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ICD-10 delayed: Proceed with caution, experts say
When it comes to ICD-10 readiness, invest in low-cost, high-impact steps that will benefit the October 2015 switch to a new code set, but will also improve the general health of the medical practice.
Now that implementation of ICD-10 has been delayed a full year, "I’d avoid spending too much money at this stage," said Robert Tennant, senior policy adviser at the Medical Group Management Association (MGMA).
Practical steps include checking claims already paid under ICD-9 to see whether the documentation was sufficient to assign an ICD-10 code. In the case of a sprained wrist, for example, make sure the documentation includes whether the injury was to the left or right wrist, Mr. Tennant said.
Consider dual coding – coding the same claims in both ICD-9 and ICD-10 – for some most commonly used codes, Mr. Tennant advised. If you "go through the clinical documentation improvement exercises, you will produce a better quality medical record and that can help the practice in a number of ways even if ICD-10 never goes forward."
Other low-cost, high-impact steps include reaching out to clearinghouses to request reports on the practice’s top diagnosis codes, the top pended or rejected claims, and the most frequently used unspecified codes.
"That should really focus the practice in on those claims that are the most problematic," he said.
One tough decision is when to upgrade software. Upgrade too early and the practice could lose money if there’s another delay. Wait too long and the practice risks being unprepared for the compliance date, according to Mr. Tennant.
He advised finding out when the vendor will be ready with upgrades and how long it will take them to install the software and provide training. Use that to build an implementation timeline.
"It’s such a tightrope that practices have to walk," Mr. Tennant said.
Dallas-based pediatrician Joseph Schneider has been helping physicians prepare for ICD-10 in his role as chair of the Texas Medical Association’s Practice Management Services Council. The association’s official policy is that the move to ICD-10 should be scrapped, but the group is urging physicians and hospitals to prepare anyway.
Dr. Schneider said smaller practices should check in with payers, vendors, and clearinghouses now, but save significant investments and training for next year.
"If you’re in a small physician practice, probably doing not very much between now and December might be a pretty good strategy," he said. "From January forward, you have to start your engines and get everything ready."
But larger practices and health systems don’t have the luxury of waiting, he said.
Dr. George Abraham, who is part of a six-physician practice in Worcester, Mass., was ready for ICD-10 to take effect this year. His practice spent more than $25,000 preparing for the scheduled switch and had done some initial testing of systems when the delay was announced.
Now the practice faces an additional expenditure on upgrades and refresher courses for coders and physicians.
"After everything, poof, it’s gone in a puff of smoke because everything came to a standstill when ICD-10 got suspended for a year," said Dr. Abraham, governor of the Massachusetts chapter of the American College of Physicians.
"It will be déjà vu all over again come summer of next year. We’ll be doing the same thing in preparation for ICD-10 being rolled out in October 2015."
Most health plans won’t begin end-to-end testing of claims until next year, Dr. Abraham said, and that’s worrisome because it may not provide enough time to work out potential glitches.
"A delay in claims being processed is our biggest anxiety," he said. "A delay in payments will lead to a severe cash flow crunch."
When it comes to ICD-10 readiness, invest in low-cost, high-impact steps that will benefit the October 2015 switch to a new code set, but will also improve the general health of the medical practice.
Now that implementation of ICD-10 has been delayed a full year, "I’d avoid spending too much money at this stage," said Robert Tennant, senior policy adviser at the Medical Group Management Association (MGMA).
Practical steps include checking claims already paid under ICD-9 to see whether the documentation was sufficient to assign an ICD-10 code. In the case of a sprained wrist, for example, make sure the documentation includes whether the injury was to the left or right wrist, Mr. Tennant said.
Consider dual coding – coding the same claims in both ICD-9 and ICD-10 – for some most commonly used codes, Mr. Tennant advised. If you "go through the clinical documentation improvement exercises, you will produce a better quality medical record and that can help the practice in a number of ways even if ICD-10 never goes forward."
Other low-cost, high-impact steps include reaching out to clearinghouses to request reports on the practice’s top diagnosis codes, the top pended or rejected claims, and the most frequently used unspecified codes.
"That should really focus the practice in on those claims that are the most problematic," he said.
One tough decision is when to upgrade software. Upgrade too early and the practice could lose money if there’s another delay. Wait too long and the practice risks being unprepared for the compliance date, according to Mr. Tennant.
He advised finding out when the vendor will be ready with upgrades and how long it will take them to install the software and provide training. Use that to build an implementation timeline.
"It’s such a tightrope that practices have to walk," Mr. Tennant said.
Dallas-based pediatrician Joseph Schneider has been helping physicians prepare for ICD-10 in his role as chair of the Texas Medical Association’s Practice Management Services Council. The association’s official policy is that the move to ICD-10 should be scrapped, but the group is urging physicians and hospitals to prepare anyway.
Dr. Schneider said smaller practices should check in with payers, vendors, and clearinghouses now, but save significant investments and training for next year.
"If you’re in a small physician practice, probably doing not very much between now and December might be a pretty good strategy," he said. "From January forward, you have to start your engines and get everything ready."
But larger practices and health systems don’t have the luxury of waiting, he said.
Dr. George Abraham, who is part of a six-physician practice in Worcester, Mass., was ready for ICD-10 to take effect this year. His practice spent more than $25,000 preparing for the scheduled switch and had done some initial testing of systems when the delay was announced.
Now the practice faces an additional expenditure on upgrades and refresher courses for coders and physicians.
"After everything, poof, it’s gone in a puff of smoke because everything came to a standstill when ICD-10 got suspended for a year," said Dr. Abraham, governor of the Massachusetts chapter of the American College of Physicians.
"It will be déjà vu all over again come summer of next year. We’ll be doing the same thing in preparation for ICD-10 being rolled out in October 2015."
Most health plans won’t begin end-to-end testing of claims until next year, Dr. Abraham said, and that’s worrisome because it may not provide enough time to work out potential glitches.
"A delay in claims being processed is our biggest anxiety," he said. "A delay in payments will lead to a severe cash flow crunch."
When it comes to ICD-10 readiness, invest in low-cost, high-impact steps that will benefit the October 2015 switch to a new code set, but will also improve the general health of the medical practice.
Now that implementation of ICD-10 has been delayed a full year, "I’d avoid spending too much money at this stage," said Robert Tennant, senior policy adviser at the Medical Group Management Association (MGMA).
Practical steps include checking claims already paid under ICD-9 to see whether the documentation was sufficient to assign an ICD-10 code. In the case of a sprained wrist, for example, make sure the documentation includes whether the injury was to the left or right wrist, Mr. Tennant said.
Consider dual coding – coding the same claims in both ICD-9 and ICD-10 – for some most commonly used codes, Mr. Tennant advised. If you "go through the clinical documentation improvement exercises, you will produce a better quality medical record and that can help the practice in a number of ways even if ICD-10 never goes forward."
Other low-cost, high-impact steps include reaching out to clearinghouses to request reports on the practice’s top diagnosis codes, the top pended or rejected claims, and the most frequently used unspecified codes.
"That should really focus the practice in on those claims that are the most problematic," he said.
One tough decision is when to upgrade software. Upgrade too early and the practice could lose money if there’s another delay. Wait too long and the practice risks being unprepared for the compliance date, according to Mr. Tennant.
He advised finding out when the vendor will be ready with upgrades and how long it will take them to install the software and provide training. Use that to build an implementation timeline.
"It’s such a tightrope that practices have to walk," Mr. Tennant said.
Dallas-based pediatrician Joseph Schneider has been helping physicians prepare for ICD-10 in his role as chair of the Texas Medical Association’s Practice Management Services Council. The association’s official policy is that the move to ICD-10 should be scrapped, but the group is urging physicians and hospitals to prepare anyway.
Dr. Schneider said smaller practices should check in with payers, vendors, and clearinghouses now, but save significant investments and training for next year.
"If you’re in a small physician practice, probably doing not very much between now and December might be a pretty good strategy," he said. "From January forward, you have to start your engines and get everything ready."
But larger practices and health systems don’t have the luxury of waiting, he said.
Dr. George Abraham, who is part of a six-physician practice in Worcester, Mass., was ready for ICD-10 to take effect this year. His practice spent more than $25,000 preparing for the scheduled switch and had done some initial testing of systems when the delay was announced.
Now the practice faces an additional expenditure on upgrades and refresher courses for coders and physicians.
"After everything, poof, it’s gone in a puff of smoke because everything came to a standstill when ICD-10 got suspended for a year," said Dr. Abraham, governor of the Massachusetts chapter of the American College of Physicians.
"It will be déjà vu all over again come summer of next year. We’ll be doing the same thing in preparation for ICD-10 being rolled out in October 2015."
Most health plans won’t begin end-to-end testing of claims until next year, Dr. Abraham said, and that’s worrisome because it may not provide enough time to work out potential glitches.
"A delay in claims being processed is our biggest anxiety," he said. "A delay in payments will lead to a severe cash flow crunch."
Opioid Prescribing Varies Widely Across the Country
Earn 0.25 hours AMA PRA Category 1 credit: Read this article, and click the link at the end to take the posttest.
The amount of opioid painkillers that physicians prescribe appears to have more to do with where they live than the patient’s condition, according to a new analysis from the Centers for Disease Control and Prevention.
Nationwide, physicians and other health care providers prescribed 82.5 opioid pain relievers per 100 persons during 2012. But prescribing rates varied widely. Hawaii had the lowest rate at 52.0 prescriptions per 100 persons; and Alabama had the highest at 142.9 prescriptions per 100 persons, according to the CDC (MMWR Morb. Mortal. Wkly. Rep. 2014;63:1-6).
The CDC analyzed the IMS Health National Prescription Audit database of 2012 prescription data from 57,000 pharmacies nationwide.
Regionally, the Southern states had the highest rates of opioid pain reliever prescribing overall, while states in the Northeast had the highest prescribing rate for high-dose opioids and for long-acting or extended-release formulations.
"What type of pain treatment you get shouldn’t depend on where you live," Dr. Tom Frieden, CDC director, said during a July 1 press conference to announce the findings.
The large variations don’t exist because these states have more people with pain needs, Dr. Frieden said. Rather, the variation is due to a combination of factors, he said, including a lack of clear consensus on evidence about when to use opioids, abuse of the drugs, and the growth of "pill mills" that do large volumes of inappropriate prescribing of opioids.
Dr. Frieden urged state governments to step up their education of physicians.
"If we’re not careful, the treatment can quickly become the problem," Dr. Frieden said.
But there is encouraging news from Florida about reversing overprescribing and related deaths from drug overdose, according to the CDC.
In a separate report, CDC officials showed that various law and enforcement actions were associated with a rapid decrease in drug overdose deaths and opioid prescribing rates, though they couldn’t say for certain that the policy changes were the cause.
During 2003-2009, drug overdose deaths in Florida increased 61% to 2,905, with the largest increase caused by the opioid oxycodone and the benzodiazepine alprazolam. Following policy changes, drug overdoses decreased 16.7% during 2010-2012, from 3,201 to 2,666. Oxycodone overdose deaths dropped 52.1%. The state reported similar decreases in prescribing rates during the same time period.
In response to soaring overdose rates, the Florida legislature required pain clinics using controlled substances to register with the state by January 2010. And in 2011, law enforcement agencies began conducting statewide raids, which resulted in arrests, asset seizures, and the closure of about 250 pain clinics. Also in 2011, the state legislature barred physician dispensing of schedule II or III drugs from their offices and required reporting to a new prescription drug monitoring program.
Dr. Frieden said the Florida experience is significant because it’s the first substantial and sustained decline in opioid prescribing and overdose deaths in a decade. "Change at the state level has the greatest promise," he said.
The analysis was conducted by researchers at the Centers for Disease Control and Prevention, and Emory University, both in Atlanta. The authors reported having no financial disclosures.
To earn 0.25 hours AMA PRA Category 1 credit after reading this article, take the post-test here.
On Twitter @maryellenny
Earn 0.25 hours AMA PRA Category 1 credit: Read this article, and click the link at the end to take the posttest.
The amount of opioid painkillers that physicians prescribe appears to have more to do with where they live than the patient’s condition, according to a new analysis from the Centers for Disease Control and Prevention.
