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IOM identifies 17 social factors to collect in EHRs
The Institute of Medicine has identified the top 17 social and behavioral areas that should be addressed in all electronic health records to improve health outcomes and advance public health research efforts.
The IOM compiled the list as a guide for federal officials who are currently developing criteria for Stage 3 of the meaningful use program for EHRs, slated to begin in 2017.
A 13-member committee, which included physicians as well as experts in health information technology and social determinants of health, compiled a list of "candidate" domains that included sociodemographic, psychological, and behavioral factors. The committee also identified domains related to individual-level social relationships and the effect of neighborhoods and communities.
The candidate domains (in no particular order) are sexual orientation, race/ethnicity, country of origin, education, employment, financial resources strain (food and housing insecurity), health literacy, stress, negative mood and affect, psychological assets (patient engagement, conscientiousness, optimism, and self-efficacy), dietary patterns, physical activity, nicotine use and exposure, alcohol use, social connections and social isolation, exposure to violence, and area socioeconomic and racial/ethnic characteristics.
In selecting the domains, the IOM committee considered the evidence for whether the domains were associated with health outcomes, as well as whether collecting the information in an electronic health record would be useful for treatment and in public health research.
While some of the information, such as race, ethnicity, gender, language, and smoking status, is routinely collected in electronic health records now, the committee included them on the list to ensure they would remain a priority.
The IOM is planning a follow-up report to narrow down the current list and to recommend specific measures for each of the domains. The second report will also look closely at the barriers to collecting this type of social and behavioral information from patients.
On Twitter @maryellenny
The Institute of Medicine has identified the top 17 social and behavioral areas that should be addressed in all electronic health records to improve health outcomes and advance public health research efforts.
The IOM compiled the list as a guide for federal officials who are currently developing criteria for Stage 3 of the meaningful use program for EHRs, slated to begin in 2017.
A 13-member committee, which included physicians as well as experts in health information technology and social determinants of health, compiled a list of "candidate" domains that included sociodemographic, psychological, and behavioral factors. The committee also identified domains related to individual-level social relationships and the effect of neighborhoods and communities.
The candidate domains (in no particular order) are sexual orientation, race/ethnicity, country of origin, education, employment, financial resources strain (food and housing insecurity), health literacy, stress, negative mood and affect, psychological assets (patient engagement, conscientiousness, optimism, and self-efficacy), dietary patterns, physical activity, nicotine use and exposure, alcohol use, social connections and social isolation, exposure to violence, and area socioeconomic and racial/ethnic characteristics.
In selecting the domains, the IOM committee considered the evidence for whether the domains were associated with health outcomes, as well as whether collecting the information in an electronic health record would be useful for treatment and in public health research.
While some of the information, such as race, ethnicity, gender, language, and smoking status, is routinely collected in electronic health records now, the committee included them on the list to ensure they would remain a priority.
The IOM is planning a follow-up report to narrow down the current list and to recommend specific measures for each of the domains. The second report will also look closely at the barriers to collecting this type of social and behavioral information from patients.
On Twitter @maryellenny
The Institute of Medicine has identified the top 17 social and behavioral areas that should be addressed in all electronic health records to improve health outcomes and advance public health research efforts.
The IOM compiled the list as a guide for federal officials who are currently developing criteria for Stage 3 of the meaningful use program for EHRs, slated to begin in 2017.
A 13-member committee, which included physicians as well as experts in health information technology and social determinants of health, compiled a list of "candidate" domains that included sociodemographic, psychological, and behavioral factors. The committee also identified domains related to individual-level social relationships and the effect of neighborhoods and communities.
The candidate domains (in no particular order) are sexual orientation, race/ethnicity, country of origin, education, employment, financial resources strain (food and housing insecurity), health literacy, stress, negative mood and affect, psychological assets (patient engagement, conscientiousness, optimism, and self-efficacy), dietary patterns, physical activity, nicotine use and exposure, alcohol use, social connections and social isolation, exposure to violence, and area socioeconomic and racial/ethnic characteristics.
In selecting the domains, the IOM committee considered the evidence for whether the domains were associated with health outcomes, as well as whether collecting the information in an electronic health record would be useful for treatment and in public health research.
While some of the information, such as race, ethnicity, gender, language, and smoking status, is routinely collected in electronic health records now, the committee included them on the list to ensure they would remain a priority.
The IOM is planning a follow-up report to narrow down the current list and to recommend specific measures for each of the domains. The second report will also look closely at the barriers to collecting this type of social and behavioral information from patients.
On Twitter @maryellenny
Medicare to release physician pay data in April
Medicare officials are preparing to publish data on the specific services and procedures performed by individual physicians and how much they were paid by the program. The data could be posted on the Medicare website as early as April 9.
This will be the first time the federal government has published data on individual physicians.
But the news is being greeted cautiously by physicians. The American Medical Association is asking the Centers for Medicare & Medicaid Services to let physicians review and correct their data before it is publicly released.
"This safeguard is not only practical but was recognized and included in other data release proposals," Dr. Ardis Dee Hoven, AMA president, said in a statement. "Additionally, any analysis of the data released should note methodologies to ensure understanding of its limitations. Taking an approach that provides no assurances of accuracy of the data or explanations of its limitations will not allow patients to draw meaningful conclusions about the quality of care."
Dr. Reid Blackwelder, president of the American Academy of Family Physicians, agreed. While the AAFP is generally supportive of greater transparency of physician payment data, Dr. Blackwelder said the context can often be missed when releasing this type of data.
"It may not be quite as straightforward as it might appear," he said.
The CMS announced in January that it would reverse more than 30 years of policy that restricted the release of that information. The policy shift came after a federal court lifted an injunction that had previously barred the agency from making its database of Medicare physician claims public. Agency officials said then that they would use a "case-by-case" approach when reviewing the data requests.
Since then, the CMS has received multiple Freedom of Information Act requests seeking Medicare physician data, according to Jonathan Blum, principal deputy administrator for CMS.
In an April 2 letter to the American Medical Association, the CMS said that it would begin releasing the data on its web site no sooner than April 9. The information will be organized by National Provider Identifier, Healthcare Common Procedure Coding System (HCPCS) code, and by place of service. The data set will include the average and the standard deviation for submitted charges, allowed amounts, and Medicare payments for services performed in 2012.
"Data like these can shine a light on how care is delivered in the Medicare program," Mr. Blum wrote in a blog post "They can help consumers compare the services provided and payments received by individual health care providers. Businesses and consumers alike can use these data to drive decision-making and reward quality, cost-effective care."
The data being released will provide information on more than 880,000 health care providers in all states. Collectively, these providers received $77 billion from Medicare Part B in 2012.
The CMS will not release personally identifiable information about beneficiaries and will redact all data in cases in which a data set has fewer than 11 beneficiaries.
On Twitter @maryellenny
Medicare officials are preparing to publish data on the specific services and procedures performed by individual physicians and how much they were paid by the program. The data could be posted on the Medicare website as early as April 9.
This will be the first time the federal government has published data on individual physicians.
But the news is being greeted cautiously by physicians. The American Medical Association is asking the Centers for Medicare & Medicaid Services to let physicians review and correct their data before it is publicly released.
"This safeguard is not only practical but was recognized and included in other data release proposals," Dr. Ardis Dee Hoven, AMA president, said in a statement. "Additionally, any analysis of the data released should note methodologies to ensure understanding of its limitations. Taking an approach that provides no assurances of accuracy of the data or explanations of its limitations will not allow patients to draw meaningful conclusions about the quality of care."
Dr. Reid Blackwelder, president of the American Academy of Family Physicians, agreed. While the AAFP is generally supportive of greater transparency of physician payment data, Dr. Blackwelder said the context can often be missed when releasing this type of data.
"It may not be quite as straightforward as it might appear," he said.
The CMS announced in January that it would reverse more than 30 years of policy that restricted the release of that information. The policy shift came after a federal court lifted an injunction that had previously barred the agency from making its database of Medicare physician claims public. Agency officials said then that they would use a "case-by-case" approach when reviewing the data requests.
Since then, the CMS has received multiple Freedom of Information Act requests seeking Medicare physician data, according to Jonathan Blum, principal deputy administrator for CMS.
In an April 2 letter to the American Medical Association, the CMS said that it would begin releasing the data on its web site no sooner than April 9. The information will be organized by National Provider Identifier, Healthcare Common Procedure Coding System (HCPCS) code, and by place of service. The data set will include the average and the standard deviation for submitted charges, allowed amounts, and Medicare payments for services performed in 2012.
"Data like these can shine a light on how care is delivered in the Medicare program," Mr. Blum wrote in a blog post "They can help consumers compare the services provided and payments received by individual health care providers. Businesses and consumers alike can use these data to drive decision-making and reward quality, cost-effective care."
The data being released will provide information on more than 880,000 health care providers in all states. Collectively, these providers received $77 billion from Medicare Part B in 2012.
The CMS will not release personally identifiable information about beneficiaries and will redact all data in cases in which a data set has fewer than 11 beneficiaries.
On Twitter @maryellenny
Medicare officials are preparing to publish data on the specific services and procedures performed by individual physicians and how much they were paid by the program. The data could be posted on the Medicare website as early as April 9.
This will be the first time the federal government has published data on individual physicians.
But the news is being greeted cautiously by physicians. The American Medical Association is asking the Centers for Medicare & Medicaid Services to let physicians review and correct their data before it is publicly released.
