Dr. Kosaraju

Michael Campbell, MD, has been named one of the 2013 Physicians of the Year at Lake Health community health system in Lake County, Ohio. Dr. Campbell is a hospitalist who is board certified in family practice. He has been with Lake Health since 2011.

Nitish Kosaraju, MD, and Jocelyn Hendricks, DO, both received the 2013 Hospitalist of the Year award for an acute care practice from IPC The Hospitalist Company, based in North Hollywood, Calif. Dr. Kosaraju is a practice group leader for IPC in Houston and has been an IPC hospitalist since 2010. Dr. Hendricks is a practice group leader in Tucson, Ariz., and has been part of IPC since 2004.

Pedram Taher, MD, received IPC’s 2013 Hospitalist of the Year award for a post-acute care practice. Dr. Taher has worked for IPC since 2009 and is a practice group leader in the San Francisco Bay area.

Tammy Hilliard, FNP-C, earned IPC’s 2013 Hospitalist of the Year award for a non-physician provider. Hilliard has been with IPC since 2009 and now serves as a nurse practitioner and practice group representative in Phoenix, Ariz.

Jeffrey Harris, MD, received IPC’s 2013 Newcomer Clinician of the Year award. Dr. Harris is a neuro-hospitalist in San Antonio, Texas, and joined IPC in January 2013.

Corbi Milligan, MD, was featured in Murfreesboro Magazine for her exemplary leadership as the EmCare hospitalist site medical director for TriStar StoneCrest Medical Center in Smyrna, Tenn. Dr. Milligan oversees 10 hospitalists in her role and has been with TriStar StoneCrest since 2004.

Business Moves

St. Anthony’s Memorial Hospital in Effingham, Ill., has announced a brand new hospitalist program. The 146-bed acute care center will staff two full-time hospitalists.

Laurens County Memorial Hospital (LCMH) in Clinton, S.C., has partnered with the hospitalist program at Greenville Health System (GHS) in Greenville, S.C., to provide 24-hour hospitalist services. GHS’s lead hospitalist, Kevin Gilroy, MD, will oversee the new program at LCMH. GHS is a public, nonprofit healthcare system comprising seven regional medical centers, including LCMH, as well as numerous post-acute care facilities and offices.

The hospitalist program at Erlanger Health System in Chattanooga, Tenn., will now be managed by MDP Management, a Chattanooga-based physician management company. Erlanger’s hospitalist program has 18 full-time physicians at the nonprofit, level-one trauma center.

IPC The Hospitalist Company has acquired the post-acute hospitalist practice CAP Medical Group, PLLC, in New Hartford, N.Y. CAP Medical Group has served the Oneida County area of upstate New York since 2007. IPC oversees hospitalist services in over 400 hospitals and 1,100 post-acute care practices across the country.

Dr. Kosaraju

Michael Campbell, MD, has been named one of the 2013 Physicians of the Year at Lake Health community health system in Lake County, Ohio. Dr. Campbell is a hospitalist who is board certified in family practice. He has been with Lake Health since 2011.

Nitish Kosaraju, MD, and Jocelyn Hendricks, DO, both received the 2013 Hospitalist of the Year award for an acute care practice from IPC The Hospitalist Company, based in North Hollywood, Calif. Dr. Kosaraju is a practice group leader for IPC in Houston and has been an IPC hospitalist since 2010. Dr. Hendricks is a practice group leader in Tucson, Ariz., and has been part of IPC since 2004.

Pedram Taher, MD, received IPC’s 2013 Hospitalist of the Year award for a post-acute care practice. Dr. Taher has worked for IPC since 2009 and is a practice group leader in the San Francisco Bay area.

Tammy Hilliard, FNP-C, earned IPC’s 2013 Hospitalist of the Year award for a non-physician provider. Hilliard has been with IPC since 2009 and now serves as a nurse practitioner and practice group representative in Phoenix, Ariz.

Jeffrey Harris, MD, received IPC’s 2013 Newcomer Clinician of the Year award. Dr. Harris is a neuro-hospitalist in San Antonio, Texas, and joined IPC in January 2013.

Corbi Milligan, MD, was featured in Murfreesboro Magazine for her exemplary leadership as the EmCare hospitalist site medical director for TriStar StoneCrest Medical Center in Smyrna, Tenn. Dr. Milligan oversees 10 hospitalists in her role and has been with TriStar StoneCrest since 2004.

Business Moves

St. Anthony’s Memorial Hospital in Effingham, Ill., has announced a brand new hospitalist program. The 146-bed acute care center will staff two full-time hospitalists.

Laurens County Memorial Hospital (LCMH) in Clinton, S.C., has partnered with the hospitalist program at Greenville Health System (GHS) in Greenville, S.C., to provide 24-hour hospitalist services. GHS’s lead hospitalist, Kevin Gilroy, MD, will oversee the new program at LCMH. GHS is a public, nonprofit healthcare system comprising seven regional medical centers, including LCMH, as well as numerous post-acute care facilities and offices.

The hospitalist program at Erlanger Health System in Chattanooga, Tenn., will now be managed by MDP Management, a Chattanooga-based physician management company. Erlanger’s hospitalist program has 18 full-time physicians at the nonprofit, level-one trauma center.

IPC The Hospitalist Company has acquired the post-acute hospitalist practice CAP Medical Group, PLLC, in New Hartford, N.Y. CAP Medical Group has served the Oneida County area of upstate New York since 2007. IPC oversees hospitalist services in over 400 hospitals and 1,100 post-acute care practices across the country.

Dr. Kosaraju

Michael Campbell, MD, has been named one of the 2013 Physicians of the Year at Lake Health community health system in Lake County, Ohio. Dr. Campbell is a hospitalist who is board certified in family practice. He has been with Lake Health since 2011.

Nitish Kosaraju, MD, and Jocelyn Hendricks, DO, both received the 2013 Hospitalist of the Year award for an acute care practice from IPC The Hospitalist Company, based in North Hollywood, Calif. Dr. Kosaraju is a practice group leader for IPC in Houston and has been an IPC hospitalist since 2010. Dr. Hendricks is a practice group leader in Tucson, Ariz., and has been part of IPC since 2004.

Pedram Taher, MD, received IPC’s 2013 Hospitalist of the Year award for a post-acute care practice. Dr. Taher has worked for IPC since 2009 and is a practice group leader in the San Francisco Bay area.

Tammy Hilliard, FNP-C, earned IPC’s 2013 Hospitalist of the Year award for a non-physician provider. Hilliard has been with IPC since 2009 and now serves as a nurse practitioner and practice group representative in Phoenix, Ariz.

Jeffrey Harris, MD, received IPC’s 2013 Newcomer Clinician of the Year award. Dr. Harris is a neuro-hospitalist in San Antonio, Texas, and joined IPC in January 2013.

Corbi Milligan, MD, was featured in Murfreesboro Magazine for her exemplary leadership as the EmCare hospitalist site medical director for TriStar StoneCrest Medical Center in Smyrna, Tenn. Dr. Milligan oversees 10 hospitalists in her role and has been with TriStar StoneCrest since 2004.

Business Moves

St. Anthony’s Memorial Hospital in Effingham, Ill., has announced a brand new hospitalist program. The 146-bed acute care center will staff two full-time hospitalists.

