FY08 marked a turning point in state finances, with a significant increase in the number of states experiencing fiscal difficulties after several years of relative stability, according to the National Governors Association (NGA) and the National Association of State Budget Officers (NASBO).
In a report released June 19, The Fiscal Survey of States, NGA and NASBO found that while fiscal conditions varied dramatically across states, overall expenditure growth rates declined in FY08 and the number of states experiencing revenue shortfalls increased. States expect continued expenditure pressures from a variety of sources, including health care and Medicaid, employee pensions, and infrastructure.
States’ largest expenditure for FY08 was health care, which accounts for nearly one-third of total state spending; Medicaid alone comprises about 22 percent of total state spending. With a projected growth rate of 8 percent annually through FY18, healthcare spending will continue to strain state budgets. Meanwhile, about half of governors included proposals to expand healthcare coverage for the uninsured in their proposed FY09 budgets. Approaches include using traditional Medicaid expansion and flexibilities offered under the Deficit Reduction Act, expanding the State Children’s Health Insurance Program, and using public-private partnerships to increase coverage. Read the report.
Medicare beneficiaries who live in rural and underserved areas would be able to continue to get their healthcare services from rural health clinics (RHCs) whose services are tailored to meet their individual needs under new rules proposed June 26 by the Centers for Medicare and Medicaid Services.
The proposed regulation would require RHCs to establish quality assessment and performance improvement programs. It would also establish location requirements necessary for a clinic to continue to participate as an RHC, which would ensure that the RHC program kept pace with demographic changes in the service areas and best met the needs of underserved beneficiaries.
Many changes in the proposed rule, such as revisions to the payment methodology, would also apply to federally qualified health centers. Comments are due by Aug. 27, 2008. Download the proposed rule.
More than 20 percent of the U.S. population in 2007--one in five people--reported not getting or delaying needed medical care in the previous 12 months, up significantly from 14 percent in 2003, according to a national study released June 26 by the Center for Studying Health System Change (HSC).
In 2007, more than 23 million people reported going without needed care, and approximately 36 million people delayed care, for a total of about 59 million people reporting access problems, according to findings from HSC’s 2007 Health Tracking Household Survey, a nationally representative survey containing information on 18,000 people; the survey had a 43 percent response rate. HSC has conducted the survey five times since 1997 as part of the Community Tracking Study, and the 2007 survey shows the sharpest increase in access problems in a decade, particularly among insured Americans.
The study’s findings are detailed in a new HSC tracking report, Falling Behind: Americans’ Access to Medical Care Deteriorates, 2003-2007. Read the report.
Covering low-income people through public programs such as Medicaid and the State Children’s Health Insurance Program (SCHIP), rather than through private health insurance, results in lower per person medical spending and considerably lower out-of-pocket expenses for consumers. That’s the conclusion of a new study published June 24 on the Health Affairs web site, which looks at different ways of providing health insurance to Americans with family incomes below 200 percent of the federal poverty level.
For example, the total annual medical spending required to cover an average low-income uninsured adult with Medicaid for a full year would have been $3,084 in 2005, while covering that person with private health insurance instead would have cost $3,899, or about 26 percent more. More dramatically, if the uninsured person were covered by Medicaid, the annual out-of-pocket expenses for that person--including payments for deductibles, copayments and coinsurance, and noncovered services, but not premiums--would be $109, but would be $771 under private health insurance, or about 600 percent more. Similarly, if an average uninsured child were covered for a full year by Medicaid or SCHIP, total annual spending would be $918, but would be $1,194 with private insurance. The amount spent out of pocket for the child would be $36 per year with Medicaid or SCHIP, compared with $305 with private insurance, say the coauthors. Read the abstract.
New England had the lowest percentage of uninsured individuals under age 65 in 2004-06 and the Southwest had the highest, according to a report from the Centers for Disease Control and Prevention’s (CDC) National Center for Health Statistics released June 25. The report is based on data collected from 240,000 people under age 65 as part of the 2004-06 National Health Interview Survey.
Overall, 91.1 percent of New Englanders had some kind of health insurance in 2004-06. The Southwest had the greatest proportion of uninsured--18.2 percent of children and nearly 30 percent of adults.
Among other findings, the survey found that nationally, 67.8 percent of the population under age 65 had private health insurance, whereas 13.2 percent had insurance through Medicaid or the State Children’s Health Insurance Program and 3.4 percent had other types of public coverage, leaving 16.6 percent uninsured during the 2004-06 period.
Preliminary national data for 2007 were also released in a separate report, showing 43.1 million Americans of all ages were uninsured in 2007 (14.5 percent of the population.) This report also shows that 8.9 percent of children under age 18 had no health insurance in 2007--the lowest percentage of uninsured children in the past decade. Read the report.
