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CMS delays two-midnight rule until Oct. 1
Enforcement of Medicare’s two-midnight rule has been delayed until Oct. 1, officials at the Centers for Medicare & Medicaid Services announced.
The two-midnight rule calls on doctors and hospitals to admit patients undergoing surgical procedures, diagnostic tests, or other treatments if they anticipate that the patient will be in the hospital for two midnights. The change is aimed at clarifying when a patient should be admitted vs. being kept in observation status. The rule was originally released in August 2013.
The delay, announced Jan. 31, will provide more time to educate physicians and hospitals about the changes, according to the agency.
Until then, Medicare Administrative Contractors (MACs) will review claims with admission dates between March 31, 2014, and Sept. 30, 2014, and deny those claims that are out of compliance with the rule. The MACs will review 10 claims for most hospitals and 25 for large hospitals and conduct additional education with hospitals, according to the CMS.
But Recovery Auditors will not perform postpayment audits of claims until Oct. 1.
"The delay only postpones the inevitable," said Dr. Bradley E. Flansbaum, a hospitalist in New York City and a member of the Society of Hospital Medicine’s public policy committee. "We still want clarity on what the rule means and how to implement it."
The SHM has asked the CMS to provide more information on how and why time in an intensive care unit could be considered observation/outpatient.
Also, the SHM is seeking guidance on how physicians should handle cases in which the expected length of stay is longer than two midnights, but the patient recovers more quickly. The rule indicates that those patients should retain their inpatient status for payment, but physicians likely will face pressure to change that status back to observation, the SHM noted in a letter to CMS.
Despite the lingering questions, Dr. Flansbaum said there’s enough information available for physicians to start preparing for the change. He advised doctors to use the 6-month delay wisely and begin working as if the postpayment audits were already underway.
CMS, as well as the MACs, will hold educational sessions with hospitals through the end of September. On Feb. 27, CMS will host a call for hospitals, physicians, case managers, and other health care providers to answer frequently asked questions about the two-midnight rule.
The agency also issued guidance that outlines what information should be included in the physician certification of inpatient services; the timing of physician certification and discharge orders; who can sign the inpatient certification; the format required for certification; and the timing, content, and specificity required with an inpatient admission order.
On Twitter @maryellenny
Enforcement of Medicare’s two-midnight rule has been delayed until Oct. 1, officials at the Centers for Medicare & Medicaid Services announced.
The two-midnight rule calls on doctors and hospitals to admit patients undergoing surgical procedures, diagnostic tests, or other treatments if they anticipate that the patient will be in the hospital for two midnights. The change is aimed at clarifying when a patient should be admitted vs. being kept in observation status. The rule was originally released in August 2013.
The delay, announced Jan. 31, will provide more time to educate physicians and hospitals about the changes, according to the agency.
Until then, Medicare Administrative Contractors (MACs) will review claims with admission dates between March 31, 2014, and Sept. 30, 2014, and deny those claims that are out of compliance with the rule. The MACs will review 10 claims for most hospitals and 25 for large hospitals and conduct additional education with hospitals, according to the CMS.
But Recovery Auditors will not perform postpayment audits of claims until Oct. 1.
"The delay only postpones the inevitable," said Dr. Bradley E. Flansbaum, a hospitalist in New York City and a member of the Society of Hospital Medicine’s public policy committee. "We still want clarity on what the rule means and how to implement it."
The SHM has asked the CMS to provide more information on how and why time in an intensive care unit could be considered observation/outpatient.
Also, the SHM is seeking guidance on how physicians should handle cases in which the expected length of stay is longer than two midnights, but the patient recovers more quickly. The rule indicates that those patients should retain their inpatient status for payment, but physicians likely will face pressure to change that status back to observation, the SHM noted in a letter to CMS.
Despite the lingering questions, Dr. Flansbaum said there’s enough information available for physicians to start preparing for the change. He advised doctors to use the 6-month delay wisely and begin working as if the postpayment audits were already underway.
CMS, as well as the MACs, will hold educational sessions with hospitals through the end of September. On Feb. 27, CMS will host a call for hospitals, physicians, case managers, and other health care providers to answer frequently asked questions about the two-midnight rule.
The agency also issued guidance that outlines what information should be included in the physician certification of inpatient services; the timing of physician certification and discharge orders; who can sign the inpatient certification; the format required for certification; and the timing, content, and specificity required with an inpatient admission order.
On Twitter @maryellenny
Enforcement of Medicare’s two-midnight rule has been delayed until Oct. 1, officials at the Centers for Medicare & Medicaid Services announced.
The two-midnight rule calls on doctors and hospitals to admit patients undergoing surgical procedures, diagnostic tests, or other treatments if they anticipate that the patient will be in the hospital for two midnights. The change is aimed at clarifying when a patient should be admitted vs. being kept in observation status. The rule was originally released in August 2013.
The delay, announced Jan. 31, will provide more time to educate physicians and hospitals about the changes, according to the agency.
Until then, Medicare Administrative Contractors (MACs) will review claims with admission dates between March 31, 2014, and Sept. 30, 2014, and deny those claims that are out of compliance with the rule. The MACs will review 10 claims for most hospitals and 25 for large hospitals and conduct additional education with hospitals, according to the CMS.
But Recovery Auditors will not perform postpayment audits of claims until Oct. 1.
"The delay only postpones the inevitable," said Dr. Bradley E. Flansbaum, a hospitalist in New York City and a member of the Society of Hospital Medicine’s public policy committee. "We still want clarity on what the rule means and how to implement it."
The SHM has asked the CMS to provide more information on how and why time in an intensive care unit could be considered observation/outpatient.
Also, the SHM is seeking guidance on how physicians should handle cases in which the expected length of stay is longer than two midnights, but the patient recovers more quickly. The rule indicates that those patients should retain their inpatient status for payment, but physicians likely will face pressure to change that status back to observation, the SHM noted in a letter to CMS.
Despite the lingering questions, Dr. Flansbaum said there’s enough information available for physicians to start preparing for the change. He advised doctors to use the 6-month delay wisely and begin working as if the postpayment audits were already underway.
CMS, as well as the MACs, will hold educational sessions with hospitals through the end of September. On Feb. 27, CMS will host a call for hospitals, physicians, case managers, and other health care providers to answer frequently asked questions about the two-midnight rule.
The agency also issued guidance that outlines what information should be included in the physician certification of inpatient services; the timing of physician certification and discharge orders; who can sign the inpatient certification; the format required for certification; and the timing, content, and specificity required with an inpatient admission order.
On Twitter @maryellenny
Surgeon general nominee gets light questioning in Senate
If confirmed as the next surgeon general, Dr. Vivek Murthy said that he plans to focus on combating obesity, reducing disease from tobacco use, and rolling back the resurgence of vaccine-preventable diseases.
The noncontroversial set of public health goals runs contrary to the activist stance Dr. Murthy, a Harvard Medical School instructor and hospitalist, took as cofounder and president of Doctors for America, an organization that strongly advocated for the passage of the Affordable Care Act.
"I see my primary role as education," Dr. Murthy said Feb. 4 during questioning by the Senate Health, Education, Labor, and Pensions Committee.
If he becomes surgeon general, his focus will be on building local coalitions among government, business, and faith-based organizations to address public health issues ranging from food deserts to mental health stigma, Dr. Murthy repeatedly told senators.
He received relatively light questioning from Republicans on the committee during the 90 minute hearing, with Sen. Mike Enzi (R-Wyo.) noting that Dr. Murthy was likely to win confirmation regardless of GOP opposition since Senate rules now require only a majority to agree to bring up votes on presidential nominees.
However, some senators did raise concerns that Dr. Murthy was far more political than previous nominees and that he lacked sufficient public health experience. Sen. Lamar Alexander (R-Tenn.), the ranking Republican on the committee, said it would be hard for Dr. Murthy to be a credible advocate for reducing obesity if he also used his office to promote more controversial issues like gun control.
But Dr. Murthy pushed back on both issues. He pledged not to use the bully pulpit of the surgeon general to advocate for stronger gun control. The role of the surgeon general is to be a public health educator, "not a legislator or a judge," he said.
He also defended his experience, saying that he brings a useful perspective as a physician, researcher, teacher, and public health educator. And he pointed to his experience setting up public health programs in India to help educate young woman about HIV/AIDS prevention. That program relied on the type of local coalitions that he wants to use here to chip away at the obesity epidemic.
On Twitter @maryellenny
Doctors for America, the Affordable Care Act, Senate Health, Education, Labor, Pensions Committee, surgeon general,
If confirmed as the next surgeon general, Dr. Vivek Murthy said that he plans to focus on combating obesity, reducing disease from tobacco use, and rolling back the resurgence of vaccine-preventable diseases.
The noncontroversial set of public health goals runs contrary to the activist stance Dr. Murthy, a Harvard Medical School instructor and hospitalist, took as cofounder and president of Doctors for America, an organization that strongly advocated for the passage of the Affordable Care Act.
"I see my primary role as education," Dr. Murthy said Feb. 4 during questioning by the Senate Health, Education, Labor, and Pensions Committee.