Nationwide, physicians and other health care providers prescribed 82.5 opioid pain relievers per 100 persons during 2012. But prescribing rates varied widely. Hawaii had the lowest rate at 52.0 prescriptions per 100 persons; and Alabama had the highest at 142.9 prescriptions per 100 persons, according to the CDC (MMWR Morb. Mortal. Wkly. Rep. 2014;63:1-6).
The CDC analyzed the IMS Health National Prescription Audit database of 2012 prescription data from 57,000 pharmacies nationwide.
Regionally, the Southern states had the highest rates of opioid pain reliever prescribing overall, while states in the Northeast had the highest prescribing rate for high-dose opioids and for long-acting or extended-release formulations.
"What type of pain treatment you get shouldn’t depend on where you live," Dr. Tom Frieden, CDC director, said during a July 1 press conference to announce the findings.
The large variations don’t exist because these states have more people with pain needs, Dr. Frieden said. Rather, the variation is due to a combination of factors, he said, including a lack of clear consensus on evidence about when to use opioids, abuse of the drugs, and the growth of "pill mills" that do large volumes of inappropriate prescribing of opioids.
Dr. Frieden urged state governments to step up their education of physicians.
"If we’re not careful, the treatment can quickly become the problem," Dr. Frieden said.
But there is encouraging news from Florida about reversing overprescribing and related deaths from drug overdose, according to the CDC.
In a separate report, CDC officials showed that various law and enforcement actions were associated with a rapid decrease in drug overdose deaths and opioid prescribing rates, though they couldn’t say for certain that the policy changes were the cause.
During 2003-2009, drug overdose deaths in Florida increased 61% to 2,905, with the largest increase caused by the opioid oxycodone and the benzodiazepine alprazolam. Following policy changes, drug overdoses decreased 16.7% during 2010-2012, from 3,201 to 2,666. Oxycodone overdose deaths dropped 52.1%. The state reported similar decreases in prescribing rates during the same time period.
In response to soaring overdose rates, the Florida legislature required pain clinics using controlled substances to register with the state by January 2010. And in 2011, law enforcement agencies began conducting statewide raids, which resulted in arrests, asset seizures, and the closure of about 250 pain clinics. Also in 2011, the state legislature barred physician dispensing of schedule II or III drugs from their offices and required reporting to a new prescription drug monitoring program.
Dr. Frieden said the Florida experience is significant because it’s the first substantial and sustained decline in opioid prescribing and overdose deaths in a decade. "Change at the state level has the greatest promise," he said.
The analysis was conducted by researchers at the Centers for Disease Control and Prevention, and Emory University, both in Atlanta. The authors reported having no financial disclosures.
To earn 0.25 hours AMA PRA Category 1 credit after reading this article, take the post-test here.
On Twitter @maryellenny
Earn 0.25 hours AMA PRA Category 1 credit: Read this article, and click the link at the end to take the posttest.
The amount of opioid painkillers that physicians prescribe appears to have more to do with where they live than the patient’s condition, according to a new analysis from the Centers for Disease Control and Prevention.
Nationwide, physicians and other health care providers prescribed 82.5 opioid pain relievers per 100 persons during 2012. But prescribing rates varied widely. Hawaii had the lowest rate at 52.0 prescriptions per 100 persons; and Alabama had the highest at 142.9 prescriptions per 100 persons, according to the CDC (MMWR Morb. Mortal. Wkly. Rep. 2014;63:1-6).
The CDC analyzed the IMS Health National Prescription Audit database of 2012 prescription data from 57,000 pharmacies nationwide.
Regionally, the Southern states had the highest rates of opioid pain reliever prescribing overall, while states in the Northeast had the highest prescribing rate for high-dose opioids and for long-acting or extended-release formulations.
"What type of pain treatment you get shouldn’t depend on where you live," Dr. Tom Frieden, CDC director, said during a July 1 press conference to announce the findings.
The large variations don’t exist because these states have more people with pain needs, Dr. Frieden said. Rather, the variation is due to a combination of factors, he said, including a lack of clear consensus on evidence about when to use opioids, abuse of the drugs, and the growth of "pill mills" that do large volumes of inappropriate prescribing of opioids.
Dr. Frieden urged state governments to step up their education of physicians.
"If we’re not careful, the treatment can quickly become the problem," Dr. Frieden said.
But there is encouraging news from Florida about reversing overprescribing and related deaths from drug overdose, according to the CDC.
In a separate report, CDC officials showed that various law and enforcement actions were associated with a rapid decrease in drug overdose deaths and opioid prescribing rates, though they couldn’t say for certain that the policy changes were the cause.
During 2003-2009, drug overdose deaths in Florida increased 61% to 2,905, with the largest increase caused by the opioid oxycodone and the benzodiazepine alprazolam. Following policy changes, drug overdoses decreased 16.7% during 2010-2012, from 3,201 to 2,666. Oxycodone overdose deaths dropped 52.1%. The state reported similar decreases in prescribing rates during the same time period.
In response to soaring overdose rates, the Florida legislature required pain clinics using controlled substances to register with the state by January 2010. And in 2011, law enforcement agencies began conducting statewide raids, which resulted in arrests, asset seizures, and the closure of about 250 pain clinics. Also in 2011, the state legislature barred physician dispensing of schedule II or III drugs from their offices and required reporting to a new prescription drug monitoring program.
Dr. Frieden said the Florida experience is significant because it’s the first substantial and sustained decline in opioid prescribing and overdose deaths in a decade. "Change at the state level has the greatest promise," he said.
The analysis was conducted by researchers at the Centers for Disease Control and Prevention, and Emory University, both in Atlanta. The authors reported having no financial disclosures.
To earn 0.25 hours AMA PRA Category 1 credit after reading this article, take the post-test here.
On Twitter @maryellenny
FROM MORBIDITY AND MORTALITY WEEKLY REPORT
Opioid prescribing varies widely across the country
The amount of opioid painkillers that physicians prescribe appears to have more to do with where they live than the patient’s condition, according to a new analysis from the Centers for Disease Control and Prevention.
Nationwide, physicians and other health care providers prescribed 82.5 opioid pain relievers per 100 persons during 2012. But prescribing rates varied widely. Hawaii had the lowest rate at 52.0 prescriptions per 100 persons; and Alabama had the highest at 142.9 prescriptions per 100 persons, according to the CDC (MMWR Morb. Mortal. Wkly. Rep. 2014;63:1-6).
The CDC analyzed the IMS Health National Prescription Audit database of 2012 prescription data from 57,000 pharmacies nationwide.
Regionally, the Southern states had the highest rates of opioid pain reliever prescribing overall, while states in the Northeast had the highest prescribing rate for high-dose opioids and for long-acting or extended-release formulations.
"What type of pain treatment you get shouldn’t depend on where you live," Dr. Tom Frieden, CDC director, said during a July 1 press conference to announce the findings.
The large variations don’t exist because these states have more people with pain needs, Dr. Frieden said. Rather, the variation is due to a combination of factors, he said, including a lack of clear consensus on evidence about when to use opioids, abuse of the drugs, and the growth of "pill mills" that do large volumes of inappropriate prescribing of opioids.
Dr. Frieden urged state governments to step up their education of physicians.
"If we’re not careful, the treatment can quickly become the problem," Dr. Frieden said.
But there is encouraging news from Florida about reversing overprescribing and related deaths from drug overdose, according to the CDC.
In a separate report, CDC officials showed that various law and enforcement actions were associated with a rapid decrease in drug overdose deaths and opioid prescribing rates, though they couldn’t say for certain that the policy changes were the cause.
During 2003-2009, drug overdose deaths in Florida increased 61% to 2,905, with the largest increase caused by the opioid oxycodone and the benzodiazepine alprazolam. Following policy changes, drug overdoses decreased 16.7% during 2010-2012, from 3,201 to 2,666. Oxycodone overdose deaths dropped 52.1%. The state reported similar decreases in prescribing rates during the same time period.
In response to soaring overdose rates, the Florida legislature required pain clinics using controlled substances to register with the state by January 2010. And in 2011, law enforcement agencies began conducting statewide raids, which resulted in arrests, asset seizures, and the closure of about 250 pain clinics. Also in 2011, the state legislature barred physician dispensing of schedule II or III drugs from their offices and required reporting to a new prescription drug monitoring program.
Dr. Frieden said the Florida experience is significant because it’s the first substantial and sustained decline in opioid prescribing and overdose deaths in a decade. "Change at the state level has the greatest promise," he said.
The analysis was conducted by researchers at the Centers for Disease Control and Prevention, and Emory University, both in Atlanta. The authors reported having no financial disclosures.
On Twitter @maryellenny
The amount of opioid painkillers that physicians prescribe appears to have more to do with where they live than the patient’s condition, according to a new analysis from the Centers for Disease Control and Prevention.
Nationwide, physicians and other health care providers prescribed 82.5 opioid pain relievers per 100 persons during 2012. But prescribing rates varied widely. Hawaii had the lowest rate at 52.0 prescriptions per 100 persons; and Alabama had the highest at 142.9 prescriptions per 100 persons, according to the CDC (MMWR Morb. Mortal. Wkly. Rep. 2014;63:1-6).
The CDC analyzed the IMS Health National Prescription Audit database of 2012 prescription data from 57,000 pharmacies nationwide.
Regionally, the Southern states had the highest rates of opioid pain reliever prescribing overall, while states in the Northeast had the highest prescribing rate for high-dose opioids and for long-acting or extended-release formulations.
"What type of pain treatment you get shouldn’t depend on where you live," Dr. Tom Frieden, CDC director, said during a July 1 press conference to announce the findings.
The large variations don’t exist because these states have more people with pain needs, Dr. Frieden said. Rather, the variation is due to a combination of factors, he said, including a lack of clear consensus on evidence about when to use opioids, abuse of the drugs, and the growth of "pill mills" that do large volumes of inappropriate prescribing of opioids.
Dr. Frieden urged state governments to step up their education of physicians.
"If we’re not careful, the treatment can quickly become the problem," Dr. Frieden said.
But there is encouraging news from Florida about reversing overprescribing and related deaths from drug overdose, according to the CDC.
In a separate report, CDC officials showed that various law and enforcement actions were associated with a rapid decrease in drug overdose deaths and opioid prescribing rates, though they couldn’t say for certain that the policy changes were the cause.
During 2003-2009, drug overdose deaths in Florida increased 61% to 2,905, with the largest increase caused by the opioid oxycodone and the benzodiazepine alprazolam. Following policy changes, drug overdoses decreased 16.7% during 2010-2012, from 3,201 to 2,666. Oxycodone overdose deaths dropped 52.1%. The state reported similar decreases in prescribing rates during the same time period.
In response to soaring overdose rates, the Florida legislature required pain clinics using controlled substances to register with the state by January 2010. And in 2011, law enforcement agencies began conducting statewide raids, which resulted in arrests, asset seizures, and the closure of about 250 pain clinics. Also in 2011, the state legislature barred physician dispensing of schedule II or III drugs from their offices and required reporting to a new prescription drug monitoring program.
Dr. Frieden said the Florida experience is significant because it’s the first substantial and sustained decline in opioid prescribing and overdose deaths in a decade. "Change at the state level has the greatest promise," he said.
The analysis was conducted by researchers at the Centers for Disease Control and Prevention, and Emory University, both in Atlanta. The authors reported having no financial disclosures.
On Twitter @maryellenny
The amount of opioid painkillers that physicians prescribe appears to have more to do with where they live than the patient’s condition, according to a new analysis from the Centers for Disease Control and Prevention.
Nationwide, physicians and other health care providers prescribed 82.5 opioid pain relievers per 100 persons during 2012. But prescribing rates varied widely. Hawaii had the lowest rate at 52.0 prescriptions per 100 persons; and Alabama had the highest at 142.9 prescriptions per 100 persons, according to the CDC (MMWR Morb. Mortal. Wkly. Rep. 2014;63:1-6).
The CDC analyzed the IMS Health National Prescription Audit database of 2012 prescription data from 57,000 pharmacies nationwide.
Regionally, the Southern states had the highest rates of opioid pain reliever prescribing overall, while states in the Northeast had the highest prescribing rate for high-dose opioids and for long-acting or extended-release formulations.
"What type of pain treatment you get shouldn’t depend on where you live," Dr. Tom Frieden, CDC director, said during a July 1 press conference to announce the findings.
The large variations don’t exist because these states have more people with pain needs, Dr. Frieden said. Rather, the variation is due to a combination of factors, he said, including a lack of clear consensus on evidence about when to use opioids, abuse of the drugs, and the growth of "pill mills" that do large volumes of inappropriate prescribing of opioids.