"This safeguard is not only practical but was recognized and included in other data release proposals," Dr. Ardis Dee Hoven, AMA president, said in a statement. "Additionally, any analysis of the data released should note methodologies to ensure understanding of its limitations. Taking an approach that provides no assurances of accuracy of the data or explanations of its limitations will not allow patients to draw meaningful conclusions about the quality of care."
Dr. Reid Blackwelder, president of the American Academy of Family Physicians, agreed. While the AAFP is generally supportive of greater transparency of physician payment data, Dr. Blackwelder said the context can often be missed when releasing this type of data.
"It may not be quite as straightforward as it might appear," he said.
The CMS announced in January that it would reverse more than 30 years of policy that restricted the release of that information. The policy shift came after a federal court lifted an injunction that had previously barred the agency from making its database of Medicare physician claims public. Agency officials said then that they would use a "case-by-case" approach when reviewing the data requests.
Since then, the CMS has received multiple Freedom of Information Act requests seeking Medicare physician data, according to Jonathan Blum, principal deputy administrator for CMS.
In an April 2 letter to the American Medical Association, the CMS said that it would begin releasing the data on its web site no sooner than April 9. The information will be organized by National Provider Identifier, Healthcare Common Procedure Coding System (HCPCS) code, and by place of service. The data set will include the average and the standard deviation for submitted charges, allowed amounts, and Medicare payments for services performed in 2012.
"Data like these can shine a light on how care is delivered in the Medicare program," Mr. Blum wrote in a blog post "They can help consumers compare the services provided and payments received by individual health care providers. Businesses and consumers alike can use these data to drive decision-making and reward quality, cost-effective care."
The data being released will provide information on more than 880,000 health care providers in all states. Collectively, these providers received $77 billion from Medicare Part B in 2012.
The CMS will not release personally identifiable information about beneficiaries and will redact all data in cases in which a data set has fewer than 11 beneficiaries.
On Twitter @maryellenny
President signs SGR patch; bill has fine print for docs
On April 1, President Obama officially halted the 24% Medicare physician pay cut when he signed into law a bill that provides a 12-month pay patch.
The legislation (H.R. 4302) replaces the scheduled fee cut with a 0.5% pay increase through the end of 2014. It then freezes payment levels for the first 3 months of 2015, giving Congress another year to figure out if it can pass legislation to permanently repeal Medicare’s Sustainable Growth Rate (SGR) formula.
The good news, said Dr. Reid Blackwelder, president of the American Academy of Family Physicians (AAFP), is that lawmakers have already made a lot of progress toward a permanent repeal of the SGR. But the 1-year patch may give Congress only a few months to work out its disagreements, he said, because the midterm elections are likely to disrupt the process and bring in new faces unfamiliar with the work that’s already been done.
"There are likely to be changes in the Congress itself, which creates some worry," he said. "What we don’t want to see happen is to start over."
But the 45-page bill did a lot more than just put a Band-Aid on the problem of the SGR.
The biggest policy change is the 1-year delay of the implementation of the ICD-10 coding sets, which had been scheduled to go into effect on Oct. 1, 2014. Under the recently passed law, the Department of Health & Human Services (HHS) is barred from implementing the new coding sets until at least Oct. 1, 2015.
The delay was greeted with relief from most physician groups, which had already warned the government that many physicians, especially those in small practices, weren’t ready to make the switch. But a coalition that includes health information technology companies, health plans, and the American Hospital Association decried the delay. The industry has already invested time and money in the switch, and a delay will only cause disruption, according to the Coalition for ICD-10.
The SGR legislation also further delays the full implementation of the two-midnight rule governing when Medicare patients should be admitted to the hospital versus placed under observation. Enforcement of the controversial policy by Recovery Audit Contractors (RACs) had already been delayed until Oct. 1, 2014. Under H.R. 4302, most postpayment claims audits by RACs are now delayed until March 31, 2015. However, RACs are allowed to perform audits in cases where there is evidence of systematic gaming, fraud, abuse, or delays in delivering care, according to the legislation.
The enforcement delay is a relief for hospitalists, who continue to be confused about how to implement the new policy, said Bradley Flansbaum, D.O., a hospitalist in New York City and a member of the Society of Hospital Medicine’s public policy committee. But it will be critical for the Centers for Medicare & Medicaid Services to spend the extra time improving and simplifying the rule, he said.
The bill also includes a provision to target more aggressively potentially misvalued codes. For instance, it directs HHS to examine codes that:
• have experienced the fastest growth,
• have undergone substantial changes in practice expenses,
• describe new technologies,
• account for the majority of spending under the Physician Fee Schedule, and
• have high-cost supplies, among others.
The bill sets a target for reducing misvalued services from 2017 through 2020 (0.5% of the estimated amount of the fee schedule spending). If the target is met, the savings are redistributed to other services in the fee schedule. However, if the target is not met, payments are reduced. Cuts of 20% or more in a year will be phased in over a 2-year period, according to the legislation.
While primary care groups have been urging the government to shift payments toward cognitive services and away from procedural work for years, they said the bill’s misvalued code provision is likely bad news for physicians.
The problem, said Norman E. Vinn, D.O., president of the American Osteopathic Association, is that it doesn’t just redirect payments from one area to another but instead appears to cut payments to physicians across the board.
"We agree with the goal, but not the method," said Dr. Blackwelder of the AAFP.
But physicians praised the bill’s increased funding for mental health services. The bill funds a 2-year pilot project aimed at improving community mental health services and a grant program for assisted outpatient treatment for people with serious mental illness.
In the pilot project, which will include eight states, community behavior health clinics will certify that they have met certain standards, including offering 24-hour crisis management; screening assessments and diagnosis services; outpatient mental health and substance abuse services; outpatient primary care screening; and peer counseling. In exchange, they can qualify for higher federal matching funds through Medicaid.
Under the 4-year grant program, HHS will award up to $1 million each to no more than 50 institutions providing outpatient care to individuals with serious mental illness who have been ordered by a court to seek treatment.
On Twitter @maryellenny
The AGA and almost the entire medical community opposed the passage of H.R. 4302, since it does nothing to fix the underlying problem with the Medicare physician payment system - it's a temporary solution that finances the fix on the backs of specialty medicine.
 |
| Dr. John I. Allen |
The AGA is extremely disappointed that Congress passed a Sustainable Growth Rate patch because this was the closest we have been to enacting a permanent solution to the SGR. This action jeopardizes the chances of Congress enacting a long-term solution this year, and also continues to put specialties like gastroenterology in jeopardy by expanding the Centers for Medicare & Medicaid Services' existing authority to identify misvalued codes. Since GI has already been resurveyed by the CMS for both upper and lower procedures, we remain concerned that nothing in this legislation protects us from being targeted again by the agency since the CMS needs to come up with savings associated with this section.
For some specialties like gastroenterology, this "freeze" amounts to a cut in payments when factored with the 2% across-the-board Medicare sequestration cut and recent CMS cuts to GI services. The misvalued codes provision, which basically "doubles down" the administration's existing authority, will put more pressure on the agency to find savings. Given this increased authority, the AGA, ACG, and ASGE continue to call on Congress to sign on to the "Dear Colleague" letter being circulated by Rep. Bill Cassidy (R-La.) asking for more transparency in how they determine relative values. The need for greater transparency and the need for physicians to be able to meaningfully comment on significant changes to their practices will be imperative given the pressure that the CMS will be under to find savings from physician services.
The AGA and the entire GI community will continue to advocate on behalf of gastroenterology to ensure that it is adequately compensated, commensurate with the value that we provide to patients with digestive diseases.
Dr. John I. Allen, AGAF, M.B.A., is professor of medicine and clinical chief of digestive diseases at Yale University School of Medicine, New Haven, Conn.
The AGA and almost the entire medical community opposed the passage of H.R. 4302, since it does nothing to fix the underlying problem with the Medicare physician payment system - it's a temporary solution that finances the fix on the backs of specialty medicine.
|
| Dr. John I. Allen |
The AGA is extremely disappointed that Congress passed a Sustainable Growth Rate patch because this was the closest we have been to enacting a permanent solution to the SGR. This action jeopardizes the chances of Congress enacting a long-term solution this year, and also continues to put specialties like gastroenterology in jeopardy by expanding the Centers for Medicare & Medicaid Services' existing authority to identify misvalued codes. Since GI has already been resurveyed by the CMS for both upper and lower procedures, we remain concerned that nothing in this legislation protects us from being targeted again by the agency since the CMS needs to come up with savings associated with this section.
For some specialties like gastroenterology, this "freeze" amounts to a cut in payments when factored with the 2% across-the-board Medicare sequestration cut and recent CMS cuts to GI services. The misvalued codes provision, which basically "doubles down" the administration's existing authority, will put more pressure on the agency to find savings. Given this increased authority, the AGA, ACG, and ASGE continue to call on Congress to sign on to the "Dear Colleague" letter being circulated by Rep. Bill Cassidy (R-La.) asking for more transparency in how they determine relative values. The need for greater transparency and the need for physicians to be able to meaningfully comment on significant changes to their practices will be imperative given the pressure that the CMS will be under to find savings from physician services.
The AGA and the entire GI community will continue to advocate on behalf of gastroenterology to ensure that it is adequately compensated, commensurate with the value that we provide to patients with digestive diseases.