If he becomes surgeon general, his focus will be on building local coalitions among government, business, and faith-based organizations to address public health issues ranging from food deserts to mental health stigma, Dr. Murthy repeatedly told senators.
He received relatively light questioning from Republicans on the committee during the 90 minute hearing, with Sen. Mike Enzi (R-Wyo.) noting that Dr. Murthy was likely to win confirmation regardless of GOP opposition since Senate rules now require only a majority to agree to bring up votes on presidential nominees.
However, some senators did raise concerns that Dr. Murthy was far more political than previous nominees and that he lacked sufficient public health experience. Sen. Lamar Alexander (R-Tenn.), the ranking Republican on the committee, said it would be hard for Dr. Murthy to be a credible advocate for reducing obesity if he also used his office to promote more controversial issues like gun control.
But Dr. Murthy pushed back on both issues. He pledged not to use the bully pulpit of the surgeon general to advocate for stronger gun control. The role of the surgeon general is to be a public health educator, "not a legislator or a judge," he said.
He also defended his experience, saying that he brings a useful perspective as a physician, researcher, teacher, and public health educator. And he pointed to his experience setting up public health programs in India to help educate young woman about HIV/AIDS prevention. That program relied on the type of local coalitions that he wants to use here to chip away at the obesity epidemic.
On Twitter @maryellenny
If confirmed as the next surgeon general, Dr. Vivek Murthy said that he plans to focus on combating obesity, reducing disease from tobacco use, and rolling back the resurgence of vaccine-preventable diseases.
The noncontroversial set of public health goals runs contrary to the activist stance Dr. Murthy, a Harvard Medical School instructor and hospitalist, took as cofounder and president of Doctors for America, an organization that strongly advocated for the passage of the Affordable Care Act.
"I see my primary role as education," Dr. Murthy said Feb. 4 during questioning by the Senate Health, Education, Labor, and Pensions Committee.
If he becomes surgeon general, his focus will be on building local coalitions among government, business, and faith-based organizations to address public health issues ranging from food deserts to mental health stigma, Dr. Murthy repeatedly told senators.
He received relatively light questioning from Republicans on the committee during the 90 minute hearing, with Sen. Mike Enzi (R-Wyo.) noting that Dr. Murthy was likely to win confirmation regardless of GOP opposition since Senate rules now require only a majority to agree to bring up votes on presidential nominees.
However, some senators did raise concerns that Dr. Murthy was far more political than previous nominees and that he lacked sufficient public health experience. Sen. Lamar Alexander (R-Tenn.), the ranking Republican on the committee, said it would be hard for Dr. Murthy to be a credible advocate for reducing obesity if he also used his office to promote more controversial issues like gun control.
But Dr. Murthy pushed back on both issues. He pledged not to use the bully pulpit of the surgeon general to advocate for stronger gun control. The role of the surgeon general is to be a public health educator, "not a legislator or a judge," he said.
He also defended his experience, saying that he brings a useful perspective as a physician, researcher, teacher, and public health educator. And he pointed to his experience setting up public health programs in India to help educate young woman about HIV/AIDS prevention. That program relied on the type of local coalitions that he wants to use here to chip away at the obesity epidemic.
On Twitter @maryellenny
Doctors for America, the Affordable Care Act, Senate Health, Education, Labor, Pensions Committee, surgeon general,
Doctors for America, the Affordable Care Act, Senate Health, Education, Labor, Pensions Committee, surgeon general,
Healthcare.gov woes keep 1 million out of insurance marketplace
The technical problems that plagued healthcare.gov throughout October and November could lead to 1 million fewer Americans signing up for health insurance in 2014, according to a report from the Congressional Budget Office.
The CBO previously estimated that 7 million individuals would enroll in health plans through the Affordable Care Act’s (ACA’s) insurance exchanges this year. But a report released Feb. 4 says it’s more likely that 6 million Americans will sign up during the open enrollment period that ends on March 31.
Currently, more than 3 million people have enrolled in health plans through the state- and federally run exchanges, according to the Centers for Medicare & Medicaid Services. But CBO officials said that they expect many people to sign up toward the end of the open enrollment period, especially if they are purchasing a plan primarily to avoid a tax penalty for being uninsured.
"Thus, it is possible that the number of enrollees will reach the 7 million originally projected for 2014, just as it is possible that the number will fall short of the current estimate of 6 million," the report notes.
The CBO predicts that enrollment through the exchanges will reach 22 million by 2016 as people become more familiar with the new insurance options and federal subsidies.
Healthcare.gov’s technical problems likely also depressed enrollment through Medicaid and the Children’s Health Insurance Program (CHIP) this year. The CBO now estimates that 8 million individuals, not the 9 million initially projected, will enroll in Medicaid and CHIP in 2014.
Employment also could take a hit under the ACA, according to the CBO.
Between 2017 and 2024, there could be about a 1.5% to 2% drop in the total number of hours worked in the United States, mostly among low-wage earners as they choose to cut their hours and income to maintain eligibility for federal health insurance subsidies.
On the employer side, the CBO predicts that businesses could cut back on hiring to stay below the 50-worker threshold that requires them to either offer health insurance or pay a penalty. But the CBO also expects that over time, the penalty will have little effect on the hiring of workers because businesses will pass it on to their employees in the form of reduced wages.
Overall, the CBO estimates that the ACA will reduce aggregate compensation by about 1% over the 2017-2024 period, up from a 2010 estimate of 0.5%.
On Twitter @maryellenny
The technical problems that plagued healthcare.gov throughout October and November could lead to 1 million fewer Americans signing up for health insurance in 2014, according to a report from the Congressional Budget Office.
The CBO previously estimated that 7 million individuals would enroll in health plans through the Affordable Care Act’s (ACA’s) insurance exchanges this year. But a report released Feb. 4 says it’s more likely that 6 million Americans will sign up during the open enrollment period that ends on March 31.
Currently, more than 3 million people have enrolled in health plans through the state- and federally run exchanges, according to the Centers for Medicare & Medicaid Services. But CBO officials said that they expect many people to sign up toward the end of the open enrollment period, especially if they are purchasing a plan primarily to avoid a tax penalty for being uninsured.
"Thus, it is possible that the number of enrollees will reach the 7 million originally projected for 2014, just as it is possible that the number will fall short of the current estimate of 6 million," the report notes.
The CBO predicts that enrollment through the exchanges will reach 22 million by 2016 as people become more familiar with the new insurance options and federal subsidies.
Healthcare.gov’s technical problems likely also depressed enrollment through Medicaid and the Children’s Health Insurance Program (CHIP) this year. The CBO now estimates that 8 million individuals, not the 9 million initially projected, will enroll in Medicaid and CHIP in 2014.
Employment also could take a hit under the ACA, according to the CBO.
Between 2017 and 2024, there could be about a 1.5% to 2% drop in the total number of hours worked in the United States, mostly among low-wage earners as they choose to cut their hours and income to maintain eligibility for federal health insurance subsidies.
On the employer side, the CBO predicts that businesses could cut back on hiring to stay below the 50-worker threshold that requires them to either offer health insurance or pay a penalty. But the CBO also expects that over time, the penalty will have little effect on the hiring of workers because businesses will pass it on to their employees in the form of reduced wages.
Overall, the CBO estimates that the ACA will reduce aggregate compensation by about 1% over the 2017-2024 period, up from a 2010 estimate of 0.5%.
On Twitter @maryellenny
The technical problems that plagued healthcare.gov throughout October and November could lead to 1 million fewer Americans signing up for health insurance in 2014, according to a report from the Congressional Budget Office.
The CBO previously estimated that 7 million individuals would enroll in health plans through the Affordable Care Act’s (ACA’s) insurance exchanges this year. But a report released Feb. 4 says it’s more likely that 6 million Americans will sign up during the open enrollment period that ends on March 31.
Currently, more than 3 million people have enrolled in health plans through the state- and federally run exchanges, according to the Centers for Medicare & Medicaid Services. But CBO officials said that they expect many people to sign up toward the end of the open enrollment period, especially if they are purchasing a plan primarily to avoid a tax penalty for being uninsured.
"Thus, it is possible that the number of enrollees will reach the 7 million originally projected for 2014, just as it is possible that the number will fall short of the current estimate of 6 million," the report notes.
The CBO predicts that enrollment through the exchanges will reach 22 million by 2016 as people become more familiar with the new insurance options and federal subsidies.
Healthcare.gov’s technical problems likely also depressed enrollment through Medicaid and the Children’s Health Insurance Program (CHIP) this year. The CBO now estimates that 8 million individuals, not the 9 million initially projected, will enroll in Medicaid and CHIP in 2014.
Employment also could take a hit under the ACA, according to the CBO.
Between 2017 and 2024, there could be about a 1.5% to 2% drop in the total number of hours worked in the United States, mostly among low-wage earners as they choose to cut their hours and income to maintain eligibility for federal health insurance subsidies.