Diabetes now affects nearly 24 million people in the United States, an increase of more than 3 million in approximately two years, according to new 2007 prevalence data estimates released June 25 by the Centers for Disease Control and Prevention (CDC). This means that nearly 8 percent of the U.S. population has diabetes.
In addition to the 24 million with diabetes, another 57 million people are estimated to have pre-diabetes, a condition that puts people at increased risk for diabetes. Among people with diabetes, those who do not know they have the disease decreased from 30 percent to 25 percent over a two-year period.
Among adults, diabetes increased in both men and women and in all age groups, but still disproportionately affects the elderly. Almost 25 percent of the population 60 years and older had diabetes in 2007. And, as in previous years, disparities exist among ethnic groups and minority populations including Native Americans, blacks and Hispanics. After adjusting for population age differences between the groups, the rate of diagnosed diabetes was highest among Native Americans and Alaska Natives (16.5 percent). This was followed by blacks (11.8 percent) and Hispanics (10.4 percent), which includes rates for Puerto Ricans (12.6 percent), Mexican Americans (11.9 percent), and Cubans (8.2 percent). By comparison, the rate for Asian Americans was 7.5 percent with whites at 6.6 percent. Access the National Diabetes Fact Sheet.
The IRS announced on June 25 an increase in the optional standard mileage rates for the final six months of 2008. Taxpayers may use the optional standard rates to calculate the deductible costs of operating an automobile for business, charitable, medical, or moving purposes.
The rate will increase to 58.5 cents a mile for all business miles driven from July 1, 2008, through Dec. 31, 2008. This is an increase of eight cents from the 50.5-cent rate in effect for the first six months of 2008. In recognition of recent gasoline price increases, the IRS made this special adjustment for the final months of 2008. The IRS normally updates the mileage rates once a year in the fall for the next calendar year.
The new six-month rate for computing deductible medical or moving expenses will also increase by eight cents to 27 cents a mile, up from 19 cents for the first six months of 2008. The rate for providing services for charitable organizations is set by statute, not the IRS, and remains at 14 cents a mile. Read the announcement.
Yesterday at its Annual National Institute in Las Vegas, HFMA released the first in a series of reports that will collectively address building a new healthcare payment system, Healthcare Payment Reform: From Principles to Action. The report was the result of significant input from representatives of a variety of key stakeholders--consumers, providers, payers, and employers--who took time to contribute to this critical topic.
According to the report, the current healthcare payment system blocks true reform by inadequately rewarding wellness, high-quality care, and efficiency, and by driving up costs through the system’s complexity. Effective payment system reform must take place within a set of principles that support the nation’s health goals, as well as the needs of all key stakeholder groups. HFMA has worked with healthcare thought leaders around the country to identify the following principles, as well as actions needed to make those principles a reality:
* Quality: Payments should encourage and reward high-quality care and discourage medical errors and ineffective care.* Alignment: Payments should align incentives among all stakeholders to maximize the efficiency and coordination of health services.* Fairness: Payment systems should sufficiently balance the needs and concerns of all stakeholders.* Simplification: Payment processes should be simplified, standard, and transparent.* Societal benefit: The resources needed to support broad societal benefits such as medical and public education, medical research, and care for disenfranchised or uninsured persons should be identified and paid for explicitly.
The report also presents a number of payment types and elements that can support these principles, along with areas of stakeholder consensus and concern about each. Read the report.
Two-thirds of health leaders, including government and private payers from 20 different countries, see problems with their current payment system, and they are exploring new payment models that use incentives to better balance access, quality, efficiency, and demand, according to a report published June 23 by PricewaterhouseCoopers’ Health Research Institute. The report, entitled You Get What You Pay For: A Global Look at Balancing Demand, Quality and Efficiency in Healthcare Payment Reform, provides a comprehensive overview of how payment models are changing in different countries, lessons learned from the experiences of other health systems, and findings of a survey of 200 health industry executives including government payers, private payers, hospital executives, and physicians.
Among other findings in the report, case-based prospective payment that groups reimbursement rates into diagnosis-related groups is the emerging standard for hospital payment, having proven to improve efficiencies. This type of hospital reimbursement already has been adopted by 70 percent of countries within the Organisation for Economic Cooperation and Development. Also, reimbursement to general practitioners and primary care physicians is far more varied among different countries and regions than reimbursement to hospitals. Models that integrate hospital and physician payment have proven best at creating mutually aligned incentives. Download the report.
People with psychiatric illnesses, including children, who are admitted to the hospital from the emergency department (ED) can wait 24 hours or longer for an inpatient bed, principally because of a lack of psychiatric beds. The findings of a survey of ED directors were reported June 18 by the American College of Emergency Physicians.
Of the 328 ED directors who responded to the survey, almost 80 percent said their hospital boards psychiatric patients in the ED. Thirty percent said their hospitals board psychiatric patients between eight and 24 hours, and more than one-quarter said that their hospitals board children with psychiatric illnesses for that long.
