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CMS withdraws proposal to have AOs post survey reports online

A proposal by CMS to have accrediting organizations (AOs) post the details of survey reports online was withdrawn by the agency, not because of negative comments — although there were plenty — but because, well, it might be prohibited under federal law.

CMS first made the proposal in April, tucking it into the latter pages of the always-long proposed on changes to the Inpatient Prospective Payment System (IPPS) for the upcoming fiscal year.

The proposal was to have AOs post final survey reports online within 90 days that the same information is available to the hospital or other health care organization, including details of all initial and recertification surveys at that provider in the prior three years, as well as the accepted plans of correction (PoCs).

AOs now post only whether an organization is accredited or not, and do not make details of findings public.

CMS argued its proposal was to promote transparency in health care, and noted that it posts its own  survey reports online. But critics responded that the CMS reports are made available in a hard-to-read spreadsheet and that the federal agency was responsible for far fewer surveys at health care organizations that were often surveyed only after a complaint (IJC 5/1/17).

In public comments to CMS concerning the proposal, The Joint Commission said that requiring survey details be made public would have “chilling effect” on efforts to raise standards of quality. Dr. Mark R. Chassin, president and CEO of The Joint Commission, wrote: “There will be a race to the bottom on quality as health care organizations seek out oversight bodies that will report on the least number of standards comparable to the Medicare requirements. This may also lead to a growth in non-accredited facilities that will then be surveyed at taxpayer expense and with fewer oversight visits.”

Other groups similarly weighed in against the proposal, and offered alternatives. In the end though, it was shot down because it might potentially be prohibited.

In the IPPS final rule published Aug. 2, CMS noted that its proposal included revising the federal regulations overseeing Medicare to incorporate the requirement for AOs to post report details publically.

“Section 1865(b) of the Act prohibits CMS from disclosing survey reports or compelling the AOs to disclose their reports themselves. The suggestion by CMS to have the AOs post their survey reports may appear as if CMS was attempting to circumvent the provision of section 1865(b) of the Act. Therefore, this provision is effectively being withdrawn.” — A.J. Plunkett (aplunkett@h3.group)

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NQF launches opioid stewardship initiative

The National Quality Forum earlier this month announced the creation of an Opioid Stewardship Action Team. The team will summon experts together to develop new best practices, strategies, and tactics to curb the opioid epidemic in America.

“As an emergency medicine doctor, I’ve seen first-hand the devastating effects of opioid misuse on our nation’s health, and it is imperative that we all work together to address it,” said Shantanu Agrawal, MD, NQF’s president and CEO, in a press release. “This new initiative will provide those on the frontlines with essential guidance for better, safer management of patients’ pain.”

Nearly 2 million people suffer from prescription opioid disorder and the number of opioid prescriptions written annually has quadrupled in under two decades.

Along with the NQF team, there are several ongoing efforts to stop the problem, including controversial guidelines released by the Centers for Disease Control and Prevention in 2016.

The team will consist of nurses, physicians, consumers, and others to build upon on current efforts to address the opioid epidemic, with a focus on improving prescribing practices. The team is being modeled after successful NQF action plans, such as NQF’s playbook on antibiotic stewardship.

Those interested in joining or supporting the Opioid Stewardship Action Team should contact the National Quality Partners at nationalqualitypartners@qualityforum.org.

Caucus pushes for telemedicine expansion in Congress

When it comes to healthcare and congress, finding bipartisan support on anything is a daunting task. That said, politicians from both sides are coming together in support of new bills aimed at improving and expanding telemedicine services in the United States.

The U.S. House of Representatives and Senate are considering both the Creating Opportunities Now for Necessary and Effective Care Technologies (CONNECT) for Health Act of 2017 and the Medicare Telehealth Parity Act (MTPA). The two bills are aimed at lowering CMS restrictions on telemedicine coverage and test the efficacy of telehealth services in Medicare healthcare delivery reform models. The Senate Finance Committee is also considering a bill called the Creating High-Quality Results and Outcomes Necessary to Improve Chronic (CHRONIC) Care Act of 2017, which includes a section that would allow greater use of telehealth.

Both CONNECT and MTPA had failed to advance during previous sessions of Congress, and were re-launched by members of the newly formed bipartisan Congressional Telehealth Caucus on May 19. The four founding members of that caucus are Representatives Mike Thompson (D-Calif.), Gregg Harper (R-Mass.), Diane Black (R-Tenn.), and Peter Welch (D-Vt.)

