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Medical Industry Reimbursement News

PCORI Board Members Named

September 23rd, 2016

The Government Accountability Office (GAO) has named two new members to six-year terms on the Patient-Centered Outcomes Research Institute (PCORI) Board of Governors: Russell Howerton, M.D., chief medical officer and vice president of clinical operations at Wake Forest Baptist Medical Center in Winston-Salem, NC; and Kathleen Troeger, director of outcomes research at Hologic Inc. Reappointed to the board were: Christine Goertz, vice chancellor for research and health policy at Palmer College of Chiropractic in Davenport, IA; Sharon Levine, M.D., associate executive director for The Permanente Medical Group of Northern California; Ellen Sigal, chairperson and founder of Friends of Cancer Research; Robert Zwolak, M.D., vascular surgeon at Dartmouth-Hitchcock Medical Center in Lebanon, NH; and Grayson Norquist, M.D., chief of psychiatry service at Grady Health System in Atlanta.

The press released is available at http://www.gao.gov/press/pcori_2016sep.htm?utm_medium=email&utm_source=govdelivery

Cybersecurity Discussion Guide Released by CDC

September 22nd, 2016

The Centers for Disease Control and Prevention (CDC) has released a discussion guide to help hospitals and health care organizations identify issues to address when responding to a cyber breach or attack. The guide includes scenarios and questions to facilitate small group discussions on the issue for cybersecurity preparedness and response planning.

The guide can be found at, http://www.cdc.gov/phpr/healthcare/documents/healthcare-organization-and-hospital-cyber-discussion-guide.pdf

Medicare 30-day Hospital Readmissions Fall by 565,000

September 14th, 2016

Medicare 30-day readmission rates declined in 49 states between 2010 and 2015, resulting in an estimated 565,000 fewer hospital readmissions, according to data released by the Centers for Medicare & Medicaid Services (CMS).  According to CMS, rates fell by more than 5% in 43 states and by more than 10% in 11 states. While hospitals have reduced readmissions since 2010, the program has penalized them by $1.9 billion.

For further details, visit https://blog.cms.gov/2016/09/13/new-data-49-states-plus-dc-reduce-avoidable-hospital-readmissions/

Increase in Hospital Patient Access to EHR Information Reported by ONC

September 13th, 2016

According to a report released by the Department of Health and Human Services’ Office of the National Coordinator for Health Information Technology, seven in ten hospitals provided their patients with the ability to view, download, and transmit their health information electronically in 2015, a seven-fold increase from 2013. At least 40% of hospitals in every state had these patient engagement capabilities. Among other capabilities, about three-quarters of hospitals enabled patients to request an amendment to their health data and offered patients the ability to electronically pay their bills, while more than one-third enabled patients to submit patient-generated data.

The report can be found at http://dashboard.healthit.gov/evaluations/data-briefs/hospitals-patient-engagement-electronic-capabilities-2015.php

QIOs Resume Two-midnight Reviews

September 9th, 2016

The Centers for Medicare & Medicaid Services (CMS) has announced Quality Improvement Organizations (QIO) resumed claim audits under the two-midnight inpatient admissions policy. CMS temporarily paused the patient status reviews in May to improve standardization. CMS said it was lifting the pause in reviews because the Beneficiary and Family Centered Care (BFCC) QIOs have completed re-training on the two-midnight policy, re-reviewed claims that were previously formally denied, performed provider outreach on claims affected by the temporary suspension, and initiated provider outreach and education regarding the two-midnight policy. In addition, CMS said it examined and validated the BFCC-QIOs’ peer review activities related to short-stay reviews and will continue to review a sample of completed claim reviews each month, monitor provider education calls, and respond to individual provider inquiries and concerns.

For further details, visit http://qioprogram.org/end-temporary-suspension-bfcc-qio-short-stay-reviews-faq

Emergency Preparedness Final Rule Released

September 8th, 2016

The Centers for Medicare & Medicaid Services (CMS) has released a final rule increasing emergency preparedness requirements for hospitals and other critical facilities. Recent national disasters prompted the agency to increase requirements for health care facilities in the Medicare Conditions of Participation. In the rule, CMS finalizes its proposal requiring hospitals to conduct a comprehensive all-hazard risk assessment and act to mitigate the identified risks, and to work with their community to be ready. The agency provided flexibility to hospitals in locating new generators and not requiring relocation of existing generators.

The rule is available at https://www.federalregister.gov/documents/2016/09/16/2016-21404/medicare-and-medicaid-programs-emergency-preparedness-requirements-for-medicare-and-medicaid

Navigator Grants for 2017 Marketplace Awarded

September 5th, 2016

The Centers for Medicare & Medicaid Services (CMS) has awarded $63 million in grants to support “navigators” to help consumers enroll in coverage through the federally-facilitated Health Insurance Marketplace for a 12-month period beginning September 2nd. The grants went to 98 organizations, several of which include partnerships with hospitals and hospital systems. Marketplace CEO Kevin Counihan stated that they are committed to making sure consumers have all the resources they need to find the right plan when open enrollment begins on November 1.

For further details, visit https://www.cms.gov/CCIIO/Programs-and-Initiatives/Health-Insurance-Marketplaces/Downloads/Navigator-Grantee-Summaries-2016.pdf

CMS Releases Medicare ACO Performance Data

August 25th, 2016

On August 25, the Centers for Medicare & Medicaid announced that the Medicare Accountable Care Organizations (ACOs) qualified for more than $466 million in shared savings in 2015 by meeting quality standards and their savings threshold. Eight Pioneer ACOs generated more than $37 million in shared savings, while four generated losses. In addition, 119 Medicare Shared Savings Program ACOs earned $429 million in shared savings. Pioneer ACOs are early adopters of coordinated care and assume greater performance-based financial risk. ACOs with three years of experience in the program were more likely to earn savings (42%) than those participating one (22%) or two years (37%). Pioneer ACOs increased their mean quality score to more than 92%, an increase of more than 21 percentage points since the first year. MSSP ACOs improved on 84% of the quality measures that were reported in both 2014 and 2015.

For more information, go to https://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2016-Fact-sheets-items/2016-08-25.html

CDC Releases Vital Signs Report on Sepsis

August 23rd, 2016

According to a Vital Signs report released by the Centers for Disease Control and Prevention, health care providers are key to preventing, recognizing, and rapidly treating sepsis, since seven in ten patients who develop sepsis recently interacted with a health care provider or are likely to due to a chronic condition. The agency is partnering with provider organizations and patients to raise awareness about sepsis, a life-threatening complication of infection that begins outside of the hospital for nearly 80% of patients.

The report can be found at http://www.cdc.gov/mmwr/volumes/65/wr/mm6533e1.htm?s_cid=mm65

Draft 2017 Interoperability Standards Advisory Issued

August 23rd, 2016

The Department of Health and Human Services’ Office of the National Coordinator (ONC) for Health Information Technology has released for public comments the 2017 Draft Interoperability Standards Advisory. The advisory is an updated list and assessment of the standards and implementation specifications available to meet clinical health IT interoperability needs. The advisory is a non-binding document, but the standards and implementation specifications may be considered for rulemaking or other federal requirements. ONC particularly seeks comments on the references to more than one standard or implementation specification for a specific need. Comments are due October 24.

For more information, visit https://www.healthit.gov/standards-advisory/draft-2017