On the employer side, the CBO predicts that businesses could cut back on hiring to stay below the 50-worker threshold that requires them to either offer health insurance or pay a penalty. But the CBO also expects that over time, the penalty will have little effect on the hiring of workers because businesses will pass it on to their employees in the form of reduced wages.
Overall, the CBO estimates that the ACA will reduce aggregate compensation by about 1% over the 2017-2024 period, up from a 2010 estimate of 0.5%.
On Twitter @maryellenny
House passes bill to ban federal funding of abortion
The U.S. House of Representatives has passed a bill that would bar the use of any federal funds in paying for an abortion, including tax subsidies to purchase insurance under the Affordable Care Act.
On Jan. 28, the House voted 227 to 188, with one lawmaker voting "present," to approve H.R. 7, the No Taxpayer Funding for Abortion Act. The bill would make permanent the Hyde Amendment, an annual rider placed on spending bills that prohibits federal funds from being used to pay for abortions. H.R. 7 would also bar individuals and small businesses from using federal tax subsidies under the Affordable Care Act (ACA) to purchase health plans that include coverage for abortion.
The bill includes exceptions in cases of rape or incest, or when the mother’s life is endangered.
The bill is not expected to advance in the Senate.
The bill’s sponsor, Rep. Chris Smith (R-N.J.), said that without the new legislation, the ACA would create a massive expansion of public funding for abortion. He estimated that of the 112 health plans available to members of Congress and their staff through the ACA, 103 include coverage of abortion services.
But reproductive health advocates said the bill interferes with a woman’s private health care decisions and attempts to restrict the health care services that can be offered in private insurance plans.
"This bill is as callous as it is cynical, denying insurance coverage of critical health care to millions of women across the U.S. and worsening especially the hardship of women already struggling under challenging economic conditions," Nancy Northup, president and CEO of the Center for Reproductive Rights, said in a statement.
On Twitter @maryellenny
The U.S. House of Representatives has passed a bill that would bar the use of any federal funds in paying for an abortion, including tax subsidies to purchase insurance under the Affordable Care Act.
On Jan. 28, the House voted 227 to 188, with one lawmaker voting "present," to approve H.R. 7, the No Taxpayer Funding for Abortion Act. The bill would make permanent the Hyde Amendment, an annual rider placed on spending bills that prohibits federal funds from being used to pay for abortions. H.R. 7 would also bar individuals and small businesses from using federal tax subsidies under the Affordable Care Act (ACA) to purchase health plans that include coverage for abortion.
The bill includes exceptions in cases of rape or incest, or when the mother’s life is endangered.
The bill is not expected to advance in the Senate.
The bill’s sponsor, Rep. Chris Smith (R-N.J.), said that without the new legislation, the ACA would create a massive expansion of public funding for abortion. He estimated that of the 112 health plans available to members of Congress and their staff through the ACA, 103 include coverage of abortion services.
But reproductive health advocates said the bill interferes with a woman’s private health care decisions and attempts to restrict the health care services that can be offered in private insurance plans.
"This bill is as callous as it is cynical, denying insurance coverage of critical health care to millions of women across the U.S. and worsening especially the hardship of women already struggling under challenging economic conditions," Nancy Northup, president and CEO of the Center for Reproductive Rights, said in a statement.
On Twitter @maryellenny
The U.S. House of Representatives has passed a bill that would bar the use of any federal funds in paying for an abortion, including tax subsidies to purchase insurance under the Affordable Care Act.
On Jan. 28, the House voted 227 to 188, with one lawmaker voting "present," to approve H.R. 7, the No Taxpayer Funding for Abortion Act. The bill would make permanent the Hyde Amendment, an annual rider placed on spending bills that prohibits federal funds from being used to pay for abortions. H.R. 7 would also bar individuals and small businesses from using federal tax subsidies under the Affordable Care Act (ACA) to purchase health plans that include coverage for abortion.
The bill includes exceptions in cases of rape or incest, or when the mother’s life is endangered.
The bill is not expected to advance in the Senate.
The bill’s sponsor, Rep. Chris Smith (R-N.J.), said that without the new legislation, the ACA would create a massive expansion of public funding for abortion. He estimated that of the 112 health plans available to members of Congress and their staff through the ACA, 103 include coverage of abortion services.
But reproductive health advocates said the bill interferes with a woman’s private health care decisions and attempts to restrict the health care services that can be offered in private insurance plans.
"This bill is as callous as it is cynical, denying insurance coverage of critical health care to millions of women across the U.S. and worsening especially the hardship of women already struggling under challenging economic conditions," Nancy Northup, president and CEO of the Center for Reproductive Rights, said in a statement.
On Twitter @maryellenny
Testing now is critical to ICD-10 readiness
Still not prepared for the switch over to ICD-10? Experts say there’s still time to catch up before the Oct. 1 compliance date.
In an ideal world, physicians, their coders, and office staff would have already fully assessed the cost of transitioning to ICD-10, would have undergone training about how to improve clinical documentation and appropriate use of the new diagnosis codes, and would have internally tested their upgraded software. That would leave more than half a year to complete external testing with health plans to ensure that they get paid in October.
The reality? Few are on track to meet those milestones on time.
"Everybody is behind, not just practices," said Robert Tennant, senior policy adviser at the Medical Group Management Association (MGMA). For a practice to be ready for ICD-10, the "key trading partners have to be ready and our surveys are indicating that they are not," he said.
Those partners include practice management software vendors, electronic health record (EHR) vendors, clearinghouses, and private and public payers.
So does that mean another ICD-10 delay is likely? The Centers for Medicare and Medicaid Services says no.
Part of the reason may be that health plans, which are investing money in upgrading their own systems, are pushing the agency to move forward on time. They are signaling to the government that they don’t want another delay, Mr. Tennant said.
The MGMA is advising its members to prepare for an Oct. 1 launch of ICD-10. But Mr. Tennant said he’s not entirely convinced that the CMS will stick to the date if much of the health care industry is unprepared to make the switch.
"Claims have to be paid," he said. "The system cannot grind to a halt because practices that aren’t paid can’t see patients."
Start with training
Assuming that most physician offices have assessed which parts of their practice management and EHR systems need to be upgraded, and have determined the cost for upgrades and training, it’s time to get familiar with the new diagnosis coding system.
Coders and billers will need the most training on the new coding methodology, but doctors still need to get familiar with the level of documentation that’s need for their most frequently used codes. In general, the new system calls for great specificity, though it’s not an absolute rule.
For instance, the classification for asthma has changed from ICD-9 to ICD-10. Physicians will need to provide more specific documentation about the severity level (moderately persistent, severely persistent, etc.) for their coders to select the appropriate ICD-10 code, according to Kathryn DeVault, a coding expert at the American Health Information Management Association (AHIMA).
"The good news is that as different as ICD-10 and ICD-9 are, they are similar," Ms. DeVault said. "If there’s a familiarity or comfort level working with ICD-9, it’s a natural transition to ICD-10."
While there are some significant changes, especially related to orthopedic codes, for many subspecialties the differences will be minimal, she said.
Ms. DeVault recommended having the practice manager or lead coder identify the top 20 diagnosis codes for every physician in the practice and build some education around those frequently used codes.
She cautioned doctors not to skimp on the time and money needed to thoroughly train themselves and their staffs. "The key here is to do it right and do it right the first time," she said.
Check the books
Physicians and their staff also need to evaluate their current cash flow and revenue cycle, including the age of account balances, billing lag time, and other issues that may result in delayed or denied claims, said Asia Blunt, practice management strategist at the American Academy of Family Physicians. Correct those problems now, she said, then reevaluate between April and August.
Experts at the AAFP are recommending that physicians put aside a cash reserve, if possible, to cover expenses during the first 3 months of the transition in case large numbers of claims are denied. (See below for more tips on planning for the worst.)
Testing with vendors, payers
Internal and external testing is also key. Before Oct. 1, practices should have completed end-to-end testing of their upgraded systems, ensuring that everything works smoothly from the time they code a claim to when they receive payment from the health insurer.
Practices can begin internal testing as soon as they have upgraded their software. But external testing will depend on when clearinghouses and health plans are ready.
The CMS will provide the first testing opportunity March 3-7. The agency will hold a national ICD-10 testing week allowing practices and clearinghouses to submit claims using the new coding system. Practices will receive an acknowledgement that the claims were either accepted or rejected by the system. Practices must register in advance through their local Medicare Administrative Contractor (MAC) website to test. Find your local MAC here.
But this type of front-end testing is only a first step, Mr. Tennant said. Front-end testing determines whether the claim contains an ICD-10 code and if it is in the right place and the right format. But practices will need to conduct further testing with payers to determine if the code they used is appropriate and whether they will get paid.
For instance, when submitting a claim for a sprained ankle under ICD-10, the coder might specify right or left ankle, or leave it as unspecified. Depending on the health insurer’s policy around the code, the insurer could pay the claim, reject it, or hold or "pend" it while seeking additional information. The complicating factor, Mr. Tennant said, is that each health insurer has different coding policies and those policies have yet to be released for ICD-10.
"It’s very frustrating for everybody," Mr. Tennant said.