Laurens County Memorial Hospital (LCMH) in Clinton, S.C., has partnered with the hospitalist program at Greenville Health System (GHS) in Greenville, S.C., to provide 24-hour hospitalist services. GHS’s lead hospitalist, Kevin Gilroy, MD, will oversee the new program at LCMH. GHS is a public, nonprofit healthcare system comprising seven regional medical centers, including LCMH, as well as numerous post-acute care facilities and offices.

The hospitalist program at Erlanger Health System in Chattanooga, Tenn., will now be managed by MDP Management, a Chattanooga-based physician management company. Erlanger’s hospitalist program has 18 full-time physicians at the nonprofit, level-one trauma center.

IPC The Hospitalist Company has acquired the post-acute hospitalist practice CAP Medical Group, PLLC, in New Hartford, N.Y. CAP Medical Group has served the Oneida County area of upstate New York since 2007. IPC oversees hospitalist services in over 400 hospitals and 1,100 post-acute care practices across the country.

Looking to recruit new hospitalists? Or are you a hospitalist looking for a change? Visit the new SHM Career Center (www.shmcareercenter.org) to recruit and look for new jobs. The new site enables visitors to highlight their favorite opportunities, get alerts via e-mail, and search through hospitalist jobs across the country. Recruiters will find easy-to-use instructions for posting jobs and searching through resumes.

Looking to recruit new hospitalists? Or are you a hospitalist looking for a change? Visit the new SHM Career Center (www.shmcareercenter.org) to recruit and look for new jobs. The new site enables visitors to highlight their favorite opportunities, get alerts via e-mail, and search through hospitalist jobs across the country. Recruiters will find easy-to-use instructions for posting jobs and searching through resumes.

Looking to recruit new hospitalists? Or are you a hospitalist looking for a change? Visit the new SHM Career Center (www.shmcareercenter.org) to recruit and look for new jobs. The new site enables visitors to highlight their favorite opportunities, get alerts via e-mail, and search through hospitalist jobs across the country. Recruiters will find easy-to-use instructions for posting jobs and searching through resumes.

Thousands of hospitalists have logged into HMX (www.hmxchange.org) to ask questions and share answers to some of the most pressing questions for hospitalists everywhere. Recent conversations include:

• How residents can get involved with SHM;
• How hospitalists can simplify the process of transferring a patient from one facility to another;
• How hospitalists can staff long-term acute care hospitals; and
• Pediatric hospital medicine subspecialty certification.

Thousands of hospitalists have logged into HMX (www.hmxchange.org) to ask questions and share answers to some of the most pressing questions for hospitalists everywhere. Recent conversations include:

• How residents can get involved with SHM;
• How hospitalists can simplify the process of transferring a patient from one facility to another;
• How hospitalists can staff long-term acute care hospitals; and
• Pediatric hospital medicine subspecialty certification.

Thousands of hospitalists have logged into HMX (www.hmxchange.org) to ask questions and share answers to some of the most pressing questions for hospitalists everywhere. Recent conversations include:

• How residents can get involved with SHM;
• How hospitalists can simplify the process of transferring a patient from one facility to another;
• How hospitalists can staff long-term acute care hospitals; and
• Pediatric hospital medicine subspecialty certification.

SHM’s blog, “The Hospital Leader,” showcases some of the most cutting-edge ideas and fresh perspectives in the hospitalist movement. For all posts, visit www.hospitalleader.org. Here’s a sampling of our most popular recent posts:

• The Next Dose: Hospitalist Brett Hendel-Paterson juxtaposes his experience as a cancer patient with his experience as a caregiver, especially when it comes to prescribing treatments for his patients.
• 15 Patients a Day: Starling Curve or Sweet Spot?: SHM President Burke Kealey asks whether a 15-patient census is really the most important factor in a hospitalist’s day.
• Broken RAC System Continues to Hurt Patients, Providers: Hospitalist Bart Caponi dissects the Recovery Audit Contractor (RAC) system in a post that was featured on the Forbes.com Pharma & Healthcare section.

SHM’s blog, “The Hospital Leader,” showcases some of the most cutting-edge ideas and fresh perspectives in the hospitalist movement. For all posts, visit www.hospitalleader.org. Here’s a sampling of our most popular recent posts:

• The Next Dose: Hospitalist Brett Hendel-Paterson juxtaposes his experience as a cancer patient with his experience as a caregiver, especially when it comes to prescribing treatments for his patients.
• 15 Patients a Day: Starling Curve or Sweet Spot?: SHM President Burke Kealey asks whether a 15-patient census is really the most important factor in a hospitalist’s day.
• Broken RAC System Continues to Hurt Patients, Providers: Hospitalist Bart Caponi dissects the Recovery Audit Contractor (RAC) system in a post that was featured on the Forbes.com Pharma & Healthcare section.

SHM’s blog, “The Hospital Leader,” showcases some of the most cutting-edge ideas and fresh perspectives in the hospitalist movement. For all posts, visit www.hospitalleader.org. Here’s a sampling of our most popular recent posts:

• The Next Dose: Hospitalist Brett Hendel-Paterson juxtaposes his experience as a cancer patient with his experience as a caregiver, especially when it comes to prescribing treatments for his patients.
• 15 Patients a Day: Starling Curve or Sweet Spot?: SHM President Burke Kealey asks whether a 15-patient census is really the most important factor in a hospitalist’s day.
• Broken RAC System Continues to Hurt Patients, Providers: Hospitalist Bart Caponi dissects the Recovery Audit Contractor (RAC) system in a post that was featured on the Forbes.com Pharma & Healthcare section.

Improving the quality of care in your hospital isn’t just good for your hospital medicine group or your hospital; it’s good for the community. Each year, SHM leads some of the best quality improvement programs in healthcare, and you can get involved.

SHM is now accepting applications for the Glycemic Control Mentored Implementation Program. An informational webinar about the program will be available on Aug. 14. For details, visit www.hospitalmedicine.org/gcmi.

There is still time to apply for the Project BOOST fall cohort. For details, visit www.hospitalmedicine.org/boost.

Are you implementing Choosing Wisely in your hospital? You could win SHM’s Choosing Wisely competition and share your expertise with thousands of other hospitalists.

Visit www.hospitalmedicine.org/choosingwisely to learn more.

Improving the quality of care in your hospital isn’t just good for your hospital medicine group or your hospital; it’s good for the community. Each year, SHM leads some of the best quality improvement programs in healthcare, and you can get involved.

SHM is now accepting applications for the Glycemic Control Mentored Implementation Program. An informational webinar about the program will be available on Aug. 14. For details, visit www.hospitalmedicine.org/gcmi.

There is still time to apply for the Project BOOST fall cohort. For details, visit www.hospitalmedicine.org/boost.

Are you implementing Choosing Wisely in your hospital? You could win SHM’s Choosing Wisely competition and share your expertise with thousands of other hospitalists.

Visit www.hospitalmedicine.org/choosingwisely to learn more.

Improving the quality of care in your hospital isn’t just good for your hospital medicine group or your hospital; it’s good for the community. Each year, SHM leads some of the best quality improvement programs in healthcare, and you can get involved.

SHM is now accepting applications for the Glycemic Control Mentored Implementation Program. An informational webinar about the program will be available on Aug. 14. For details, visit www.hospitalmedicine.org/gcmi.

