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Archive for August, 2011

Final Rule for Electronic Prescribing Incentive Program Issued

Wednesday, August 31st, 2011

The Centers for Medicare & Medicaid Services (CMS) has issued a final rule modifying the Medicare Electronic Prescribing (eRx) Incentive Program. Beginning in January, eligible physicians who fail to meet the program’s e-prescribing requirements or obtain an exemption will be subject to a 1% payment penalty. The rule implements the four new significant hardship exemption categories proposed for the 2012 payment adjustment. The rule also extends to November 1 the deadline for eligible professionals and group practices to request a significant hardship exemption, and changes the e-prescribing measure to recognize adoption of certified electronic health records (EHR) technology as a “qualified” system under the e-Prescribing Incentive Program.

For more information, see the CMS announcement here.

Draft Strategies Aligning Quality Measures Released

Tuesday, August 30th, 2011

The Measures Application Partnership (MAP) released draft strategies for aligning public and private efforts to reduce healthcare-acquired conditions (HAC) and readmissions, and for aligning physician performance measurement across federal programs. As part of the Patient Protection and Affordable Care Act (ACA), MAP is a public-private partnership convened by the National Quality Forum to provide input to the Department of Health and Human Services (HHS) on selecting and aligning performance measures for public reporting and performance-based payment programs. MAP will give pre-rulemaking input to Health and Human Services (HHS) next February and it will be based on a list of measures that HHS will post in December.

The draft strategies can be accessed here.

Second Phase of Competitive Bidding Program Announced

Friday, August 19th, 2011

On August 19, the Centers for Medicare & Medicaid Services (CMS) announced that the competitive bidding program for durable medical equipment, prosthetics, orthotics and supplies (DMEPOS) will expand to additional regions and products effective July 1, 2013. The second phase of the program will include 91 metropolitan areas and eight product categories. CMS plans this fall to announce the schedule for bidding, which would begin in winter 2012. Round-two zip codes and a list of the specific items in each product category are available at www.dmecompetitivebid.com.

The announcement can be found by visiting this link.

Updated Outcomes Available on Hospital Compare

Wednesday, August 10th, 2011

The Centers for Medicare & Medicaid Services (CMS) has updated data for outcomes of inpatient hospital care on Hospital Compare. The update includes new 30-day mortality rates and 30-day readmission rates for inpatients admitted with heart attack, heart failure and pneumonia. This year, the national 30-day mortality rates for heart attack have continued to decline, falling by 0.3 percent from the 2006 through 2009 rate of 16.2% to the more recent 2007 through 2010 rate of 15.9%. Mortality rates for heart failure and pneumonia increase slightly over the same periods, showing an increase from 11.2 to 11.3 % for heart failure and 11.6 to 11.9 % for pneumonia, respectively.

More information about Hospital Compare is online at www.hospitalcompare.hhs.gov

PGP Demonstration Improves Quality and Reduces Costs

Monday, August 8th, 2011

On August 8, the Centers for Medicare & Medicaid Services (CMS) announced the results from the initial Physician Group Practice (PGP) Demonstration. The PGP is a partnership with physician group practices that aims to better coordinate care across different settings. After five years, this demonstration has shown positive results, improvements in quality and savings in Medicare expenditures.

Currently, there are 10 physician groups participating. Seven of the groups achieved benchmark performance on all 32 performance measures and the remaining three groups achieved at least 30 of the 32 reported measures. All 10 groups achieved benchmark performance on heart failure, coronary artery and preventive care measures. Four of the groups will receive incentive payments of $29.4 million.

For additional details on the design of the PGP Demonstration, visit the PGP Demonstration webpage at: http://www.cms.gov/demoprojectsevalrpts/md/itemdetail.asp?itemid=CMS1198992

IPPS and LTCH Final Rule for FY 2012 Released

Monday, August 1st, 2011

The Centers for Medicare & Medicaid Services (CMS) has issued the final rule establishing fiscal year (FY) 2012 policies and payment rates for inpatient services furnished to Medicare beneficiaries by acute care hospitals, long term care hospitals (LTCH) and certain excluded hospitals. CMS projects that total Medicare operating payments to acute care hospitals for inpatient services occurring in FY 2012 will increase by $1.13 billion, or 1.1% because of a 1.0 percent increase in payment rates together with other policies adopted in the final rule. Medicare payments to LTCHs are projected to increase by $126 million or 2.5 percent.

The final rule also strengthens the Hospital Inpatient Quality Reporting (IQR) Program by placing greater emphasis on preventing health care-associated infections in general acute care hospitals and establishes the framework for a new quality reporting programs that will apply to hospitals paid under the LTCH PPS.

In addition, CMS is required by provisions in the Affordable Care Act (ACA) to implement the Hospital Readmissions Reduction Program beginning October 1, 2012. Through this program, CMS will reduce payment to those hospitals that have excessive readmissions for three conditions – acute myocardial infarction, heart failure, and pneumonia. The rule also establishes the methodology that will be used to calculate excessive readmission rates for these conditions.

The final rule also lays the groundwork for a quality reporting program under the LTCH PPS by establishing the first measure set for reporting beginning October 1, 2012.

The final rule can be found by going to http://www.ofr.gov/OFRUpload/OFRData/2011-19719_PI.pdf