Blue Cross and Blue Shield of Georgia will cover the H1N1 vaccine for members who have benefit plans that include coverage for vaccines. BCBSGA decided to cover H1N1 vaccines because it was formally suggested by The U.S. Centers for Disease Control and Prevention's Advisory Committee on Immunization Practices, which recommends initial prioritization for those administering the vaccine for five key populations.
Drug companies—the leading source of lobbyist money—now have "a seat at the table" at the White House and on Capitol Hill as healthcare legislation works its way through Congress. The pharmaceutical industry's political transformation provides an example of Obama's approach to achieving his healthcare goals, which includes negotiation and compromise, even with those that the administration previously portrayed as a source of the problem.
Dozens of large and small companies are turning to wireless technology to help achieve the Obama administration's goal of a healthcare system that keeps people healthier for less. A 2008 study that was distributed by a coalition of companies and organizations that support healthcare reform predicted annual savings from remote monitoring at $10.1 billion for U.S. sufferers of congestive heart failure, $6.1 billion for diabetes, and $4.9 billion for chronic obstructive pulmonary disease. But claims about cost savings from new technology often don't pan out.
Under the Obama administration's stimulus bill and other proposals, portions of a $29 billion fund are available to reimburse hospitals and doctors' offices that invest in electronic records systems and other software that might improve care and lower healthcare costs. The government has stressed the need for increased security as part of this digitization initiative, but making patient data more accessible also creates the potential of it falling into the wrong hands.
Though many hospitals feared a 1.9% reduction in payment for 2010, they will actually see a 2.1% increase, according to the fiscal year 2010 IPPS final rule that CMS released Friday.
CMS had originally proposed a documentation and coding adjustment to account for the effect of increases in aggregate payments because of changes in hospital coding practices that it said do not reflect increases in patients' severity of illness.
The proposed adjustment would have resulted in historically low payments for hospitals and especially penalize hospitals that have yet to develop a clinical documentation improvement (CDI) program, says DeAnne Bloomquist, RHIT, CCS, president and chief consultant for Mid-Continent Coding, Inc., in Overland Park, KS. "I think that means that hospitals can breathe a sigh of relief."
James S. Kennedy, MD, CCS, a director with FTI Healthcare in Atlanta, agrees. "CMS' proposed imposition of a documentation and coding adjustment, while logical and consistent with their rules, would have financially disadvantaged hospitals that have not enacted rigorous clinical definition accountability and documentation improvement programs," he says.
Payment changes
In the proposed IPPS rule, CMS intended to reduce future payment rates "based on the observed increase in spending due to documentation and coding that occurred in fiscal 2008," according to CMS' press release. However, because it does not have a full year of data that would show the extent of documentation and coding effects on 2009, CMS decided not to implement the adjustment until it has a full year of FY 2009 data.
This does not mean hospitals won't see an adjustment in the future, however. The press release also states, "Based on complete analysis of fiscal 2008 and fiscal 2009 data, CMS will consider phasing in future adjustments over an extended period beginning in fiscal 2011."
"This is basically granting [hospitals] a reprieve," Bloomquist says.
In the next year, hospitals with CDI programs should continue their initiatives, while those who have not implemented one yet should work toward that goal, says Gloryanne Bryant, RHIA, CCS, CCDS, Regional Managing HIM Director at Kaiser Foundation Health Plan Inc & Hospitals.
"This does not mean that hospitals should slow down or abandon their clinical documentation and coding improvement activities or initiatives," she says. "Hospitals should be capturing all valid codeable conditions to represent the patient severity, acuity and risk of mortality. We will need to stay tuned on the analysis that CMS will be doing on the data in so far as the possible impact and/or reduction for FY2011."
In a prepared statement, Jonathan Blum, director of the CMS Center for Medicare Management, said, "The policies and payment rates in this final rule will ensure that Medicare beneficiaries continue to have access to high quality inpatient care in both short-stay acute care and long-term care hospitals. In developing the final rule, CMS has paid careful attention to comments submitted by the public to proposals issued in May."
The Joint Commission recently announced a focus on the interpretation of standards and survey process related to sterilization using steam. Now the field is preparing to address this renewed focus.
"Let's be clear that these standards are not new standards—these are just receiving critical attention as they should," says Jodi Eisenberg, MHA, CPMSM, CPHQ, CSHA, program manager of accreditation and clinical compliance at Northwestern Memorial Hospital in Chicago. Eisenberg is an advisor and regular columnist for Briefings on The Joint Commission.
This increased focus is well timed as there has been news of incidents involving exposure to infectious body fluids from other patients via equipment that had not been appropriately cleaned, disinfected, and sterilized.