There is still time to apply for the Project BOOST fall cohort. For details, visit www.hospitalmedicine.org/boost.

Are you implementing Choosing Wisely in your hospital? You could win SHM’s Choosing Wisely competition and share your expertise with thousands of other hospitalists.

Visit www.hospitalmedicine.org/choosingwisely to learn more.

The State of Hospital Medicine Report is the authoritative source for hospitalists to compare and contrast their staffing, productivity, and compensation with other HM groups across the country. SHM publishes the State of Hospital Medicine every two years. SHM is accepting pre-orders now. For more information, visit www.hospitalmedicine.org/sohm.

The State of Hospital Medicine Report is the authoritative source for hospitalists to compare and contrast their staffing, productivity, and compensation with other HM groups across the country. SHM publishes the State of Hospital Medicine every two years. SHM is accepting pre-orders now. For more information, visit www.hospitalmedicine.org/sohm.

The State of Hospital Medicine Report is the authoritative source for hospitalists to compare and contrast their staffing, productivity, and compensation with other HM groups across the country. SHM publishes the State of Hospital Medicine every two years. SHM is accepting pre-orders now. For more information, visit www.hospitalmedicine.org/sohm.

Looking for ways to make your HM group run better? SHM is introducing new tools and information to keep you ahead of the curve.

CODE-H Interactive is an industry first: an interactive tool to help hospitalist groups code effectively and efficiently. CODE-H Interactive allows users to validate documentation against coding criteria and provides a guided tour through clinical documentation, allowing users to ensure they are choosing the correct billing code while providing a conceptual framework that enables the user to easily “connect the dots” between clinical documentation and the applicable CPT coding.

CODE-H Interactive includes two modules: one that reviews three admission notes and a second that reviews three daily notes. It also enables users to assess other E/M codes, such as consultations and ED visits. To get started, visit www.hospitalmedicine.org/CODEHI.

Looking for ways to make your HM group run better? SHM is introducing new tools and information to keep you ahead of the curve.

CODE-H Interactive is an industry first: an interactive tool to help hospitalist groups code effectively and efficiently. CODE-H Interactive allows users to validate documentation against coding criteria and provides a guided tour through clinical documentation, allowing users to ensure they are choosing the correct billing code while providing a conceptual framework that enables the user to easily “connect the dots” between clinical documentation and the applicable CPT coding.

CODE-H Interactive includes two modules: one that reviews three admission notes and a second that reviews three daily notes. It also enables users to assess other E/M codes, such as consultations and ED visits. To get started, visit www.hospitalmedicine.org/CODEHI.

Looking for ways to make your HM group run better? SHM is introducing new tools and information to keep you ahead of the curve.

CODE-H Interactive is an industry first: an interactive tool to help hospitalist groups code effectively and efficiently. CODE-H Interactive allows users to validate documentation against coding criteria and provides a guided tour through clinical documentation, allowing users to ensure they are choosing the correct billing code while providing a conceptual framework that enables the user to easily “connect the dots” between clinical documentation and the applicable CPT coding.

CODE-H Interactive includes two modules: one that reviews three admission notes and a second that reviews three daily notes. It also enables users to assess other E/M codes, such as consultations and ED visits. To get started, visit www.hospitalmedicine.org/CODEHI.

In April, The Hospitalist explored the many paths that hospitalists have taken to leadership positions within their hospitals. Among the many skill sets required to grow as a leader in the hospital, hospital CEOs, presidents, and others noted that hospitalists have a unique grasp on the ability to deal with complexity and solve problems within the hospital.

Those very skills—and many others—are the focus of SHM’s Leadership Academy, presented Nov. 3-6 in Honolulu, Hawaii. Leadership Academy comprises three different courses, each of which will be available at the Hilton Hawaiian Village Waikiki Beach Resort:

• Leadership Foundations;
• Advanced Leadership: Influential Management; and
• Advanced Leadership: Mastering Teamwork.

Details and registration are now available at www.hospitalmedicine.org/leadership.

Hospitalist Binu Pappachen, MD, who will be attending one of the Advanced Leadership sessions in Hawaii, plans on completing the program and earning SHM’s Certificate of Leadership in Hospital Medicine.

“I consider this as a great opportunity for my road ahead, get to know more people, and networking,” says Dr. Pappachen, who highly recommends the training to fellow hospitalists. “The first academy course was an eye opener to the different aspects of medicine, team-building, problem solving, and business aspects.”

In fact, Dr. Pappachen feels as though Leadership Academy already has made him a better hospitalist. “A better team player, committed and taking ownership of what I do,” he says.

All three courses focus on practical leadership, hands-on collaboration, and networking. In fact, Leadership Academy alumni have begun their own community on SHM’s online collaboration forum, HMX (www.hmxchange.com).

Brendon Shank is SHM’s associate vice president of communications.

In April, The Hospitalist explored the many paths that hospitalists have taken to leadership positions within their hospitals. Among the many skill sets required to grow as a leader in the hospital, hospital CEOs, presidents, and others noted that hospitalists have a unique grasp on the ability to deal with complexity and solve problems within the hospital.

Those very skills—and many others—are the focus of SHM’s Leadership Academy, presented Nov. 3-6 in Honolulu, Hawaii. Leadership Academy comprises three different courses, each of which will be available at the Hilton Hawaiian Village Waikiki Beach Resort:

• Leadership Foundations;
• Advanced Leadership: Influential Management; and
• Advanced Leadership: Mastering Teamwork.

Details and registration are now available at www.hospitalmedicine.org/leadership.

Hospitalist Binu Pappachen, MD, who will be attending one of the Advanced Leadership sessions in Hawaii, plans on completing the program and earning SHM’s Certificate of Leadership in Hospital Medicine.

“I consider this as a great opportunity for my road ahead, get to know more people, and networking,” says Dr. Pappachen, who highly recommends the training to fellow hospitalists. “The first academy course was an eye opener to the different aspects of medicine, team-building, problem solving, and business aspects.”

In fact, Dr. Pappachen feels as though Leadership Academy already has made him a better hospitalist. “A better team player, committed and taking ownership of what I do,” he says.

All three courses focus on practical leadership, hands-on collaboration, and networking. In fact, Leadership Academy alumni have begun their own community on SHM’s online collaboration forum, HMX (www.hmxchange.com).

Brendon Shank is SHM’s associate vice president of communications.

In April, The Hospitalist explored the many paths that hospitalists have taken to leadership positions within their hospitals. Among the many skill sets required to grow as a leader in the hospital, hospital CEOs, presidents, and others noted that hospitalists have a unique grasp on the ability to deal with complexity and solve problems within the hospital.

Those very skills—and many others—are the focus of SHM’s Leadership Academy, presented Nov. 3-6 in Honolulu, Hawaii. Leadership Academy comprises three different courses, each of which will be available at the Hilton Hawaiian Village Waikiki Beach Resort:

• Leadership Foundations;
• Advanced Leadership: Influential Management; and
• Advanced Leadership: Mastering Teamwork.

Details and registration are now available at www.hospitalmedicine.org/leadership.

Hospitalist Binu Pappachen, MD, who will be attending one of the Advanced Leadership sessions in Hawaii, plans on completing the program and earning SHM’s Certificate of Leadership in Hospital Medicine.