Dr. Frieden urged state governments to step up their education of physicians.
"If we’re not careful, the treatment can quickly become the problem," Dr. Frieden said.
But there is encouraging news from Florida about reversing overprescribing and related deaths from drug overdose, according to the CDC.
In a separate report, CDC officials showed that various law and enforcement actions were associated with a rapid decrease in drug overdose deaths and opioid prescribing rates, though they couldn’t say for certain that the policy changes were the cause.
During 2003-2009, drug overdose deaths in Florida increased 61% to 2,905, with the largest increase caused by the opioid oxycodone and the benzodiazepine alprazolam. Following policy changes, drug overdoses decreased 16.7% during 2010-2012, from 3,201 to 2,666. Oxycodone overdose deaths dropped 52.1%. The state reported similar decreases in prescribing rates during the same time period.
In response to soaring overdose rates, the Florida legislature required pain clinics using controlled substances to register with the state by January 2010. And in 2011, law enforcement agencies began conducting statewide raids, which resulted in arrests, asset seizures, and the closure of about 250 pain clinics. Also in 2011, the state legislature barred physician dispensing of schedule II or III drugs from their offices and required reporting to a new prescription drug monitoring program.
Dr. Frieden said the Florida experience is significant because it’s the first substantial and sustained decline in opioid prescribing and overdose deaths in a decade. "Change at the state level has the greatest promise," he said.
The analysis was conducted by researchers at the Centers for Disease Control and Prevention, and Emory University, both in Atlanta. The authors reported having no financial disclosures.
On Twitter @maryellenny
FROM MORBIDITY AND MORTALITY WEEKLY REPORT
Key clinical point: Increasing physician education, changes in legislation, and enforcement action at the state level may have the greatest promise for decreasing overdose deaths.
Major finding: In 2012, prescribers wrote 82.5 opioid pain reliever prescriptions per 100 persons in the United States. The state rates ranged from a low of 52.0 prescriptions per 100 (Hawaii), to a high of 142.9 per 100 (Alabama).
Data source: IMS Health National Prescription Audit database with 2012 prescription data from 57,000 pharmacies nationwide.
Disclosures: The analysis was conducted by researchers at the Centers for Disease Control and Prevention, and Emory University, both in Atlanta. The authors reported having no financial disclosures.
Q&A: “Code Black” Offers Insider Look at ED Challenges
Interview by Mary Ellen Schneider
“Code Black,” the award-winning documentary about working in the ED at Los Angeles County Hospital, opened in theaters in 40 US cities this summer.
It’s the film debut for emergency physician Ryan McGarry, who both stars in and directs the feature-length documentary. It highlights the thrills and challenges of working in a busy ED through the eyes of senior residents, including Dr McGarry, who completed his training while working on the film. The young doctors start the film as fresh-faced idealists in the “C-Booth” trauma bay at LA County Hospital, the famed birthplace of emergency medicine. Later they move to the county’s newly built hospital, which, though state-of-the-art, lacks some of the camaraderie of the original ED.
“Code Black” was the Best Documentary winner at the Los Angeles Film Festival and the Hamptons International Film Festival. And it was the Audience Award winner at both the Starz Denver Film Festival and the Aspen Filmfest.
Dr McGarry, who is now an attending physician at New York-Presbyterian Hospital in New York City, discussed why he made the film and how it is likely to impact the health care debate.
Question: What inspired you to make this film?
Dr McGarry: As documentaries go, this one was kind of an accident in the sense of its narrative development. I set out to capture what I thought was a phenomenally intense, and in some ways, dated and brutal trauma bay. At this point, most people associate modern health care with a lot of sterility and technology and white and blue spaces that are kind of contained. And this shows the opposite. This looks like battlefield medicine. To my surprise, it was working very well. Of course, at the time I was a young medical student, so my basis for evaluating that matured along with the film. As time went on, we migrated from the old L.A. County Hospital to a newer space. So in the course of filming, they closed down an 80-year-old structure in favor of a brand new, billion-dollar, shining, technology-laden palace. What we found was that as we were brought up to speed on modern health care, and of course regulation, the care became much more complicated.
Question: What do you want the audience to take away from the film?
Dr McGarry: It’s hopefully a primer for health care discussion that has not yet existed. There are plenty of films that ride the political undertones of health care very well and, I think, if anything, they seem to keep people in their camps. They don’t really bring people to the middle. They may make discussion more satisfying for people who are politically charged, but from the provider’s point of view, I’m not sure if they get us anywhere. “Code Black” does not have a call to action, as they call it in the documentary world. That’s on purpose. What we’re hoping for is for people to watch it and be a bit more primed when we talk about health care. My prediction—this could be wrong—is that the real discussion for the next quarter-century, as we improve access with the [Affordable Care Act], is going to be the patient-doctor connection and some deregulation. There are just too many barriers right now. The equation is too complicated. The healing and listening that people want are not happening.
Question: So would you like to see policy makers ease up on some of the health care regulations?
Dr McGarry: We all want safety. But as a scientist would say, these regulations ought to be evidence based. What we know as physicians is that any evidence-based truth is a hard thing to prove, period. I think a lot of these regulations are well intentioned. Nobody doubts that. But yesterday, the Joint Commission visited our hospital. Everybody was working hard on a shift trying to move patients through, trying to provide both quick and safe care, and one of the things that [the regulators] were watching out for was keeping the employee bags and coffee off the computer desks. Meanwhile, I have patients with chest pain, patients with stroke, patients with fractures, who are not getting the attention they need because we’re totally focused on pleasing the federal regulators that our bags and coffee aren’t out.
Question: The film is from the perspective of young doctors and talks a lot about their initial idealism. Do you think the messages in the film will also resonate with older doctors?
Dr McGarry: One of the more surprising aspects of “Code Black” is the nostalgia factor, that fact that both physicians who have been working for a while and those who have become administrators watched this film. We thought it would be offensive to them—especially people from private hospitals, whom we are sort of tough on in the movie. We thought that they would find us a little unrealistic and idealistic. Interestingly, they all watched it and they said, “I long for the day in my residency when all I had to worry about was just getting the science right, getting that patient connection right.”
Question: Working in C-Booth was a great experience for ED physicians in training. Can you ever recapture that feeling in the new, heavily regulated environment?
Dr McGarry: One thing we wouldn’t want to return to would be the lack of privacy. The biggest aspect of C-Booth that probably we wouldn’t be proud of is the lack of privacy. I’m definitely for privacy and for a dignified experience. After that, I feel like things are quite undefined. I think we have expectations that technology, in particular, is a huge answer to medicine. But we know it can be expensive and it can be dangerous. And in the case of electronic medical records, it certainly doesn’t make things faster. We know that every institution that has gone from paper charts to an EMR has found not just an immediate slowing of care, but a permanent slowing. And yet there are benefits with being able to quickly look up old medical information. But what about when my patient is waiting 20 minutes for pain medicine because it takes almost that long to get them in the computer, pull up the order, select the medicine, and go through all these stupid hard stops that are built in? Before, I could just write it down on a piece of paper, communicate it to the nurse, and get it done. If you’re the one in pain, is [the EMR] worth it? I don’t know.
Question: How did you find the time to make this movie?
Dr McGarry: There were a lot of consequences. I probably pushed it from a health perspective. I really found myself in a unique position as both a filmmaker and subject. For almost 3 years, I would do every ounce of my residency and then would race from the hospital to the edit room and would live and breathe it for 3 years. You would imagine there’s a cost to that. Lost a girlfriend. Didn’t sleep. Happily, I came through without any major damage, but that’s a heck of a lot of emergency medicine.
Question: What are you doing next? Are you working on another film and how are you balancing your new project with your day job in medicine?
Dr McGarry: This is a different game than it was in residency. I have an option for a scripted series, so basically it means that producers have identified it as a viable project for a fiction series like you would see on HBO. That’s in active development. We just shot a 3-minute spot with the New York and L.A. ballets, which involves these dancers in the old abandoned general hospital. As far as balancing all this, I’m so lucky in that Cornell/New York-Presbyterian and Dr Neal Flomenbaum have been incredibly supportive of me, allowing me to be full time there but with the work flexibility to jump on these projects as they come.
On Twitter @maryellenny
Interview by Mary Ellen Schneider
“Code Black,” the award-winning documentary about working in the ED at Los Angeles County Hospital, opened in theaters in 40 US cities this summer.
It’s the film debut for emergency physician Ryan McGarry, who both stars in and directs the feature-length documentary. It highlights the thrills and challenges of working in a busy ED through the eyes of senior residents, including Dr McGarry, who completed his training while working on the film. The young doctors start the film as fresh-faced idealists in the “C-Booth” trauma bay at LA County Hospital, the famed birthplace of emergency medicine. Later they move to the county’s newly built hospital, which, though state-of-the-art, lacks some of the camaraderie of the original ED.
“Code Black” was the Best Documentary winner at the Los Angeles Film Festival and the Hamptons International Film Festival. And it was the Audience Award winner at both the Starz Denver Film Festival and the Aspen Filmfest.
Dr McGarry, who is now an attending physician at New York-Presbyterian Hospital in New York City, discussed why he made the film and how it is likely to impact the health care debate.
Question: What inspired you to make this film?
Dr McGarry: As documentaries go, this one was kind of an accident in the sense of its narrative development. I set out to capture what I thought was a phenomenally intense, and in some ways, dated and brutal trauma bay. At this point, most people associate modern health care with a lot of sterility and technology and white and blue spaces that are kind of contained. And this shows the opposite. This looks like battlefield medicine. To my surprise, it was working very well. Of course, at the time I was a young medical student, so my basis for evaluating that matured along with the film. As time went on, we migrated from the old L.A. County Hospital to a newer space. So in the course of filming, they closed down an 80-year-old structure in favor of a brand new, billion-dollar, shining, technology-laden palace. What we found was that as we were brought up to speed on modern health care, and of course regulation, the care became much more complicated.
Question: What do you want the audience to take away from the film?
Dr McGarry: It’s hopefully a primer for health care discussion that has not yet existed. There are plenty of films that ride the political undertones of health care very well and, I think, if anything, they seem to keep people in their camps. They don’t really bring people to the middle. They may make discussion more satisfying for people who are politically charged, but from the provider’s point of view, I’m not sure if they get us anywhere. “Code Black” does not have a call to action, as they call it in the documentary world. That’s on purpose. What we’re hoping for is for people to watch it and be a bit more primed when we talk about health care. My prediction—this could be wrong—is that the real discussion for the next quarter-century, as we improve access with the [Affordable Care Act], is going to be the patient-doctor connection and some deregulation. There are just too many barriers right now. The equation is too complicated. The healing and listening that people want are not happening.
Question: So would you like to see policy makers ease up on some of the health care regulations?
Dr McGarry: We all want safety. But as a scientist would say, these regulations ought to be evidence based. What we know as physicians is that any evidence-based truth is a hard thing to prove, period. I think a lot of these regulations are well intentioned. Nobody doubts that. But yesterday, the Joint Commission visited our hospital. Everybody was working hard on a shift trying to move patients through, trying to provide both quick and safe care, and one of the things that [the regulators] were watching out for was keeping the employee bags and coffee off the computer desks. Meanwhile, I have patients with chest pain, patients with stroke, patients with fractures, who are not getting the attention they need because we’re totally focused on pleasing the federal regulators that our bags and coffee aren’t out.
Question: The film is from the perspective of young doctors and talks a lot about their initial idealism. Do you think the messages in the film will also resonate with older doctors?
Dr McGarry: One of the more surprising aspects of “Code Black” is the nostalgia factor, that fact that both physicians who have been working for a while and those who have become administrators watched this film. We thought it would be offensive to them—especially people from private hospitals, whom we are sort of tough on in the movie. We thought that they would find us a little unrealistic and idealistic. Interestingly, they all watched it and they said, “I long for the day in my residency when all I had to worry about was just getting the science right, getting that patient connection right.”
Question: Working in C-Booth was a great experience for ED physicians in training. Can you ever recapture that feeling in the new, heavily regulated environment?