Cleaning equipment, along with the ubiquitous topic of hand hygiene, is among the most important parts of the process for preventing transmission of infection. It appears that the initial focus of these new initiatives will be on Central Sterile Processing. The Joint Commission surveyors will be focusing on observing instruments from the time they leave one operating room to when they are returned. They will be observing the instrument cleaning process and surveyors will be looking for appropriate personal protective equipment as well as reviewing sterilization logs.
"I agree that this is a critical process and will be a challenge for some organizations," says Eisenberg. "An additional area of focus for organizations needs to be on the decentralized process for cleaning and disinfection."
In many areas, the centralized process for cleaning has been replaced through the use of chemical sterilization agents being used in departments and areas outside Central Sterile Processing, she adds.
Economically, this process seems to be less expensive because it takes less time and uses fewer resources.
However, in some cases, organizations have taken this critical cleaning element and delegated it to people who may not be trained appropriately or may not understand the appropriate procedure or details of decontamination, thereby increasing the potential of cleaning and disinfection errors.
"The result is an inconsistency in the cleaning and disinfection standards across the organization," says Eisenberg.
In order to address this in your organization, the first step is to delineate an inventory of units or departments using chemical sterilization agents to clean equipment. The staff conducting hazard surveillance within an organization may already have this inventory completed. Using a decentralized sterilization inventory tool, organizations can identify where this decentralized sterilization is occurring, what products are being used, and what equipment is being processed.
Once the data is collected, a review of the procedures should occur to determine the appropriateness and consistency.
"The goal is not necessarily to eliminate the decentralized sterilization, but to ensure its integrity and safety," says Eisenberg.
Doctors' leaders in the United Kingdom claim the National Health Service has failed to prepare properly for cuts in junior doctors' working hours. Under the rules, junior doctors working hours were cut from 56 to 48 hours a week to comply with the European working time directive. The British Medical Association says the assembly government and NHS trusts have not planned to cover the reduced staffing that will result.
In this opinion piece published in the Boston Globe, Dean Baker, the co-director of the Center for Economic and Policy Research, makes the case for globalizing American healthcare. There are clear ways to take advantage of lower costs in other countries, making the U.S. system more affordable without diminishing the quality, Baker says.
Michael M. Rachlis, a physician, health policy analyst and author based in Toronto, compares the United States' and Canada's respective health systems. In this article for the Los Angeles Times, Rachlis says the caricature of socialized medicine" is used by corporate interests to confuse Americans and maintain their bottom lines instead of patients' health.
The secretary of HHS shifted enforcement of the HIPAA Security Rule from CMS to the Office for Civil Rights (OCR), according to an HHS announcement published Tuesday in the Federal Register.
Until now, OCR has enforced only the HIPAA Privacy Rule, which protects the privacy of patients' health information and the confidentiality provisions of the Patient Safety Rule, which protect PHI from being used to analyze patient safety events and improve patient safety.
The security rule–published in the Federal Register on February 20, 2003–specifies a series of administrative, technical, and physical security procedures for covered entities to assure the confidentiality of electronic protected health information (i.e., encryption standards).
"I think it's smart for HHS to merge the enforcement responsibilities," says Jeff Drummond, health law partner in the Dallas office of Jackson Walker LLP. "But I don't think this signals a watershed shift in enforcement strategy."
The announcement by HHS Secretary Kathleen Sebelius comes as Congress this year helped move a bill through that supports stronger enforcement of HIPAA laws and greater compliance duties from entities who handle PHI.
The Health Information for Economic and Clinical Health (HITECH) Act, signed into law by President Barack Obama February 17, 2009, calls for:
New security breach notification requirements
HIPAA Security Rule compliance for business associates who handle PHI
Contract revisions between covered entities and business associates
Definition of "unsecure protected health information"
Expanded criminal penalties and higher monetary penalties
Power to state attorneys general to pursue HIPAA civil cases
Restricting access to some PHI
Will giving OCR the security rule have a great effect on enforcement?
Drummond says there will be more of an impact from the provisions in the HITECH that give state attorneys general the ability to pursue HIPAA violations.
"It never made sense for privacy enforcement and security enforcement to be split up into different agencies," Drummond says. "The new enforcement provisions in [HITECH] were probably the impetus for making the change now. Why OCR instead of CMS? Maybe because OCR has been more visible on the enforcement front and already has more infrastructure to do it, or maybe HHS knew it had to respond to the folks who decried lax enforcement, but was ultimately happy with the way OCR had approached it so far."