“I consider this as a great opportunity for my road ahead, get to know more people, and networking,” says Dr. Pappachen, who highly recommends the training to fellow hospitalists. “The first academy course was an eye opener to the different aspects of medicine, team-building, problem solving, and business aspects.”

In fact, Dr. Pappachen feels as though Leadership Academy already has made him a better hospitalist. “A better team player, committed and taking ownership of what I do,” he says.

All three courses focus on practical leadership, hands-on collaboration, and networking. In fact, Leadership Academy alumni have begun their own community on SHM’s online collaboration forum, HMX (www.hmxchange.com).

Brendon Shank is SHM’s associate vice president of communications.

When she presents information to hospitalists about the little-known revision to Medicare’s condition of participation for discharge planning by hospitals, most hospitalists have no idea what Amy Boutwell, MD, MPP, is talking about. Even hospitalists who are active in their institutions’ efforts to improve transitions of care out of the hospital setting are unaware of the change, which was published in the Centers for Medicare & Medicaid Services’ Transmittal 87 and became effective July 19, 2013.

“I just don’t hear hospital professionals talking about it,” says Dr. Boutwell, a hospitalist at Newton-Wellesley Hospital and president of Collaborative Healthcare Strategies in Lexington, Mass. “When I say, ‘There are new rules of the road for discharge planning and evaluation,’ many are not aware of it.”

The revised condition states that the hospital must have a discharge planning process that applies to all patients—not just Medicare beneficiaries. Not every patient needs to have a written discharge plan—although this is recommended—but all patients should be screened and, if indicated, evaluated at an early stage of their hospitalization for risk of adverse post-discharge outcomes. Observation patients are not included in this requirement.

The discharge plan is different from a discharge summary document, which must be completed by the inpatient attending physician, not the hospital, and is not directly addressed in the regulation. The regulation does address the need for transfer of essential information to the next provider of care and says the hospital should have a written policy and procedure in place for discharge planning. The policy and procedure should be developed with input from medical staff and approved by the hospital’s governing body.

Any hospitalist participating with a hospital QI team involved in Project BOOST is helping their hospital comply with this condition of participation.

—Mark Williams, MD, FACP, SFHM, principal investigator of SHM’s Project BOOST

Transmittal 87 represents the first major update of the discharge planning regulation (Standard 482.43) and accompanying interpretive guidelines in more than a decade, Dr. Boutwell says. It consolidates and reorganizes 24 “tags” of regulatory language down to 13 and contains blue advisory boxes recommending best practices in discharge planning, drawn from the suggestions of a technical expert panel convened by CMS.

That panel included many of the country’s recognized thought leaders on improving care transitions, such as Mark Williams, MD, FACP, SFHM, principal investigator of SHM’s Project BOOST; Eric Coleman, MD, MPH, head of the University of Colorado’s division of health care policy and research and creator of the widely-adopted Care Transitions Program (caretransitions.org), and Dr. Boutwell, co-founder of the STAAR initiative (www.ihi.org/engage/Initiatives/completed/STAAR).

The new condition raises baseline expectations for discharge planning and elevates care transitions efforts from a quality improvement issue to the realm of regulatory compliance, Dr. Boutwell says.

“This goes way beyond case review,” she adds. “It represents an evolution from discharge planning case by case to a system for improving transitions of care [for the hospital]. I’m impressed.”

The recommendations are consistent with best practices promoted by Project BOOST, STAAR, Project RED [Re-Engineered Discharge], and other national quality initiatives for improving care transitions.

“Any hospitalist participating with a hospital QI team involved in Project BOOST is helping their hospital comply with this condition of participation,” Dr. Williams says.

In the Byzantine structure of federal regulations, Medicare’s conditions of participation are the regulations providers must meet in order to participate in the Medicare program and bill for their services. Condition-level citations, if not resolved, can cause hospitals to be decertified from Medicare. The accompanying interpretive guidelines, with survey protocols, are the playbook to help state auditors and providers know how to interpret and apply the language of the regulations. The suggestions and examples of best practices contained in the new condition are not required of hospitals but, if followed, could increase their likelihood of achieving better patient outcomes and staying in compliance with the regulations on surveys.

“If hospitals were to actually implement all of the CMS advisory practice recommendations contained in this 35-page document, they’d be in really good shape for effectively managing transitions of care,” says Teresa L. Hamblin, RN, MS, a CMS consultant with Joint Commission Resources. “The government has provided robust practice recommendations that are a model for what hospitals can do. I’d advise doing your best to implement these recommendations. Check your current processes using this detailed document for reference.”

Discharge planning starts at admission, Hamblin says. If the hospitalist assumes that responsibility, it becomes easier to leave a paper trail in the patient’s chart. Other important lessons for hospitalists include participation in a multidisciplinary approach to discharge planning (i.e., interdisciplinary rounding) and development of policies and procedures in this area.

“If the hospital has not elected to do a discharge plan on every patient, request this for your own patients and recommend it as a policy,” Hamblin says. “Go the extra mile, making follow-up appointments for your patients, filling prescriptions in house, and calling the patient 24 to 72 hours after discharge.”

Weekend coverage, when case managers typically are not present, is a particular challenge in care transitions.

“Encourage your hospital to provide reliable weekend coverage for discharge planning. Involve the nurses,” Hamblin says. “Anything the hospitalist can do to help the hospital close this gap is important.”

Larry Beresford is a freelance writer in Alameda, Calif.

When she presents information to hospitalists about the little-known revision to Medicare’s condition of participation for discharge planning by hospitals, most hospitalists have no idea what Amy Boutwell, MD, MPP, is talking about. Even hospitalists who are active in their institutions’ efforts to improve transitions of care out of the hospital setting are unaware of the change, which was published in the Centers for Medicare & Medicaid Services’ Transmittal 87 and became effective July 19, 2013.

“I just don’t hear hospital professionals talking about it,” says Dr. Boutwell, a hospitalist at Newton-Wellesley Hospital and president of Collaborative Healthcare Strategies in Lexington, Mass. “When I say, ‘There are new rules of the road for discharge planning and evaluation,’ many are not aware of it.”

The revised condition states that the hospital must have a discharge planning process that applies to all patients—not just Medicare beneficiaries. Not every patient needs to have a written discharge plan—although this is recommended—but all patients should be screened and, if indicated, evaluated at an early stage of their hospitalization for risk of adverse post-discharge outcomes. Observation patients are not included in this requirement.

The discharge plan is different from a discharge summary document, which must be completed by the inpatient attending physician, not the hospital, and is not directly addressed in the regulation. The regulation does address the need for transfer of essential information to the next provider of care and says the hospital should have a written policy and procedure in place for discharge planning. The policy and procedure should be developed with input from medical staff and approved by the hospital’s governing body.

Any hospitalist participating with a hospital QI team involved in Project BOOST is helping their hospital comply with this condition of participation.

—Mark Williams, MD, FACP, SFHM, principal investigator of SHM’s Project BOOST

Transmittal 87 represents the first major update of the discharge planning regulation (Standard 482.43) and accompanying interpretive guidelines in more than a decade, Dr. Boutwell says. It consolidates and reorganizes 24 “tags” of regulatory language down to 13 and contains blue advisory boxes recommending best practices in discharge planning, drawn from the suggestions of a technical expert panel convened by CMS.