Dr McGarry: One thing we wouldn’t want to return to would be the lack of privacy. The biggest aspect of C-Booth that probably we wouldn’t be proud of is the lack of privacy. I’m definitely for privacy and for a dignified experience. After that, I feel like things are quite undefined. I think we have expectations that technology, in particular, is a huge answer to medicine. But we know it can be expensive and it can be dangerous. And in the case of electronic medical records, it certainly doesn’t make things faster. We know that every institution that has gone from paper charts to an EMR has found not just an immediate slowing of care, but a permanent slowing. And yet there are benefits with being able to quickly look up old medical information. But what about when my patient is waiting 20 minutes for pain medicine because it takes almost that long to get them in the computer, pull up the order, select the medicine, and go through all these stupid hard stops that are built in? Before, I could just write it down on a piece of paper, communicate it to the nurse, and get it done. If you’re the one in pain, is [the EMR] worth it? I don’t know.
Question: How did you find the time to make this movie?
Dr McGarry: There were a lot of consequences. I probably pushed it from a health perspective. I really found myself in a unique position as both a filmmaker and subject. For almost 3 years, I would do every ounce of my residency and then would race from the hospital to the edit room and would live and breathe it for 3 years. You would imagine there’s a cost to that. Lost a girlfriend. Didn’t sleep. Happily, I came through without any major damage, but that’s a heck of a lot of emergency medicine.
Question: What are you doing next? Are you working on another film and how are you balancing your new project with your day job in medicine?
Dr McGarry: This is a different game than it was in residency. I have an option for a scripted series, so basically it means that producers have identified it as a viable project for a fiction series like you would see on HBO. That’s in active development. We just shot a 3-minute spot with the New York and L.A. ballets, which involves these dancers in the old abandoned general hospital. As far as balancing all this, I’m so lucky in that Cornell/New York-Presbyterian and Dr Neal Flomenbaum have been incredibly supportive of me, allowing me to be full time there but with the work flexibility to jump on these projects as they come.
On Twitter @maryellenny
Interview by Mary Ellen Schneider
“Code Black,” the award-winning documentary about working in the ED at Los Angeles County Hospital, opened in theaters in 40 US cities this summer.
It’s the film debut for emergency physician Ryan McGarry, who both stars in and directs the feature-length documentary. It highlights the thrills and challenges of working in a busy ED through the eyes of senior residents, including Dr McGarry, who completed his training while working on the film. The young doctors start the film as fresh-faced idealists in the “C-Booth” trauma bay at LA County Hospital, the famed birthplace of emergency medicine. Later they move to the county’s newly built hospital, which, though state-of-the-art, lacks some of the camaraderie of the original ED.
“Code Black” was the Best Documentary winner at the Los Angeles Film Festival and the Hamptons International Film Festival. And it was the Audience Award winner at both the Starz Denver Film Festival and the Aspen Filmfest.
Dr McGarry, who is now an attending physician at New York-Presbyterian Hospital in New York City, discussed why he made the film and how it is likely to impact the health care debate.
Question: What inspired you to make this film?
Dr McGarry: As documentaries go, this one was kind of an accident in the sense of its narrative development. I set out to capture what I thought was a phenomenally intense, and in some ways, dated and brutal trauma bay. At this point, most people associate modern health care with a lot of sterility and technology and white and blue spaces that are kind of contained. And this shows the opposite. This looks like battlefield medicine. To my surprise, it was working very well. Of course, at the time I was a young medical student, so my basis for evaluating that matured along with the film. As time went on, we migrated from the old L.A. County Hospital to a newer space. So in the course of filming, they closed down an 80-year-old structure in favor of a brand new, billion-dollar, shining, technology-laden palace. What we found was that as we were brought up to speed on modern health care, and of course regulation, the care became much more complicated.
Question: What do you want the audience to take away from the film?
Dr McGarry: It’s hopefully a primer for health care discussion that has not yet existed. There are plenty of films that ride the political undertones of health care very well and, I think, if anything, they seem to keep people in their camps. They don’t really bring people to the middle. They may make discussion more satisfying for people who are politically charged, but from the provider’s point of view, I’m not sure if they get us anywhere. “Code Black” does not have a call to action, as they call it in the documentary world. That’s on purpose. What we’re hoping for is for people to watch it and be a bit more primed when we talk about health care. My prediction—this could be wrong—is that the real discussion for the next quarter-century, as we improve access with the [Affordable Care Act], is going to be the patient-doctor connection and some deregulation. There are just too many barriers right now. The equation is too complicated. The healing and listening that people want are not happening.
Question: So would you like to see policy makers ease up on some of the health care regulations?
Dr McGarry: We all want safety. But as a scientist would say, these regulations ought to be evidence based. What we know as physicians is that any evidence-based truth is a hard thing to prove, period. I think a lot of these regulations are well intentioned. Nobody doubts that. But yesterday, the Joint Commission visited our hospital. Everybody was working hard on a shift trying to move patients through, trying to provide both quick and safe care, and one of the things that [the regulators] were watching out for was keeping the employee bags and coffee off the computer desks. Meanwhile, I have patients with chest pain, patients with stroke, patients with fractures, who are not getting the attention they need because we’re totally focused on pleasing the federal regulators that our bags and coffee aren’t out.
Question: The film is from the perspective of young doctors and talks a lot about their initial idealism. Do you think the messages in the film will also resonate with older doctors?
Dr McGarry: One of the more surprising aspects of “Code Black” is the nostalgia factor, that fact that both physicians who have been working for a while and those who have become administrators watched this film. We thought it would be offensive to them—especially people from private hospitals, whom we are sort of tough on in the movie. We thought that they would find us a little unrealistic and idealistic. Interestingly, they all watched it and they said, “I long for the day in my residency when all I had to worry about was just getting the science right, getting that patient connection right.”
Question: Working in C-Booth was a great experience for ED physicians in training. Can you ever recapture that feeling in the new, heavily regulated environment?
Dr McGarry: One thing we wouldn’t want to return to would be the lack of privacy. The biggest aspect of C-Booth that probably we wouldn’t be proud of is the lack of privacy. I’m definitely for privacy and for a dignified experience. After that, I feel like things are quite undefined. I think we have expectations that technology, in particular, is a huge answer to medicine. But we know it can be expensive and it can be dangerous. And in the case of electronic medical records, it certainly doesn’t make things faster. We know that every institution that has gone from paper charts to an EMR has found not just an immediate slowing of care, but a permanent slowing. And yet there are benefits with being able to quickly look up old medical information. But what about when my patient is waiting 20 minutes for pain medicine because it takes almost that long to get them in the computer, pull up the order, select the medicine, and go through all these stupid hard stops that are built in? Before, I could just write it down on a piece of paper, communicate it to the nurse, and get it done. If you’re the one in pain, is [the EMR] worth it? I don’t know.
Question: How did you find the time to make this movie?
Dr McGarry: There were a lot of consequences. I probably pushed it from a health perspective. I really found myself in a unique position as both a filmmaker and subject. For almost 3 years, I would do every ounce of my residency and then would race from the hospital to the edit room and would live and breathe it for 3 years. You would imagine there’s a cost to that. Lost a girlfriend. Didn’t sleep. Happily, I came through without any major damage, but that’s a heck of a lot of emergency medicine.
Question: What are you doing next? Are you working on another film and how are you balancing your new project with your day job in medicine?
Dr McGarry: This is a different game than it was in residency. I have an option for a scripted series, so basically it means that producers have identified it as a viable project for a fiction series like you would see on HBO. That’s in active development. We just shot a 3-minute spot with the New York and L.A. ballets, which involves these dancers in the old abandoned general hospital. As far as balancing all this, I’m so lucky in that Cornell/New York-Presbyterian and Dr Neal Flomenbaum have been incredibly supportive of me, allowing me to be full time there but with the work flexibility to jump on these projects as they come.
On Twitter @maryellenny
HHS proposes auto-enrollment for 2015 ACA plans
Federal health officials propose to automatically reenroll consumers in Affordable Care Act health plans for 2015 if they purchased coverage through the federally run marketplace earlier this year.
The auto-enrollment feature is part of an effort by the Health & Human Services department to make the ACA’s second open enrollment period run more smoothly than the first.
The auto-enrollment feature puts the federal marketplace in line with the Federal Employee Health Benefits Program (FEHBP) and many employer-sponsored plans. Close to 90% of federal employees who use the FEHBP system don’t switch plans each year, but instead auto-enroll in their current plan with updated premiums and benefits, according to HHS.
Under the proposed rule, released on June 26, the agency will automatically reenroll consumers in the same plan they had in 2014. If that plan is unavailable, the marketplace will select a similar plan.
During the open enrollment period this fall, consumers who are happy with the selected plan won’t have to make new selections. But they have the option to select a different plan.
The proposed rule notes, however, that even if consumers are auto-enrolled, they may need to provide updated income information to continue to receive a tax credit to subsidize their insurance premiums.
State-run marketplaces can follow the federal government’s lead or propose an alternative, according to HHS.
On Twitter @maryellenny
Federal health officials propose to automatically reenroll consumers in Affordable Care Act health plans for 2015 if they purchased coverage through the federally run marketplace earlier this year.
The auto-enrollment feature is part of an effort by the Health & Human Services department to make the ACA’s second open enrollment period run more smoothly than the first.
The auto-enrollment feature puts the federal marketplace in line with the Federal Employee Health Benefits Program (FEHBP) and many employer-sponsored plans. Close to 90% of federal employees who use the FEHBP system don’t switch plans each year, but instead auto-enroll in their current plan with updated premiums and benefits, according to HHS.
Under the proposed rule, released on June 26, the agency will automatically reenroll consumers in the same plan they had in 2014. If that plan is unavailable, the marketplace will select a similar plan.
During the open enrollment period this fall, consumers who are happy with the selected plan won’t have to make new selections. But they have the option to select a different plan.
The proposed rule notes, however, that even if consumers are auto-enrolled, they may need to provide updated income information to continue to receive a tax credit to subsidize their insurance premiums.
State-run marketplaces can follow the federal government’s lead or propose an alternative, according to HHS.
On Twitter @maryellenny
Federal health officials propose to automatically reenroll consumers in Affordable Care Act health plans for 2015 if they purchased coverage through the federally run marketplace earlier this year.
The auto-enrollment feature is part of an effort by the Health & Human Services department to make the ACA’s second open enrollment period run more smoothly than the first.
The auto-enrollment feature puts the federal marketplace in line with the Federal Employee Health Benefits Program (FEHBP) and many employer-sponsored plans. Close to 90% of federal employees who use the FEHBP system don’t switch plans each year, but instead auto-enroll in their current plan with updated premiums and benefits, according to HHS.
Under the proposed rule, released on June 26, the agency will automatically reenroll consumers in the same plan they had in 2014. If that plan is unavailable, the marketplace will select a similar plan.
During the open enrollment period this fall, consumers who are happy with the selected plan won’t have to make new selections. But they have the option to select a different plan.
The proposed rule notes, however, that even if consumers are auto-enrolled, they may need to provide updated income information to continue to receive a tax credit to subsidize their insurance premiums.
State-run marketplaces can follow the federal government’s lead or propose an alternative, according to HHS.
On Twitter @maryellenny
July 1 deadline: Observation status coding could yield meaningful use penalty
July 1 is the deadline for hospitalists and other physicians to seek hardship exemptions from the federal government’s meaningful use electronic health record incentive program.
Many hospitalists don’t have to worry about attesting to meaningful use because they are considered "hospital-based" professionals who bill mainly for inpatient services. But frequent use of observation status, which is billed as an outpatient service, could shift hospitalists out of that exempt category and make them subject to meaningful use requirements and penalties.
Under the meaningful use rules, if 90% or more of the services billed by an individual hospitalist are for inpatient services, they are automatically exempt from meaningful use. But the Society of Hospital Medicine is urging hospitalists to check their status because billing for observation status, billing at a skilled nursing facility, and other outpatient hospital billing could tip them over the threshold.
Hospitalists can check their status with the Centers for Medicare & Medicaid Services by going through the Medicare EHR Incentive Programs Registration System or calling the agency’s EHR Information Center Help Desk at 1-888-734-6433.
To avoid the 1% payment penalty in 2015, hospitalists who provide 10% or more outpatient services can seek a hardship exemption from the CMS. The hardship is based on the fact that hospitalists lack control over the availability of certified electronic health record technology for more than half of their patient encounters.
