Legislative Updates

RAC Updates Nationwide

Posted on: 9/8/2010

Region A
DCS Healthcare, the Medicare Recovery Audit Contractor (RAC) for Region A, added two new CMS-approved RAC audit issues for ambulatory surgical center claims and non-medical necessity inpatient claims.

For more information, click here.

Region B
CGI Technologies and Solutions Inc., the RAC for Region B recently modified two existing issues: medical unlikely edit (MUEs) outpatient and MUEs professional.

For more information, click here.

Region C
Connolly Healthcare, the RAC for Region C, recently added 18 CMS-approved medical necessity issues for providers.

For more information, click here.

Region D
HealthDataInsights (HDI), the RAC for Region D, recently added medical necessity to 10 existing DRG validation issues for Region D providers. HDI also removed an issue for Part B claims.

For more information, click here.

To visit the CMS RAC webpage, click here.

Percentage of Hospitals with EHRs Increases, But 2% Meet “Meaningful Use” Criteria

Posted on: 9/1/2010

According to a recent study released by Health Affairs, the percentage of U.S. hospitals with basic or comprehensive electronic health records (EHR) rose by 3.2 points in 2009, to 11.9%. However, only 2% of those EHRs would meet the federal government’s “meaningful use” criteria for 2011 and 2012.

Background - The Health Information Technology for Economic and Clinical Health (HITECH) Act gave the U.S. Department of Health and Human Services (HHS) the authority to establish programs to improve health care quality, safety, and efficiency through the promotion of health information technology, including electronic health records and private and secure electronic health information exchange. Under HITECH, eligible health care professionals and hospitals can qualify for Medicare and Medicaid incentive payments when they adopt certified EHR technology and use it to achieve specified objectives - “meaningful use.”

Researchers found that levels of adoption of individual criteria were consistently lower in critical access, small, and rural hospitals than in large or urban hospitals. The study concluded that policy makers need to consider ways to make it easier for hospitals to adopt EHRs and meet the criteria for their meaningful use – especially in the case of smaller, rural, and public hospitals.

To read the study, click here.

For more information on “meaningful use," click here.

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CMS Seeks Hospitals for Rural Community Hospital Demonstration Program

Posted on: 9/1/2010

The Centers for Medicare & Medicaid Services (CMS) seeks up to 20 additional hospitals to participate in the Rural Community Hospital Demonstration Program.

Hospitals selected for participation in the program will receive payment for inpatient services, with the exclusion of services furnished in a psychiatric or rehabilitation unit that is a distinct part of the hospital, and according to CMS rules.

To participate, hospitals must have fewer than 51 acute-care inpatient beds and be located in one of the designated rural States: Alaska, Arizona, Arkansas, Colorado, Idaho, Iowa, Kansas, Maine, Minnesota, Mississippi, Montana, Nebraska, Nevada, New Mexico, North Dakota, Oklahoma, Oregon, South Dakota, Utah or Wyoming.

Applications are due to CMS by October 14, 2010.

For more information, click here.

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ACS’s Dr. Lichtenfeld on the Unexpected Benefits of Palliative Care

Posted on: 8/25/2010

In a recent entry to his Cancer Blog on the American Cancer Society’s website, J. Leonard Lichtenfeld, MD, MACP, Deputy Chief Medical Officer for the national office of the American Cancer Society, examines a study in the The New England Journal of Medicine.

The study examines palliative care as a means of helping patients deal with the symptoms of metastatic non–small-cell lung cancer and its treatment early in the course of the disease leading to a dramatic improvement in survival.

Dr. Lichtenfeld remarks that though the concept may not generate the same level of excitement as a new chemotherapy drug, targeted therapy or vaccine, “it's much simpler than an expensive, complicated new treatment for a devastating disease.”

To read Dr. Lichtenfeld's blog entry, click here.

To view the study, click here.

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Region B RAC Releases List of 18 Medical Necessity Reviews

Posted on: 8/13/2010

CGI Technologies and Solutions Inc., the Medicare Recovery Audit Contractor (RAC) for Region B, recently released a list of 18 medical necessity reviews approved for audit by the Centers for Medicare & Medicaid Services (CMS).

RAC Region B states include: Illinois, Indiana, Kentucky, Ohio, Michigan, Minnesota and Wisconsin.

To view the list on the CGI website, click here.

Practitioners Seek More Patient-Centered Approach to Care in the ED

Posted on: 8/11/2010

According to a recent article on Slate.com, a growing number of emergency department (ED) physicians and nurses have begun to emphasize the importance of integrating palliative care into the ED in order to create a more patient-centered approach to emergency care for the seriously ill or the dying.