That panel included many of the country’s recognized thought leaders on improving care transitions, such as Mark Williams, MD, FACP, SFHM, principal investigator of SHM’s Project BOOST; Eric Coleman, MD, MPH, head of the University of Colorado’s division of health care policy and research and creator of the widely-adopted Care Transitions Program (caretransitions.org), and Dr. Boutwell, co-founder of the STAAR initiative (www.ihi.org/engage/Initiatives/completed/STAAR).

The new condition raises baseline expectations for discharge planning and elevates care transitions efforts from a quality improvement issue to the realm of regulatory compliance, Dr. Boutwell says.

“This goes way beyond case review,” she adds. “It represents an evolution from discharge planning case by case to a system for improving transitions of care [for the hospital]. I’m impressed.”

The recommendations are consistent with best practices promoted by Project BOOST, STAAR, Project RED [Re-Engineered Discharge], and other national quality initiatives for improving care transitions.

“Any hospitalist participating with a hospital QI team involved in Project BOOST is helping their hospital comply with this condition of participation,” Dr. Williams says.

In the Byzantine structure of federal regulations, Medicare’s conditions of participation are the regulations providers must meet in order to participate in the Medicare program and bill for their services. Condition-level citations, if not resolved, can cause hospitals to be decertified from Medicare. The accompanying interpretive guidelines, with survey protocols, are the playbook to help state auditors and providers know how to interpret and apply the language of the regulations. The suggestions and examples of best practices contained in the new condition are not required of hospitals but, if followed, could increase their likelihood of achieving better patient outcomes and staying in compliance with the regulations on surveys.

“If hospitals were to actually implement all of the CMS advisory practice recommendations contained in this 35-page document, they’d be in really good shape for effectively managing transitions of care,” says Teresa L. Hamblin, RN, MS, a CMS consultant with Joint Commission Resources. “The government has provided robust practice recommendations that are a model for what hospitals can do. I’d advise doing your best to implement these recommendations. Check your current processes using this detailed document for reference.”

Discharge planning starts at admission, Hamblin says. If the hospitalist assumes that responsibility, it becomes easier to leave a paper trail in the patient’s chart. Other important lessons for hospitalists include participation in a multidisciplinary approach to discharge planning (i.e., interdisciplinary rounding) and development of policies and procedures in this area.

“If the hospital has not elected to do a discharge plan on every patient, request this for your own patients and recommend it as a policy,” Hamblin says. “Go the extra mile, making follow-up appointments for your patients, filling prescriptions in house, and calling the patient 24 to 72 hours after discharge.”

Weekend coverage, when case managers typically are not present, is a particular challenge in care transitions.

“Encourage your hospital to provide reliable weekend coverage for discharge planning. Involve the nurses,” Hamblin says. “Anything the hospitalist can do to help the hospital close this gap is important.”

Larry Beresford is a freelance writer in Alameda, Calif.

When she presents information to hospitalists about the little-known revision to Medicare’s condition of participation for discharge planning by hospitals, most hospitalists have no idea what Amy Boutwell, MD, MPP, is talking about. Even hospitalists who are active in their institutions’ efforts to improve transitions of care out of the hospital setting are unaware of the change, which was published in the Centers for Medicare & Medicaid Services’ Transmittal 87 and became effective July 19, 2013.

“I just don’t hear hospital professionals talking about it,” says Dr. Boutwell, a hospitalist at Newton-Wellesley Hospital and president of Collaborative Healthcare Strategies in Lexington, Mass. “When I say, ‘There are new rules of the road for discharge planning and evaluation,’ many are not aware of it.”

The revised condition states that the hospital must have a discharge planning process that applies to all patients—not just Medicare beneficiaries. Not every patient needs to have a written discharge plan—although this is recommended—but all patients should be screened and, if indicated, evaluated at an early stage of their hospitalization for risk of adverse post-discharge outcomes. Observation patients are not included in this requirement.

The discharge plan is different from a discharge summary document, which must be completed by the inpatient attending physician, not the hospital, and is not directly addressed in the regulation. The regulation does address the need for transfer of essential information to the next provider of care and says the hospital should have a written policy and procedure in place for discharge planning. The policy and procedure should be developed with input from medical staff and approved by the hospital’s governing body.

Any hospitalist participating with a hospital QI team involved in Project BOOST is helping their hospital comply with this condition of participation.

—Mark Williams, MD, FACP, SFHM, principal investigator of SHM’s Project BOOST

Transmittal 87 represents the first major update of the discharge planning regulation (Standard 482.43) and accompanying interpretive guidelines in more than a decade, Dr. Boutwell says. It consolidates and reorganizes 24 “tags” of regulatory language down to 13 and contains blue advisory boxes recommending best practices in discharge planning, drawn from the suggestions of a technical expert panel convened by CMS.

That panel included many of the country’s recognized thought leaders on improving care transitions, such as Mark Williams, MD, FACP, SFHM, principal investigator of SHM’s Project BOOST; Eric Coleman, MD, MPH, head of the University of Colorado’s division of health care policy and research and creator of the widely-adopted Care Transitions Program (caretransitions.org), and Dr. Boutwell, co-founder of the STAAR initiative (www.ihi.org/engage/Initiatives/completed/STAAR).

The new condition raises baseline expectations for discharge planning and elevates care transitions efforts from a quality improvement issue to the realm of regulatory compliance, Dr. Boutwell says.

“This goes way beyond case review,” she adds. “It represents an evolution from discharge planning case by case to a system for improving transitions of care [for the hospital]. I’m impressed.”

The recommendations are consistent with best practices promoted by Project BOOST, STAAR, Project RED [Re-Engineered Discharge], and other national quality initiatives for improving care transitions.

“Any hospitalist participating with a hospital QI team involved in Project BOOST is helping their hospital comply with this condition of participation,” Dr. Williams says.

In the Byzantine structure of federal regulations, Medicare’s conditions of participation are the regulations providers must meet in order to participate in the Medicare program and bill for their services. Condition-level citations, if not resolved, can cause hospitals to be decertified from Medicare. The accompanying interpretive guidelines, with survey protocols, are the playbook to help state auditors and providers know how to interpret and apply the language of the regulations. The suggestions and examples of best practices contained in the new condition are not required of hospitals but, if followed, could increase their likelihood of achieving better patient outcomes and staying in compliance with the regulations on surveys.

“If hospitals were to actually implement all of the CMS advisory practice recommendations contained in this 35-page document, they’d be in really good shape for effectively managing transitions of care,” says Teresa L. Hamblin, RN, MS, a CMS consultant with Joint Commission Resources. “The government has provided robust practice recommendations that are a model for what hospitals can do. I’d advise doing your best to implement these recommendations. Check your current processes using this detailed document for reference.”

Discharge planning starts at admission, Hamblin says. If the hospitalist assumes that responsibility, it becomes easier to leave a paper trail in the patient’s chart. Other important lessons for hospitalists include participation in a multidisciplinary approach to discharge planning (i.e., interdisciplinary rounding) and development of policies and procedures in this area.

“If the hospital has not elected to do a discharge plan on every patient, request this for your own patients and recommend it as a policy,” Hamblin says. “Go the extra mile, making follow-up appointments for your patients, filling prescriptions in house, and calling the patient 24 to 72 hours after discharge.”

Weekend coverage, when case managers typically are not present, is a particular challenge in care transitions.