Hospitalists who want to avoid a penalty in 2015, must file a hardship exemption application by July 1, 2014. The online application and supporting documentation can be e-mailed to [email protected] or faxed to 814-464-0147. The CMS makes hardship decisions on a case-by-case basis. If granted, the exemption must be renewed each year.
On Twitter @maryellenny
July 1 is the deadline for hospitalists and other physicians to seek hardship exemptions from the federal government’s meaningful use electronic health record incentive program.
Many hospitalists don’t have to worry about attesting to meaningful use because they are considered "hospital-based" professionals who bill mainly for inpatient services. But frequent use of observation status, which is billed as an outpatient service, could shift hospitalists out of that exempt category and make them subject to meaningful use requirements and penalties.
Under the meaningful use rules, if 90% or more of the services billed by an individual hospitalist are for inpatient services, they are automatically exempt from meaningful use. But the Society of Hospital Medicine is urging hospitalists to check their status because billing for observation status, billing at a skilled nursing facility, and other outpatient hospital billing could tip them over the threshold.
Hospitalists can check their status with the Centers for Medicare & Medicaid Services by going through the Medicare EHR Incentive Programs Registration System or calling the agency’s EHR Information Center Help Desk at 1-888-734-6433.
To avoid the 1% payment penalty in 2015, hospitalists who provide 10% or more outpatient services can seek a hardship exemption from the CMS. The hardship is based on the fact that hospitalists lack control over the availability of certified electronic health record technology for more than half of their patient encounters.
Hospitalists who want to avoid a penalty in 2015, must file a hardship exemption application by July 1, 2014. The online application and supporting documentation can be e-mailed to [email protected] or faxed to 814-464-0147. The CMS makes hardship decisions on a case-by-case basis. If granted, the exemption must be renewed each year.
On Twitter @maryellenny
July 1 is the deadline for hospitalists and other physicians to seek hardship exemptions from the federal government’s meaningful use electronic health record incentive program.
Many hospitalists don’t have to worry about attesting to meaningful use because they are considered "hospital-based" professionals who bill mainly for inpatient services. But frequent use of observation status, which is billed as an outpatient service, could shift hospitalists out of that exempt category and make them subject to meaningful use requirements and penalties.
Under the meaningful use rules, if 90% or more of the services billed by an individual hospitalist are for inpatient services, they are automatically exempt from meaningful use. But the Society of Hospital Medicine is urging hospitalists to check their status because billing for observation status, billing at a skilled nursing facility, and other outpatient hospital billing could tip them over the threshold.
Hospitalists can check their status with the Centers for Medicare & Medicaid Services by going through the Medicare EHR Incentive Programs Registration System or calling the agency’s EHR Information Center Help Desk at 1-888-734-6433.
To avoid the 1% payment penalty in 2015, hospitalists who provide 10% or more outpatient services can seek a hardship exemption from the CMS. The hardship is based on the fact that hospitalists lack control over the availability of certified electronic health record technology for more than half of their patient encounters.
Hospitalists who want to avoid a penalty in 2015, must file a hardship exemption application by July 1, 2014. The online application and supporting documentation can be e-mailed to [email protected] or faxed to 814-464-0147. The CMS makes hardship decisions on a case-by-case basis. If granted, the exemption must be renewed each year.
On Twitter @maryellenny
'Code Black' offers insider look at ED challenges
"Code Black," the award-winning documentary about working in the emergency department at Los Angeles County Hospital, opens in theaters in 40 U.S. cities this summer.
It’s the film debut for young emergency physician Ryan McGarry, who both stars in and directs the feature-length documentary. It highlights the thrills and challenges of working in a busy emergency department through the eyes of senior residents, including Dr. McGarry, who completed his training while working on the film. The young doctors start the film as fresh-faced idealists in the "C-Booth" trauma bay at L.A. County Hospital, the famed birthplace of emergency medicine. Later they move to the county’s newly built hospital, which, though state-of-the-art, lacks some of the camaraderie of the original ED.
"Code Black" was the Best Documentary winner at the Los Angeles Film Festival and the Hamptons International Film Festival. And it was the Audience Award winner at both the Starz Denver Film Festival and the Aspen Filmfest.
Dr. McGarry, who is now an attending physician at New York-Presbyterian Hospital in New York City, discussed why he made the film and how it is likely to impact the health care debate.
Question: What inspired you to make this film?
Dr. McGarry: As documentaries go, this one was kind of an accident in the sense of its narrative development. I set out to capture what I thought was a phenomenally intense, and in some ways, dated and brutal trauma bay. At this point, most people associate modern health care with a lot of sterility and technology and white and blue spaces that are kind of contained. And this shows the opposite. This looks like battlefield medicine. To my surprise, it was working very well. Of course, at the time I was a young medical student, so my basis for evaluating that matured along with the film. As time went on, we migrated from the old L.A. County Hospital to a newer space. So in the course of filming, they closed down an 80-year-old structure in favor of a brand new, billion-dollar, shining, technology-laden palace. What we found was that as we were brought up to speed on modern health care, and of course regulation, the care became much more complicated.
Question: What do you want the audience to take away from the film?
Dr. McGarry: It’s hopefully a primer for health care discussion that has not yet existed. There are plenty of films that ride the political undertones of health care very well and, I think, if anything, they seem to keep people in their camps. They don’t really bring people to the middle. They may make discussion more satisfying for people who are politically charged, but from the provider’s point of view, I’m not sure if they get us anywhere. "Code Black" does not have a call to action, as they call it in the documentary world. That’s on purpose. What we’re hoping for is for people to watch it and be a bit more primed when we talk about health care. My prediction – this could be wrong – is that the real discussion for the next quarter-century, as we improve access with the [Affordable Care Act], is going to be the patient-doctor connection and some deregulation. There are just too many barriers right now. The equation is too complicated. The healing and listening that people want are not happening.
Question: So would you like to see policy makers ease up on some of the health care regulations?
Dr. McGarry: We all want safety. But as a scientist would say, these regulations ought to be evidence based. What we know as physicians is that any evidence-based truth is a hard thing to prove, period. I think a lot of these regulations are well intentioned. Nobody doubts that. But yesterday, the Joint Commission visited our hospital. Everybody was working hard on a shift trying to move patients through, trying to provide both quick and safe care, and one of the things that they were watching out for was keeping the employee bags and coffee off the computer desks. Meanwhile, I have patients with chest pain, patients with stroke, patients with fractures, who are not getting the attention they need because we’re totally focused on pleasing the federal regulators that our bags and coffee aren’t out.
Question: The film is from the perspective of young doctors and talks a lot about their initial idealism. Do you think the messages in the film will also resonate with older doctors?
Dr. McGarry: One of the more surprising aspects of "Code Black" is the nostalgia factor, that fact that both physicians that have been working for awhile and those that have become administrators watched this film. We thought it would be offensive to them, especially people from private hospitals, whom we are sort of tough on in the movie. We thought that they would find us a little unrealistic and idealistic. Interestingly, they all watched it and they said, "I long for the day in my residency when all I had to worry about was just getting the science right, getting that patient connection right."
Question: Working in C-Booth was a great experience for ED physicians in training. Can you ever recapture that feeling in the new, heavily regulated environment?
Dr. McGarry: One thing we wouldn’t want to return to would be the lack of privacy. The biggest aspect of C-Booth that probably we wouldn’t be proud of would be the lack of privacy. I’m definitely for privacy and for a dignified experience. After that, I feel like things are quite undefined. I think we have expectations that technology, in particular, is a huge answer to medicine. But we know it can be expensive and it can be dangerous. And in the case of electronic medical records, it certainly doesn’t make things faster. We know that every institution that has gone from paper charts to an EMR has found not just an immediate slowing of care, but a permanent slowing. And yet there are benefits with being able to quickly look up old medical information. But what about when my patient is waiting 20 minutes for pain medicine because it takes almost that long to get them in the computer, pull up the order, select the medicine, and go through all these stupid hard stops that are built in. Before, I could just write it down on a piece of paper, communicate it to the nurse, and get it done. If you’re the one in pain, is that worth it? I don’t know.
Question: How did you find the time to make this movie?
Dr. McGarry: There were a lot of consequences there. I probably pushed it from a health perspective. I really found myself in a unique position as both a filmmaker and subject. For almost 3 years, I would do every ounce of my residency and then would race from the hospital to the edit room and would live and breathe it for 3 years. You would imagine there’s a cost to that. Lost a girlfriend. Didn’t sleep. Happily, I came through without any major damage, but that’s a heck of a lot of emergency medicine.
Question: What are you doing next? Are you working on another film and how are balancing that with your day job in medicine?
Dr. McGarry: This is a different game than it was in residency. I have an option for a scripted series, so basically it means that producers have identified it as a viable project for a fiction series like you would see on HBO. That’s in active development. We just shot a 3-minute spot with the New York and L.A. ballets, which involves these dancers in the old abandoned general hospital. As far as balancing all this, I’m so lucky in that. Cornell/New York Presbyterian and Dr. Neal Flomenbaum have been incredibly supportive of me and allowing me to be full time there, but with the work flexibility to jump on these projects as they come.
On Twitter @maryellenny
"Code Black," the award-winning documentary about working in the emergency department at Los Angeles County Hospital, opens in theaters in 40 U.S. cities this summer.
It’s the film debut for young emergency physician Ryan McGarry, who both stars in and directs the feature-length documentary. It highlights the thrills and challenges of working in a busy emergency department through the eyes of senior residents, including Dr. McGarry, who completed his training while working on the film. The young doctors start the film as fresh-faced idealists in the "C-Booth" trauma bay at L.A. County Hospital, the famed birthplace of emergency medicine. Later they move to the county’s newly built hospital, which, though state-of-the-art, lacks some of the camaraderie of the original ED.
"Code Black" was the Best Documentary winner at the Los Angeles Film Festival and the Hamptons International Film Festival. And it was the Audience Award winner at both the Starz Denver Film Festival and the Aspen Filmfest.
Dr. McGarry, who is now an attending physician at New York-Presbyterian Hospital in New York City, discussed why he made the film and how it is likely to impact the health care debate.
Question: What inspired you to make this film?
Dr. McGarry: As documentaries go, this one was kind of an accident in the sense of its narrative development. I set out to capture what I thought was a phenomenally intense, and in some ways, dated and brutal trauma bay. At this point, most people associate modern health care with a lot of sterility and technology and white and blue spaces that are kind of contained. And this shows the opposite. This looks like battlefield medicine. To my surprise, it was working very well. Of course, at the time I was a young medical student, so my basis for evaluating that matured along with the film. As time went on, we migrated from the old L.A. County Hospital to a newer space. So in the course of filming, they closed down an 80-year-old structure in favor of a brand new, billion-dollar, shining, technology-laden palace. What we found was that as we were brought up to speed on modern health care, and of course regulation, the care became much more complicated.
Question: What do you want the audience to take away from the film?
Dr. McGarry: It’s hopefully a primer for health care discussion that has not yet existed. There are plenty of films that ride the political undertones of health care very well and, I think, if anything, they seem to keep people in their camps. They don’t really bring people to the middle. They may make discussion more satisfying for people who are politically charged, but from the provider’s point of view, I’m not sure if they get us anywhere. "Code Black" does not have a call to action, as they call it in the documentary world. That’s on purpose. What we’re hoping for is for people to watch it and be a bit more primed when we talk about health care. My prediction – this could be wrong – is that the real discussion for the next quarter-century, as we improve access with the [Affordable Care Act], is going to be the patient-doctor connection and some deregulation. There are just too many barriers right now. The equation is too complicated. The healing and listening that people want are not happening.
Question: So would you like to see policy makers ease up on some of the health care regulations?
Dr. McGarry: We all want safety. But as a scientist would say, these regulations ought to be evidence based. What we know as physicians is that any evidence-based truth is a hard thing to prove, period. I think a lot of these regulations are well intentioned. Nobody doubts that. But yesterday, the Joint Commission visited our hospital. Everybody was working hard on a shift trying to move patients through, trying to provide both quick and safe care, and one of the things that they were watching out for was keeping the employee bags and coffee off the computer desks. Meanwhile, I have patients with chest pain, patients with stroke, patients with fractures, who are not getting the attention they need because we’re totally focused on pleasing the federal regulators that our bags and coffee aren’t out.
Question: The film is from the perspective of young doctors and talks a lot about their initial idealism. Do you think the messages in the film will also resonate with older doctors?