Dr. John I. Allen, AGAF, M.B.A., is professor of medicine and clinical chief of digestive diseases at Yale University School of Medicine, New Haven, Conn.
The AGA and almost the entire medical community opposed the passage of H.R. 4302, since it does nothing to fix the underlying problem with the Medicare physician payment system - it's a temporary solution that finances the fix on the backs of specialty medicine.
|
| Dr. John I. Allen |
The AGA is extremely disappointed that Congress passed a Sustainable Growth Rate patch because this was the closest we have been to enacting a permanent solution to the SGR. This action jeopardizes the chances of Congress enacting a long-term solution this year, and also continues to put specialties like gastroenterology in jeopardy by expanding the Centers for Medicare & Medicaid Services' existing authority to identify misvalued codes. Since GI has already been resurveyed by the CMS for both upper and lower procedures, we remain concerned that nothing in this legislation protects us from being targeted again by the agency since the CMS needs to come up with savings associated with this section.
For some specialties like gastroenterology, this "freeze" amounts to a cut in payments when factored with the 2% across-the-board Medicare sequestration cut and recent CMS cuts to GI services. The misvalued codes provision, which basically "doubles down" the administration's existing authority, will put more pressure on the agency to find savings. Given this increased authority, the AGA, ACG, and ASGE continue to call on Congress to sign on to the "Dear Colleague" letter being circulated by Rep. Bill Cassidy (R-La.) asking for more transparency in how they determine relative values. The need for greater transparency and the need for physicians to be able to meaningfully comment on significant changes to their practices will be imperative given the pressure that the CMS will be under to find savings from physician services.
The AGA and the entire GI community will continue to advocate on behalf of gastroenterology to ensure that it is adequately compensated, commensurate with the value that we provide to patients with digestive diseases.
Dr. John I. Allen, AGAF, M.B.A., is professor of medicine and clinical chief of digestive diseases at Yale University School of Medicine, New Haven, Conn.
On April 1, President Obama officially halted the 24% Medicare physician pay cut when he signed into law a bill that provides a 12-month pay patch.
The legislation (H.R. 4302) replaces the scheduled fee cut with a 0.5% pay increase through the end of 2014. It then freezes payment levels for the first 3 months of 2015, giving Congress another year to figure out if it can pass legislation to permanently repeal Medicare’s Sustainable Growth Rate (SGR) formula.
The good news, said Dr. Reid Blackwelder, president of the American Academy of Family Physicians (AAFP), is that lawmakers have already made a lot of progress toward a permanent repeal of the SGR. But the 1-year patch may give Congress only a few months to work out its disagreements, he said, because the midterm elections are likely to disrupt the process and bring in new faces unfamiliar with the work that’s already been done.
"There are likely to be changes in the Congress itself, which creates some worry," he said. "What we don’t want to see happen is to start over."
But the 45-page bill did a lot more than just put a Band-Aid on the problem of the SGR.
The biggest policy change is the 1-year delay of the implementation of the ICD-10 coding sets, which had been scheduled to go into effect on Oct. 1, 2014. Under the recently passed law, the Department of Health & Human Services (HHS) is barred from implementing the new coding sets until at least Oct. 1, 2015.
The delay was greeted with relief from most physician groups, which had already warned the government that many physicians, especially those in small practices, weren’t ready to make the switch. But a coalition that includes health information technology companies, health plans, and the American Hospital Association decried the delay. The industry has already invested time and money in the switch, and a delay will only cause disruption, according to the Coalition for ICD-10.
The SGR legislation also further delays the full implementation of the two-midnight rule governing when Medicare patients should be admitted to the hospital versus placed under observation. Enforcement of the controversial policy by Recovery Audit Contractors (RACs) had already been delayed until Oct. 1, 2014. Under H.R. 4302, most postpayment claims audits by RACs are now delayed until March 31, 2015. However, RACs are allowed to perform audits in cases where there is evidence of systematic gaming, fraud, abuse, or delays in delivering care, according to the legislation.
The enforcement delay is a relief for hospitalists, who continue to be confused about how to implement the new policy, said Bradley Flansbaum, D.O., a hospitalist in New York City and a member of the Society of Hospital Medicine’s public policy committee. But it will be critical for the Centers for Medicare & Medicaid Services to spend the extra time improving and simplifying the rule, he said.
The bill also includes a provision to target more aggressively potentially misvalued codes. For instance, it directs HHS to examine codes that:
• have experienced the fastest growth,
• have undergone substantial changes in practice expenses,
• describe new technologies,
• account for the majority of spending under the Physician Fee Schedule, and
• have high-cost supplies, among others.
The bill sets a target for reducing misvalued services from 2017 through 2020 (0.5% of the estimated amount of the fee schedule spending). If the target is met, the savings are redistributed to other services in the fee schedule. However, if the target is not met, payments are reduced. Cuts of 20% or more in a year will be phased in over a 2-year period, according to the legislation.
While primary care groups have been urging the government to shift payments toward cognitive services and away from procedural work for years, they said the bill’s misvalued code provision is likely bad news for physicians.
The problem, said Norman E. Vinn, D.O., president of the American Osteopathic Association, is that it doesn’t just redirect payments from one area to another but instead appears to cut payments to physicians across the board.
"We agree with the goal, but not the method," said Dr. Blackwelder of the AAFP.
But physicians praised the bill’s increased funding for mental health services. The bill funds a 2-year pilot project aimed at improving community mental health services and a grant program for assisted outpatient treatment for people with serious mental illness.
In the pilot project, which will include eight states, community behavior health clinics will certify that they have met certain standards, including offering 24-hour crisis management; screening assessments and diagnosis services; outpatient mental health and substance abuse services; outpatient primary care screening; and peer counseling. In exchange, they can qualify for higher federal matching funds through Medicaid.
Under the 4-year grant program, HHS will award up to $1 million each to no more than 50 institutions providing outpatient care to individuals with serious mental illness who have been ordered by a court to seek treatment.
On Twitter @maryellenny
On April 1, President Obama officially halted the 24% Medicare physician pay cut when he signed into law a bill that provides a 12-month pay patch.
The legislation (H.R. 4302) replaces the scheduled fee cut with a 0.5% pay increase through the end of 2014. It then freezes payment levels for the first 3 months of 2015, giving Congress another year to figure out if it can pass legislation to permanently repeal Medicare’s Sustainable Growth Rate (SGR) formula.
The good news, said Dr. Reid Blackwelder, president of the American Academy of Family Physicians (AAFP), is that lawmakers have already made a lot of progress toward a permanent repeal of the SGR. But the 1-year patch may give Congress only a few months to work out its disagreements, he said, because the midterm elections are likely to disrupt the process and bring in new faces unfamiliar with the work that’s already been done.
"There are likely to be changes in the Congress itself, which creates some worry," he said. "What we don’t want to see happen is to start over."
But the 45-page bill did a lot more than just put a Band-Aid on the problem of the SGR.
The biggest policy change is the 1-year delay of the implementation of the ICD-10 coding sets, which had been scheduled to go into effect on Oct. 1, 2014. Under the recently passed law, the Department of Health & Human Services (HHS) is barred from implementing the new coding sets until at least Oct. 1, 2015.
The delay was greeted with relief from most physician groups, which had already warned the government that many physicians, especially those in small practices, weren’t ready to make the switch. But a coalition that includes health information technology companies, health plans, and the American Hospital Association decried the delay. The industry has already invested time and money in the switch, and a delay will only cause disruption, according to the Coalition for ICD-10.
The SGR legislation also further delays the full implementation of the two-midnight rule governing when Medicare patients should be admitted to the hospital versus placed under observation. Enforcement of the controversial policy by Recovery Audit Contractors (RACs) had already been delayed until Oct. 1, 2014. Under H.R. 4302, most postpayment claims audits by RACs are now delayed until March 31, 2015. However, RACs are allowed to perform audits in cases where there is evidence of systematic gaming, fraud, abuse, or delays in delivering care, according to the legislation.
The enforcement delay is a relief for hospitalists, who continue to be confused about how to implement the new policy, said Bradley Flansbaum, D.O., a hospitalist in New York City and a member of the Society of Hospital Medicine’s public policy committee. But it will be critical for the Centers for Medicare & Medicaid Services to spend the extra time improving and simplifying the rule, he said.
The bill also includes a provision to target more aggressively potentially misvalued codes. For instance, it directs HHS to examine codes that:
• have experienced the fastest growth,
• have undergone substantial changes in practice expenses,
• describe new technologies,
• account for the majority of spending under the Physician Fee Schedule, and
• have high-cost supplies, among others.
The bill sets a target for reducing misvalued services from 2017 through 2020 (0.5% of the estimated amount of the fee schedule spending). If the target is met, the savings are redistributed to other services in the fee schedule. However, if the target is not met, payments are reduced. Cuts of 20% or more in a year will be phased in over a 2-year period, according to the legislation.
While primary care groups have been urging the government to shift payments toward cognitive services and away from procedural work for years, they said the bill’s misvalued code provision is likely bad news for physicians.
The problem, said Norman E. Vinn, D.O., president of the American Osteopathic Association, is that it doesn’t just redirect payments from one area to another but instead appears to cut payments to physicians across the board.
"We agree with the goal, but not the method," said Dr. Blackwelder of the AAFP.
But physicians praised the bill’s increased funding for mental health services. The bill funds a 2-year pilot project aimed at improving community mental health services and a grant program for assisted outpatient treatment for people with serious mental illness.