“Encourage your hospital to provide reliable weekend coverage for discharge planning. Involve the nurses,” Hamblin says. “Anything the hospitalist can do to help the hospital close this gap is important.”

Larry Beresford is a freelance writer in Alameda, Calif.

Dr. Lenchus

Congress has once again delayed implementation of draconian Medicare cuts tied to the sustainable growth rate (SGR) formula. It was the 17th temporary patch applied to the ailing physician reimbursement program, so the decision caused little surprise.

But with the same legislation—the Protecting Access to Medicare Act of 2014—being used to delay the long-awaited debut of ICD-10, many hospitalists and physicians couldn’t help but wonder whether billing and coding would now be as much of a political football as the SGR fix.¹

The upshot: It doesn’t seem that way.

“I think it’s two separate issues,” says Phyllis “PJ” Floyd, RN, BSN, MBA, NE-BC, CCA, director of health information services and clinical documentation improvement at Medical University of South Carolina (MUSC) in Charleston, S.C. “The fact that it was all in one bill, I don’t know that it was well thought out as much as it was, ‘Let’s put the ICD-10 in here at the same time.’

“It was just a few sentences, and then it wasn’t even brought up in the discussion on the floor.”

Four policy wonks interviewed by The Hospitalist concurred that while tying the ICD-10 delay to the SGR issue was an unexpected and frustrating development, the coding system likely will be implemented in the relative short term. Meanwhile, a long-term resolution of the SGR dilemma remains much more elusive.

“For about 12 hours, I felt relief about the ICD-10 [being delayed], and then I just realized, it’s still coming, presumably,” says John Nelson, MD, MHM, a co-founder and past president of SHM and medical director of the hospitalist practice at Overlake Hospital Medical Center in Bellevue, Wash. “[It’s] like a patient who needs surgery and finds out it’s canceled for the day and he’ll have it tomorrow. Well, that’s good for right now, but [he] still has to face this eventually.”

“Doc-Pay” Fix Near?

Congress’ recent decision to delay both an SGR fix and the ICD-10 are troubling to some hospitalists and others for different reasons.

The SGR extension through this year’s end means that physicians do not face a 24% cut to physician payments under Medicare. SHM has long lobbied against temporary patches to the SGR, repeatedly backing legislation that would once and for all scrap the formula and replace it with something sustainable.

The SGR formula was first crafted in 1997, but the now often-delayed cuts were a byproduct of the federal sequester that was included in the Budget Control Act of 2011. At the time, the massive reduction to Medicare payments was tied to political brinksmanship over the country’s debt ceiling. The cuts were implemented as a doomsday scenario that was never likely to actually happen, but despite negotiations over the past three years, no long-term compromise can be found. Paying for the reform remains the main stumbling block.

“I think, this year, Congress was as close as it’s been in a long time to enacting a serious fix, aided by the agreement of major professional societies like the American College of Physicians and American College of Surgeons,” says David Howard, PhD, an associate professor in the department of health policy and management at the Rollins School of Public Health at Emory University in Atlanta. “They were all on board with this solution. ... Who knows, maybe if the economic situation continues to improve [and] tax revenues continue to go up...that will create a more favorable environment for compromise.”

Dr. Howard adds that while Congress might be close to a solution in theory, agreement on how to offset the roughly $100 billion in costs “is just very difficult.” That is why the healthcare professor is pessimistic that a long-term fix is truly at hand.

“The places where Congress might have looked for savings to offset the cost of the doc fix, such as hospital reimbursement rates or payment rates to Medicare Advantage plans—those are exactly the areas that the Affordable Care Act is targeting to pay for insurance expansion,” Dr. Howard adds. “So those areas of savings are not going to be available to offset the cost of the doc fix.”

ICD-10 Delays “Unfair”

Dr. Lenchus

The medical coding conundrum presents a different set of issues. The delay in transitioning healthcare providers from the ICD-9 medical coding classification system to the more complicated ICD-10 means the upgraded system is now against an Oct. 1, 2015, deadline. This comes after the Centers for Medicare & Medicaid Services (CMS) already pushed back the original implementation date for ICD-10 by one year.

SHM Public Policy Committee member Joshua Lenchus, DO, RPh, FACP, SFHM, says he thinks most doctors are content with the delay, particularly in light of some estimates that show that only about 20% of physicians “have actually initiated the ICD-10 transition.” But he also notes that it’s unfair to the health systems that have prepared for ICD-10.

“ICD-9 has a little more than 14,000 diagnostic codes and nearly 4,000 procedural codes. That is to be contrasted to ICD-10, which has more than 68,000 diagnostic codes ... and over 72,000 procedural codes,” Dr. Lenchus says. “So, it is not surprising that many take solace in the delay.”

Dr. Nelson says the level of frustration for hospitalists is growing; however, the level of disruption for hospitals and health systems is reaching a boiling point.

“Of course, in some places, hospitalists may be the physician lead on ICD-10 efforts, so [they are] very much wrapped up in the problem of ‘What do we do now?’”

The answer, at least to the Coalition for ICD-10, a group of medical/technology trade groups, is to fight to ensure that the delays go no further. In an April letter to CMS Administrator Marilyn Tavenner, the coalition made that case, noting that in 2012, “CMS estimated the cost to the healthcare industry of a one-year delay to be as much as $6.6 billion, or approximately 30% of the $22 billion that CMS estimated had been invested or budgeted for ICD-10 implementation.”²

The letter went on to explain that the disruption and cost will grow each time the ICD-10 deadline is pushed.

“Furthermore, as CMS stated in 2012, implementation costs will continue to increase considerably with every year of a delay,” according to the letter. “The lost opportunity costs of failing to move to a more effective code set also continue to climb every year.”

Stay Engaged, Switch Gears

One of Floyd’s biggest concerns is that the ICD-10 implementation delays will affect physician engagement. The hospitalist groups at MUSC began training for ICD-10 in January 2013; however, the preparation and training were geared toward a 2014 implementation.

“You have to switch gears a little bit,” she says. “What we plan to do now is begin to do heavy auditing, and then from those audits we can give real-time feedback on what we’re doing well and what we’re not doing well. So I think that will be a method for engagement.”

She urges hospitalists, practice leaders, and informatics professionals to discuss ICD-10 not as a theoretical application, but as one tied to reimbursement that will have major impact in the years ahead. To that end, the American Health Information Management Association highlights the fact that the new coding system will result in higher-quality data that can improve performance measures, provide “increased sensitivity” to reimbursement methodologies, and help with stronger public health surveillance.³

“A lot of physicians see this as a hospital issue, and I think that’s why they shy away,” Floyd says. “Now there are some physicians who are interested in how well the hospital does, but the other piece is that it does affect things like [reduced] risk of mortality [and] comparison of data worldwide—those are things that we just have to continue to reiterate … and give them real examples.”

Richard Quinn is a freelance writer in New Jersey.

References

1. Govtrack. H.R. 4302: Protecting Access to Medicare Act of 2014. https://www.govtrack.us/congress/bills/113/hr4302. Accessed June 5, 2014.
2. Coalition for ICD. Letter to CMS Administrator Tavenner, April 11, 2014. http://coalitionforicd10.wordpress.com/2014/03/26/letter-from-the-coalition-for-icd-10. Accessed June 5, 2014.
3. American Health Information Management Association. ICD-10-CM/PCS Transition: Planning and Preparation Checklist. http://journal.ahima.org/wp-content/uploads/ICD10-checklist.pdf. Accessed June 5, 2014.