The main reasons given for boarding of psychiatric patients in the ED are the lack of in-house inpatient psychiatric beds, and either absence or inability of any facility to accept transfers of these patients. Sixty percent of respondents said their ED does not have a dedicated area for psychiatric patients. Read the report summary.
Despite the promises it offers health care and quality improvement, only a small minority of U.S. physicians have embraced electronic health records (EHRs) as a routine part of practice, says a study report in the June 19 online edition of the New England Journal of Medicine. The survey of 2,758 physicians shows that only 4 percent have a fully functional EHR system and 13 percent have a basic one.
The survey shows that 16 percent of physicians said their practice had purchased an EHR but had not employed it yet. Another 26 percent said their practice was planning on purchasing a digital recordkeeping system within the next two years. Also, physicians who practiced in groups of at least 50 were three times more likely as those in very small practices (three doctors or less) to have a basic EHR. Nevertheless, only a minority of physicians in these larger groups (17 percent) had a fully functional EHR and 49 percent did not have an EHR at all.
Cost and complexity are key barriers. Two-thirds of physicians without EHRs cited affordability as the reason; other reasons included finding the right EHR, concern about ROI, and the fact that the system may become obsolete quickly. Read the article.
More than 27,000 healthcare providers (about 6 percent of all such providers) who were paid under Medicare during CY06 had payroll and other agreed-to federal tax debts totaling more than $2 billion, according to a Government Accountability Office (GAO) analysis of data provided by the Centers for Medicare and Medicaid Services (CMS) and IRS. The $2 billion in unpaid tax debts includes only those debts reported on a tax return or assessed by IRS through its enforcement programs. According to the GAO, this $2 billion figure is understated because some providers owed taxes under tax identification numbers (TINs) separate from the TINs that received the Medicare payments, or they did not file their tax returns.
GAO examined about 436,000 Medicare providers who received payments in 2006. Among other investigative activities, the agency compared claim payment data from CMS and tax debt data from the IRS. It found that $896 million, or about half, of the back taxes were from payroll taxes the providers withheld from employees but did not turn over to the Treasury Department. In some cases, the funds were diverted into personal accounts, according to the report. Read the highlights.
All 16,000 of the nation’s long-term care (LTC) facilities will have to install full sprinkler systems if they wish to continue to serve Medicare and Medicaid beneficiaries, under a new regulation to be issued by the Centers for Medicare and Medicaid Services (CMS). Facilities will have a five-year phase-in period to fully comply with the new rule.
As an interim step taken prior to publication of this rule, CMS in March 2005 began requiring all LTC facilities that did not have sprinklers to install battery-operated smoke alarms in all patient rooms and public areas. Although fatal fires in nursing homes are rare, in a July 2004 report, the Government Accountability Office estimated that automatic sprinkler systems can decrease the chance of fire-related deaths by 82 percent.
All new sprinkler systems installed as a result of this rule will have to meet National Fire Protection Association technical specifications. To be in compliance with the new rule, nursing homes must have sprinkler coverage in all areas such as resident rooms; kitchen, dining and activity areas; corridors; attics; canopies; overhangs; offices; waiting areas; closets; storage areas for trash and linen; and maintenance areas. Read the press release.
The Centers for Medicare and Medicaid Services (CMS) on June 18 announced it will soon launch a ranking system of U.S. nursing homes, giving each a “star” rating. The ratings will be posted on the agency’s Nursing Home Compare web site beginning in December 2008.
The agency is also considering adding new information to that already available on Nursing Home Compare such as whether a nursing home specializes in caring for patients with dementia, on ventilators, or in need of specialized rehabilitation services. Information on patient and family satisfaction with services at a facility may also be added to Nursing Home Compare.
During June and July the agency is soliciting ideas, comments, and suggestions from the public, consumer groups, nursing homes, and many others. Read the press release.
The Centers for Medicare and Medicaid Services (CMS) announced on June 17 that it will award incentive payments of more than $7 million to 112 top-performing hospitals in the third year of the CMS/Premier Hospital Quality Incentive Demonstration (HQID) project. Through the project’s first three years, CMS has awarded more than $24.5 million to top performers.
According to the results released June 17, more than 250 hospitals participating in the project have raised overall quality by an average of 15.8 percent over three years based on their delivery of 30 nationally standardized and widely accepted care measures to patients in five clinical areas. And 15 hospitals moved from “worst to first” rankings, moving from the bottom to the top fifth of hospitals in one or more clinical areas. These hospitals improved by an average 32.6 percentage points in quality scores over three years.
Improvements in quality of care saved the lives of an estimated 2,500 heart attack patients across the first three years of the project, according to an analysis of mortality rates at participating hospitals. Patients also received approximately 300,000 additional recommended evidence-based clinical quality measures, such as smoking cessation, discharge instructions, and pneumococcal vaccination, during that same timeframe. Read the press release.