To minimize the impact, Mr. Tennant recommended identifying the payers responsible for the majority of your claims. Keep in contact with them about the release of their payment policies and testing schedules, he said.
"Be aggressive in your outreach to those plans," he said.
Contingency plans
Just in case a worst-case scenario develops, Mr. Tennant offered the advice on ICD-10 contingency plans:
• Research back-up options for practice management systems and clearinghouses. If the vendors aren’t providing a clear answer on when they will be ready to offer upgrades and testing, start researching alternatives. Ask colleagues if they have vendors that are prepared for the transition.
• Don’t rely on one coder. Train more than one staff member on how to use the new coding system. That way, if the chief coder leaves 3 weeks before the compliance date, someone else can step in.
• Limit vacations around the Oct. 1 compliance date. This is not a time to operate short staffed.
• Don’t wait around for health plans to start ICD-10 testing. Start with context testing. Take a subset of high-dollar, high-volume ICD-9 claims that have already been paid by the health plan and practice coding them in ICD-10. Similarly, begin to code claims in parallel in both ICD-9 and ICD-10 and move them through your internal workflow. In both of these testing approaches, check if the documentation provided is sufficient to identify the best ICD-10 code. If not, it’s time for more training.
• Ensure you have enough cash to operate in case claims are rejected or delayed. Setting aside cash reserves is a good move. Consider postponing major capital investments for a few months before and after Oct. 1. Obtaining a line of credit to cover a few months of operating expenses is another option.
• Submit as many of claims as possible with ICD-9 codes before Oct. 1.
Free ICD-10 resources
• ICD-10 guide with checklists and timelines (CMS).
• Sample letter to gauge vendors’ ICD-10 readiness (AHIMA).
• Cost calculator and ICD-10 timeline (AAFP).
• Twelve step transition plan, white papers, and practice tool (AMA)
On Twitter @maryellenny
Still not prepared for the switch over to ICD-10? Experts say there’s still time to catch up before the Oct. 1 compliance date.
In an ideal world, physicians, their coders, and office staff would have already fully assessed the cost of transitioning to ICD-10, would have undergone training about how to improve clinical documentation and appropriate use of the new diagnosis codes, and would have internally tested their upgraded software. That would leave more than half a year to complete external testing with health plans to ensure that they get paid in October.
The reality? Few are on track to meet those milestones on time.
"Everybody is behind, not just practices," said Robert Tennant, senior policy adviser at the Medical Group Management Association (MGMA). For a practice to be ready for ICD-10, the "key trading partners have to be ready and our surveys are indicating that they are not," he said.
Those partners include practice management software vendors, electronic health record (EHR) vendors, clearinghouses, and private and public payers.
So does that mean another ICD-10 delay is likely? The Centers for Medicare and Medicaid Services says no.
Part of the reason may be that health plans, which are investing money in upgrading their own systems, are pushing the agency to move forward on time. They are signaling to the government that they don’t want another delay, Mr. Tennant said.
The MGMA is advising its members to prepare for an Oct. 1 launch of ICD-10. But Mr. Tennant said he’s not entirely convinced that the CMS will stick to the date if much of the health care industry is unprepared to make the switch.
"Claims have to be paid," he said. "The system cannot grind to a halt because practices that aren’t paid can’t see patients."
Start with training
Assuming that most physician offices have assessed which parts of their practice management and EHR systems need to be upgraded, and have determined the cost for upgrades and training, it’s time to get familiar with the new diagnosis coding system.
Coders and billers will need the most training on the new coding methodology, but doctors still need to get familiar with the level of documentation that’s need for their most frequently used codes. In general, the new system calls for great specificity, though it’s not an absolute rule.
For instance, the classification for asthma has changed from ICD-9 to ICD-10. Physicians will need to provide more specific documentation about the severity level (moderately persistent, severely persistent, etc.) for their coders to select the appropriate ICD-10 code, according to Kathryn DeVault, a coding expert at the American Health Information Management Association (AHIMA).
"The good news is that as different as ICD-10 and ICD-9 are, they are similar," Ms. DeVault said. "If there’s a familiarity or comfort level working with ICD-9, it’s a natural transition to ICD-10."
While there are some significant changes, especially related to orthopedic codes, for many subspecialties the differences will be minimal, she said.
Ms. DeVault recommended having the practice manager or lead coder identify the top 20 diagnosis codes for every physician in the practice and build some education around those frequently used codes.
She cautioned doctors not to skimp on the time and money needed to thoroughly train themselves and their staffs. "The key here is to do it right and do it right the first time," she said.
Check the books
Physicians and their staff also need to evaluate their current cash flow and revenue cycle, including the age of account balances, billing lag time, and other issues that may result in delayed or denied claims, said Asia Blunt, practice management strategist at the American Academy of Family Physicians. Correct those problems now, she said, then reevaluate between April and August.
Experts at the AAFP are recommending that physicians put aside a cash reserve, if possible, to cover expenses during the first 3 months of the transition in case large numbers of claims are denied. (See below for more tips on planning for the worst.)
Testing with vendors, payers
Internal and external testing is also key. Before Oct. 1, practices should have completed end-to-end testing of their upgraded systems, ensuring that everything works smoothly from the time they code a claim to when they receive payment from the health insurer.
Practices can begin internal testing as soon as they have upgraded their software. But external testing will depend on when clearinghouses and health plans are ready.
The CMS will provide the first testing opportunity March 3-7. The agency will hold a national ICD-10 testing week allowing practices and clearinghouses to submit claims using the new coding system. Practices will receive an acknowledgement that the claims were either accepted or rejected by the system. Practices must register in advance through their local Medicare Administrative Contractor (MAC) website to test. Find your local MAC here.
But this type of front-end testing is only a first step, Mr. Tennant said. Front-end testing determines whether the claim contains an ICD-10 code and if it is in the right place and the right format. But practices will need to conduct further testing with payers to determine if the code they used is appropriate and whether they will get paid.
For instance, when submitting a claim for a sprained ankle under ICD-10, the coder might specify right or left ankle, or leave it as unspecified. Depending on the health insurer’s policy around the code, the insurer could pay the claim, reject it, or hold or "pend" it while seeking additional information. The complicating factor, Mr. Tennant said, is that each health insurer has different coding policies and those policies have yet to be released for ICD-10.
"It’s very frustrating for everybody," Mr. Tennant said.
To minimize the impact, Mr. Tennant recommended identifying the payers responsible for the majority of your claims. Keep in contact with them about the release of their payment policies and testing schedules, he said.
"Be aggressive in your outreach to those plans," he said.
Contingency plans
Just in case a worst-case scenario develops, Mr. Tennant offered the advice on ICD-10 contingency plans:
• Research back-up options for practice management systems and clearinghouses. If the vendors aren’t providing a clear answer on when they will be ready to offer upgrades and testing, start researching alternatives. Ask colleagues if they have vendors that are prepared for the transition.
• Don’t rely on one coder. Train more than one staff member on how to use the new coding system. That way, if the chief coder leaves 3 weeks before the compliance date, someone else can step in.
• Limit vacations around the Oct. 1 compliance date. This is not a time to operate short staffed.
• Don’t wait around for health plans to start ICD-10 testing. Start with context testing. Take a subset of high-dollar, high-volume ICD-9 claims that have already been paid by the health plan and practice coding them in ICD-10. Similarly, begin to code claims in parallel in both ICD-9 and ICD-10 and move them through your internal workflow. In both of these testing approaches, check if the documentation provided is sufficient to identify the best ICD-10 code. If not, it’s time for more training.
• Ensure you have enough cash to operate in case claims are rejected or delayed. Setting aside cash reserves is a good move. Consider postponing major capital investments for a few months before and after Oct. 1. Obtaining a line of credit to cover a few months of operating expenses is another option.
• Submit as many of claims as possible with ICD-9 codes before Oct. 1.
Free ICD-10 resources
• ICD-10 guide with checklists and timelines (CMS).
• Sample letter to gauge vendors’ ICD-10 readiness (AHIMA).
• Cost calculator and ICD-10 timeline (AAFP).
• Twelve step transition plan, white papers, and practice tool (AMA)
On Twitter @maryellenny
Still not prepared for the switch over to ICD-10? Experts say there’s still time to catch up before the Oct. 1 compliance date.
In an ideal world, physicians, their coders, and office staff would have already fully assessed the cost of transitioning to ICD-10, would have undergone training about how to improve clinical documentation and appropriate use of the new diagnosis codes, and would have internally tested their upgraded software. That would leave more than half a year to complete external testing with health plans to ensure that they get paid in October.
The reality? Few are on track to meet those milestones on time.
"Everybody is behind, not just practices," said Robert Tennant, senior policy adviser at the Medical Group Management Association (MGMA). For a practice to be ready for ICD-10, the "key trading partners have to be ready and our surveys are indicating that they are not," he said.
Those partners include practice management software vendors, electronic health record (EHR) vendors, clearinghouses, and private and public payers.
So does that mean another ICD-10 delay is likely? The Centers for Medicare and Medicaid Services says no.