Dr. Lenchus

Congress has once again delayed implementation of draconian Medicare cuts tied to the sustainable growth rate (SGR) formula. It was the 17th temporary patch applied to the ailing physician reimbursement program, so the decision caused little surprise.

But with the same legislation—the Protecting Access to Medicare Act of 2014—being used to delay the long-awaited debut of ICD-10, many hospitalists and physicians couldn’t help but wonder whether billing and coding would now be as much of a political football as the SGR fix.¹

The upshot: It doesn’t seem that way.

“I think it’s two separate issues,” says Phyllis “PJ” Floyd, RN, BSN, MBA, NE-BC, CCA, director of health information services and clinical documentation improvement at Medical University of South Carolina (MUSC) in Charleston, S.C. “The fact that it was all in one bill, I don’t know that it was well thought out as much as it was, ‘Let’s put the ICD-10 in here at the same time.’

“It was just a few sentences, and then it wasn’t even brought up in the discussion on the floor.”

Four policy wonks interviewed by The Hospitalist concurred that while tying the ICD-10 delay to the SGR issue was an unexpected and frustrating development, the coding system likely will be implemented in the relative short term. Meanwhile, a long-term resolution of the SGR dilemma remains much more elusive.

“For about 12 hours, I felt relief about the ICD-10 [being delayed], and then I just realized, it’s still coming, presumably,” says John Nelson, MD, MHM, a co-founder and past president of SHM and medical director of the hospitalist practice at Overlake Hospital Medical Center in Bellevue, Wash. “[It’s] like a patient who needs surgery and finds out it’s canceled for the day and he’ll have it tomorrow. Well, that’s good for right now, but [he] still has to face this eventually.”

“Doc-Pay” Fix Near?

Congress’ recent decision to delay both an SGR fix and the ICD-10 are troubling to some hospitalists and others for different reasons.

The SGR extension through this year’s end means that physicians do not face a 24% cut to physician payments under Medicare. SHM has long lobbied against temporary patches to the SGR, repeatedly backing legislation that would once and for all scrap the formula and replace it with something sustainable.

The SGR formula was first crafted in 1997, but the now often-delayed cuts were a byproduct of the federal sequester that was included in the Budget Control Act of 2011. At the time, the massive reduction to Medicare payments was tied to political brinksmanship over the country’s debt ceiling. The cuts were implemented as a doomsday scenario that was never likely to actually happen, but despite negotiations over the past three years, no long-term compromise can be found. Paying for the reform remains the main stumbling block.

“I think, this year, Congress was as close as it’s been in a long time to enacting a serious fix, aided by the agreement of major professional societies like the American College of Physicians and American College of Surgeons,” says David Howard, PhD, an associate professor in the department of health policy and management at the Rollins School of Public Health at Emory University in Atlanta. “They were all on board with this solution. ... Who knows, maybe if the economic situation continues to improve [and] tax revenues continue to go up...that will create a more favorable environment for compromise.”

Dr. Howard adds that while Congress might be close to a solution in theory, agreement on how to offset the roughly $100 billion in costs “is just very difficult.” That is why the healthcare professor is pessimistic that a long-term fix is truly at hand.

“The places where Congress might have looked for savings to offset the cost of the doc fix, such as hospital reimbursement rates or payment rates to Medicare Advantage plans—those are exactly the areas that the Affordable Care Act is targeting to pay for insurance expansion,” Dr. Howard adds. “So those areas of savings are not going to be available to offset the cost of the doc fix.”

ICD-10 Delays “Unfair”

Dr. Lenchus

The medical coding conundrum presents a different set of issues. The delay in transitioning healthcare providers from the ICD-9 medical coding classification system to the more complicated ICD-10 means the upgraded system is now against an Oct. 1, 2015, deadline. This comes after the Centers for Medicare & Medicaid Services (CMS) already pushed back the original implementation date for ICD-10 by one year.

SHM Public Policy Committee member Joshua Lenchus, DO, RPh, FACP, SFHM, says he thinks most doctors are content with the delay, particularly in light of some estimates that show that only about 20% of physicians “have actually initiated the ICD-10 transition.” But he also notes that it’s unfair to the health systems that have prepared for ICD-10.

“ICD-9 has a little more than 14,000 diagnostic codes and nearly 4,000 procedural codes. That is to be contrasted to ICD-10, which has more than 68,000 diagnostic codes ... and over 72,000 procedural codes,” Dr. Lenchus says. “So, it is not surprising that many take solace in the delay.”

Dr. Nelson says the level of frustration for hospitalists is growing; however, the level of disruption for hospitals and health systems is reaching a boiling point.

“Of course, in some places, hospitalists may be the physician lead on ICD-10 efforts, so [they are] very much wrapped up in the problem of ‘What do we do now?’”

The answer, at least to the Coalition for ICD-10, a group of medical/technology trade groups, is to fight to ensure that the delays go no further. In an April letter to CMS Administrator Marilyn Tavenner, the coalition made that case, noting that in 2012, “CMS estimated the cost to the healthcare industry of a one-year delay to be as much as $6.6 billion, or approximately 30% of the $22 billion that CMS estimated had been invested or budgeted for ICD-10 implementation.”²

The letter went on to explain that the disruption and cost will grow each time the ICD-10 deadline is pushed.

“Furthermore, as CMS stated in 2012, implementation costs will continue to increase considerably with every year of a delay,” according to the letter. “The lost opportunity costs of failing to move to a more effective code set also continue to climb every year.”

Stay Engaged, Switch Gears

One of Floyd’s biggest concerns is that the ICD-10 implementation delays will affect physician engagement. The hospitalist groups at MUSC began training for ICD-10 in January 2013; however, the preparation and training were geared toward a 2014 implementation.

“You have to switch gears a little bit,” she says. “What we plan to do now is begin to do heavy auditing, and then from those audits we can give real-time feedback on what we’re doing well and what we’re not doing well. So I think that will be a method for engagement.”

She urges hospitalists, practice leaders, and informatics professionals to discuss ICD-10 not as a theoretical application, but as one tied to reimbursement that will have major impact in the years ahead. To that end, the American Health Information Management Association highlights the fact that the new coding system will result in higher-quality data that can improve performance measures, provide “increased sensitivity” to reimbursement methodologies, and help with stronger public health surveillance.³

“A lot of physicians see this as a hospital issue, and I think that’s why they shy away,” Floyd says. “Now there are some physicians who are interested in how well the hospital does, but the other piece is that it does affect things like [reduced] risk of mortality [and] comparison of data worldwide—those are things that we just have to continue to reiterate … and give them real examples.”

Richard Quinn is a freelance writer in New Jersey.

References

1. Govtrack. H.R. 4302: Protecting Access to Medicare Act of 2014. https://www.govtrack.us/congress/bills/113/hr4302. Accessed June 5, 2014.
2. Coalition for ICD. Letter to CMS Administrator Tavenner, April 11, 2014. http://coalitionforicd10.wordpress.com/2014/03/26/letter-from-the-coalition-for-icd-10. Accessed June 5, 2014.
3. American Health Information Management Association. ICD-10-CM/PCS Transition: Planning and Preparation Checklist. http://journal.ahima.org/wp-content/uploads/ICD10-checklist.pdf. Accessed June 5, 2014.