In the pilot project, which will include eight states, community behavior health clinics will certify that they have met certain standards, including offering 24-hour crisis management; screening assessments and diagnosis services; outpatient mental health and substance abuse services; outpatient primary care screening; and peer counseling. In exchange, they can qualify for higher federal matching funds through Medicaid.
Under the 4-year grant program, HHS will award up to $1 million each to no more than 50 institutions providing outpatient care to individuals with serious mental illness who have been ordered by a court to seek treatment.
On Twitter @maryellenny
Study: Overworking hospitalists has a cost
Increasing hospitalist workloads to more than 15 patients a day is associated with clinically meaningful increases in both length of stay and cost of care, according to a study of a single hospitalist practice in Delaware.
The study, published in JAMA Internal Medicine, could serve as a warning to hospital administrators who have linked hospitalist incentives to productivity.
"Most hospitalist programs are subsidized by hospital systems, and incentives based on productivity are common," Dr. Daniel J. Elliott of the Christiana Care Health System, Newark, and his colleagues wrote. "Programs that employ or support hospitalist practices should be aware that policies and incentives that increase workload to minimize short-term costs may undermine larger system efforts targeting efficiency and costs of care. At a minimum, incentive programs should balance productivity, efficiency, and quality measures."
In a retrospective cohort study, researchers analyzed 20,241 inpatient admissions to a 780-bed tertiary care hospital and a 291-bed urban community hospital. The researchers looked at the experience of one of the private hospital medicine groups serving the Delaware health system (JAMA Intern Med. 2014 Mar. 31 [doi:10.1001/jamainternmed.2014.300]).
They found that, as workload increased above the mean of 15.5 patient encounters per day, so did the length of stay. The association was linear at lower hospital occupancies. For instance, with hospital occupancies less than 75%, the length of stay increased from 5.5 to 7.5 days as the daily census climbed from 11 to 22 patients.
For middle occupancies of 75% to 85%, the length of stay was stable across lower workloads but increased to about 8 days when the census hit 22 patients. For high occupancies of more than 85%, there was a J-shaped pattern, with length of stay dipping slightly when the census was 16-17 patients and rising to more than 7 days when the census rose to 21 patients, Dr. Elliott and his associates said.
Costs also increased with workload. After controlling for the length of stay, the researchers found that cost increased by $111 for every 1-unit increase in the relative value unit; it increased $205 for every 1-unit increase in patient census, they reported.
The study, however, showed no statistically significant associations between hospitalist workload and certain quality metrics, including the activation of a rapid response team, mortality, readmissions at 7 and 30 days, and patient satisfaction.
Dr. Elliott and his colleagues recommended that hospital medicine practices provide extra support to physicians for care coordination and discharge services as their census climbs.
The study was supported by the Chairs Leadership Council at Christiana Care Health System. One of the authors, Dr. Joanne Brice, served as division chief of hospital medicine at Christiana during the study and evaluation period.
On Twitter @maryellenny
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In an accompanying editorial, Dr. Robert M. Wachter, who coined the term "hospitalist" in 1996, said the Christiana Care Health System study was an "important and well-executed" study that helps shed light on whether a census of 15 is the "magic number" for hospitalist workload.
"For now, this study illustrates that, although 15 patients per hospitalists might not be a magic number in every setting, programs that generally run censuses of more than 15 may want to find ways to lower this workload, perhaps by employing more physicians or by using nonphysician providers (nurse practitioners, physician assistants, or even scribes). They should also look at local data to see what their own workload vs. outcomes curves look like. The right census number will be the one in a given setting that maximizes patient (and, in a teaching hospital, educational) outcomes, efficiency, and the satisfaction of both patients and clinicians, and does so in an economically sustainable way," he wrote (JAMA Intern Med. 2014 Mar. 31 [doi:10.1001/jamainternmed.2014.18]).
Dr. Wachter is professor and associate chairman of the department of medicine at the University of California, San Francisco. He is also the chief of the division of hospital medicine and chief of the medical service at UCSF Medical Center.
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In an accompanying editorial, Dr. Robert M. Wachter, who coined the term "hospitalist" in 1996, said the Christiana Care Health System study was an "important and well-executed" study that helps shed light on whether a census of 15 is the "magic number" for hospitalist workload.
"For now, this study illustrates that, although 15 patients per hospitalists might not be a magic number in every setting, programs that generally run censuses of more than 15 may want to find ways to lower this workload, perhaps by employing more physicians or by using nonphysician providers (nurse practitioners, physician assistants, or even scribes). They should also look at local data to see what their own workload vs. outcomes curves look like. The right census number will be the one in a given setting that maximizes patient (and, in a teaching hospital, educational) outcomes, efficiency, and the satisfaction of both patients and clinicians, and does so in an economically sustainable way," he wrote (JAMA Intern Med. 2014 Mar. 31 [doi:10.1001/jamainternmed.2014.18]).
Dr. Wachter is professor and associate chairman of the department of medicine at the University of California, San Francisco. He is also the chief of the division of hospital medicine and chief of the medical service at UCSF Medical Center.
|
|
In an accompanying editorial, Dr. Robert M. Wachter, who coined the term "hospitalist" in 1996, said the Christiana Care Health System study was an "important and well-executed" study that helps shed light on whether a census of 15 is the "magic number" for hospitalist workload.
"For now, this study illustrates that, although 15 patients per hospitalists might not be a magic number in every setting, programs that generally run censuses of more than 15 may want to find ways to lower this workload, perhaps by employing more physicians or by using nonphysician providers (nurse practitioners, physician assistants, or even scribes). They should also look at local data to see what their own workload vs. outcomes curves look like. The right census number will be the one in a given setting that maximizes patient (and, in a teaching hospital, educational) outcomes, efficiency, and the satisfaction of both patients and clinicians, and does so in an economically sustainable way," he wrote (JAMA Intern Med. 2014 Mar. 31 [doi:10.1001/jamainternmed.2014.18]).
Dr. Wachter is professor and associate chairman of the department of medicine at the University of California, San Francisco. He is also the chief of the division of hospital medicine and chief of the medical service at UCSF Medical Center.
Increasing hospitalist workloads to more than 15 patients a day is associated with clinically meaningful increases in both length of stay and cost of care, according to a study of a single hospitalist practice in Delaware.
The study, published in JAMA Internal Medicine, could serve as a warning to hospital administrators who have linked hospitalist incentives to productivity.
"Most hospitalist programs are subsidized by hospital systems, and incentives based on productivity are common," Dr. Daniel J. Elliott of the Christiana Care Health System, Newark, and his colleagues wrote. "Programs that employ or support hospitalist practices should be aware that policies and incentives that increase workload to minimize short-term costs may undermine larger system efforts targeting efficiency and costs of care. At a minimum, incentive programs should balance productivity, efficiency, and quality measures."
In a retrospective cohort study, researchers analyzed 20,241 inpatient admissions to a 780-bed tertiary care hospital and a 291-bed urban community hospital. The researchers looked at the experience of one of the private hospital medicine groups serving the Delaware health system (JAMA Intern Med. 2014 Mar. 31 [doi:10.1001/jamainternmed.2014.300]).
They found that, as workload increased above the mean of 15.5 patient encounters per day, so did the length of stay. The association was linear at lower hospital occupancies. For instance, with hospital occupancies less than 75%, the length of stay increased from 5.5 to 7.5 days as the daily census climbed from 11 to 22 patients.
For middle occupancies of 75% to 85%, the length of stay was stable across lower workloads but increased to about 8 days when the census hit 22 patients. For high occupancies of more than 85%, there was a J-shaped pattern, with length of stay dipping slightly when the census was 16-17 patients and rising to more than 7 days when the census rose to 21 patients, Dr. Elliott and his associates said.
Costs also increased with workload. After controlling for the length of stay, the researchers found that cost increased by $111 for every 1-unit increase in the relative value unit; it increased $205 for every 1-unit increase in patient census, they reported.
The study, however, showed no statistically significant associations between hospitalist workload and certain quality metrics, including the activation of a rapid response team, mortality, readmissions at 7 and 30 days, and patient satisfaction.
Dr. Elliott and his colleagues recommended that hospital medicine practices provide extra support to physicians for care coordination and discharge services as their census climbs.
The study was supported by the Chairs Leadership Council at Christiana Care Health System. One of the authors, Dr. Joanne Brice, served as division chief of hospital medicine at Christiana during the study and evaluation period.
On Twitter @maryellenny
Increasing hospitalist workloads to more than 15 patients a day is associated with clinically meaningful increases in both length of stay and cost of care, according to a study of a single hospitalist practice in Delaware.
The study, published in JAMA Internal Medicine, could serve as a warning to hospital administrators who have linked hospitalist incentives to productivity.
"Most hospitalist programs are subsidized by hospital systems, and incentives based on productivity are common," Dr. Daniel J. Elliott of the Christiana Care Health System, Newark, and his colleagues wrote. "Programs that employ or support hospitalist practices should be aware that policies and incentives that increase workload to minimize short-term costs may undermine larger system efforts targeting efficiency and costs of care. At a minimum, incentive programs should balance productivity, efficiency, and quality measures."
In a retrospective cohort study, researchers analyzed 20,241 inpatient admissions to a 780-bed tertiary care hospital and a 291-bed urban community hospital. The researchers looked at the experience of one of the private hospital medicine groups serving the Delaware health system (JAMA Intern Med. 2014 Mar. 31 [doi:10.1001/jamainternmed.2014.300]).