“Telehealth saves lives and reduces costs; it’s a win-win for both patients and providers,” said Thompson in a press release. “We’ve all seen how technology has made us more connected in our daily lives. These same advances allow physicians to provide more patients with better healthcare—especially patients in rural, difficult-to-access, and underserved communities. Unfortunately, regulations haven’t kept pace with the times. These commonsense, bipartisan policies will allow us to make sure every American gets the best care and the best treatment—no matter where they live. The Caucus will give us a venue to collaborate with our interested colleagues to advance the delivery of care via telemedicine.”

“My many years as a nurse, especially my time spent working in long-term care, taught me that if Medicare is to provide real benefit to seniors while ensuring real efficiency for taxpayers, it must embrace the advances in technology and innovation that are already taking place across the health care sector,” said Black. “That is what telehealth is all about—promoting cost savings and quality care through the use of technology like remote patient monitoring services. Harnessing the power of telemedicine is a win for seniors, a win for providers, a win for taxpayers, and a win for rural Tennessee.”

If passed, the Medicare Telehealth Parity Act would:

•    Allow for the provision of telehealth services in rural, underserved, and metropolitan areas, rather than just rural areas
•    Expand the types of providers who can be reimbursed for telehealth services to include several kinds of allied health professionals
•    Expand access to telestroke services
•    Allow remote patient monitoring for patients with chronic conditions
•    Allow a Medicare beneficiary’s home to serve as a site of care for remote dialysis, hospice care, outpatient mental health services, and home health services

If passed, the CONNECT for Health Act of 2017 would:

•    Expand originating sites for telehealth care
•    Create a Medicare remote patient monitoring benefit for certain high-risk, high-cost patients;
•    Lift restrictions on the use of telehealth in ACOs and Medicare Advantage plans;
•    Urge the Secretary of Health and Human Services to have CMMI evaluate the applicability of telehealth in demonstration projects;
•    Authorize a study on the use of telehealth services after restrictions on coverage have been lifted.
•    Save Medicare around $1.8 billion over the course of 10 years 

It’s important to remember that even if these bills become law, providers will still have to be licensed in whatever state their patient is physically located.

For example, if you’re in New York and one of your patients is on vacation in California, you have to be licensed by the California medical board to treat him via telemedicine. And you still have to meet the standard of care required under California law. That won’t change under these proposed laws.

AHA offering free cybersecurity training for hospitals

For years, security experts have tried to warn hospitals and clinics about the dangers of hackers and computer viruses. And as the recent Wanna Cry ransomware attack on the UK’s National Health Service (along with thousands of others) shows, many still haven’t taken the steps needed. The American Hospital Association (AHA) is now offering free cybersecurity training programs for hospital and health system leaders to help educate people on how to prevent and limit the effects of a cyberattack.

5ntkpxqt54y-sai-kiran-anagani“Every organization, no matter what its size, can do a great deal to reduce their risk and prevent attacks,” said Lawrence Hughes, AHA assistant general counsel, in a press release.

The remaining programs are scheduled for July 20 in San Francisco and October 26 in Chicago. To learn more and see the AHA’s library of cybersecurity tools, resources, click here.

Easily preventable ransomware attack hits hospitals worldwide

Wanna Cry map, Screenshot, Sunday 14

A map of all computer systems struck by the Wanna Cry virus as of May 14. Courtesy of Malwaretech.com

As of Monday, May 15, , forcing them to pay $300 in untraceable currency to regain access to their files. One of the most notable victims of Wanna Cry was the United Kingdom’s National Health Service (NHS). At least 25 NHS hospitals had to reroute patients and cancel appointments while trying to save their medical records from the virus.

Ransomware is a new twist on an old crime. The virus locks down all your computer files so you can’t access them. Then a screen appears telling you that you have a certain number of days to pay the hacker in untraceable currency. Pay and you get all your files back. Refuse and your computer remains locked and your files, documents, photos, and videos are lost forever.

This type of attack particularly devastating for hospitals, where the locked medical records and computer system are critical for patient care and treatment. Nor is Wanna Cry the first ransomware attack to affect hospitals. Here’s a quick list of 12 that happened in 2016,  with many more cases occurring that same year.

Barts Health NHS Trust, which runs four hospitals in London, had its files locked on May 13. The hospital noted the attack had forced it to cancel some appointments, send incoming patients to other hospitals, and slowed down the facilities’ pathology and diagnostic services.

“Barts Health staff are working tirelessly, using tried and tested processes to keep patients safe and well cared for,” the system wrote on Monday. “We are no longer diverting ambulances from any of our hospitals. Trauma and stroke care is also now fully operational. However, we continue to experience IT disruption, and we are very sorry for any delays and cancellations that patients experience. In these circumstances, we would ask the public to use other NHS services wherever possible.”