The Joint Commission on June 17 announced the 2009 National Patient Safety Goals and related requirements for each of its accreditation programs and its Disease-Specific Care Certification program. The goals apply to the more than 15,000 Joint Commission-accredited and -certified healthcare organizations and programs.
Major changes for 2009 include three new hospital and critical access hospital requirements related to preventing deadly healthcare-associated infections due to multiple drug-resistant organisms (MDROs), central line-associated bloodstream infections, and surgical site infections. These additions build on an existing goal to reduce the risk of healthcare-associated infections, and recognize that patients continue to acquire preventable infections at an alarming rate within hospitals. The new requirements related to central line-associated bloodstream infections also will take effect for ambulatory care facilities and office-based surgery practices, home care organizations, and long-term care organizations. In addition, prevention of surgical site infections will be a new requirement for ambulatory care facilities and office-based surgery practices. These new infection-related requirements have a one-year phase-in period that includes defined milestones, with full implementation expected by Jan. 1, 2010. Access the 2009 National Patient Safety Goals.
Although medical costs have increased steadily for decades, the rate of growth has been slowing in each of the past five years. No more, however: In 2009, the downward trend is expected to level off, and actual medical costs are expected to grow 9.6 percent, according to a new PricewaterhouseCoopers Health Research Institute (HRI) report, Behind the Numbers: Medical Cost Trends for 2009. The report is based on HRI analyses and a survey of more than 500 employers and provider-based health plans.
According to the report, multiple factors are expected to help drive medical cost increases in 2009, including booming healthcare construction and increasing cost-shifting from the uninsured, Medicare, and Medicaid to private payers. Also, a recession in 2009 could result in higher costs, since medical price growth historically has risen faster during recessions. The outcome of this year’s elections also could have an impact: If a Democratic president takes office in 2009 and puts in place initiatives to expand coverage of the uninsured, cost-shifting could be reduced, which may benefit employers and workers, but also may increase taxes. Access the report.
The Department of Health and Human Services (HHS) Office of Inspector General (OIG) Semiannual Report to Congress has announced expected recoveries of $2.2 billion for the first half of FY08 from efforts to reduce fraud, waste, and abuse in HHS programs.
Specifically, OIG’s $2.2 billion in expected recoveries encompasses $1.1 billion in audit-related recoveries and another $1.1 billion in investigative-related recoveries. Also for this period, OIG reported exclusions of 1,291 individuals and organizations for fraud or abuse of federal healthcare programs; 293 criminal actions against individuals or organizations that engaged in crimes against HHS programs; and 142 civil actions, which include False Claims Act and unjust enrichment suits filed in district court, Civil Monetary Penalties Law settlements, and administrative recoveries related to provider self-disclosure matters. Download the report.
To help reduce the administrative burden of ensuring accurate insurance payments, the American Medical Association (AMA) on June 16 launched the Cure for Claims campaign, and unveiled its National Health Insurer Report Card on claims processing. Inefficiencies in the current system of processing medical claims add unnecessary cost to the healthcare system, estimated as much as $210 billion annually, said the AMA in a statement.
The health insurer report card is intended to provide physicians and the public with information on the timeliness, transparency, and accuracy of claims processing by health insurance companies. Based on a random sample pulled from more than 5 million electronically billed services, the report card provides an in-depth look at the claims processing performance of Medicare and seven national commercial health insurers: Aetna, Anthem Blue Cross Blue Shield, CIGNA, Coventry Health Care, Health Net, Humana, and United Healthcare.
The report card demonstrates the inconsistency and confusion that results from each health insurer using different rules for processing and paying medical claims. It also suggests that both physicians and health insurers can help reduce unnecessary administrative costs if electronic transactions and full transparency are widely adopted. Read the press release.
Department of Health and Human Services (HHS) Secretary Mike Leavitt on June 16 declared a public health emergency in the flood-stricken states of Iowa and Indiana. The action is intended to give Centers for Medicare and Medicaid Services’ (CMS) Medicare beneficiaries and their healthcare providers greater flexibility in meeting emergency health needs.
Because of flood damage to local healthcare facilities, many beneficiaries have been evacuated to neighboring communities, where receiving hospitals and nursing homes may have no healthcare records, information on current health status, or even verification of the person’s status as a Medicare beneficiary. CMS is assuring those facilities that in this circumstance, they can act under a presumption of eligibility.
Among other actions, CMS will waive the three-day prior hospitalization requirement for evacuated patients admitted to skilled nursing facilities and relax limitations on the benefit period for those evacuated patients; it will also not count the evacuated patients in calculating the 25-day average length of stay in affected long-term care hospitals. CMS is also allowing beneficiaries in health plans to go out of network during this emergency. Access the web site.