They found that, as workload increased above the mean of 15.5 patient encounters per day, so did the length of stay. The association was linear at lower hospital occupancies. For instance, with hospital occupancies less than 75%, the length of stay increased from 5.5 to 7.5 days as the daily census climbed from 11 to 22 patients.
For middle occupancies of 75% to 85%, the length of stay was stable across lower workloads but increased to about 8 days when the census hit 22 patients. For high occupancies of more than 85%, there was a J-shaped pattern, with length of stay dipping slightly when the census was 16-17 patients and rising to more than 7 days when the census rose to 21 patients, Dr. Elliott and his associates said.
Costs also increased with workload. After controlling for the length of stay, the researchers found that cost increased by $111 for every 1-unit increase in the relative value unit; it increased $205 for every 1-unit increase in patient census, they reported.
The study, however, showed no statistically significant associations between hospitalist workload and certain quality metrics, including the activation of a rapid response team, mortality, readmissions at 7 and 30 days, and patient satisfaction.
Dr. Elliott and his colleagues recommended that hospital medicine practices provide extra support to physicians for care coordination and discharge services as their census climbs.
The study was supported by the Chairs Leadership Council at Christiana Care Health System. One of the authors, Dr. Joanne Brice, served as division chief of hospital medicine at Christiana during the study and evaluation period.
On Twitter @maryellenny
FROM JAMA INTERNAL MEDICINE
Administration reports ACA enrollment at over 7 million
Just over 7 million Americans signed up for private health insurance plans through federal and state insurance marketplaces during the Affordable Care Act’s first open enrollment period, according to preliminary figures released by the White House April 1.
The number is a bit of a surprise since only 4.2 million individuals had signed up for health plans as of March 1. A last minute surge helped the administration meet enrollment projections that were made before the technical glitches plagued the start of healthcare.gov in October and November.
Complete enrollment numbers, as well information on how many people have actually paid their premiums, will not be available for a few more weeks, administration officials said.
In the meantime, President Obama pointed to the enrollment number as proof that the health care law is working. And he blasted opponents who have spent the last several months trying to repeal or undermine the law.
"I will always work with anyone who is willing to make this law work even better," President Obama said from the Rose Garden. "But the debate over repealing this law is over. The Affordable Care Act is here to stay."
On Twitter @maryellenny
Just over 7 million Americans signed up for private health insurance plans through federal and state insurance marketplaces during the Affordable Care Act’s first open enrollment period, according to preliminary figures released by the White House April 1.
The number is a bit of a surprise since only 4.2 million individuals had signed up for health plans as of March 1. A last minute surge helped the administration meet enrollment projections that were made before the technical glitches plagued the start of healthcare.gov in October and November.
Complete enrollment numbers, as well information on how many people have actually paid their premiums, will not be available for a few more weeks, administration officials said.
In the meantime, President Obama pointed to the enrollment number as proof that the health care law is working. And he blasted opponents who have spent the last several months trying to repeal or undermine the law.
"I will always work with anyone who is willing to make this law work even better," President Obama said from the Rose Garden. "But the debate over repealing this law is over. The Affordable Care Act is here to stay."
On Twitter @maryellenny
Just over 7 million Americans signed up for private health insurance plans through federal and state insurance marketplaces during the Affordable Care Act’s first open enrollment period, according to preliminary figures released by the White House April 1.
The number is a bit of a surprise since only 4.2 million individuals had signed up for health plans as of March 1. A last minute surge helped the administration meet enrollment projections that were made before the technical glitches plagued the start of healthcare.gov in October and November.
Complete enrollment numbers, as well information on how many people have actually paid their premiums, will not be available for a few more weeks, administration officials said.
In the meantime, President Obama pointed to the enrollment number as proof that the health care law is working. And he blasted opponents who have spent the last several months trying to repeal or undermine the law.
"I will always work with anyone who is willing to make this law work even better," President Obama said from the Rose Garden. "But the debate over repealing this law is over. The Affordable Care Act is here to stay."
On Twitter @maryellenny
Senate passes 1-year SGR patch; delays ICD-10 until 2015
In a last-minute move, Congress averted a scheduled 24% cut to Medicare physician fees slated to start on April 1, while simultaneously delaying the move to the ICD-10 coding sets.
On March 31, the Senate voted 64 to 35 to approve H.R. 4302, a bill that replaces the scheduled cut called for by the Medicare Sustainable Growth Rate formula with a 0.5% fee increase through the end of 2014 and a pay freeze from Jan. 1, 2015 through March 15, 2015. The bill also bars the Health and Human Services (HHS) department from implementing ICD-10 until Oct. 1, 2015.
The House passed the same legislation on March 27. It now heads to the White House for President Obama’s signature.
At first glance, the bill looks like good news for physicians, who will get relief from both a hefty Medicare fee cut and a costly new regulatory requirement. But many physician organizations, led by the American Medical Association, have campaigned against the temporary patch, saying that it essentially stops the work to permanently repeal the SGR.
"It appears that an unprecedented, bipartisan agreement on Medicare reform is on the verge of being cast aside because elected leaders are unwilling to make tough choices to strengthen programs serving 50 million Americans," the AMA and more than 50 other medical societies wrote to congressional leaders before the House vote.
Several physician groups had endorsed a bipartisan legislative package that would have eliminated the SGR and replaced it with a combination of small fee increases and delivery system reforms. The hurdle to passing the legislation was finding a way to pay for it that would appeal to both Democrats and Republicans.
Recently, the House passed H.R. 4015, which would have funded the permanent SGR repeal package with a 5-year delay of the Affordable Care Act’s individual insurance mandate. But that bill is unlikely to be considered in the Democratic-controlled Senate. And an attempt by Sen. Ron Wyden (D.-Ore.) to move the permanent SGR repeal forward and pay for it using the savings from the end of the wars in Iraq and Afghanistan failed to gain enough votes in the Senate.
Before the March 31 vote, Sen. Wyden chided fellow lawmakers for continuing to pass temporary fixes to the SGR problem rather than replacing it and moving to a payment system that incentivizes quality improvement. "It can’t be ducked much longer," he said.
But Sen. Orrin Hatch (R.-Utah), who worked on the bipartisan bill to replace the SGR, said he objects to the funding mechanism that Sen. Wyden proposed. He said the 12-month SGR patch will give lawmakers more time to agree on how to pay for a permanent fix. "I’m not going to make the perfect the enemy of the good," he said on the Senate floor.
On Twitter @maryellenny
In a last-minute move, Congress averted a scheduled 24% cut to Medicare physician fees slated to start on April 1, while simultaneously delaying the move to the ICD-10 coding sets.
On March 31, the Senate voted 64 to 35 to approve H.R. 4302, a bill that replaces the scheduled cut called for by the Medicare Sustainable Growth Rate formula with a 0.5% fee increase through the end of 2014 and a pay freeze from Jan. 1, 2015 through March 15, 2015. The bill also bars the Health and Human Services (HHS) department from implementing ICD-10 until Oct. 1, 2015.
The House passed the same legislation on March 27. It now heads to the White House for President Obama’s signature.
At first glance, the bill looks like good news for physicians, who will get relief from both a hefty Medicare fee cut and a costly new regulatory requirement. But many physician organizations, led by the American Medical Association, have campaigned against the temporary patch, saying that it essentially stops the work to permanently repeal the SGR.
"It appears that an unprecedented, bipartisan agreement on Medicare reform is on the verge of being cast aside because elected leaders are unwilling to make tough choices to strengthen programs serving 50 million Americans," the AMA and more than 50 other medical societies wrote to congressional leaders before the House vote.
Several physician groups had endorsed a bipartisan legislative package that would have eliminated the SGR and replaced it with a combination of small fee increases and delivery system reforms. The hurdle to passing the legislation was finding a way to pay for it that would appeal to both Democrats and Republicans.
Recently, the House passed H.R. 4015, which would have funded the permanent SGR repeal package with a 5-year delay of the Affordable Care Act’s individual insurance mandate. But that bill is unlikely to be considered in the Democratic-controlled Senate. And an attempt by Sen. Ron Wyden (D.-Ore.) to move the permanent SGR repeal forward and pay for it using the savings from the end of the wars in Iraq and Afghanistan failed to gain enough votes in the Senate.
Before the March 31 vote, Sen. Wyden chided fellow lawmakers for continuing to pass temporary fixes to the SGR problem rather than replacing it and moving to a payment system that incentivizes quality improvement. "It can’t be ducked much longer," he said.
But Sen. Orrin Hatch (R.-Utah), who worked on the bipartisan bill to replace the SGR, said he objects to the funding mechanism that Sen. Wyden proposed. He said the 12-month SGR patch will give lawmakers more time to agree on how to pay for a permanent fix. "I’m not going to make the perfect the enemy of the good," he said on the Senate floor.
On Twitter @maryellenny
In a last-minute move, Congress averted a scheduled 24% cut to Medicare physician fees slated to start on April 1, while simultaneously delaying the move to the ICD-10 coding sets.
On March 31, the Senate voted 64 to 35 to approve H.R. 4302, a bill that replaces the scheduled cut called for by the Medicare Sustainable Growth Rate formula with a 0.5% fee increase through the end of 2014 and a pay freeze from Jan. 1, 2015 through March 15, 2015. The bill also bars the Health and Human Services (HHS) department from implementing ICD-10 until Oct. 1, 2015.
