to ECHN in a $65 million deal subject to approval by state officials. ECHN operates Manchester Memorial Hospital and Rockville General Hospital and would maintain the 96-bed Johnson Memorial as a separate entity.
After a decade of debate and one unsuccessful attempt to generate support for a new public hospital in Dallas County, a $747 million hospital bond issue has finally made it onto the Nov. 4 ballot. But supporters of the plan to build a new Parkland Memorial Hospital are worried now that voters won't find the bond measure on the back of the crowded ballot.
The Office of Inspector General issued a final report October 27 reviewing CMS' HIPAA security rule oversight, implementation, and enforcement.
The largely critical report ("Nationwide Review of the Centers for Medicare & Medicaid Services Health Insurance Portability and Accountability Act of 1996 Oversight [A-04-07~05064]") describes the OIG's findings and recommendations for CMS, but it also sends a message to covered entities.
"This is a formalized wakeup call for CMS; as an enforcement arm, it will be held accountable to fulfill its duties," says John C. Parmigiani, MS, BES, president of John C. Parmigiani & Associates, LLC, in Ellicott City, MD, and former chairperson of the team that created the HIPAA security rule. "But it also says to the healthcare industry that CMS is going to be coming after you."
The OIG findings and recommendation
CMS' limited actions in terms of security rule implementation have "not provided effective oversight or encouraged enforcement" of covered entities, according to the report. Because CMS only investigated noncompliant covered entities when it received a complaint, the OIG also determined that "CMS had no effective mechanism to ensure that covered entities were complying with the HIPAA Security Rule or that ePHI [electronic protected health information] was being adequately protected."
OIG audits of multiple covered entities confirmed this fact. According to the report, OIG audits of several hospitals showed "numerous, significant vulnerabilities" in security systems intended to protect ePHI, leaving it at high risk. Further, it determined that complaints would not have exposed many of the vulnerabilities the OIG has since found.
"If you just focus on a complaint, and resolving that complaint, that's not enough," says Kate Borten, CISSP, CISM, president of The Marblehead (MA) Group. "The OIG went in and found all these other problems that would never have come to light without a full compliance review."
There are generally fewer security rule complaints compared to privacy rule complaints; the Office for Civil Rights had received more than 16,000 privacy rule complaints as of October 31, 2005, whereas CMS received approximately 400 security rule complaints during the same time period. This is because security rule violations are largely hidden from the public eye, not because the problems don't exist, Borten says.
As a result of its findings, the OIG recommended that CMS conduct compliance reviews. CMS contracted with PricewaterhouseCoopers to conduct reviews following the OIG investigation but prior to the release of the OIG report.
The future of security rule audits
Security rule audits and reviews are not going away any time soon. In a response to the OIG's recommendation dated June 30, 2008, CMS acting administrator Kerry Weems agreed with the recommendation that CMS should implement policies and procedures for conducting compliance reviews of covered entities—both complaint-driven and not.
"We are definitely going to see more of these compliance reviews, not fewer," Borten says. "I think this year CMS is just testing the waters, getting their feet wet."
Weems also indicated that CMS and the OIG are considering possible future collaboration on security rule enforcement efforts, including compliance reviews, in fiscal year 2009. The OIG also has multiple audits of covered entities currently ongoing, according to the report.
"The OIG is now on record saying that this is a serious ongoing program that is going to be periodically watched," Parmigiani says. "In other words, listen up. This isn't a one-shot deal. You need to be audit-ready."
"The enforcement heat is on, and it could be turned up," he says.
Understanding the link between insomnia and poor health, health insurance companies are providing cognitive behavior therapy programs to their members to help them get a good night's sleep. WellPoint, Aetna, Cigna, Kaiser Permanente, and several Blue Cross plans are offering their members online programs rather than relying on sleeping pills.
Some health plans offered by AARP mislead consumers into thinking they're protected from catastrophic health costs but leave them vulnerable to paying tens of thousands of dollars, Sen. Chuck Grassley, R-Iowa, says. Grassley, the top Republican on the Senate Finance Committee, is sending more than a dozen questions to AARP CEO William Novelli about AARP plans that cover about 1 million people. The actions are part of Grassley's broader health coverage and cost inquiry.
A southwestern Pennsylvania hospital is planning a $3 million renovation that will include expanding its emergency room and creating a new specialized surgical care area. Southwest Regional Medical Center Chief Executive Officer Cindy Cowie says the hospital’s revitalization in recent years means it must expand in order to continue providing quality healthcare to people in the region.
Hospital patients and the companies insuring them would no longer be on the hook to pay for care after a serious medical error occurs under legislation introduced by New Jersey Assemblyman Paul Moriarty. The bill would prohibit New Jersey hospitals from charging for treating hospital-acquired conditions such as when an object is left inside a body during surgery, surgical-site infections, urinary tract infections resulting from a catheter, receiving incompatible blood, and others. The measure mirrors new federal restrictions refusing Medicare reimbursement for care resulting from mistakes.
