Medical Industry Reimbursement News

In a new report published by the Institute of Medicine (IOM), it is recommended that the Centers for Disease Control and Prevention (CDC), as well as state and local health jurisdictions, focus on population-based strategies that can reach large numbers of people and improve the well-being of entire communities in dealing with hypertension. Behavioral and lifestyle interventions, i.e. reducing sodium intake, increasing consumption of fruits and vegetables and increasing physical activity are among the best examples. The report also highlights the need to improve providers’ adherence to the treatment guidelines for hypertension, especially in the elderly population, and to encourage patients to take medication consistently by reducing or eliminating the cost of antihypertensive medication. 

For information about the report, go to http://www.iom.edu/Reports/2010/A-Population-Based-Policy-and-Systems-Change-Approach-to-Prevent-and-Control-Hypertension.aspx

The Food and Drug Administration (FDA) has announced an initiative to reduce unnecessary radiation exposure from computed tomography (CT), nuclear medicine studies and fluoroscopy procedures. The FDA stated that the initiative will promote the safe use of medical imaging devices, support informed clinical decision-making and increase patient awareness of their own exposure. The agency intends to require manufacturers of CT and fluoroscopic devices to incorporate safeguards into the design of their machines and provide appropriate training to support safe use by practitioners, and has scheduled a public meeting on March 30-31 to solicit input on those requirements. It also is working with the Centers for Medicare and Medicaid Services to incorporate quality assurance practices into the mandatory accreditation and conditions of participation survey processes for imaging facilities and hospitals.

More information is available at http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm200085.htm

A $3.5 million research project that will study the long-term benefits and risks of implantable cardioverter defibrillators  (ICDs) in patients at risk of death from ventricular fibrillation will be supported by the Department of Health & Human Services’ (HHS) Agency for Healthcare Research and Quality (AHRQ) and the American College of Cardiology (ACC). The project is being conducted in cooperation with the National Heart, Lung and Blood Institute and will follow 3500 patients with ICDs from the cardiovascular Research Network.

More information is available at http://www.ahrq.gov/news/press/pr2010/accicdpr.htm

The Centers for Medicare & Medicaid Services (CMS) has approved The Joint Commission, American College of Radiology and Intersocietal Accreditation Commission as national accrediting organizations for physicians and others seeking to furnish the technical component of advanced diagnostic imaging services under the Medicare physician fee schedule. The Medicare Improvements for Patients and Providers Act (MIPPA) of 2008 requires suppliers of these services under the physician fee schedule to become accredited by a designated accreditation organization by January 1, 2012.

In the meantime, CMS is reassuring hospitals that they do not have to become accredited to furnish the technical component of advanced diagnostic imaging services. The MIPPA requirement does not apply to advanced imaging services paid under Medicare’s hospital inpatient and outpatient prospective payment systems

Information is in the Federal Register at http://edocket.access.gpo.gov/2010/pdf/2010-1457.pdf.

The Health Research & Educational Trust (HRET) has released a guide that will help hospital administrations address the issue of avoidable hospital readmissions. The guide suggests a four-step approach that will assist hospitals in these efforts and outlines potential strategies during the various stages in the care continuum.

The guide is available at http://www.hret.org/hret/programs/readmissions.html

On January 20, FDA Commissioner Margaret Hamburg appointed Jeffrey Shuren as the permanent director of the Center for Devices and Radiological Health (CDRH).  The announcement was made while launching the center’s FY 2010 “strategic priorities” report, which includes implementing recommendations from an internal 510(k) working group by September 30 and taking appropriate measures to improve the quality of clinical data submitted in premarket approval applications. 

For more information, visit www.fda.gov

According to The Joint Commission’s annual report on hospital quality and patient safety, hospitals continue to improve the quality of patient care, saving lives and improving the health of thousands of patients. The report reviews the performance by accredited hospitals on 31 care measures for heart attack, heart failure, pneumonia, surgery and children’s asthma. Between 2002 and 2008, compliance with the quality measures improved to 96.7% from 86.9% for heart attack care, 91.6% from 59.7% for heart failure care, and 92.9% from 72.3% for pneumonia care. Hospitals also showed steady improvement on surgical care measures, and more than 99% achieved the asthma care measures.

The Joint Commission’s report is available at http://www.jointcommission.org/NR/rdonlyres/22D58F1F-14FF-4B72-A870-378DAF26189E/0/2009_Annual_Report.pdf.

The Medicare Payment Advisory Commission (MedPAC) has made two hospital payment recommendations to Congress. The first recommendation is that Congress increase payment rates for the acute inpatient and outpatient prospective payment systems in 2011 by the projected rate of increase in the hospital market basket index concurrent with implementation of a quality incentive payment program.

The second recommendation is that, in order to restore budget neutrality, Congress requires the Secretary to fully offset increases in inpatient payments due to hospital’s documentation and coding improvements. To accomplish this, the Secretary must reduce payment rates for the inpatient prospective payment system by the same percentage each year in 2011, 2012, 2013.

Also, MedPAC recommended that Congress give physicians a 1% payment update in FY 2011.

More information is available at http://www.medpac.gov/

The Department of Health and Human Services (HHS) has activated the National Disaster Medical System and the U.S. Public Health Service Commissioned Corps. More than 250 personnel are in the process of deploying to Haiti and over 12,000 personnel could possibly assist in the coming days. 

The medical teams include doctors, nurses, paramedics, emergency medical technicians, emergency medical and surgical physicians, and other medical personnel from Georgia, California, New Jersey, Massachusetts and Florida. An International Medical Surgical Response Team will provide care for severely injured patients and five Disaster Medical Assistance Teams will provide basic medical care. These personnel will be accompanied by 22,000 pounds of medical equipment and supplies. In addition, experts from the U.S. Centers for Disease Control and Prevention will assist with checking the water and food supply. 

For the latest information, visit www.hhs.gov.

The print version of the revised Medicare Physician Guide: A Resource for Residents, Practicing Physicians, and Other Health Care Professionals, which offers general information about the Medicare program, is now available from the Centers for Medicare & Medicaid Services (CMS) Medicare Learning Network.  This guide covers such topics as how to become a Medicare provider or supplier, Medicare payment policies, Medicare reimbursement, evaluation and management services, protecting the Medicare Trust Fund, inquiries, overpayments and fee-for-service appeals. 

 For more information, go to http://www.cms.hhs.gov/MLNGenInfo/