The National Committee for Quality Assurance (NCQA), in collaboration with Mathematica Policy Research and the American Medical Association (AMA)-convened Physician Consortium for Performance ImprovementTM, on June 10 released a set of measures assessing clinician performance in four areas of care for public comment. The set comprises 22 measures in rheumatoid arthritis care, palliative/end-of-life care, endoscopy and polyp surveillance, and chronic wound care. These measures may be used for quality improvement efforts, maintenance of certification programs, or pay-for-performance initiatives.
Clinician-level measures allow physicians, nurse practitioners, and other health professionals to improve performance in specialty areas.
All topic areas for public comment will be available for review on NCQA’s web site (www.ncqa.org) through July 1. All interested parties are invited to comment. Read the press release.
The Centers for Medicare and Medicaid Services (CMS) on June 10 announced that Pinnacle Business Solutions, Inc. (PBSI) has been awarded a contract of up to five years for the combined administration of Part A and Part B Medicare claims payment in Arkansas, Louisiana, and Mississippi.
PBSI will serve as the first point of contact for the processing and payment of Medicare fee-for-service claims from hospitals, skilled nursing facilities, physicians, and other healthcare practitioners in the three states.
The new Part A/Part B Medicare administrative contractor (A/B MAC) will take claims payment work now performed by three fiscal intermediaries and two carriers in the three states. The A/B MAC contract has an approximate value of $178 million over five years. PBSI will immediately begin implementation activities and will assume full responsibility for the claims processing work in its three-state jurisdiction no later than February 2009. Read the press release.
Communities fear waning attention to health system surge capacity--the space, supplies, people, and command structure to care for many injured or ill people--could jeopardize progress to respond in a terrorist attack, natural disaster, or infectious disease pandemic, according to a study released June 12 by the Center for Studying Health System Change (HSC).
The study examined community-level surge capacity development and variation across six communities: Boston; Greenville, S.C.; Miami; Phoenix; Orange County, Calif.; and Seattle. To place these communities’ perspectives in a broader context with communities that have faced large-scale disasters, interviews also were conducted with officials in New York City, Washington, D.C., and New Orleans, as well as with national leaders. The findings are detailed in a new HSC research brief, Developing Health System Surge Capacity: Community Efforts in Jeopardy.
Communities rely on federal funding to help coordinate and plan across agencies and healthcare providers, conduct training and drills, recruit volunteers, and purchase equipment and stockpile supplies for a disaster, according to the study. Although federal funding has raised community awareness of the need for surge capacity and enabled communities to carry out those activities, respondents reported that federal funding is fragmented and declining, making it difficult for communities to pursue a comprehensive surge capacity strategy. Read the research brief.
Age-adjusted death rates in the United States declined significantly between 2005 and 2006 and life expectancy hit another record high, according to preliminary death statistics released June 11 by the Centers for Disease Control and Prevention’s National Center for Health Statistics.
The 2006 age-adjusted death rate fell to 776.4 deaths per 100,000 population from 799 deaths per 100,000 in 2005. In addition, death rates for eight of the 10 leading causes of death in the United States all dropped significantly in 2006, including a very sharp drop in mortality from influenza and pneumonia. Download the report.
In a June 10 letter citing concerns about alleged discrepancies, unfair bidding rules, and data anomalies in the Medicare demonstration program for durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS), 40 senators supported legislation that would delay the program. The competitive bidding program is slated to begin in 10 metropolitan areas July 1.
Citing the fact that almost 4 million Medicare beneficiaries would be affected by the first round of the program, and 18 million by the second round (scheduled to start in 2009), the senators expressed their overall concern regarding the “implications for Medicare beneficiaries receiving high-quality health care.” Specifically, they urge an internal review to ensure the accuracy and effectiveness of the criteria for future bidding. Read the letter.
E-prescribing is an intelligent, efficient technology that improves patient safety and saves money by eliminating the inefficiencies of a paper-based system. So concludes a new white paper on electronic prescribing released June 11 by the Center for Health Transformation. The paper presents a comprehensive look at the technology, its benefits in saving lives and money, and how to overcome the barriers to its widespread adoption. A broad coalition of member organizations, from physicians and hospitals to health insurers, pharmacy benefit managers, and technology leaders, prepared the report.
The paper was written by Center members, including the American Hospital Association, American Medical Group Association, Blue Cross Blue Shield Association, Healthvision, Microsoft, MinuteClinic, and the Pharmaceutical Care Management Association. Download the paper.
The number of underinsured adults rose by 60 percent between 2003 and 2007, from 16 million to more than 25 million, according to a new Commonwealth Fund study released June 10 as a Health Affairs web exclusive. Middle- and higher-income families were hit the hardest by the steep increase: Underinsurance rates nearly tripled for those with incomes above 200 percent of the federal poverty level (annual income of $40,000 or higher for a family).