Less restrictive conditions for coverage (CfC) for ambulatory surgery centers (ASC), new composite APCs, and revised definitions for new and established patients are among the provisions of the outpatient prospective payment system (OPPS) final rule for calendar year (CY) 2009. CMS released the 2009 OPPS final rule as a display copy on October 31.
In a CMS news release, CMS Acting Administrator Kerry Weems says, "In this final rule, we are continuing to pay appropriately for care while working with healthcare providers as we look for ways to make sure beneficiaries who come in for treatment of one complaint don't leave with two as a result of adverse events during their outpatient visits."
The rule also establishes new CfCs for ASCs that reflect current ASC practice by focusing on the care provided to patients and the impact of that care on patient outcomes. The final rule defines an ASC as a distinct entity that operates exclusively for the purpose of providing surgical services to patients not requiring hospitalization and in which the expected duration of services would not exceed 24 hours following an admission.
A news release on the Web site of the Ambulatory Surgery Center Association says the CfCs are less restrictive than a revision CMS proposed last year.
Jugna Shah, MPH, president of Nimitt Consulting in Washington, DC, says her quick review of the final rule indicates that CMS appears to have moved forward with the majority of its proposals, despite concerns expressed by numerous commenters on sensitive issues, such as the creation of new imaging composite APCs and further decreases in drug reimbursement.
Packaging and composite APCs
CMS continues to expand its concepts of packaging and composite APCs as mechanisms to promote provider efficiency. "This is clearly evidenced by CMS' tone throughout the rule and, in particular, with its finalization of the multiple imaging composite APCs, the elimination of the IVIG pre-administration HCPCS G0332 separate payment, and its persistence in keeping all diagnostic radiopharmaceuticals packaged despite well-thought-out arguments brought forth by commenters," says Shah.
CMS has decided to move forward with its multiple imaging composite methodology, which means it will provide a single composite APC payment each time a hospital bills more than one procedure from an imaging family on a single date of service. Shah says providers should examine the financial impact of this measure by evaluating the number and types of imaging services they regularly provide on a given date of service, as CMS is not distinguishing between multiple services provided on the same date of service in the same session and multiple services provided on the same day at two different sessions.
Separately payable drugs
Shah notes that although CMS has shown an interest in further exploring the pharmacy stakeholder proposal to allocate a portion of packaged drug costs to cover pharmacy overhead costs, it has not moved forward with this for 2009 and instead has finalized its proposal that all separately payable drugs will be paid at average sales price (ASP) plus 4%.
This additional decrease in separately payable drug reimbursement is disappointing given the compelling arguments that provider and industry groups have made highlighting that ASP plus 4% in no way comes close to covering both the drug acquisition and pharmacy overhead cost," Shah says. "[It] could leave hospitals facing a larger than expected financial impact, especially when taken together with a number of the other changes CMS has finalized for 2009."
However, CMS abandoned its proposal to create two new costs centers for drugs—drugs with low overhead costs and drugs with high overhead costs—in response to commenter objections. "This is good news indeed and it's great that so many providers and industry organizations commented, and that CMS listened," says Shah.
E/M visit codes
For 2009, CMS has chosen to maintain the use of evaluation and management (E/M) CPT codes distinguishing between new and established patients, while acknowledging the merits of many commenter suggestions. However, the agency has revised the definitions of new and established patients.
"This is a really a mixed bag of news for providers," says Shah. "Providers have to continue living with a distinction that most hospitals don't seem to support, but at least CMS has revised the definition, which should make the reporting of new vs. established patients easier."
Quality reporting
Four new measures for outpatient quality reporting appear in the final rule. These are all for imaging, and CMS states that it can compute the quality measure/score based on claims data.
Editor's note: for more information on the CY 2009 proposed rule for the OPPS, go to the CMS Web site. For more information on the ASC payment system, visit http://www.cms.hhs.gov/ASCPayment/. The 2009 OPPS final rule will be published in the November 18 Federal Register.
Last year, 750,000 Americans traveled abroad for care, according to estimates by the Deloitte Center for Health Solutions, a Washington-based research center. Other analysts say the numbers are lower, but hardly anyone disputes that medical care, once a highly local business, is going global like never before. By 2010, Deloitte projects, 6 million consumers a year will venture outside the United States for medical treatment. Proponents say it's a logical outgrowth of the globalization that's reshaping the industry.
A review of the California Bureau of Vocational Nursing and Psychiatric Technicians has found many cases in which regulators acted belatedly or not at all, even when explicitly told that nurses had committed serious crimes. Some were handed renewals after reporting their own felonies to the bureau.
