February 14th, 2014
The Joint Commission has appointed four new members to its Board of Commissioners. They are Grant Davies, CEO of North Bay Hospitals and executive vice president of California Pacific Medical Center, Gregg Meyer, M.D., chief clinical officer at Partners Healthcare System, and Jane Englebright, chief nursing officer, patient safety officer and vice president for the Clinical Services Group at Hospital Corporation of America. She will serve as the board’s at-large nursing representative.
For further details, go to http://www.jointcommission.org/four_new_members_appointed_to_joint_commission_board/
February 8th, 2014
On February 7, the Centers for Medicare & Medicaid Services (CMS) issued a notice announcing that registration for Open Payments will begin on February 18, 2014. The Physician Payment Sunshine Act and accompanying rules require applicable drug and device manufacturers and group purchasing organizations (GPOs) to record payments and other transfers of value to physicians and teaching hospitals. The requirement applies to payments made on or after August 1, 2013.
For more information about Open Payments, go to http://www.cms.gov/Regulations-and-Guidance/Legislation/National-Physician-payment-Transparency-Program/index.html
January 31st, 2014
The Department of Health and Human Services (HHS) has issued a final rule allowing laboratories to give patients or their designated representative direct access to completed test reports. While patients can continue to get access to their laboratory test reports from their doctors, the rule amends the Clinical Laboratory Improvement Amendments (CLIA) and Health Insurance Portability and Accountability Act Privacy (HIPAA) Rule to provide patients a new way to obtain their test reports directly from the laboratory.
The final rule is available at http://www.gpo.gov/fdsys/pkg/FR-2014-02-06/pdf/2014-02280.pdf.
January 31st, 2014
The Centers for Medicare & Medicaid Services (CMS) has extended the partial enforcement delay of the two-midnight policy for inpatient admission and medical review criteria for six months. According to CMS, recovery auditors and other Medicare review contractors will not conduct post-payment patient status reviews of inpatient hospital claims with dates of admission on or after October 1, 2013 through September 30, 2014. However, Medicare Administrative Contractors (MAC) will continue to conduct pre-payment “probe and educate” audits on select claims.
More information is available at http://cms.gov/Research-Statistics-Data-and-Systems/Monitoring-Programs/Medicare-FFS-Compliance-Programs/Medical-Review/InpatientHospitalReviews.html.
January 30th, 2014
The Centers for Medicare & Medicaid Services (CMS) has announced that Medicare accountable care organizations (ACOs) have generated more than $380 million in savings in the first year of the Shared Savings and Pioneer ACO programs. In addition, CMS announced that 232 additional acute-care hospitals, skilled nursing homes, physician group practices, long-term care hospitals, and home health agencies have entered agreements to participate in the Bundled Payments for Care Improvement initiative. The Medicare demonstration project includes four models of care that bundle payments for multiple services received during an episode of inpatient and/or post-acute care.
A press release is available at http://www.cms.gov/Newsroom/MediaReleaseDatabase/Press-Releases/2014-Press-releases-items/2014-01-30.html.
January 23rd, 2014
The National Quality Forum and Joint Commission have announced the 2013 John M. Eisenberg Patient Safety and Quality Award winners. The awards for innovation at the national level will go the Minnesota Hospital Association, Institute for Clinical Systems Improvement and Stratis Health for their partnership to reduce avoidable readmissions. The Hospital Association of Southern California, Hospital Association of San Diego & Imperial Counties, Hospital Council of Northern & Central California, Anthem Blue Cross, and National Health Foundation will receive an award for their quality improvement initiative. The award for innovation at a local level will go to Vidant Health in Greenville, SC., and the individual achievement award will go to Gail Warden, president emeritus of Henry Ford Health System in Detroit.
For more information, visit this link.
January 23rd, 2014
The Centers for Medicare & Medicaid Services (CMS) has clarified that hospitals can continue to use service vendors to assist them in making Medicaid presumptive eligibility (PE) determinations under the Affordable Care Act (ACA). In their clarification, CMS states that hospitals can rely on third-party contractors to help staff their in-hospital PE operations by staffing welcome desks, meeting with consumers, and helping them fill out PE applications as long as the hospital takes responsibility for the PE determinations that result.
CMS issued the clarifications in a series of FAQs on hospital PE. The FAQ can be viewed at http://www.medicaid.gov/State-Resource-Center/FAQ-Medicaid-and-CHIP-Affordable-Care-Act-Implementation/Downloads/FAQs-by-Topic-Hospital-PE-01-23-14.pdf.
The clarification is available at http://content.govdelivery.com/attachments/USCMS/2014/01/24/file_attachments/265156/CIB-01-24-2014.pdf.
January 13th, 2014
The Medicare Payment Advisory Commission (MedPAC) has approved a final recommendation to Congress that increases Medicare payment rates in 2015 for the hospital inpatient and outpatient prospective payment systems by 3.25%. They also note that their recommendation is 5.25% if the sequester continues in 2015. The Commission has also recommended that Congress reduce or eliminate differences in payment between hospital outpatient departments and physician offices for certain procedures, and that long-term care hospitals be reimbursed at the same rates as general acute-care hospitals for patients who are not chronically critically ill, which is defined as an intensive care unit stay of at least eight days.
For more information, visit http://medpac.gov/
January 10th, 2014
On January 10, the Centers for Medicare & Medicaid Services (CMS) and the state of Maryland jointly announced a new initiative to modernize Maryland’s unique all-payer rate-setting system for hospital services.
Maryland operates the nation’s only all-payer hospital rate regulation system. This system is made possible, in part, by a 36 year old Medicare waiver that exempts Maryland from the Inpatient Prospective Payment System (IPPS) and the Outpatient Prospective Payment System (OPPS), and allows Maryland to set rates for these services. Under the waiver, all third party purchasers pay the same rate. The State of Maryland and CMS believe that the new model test will provide an opportunity for Maryland to reform its delivery system to align with the goals of delivering better health, better care, and lower cost.
For further details, the press release can be found at: http://www.cms.gov/Newsroom/Newsroom-Center.html
January 8th, 2014
According to a report released by the Department of Health and Human Services’ Office of Inspector General (OIG), the Centers for Medicare & Medicaid Services (CMS) should provide best practices and guidance to its contractors for detecting potential fraud associated with electronic health records (EHR). In addition, CMS should direct its contractors to use EHR audit logs when reviewing medical records.
The report can be found by going to http://oig.hhs.gov/oei/reports/oei-01-11-00571.asp