Part of the reason may be that health plans, which are investing money in upgrading their own systems, are pushing the agency to move forward on time. They are signaling to the government that they don’t want another delay, Mr. Tennant said.
The MGMA is advising its members to prepare for an Oct. 1 launch of ICD-10. But Mr. Tennant said he’s not entirely convinced that the CMS will stick to the date if much of the health care industry is unprepared to make the switch.
"Claims have to be paid," he said. "The system cannot grind to a halt because practices that aren’t paid can’t see patients."
Start with training
Assuming that most physician offices have assessed which parts of their practice management and EHR systems need to be upgraded, and have determined the cost for upgrades and training, it’s time to get familiar with the new diagnosis coding system.
Coders and billers will need the most training on the new coding methodology, but doctors still need to get familiar with the level of documentation that’s need for their most frequently used codes. In general, the new system calls for great specificity, though it’s not an absolute rule.
For instance, the classification for asthma has changed from ICD-9 to ICD-10. Physicians will need to provide more specific documentation about the severity level (moderately persistent, severely persistent, etc.) for their coders to select the appropriate ICD-10 code, according to Kathryn DeVault, a coding expert at the American Health Information Management Association (AHIMA).
"The good news is that as different as ICD-10 and ICD-9 are, they are similar," Ms. DeVault said. "If there’s a familiarity or comfort level working with ICD-9, it’s a natural transition to ICD-10."
While there are some significant changes, especially related to orthopedic codes, for many subspecialties the differences will be minimal, she said.
Ms. DeVault recommended having the practice manager or lead coder identify the top 20 diagnosis codes for every physician in the practice and build some education around those frequently used codes.
She cautioned doctors not to skimp on the time and money needed to thoroughly train themselves and their staffs. "The key here is to do it right and do it right the first time," she said.
Check the books
Physicians and their staff also need to evaluate their current cash flow and revenue cycle, including the age of account balances, billing lag time, and other issues that may result in delayed or denied claims, said Asia Blunt, practice management strategist at the American Academy of Family Physicians. Correct those problems now, she said, then reevaluate between April and August.
Experts at the AAFP are recommending that physicians put aside a cash reserve, if possible, to cover expenses during the first 3 months of the transition in case large numbers of claims are denied. (See below for more tips on planning for the worst.)
Testing with vendors, payers
Internal and external testing is also key. Before Oct. 1, practices should have completed end-to-end testing of their upgraded systems, ensuring that everything works smoothly from the time they code a claim to when they receive payment from the health insurer.
Practices can begin internal testing as soon as they have upgraded their software. But external testing will depend on when clearinghouses and health plans are ready.
The CMS will provide the first testing opportunity March 3-7. The agency will hold a national ICD-10 testing week allowing practices and clearinghouses to submit claims using the new coding system. Practices will receive an acknowledgement that the claims were either accepted or rejected by the system. Practices must register in advance through their local Medicare Administrative Contractor (MAC) website to test. Find your local MAC here.
But this type of front-end testing is only a first step, Mr. Tennant said. Front-end testing determines whether the claim contains an ICD-10 code and if it is in the right place and the right format. But practices will need to conduct further testing with payers to determine if the code they used is appropriate and whether they will get paid.
For instance, when submitting a claim for a sprained ankle under ICD-10, the coder might specify right or left ankle, or leave it as unspecified. Depending on the health insurer’s policy around the code, the insurer could pay the claim, reject it, or hold or "pend" it while seeking additional information. The complicating factor, Mr. Tennant said, is that each health insurer has different coding policies and those policies have yet to be released for ICD-10.
"It’s very frustrating for everybody," Mr. Tennant said.
To minimize the impact, Mr. Tennant recommended identifying the payers responsible for the majority of your claims. Keep in contact with them about the release of their payment policies and testing schedules, he said.
"Be aggressive in your outreach to those plans," he said.
Contingency plans
Just in case a worst-case scenario develops, Mr. Tennant offered the advice on ICD-10 contingency plans:
• Research back-up options for practice management systems and clearinghouses. If the vendors aren’t providing a clear answer on when they will be ready to offer upgrades and testing, start researching alternatives. Ask colleagues if they have vendors that are prepared for the transition.
• Don’t rely on one coder. Train more than one staff member on how to use the new coding system. That way, if the chief coder leaves 3 weeks before the compliance date, someone else can step in.
• Limit vacations around the Oct. 1 compliance date. This is not a time to operate short staffed.
• Don’t wait around for health plans to start ICD-10 testing. Start with context testing. Take a subset of high-dollar, high-volume ICD-9 claims that have already been paid by the health plan and practice coding them in ICD-10. Similarly, begin to code claims in parallel in both ICD-9 and ICD-10 and move them through your internal workflow. In both of these testing approaches, check if the documentation provided is sufficient to identify the best ICD-10 code. If not, it’s time for more training.
• Ensure you have enough cash to operate in case claims are rejected or delayed. Setting aside cash reserves is a good move. Consider postponing major capital investments for a few months before and after Oct. 1. Obtaining a line of credit to cover a few months of operating expenses is another option.
• Submit as many of claims as possible with ICD-9 codes before Oct. 1.
Free ICD-10 resources
• ICD-10 guide with checklists and timelines (CMS).
• Sample letter to gauge vendors’ ICD-10 readiness (AHIMA).
• Cost calculator and ICD-10 timeline (AAFP).
• Twelve step transition plan, white papers, and practice tool (AMA)
On Twitter @maryellenny
SGR fix could cost as much as $150 billion
Current proposals to repeal the Medicare Sustainable Growth Rate formula and replace it with a new payment system could cost anywhere from $121 billion to $150 billion over the next decade, according to new estimates from the Congressional Budget Office.
Legislation (H.R. 2810) approved by the House Ways and Means Committee in December is the least expensive option. It would cost about $121 billion over 10 years, according to the CBO projection. That bill includes 2 years of 0.5% pay updates for physicians and begins to partially tie payment to performance.
A more expensive option (S. 1871), approved by the Senate Finance Committee in December, would cost $150.4 billion through 2023, the CBO estimated. The Senate version would freeze physician payments for the next decade, but would allow physicians to earn more by participating in alternative payment models or another incentive program that measures quality of care and resource use.
The additional cost for this bill comes from extending some Medicare and Medicaid programs; the physician payment portion alone would cost about $111.5 billion over 10 years, CBO predicted.
The price tag will have a big impact on whether Congress can pass an SGR repeal bill this year. The Medicare fee cut for 2014 – which was to kick in Jan. 1 – was replaced by a 0.5% physician pay increase through March 31. But the cut will take effect on April 1 if Congress does not enact either another temporary SGR fix or a permanent repeal of the formula.
While there has been widespread bipartisan support for SGR repeal, there has yet to be any serious discussion of how lawmakers would pay for the fix. Physician groups, which have been deeply involved in the policy discussions surrounding SGR repeal, have also remained silent on how to pay for it.
On Twitter @maryellenny
Current proposals to repeal the Medicare Sustainable Growth Rate formula and replace it with a new payment system could cost anywhere from $121 billion to $150 billion over the next decade, according to new estimates from the Congressional Budget Office.
Legislation (H.R. 2810) approved by the House Ways and Means Committee in December is the least expensive option. It would cost about $121 billion over 10 years, according to the CBO projection. That bill includes 2 years of 0.5% pay updates for physicians and begins to partially tie payment to performance.
A more expensive option (S. 1871), approved by the Senate Finance Committee in December, would cost $150.4 billion through 2023, the CBO estimated. The Senate version would freeze physician payments for the next decade, but would allow physicians to earn more by participating in alternative payment models or another incentive program that measures quality of care and resource use.
The additional cost for this bill comes from extending some Medicare and Medicaid programs; the physician payment portion alone would cost about $111.5 billion over 10 years, CBO predicted.
The price tag will have a big impact on whether Congress can pass an SGR repeal bill this year. The Medicare fee cut for 2014 – which was to kick in Jan. 1 – was replaced by a 0.5% physician pay increase through March 31. But the cut will take effect on April 1 if Congress does not enact either another temporary SGR fix or a permanent repeal of the formula.
While there has been widespread bipartisan support for SGR repeal, there has yet to be any serious discussion of how lawmakers would pay for the fix. Physician groups, which have been deeply involved in the policy discussions surrounding SGR repeal, have also remained silent on how to pay for it.
On Twitter @maryellenny
Current proposals to repeal the Medicare Sustainable Growth Rate formula and replace it with a new payment system could cost anywhere from $121 billion to $150 billion over the next decade, according to new estimates from the Congressional Budget Office.
Legislation (H.R. 2810) approved by the House Ways and Means Committee in December is the least expensive option. It would cost about $121 billion over 10 years, according to the CBO projection. That bill includes 2 years of 0.5% pay updates for physicians and begins to partially tie payment to performance.
A more expensive option (S. 1871), approved by the Senate Finance Committee in December, would cost $150.4 billion through 2023, the CBO estimated. The Senate version would freeze physician payments for the next decade, but would allow physicians to earn more by participating in alternative payment models or another incentive program that measures quality of care and resource use.