In How Many Are Underinsured? Trends Among U.S. Adults, 2003 and 2007, Commonwealth Fund authors use 2007 national survey data to provide a national estimate of the number of adults who are underinsured, updating a 2003 study. The analysis finds that 25.2 million insured adults ages 19-64 were underinsured based on their out-of-pocket healthcare costs relative to their incomes. Including those who had any time without insurance during the year, the study estimates that 42 percent of adults age 19-64, or 75 million people, were either uninsured or underinsured during the year as of 2007, up from one-third in 2003.
The study found that despite the fact that the underinsured have health insurance all year long, they are at high risk of access problems and financial stress--with experiences often similar to those of the uninsured. The authors conclude that benefit designs that reduce cost sharing for high-value, cost-effective care and lower cost sharing for families with low and modest incomes will be necessary to achieve high-quality care and better health outcomes rather than just coverage. Read the abstract.
Department of Health and Human Services (HHS) Secretary Mike Leavitt on June 10 named 12 communities that will participate in a national Medicare demonstration project that provides incentive payments to physicians for using certified electronic health records (EHR) to improve the quality of patient care.
The communities selected to work with the Centers for Medicare and Medicaid Services (CMS) on the EHR demonstration project range from county and state level to multistate collaborations. They include Alabama; Delaware; Jacksonville, Fla. (multi-county); Georgia; Madison, Wis. (multi-county); Maine; Louisiana; Maryland/Washington, D.C.; Oklahoma; Pittsburgh (multi-county); South Dakota (multi-state); and Virginia.
Over the five-year demonstration project, financial incentives will be provided to as many as 1,200 primary care physician practices in the selected communities that use certified EHRs to improve quality as measured by their performance on specific clinical quality measures. In addition to the incentive payments, bonus payments may be awarded based on a standardized survey measuring the number of EHR functionalities a physician group has incorporated into its practice. Total payments under the demonstration for all five years may be up to $58,000 per physician or $290,000 per practice.
Findings from the demonstration will help determine the role of EHRs in delivering high-quality care and reducing errors; it will also assess the role of incentive payments in encouraging adoption and use of EHRs. Read the release.
Kaiser Permanente and Microsoft Corp. announced June 9 that the two companies will pilot health data transfers between Kaiser Permanente’s My Health Manager and Microsoft’s Health Vault consumer health platform. The program is expected to unveil new strategies for expanding consumer access to online health information and management tools.
Connecting My Health Manager to the HealthVault platform will allow users to combine personal health information from Kaiser and other sources, including health and wellness management applications and devices such as blood pressure monitors.
Kaiser’s 159,000 employees will be eligible to participate in the pilot program. Participation in the employee pilot is voluntary and is designed to test the ability to transfer data easily and securely, and ensure that the functionality allows easy access to individual personal health information, as well as the ability to manage those data. If the pilot is successful, the program will be expanded to include Kaiser Permanentes more than 8 million members. Read the press release.
The Centers for Medicare and Medicaid Services (CMS) on June 6 announced that an additional $15 million will be distributed to State Health Insurance Assistance Programs (SHIPs) to help people with Medicare get more information about their healthcare choices.
The $15 million is the second of three installments of SHIP funding in 2008 and will be distributed in June. CMS will distribute more than $50 million to the nation’s SHIPs in 2008; of that, $36 million was distributed on April 1 and an additional $1.5 million will be distributed in performance-based awards to SHIPs in September. This funding represents a $20 million increase in SHIP funding over FY07.
SHIPs are state-based programs that use community-based networks to provide Medicare beneficiaries with local, personalized assistance on a wide variety of Medicare and health insurance topics. CMS expects the SHIPs to use the increased 2008 funding to conduct community-based programs targeted at reaching more beneficiaries who are unable to access other sources of information such as the CMS online tools. Read the press release.
As of October, the New York State Medicaid program will deny reimbursement on 14 “never events,” announced state Health Commissioner Richard F. Daines, MD, on June 5.
Hospitals receiving payment under New York Medicaid will be required to provide information on each admission that will designate which complications were present on admission, and which ones occurred during or as a result of hospital care. Among the 14 avoidable hospital conditions that New York State Medicaid has identified as nonreimbursable are surgery performed on the wrong body part or patient, a foreign object inadvertently left in a patient after surgery, medication error, and blood incompatibility. Read the press release.
The National Committee for Quality Assurance (NCQA) on June 2 released for public comment proposed standards and measures for a new wellness and health promotion (WHP) product evaluation suite. The program will examine organizations that provide services to employers and health plans that seek to help employees and other participants better manage their own health. Nearly two-thirds of employers in the United States offer such services, including health coaching, smoking cessation, and obesity management programs.
