All Entries Tagged With: "cms"
CMS hops on bandwagon for personal health records
The Centers for Medicare & Medicaid (CMS) last month announced a new program: Medicare Personal Health Record (PHR) Choice Pilot. In this program, beneficiaries can maintain their own medical information through four selected companies, Google Health, HealthTrio, NoMoreClipboard, and PassportMD. PHR launches next year in Arizona and Utah.
As part of an initiative for patient-driven health information management, users can maintain their Medicare claims from the last two years, manage their medication records, find pharmacy information, and follow links to wellness programs. Unlike an electronic health record that is strictly controlled by the physician, a PHR is controlled by the consumer, that is, that patient (and his or her provider if the beneficiary chooses so), according to a Nov. 12 CMS press release.
“This pilot is a major step forward for Medicare. It will provide information and tools that will empower consumers to manage their health better,” said HHS Secretary Mike Leavitt in the release. “Importantly, the pilot provides beneficiaries with a choice of products to meet their individual needs.”
CMS extends deadline for inpatient quality data
The Centers for Medicare & Medicaid Services (CMS) changed the deadline for reporting inpatient quality data to Friday, Nov. 21, extended from the original deadline of Nov. 15, according to the American Hospital Association. The new deadline gives hospitals an extra week’s extension to report quality data to CMS for annual payment. These data are posted to the Hospital Compare Web site.
P4P programs forget patient demographics, sway hospital rankings, study says
Hospital performance rankings and eligibility for financial benefits may not be accurate in pay-for-performance programs, according to a new study, “Association of Patient Case-Mix Adjustment, Hospital Process Performance Rankings, and Eligibility for Financial Incentives,” published in the October issue of The Journal of the American Medical Association.
The study evaluated how hospital performance ratings and eligibility for financial incentives were altered by patient demographics, clinical characteristics, and treatment. With performance based on Centers for Medicare & Medicaid Services' core measures for acute myocardial infarction, researchers found that current metrics used to gauge performance do not take into account patient demographics, such as race and ethnicity.
The study did not evaluate whether or not hospitals might be deterred from caring for underserved populations with a less lucrative payer mix.
In its abstract, the study’s researchers concluded: “Our findings suggest that accounting for hospital differences in patient characteristics and treatment opportunities is associated with modest changes in hospital performance rankings and eligibility for financial benefits in pay-for-performance programs for treatment of myocardial infarction.
Medicaid spending to double in next decade
The government will spend nearly double on Medicaid annual payments over the next 10 years, according to projected reports from Centers for Medicare & Medicaid Services (CMS). CMS submitted the report, “Medicaid Actuarial Report on the Financial Outlook for Medicaid,” to Michael O. Leavitt, Secretary of Health and Human Services, last Friday.
Expenditures for medical assistance payments in federal and state spending will soar to $673.7 billion by fiscal year 2017, up from $339 billion this year. The average Medicaid enrollment will also reach 50 million people this year and 55.1 million by 2017.
Medicaid provides healthcare assistance to low-income populations and is one of the largest payers of healthcare in the nation.
Medicare HAC and POA non-payment changes take effective today
The Centers for Medicare & Medicaid Services (CMS) overhauled its system of MS-DRG hospital reimbursement. Taking effect today, Oct. 1, CMS will cease to pay hospitals for certain “never events,” including hospital-acquired conditions (HAC) with adjustments to present-on-admission (POA) conditions.
For discharges occurring on or after Oct. 1, hospitals will not receive reimbursement for conditions that are “(a) high cost or high volume or both, (b) result in the assignment of a case to a DRG that has a higher payment when present as a secondary diagnosis, and (c) could reasonably have been prevented through the application of evidence-based guidelines,” states the CMS Web site. The CMS changes were brought forth by the Deficit Reduction Act (DRA) of 2005, signed by the president on Feb. 8, 2006, in which the secretary of the Department of Health and Human Services named what conditions were reasonably preventable. The changes were published in the CMS Inpatient Prospective Payment System (IPPS) Fiscal Year 2009 Final Rule on July 31.
The 10 categories of HACs under payment provision are the following conditions:
- Foreign object retained after surgery
- Air embolism
- Blood incompatibility
- Stage III and IV pressure ulcers
- Falls and trauma
- Manifestations of poor glycemic control
- Catheter-associated urinary tract infection
- Vascular catheter-associated infection
- Surgical site infection
- Deep Vein Thrombosis (DVT)/Pulmonary Embolism (PE)
The POA Indicator and HAC payment provision apply only to IPPS hospitals. Some hospitals are exempt, including cancer hospitals, children’s inpatient facilities, and critical access hospitals.
To receive more information on MS-DRGs and to earn CME credits, register for the Webcast called “Clinical Documentation Updates for Hospitalists: Position Your Practice to Maximize Value,” sponsored by HCPro, Inc., in partnership with the Society of Hospital Medicine.