The additional cost for this bill comes from extending some Medicare and Medicaid programs; the physician payment portion alone would cost about $111.5 billion over 10 years, CBO predicted.
The price tag will have a big impact on whether Congress can pass an SGR repeal bill this year. The Medicare fee cut for 2014 – which was to kick in Jan. 1 – was replaced by a 0.5% physician pay increase through March 31. But the cut will take effect on April 1 if Congress does not enact either another temporary SGR fix or a permanent repeal of the formula.
While there has been widespread bipartisan support for SGR repeal, there has yet to be any serious discussion of how lawmakers would pay for the fix. Physician groups, which have been deeply involved in the policy discussions surrounding SGR repeal, have also remained silent on how to pay for it.
On Twitter @maryellenny
ACGME guidance aims to improve safety, quality
New guidance from the Accreditation Council for Graduate Medical Education aims to upgrade resident and fellow instruction in patient safety and quality improvement.
The guidance is designed to address a shortcoming ACGME officials saw during the course of site visits to more than 100 hospitals.
The problem can be summed up in an example from a site visit: A second-year anesthesiology resident administered the wrong dose of fentanyl, and the procedure had to be temporarily halted after the patient developed severe hypotension. Ultimately, the patient suffered no harm from the mix-up. After reporting the incident in the department’s morbidity and mortality conference and discussing it with the attending physician, the resident was told to review the approach to dosing fentanyl and to "be more careful."
The hospital’s response focuses on the resident’s actions, but misses all of the systems issues that may have contributed to the error, Dr. Thomas J. Nasca, Dr. Kevin B. Weiss, and Dr. James P. Bagian of ACGME, wrote in a perspective published Jan. 27 in the New England Journal of Medicine (doi:10.1056/NEJMp1314628).
"Such an approach does little to expand the resident’s knowledge and reflects poorly on the institutional clinical environment," they wrote.
The ACGME is calling on hospitals to ensure that all residents and faculty members know how to report patient safety events and that they receive periodic, interprofessional, and team training on patient safety. Residents and fellows should also have the chance to participate in either real or simulated interprofessional patient-safety investigations, such as root cause analyses. And hospitals should give feedback after an adverse event so that residents and fellows know what actions the institution is taking to fix any systems issues that may have been involved.
The new guidance also recommends that:
• Residents and fellows engage in periodic quality improvement education that highlights systems-based challenges.
• Hospitals provide residents and fellows with specialty-specific data on quality metrics and benchmarks for the patients they treat.
• Hospitals include residents and fellows in quality improvement committees.
• Residents and fellows receive training cultural competency relevant to the patient population at their hospital.
• Residents and fellows participate in simulated or real-time interprofessional training on better communicating transitions of care.
Site visits were conducted as part of ACGME’s Clinical Learning Environment Review (CLER) program, which assesses teaching institutions in terms of patient safety, quality improvement, transitions of care, supervision, duty hour oversight, and professionalism.
On Twitter @maryellenny
The guidance is designed to address a shortcoming ACGME officials saw during the course of site visits to more than 100 hospitals.
The problem can be summed up in an example from a site visit: A second-year anesthesiology resident administered the wrong dose of fentanyl, and the procedure had to be temporarily halted after the patient developed severe hypotension. Ultimately, the patient suffered no harm from the mix-up. After reporting the incident in the department’s morbidity and mortality conference and discussing it with the attending physician, the resident was told to review the approach to dosing fentanyl and to "be more careful."
New guidance from the Accreditation Council for Graduate Medical Education aims to upgrade resident and fellow instruction in patient safety and quality improvement.
The guidance is designed to address a shortcoming ACGME officials saw during the course of site visits to more than 100 hospitals.
The problem can be summed up in an example from a site visit: A second-year anesthesiology resident administered the wrong dose of fentanyl, and the procedure had to be temporarily halted after the patient developed severe hypotension. Ultimately, the patient suffered no harm from the mix-up. After reporting the incident in the department’s morbidity and mortality conference and discussing it with the attending physician, the resident was told to review the approach to dosing fentanyl and to "be more careful."
The hospital’s response focuses on the resident’s actions, but misses all of the systems issues that may have contributed to the error, Dr. Thomas J. Nasca, Dr. Kevin B. Weiss, and Dr. James P. Bagian of ACGME, wrote in a perspective published Jan. 27 in the New England Journal of Medicine (doi:10.1056/NEJMp1314628).
"Such an approach does little to expand the resident’s knowledge and reflects poorly on the institutional clinical environment," they wrote.
The ACGME is calling on hospitals to ensure that all residents and faculty members know how to report patient safety events and that they receive periodic, interprofessional, and team training on patient safety. Residents and fellows should also have the chance to participate in either real or simulated interprofessional patient-safety investigations, such as root cause analyses. And hospitals should give feedback after an adverse event so that residents and fellows know what actions the institution is taking to fix any systems issues that may have been involved.
The new guidance also recommends that:
• Residents and fellows engage in periodic quality improvement education that highlights systems-based challenges.
• Hospitals provide residents and fellows with specialty-specific data on quality metrics and benchmarks for the patients they treat.
• Hospitals include residents and fellows in quality improvement committees.
• Residents and fellows receive training cultural competency relevant to the patient population at their hospital.
• Residents and fellows participate in simulated or real-time interprofessional training on better communicating transitions of care.
Site visits were conducted as part of ACGME’s Clinical Learning Environment Review (CLER) program, which assesses teaching institutions in terms of patient safety, quality improvement, transitions of care, supervision, duty hour oversight, and professionalism.
On Twitter @maryellenny
New guidance from the Accreditation Council for Graduate Medical Education aims to upgrade resident and fellow instruction in patient safety and quality improvement.
The guidance is designed to address a shortcoming ACGME officials saw during the course of site visits to more than 100 hospitals.
The problem can be summed up in an example from a site visit: A second-year anesthesiology resident administered the wrong dose of fentanyl, and the procedure had to be temporarily halted after the patient developed severe hypotension. Ultimately, the patient suffered no harm from the mix-up. After reporting the incident in the department’s morbidity and mortality conference and discussing it with the attending physician, the resident was told to review the approach to dosing fentanyl and to "be more careful."
The hospital’s response focuses on the resident’s actions, but misses all of the systems issues that may have contributed to the error, Dr. Thomas J. Nasca, Dr. Kevin B. Weiss, and Dr. James P. Bagian of ACGME, wrote in a perspective published Jan. 27 in the New England Journal of Medicine (doi:10.1056/NEJMp1314628).
"Such an approach does little to expand the resident’s knowledge and reflects poorly on the institutional clinical environment," they wrote.
The ACGME is calling on hospitals to ensure that all residents and faculty members know how to report patient safety events and that they receive periodic, interprofessional, and team training on patient safety. Residents and fellows should also have the chance to participate in either real or simulated interprofessional patient-safety investigations, such as root cause analyses. And hospitals should give feedback after an adverse event so that residents and fellows know what actions the institution is taking to fix any systems issues that may have been involved.
The new guidance also recommends that:
• Residents and fellows engage in periodic quality improvement education that highlights systems-based challenges.
• Hospitals provide residents and fellows with specialty-specific data on quality metrics and benchmarks for the patients they treat.
• Hospitals include residents and fellows in quality improvement committees.
• Residents and fellows receive training cultural competency relevant to the patient population at their hospital.
• Residents and fellows participate in simulated or real-time interprofessional training on better communicating transitions of care.
Site visits were conducted as part of ACGME’s Clinical Learning Environment Review (CLER) program, which assesses teaching institutions in terms of patient safety, quality improvement, transitions of care, supervision, duty hour oversight, and professionalism.
On Twitter @maryellenny
The guidance is designed to address a shortcoming ACGME officials saw during the course of site visits to more than 100 hospitals.
The problem can be summed up in an example from a site visit: A second-year anesthesiology resident administered the wrong dose of fentanyl, and the procedure had to be temporarily halted after the patient developed severe hypotension. Ultimately, the patient suffered no harm from the mix-up. After reporting the incident in the department’s morbidity and mortality conference and discussing it with the attending physician, the resident was told to review the approach to dosing fentanyl and to "be more careful."
The guidance is designed to address a shortcoming ACGME officials saw during the course of site visits to more than 100 hospitals.
The problem can be summed up in an example from a site visit: A second-year anesthesiology resident administered the wrong dose of fentanyl, and the procedure had to be temporarily halted after the patient developed severe hypotension. Ultimately, the patient suffered no harm from the mix-up. After reporting the incident in the department’s morbidity and mortality conference and discussing it with the attending physician, the resident was told to review the approach to dosing fentanyl and to "be more careful."
Supreme Court gives Catholic organizations a pass on contraception mandate
The Supreme Court will not require a religiously affiliated nursing home and more than 400 associated Catholic organizations to comply with the Affordable Care Act’s contraception mandate, at least for now.