The House passed the same legislation on March 27. It now heads to the White House for President Obama’s signature.
At first glance, the bill looks like good news for physicians, who will get relief from both a hefty Medicare fee cut and a costly new regulatory requirement. But many physician organizations, led by the American Medical Association, have campaigned against the temporary patch, saying that it essentially stops the work to permanently repeal the SGR.
"It appears that an unprecedented, bipartisan agreement on Medicare reform is on the verge of being cast aside because elected leaders are unwilling to make tough choices to strengthen programs serving 50 million Americans," the AMA and more than 50 other medical societies wrote to congressional leaders before the House vote.
Several physician groups had endorsed a bipartisan legislative package that would have eliminated the SGR and replaced it with a combination of small fee increases and delivery system reforms. The hurdle to passing the legislation was finding a way to pay for it that would appeal to both Democrats and Republicans.
Recently, the House passed H.R. 4015, which would have funded the permanent SGR repeal package with a 5-year delay of the Affordable Care Act’s individual insurance mandate. But that bill is unlikely to be considered in the Democratic-controlled Senate. And an attempt by Sen. Ron Wyden (D.-Ore.) to move the permanent SGR repeal forward and pay for it using the savings from the end of the wars in Iraq and Afghanistan failed to gain enough votes in the Senate.
Before the March 31 vote, Sen. Wyden chided fellow lawmakers for continuing to pass temporary fixes to the SGR problem rather than replacing it and moving to a payment system that incentivizes quality improvement. "It can’t be ducked much longer," he said.
But Sen. Orrin Hatch (R.-Utah), who worked on the bipartisan bill to replace the SGR, said he objects to the funding mechanism that Sen. Wyden proposed. He said the 12-month SGR patch will give lawmakers more time to agree on how to pay for a permanent fix. "I’m not going to make the perfect the enemy of the good," he said on the Senate floor.
On Twitter @maryellenny
Senate passes 1-year SGR patch; delays ICD-10 until 2015
In a last-minute move, Congress averted a scheduled 24% cut to Medicare physician fees slated to start on April 1, while simultaneously delaying the move to the ICD-10 coding sets.
On March 31, the Senate voted 64 to 35 to approve H.R. 4302, a bill that replaces the scheduled cut called for by the Medicare Sustainable Growth Rate formula with a 0.5% fee increase through the end of 2014 and a pay freeze from Jan. 1, 2015 through March 15, 2015. The bill also bars the Health and Human Services (HHS) department from implementing ICD-10 until Oct. 1, 2015.
The House passed the same legislation on March 27. It now heads to the White House for President Obama’s signature.
At first glance, the bill looks like good news for physicians, who will get relief from both a hefty Medicare fee cut and a costly new regulatory requirement. But many physician organizations, led by the American Medical Association, have campaigned against the temporary patch, saying that it essentially stops the work to permanently repeal the SGR.
"It appears that an unprecedented, bipartisan agreement on Medicare reform is on the verge of being cast aside because elected leaders are unwilling to make tough choices to strengthen programs serving 50 million Americans," the AMA and more than 50 other medical societies wrote to congressional leaders before the House vote.
Several physician groups had endorsed a bipartisan legislative package that would have eliminated the SGR and replaced it with a combination of small fee increases and delivery system reforms. The hurdle to passing the legislation was finding a way to pay for it that would appeal to both Democrats and Republicans.
Recently, the House passed H.R. 4015, which would have funded the permanent SGR repeal package with a 5-year delay of the Affordable Care Act’s individual insurance mandate. But that bill is unlikely to be considered in the Democratic-controlled Senate. And an attempt by Sen. Ron Wyden (D.-Ore.) to move the permanent SGR repeal forward and pay for it using the savings from the end of the wars in Iraq and Afghanistan failed to gain enough votes in the Senate.
Before the March 31 vote, Sen. Wyden chided fellow lawmakers for continuing to pass temporary fixes to the SGR problem rather than replacing it and moving to a payment system that incentivizes quality improvement. "It can’t be ducked much longer," he said.
But Sen. Orrin Hatch (R.-Utah), who worked on the bipartisan bill to replace the SGR, said he objects to the funding mechanism that Sen. Wyden proposed. He said the 12-month SGR patch will give lawmakers more time to agree on how to pay for a permanent fix. "I’m not going to make the perfect the enemy of the good," he said on the Senate floor.
On Twitter @maryellenny
In a last-minute move, Congress averted a scheduled 24% cut to Medicare physician fees slated to start on April 1, while simultaneously delaying the move to the ICD-10 coding sets.
On March 31, the Senate voted 64 to 35 to approve H.R. 4302, a bill that replaces the scheduled cut called for by the Medicare Sustainable Growth Rate formula with a 0.5% fee increase through the end of 2014 and a pay freeze from Jan. 1, 2015 through March 15, 2015. The bill also bars the Health and Human Services (HHS) department from implementing ICD-10 until Oct. 1, 2015.
The House passed the same legislation on March 27. It now heads to the White House for President Obama’s signature.
At first glance, the bill looks like good news for physicians, who will get relief from both a hefty Medicare fee cut and a costly new regulatory requirement. But many physician organizations, led by the American Medical Association, have campaigned against the temporary patch, saying that it essentially stops the work to permanently repeal the SGR.
"It appears that an unprecedented, bipartisan agreement on Medicare reform is on the verge of being cast aside because elected leaders are unwilling to make tough choices to strengthen programs serving 50 million Americans," the AMA and more than 50 other medical societies wrote to congressional leaders before the House vote.
Several physician groups had endorsed a bipartisan legislative package that would have eliminated the SGR and replaced it with a combination of small fee increases and delivery system reforms. The hurdle to passing the legislation was finding a way to pay for it that would appeal to both Democrats and Republicans.
Recently, the House passed H.R. 4015, which would have funded the permanent SGR repeal package with a 5-year delay of the Affordable Care Act’s individual insurance mandate. But that bill is unlikely to be considered in the Democratic-controlled Senate. And an attempt by Sen. Ron Wyden (D.-Ore.) to move the permanent SGR repeal forward and pay for it using the savings from the end of the wars in Iraq and Afghanistan failed to gain enough votes in the Senate.
Before the March 31 vote, Sen. Wyden chided fellow lawmakers for continuing to pass temporary fixes to the SGR problem rather than replacing it and moving to a payment system that incentivizes quality improvement. "It can’t be ducked much longer," he said.
But Sen. Orrin Hatch (R.-Utah), who worked on the bipartisan bill to replace the SGR, said he objects to the funding mechanism that Sen. Wyden proposed. He said the 12-month SGR patch will give lawmakers more time to agree on how to pay for a permanent fix. "I’m not going to make the perfect the enemy of the good," he said on the Senate floor.
On Twitter @maryellenny
In a last-minute move, Congress averted a scheduled 24% cut to Medicare physician fees slated to start on April 1, while simultaneously delaying the move to the ICD-10 coding sets.
On March 31, the Senate voted 64 to 35 to approve H.R. 4302, a bill that replaces the scheduled cut called for by the Medicare Sustainable Growth Rate formula with a 0.5% fee increase through the end of 2014 and a pay freeze from Jan. 1, 2015 through March 15, 2015. The bill also bars the Health and Human Services (HHS) department from implementing ICD-10 until Oct. 1, 2015.
The House passed the same legislation on March 27. It now heads to the White House for President Obama’s signature.
At first glance, the bill looks like good news for physicians, who will get relief from both a hefty Medicare fee cut and a costly new regulatory requirement. But many physician organizations, led by the American Medical Association, have campaigned against the temporary patch, saying that it essentially stops the work to permanently repeal the SGR.
"It appears that an unprecedented, bipartisan agreement on Medicare reform is on the verge of being cast aside because elected leaders are unwilling to make tough choices to strengthen programs serving 50 million Americans," the AMA and more than 50 other medical societies wrote to congressional leaders before the House vote.
Several physician groups had endorsed a bipartisan legislative package that would have eliminated the SGR and replaced it with a combination of small fee increases and delivery system reforms. The hurdle to passing the legislation was finding a way to pay for it that would appeal to both Democrats and Republicans.
Recently, the House passed H.R. 4015, which would have funded the permanent SGR repeal package with a 5-year delay of the Affordable Care Act’s individual insurance mandate. But that bill is unlikely to be considered in the Democratic-controlled Senate. And an attempt by Sen. Ron Wyden (D.-Ore.) to move the permanent SGR repeal forward and pay for it using the savings from the end of the wars in Iraq and Afghanistan failed to gain enough votes in the Senate.
Before the March 31 vote, Sen. Wyden chided fellow lawmakers for continuing to pass temporary fixes to the SGR problem rather than replacing it and moving to a payment system that incentivizes quality improvement. "It can’t be ducked much longer," he said.
But Sen. Orrin Hatch (R.-Utah), who worked on the bipartisan bill to replace the SGR, said he objects to the funding mechanism that Sen. Wyden proposed. He said the 12-month SGR patch will give lawmakers more time to agree on how to pay for a permanent fix. "I’m not going to make the perfect the enemy of the good," he said on the Senate floor.
On Twitter @maryellenny
Senate passes 1-year SGR patch; delays ICD-10 until 2015
In a last-minute move, Congress averted a scheduled 24% cut to Medicare physician fees slated to start on April 1, while simultaneously delaying the move to the ICD-10 coding sets.