According to the article, one in 500 ED patients—200,000 a year—dies in the ED. Another 500,000, or 3%, die during hospital stays following their ED treatment. The article states that a small contingent of practitioners is working to bring the deliberative goal-setting, symptom-controlling culture of palliative care into the “adrenaline-charged” ED environment.

To read the article on Slate.com, click here.

For More on Care in the ED - Kevin M. Terrell, DO, MS, will present a session titled, Transfers of Care between Nursing Homes and Emergency Departments, at the ACMA Transitions of Care Conference, November 10-11, 2010 in Little Rock, AR. For more information on the session, click here.

AHA Releases Resources to Help Hospitals Implement Health Care Reform

Posted on: 8/4/2010

The American Hospital Association (AHA) recently released a compendium of resources available through its Hospitals in Pursuit of Excellence initiative designed to “help hospital leaders advance performance improvement and implement health care reform.”

AHA also released a guide to implementing electronic health records, which was produced in collaboration with the College of Health Information Management Executives; and a summary of lessons learned to date from the Centers for Medicare & Medicaid Services' (CMS) demonstration project on the effect of bundling Medicare Part A and B payments for episodes of care.

To access the compendium of resources, click here.

To download the guide to implementing electronic health records, click here.

To download the summary of lessons learned to date from the CMS demonstration project on the effect of bundling Medicare Part A and B payments for episodes of care, click here.

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ACMA Public Policy Committee Update: Accountable Care Organizations

Posted on: 8/4/2010

The discussion of Accountable Care Organizations is the latest concept to come out of healthcare reform. In an attempt to address the slow rising costs of healthcare and achieve quality care for patients, legislation is being discussed to address the concept of cost and quality. Even though the final components have not been defined, hospitals and physician groups around the country are looking at what they need to have in place to be identified by the federal government as an ACO. The goal is to encourage the people and organizations that provide care to patients to be accountable for the cost/care continuum.

The essential characteristics of an Accountable Care Organization are defined as the ability to provide, and manage with patients across the continuum of care in different institutional settings, including at least ambulatory and inpatient hospital care and possibly post acute care. They must have the capability of prospectively planning budgets and resource needs, and be of sufficient size to support comprehensive, valid, and reliable performance measurement.

The program will target organizations consisting of the various physicians and aligned multi-specialty medical groups that are associated with local acute care hospitals which can be held accountable for cost and quality of patient care. The hospital and physician goals are centered around improving quality and lowering cost. In exchange, those hospitals that are chosen to participate as an ACO member will share in the savings that result from their cooperation and coordination.

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Hospital Employment Declines in June While U.S. Unemployment Rate Drops

Posted on: 7/28/2010

According to a recent report released by the U.S. Bureau of Labor Statistics, employment at U.S. hospitals declined by 0.05% in June to a seasonally adjusted 4,705,700 people. This decrease is 2,200 fewer individuals than the total for the month of May, however it is 33,600 more than one year prior. The report also stated that overall U.S. unemployment rate fell by 0.2% in June to reach 9.5%.

For more information, view this news release.

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One Out of Every Eight ED Visits Related to Mental Health and/or Substance Abuse

Posted on: 7/21/2010

According to a recent report released by the Agency for Healthcare Research and Quality (AHRQ), in 2007, 12 million emergency department (ED) visits involved a diagnosis related to a mental health and/or substance abuse condition (MHSA), accounting for 12.5% of all ED visits in the U.S., or one out of every eight ED visits.

The report also found that MHSA-related ED visits were two and a half times more likely to result in hospital admission than ED visits related to non-MHSA conditions—nearly 41% of MHSA-related ED visits resulted in hospitalization.

To view the report, click here.

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Announcements

Register Now! Save $100 - Transitions of Care Conference

Act now for registration savings at the 2010 ACMA Transitions of Care Conference. The conference is November 10-11, 2010 at the Peabody Little Rock hotel in Little Rock, AR. Dr. Eric Coleman will speak and serve as the event’s course director - Register Now!

2011 NICM/ACMA National Conference

Mark Your Calendar - The 2011 NICM/ACMA National Conference will be held April 7-10, 2011 at the Marriott World Center Resort in Orlando, Florida

National Case Management Week Products & Catalog Now Available

National Case Management Week (NCMW) items are now available for purchase online, and the 2010 NCMW Product Catalog is available to download.

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