Dr. McGarry: One of the more surprising aspects of "Code Black" is the nostalgia factor, that fact that both physicians that have been working for awhile and those that have become administrators watched this film. We thought it would be offensive to them, especially people from private hospitals, whom we are sort of tough on in the movie. We thought that they would find us a little unrealistic and idealistic. Interestingly, they all watched it and they said, "I long for the day in my residency when all I had to worry about was just getting the science right, getting that patient connection right."
Question: Working in C-Booth was a great experience for ED physicians in training. Can you ever recapture that feeling in the new, heavily regulated environment?
Dr. McGarry: One thing we wouldn’t want to return to would be the lack of privacy. The biggest aspect of C-Booth that probably we wouldn’t be proud of would be the lack of privacy. I’m definitely for privacy and for a dignified experience. After that, I feel like things are quite undefined. I think we have expectations that technology, in particular, is a huge answer to medicine. But we know it can be expensive and it can be dangerous. And in the case of electronic medical records, it certainly doesn’t make things faster. We know that every institution that has gone from paper charts to an EMR has found not just an immediate slowing of care, but a permanent slowing. And yet there are benefits with being able to quickly look up old medical information. But what about when my patient is waiting 20 minutes for pain medicine because it takes almost that long to get them in the computer, pull up the order, select the medicine, and go through all these stupid hard stops that are built in. Before, I could just write it down on a piece of paper, communicate it to the nurse, and get it done. If you’re the one in pain, is that worth it? I don’t know.
Question: How did you find the time to make this movie?
Dr. McGarry: There were a lot of consequences there. I probably pushed it from a health perspective. I really found myself in a unique position as both a filmmaker and subject. For almost 3 years, I would do every ounce of my residency and then would race from the hospital to the edit room and would live and breathe it for 3 years. You would imagine there’s a cost to that. Lost a girlfriend. Didn’t sleep. Happily, I came through without any major damage, but that’s a heck of a lot of emergency medicine.
Question: What are you doing next? Are you working on another film and how are balancing that with your day job in medicine?
Dr. McGarry: This is a different game than it was in residency. I have an option for a scripted series, so basically it means that producers have identified it as a viable project for a fiction series like you would see on HBO. That’s in active development. We just shot a 3-minute spot with the New York and L.A. ballets, which involves these dancers in the old abandoned general hospital. As far as balancing all this, I’m so lucky in that. Cornell/New York Presbyterian and Dr. Neal Flomenbaum have been incredibly supportive of me and allowing me to be full time there, but with the work flexibility to jump on these projects as they come.
On Twitter @maryellenny
"Code Black," the award-winning documentary about working in the emergency department at Los Angeles County Hospital, opens in theaters in 40 U.S. cities this summer.
It’s the film debut for young emergency physician Ryan McGarry, who both stars in and directs the feature-length documentary. It highlights the thrills and challenges of working in a busy emergency department through the eyes of senior residents, including Dr. McGarry, who completed his training while working on the film. The young doctors start the film as fresh-faced idealists in the "C-Booth" trauma bay at L.A. County Hospital, the famed birthplace of emergency medicine. Later they move to the county’s newly built hospital, which, though state-of-the-art, lacks some of the camaraderie of the original ED.
"Code Black" was the Best Documentary winner at the Los Angeles Film Festival and the Hamptons International Film Festival. And it was the Audience Award winner at both the Starz Denver Film Festival and the Aspen Filmfest.
Dr. McGarry, who is now an attending physician at New York-Presbyterian Hospital in New York City, discussed why he made the film and how it is likely to impact the health care debate.
Question: What inspired you to make this film?
Dr. McGarry: As documentaries go, this one was kind of an accident in the sense of its narrative development. I set out to capture what I thought was a phenomenally intense, and in some ways, dated and brutal trauma bay. At this point, most people associate modern health care with a lot of sterility and technology and white and blue spaces that are kind of contained. And this shows the opposite. This looks like battlefield medicine. To my surprise, it was working very well. Of course, at the time I was a young medical student, so my basis for evaluating that matured along with the film. As time went on, we migrated from the old L.A. County Hospital to a newer space. So in the course of filming, they closed down an 80-year-old structure in favor of a brand new, billion-dollar, shining, technology-laden palace. What we found was that as we were brought up to speed on modern health care, and of course regulation, the care became much more complicated.
Question: What do you want the audience to take away from the film?
Dr. McGarry: It’s hopefully a primer for health care discussion that has not yet existed. There are plenty of films that ride the political undertones of health care very well and, I think, if anything, they seem to keep people in their camps. They don’t really bring people to the middle. They may make discussion more satisfying for people who are politically charged, but from the provider’s point of view, I’m not sure if they get us anywhere. "Code Black" does not have a call to action, as they call it in the documentary world. That’s on purpose. What we’re hoping for is for people to watch it and be a bit more primed when we talk about health care. My prediction – this could be wrong – is that the real discussion for the next quarter-century, as we improve access with the [Affordable Care Act], is going to be the patient-doctor connection and some deregulation. There are just too many barriers right now. The equation is too complicated. The healing and listening that people want are not happening.
Question: So would you like to see policy makers ease up on some of the health care regulations?
Dr. McGarry: We all want safety. But as a scientist would say, these regulations ought to be evidence based. What we know as physicians is that any evidence-based truth is a hard thing to prove, period. I think a lot of these regulations are well intentioned. Nobody doubts that. But yesterday, the Joint Commission visited our hospital. Everybody was working hard on a shift trying to move patients through, trying to provide both quick and safe care, and one of the things that they were watching out for was keeping the employee bags and coffee off the computer desks. Meanwhile, I have patients with chest pain, patients with stroke, patients with fractures, who are not getting the attention they need because we’re totally focused on pleasing the federal regulators that our bags and coffee aren’t out.
Question: The film is from the perspective of young doctors and talks a lot about their initial idealism. Do you think the messages in the film will also resonate with older doctors?
Dr. McGarry: One of the more surprising aspects of "Code Black" is the nostalgia factor, that fact that both physicians that have been working for awhile and those that have become administrators watched this film. We thought it would be offensive to them, especially people from private hospitals, whom we are sort of tough on in the movie. We thought that they would find us a little unrealistic and idealistic. Interestingly, they all watched it and they said, "I long for the day in my residency when all I had to worry about was just getting the science right, getting that patient connection right."
Question: Working in C-Booth was a great experience for ED physicians in training. Can you ever recapture that feeling in the new, heavily regulated environment?
Dr. McGarry: One thing we wouldn’t want to return to would be the lack of privacy. The biggest aspect of C-Booth that probably we wouldn’t be proud of would be the lack of privacy. I’m definitely for privacy and for a dignified experience. After that, I feel like things are quite undefined. I think we have expectations that technology, in particular, is a huge answer to medicine. But we know it can be expensive and it can be dangerous. And in the case of electronic medical records, it certainly doesn’t make things faster. We know that every institution that has gone from paper charts to an EMR has found not just an immediate slowing of care, but a permanent slowing. And yet there are benefits with being able to quickly look up old medical information. But what about when my patient is waiting 20 minutes for pain medicine because it takes almost that long to get them in the computer, pull up the order, select the medicine, and go through all these stupid hard stops that are built in. Before, I could just write it down on a piece of paper, communicate it to the nurse, and get it done. If you’re the one in pain, is that worth it? I don’t know.
Question: How did you find the time to make this movie?
Dr. McGarry: There were a lot of consequences there. I probably pushed it from a health perspective. I really found myself in a unique position as both a filmmaker and subject. For almost 3 years, I would do every ounce of my residency and then would race from the hospital to the edit room and would live and breathe it for 3 years. You would imagine there’s a cost to that. Lost a girlfriend. Didn’t sleep. Happily, I came through without any major damage, but that’s a heck of a lot of emergency medicine.
Question: What are you doing next? Are you working on another film and how are balancing that with your day job in medicine?
Dr. McGarry: This is a different game than it was in residency. I have an option for a scripted series, so basically it means that producers have identified it as a viable project for a fiction series like you would see on HBO. That’s in active development. We just shot a 3-minute spot with the New York and L.A. ballets, which involves these dancers in the old abandoned general hospital. As far as balancing all this, I’m so lucky in that. Cornell/New York Presbyterian and Dr. Neal Flomenbaum have been incredibly supportive of me and allowing me to be full time there, but with the work flexibility to jump on these projects as they come.
On Twitter @maryellenny
Specialists join the medical neighborhood
The patient-centered medical home model has caused big changes in primary care practices and given physicians the opportunity to earn a bit more money for care coordination. Now the same forces are at work on the specialty side of medicine.
One year after the National Committee for Quality Assurance (NCQA) launched its "Patient-Centered Specialty Practice Recognition" program, 23 practices and 287 clinicians have achieved the 3-year recognition.
"Coordination is a two-way street," Margaret O’Kane, NCQA president, said during a webinar to highlight lessons learned during the first year of the program. "You can’t just do this on the primary care side."
Dr. Andrew Chapman, director of regional cancer care at Jefferson Medical Oncology Associates in Philadelphia, said receiving NCQA recognition through the new specialty-focused program was the first step toward achieving a "shared model of care" with the primary care physicians in his community.
In the past, the model in oncology was that once a cancer diagnosis was made, all of the care would be assumed by the oncologist. But that model is no longer viable, Dr. Chapman said, and integrating specialists into the medical home can improve quality and safety.
"What we do now has become so complex that taking care of many of the issues that an internist or a family medicine physician is really expert at, is really out of our realm," he said.
The NCQA recognition program is based on the concept of the medical home "neighbor" that was developed by the American College of Physicians and follows the same model as the NCQA’s patient-centered medical home recognition program for primary care physicians.
To qualify, practices must meet several standards for care coordination and information sharing, including tracking and coordinating referrals, providing extended hours and electronic access to the practice, tracking patients as they visit the hospital and emergency department, and providing previsit planning and medication management.
Specialty practices must also measure their efforts on clinical quality, utilization, care coordination, and patient satisfaction.
The model is a good fit for obstetrics and gynecology practices, according to Kristin Bell, the practice manager for Women’s Healthcare Associates in Portland, Ore.
In pursuing NCQA recognition, the practice made a number of changes aimed at improving coordination. To start, they trained a staff member as a referral navigator and tasked her with streamlining the process of gathering records, scheduling patient appointments, and ensuring that records were returned to the referring physician.
"Rather than have the whole team in the front office attempt to manage little pieces of that process, we made one person ... primarily responsible for that full process," Ms. Bell said.
They also began integrating behavioral health services into the practice, bringing a licensed clinical social worker on site. Patients are more likely to keep their appointments with the social worker now that they can do it at the ob.gyn.’s office, Ms. Bell said, and it gives patients more support in making lifestyle changes to support their health.
"It really has helped to remove barriers for patients," she said.
While physicians are embracing the medical neighborhood model, payers are moving more slowly.
Patricia Barrett, NCQA’s vice president for product development, said a few payers have indicated they that would offer bonus payments to specialty practices that achieve the NCQA recognition. But there’s not the same level of enthusiasm for paying specialists more as there was in rewarding primary care practices that become medical homes, she said.
The financial incentives for specialty practices are more likely to come through opportunities to participate in accountable care organizations or shared savings models, said Dr. Debra Karnasiewicz, director of quality and health information for Medical Associates of the Hudson Valley, a small, multispecialty practice in Kingston, N.Y. Her practice has been working with other small practices in their area, as well as payers, to develop a shared savings model similar to what is underway through the Centers for Medicare & Medicaid Services.
On Twitter @maryellenny
The patient-centered medical home model has caused big changes in primary care practices and given physicians the opportunity to earn a bit more money for care coordination. Now the same forces are at work on the specialty side of medicine.
One year after the National Committee for Quality Assurance (NCQA) launched its "Patient-Centered Specialty Practice Recognition" program, 23 practices and 287 clinicians have achieved the 3-year recognition.
"Coordination is a two-way street," Margaret O’Kane, NCQA president, said during a webinar to highlight lessons learned during the first year of the program. "You can’t just do this on the primary care side."
Dr. Andrew Chapman, director of regional cancer care at Jefferson Medical Oncology Associates in Philadelphia, said receiving NCQA recognition through the new specialty-focused program was the first step toward achieving a "shared model of care" with the primary care physicians in his community.
In the past, the model in oncology was that once a cancer diagnosis was made, all of the care would be assumed by the oncologist. But that model is no longer viable, Dr. Chapman said, and integrating specialists into the medical home can improve quality and safety.