The WHP product suite includes a broad-based accreditation program for organizations that offer comprehensive wellness services as well as certification for organizations that offer only specific components such as health appraisals and self-management tools. NCQA is also proposing a separate accreditation program for organizations that offer stand-alone weight management or smoking cessation programs. The WHP product suite is slated for launch in early 2009.
Members of the public are invited to comment on the measures through June 30. Read the press release.
The National Governors Association NGA released a statement yesterday calling on Congress to delay implementation of seven Medicaid rules scheduled to take effect Aug. 1. The Medicaid regulations represent a shift of “billions of dollars in federal costs to states,” says the statement, with a potential impact of “up to four times the Administration’s original five-year, $13 billion estimate.”
Asserting that the regulations were issued “without thoughtful dialogue between the states and federal partners,” the NGA maintains that the regulations do not offer clear guidance for compliance or reflect the unique aspects of individual state programs, and that “the issues raised by all of these regulations deserve more thoughtful, detailed and collaborative discussions” to best serve the states. Read the statement.
With increasing reports of dangerous deficiencies in the quality of health care, the Robert Wood Johnson Foundation (RWJF) on June 5 announced a $300 million commitment to improve health care in 14 communities that together cover 11 percent of the U.S. population. Underscoring the scope of the problem, RWJF also released new research showing that the quality of care people receive can vary dramatically depending on their race and where they live. The goals of the community-focused program, known as Aligning Forces for Quality, are to lift the overall quality of health care, reduce racial and ethnic disparities, and provide models for national reform.
Aligning Forces for Quality was originally launched by RWJF in 2006. In the first phase, the communities began efforts to improve health care for patients with chronic illness in outpatient settings, such as physician offices and clinics. With this expansion, Aligning Forces for Quality community teams will now strive to improve care for all patients across all settings by helping physicians improve the quality of care, giving people information that helps them make informed choices about their health care, improving care inside hospitals, and reducing inequality in care for patients of different races and ethnicities. Read the press release.
Health plan initiatives to promote health and wellness among workers are now commonplace, despite an acknowledged lack of evidence of an investment payoff, according to a study released June 4 by the Center for Studying Health System Change (HSC). The study’s findings are detailed in a new HSC issue brief, Health and Wellness Initiatives: The Shift from Managing Illness to Promoting Health.
Much of the momentum for health and wellness initiatives has come from large employers looking for long-term strategies to address rising costs and to support their broader consumer-based strategy of giving employees more responsibility for healthcare decisions and costs, the study found. However, the investment payoff for health and wellness initiatives has been difficult to demonstrate, according to the study. Because many of the health and wellness activities in existence today have been introduced only recently and not yet evaluated, there is little credible evidence regarding ROI.
“Ultimately, the credibility of health and wellness activities to improve health and contain costs will depend on evidence demonstrating both health improvements and a positive return on investment,” said Paul B. Ginsburg, PhD, president of HSC. Read the issue brief.
Everything involved in the rating process is relative to other rating factors, such as market position, business profile, financial and balance sheet ratios, management practices, and local economic factors, according to a report published June 3 by Standard & Poor’s (S&P) Ratings Services.
The report, U.S. Not-for-Profit Health Care Sector: Core Ratios and Their Role in the Rating Process, describes the key ratios that nearly always affect S&P rating decisions. These core ratios are an essential aspect of S&P’s assessment of relative financial strength or weakness, which is further refined by weighing various qualitative and quantitative rating factors.
The report also explains how S&P looks behind the numbers to less concrete rating factors and uses its outlook statements to highlight situations where historically stable situations may be turning negative or positive. Also considered are how an organization’s future debt plans and average age of plant as well as its management and board’s philosophy regarding liquidity, debt, and asset allocation factor into S&P ratings and outlooks.
For more information, call (212) 438-9823.
In the first year after Massachusetts implemented its landmark coverage expansion and health reforms, the uninsurance rate among adults in the state dropped by almost half, from 13 percent to 7.1 percent, according to a new Urban Institute study published June 3 as a Health Affairs web exclusive.
The study also shows that access to care for low-income Massachusetts adults has increased, and the share of adults with high out-of-pocket healthcare costs and problems paying medical bills has dropped. Study author Sharon Long, a principal research associate at Urban, found no evidence that the Bay State’s expansion of publicly subsidized coverage has “crowded out” employer-sponsored coverage.
Long’s findings are based on two rounds of telephone interviews with randomly selected Massachusetts adults (ages 18-64), in fall 2006 and fall 2007. Her study report is one of two articles on the Massachusetts experience appearing June 3 on the Health Affairs web site. In the other paper, John McDonough and coauthors chart the progress of the reforms and the challenges that remain.