But the injunction, issued Jan. 24, sheds little light on how the high court will ultimately rule on whether the ACA’s requirement for employer health insurance policies to cover contraceptives is constitutional or a violation of religious freedom. That’s because the court’s order is very narrow and relates only to the particular circumstances of the Mullen Home for the Aged, a Denver nursing home run by the Little Sisters of the Poor, and other Catholic organizations that receive health benefits through the Christian Brothers religious order.
The Supreme Court said that the groups do not have to comply with the ACA mandate as long as they write a letter to the Secretary of Health and Human Services stating that they are "nonprofit organizations that hold themselves out as religious and have religious objections to providing coverage for contraceptive services." That letter would prevent the government from levying fines on the organizations pending the outcome of the class action lawsuit currently before the U.S. Court of Appeals for the Tenth Circuit.
The Supreme Court will be tackling some of the larger issues of constitutionality and religious freedom in March, when it hears arguments in the case of private companies whose owners have a moral objection to providing contraceptives. Oral arguments are set to begin on March 25 in Sebelius v. Hobby Lobby Stores Inc. and Conestoga Wood Specialties v. Sebelius.
On Twitter @maryellenny
The Supreme Court will not require a religiously affiliated nursing home and more than 400 associated Catholic organizations to comply with the Affordable Care Act’s contraception mandate, at least for now.
But the injunction, issued Jan. 24, sheds little light on how the high court will ultimately rule on whether the ACA’s requirement for employer health insurance policies to cover contraceptives is constitutional or a violation of religious freedom. That’s because the court’s order is very narrow and relates only to the particular circumstances of the Mullen Home for the Aged, a Denver nursing home run by the Little Sisters of the Poor, and other Catholic organizations that receive health benefits through the Christian Brothers religious order.
The Supreme Court said that the groups do not have to comply with the ACA mandate as long as they write a letter to the Secretary of Health and Human Services stating that they are "nonprofit organizations that hold themselves out as religious and have religious objections to providing coverage for contraceptive services." That letter would prevent the government from levying fines on the organizations pending the outcome of the class action lawsuit currently before the U.S. Court of Appeals for the Tenth Circuit.
The Supreme Court will be tackling some of the larger issues of constitutionality and religious freedom in March, when it hears arguments in the case of private companies whose owners have a moral objection to providing contraceptives. Oral arguments are set to begin on March 25 in Sebelius v. Hobby Lobby Stores Inc. and Conestoga Wood Specialties v. Sebelius.
On Twitter @maryellenny
The Supreme Court will not require a religiously affiliated nursing home and more than 400 associated Catholic organizations to comply with the Affordable Care Act’s contraception mandate, at least for now.
But the injunction, issued Jan. 24, sheds little light on how the high court will ultimately rule on whether the ACA’s requirement for employer health insurance policies to cover contraceptives is constitutional or a violation of religious freedom. That’s because the court’s order is very narrow and relates only to the particular circumstances of the Mullen Home for the Aged, a Denver nursing home run by the Little Sisters of the Poor, and other Catholic organizations that receive health benefits through the Christian Brothers religious order.
The Supreme Court said that the groups do not have to comply with the ACA mandate as long as they write a letter to the Secretary of Health and Human Services stating that they are "nonprofit organizations that hold themselves out as religious and have religious objections to providing coverage for contraceptive services." That letter would prevent the government from levying fines on the organizations pending the outcome of the class action lawsuit currently before the U.S. Court of Appeals for the Tenth Circuit.
The Supreme Court will be tackling some of the larger issues of constitutionality and religious freedom in March, when it hears arguments in the case of private companies whose owners have a moral objection to providing contraceptives. Oral arguments are set to begin on March 25 in Sebelius v. Hobby Lobby Stores Inc. and Conestoga Wood Specialties v. Sebelius.
On Twitter @maryellenny
Joint Commission targets patient flow in 2014
The Joint Commission is continuing its focus on reducing emergency department boarding with the introduction of additional standards aimed at improving the flow of patients throughout the hospital.
In performance standards that went into effect on Jan. 1, the Joint Commission is requiring its accredited hospitals to measure and set goals for "mitigating and managing" the boarding of patients who come through the emergency department. And the organization recommends that hospitals try to limit boarding to no more than 4 hours after the decision to admit or transfer has been made, though the 4-hour time frame is a guideline and hospitals won’t be scored on whether they can meet it.
The Joint Commission is also requiring hospitals to do more to curb the boarding of patients with mental health or substance abuse emergencies in particular. In a new standard that took effect on Jan. 1, hospital leaders are required to reach out to behavioral health care providers in the community whenever they encounter patients at risk for boarding due to a behavioral health emergency.
The new standards come a year after hospitals were asked to make reducing boarding in the ED, a hospital-wide mission by setting specific goals on ensuring the availability of patient beds and maintaining proper throughput in laboratories, operating rooms, inpatient units, telemetry, radiology, and the postanesthesia-care unit. Also in 2013, hospitals were asked to create a safe, monitored location to board behavioral health patients awaiting treatment.
The standards are mostly good news for emergency physicians, said Dr. Frederick C. Blum, a past president of the American College of Emergency Physicians and an attending physician in the department of emergency medicine at West Virginia University in Morgantown, because they pull the hospital leadership into the issues of ED boarding in general and how to handle boarding of behavioral health patients.
"Previously, the hospitals have not given this issue as much attention," he said. "This at least makes them partners with us to try solve this problem of ED boarding."
But even with the whole hospital behind the problem, it will remain a challenge, Dr. Blum said. One complicating factor is the Affordable Care Act. No one knows for sure how the ACA will change the volume of patients coming to the ED, Dr. Blum said, and hospitals still have to deal with persistent problems such as the shortage of hospital beds.
For hospitalists, the increased focus on patient flow could bring some major changes, according to Dr. David Yu, medical director of the adult inpatient medicine service at Presbyterian Medical Group in Albuquerque, N.M.
Currently, hospitalist groups are structured financially for maximum productivity not patient flow. And, as a result, efficiently discharging patients and freeing up hospital beds isn’t a top priority for hospitalists, he said.
"It’s going to be a paradigm shift," Dr. Yu said.
To get hospitalists and other specialists in the hospital focused on improving patient flow, hospital leaders will need to switch up the financial incentives and set a hospital-wide budget that makes patient flow a priority, Dr. Yu said.
On Twitter @maryellenny
The Joint Commission is continuing its focus on reducing emergency department boarding with the introduction of additional standards aimed at improving the flow of patients throughout the hospital.
In performance standards that went into effect on Jan. 1, the Joint Commission is requiring its accredited hospitals to measure and set goals for "mitigating and managing" the boarding of patients who come through the emergency department. And the organization recommends that hospitals try to limit boarding to no more than 4 hours after the decision to admit or transfer has been made, though the 4-hour time frame is a guideline and hospitals won’t be scored on whether they can meet it.
The Joint Commission is also requiring hospitals to do more to curb the boarding of patients with mental health or substance abuse emergencies in particular. In a new standard that took effect on Jan. 1, hospital leaders are required to reach out to behavioral health care providers in the community whenever they encounter patients at risk for boarding due to a behavioral health emergency.
The new standards come a year after hospitals were asked to make reducing boarding in the ED, a hospital-wide mission by setting specific goals on ensuring the availability of patient beds and maintaining proper throughput in laboratories, operating rooms, inpatient units, telemetry, radiology, and the postanesthesia-care unit. Also in 2013, hospitals were asked to create a safe, monitored location to board behavioral health patients awaiting treatment.
The standards are mostly good news for emergency physicians, said Dr. Frederick C. Blum, a past president of the American College of Emergency Physicians and an attending physician in the department of emergency medicine at West Virginia University in Morgantown, because they pull the hospital leadership into the issues of ED boarding in general and how to handle boarding of behavioral health patients.
"Previously, the hospitals have not given this issue as much attention," he said. "This at least makes them partners with us to try solve this problem of ED boarding."
But even with the whole hospital behind the problem, it will remain a challenge, Dr. Blum said. One complicating factor is the Affordable Care Act. No one knows for sure how the ACA will change the volume of patients coming to the ED, Dr. Blum said, and hospitals still have to deal with persistent problems such as the shortage of hospital beds.
For hospitalists, the increased focus on patient flow could bring some major changes, according to Dr. David Yu, medical director of the adult inpatient medicine service at Presbyterian Medical Group in Albuquerque, N.M.
Currently, hospitalist groups are structured financially for maximum productivity not patient flow. And, as a result, efficiently discharging patients and freeing up hospital beds isn’t a top priority for hospitalists, he said.
"It’s going to be a paradigm shift," Dr. Yu said.
To get hospitalists and other specialists in the hospital focused on improving patient flow, hospital leaders will need to switch up the financial incentives and set a hospital-wide budget that makes patient flow a priority, Dr. Yu said.
On Twitter @maryellenny
The Joint Commission is continuing its focus on reducing emergency department boarding with the introduction of additional standards aimed at improving the flow of patients throughout the hospital.