Dr. Lenchus

Congress has once again delayed implementation of draconian Medicare cuts tied to the sustainable growth rate (SGR) formula. It was the 17th temporary patch applied to the ailing physician reimbursement program, so the decision caused little surprise.

But with the same legislation—the Protecting Access to Medicare Act of 2014—being used to delay the long-awaited debut of ICD-10, many hospitalists and physicians couldn’t help but wonder whether billing and coding would now be as much of a political football as the SGR fix.¹

The upshot: It doesn’t seem that way.

“I think it’s two separate issues,” says Phyllis “PJ” Floyd, RN, BSN, MBA, NE-BC, CCA, director of health information services and clinical documentation improvement at Medical University of South Carolina (MUSC) in Charleston, S.C. “The fact that it was all in one bill, I don’t know that it was well thought out as much as it was, ‘Let’s put the ICD-10 in here at the same time.’

“It was just a few sentences, and then it wasn’t even brought up in the discussion on the floor.”

Four policy wonks interviewed by The Hospitalist concurred that while tying the ICD-10 delay to the SGR issue was an unexpected and frustrating development, the coding system likely will be implemented in the relative short term. Meanwhile, a long-term resolution of the SGR dilemma remains much more elusive.

“For about 12 hours, I felt relief about the ICD-10 [being delayed], and then I just realized, it’s still coming, presumably,” says John Nelson, MD, MHM, a co-founder and past president of SHM and medical director of the hospitalist practice at Overlake Hospital Medical Center in Bellevue, Wash. “[It’s] like a patient who needs surgery and finds out it’s canceled for the day and he’ll have it tomorrow. Well, that’s good for right now, but [he] still has to face this eventually.”

“Doc-Pay” Fix Near?

Congress’ recent decision to delay both an SGR fix and the ICD-10 are troubling to some hospitalists and others for different reasons.

The SGR extension through this year’s end means that physicians do not face a 24% cut to physician payments under Medicare. SHM has long lobbied against temporary patches to the SGR, repeatedly backing legislation that would once and for all scrap the formula and replace it with something sustainable.

The SGR formula was first crafted in 1997, but the now often-delayed cuts were a byproduct of the federal sequester that was included in the Budget Control Act of 2011. At the time, the massive reduction to Medicare payments was tied to political brinksmanship over the country’s debt ceiling. The cuts were implemented as a doomsday scenario that was never likely to actually happen, but despite negotiations over the past three years, no long-term compromise can be found. Paying for the reform remains the main stumbling block.

“I think, this year, Congress was as close as it’s been in a long time to enacting a serious fix, aided by the agreement of major professional societies like the American College of Physicians and American College of Surgeons,” says David Howard, PhD, an associate professor in the department of health policy and management at the Rollins School of Public Health at Emory University in Atlanta. “They were all on board with this solution. ... Who knows, maybe if the economic situation continues to improve [and] tax revenues continue to go up...that will create a more favorable environment for compromise.”

Dr. Howard adds that while Congress might be close to a solution in theory, agreement on how to offset the roughly $100 billion in costs “is just very difficult.” That is why the healthcare professor is pessimistic that a long-term fix is truly at hand.

“The places where Congress might have looked for savings to offset the cost of the doc fix, such as hospital reimbursement rates or payment rates to Medicare Advantage plans—those are exactly the areas that the Affordable Care Act is targeting to pay for insurance expansion,” Dr. Howard adds. “So those areas of savings are not going to be available to offset the cost of the doc fix.”

ICD-10 Delays “Unfair”

Dr. Lenchus

The medical coding conundrum presents a different set of issues. The delay in transitioning healthcare providers from the ICD-9 medical coding classification system to the more complicated ICD-10 means the upgraded system is now against an Oct. 1, 2015, deadline. This comes after the Centers for Medicare & Medicaid Services (CMS) already pushed back the original implementation date for ICD-10 by one year.

SHM Public Policy Committee member Joshua Lenchus, DO, RPh, FACP, SFHM, says he thinks most doctors are content with the delay, particularly in light of some estimates that show that only about 20% of physicians “have actually initiated the ICD-10 transition.” But he also notes that it’s unfair to the health systems that have prepared for ICD-10.

“ICD-9 has a little more than 14,000 diagnostic codes and nearly 4,000 procedural codes. That is to be contrasted to ICD-10, which has more than 68,000 diagnostic codes ... and over 72,000 procedural codes,” Dr. Lenchus says. “So, it is not surprising that many take solace in the delay.”

Dr. Nelson says the level of frustration for hospitalists is growing; however, the level of disruption for hospitals and health systems is reaching a boiling point.

“Of course, in some places, hospitalists may be the physician lead on ICD-10 efforts, so [they are] very much wrapped up in the problem of ‘What do we do now?’”

The answer, at least to the Coalition for ICD-10, a group of medical/technology trade groups, is to fight to ensure that the delays go no further. In an April letter to CMS Administrator Marilyn Tavenner, the coalition made that case, noting that in 2012, “CMS estimated the cost to the healthcare industry of a one-year delay to be as much as $6.6 billion, or approximately 30% of the $22 billion that CMS estimated had been invested or budgeted for ICD-10 implementation.”²

The letter went on to explain that the disruption and cost will grow each time the ICD-10 deadline is pushed.

“Furthermore, as CMS stated in 2012, implementation costs will continue to increase considerably with every year of a delay,” according to the letter. “The lost opportunity costs of failing to move to a more effective code set also continue to climb every year.”

Stay Engaged, Switch Gears

One of Floyd’s biggest concerns is that the ICD-10 implementation delays will affect physician engagement. The hospitalist groups at MUSC began training for ICD-10 in January 2013; however, the preparation and training were geared toward a 2014 implementation.

“You have to switch gears a little bit,” she says. “What we plan to do now is begin to do heavy auditing, and then from those audits we can give real-time feedback on what we’re doing well and what we’re not doing well. So I think that will be a method for engagement.”

She urges hospitalists, practice leaders, and informatics professionals to discuss ICD-10 not as a theoretical application, but as one tied to reimbursement that will have major impact in the years ahead. To that end, the American Health Information Management Association highlights the fact that the new coding system will result in higher-quality data that can improve performance measures, provide “increased sensitivity” to reimbursement methodologies, and help with stronger public health surveillance.³

“A lot of physicians see this as a hospital issue, and I think that’s why they shy away,” Floyd says. “Now there are some physicians who are interested in how well the hospital does, but the other piece is that it does affect things like [reduced] risk of mortality [and] comparison of data worldwide—those are things that we just have to continue to reiterate … and give them real examples.”

Richard Quinn is a freelance writer in New Jersey.

References

1. Govtrack. H.R. 4302: Protecting Access to Medicare Act of 2014. https://www.govtrack.us/congress/bills/113/hr4302. Accessed June 5, 2014.
2. Coalition for ICD. Letter to CMS Administrator Tavenner, April 11, 2014. http://coalitionforicd10.wordpress.com/2014/03/26/letter-from-the-coalition-for-icd-10. Accessed June 5, 2014.
3. American Health Information Management Association. ICD-10-CM/PCS Transition: Planning and Preparation Checklist. http://journal.ahima.org/wp-content/uploads/ICD10-checklist.pdf. Accessed June 5, 2014.