On March 31, the Senate voted 64 to 35 to approve H.R. 4302, a bill that replaces the scheduled cut called for by the Medicare Sustainable Growth Rate formula with a 0.5% fee increase through the end of 2014 and a pay freeze from Jan. 1, 2015 through March 15, 2015. The bill also bars the Health and Human Services (HHS) department from implementing ICD-10 until Oct. 1, 2015.
The House passed the same legislation on March 27. It now heads to the White House for President Obama’s signature.
At first glance, the bill looks like good news for physicians, who will get relief from both a hefty Medicare fee cut and a costly new regulatory requirement. But many physician organizations, led by the American Medical Association, have campaigned against the temporary patch, saying that it essentially stops the work to permanently repeal the SGR.
"It appears that an unprecedented, bipartisan agreement on Medicare reform is on the verge of being cast aside because elected leaders are unwilling to make tough choices to strengthen programs serving 50 million Americans," the AMA and more than 50 other medical societies wrote to congressional leaders before the House vote.
Several physician groups had endorsed a bipartisan legislative package that would have eliminated the SGR and replaced it with a combination of small fee increases and delivery system reforms. The hurdle to passing the legislation was finding a way to pay for it that would appeal to both Democrats and Republicans.
Recently, the House passed H.R. 4015, which would have funded the permanent SGR repeal package with a 5-year delay of the Affordable Care Act’s individual insurance mandate. But that bill is unlikely to be considered in the Democratic-controlled Senate. And an attempt by Sen. Ron Wyden (D.-Ore.) to move the permanent SGR repeal forward and pay for it using the savings from the end of the wars in Iraq and Afghanistan failed to gain enough votes in the Senate.
Before the March 31 vote, Sen. Wyden chided fellow lawmakers for continuing to pass temporary fixes to the SGR problem rather than replacing it and moving to a payment system that incentivizes quality improvement. "It can’t be ducked much longer," he said.
But Sen. Orrin Hatch (R.-Utah), who worked on the bipartisan bill to replace the SGR, said he objects to the funding mechanism that Sen. Wyden proposed. He said the 12-month SGR patch will give lawmakers more time to agree on how to pay for a permanent fix. "I’m not going to make the perfect the enemy of the good," he said on the Senate floor.
On Twitter @maryellenny
In a last-minute move, Congress averted a scheduled 24% cut to Medicare physician fees slated to start on April 1, while simultaneously delaying the move to the ICD-10 coding sets.
On March 31, the Senate voted 64 to 35 to approve H.R. 4302, a bill that replaces the scheduled cut called for by the Medicare Sustainable Growth Rate formula with a 0.5% fee increase through the end of 2014 and a pay freeze from Jan. 1, 2015 through March 15, 2015. The bill also bars the Health and Human Services (HHS) department from implementing ICD-10 until Oct. 1, 2015.
The House passed the same legislation on March 27. It now heads to the White House for President Obama’s signature.
At first glance, the bill looks like good news for physicians, who will get relief from both a hefty Medicare fee cut and a costly new regulatory requirement. But many physician organizations, led by the American Medical Association, have campaigned against the temporary patch, saying that it essentially stops the work to permanently repeal the SGR.
"It appears that an unprecedented, bipartisan agreement on Medicare reform is on the verge of being cast aside because elected leaders are unwilling to make tough choices to strengthen programs serving 50 million Americans," the AMA and more than 50 other medical societies wrote to congressional leaders before the House vote.
Several physician groups had endorsed a bipartisan legislative package that would have eliminated the SGR and replaced it with a combination of small fee increases and delivery system reforms. The hurdle to passing the legislation was finding a way to pay for it that would appeal to both Democrats and Republicans.
Recently, the House passed H.R. 4015, which would have funded the permanent SGR repeal package with a 5-year delay of the Affordable Care Act’s individual insurance mandate. But that bill is unlikely to be considered in the Democratic-controlled Senate. And an attempt by Sen. Ron Wyden (D.-Ore.) to move the permanent SGR repeal forward and pay for it using the savings from the end of the wars in Iraq and Afghanistan failed to gain enough votes in the Senate.
Before the March 31 vote, Sen. Wyden chided fellow lawmakers for continuing to pass temporary fixes to the SGR problem rather than replacing it and moving to a payment system that incentivizes quality improvement. "It can’t be ducked much longer," he said.
But Sen. Orrin Hatch (R.-Utah), who worked on the bipartisan bill to replace the SGR, said he objects to the funding mechanism that Sen. Wyden proposed. He said the 12-month SGR patch will give lawmakers more time to agree on how to pay for a permanent fix. "I’m not going to make the perfect the enemy of the good," he said on the Senate floor.
On Twitter @maryellenny
In a last-minute move, Congress averted a scheduled 24% cut to Medicare physician fees slated to start on April 1, while simultaneously delaying the move to the ICD-10 coding sets.
On March 31, the Senate voted 64 to 35 to approve H.R. 4302, a bill that replaces the scheduled cut called for by the Medicare Sustainable Growth Rate formula with a 0.5% fee increase through the end of 2014 and a pay freeze from Jan. 1, 2015 through March 15, 2015. The bill also bars the Health and Human Services (HHS) department from implementing ICD-10 until Oct. 1, 2015.
The House passed the same legislation on March 27. It now heads to the White House for President Obama’s signature.
At first glance, the bill looks like good news for physicians, who will get relief from both a hefty Medicare fee cut and a costly new regulatory requirement. But many physician organizations, led by the American Medical Association, have campaigned against the temporary patch, saying that it essentially stops the work to permanently repeal the SGR.
"It appears that an unprecedented, bipartisan agreement on Medicare reform is on the verge of being cast aside because elected leaders are unwilling to make tough choices to strengthen programs serving 50 million Americans," the AMA and more than 50 other medical societies wrote to congressional leaders before the House vote.
Several physician groups had endorsed a bipartisan legislative package that would have eliminated the SGR and replaced it with a combination of small fee increases and delivery system reforms. The hurdle to passing the legislation was finding a way to pay for it that would appeal to both Democrats and Republicans.
Recently, the House passed H.R. 4015, which would have funded the permanent SGR repeal package with a 5-year delay of the Affordable Care Act’s individual insurance mandate. But that bill is unlikely to be considered in the Democratic-controlled Senate. And an attempt by Sen. Ron Wyden (D.-Ore.) to move the permanent SGR repeal forward and pay for it using the savings from the end of the wars in Iraq and Afghanistan failed to gain enough votes in the Senate.
Before the March 31 vote, Sen. Wyden chided fellow lawmakers for continuing to pass temporary fixes to the SGR problem rather than replacing it and moving to a payment system that incentivizes quality improvement. "It can’t be ducked much longer," he said.
But Sen. Orrin Hatch (R.-Utah), who worked on the bipartisan bill to replace the SGR, said he objects to the funding mechanism that Sen. Wyden proposed. He said the 12-month SGR patch will give lawmakers more time to agree on how to pay for a permanent fix. "I’m not going to make the perfect the enemy of the good," he said on the Senate floor.
On Twitter @maryellenny
Initial MARQUIS results offer lessons in med reconciliation
LAS VEGAS – Tired of getting a patient medication list that isn’t reliable? A 3-year study on medication reconciliation could offer a roadmap for improving that list and reducing potentially harmful errors.
Preliminary results from MARQUIS (the Multi-Center Medication Reconciliation Quality Improvement Study) indicate that hospitals are able to reduce unintentional medication discrepancies by implementing a menu of interventions ranging from training providers to take a better medication history to stationing a designated provider in the emergency department to reconcile the patient’s information with pharmacies and primary care offices. But outside forces, such as problems with an electronic health record (EHR) system, can offset those effects.
The 3-year study, which will wrap up in the next few months, is sponsored by the Society of Hospital Medicine, with $1.5 million in funding from the Agency for Healthcare Research and Quality.
In the first phase of the study, researchers identified evidence-based techniques for taking the best possible medication history from hospitalized patients and synthesized them into a toolkit for clinicians. The free toolkit includes how-to videos and pocket cards. The second phase of the study is the mentored implementation of the techniques at five sites: two academic medical centers, two community hospitals, and one Veterans Affairs medical center.
Initial results from two of the five sites show that training on how to take a better medication history and clarity about who should be working on reconciling the medication list can help improve medication discrepancies. But while the interventions are promising, the initial case studies show mixed results.
While one community hospital site was able to lower medication discrepancies significantly, a second community hospital site had a spike in its medication discrepancies as it underwent a problematic implementation of a new EHR system.
Eighteen minutes to win it
At the first site, a Medication Reconciliation Assistant (MRA) program was used to improve the reliability of medication lists. The MRA is stationed in the emergency department and interviews patients about their medications and then verifies that list with the pharmacy, the primary care physician, or the skilled nursing facility. That new medication list is then handed off to the admitting physician. The process usually takes about 18-20 minutes.
They MRA program is staffed by four full-time employees, all pharmacy technicians with experience in retail pharmacies, who work 8-hour shifts throughout the week.
"It doesn’t have to be a pharmacy technician," said Dr. Jason Stein, a MARQUIS coinvestigator and a professor of medicine at Emory University, Atlanta, at the annual meeting of the Society of Hospital Medicine. "But somebody needs to be spending that 18 minutes doing something that roughly looks like this."