"What we do now has become so complex that taking care of many of the issues that an internist or a family medicine physician is really expert at, is really out of our realm," he said.
The NCQA recognition program is based on the concept of the medical home "neighbor" that was developed by the American College of Physicians and follows the same model as the NCQA’s patient-centered medical home recognition program for primary care physicians.
To qualify, practices must meet several standards for care coordination and information sharing, including tracking and coordinating referrals, providing extended hours and electronic access to the practice, tracking patients as they visit the hospital and emergency department, and providing previsit planning and medication management.
Specialty practices must also measure their efforts on clinical quality, utilization, care coordination, and patient satisfaction.
The model is a good fit for obstetrics and gynecology practices, according to Kristin Bell, the practice manager for Women’s Healthcare Associates in Portland, Ore.
In pursuing NCQA recognition, the practice made a number of changes aimed at improving coordination. To start, they trained a staff member as a referral navigator and tasked her with streamlining the process of gathering records, scheduling patient appointments, and ensuring that records were returned to the referring physician.
"Rather than have the whole team in the front office attempt to manage little pieces of that process, we made one person ... primarily responsible for that full process," Ms. Bell said.
They also began integrating behavioral health services into the practice, bringing a licensed clinical social worker on site. Patients are more likely to keep their appointments with the social worker now that they can do it at the ob.gyn.’s office, Ms. Bell said, and it gives patients more support in making lifestyle changes to support their health.
"It really has helped to remove barriers for patients," she said.
While physicians are embracing the medical neighborhood model, payers are moving more slowly.
Patricia Barrett, NCQA’s vice president for product development, said a few payers have indicated they that would offer bonus payments to specialty practices that achieve the NCQA recognition. But there’s not the same level of enthusiasm for paying specialists more as there was in rewarding primary care practices that become medical homes, she said.
The financial incentives for specialty practices are more likely to come through opportunities to participate in accountable care organizations or shared savings models, said Dr. Debra Karnasiewicz, director of quality and health information for Medical Associates of the Hudson Valley, a small, multispecialty practice in Kingston, N.Y. Her practice has been working with other small practices in their area, as well as payers, to develop a shared savings model similar to what is underway through the Centers for Medicare & Medicaid Services.
On Twitter @maryellenny
The patient-centered medical home model has caused big changes in primary care practices and given physicians the opportunity to earn a bit more money for care coordination. Now the same forces are at work on the specialty side of medicine.
One year after the National Committee for Quality Assurance (NCQA) launched its "Patient-Centered Specialty Practice Recognition" program, 23 practices and 287 clinicians have achieved the 3-year recognition.
"Coordination is a two-way street," Margaret O’Kane, NCQA president, said during a webinar to highlight lessons learned during the first year of the program. "You can’t just do this on the primary care side."
Dr. Andrew Chapman, director of regional cancer care at Jefferson Medical Oncology Associates in Philadelphia, said receiving NCQA recognition through the new specialty-focused program was the first step toward achieving a "shared model of care" with the primary care physicians in his community.
In the past, the model in oncology was that once a cancer diagnosis was made, all of the care would be assumed by the oncologist. But that model is no longer viable, Dr. Chapman said, and integrating specialists into the medical home can improve quality and safety.
"What we do now has become so complex that taking care of many of the issues that an internist or a family medicine physician is really expert at, is really out of our realm," he said.
The NCQA recognition program is based on the concept of the medical home "neighbor" that was developed by the American College of Physicians and follows the same model as the NCQA’s patient-centered medical home recognition program for primary care physicians.
To qualify, practices must meet several standards for care coordination and information sharing, including tracking and coordinating referrals, providing extended hours and electronic access to the practice, tracking patients as they visit the hospital and emergency department, and providing previsit planning and medication management.
Specialty practices must also measure their efforts on clinical quality, utilization, care coordination, and patient satisfaction.
The model is a good fit for obstetrics and gynecology practices, according to Kristin Bell, the practice manager for Women’s Healthcare Associates in Portland, Ore.
In pursuing NCQA recognition, the practice made a number of changes aimed at improving coordination. To start, they trained a staff member as a referral navigator and tasked her with streamlining the process of gathering records, scheduling patient appointments, and ensuring that records were returned to the referring physician.
"Rather than have the whole team in the front office attempt to manage little pieces of that process, we made one person ... primarily responsible for that full process," Ms. Bell said.
They also began integrating behavioral health services into the practice, bringing a licensed clinical social worker on site. Patients are more likely to keep their appointments with the social worker now that they can do it at the ob.gyn.’s office, Ms. Bell said, and it gives patients more support in making lifestyle changes to support their health.
"It really has helped to remove barriers for patients," she said.
While physicians are embracing the medical neighborhood model, payers are moving more slowly.
Patricia Barrett, NCQA’s vice president for product development, said a few payers have indicated they that would offer bonus payments to specialty practices that achieve the NCQA recognition. But there’s not the same level of enthusiasm for paying specialists more as there was in rewarding primary care practices that become medical homes, she said.
The financial incentives for specialty practices are more likely to come through opportunities to participate in accountable care organizations or shared savings models, said Dr. Debra Karnasiewicz, director of quality and health information for Medical Associates of the Hudson Valley, a small, multispecialty practice in Kingston, N.Y. Her practice has been working with other small practices in their area, as well as payers, to develop a shared savings model similar to what is underway through the Centers for Medicare & Medicaid Services.
On Twitter @maryellenny
Burwell confirmed as HHS secretary
Sylvia Mathews Burwell is the new secretary of the Department of Health & Human Services and the de facto face of the controversial Affordable Care Act.
On June 5, the Senate voted 78-17 to confirm Ms. Burwell to lead HHS. Her nomination garnered a good deal of bipartisan support, with several GOP senators praising her competence. However, several Republicans refused to vote for the West Virginia native because of their opposition to the ACA, including Senate Minority Leader Mitch McConnell (R-Ky.).
"By most accounts, Sylvia Burwell is a smart and skilled public servant. But her embrace of Obamacare calls her policy judgment into question," Sen. McConnell said on the floor of the Senate. "And when it comes to the task of implementing this ill-conceived and disastrous law, the president may as well have nominated Sisyphus. Because, as I indicated, Ms. Burwell is being asked to do the impossible here."
On April 11, President Obama nominated Ms. Burwell, then director of the Office of Management and Budget, to replace outgoing HHS Secretary Kathleen Sebelius whose 5-year tenure at HHS was marred by the rocky rollout of healthcare.gov.
During two Senate confirmation hearings, Ms. Burwell gave a glimpse of how she will approach the job at HHS.
When asked about her approach to employing the controversial Independent Payment Advisory Board, Ms. Burwell said she hopes that it will never be triggered because the government will keep health care costs under control.
In addressing the mishandled rollout of healthcare.gov, Ms. Burwell said learned that there needs to be a different approach to handling information technology procurement and delivery. She pledged to ensure there was "ownership and accountability" in the IT operations in the future.
She also promised GOP senators that she would share information with them.
Ms. Burwell, a Rhodes Scholar from Hinton, W.Va., previously served as president of the Walmart Foundation and as president of the global development program at the Bill & Melinda Gates Foundation. During the Clinton administration, she was deputy director of the Office of Management and Budget.
On Twitter @maryellenny
Sylvia Mathews Burwell is the new secretary of the Department of Health & Human Services and the de facto face of the controversial Affordable Care Act.
On June 5, the Senate voted 78-17 to confirm Ms. Burwell to lead HHS. Her nomination garnered a good deal of bipartisan support, with several GOP senators praising her competence. However, several Republicans refused to vote for the West Virginia native because of their opposition to the ACA, including Senate Minority Leader Mitch McConnell (R-Ky.).
"By most accounts, Sylvia Burwell is a smart and skilled public servant. But her embrace of Obamacare calls her policy judgment into question," Sen. McConnell said on the floor of the Senate. "And when it comes to the task of implementing this ill-conceived and disastrous law, the president may as well have nominated Sisyphus. Because, as I indicated, Ms. Burwell is being asked to do the impossible here."
On April 11, President Obama nominated Ms. Burwell, then director of the Office of Management and Budget, to replace outgoing HHS Secretary Kathleen Sebelius whose 5-year tenure at HHS was marred by the rocky rollout of healthcare.gov.
During two Senate confirmation hearings, Ms. Burwell gave a glimpse of how she will approach the job at HHS.
When asked about her approach to employing the controversial Independent Payment Advisory Board, Ms. Burwell said she hopes that it will never be triggered because the government will keep health care costs under control.
In addressing the mishandled rollout of healthcare.gov, Ms. Burwell said learned that there needs to be a different approach to handling information technology procurement and delivery. She pledged to ensure there was "ownership and accountability" in the IT operations in the future.
She also promised GOP senators that she would share information with them.
Ms. Burwell, a Rhodes Scholar from Hinton, W.Va., previously served as president of the Walmart Foundation and as president of the global development program at the Bill & Melinda Gates Foundation. During the Clinton administration, she was deputy director of the Office of Management and Budget.
On Twitter @maryellenny
Sylvia Mathews Burwell is the new secretary of the Department of Health & Human Services and the de facto face of the controversial Affordable Care Act.
On June 5, the Senate voted 78-17 to confirm Ms. Burwell to lead HHS. Her nomination garnered a good deal of bipartisan support, with several GOP senators praising her competence. However, several Republicans refused to vote for the West Virginia native because of their opposition to the ACA, including Senate Minority Leader Mitch McConnell (R-Ky.).
"By most accounts, Sylvia Burwell is a smart and skilled public servant. But her embrace of Obamacare calls her policy judgment into question," Sen. McConnell said on the floor of the Senate. "And when it comes to the task of implementing this ill-conceived and disastrous law, the president may as well have nominated Sisyphus. Because, as I indicated, Ms. Burwell is being asked to do the impossible here."
On April 11, President Obama nominated Ms. Burwell, then director of the Office of Management and Budget, to replace outgoing HHS Secretary Kathleen Sebelius whose 5-year tenure at HHS was marred by the rocky rollout of healthcare.gov.
During two Senate confirmation hearings, Ms. Burwell gave a glimpse of how she will approach the job at HHS.
When asked about her approach to employing the controversial Independent Payment Advisory Board, Ms. Burwell said she hopes that it will never be triggered because the government will keep health care costs under control.
In addressing the mishandled rollout of healthcare.gov, Ms. Burwell said learned that there needs to be a different approach to handling information technology procurement and delivery. She pledged to ensure there was "ownership and accountability" in the IT operations in the future.
She also promised GOP senators that she would share information with them.
Ms. Burwell, a Rhodes Scholar from Hinton, W.Va., previously served as president of the Walmart Foundation and as president of the global development program at the Bill & Melinda Gates Foundation. During the Clinton administration, she was deputy director of the Office of Management and Budget.
On Twitter @maryellenny
ICD-10 delay: Proceed with caution, experts advise
When it comes to ICD-10 readiness, invest in low-cost, high-impact steps that will benefit the October 2015 switch to new code set, but will also improve the general health of the medical practice.
Now that implementation of ICD-10 has been delayed a full year, "I’d avoid spending too much money at this stage," said Robert Tennant, senior policy advisor at the Medical Group Management Association (MGMA).
Practical steps include checking claims already paid under ICD-9 to see whether the documentation was sufficient to assign an ICD-10 code. In the case of a sprained wrist, for example, make sure the documentation includes whether the injury was to the left or right wrist, Mr. Tennant said.
Consider dual coding – coding the same claims in both ICD-9 and ICD-10 – for some most commonly used codes, Mr. Tennant advised. If you "go through the clinical documentation improvement exercises, you will produce a better quality medical record and that can help the practice in a number of ways even if ICD-10 never goes forward."
Other low-cost, high-impact steps include reaching out to clearinghouses to request reports on the practice’s top diagnosis codes, the top pended or rejected claims, and the most frequently used unspecified codes.
"That should really focus the practice in on those claims that are the most problematic," he said.
One tough decision is when to upgrade software. Upgrade too early and the practice could lose money if there’s another delay. Wait too long and the practice risks being unprepared for the compliance date, Mr. Tennant said.
He advised finding out when the vendor will be ready with upgrades and how long it will take them to install the software and provide training. Use that to build an implementation timeline.
"It’s such a tightrope that practices have to walk," Mr. Tennant said.