In performance standards that went into effect on Jan. 1, the Joint Commission is requiring its accredited hospitals to measure and set goals for "mitigating and managing" the boarding of patients who come through the emergency department. And the organization recommends that hospitals try to limit boarding to no more than 4 hours after the decision to admit or transfer has been made, though the 4-hour time frame is a guideline and hospitals won’t be scored on whether they can meet it.
The Joint Commission is also requiring hospitals to do more to curb the boarding of patients with mental health or substance abuse emergencies in particular. In a new standard that took effect on Jan. 1, hospital leaders are required to reach out to behavioral health care providers in the community whenever they encounter patients at risk for boarding due to a behavioral health emergency.
The new standards come a year after hospitals were asked to make reducing boarding in the ED, a hospital-wide mission by setting specific goals on ensuring the availability of patient beds and maintaining proper throughput in laboratories, operating rooms, inpatient units, telemetry, radiology, and the postanesthesia-care unit. Also in 2013, hospitals were asked to create a safe, monitored location to board behavioral health patients awaiting treatment.
The standards are mostly good news for emergency physicians, said Dr. Frederick C. Blum, a past president of the American College of Emergency Physicians and an attending physician in the department of emergency medicine at West Virginia University in Morgantown, because they pull the hospital leadership into the issues of ED boarding in general and how to handle boarding of behavioral health patients.
"Previously, the hospitals have not given this issue as much attention," he said. "This at least makes them partners with us to try solve this problem of ED boarding."
But even with the whole hospital behind the problem, it will remain a challenge, Dr. Blum said. One complicating factor is the Affordable Care Act. No one knows for sure how the ACA will change the volume of patients coming to the ED, Dr. Blum said, and hospitals still have to deal with persistent problems such as the shortage of hospital beds.
For hospitalists, the increased focus on patient flow could bring some major changes, according to Dr. David Yu, medical director of the adult inpatient medicine service at Presbyterian Medical Group in Albuquerque, N.M.
Currently, hospitalist groups are structured financially for maximum productivity not patient flow. And, as a result, efficiently discharging patients and freeing up hospital beds isn’t a top priority for hospitalists, he said.
"It’s going to be a paradigm shift," Dr. Yu said.
To get hospitalists and other specialists in the hospital focused on improving patient flow, hospital leaders will need to switch up the financial incentives and set a hospital-wide budget that makes patient flow a priority, Dr. Yu said.
On Twitter @maryellenny
CDC: Adoption of EHRs nears 80%
Nearly 80% of office-based physicians had adopted some type of electronic health record system in 2013, according to figures from the Centers for Disease Control and Prevention.
Findings from the report, which is based on a survey of about 10,000 office-based physicians, show that adoption has skyrocketed over the past decade. Between 2001 and 2013, the use of any type of electronic health record (EHR) system jumped from 18% to 78%. And adoption climbed from 48% to 78% between 2009 and 2013, following the enactment of the Health Information Technology for Economic and Clinical Health (HITECH) Act in 2009, which allowed the federal government to make bonus payments to physicians for adopting certified EHR systems.
Even the use of more advanced systems that include a set of "basic" functionals has increased. Those basic systems include computerized orders for prescriptions, the ability to view laboratory and imaging results electronically, a comprehensive list of a patient’s medications and allergies, physician notes, problem lists, and patient history and demographics.
In 2013, nearly half (48%) of physicians reported having an EHR system that met the criteria for a basic system. That’s up from 11% in 2006, the first year that the CDC collected data on basic systems.
But adoption of EHRs varies greatly by geography. The lowest adoption rate for a basic EHR system was in New Jersey (21%), and the highest was in North Dakota (83%).
Physician interest in the Medicare and Medicaid Incentive Programs is also high, according to the survey results. But the ability to meet the "meaningful use" criteria lags behind the interest. In 2013, 69% of physicians reported that they intended to participate in the incentive programs. But only 13% of physicians both intended to participate in the programs and had an EHR system capable of meeting most of the Stage 2 core requirements of meaningful use.
But Dr. Karen DeSalvo, the new National Coordinator for Health Information Technology of the Department of Health and Human Services, said the survey results show that the incentive programs are "healthy and growing steadily." In a blog post about the survey, Dr. DeSalvo said even the fact that only 13% of physicians could meet Stage 2 requirements in 2013 is a good sign, since it means that they were ready for Stage 2 a year ahead of schedule.
"The deadline to begin attesting for Meaningful Use Stage 2 is October 2014 for the earliest adopters of Meaningful Use Stage 1, so more than one in ten physicians decided on their own to participate [in] Meaningful Use Stage 2 capabilities more than a year earlier than necessary," Dr. DeSalvo wrote. "These are early adopters who recognize the benefits of EHRs."
Nearly 80% of office-based physicians had adopted some type of electronic health record system in 2013, according to figures from the Centers for Disease Control and Prevention.
Findings from the report, which is based on a survey of about 10,000 office-based physicians, show that adoption has skyrocketed over the past decade. Between 2001 and 2013, the use of any type of electronic health record (EHR) system jumped from 18% to 78%. And adoption climbed from 48% to 78% between 2009 and 2013, following the enactment of the Health Information Technology for Economic and Clinical Health (HITECH) Act in 2009, which allowed the federal government to make bonus payments to physicians for adopting certified EHR systems.
Even the use of more advanced systems that include a set of "basic" functionals has increased. Those basic systems include computerized orders for prescriptions, the ability to view laboratory and imaging results electronically, a comprehensive list of a patient’s medications and allergies, physician notes, problem lists, and patient history and demographics.
In 2013, nearly half (48%) of physicians reported having an EHR system that met the criteria for a basic system. That’s up from 11% in 2006, the first year that the CDC collected data on basic systems.
But adoption of EHRs varies greatly by geography. The lowest adoption rate for a basic EHR system was in New Jersey (21%), and the highest was in North Dakota (83%).
Physician interest in the Medicare and Medicaid Incentive Programs is also high, according to the survey results. But the ability to meet the "meaningful use" criteria lags behind the interest. In 2013, 69% of physicians reported that they intended to participate in the incentive programs. But only 13% of physicians both intended to participate in the programs and had an EHR system capable of meeting most of the Stage 2 core requirements of meaningful use.
But Dr. Karen DeSalvo, the new National Coordinator for Health Information Technology of the Department of Health and Human Services, said the survey results show that the incentive programs are "healthy and growing steadily." In a blog post about the survey, Dr. DeSalvo said even the fact that only 13% of physicians could meet Stage 2 requirements in 2013 is a good sign, since it means that they were ready for Stage 2 a year ahead of schedule.
"The deadline to begin attesting for Meaningful Use Stage 2 is October 2014 for the earliest adopters of Meaningful Use Stage 1, so more than one in ten physicians decided on their own to participate [in] Meaningful Use Stage 2 capabilities more than a year earlier than necessary," Dr. DeSalvo wrote. "These are early adopters who recognize the benefits of EHRs."
Nearly 80% of office-based physicians had adopted some type of electronic health record system in 2013, according to figures from the Centers for Disease Control and Prevention.
Findings from the report, which is based on a survey of about 10,000 office-based physicians, show that adoption has skyrocketed over the past decade. Between 2001 and 2013, the use of any type of electronic health record (EHR) system jumped from 18% to 78%. And adoption climbed from 48% to 78% between 2009 and 2013, following the enactment of the Health Information Technology for Economic and Clinical Health (HITECH) Act in 2009, which allowed the federal government to make bonus payments to physicians for adopting certified EHR systems.
Even the use of more advanced systems that include a set of "basic" functionals has increased. Those basic systems include computerized orders for prescriptions, the ability to view laboratory and imaging results electronically, a comprehensive list of a patient’s medications and allergies, physician notes, problem lists, and patient history and demographics.
In 2013, nearly half (48%) of physicians reported having an EHR system that met the criteria for a basic system. That’s up from 11% in 2006, the first year that the CDC collected data on basic systems.
But adoption of EHRs varies greatly by geography. The lowest adoption rate for a basic EHR system was in New Jersey (21%), and the highest was in North Dakota (83%).
Physician interest in the Medicare and Medicaid Incentive Programs is also high, according to the survey results. But the ability to meet the "meaningful use" criteria lags behind the interest. In 2013, 69% of physicians reported that they intended to participate in the incentive programs. But only 13% of physicians both intended to participate in the programs and had an EHR system capable of meeting most of the Stage 2 core requirements of meaningful use.
But Dr. Karen DeSalvo, the new National Coordinator for Health Information Technology of the Department of Health and Human Services, said the survey results show that the incentive programs are "healthy and growing steadily." In a blog post about the survey, Dr. DeSalvo said even the fact that only 13% of physicians could meet Stage 2 requirements in 2013 is a good sign, since it means that they were ready for Stage 2 a year ahead of schedule.
"The deadline to begin attesting for Meaningful Use Stage 2 is October 2014 for the earliest adopters of Meaningful Use Stage 1, so more than one in ten physicians decided on their own to participate [in] Meaningful Use Stage 2 capabilities more than a year earlier than necessary," Dr. DeSalvo wrote. "These are early adopters who recognize the benefits of EHRs."