Microsoft had already created a software patch in mid-March that closed the Wanna Cry vulnerability. However, many facilities didn’t update their security systems.

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Tom Price confirmed as HHS secretary  

On February 10, the U.S. Senate voted 52 to 47 confirming Rep. Tom Price, MD (R-GA) as the new head of the Department of Health and Human Services (HHS). Price is an orthopedic surgeon and the first physician to head the HHS since the George H.W. Bush administration. He’s known for his opposition to the Affordable Care Act.HHS logo

Price’s appointment has been highly controversial, in part due to his investments in healthcare companies that could potentially benefit or be harmed by his actions as HHS secretary.

A recent survey of nearly 1,100 physicians revealed a sharp divide in opinions on Price’s appointment; with 46% feeling positive and 42% leaned negative. The survey also revealed that 47% of respondents believe that Price will diminish patients’ ability to access quality care, with 42% who believed the opposite.

Trump: For every new healthcare regulation, two must be removed

On January 30, President Trump signed a new executive order declaring a “one-in, two-out” rule for executive departments or agencies, including healthcare. Under the executive order, for a new healthcare regulation to be implemented, two older regulations will have to be eliminated.

“If you have a regulation you want, number one, we’re not going to approve it because it’s already been approved probably in 17 different forms,” Trump said during the signing. “But if we do, the only way you have a chance is we have to knock out two regulations for every new regulation. So if there’s a new regulation, they have to knock out two.”The White House

The order also sets an annual cap on the cost of new regulations and cuts the regulatory budget for fiscal year 2017 to zero. This means the only way to afford new regulations issued between now and September 30, 2017 is by repealing existing regulations.

While each agency will decide which regulations they think can be cut, the White House will ultimately decide which ones to gut. Regulations dealing with national security, foreign affairs, and the organization, management, or personnel of federal agencies are exempt.

Report: $28 billion saved through patient safety efforts

Efforts to improve patient safety are paying off, according to a new Health and Human Services (HHS) department report. Between 2010 and 2015, increased patient safety efforts have:
•    prevented 3.1 million hospital-acquired conditions (HAC), a 21% decline
•    saved 125,000 lives
•    saved $28 billion in healthcare costs

In the announcement, HHS Secretary Sylvia Burwell cited the Affordable Care Act as a major cause of the improvement in patient safety.Money

“The Affordable Care Act gave us tools to build a better healthcare system that protects patients, improves quality, and makes the most of our healthcare dollars and those tools are generating results,” said HHS Secretary Sylvia M. Burwell. “Today’s report shows us hundreds of thousands of Americans have been spared from deadly hospital-acquired conditions, resulting in thousands of lives saved and billions of dollars saved.”

There are other federal patient safety efforts mentioned in the report as aiding in patient safety improvement. Among those cited were the Partnership for Patients initiative, a public-private partnership launched in 2011 though CMS Innovation to target a specific HACs. CMS also worked with hospital networks and aligned payment incentives to improve focus on making care safer.

“These achievements demonstrate the commitment across many public and [more]

AHA asks Trump to change CMS regulations

On December 2, the American Hospital Association (AHA) sent a letter to president-elect Donald Trump asking him to reform CMS regulatory requirements. This is the second letter the group sent the president-elect in the space of three days.

The AHA has 43,000 individual members and nearly 5,000 member hospitals in its ranks. AHA CEO and President Rick Pollack wrote that the balance between flexibility in patient care and regulatory burden was at a tipping point. He continues to say that reducing administrative complexity would save billions annually and allow providers to spend more time on patients, not paperwork.The White House

“[CMS] and other agencies of the Department of Health and Human Services (HHS) released 43 hospital-related proposed and final rules in the first 10 months of the year alone, comprising almost 21,000 pages of text,” he wrote. “In addition to the sheer volume, the scope of changes required by the new regulations is beginning to outstrip the field’s ability to absorb them. Moreover, this does not include the increasing use of sub-regulatory guidance (FAQs, blogs, etc.) to implement new administrative policies.”

CMS LogoThe letter includes a list of 33 changes the AHA wants to be made, including

•    Suspend hospital star ratings
•    Suspend electronic clinical quality measure (eCQM) reporting requirements
•    Delete faulty hospital quality measures
•    Have readmission measures reflect socioeconomic factors
•    Cancel stage 3 of “meaningful use” program.
•    Stop federal agencies (HHS, CMS) from forcing private sector accreditors (Joint Commission, DNV, HFAP) to conform with government accreditation standards
•    Refocus the Office of the National Coordinator (ONC) on certifying electronic health records

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