Dallas-based pediatrician Joseph Schneider has been helping physicians prepare for ICD-10 in his role as chair of the Texas Medical Association’s Practice Management Services Council. The association’s official policy is that the move to ICD-10 should be scrapped, but the group is urging physicians and hospitals to prepare anyway.
Dr. Schneider said smaller practices should check in with payers, vendors, and clearinghouses now, but save significant investments and training for next year.
"If you’re in a small physician practice, probably doing not very much between now and December might be a pretty good strategy," he said. "From January forward, you have to start your engines and get everything ready."
But larger practices and health systems don’t have the luxury of waiting, he said.
Dr. George Abraham, who is part of a six-physician practice in Worcester, Mass., was ready for ICD-10 to take effect this year. His practice spent more than $25,000 preparing for the scheduled switch and had done some initial testing of systems when the delay was announced.
Now the practice faces an additional expenditure on upgrades and refresher courses for coders and physicians.
"After everything, poof, it’s gone in a puff of smoke because everything came to a standstill when ICD-10 got suspended for a year," said Dr. Abraham, governor of the Massachusetts chapter of the American College of Physicians. "It will be déjà vu all over again come summer of next year. We’ll be doing the same thing in preparation for ICD-10 being rolled out in October 2015."
Most health plans won’t begin end-to-end testing of claims until next year, Dr. Abraham said, and that’s worrisome because it may not provide enough time to work out potential glitches.
"A delay in claims being processed is our biggest anxiety," he said. "A delay in payments will lead to a severe cash flow crunch."
Waiting on the CMS for ICD-10 details
Few details have emerged from the Centers for Medicare & Medicaid Services since Congress delayed the implementation of the ICD-10 coding system earlier this year.
As part of Protecting Access to Medicare Act of 2014 (H.R. 4302), Congress delayed implementation of ICD-10 for at least a year. In May, CMS officials announced that the new compliance date would be Oct. 1, 2015, and that physicians and hospitals must continue to use ICD-9 through Sept. 30, 2015.
The agency said it would release an interim final rule in the "near future" with additional details about the compliance date.
Since then, the CMS canceled the end-to-end system testing that had been scheduled for July. The testing will be held sometime in 2015 instead, according to the agency.
But the CMS did report on results of acknowledgement testing conducted with Medicare fee-for-service contractors in March. During the test, providers, suppliers, billing companies, and clearinghouses sent more than 127,000 claims with ICD-10 codes to the Medicare fee-for-service claims system. They received an electronic acknowledgement if their claims were accepted. The exercise did not test whether the claims test had sufficient documentation to be paid by Medicare.
Overall, the CMS accepted 89% of the test claims, below the normal average Medicare claims acceptance rates of 95% to 98%.
Negative testing – the purposeful submission of error-filled claims to force a rejection – could be one reason for the lower acceptance rate, according to Niall Brennan, acting director of the CMS Offices of Enterprise Management.
While physicians and other providers can submit claims for acknowledgement testing anytime up to the implementation date, Mr. Brennan recommended waiting until after Oct. 6, 2014, when Medicare updates its systems.
Physicians should contact their local Medicare Administrative Contractor for information on acknowledgement testing, according to the CMS.
On Twitter @maryellenny
When it comes to ICD-10 readiness, invest in low-cost, high-impact steps that will benefit the October 2015 switch to new code set, but will also improve the general health of the medical practice.
Now that implementation of ICD-10 has been delayed a full year, "I’d avoid spending too much money at this stage," said Robert Tennant, senior policy advisor at the Medical Group Management Association (MGMA).
Practical steps include checking claims already paid under ICD-9 to see whether the documentation was sufficient to assign an ICD-10 code. In the case of a sprained wrist, for example, make sure the documentation includes whether the injury was to the left or right wrist, Mr. Tennant said.
Consider dual coding – coding the same claims in both ICD-9 and ICD-10 – for some most commonly used codes, Mr. Tennant advised. If you "go through the clinical documentation improvement exercises, you will produce a better quality medical record and that can help the practice in a number of ways even if ICD-10 never goes forward."
Other low-cost, high-impact steps include reaching out to clearinghouses to request reports on the practice’s top diagnosis codes, the top pended or rejected claims, and the most frequently used unspecified codes.
"That should really focus the practice in on those claims that are the most problematic," he said.
One tough decision is when to upgrade software. Upgrade too early and the practice could lose money if there’s another delay. Wait too long and the practice risks being unprepared for the compliance date, Mr. Tennant said.
He advised finding out when the vendor will be ready with upgrades and how long it will take them to install the software and provide training. Use that to build an implementation timeline.
"It’s such a tightrope that practices have to walk," Mr. Tennant said.
Dallas-based pediatrician Joseph Schneider has been helping physicians prepare for ICD-10 in his role as chair of the Texas Medical Association’s Practice Management Services Council. The association’s official policy is that the move to ICD-10 should be scrapped, but the group is urging physicians and hospitals to prepare anyway.
Dr. Schneider said smaller practices should check in with payers, vendors, and clearinghouses now, but save significant investments and training for next year.
"If you’re in a small physician practice, probably doing not very much between now and December might be a pretty good strategy," he said. "From January forward, you have to start your engines and get everything ready."
But larger practices and health systems don’t have the luxury of waiting, he said.
Dr. George Abraham, who is part of a six-physician practice in Worcester, Mass., was ready for ICD-10 to take effect this year. His practice spent more than $25,000 preparing for the scheduled switch and had done some initial testing of systems when the delay was announced.
Now the practice faces an additional expenditure on upgrades and refresher courses for coders and physicians.
"After everything, poof, it’s gone in a puff of smoke because everything came to a standstill when ICD-10 got suspended for a year," said Dr. Abraham, governor of the Massachusetts chapter of the American College of Physicians. "It will be déjà vu all over again come summer of next year. We’ll be doing the same thing in preparation for ICD-10 being rolled out in October 2015."
Most health plans won’t begin end-to-end testing of claims until next year, Dr. Abraham said, and that’s worrisome because it may not provide enough time to work out potential glitches.
"A delay in claims being processed is our biggest anxiety," he said. "A delay in payments will lead to a severe cash flow crunch."
Waiting on the CMS for ICD-10 details
Few details have emerged from the Centers for Medicare & Medicaid Services since Congress delayed the implementation of the ICD-10 coding system earlier this year.
As part of Protecting Access to Medicare Act of 2014 (H.R. 4302), Congress delayed implementation of ICD-10 for at least a year. In May, CMS officials announced that the new compliance date would be Oct. 1, 2015, and that physicians and hospitals must continue to use ICD-9 through Sept. 30, 2015.
The agency said it would release an interim final rule in the "near future" with additional details about the compliance date.
Since then, the CMS canceled the end-to-end system testing that had been scheduled for July. The testing will be held sometime in 2015 instead, according to the agency.
But the CMS did report on results of acknowledgement testing conducted with Medicare fee-for-service contractors in March. During the test, providers, suppliers, billing companies, and clearinghouses sent more than 127,000 claims with ICD-10 codes to the Medicare fee-for-service claims system. They received an electronic acknowledgement if their claims were accepted. The exercise did not test whether the claims test had sufficient documentation to be paid by Medicare.
Overall, the CMS accepted 89% of the test claims, below the normal average Medicare claims acceptance rates of 95% to 98%.
Negative testing – the purposeful submission of error-filled claims to force a rejection – could be one reason for the lower acceptance rate, according to Niall Brennan, acting director of the CMS Offices of Enterprise Management.
While physicians and other providers can submit claims for acknowledgement testing anytime up to the implementation date, Mr. Brennan recommended waiting until after Oct. 6, 2014, when Medicare updates its systems.
Physicians should contact their local Medicare Administrative Contractor for information on acknowledgement testing, according to the CMS.
On Twitter @maryellenny
When it comes to ICD-10 readiness, invest in low-cost, high-impact steps that will benefit the October 2015 switch to new code set, but will also improve the general health of the medical practice.
Now that implementation of ICD-10 has been delayed a full year, "I’d avoid spending too much money at this stage," said Robert Tennant, senior policy advisor at the Medical Group Management Association (MGMA).
Practical steps include checking claims already paid under ICD-9 to see whether the documentation was sufficient to assign an ICD-10 code. In the case of a sprained wrist, for example, make sure the documentation includes whether the injury was to the left or right wrist, Mr. Tennant said.
Consider dual coding – coding the same claims in both ICD-9 and ICD-10 – for some most commonly used codes, Mr. Tennant advised. If you "go through the clinical documentation improvement exercises, you will produce a better quality medical record and that can help the practice in a number of ways even if ICD-10 never goes forward."
Other low-cost, high-impact steps include reaching out to clearinghouses to request reports on the practice’s top diagnosis codes, the top pended or rejected claims, and the most frequently used unspecified codes.
"That should really focus the practice in on those claims that are the most problematic," he said.
One tough decision is when to upgrade software. Upgrade too early and the practice could lose money if there’s another delay. Wait too long and the practice risks being unprepared for the compliance date, Mr. Tennant said.
He advised finding out when the vendor will be ready with upgrades and how long it will take them to install the software and provide training. Use that to build an implementation timeline.
"It’s such a tightrope that practices have to walk," Mr. Tennant said.
Dallas-based pediatrician Joseph Schneider has been helping physicians prepare for ICD-10 in his role as chair of the Texas Medical Association’s Practice Management Services Council. The association’s official policy is that the move to ICD-10 should be scrapped, but the group is urging physicians and hospitals to prepare anyway.
Dr. Schneider said smaller practices should check in with payers, vendors, and clearinghouses now, but save significant investments and training for next year.
"If you’re in a small physician practice, probably doing not very much between now and December might be a pretty good strategy," he said. "From January forward, you have to start your engines and get everything ready."
But larger practices and health systems don’t have the luxury of waiting, he said.
Dr. George Abraham, who is part of a six-physician practice in Worcester, Mass., was ready for ICD-10 to take effect this year. His practice spent more than $25,000 preparing for the scheduled switch and had done some initial testing of systems when the delay was announced.
Now the practice faces an additional expenditure on upgrades and refresher courses for coders and physicians.
"After everything, poof, it’s gone in a puff of smoke because everything came to a standstill when ICD-10 got suspended for a year," said Dr. Abraham, governor of the Massachusetts chapter of the American College of Physicians. "It will be déjà vu all over again come summer of next year. We’ll be doing the same thing in preparation for ICD-10 being rolled out in October 2015."
Most health plans won’t begin end-to-end testing of claims until next year, Dr. Abraham said, and that’s worrisome because it may not provide enough time to work out potential glitches.
"A delay in claims being processed is our biggest anxiety," he said. "A delay in payments will lead to a severe cash flow crunch."
Waiting on the CMS for ICD-10 details
Few details have emerged from the Centers for Medicare & Medicaid Services since Congress delayed the implementation of the ICD-10 coding system earlier this year.
As part of Protecting Access to Medicare Act of 2014 (H.R. 4302), Congress delayed implementation of ICD-10 for at least a year. In May, CMS officials announced that the new compliance date would be Oct. 1, 2015, and that physicians and hospitals must continue to use ICD-9 through Sept. 30, 2015.
The agency said it would release an interim final rule in the "near future" with additional details about the compliance date.
Since then, the CMS canceled the end-to-end system testing that had been scheduled for July. The testing will be held sometime in 2015 instead, according to the agency.
But the CMS did report on results of acknowledgement testing conducted with Medicare fee-for-service contractors in March. During the test, providers, suppliers, billing companies, and clearinghouses sent more than 127,000 claims with ICD-10 codes to the Medicare fee-for-service claims system. They received an electronic acknowledgement if their claims were accepted. The exercise did not test whether the claims test had sufficient documentation to be paid by Medicare.
Overall, the CMS accepted 89% of the test claims, below the normal average Medicare claims acceptance rates of 95% to 98%.
Negative testing – the purposeful submission of error-filled claims to force a rejection – could be one reason for the lower acceptance rate, according to Niall Brennan, acting director of the CMS Offices of Enterprise Management.
While physicians and other providers can submit claims for acknowledgement testing anytime up to the implementation date, Mr. Brennan recommended waiting until after Oct. 6, 2014, when Medicare updates its systems.
Physicians should contact their local Medicare Administrative Contractor for information on acknowledgement testing, according to the CMS.
On Twitter @maryellenny