Department of Health and Human Services (HHS) Secretary Mike Leavitt on June 3 announced that the department has made available nearly $1.1 billion to continue assisting public health departments, hospitals, and other healthcare organizations to strengthen their ability to respond to public health and medical emergencies as a result of a terrorism attack or naturally occurring event.
The HHS funding is awarded via two separate but interrelated cooperative agreements. The Centers for Disease Control and Prevention is providing $704.8 million in funding to health departments in states, territories, and metro areas of New York City, Chicago, Los Angeles County, and Washington, D.C., through the Public Health Emergency Preparedness cooperative agreement. The HHS Assistant Secretary for Preparedness and Response is also awarding $398 million through the Hospital Preparedness Program.
The funds are intended to upgrade public health departments’ preparedness and response to all public health emergencies, improve the readiness of hospitals and other healthcare organizations, and strengthen medical surge capability across the nation. Read the press release.
The Centers for Medicare and Medicaid Services (CMS) announced May 30 that Medicare fee for service (FFS) has made more progress over the past week since fully implementing the National Provider Identifier (NPI) than the agency expected, with most of the Medicare contractors reporting that over 90 percent of claims are NPI-compliant, with some reporting 100 percent compliance.
CMS clarified that, on May 23, there were a number of rejections for claims with legacy numbers in the secondary provider identifier field. “We are seeing this particular issue rapidly improve,” said the agency in a statement, “as more providers realize the need for NPI-only in secondary identifier fields.” To assist those billing providers that are still unable to obtain NPIs for secondary providers, Medicare has instituted a temporary measure that allows billing providers to use their own NPI in secondary identifier fields.
CMS is also reminding Medicare providers who may be experiencing cash flow problems related to NPI claims processing issues that they should contact their Medicare contractor to determine if they are eligible for an advance or accelerated payment. Read the NPI fact sheet.
In response to survey data showing that the next generation of nurses may not be prepared to work in a technology-rich informatics environment, the National League for Nursing (NLN) has issued a position statement calling on faculty, deans, administrators, and the NLN itself to advocate that all students graduate with up-to-date knowledge and skills in computer literacy, information literacy, and informatics.
The genesis of the NLN position statement, Preparing the Next Generation of Nurses to Practice in a Technology-rich Environment: An Informatics Agenda, was a recent survey of faculty and nursing education administrators conducted by the NLN’s Informatics Competencies Task Group of the Educational Technology and Information Management Advisory Council. Results revealed that approximately 60 percent of programs had a computer literacy requirement and 40 percent had an information literacy requirement. Only 50 percent to 60 percent of respondents said that informatics was integrated into the curriculum and that clinical experience with information systems was provided during clinical experiences. The critical conclusion is that while most schools of nursing focused on computer and information literacy, there was considerable confusion as to what nursing informatics entails and what constitutes the necessary knowledge to practice in an informatics-rich environment. Read the position statement.
Voting is now open for Modern Healthcare magazine’s seventh annual 100 Most Powerful People in Healthcare recognition program. HFMA president and CEO Richard L. Clarke, DHA, FHFMA, has made the list each of the past six years. The magazine reports that more than 14,600 nominations were submitted this year, compared with about 12,600 last year.
Click here to cast your vote for Dr. Clarke and other leaders worthy of this recognition. You must vote for 10 of the 300 names on the ballot. Voting will continue through June 27, and the final ranking will be published in the Aug. 25 issue of Modern Healthcare.
American women want a healthcare system in which they and their families can conveniently obtain preventive services, see their personal physicians the day they become sick, and receive coordinated follow-up care if they require hospitalization or care from other physicians, according to a poll released May 29 by the American Academy of Family Physicians (AAFP). The poll obtained responses from 1,193 American women who said they were the primary healthcare decision makers for themselves and/or their family members.
Among the poll’s findings: 43 percent of the respondents said they have had to fill out complete patient histories and other forms at each medical provider’s office; 26 percent said they have had to inform one medical provider what another had recommended or diagnosed; and 16 percent have had to carry lab reports, X-rays, and other test results from one medical provider’s office to another.
Also, 68 percent of the respondents said same-day appointments with their/their family members’ primary care physician for unexpected illnesses were extremely/very important, 63 percent said one physician who can manage chronic medical conditions was extremely/very important, and 57 percent said one physician who can provide high-quality health care to all family members regardless of age or gender was extremely/very important. Read the executive summary.
Each of the 17 members of the Wisconsin Association of Health Plans Association has pledged to begin providing, by Sept. 1, 2008, estimates of out-of-pocket costs to enrollees who request them before receiving services. Also by that date, each plan will inform its enrollees that the out-of-pocket cost estimates are available.
Current state regulations require health plans to provide, upon request, descriptions of their coverage terms and estimates of allowable charges for a specific service from a specific provider. The association transparency initiative is intended to go beyond current requirements by giving health plan enrollees estimates of what they will be required to pay out of their own pockets. Read the press release.
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