At that first site, unintentional medication discrepancies from either history or reconciliation errors dropped from 4.5 per patient at the in the preintervention period to 3.4 per patient. And the total number of potentially harmful discrepancies was reduced from 0.25 to 0.09 per patient.
At the second site, a smaller community hospital, the quality improvement team provided training to front-line providers on medication history taking and counseling at discharge and created a new hospital policy that clarified expectations about who would perform medication reconciliation and when they would do it. And recently, they began stationing a provider in the emergency department 5 days a week to work on medication reconciliation.
But shortly after the second hospital began implementing the MARQUIS interventions, the hospital launched a new EHR system that created problems for medication reconciliation. For instance, with the paper system, the admitting physician was accountable for the initial medication history. But under the electronic system, that accountability was lost. Also, the new EHR was unable to group medications as "continued," "changed," "stopped," or "new," making it difficult to perform discharge medication counseling.
The result was that, after some initial success, unintentional medication discrepancies spiked. In the preintervention period, unintentional medication discrepancies were 2.0 per patient, but they rose to nearly 5 discrepancies per patient after the rollout of the new EHR system. They have since fallen back down to 3.8 per patient. Similarly, the total of potentially harmful discrepancies rose from 0.20 to 1.11 per patient.
The free MARQUIS toolkit is available online.
On Twitter @maryellenny
LAS VEGAS – Tired of getting a patient medication list that isn’t reliable? A 3-year study on medication reconciliation could offer a roadmap for improving that list and reducing potentially harmful errors.
Preliminary results from MARQUIS (the Multi-Center Medication Reconciliation Quality Improvement Study) indicate that hospitals are able to reduce unintentional medication discrepancies by implementing a menu of interventions ranging from training providers to take a better medication history to stationing a designated provider in the emergency department to reconcile the patient’s information with pharmacies and primary care offices. But outside forces, such as problems with an electronic health record (EHR) system, can offset those effects.
The 3-year study, which will wrap up in the next few months, is sponsored by the Society of Hospital Medicine, with $1.5 million in funding from the Agency for Healthcare Research and Quality.
In the first phase of the study, researchers identified evidence-based techniques for taking the best possible medication history from hospitalized patients and synthesized them into a toolkit for clinicians. The free toolkit includes how-to videos and pocket cards. The second phase of the study is the mentored implementation of the techniques at five sites: two academic medical centers, two community hospitals, and one Veterans Affairs medical center.
Initial results from two of the five sites show that training on how to take a better medication history and clarity about who should be working on reconciling the medication list can help improve medication discrepancies. But while the interventions are promising, the initial case studies show mixed results.
While one community hospital site was able to lower medication discrepancies significantly, a second community hospital site had a spike in its medication discrepancies as it underwent a problematic implementation of a new EHR system.
Eighteen minutes to win it
At the first site, a Medication Reconciliation Assistant (MRA) program was used to improve the reliability of medication lists. The MRA is stationed in the emergency department and interviews patients about their medications and then verifies that list with the pharmacy, the primary care physician, or the skilled nursing facility. That new medication list is then handed off to the admitting physician. The process usually takes about 18-20 minutes.
They MRA program is staffed by four full-time employees, all pharmacy technicians with experience in retail pharmacies, who work 8-hour shifts throughout the week.
"It doesn’t have to be a pharmacy technician," said Dr. Jason Stein, a MARQUIS coinvestigator and a professor of medicine at Emory University, Atlanta, at the annual meeting of the Society of Hospital Medicine. "But somebody needs to be spending that 18 minutes doing something that roughly looks like this."
At that first site, unintentional medication discrepancies from either history or reconciliation errors dropped from 4.5 per patient at the in the preintervention period to 3.4 per patient. And the total number of potentially harmful discrepancies was reduced from 0.25 to 0.09 per patient.
At the second site, a smaller community hospital, the quality improvement team provided training to front-line providers on medication history taking and counseling at discharge and created a new hospital policy that clarified expectations about who would perform medication reconciliation and when they would do it. And recently, they began stationing a provider in the emergency department 5 days a week to work on medication reconciliation.
But shortly after the second hospital began implementing the MARQUIS interventions, the hospital launched a new EHR system that created problems for medication reconciliation. For instance, with the paper system, the admitting physician was accountable for the initial medication history. But under the electronic system, that accountability was lost. Also, the new EHR was unable to group medications as "continued," "changed," "stopped," or "new," making it difficult to perform discharge medication counseling.
The result was that, after some initial success, unintentional medication discrepancies spiked. In the preintervention period, unintentional medication discrepancies were 2.0 per patient, but they rose to nearly 5 discrepancies per patient after the rollout of the new EHR system. They have since fallen back down to 3.8 per patient. Similarly, the total of potentially harmful discrepancies rose from 0.20 to 1.11 per patient.
The free MARQUIS toolkit is available online.
On Twitter @maryellenny
LAS VEGAS – Tired of getting a patient medication list that isn’t reliable? A 3-year study on medication reconciliation could offer a roadmap for improving that list and reducing potentially harmful errors.
Preliminary results from MARQUIS (the Multi-Center Medication Reconciliation Quality Improvement Study) indicate that hospitals are able to reduce unintentional medication discrepancies by implementing a menu of interventions ranging from training providers to take a better medication history to stationing a designated provider in the emergency department to reconcile the patient’s information with pharmacies and primary care offices. But outside forces, such as problems with an electronic health record (EHR) system, can offset those effects.
The 3-year study, which will wrap up in the next few months, is sponsored by the Society of Hospital Medicine, with $1.5 million in funding from the Agency for Healthcare Research and Quality.
In the first phase of the study, researchers identified evidence-based techniques for taking the best possible medication history from hospitalized patients and synthesized them into a toolkit for clinicians. The free toolkit includes how-to videos and pocket cards. The second phase of the study is the mentored implementation of the techniques at five sites: two academic medical centers, two community hospitals, and one Veterans Affairs medical center.
Initial results from two of the five sites show that training on how to take a better medication history and clarity about who should be working on reconciling the medication list can help improve medication discrepancies. But while the interventions are promising, the initial case studies show mixed results.
While one community hospital site was able to lower medication discrepancies significantly, a second community hospital site had a spike in its medication discrepancies as it underwent a problematic implementation of a new EHR system.
Eighteen minutes to win it
At the first site, a Medication Reconciliation Assistant (MRA) program was used to improve the reliability of medication lists. The MRA is stationed in the emergency department and interviews patients about their medications and then verifies that list with the pharmacy, the primary care physician, or the skilled nursing facility. That new medication list is then handed off to the admitting physician. The process usually takes about 18-20 minutes.
They MRA program is staffed by four full-time employees, all pharmacy technicians with experience in retail pharmacies, who work 8-hour shifts throughout the week.
"It doesn’t have to be a pharmacy technician," said Dr. Jason Stein, a MARQUIS coinvestigator and a professor of medicine at Emory University, Atlanta, at the annual meeting of the Society of Hospital Medicine. "But somebody needs to be spending that 18 minutes doing something that roughly looks like this."
At that first site, unintentional medication discrepancies from either history or reconciliation errors dropped from 4.5 per patient at the in the preintervention period to 3.4 per patient. And the total number of potentially harmful discrepancies was reduced from 0.25 to 0.09 per patient.
At the second site, a smaller community hospital, the quality improvement team provided training to front-line providers on medication history taking and counseling at discharge and created a new hospital policy that clarified expectations about who would perform medication reconciliation and when they would do it. And recently, they began stationing a provider in the emergency department 5 days a week to work on medication reconciliation.
But shortly after the second hospital began implementing the MARQUIS interventions, the hospital launched a new EHR system that created problems for medication reconciliation. For instance, with the paper system, the admitting physician was accountable for the initial medication history. But under the electronic system, that accountability was lost. Also, the new EHR was unable to group medications as "continued," "changed," "stopped," or "new," making it difficult to perform discharge medication counseling.
The result was that, after some initial success, unintentional medication discrepancies spiked. In the preintervention period, unintentional medication discrepancies were 2.0 per patient, but they rose to nearly 5 discrepancies per patient after the rollout of the new EHR system. They have since fallen back down to 3.8 per patient. Similarly, the total of potentially harmful discrepancies rose from 0.20 to 1.11 per patient.
The free MARQUIS toolkit is available online.
On Twitter @maryellenny
EXPERT ANALYSIS FROM HOSPITAL MEDICINE 14
VIDEO: Hospitalists see opportunities in ACA rollout
LAS VEGAS – It’s been 4 years since Congress passed the Affordable Care Act and by now virtually all hospitalists have been impacted by some part of the law.
At the annual meeting of the Society of Hospital Medicine, leaders in the field grappled with the opportunities and challenges of implementing the controversial law.
On Twitter @maryellenny
LAS VEGAS – It’s been 4 years since Congress passed the Affordable Care Act and by now virtually all hospitalists have been impacted by some part of the law.
At the annual meeting of the Society of Hospital Medicine, leaders in the field grappled with the opportunities and challenges of implementing the controversial law.
On Twitter @maryellenny
LAS VEGAS – It’s been 4 years since Congress passed the Affordable Care Act and by now virtually all hospitalists have been impacted by some part of the law.
At the annual meeting of the Society of Hospital Medicine, leaders in the field grappled with the opportunities and challenges of implementing the controversial law.
On Twitter @maryellenny
AT HOSPITAL MEDICINE 14
