CMS discusses limits on medical record requests by RACs   10/21/2008
During an AHA member call today to discuss the nationwide rollout of the permanent Medicare recovery audit contractor program, Centers for Medicare & Medicaid Services staff announced limits on the number of medical records the RACs will be allowed to request from providers. For inpatient claims, the maximum number of records RACs may request will vary by the hospital’s national provider identifier and will equal 10% of average monthly Medicare claims. The RACs will not be able to request more than 200 records in a 45-day period for both inpatient and outpatient claims combined. Providers with more than one NPI may face a unique record limit per NPI; however, CMS staff said they plan to provide further clarification on this policy. Earlier this month, CMS announced the names of the permanent RACs and revised plans for the nationwide rollout. Hospitals in the first phase of the rollout may begin to receive requests for medical records or reimbursement of overpayments as early as December. For more on the RAC program, visit www.aha.org/rac.

AHA urges speedy release of ICD-10 final rule   10/21/2008
In comments to the Department of Health and Human Services, the AHA yesterday applauded HHS’ proposal to replace the ICD-9-CM code sets with the greatly expanded ICD-10-CM/PCS code sets. In addition to urging quick adoption of a final rule to upgrade the nation’s coding system for reporting health care diagnoses and inpatient procedures, the AHA also called on HHS to set an implementation date three years after publication of the final rule and no earlier than Oct. 1, 2012, which would allow hospitals to plan and budget for the significant changes that would ensue. The AHA also provided several technical recommendations to ensure a smooth transition. “This change is welcome and long overdue,” AHA said. “The ICD-10 code sets provide a standard coding convention that is flexible, incorporates unique codes for all substantially different procedures or health conditions, and allows for new procedures and diagnoses to be easily incorporated as new codes for both existing and future clinical protocols.”

Medical schools report largest entering class   10/21/2008
First-year enrollment at U.S. medical schools for 2008-09 increased by 277 students or 1.6%, representing the largest class ever at 18,036 students, the Association of American Medical Colleges reported today. Most of the increase was at three medical schools that recently established branch campuses or plan to: Mercer University School of Medicine, Texas A&M Health Science Center College of Medicine, and University of Arizona College of Medicine. Women comprised 48% of the entering class, Latinos 7.9%, African Americans 7.2% and Native Americans 1%. After increasing for five years, the number of applicants was relatively unchanged at 42,231. "In a time of great economic uncertainty, interest in the healing profession of medicine remains stable," said AAMC President and CEO Darrell Kirch, M.D. "As medical schools expand to meet the nation's demand for more doctors, there will be even more opportunities for the most qualified and well-rounded aspiring doctors to pursue rewarding careers in medicine."

Rule finalizes birth-related coverage requirements for insurers   10/21/2008
The U.S. departments of Labor, Health and Human Services, and the Treasury have finalized with minor changes a 1998 interim final rule implementing certain provisions of the Newborns’ and Mothers’ Health Protection Act of 1996. Under the Act, health insurers may not restrict a mother or newborn’s hospital stay to less than 48 hours after a vaginal delivery or 96 hours after a cesarean delivery. The final rule applies to group and individual health insurance for coverage beginning Jan. 1.

Study: Private fee-for-service Medicare plans paid 16.6% more   10/21/2008
Private fee-for-service Medicare Advantage plans this year will be paid an average 16.6% more than what the same enrollees would have cost in the traditional Medicare fee-for-service program, according to a new study from the Commonwealth Fund. Researcher Brian Biles, M.D., professor of health policy at George Washington University , and colleagues estimate that extra payments to these plans will amount to $1,248 per beneficiary compared to traditional Medicare fee-for-service for a total of nearly $2.5 billion. "While new requirements will eliminate some of the higher payments to plans and strengthen reporting requirements, we need to determine whether these plans are the best use of limited Medicare dollars," said Commonwealth Fund President Karen Davis.

Study: Many uninsured children have a parent with health coverage   10/21/2008
An estimated 3 million children a year have no health care coverage even though at least one of their parents is insured, according to a study in the Oct. 22/29 Journal of the American Medical Association. “More than a million of these children were without coverage for the entire year,” the researchers said. Low- and middle-income families were more likely to have an uninsured child and insured parent, as were single-parent and Hispanic households and parents with private insurance. “The working adults in these families may be able to afford private insurance for themselves but cannot afford to pay the premiums to cover their entire family,” the study suggests. The findings are based on an analysis of 2002-2005 data from the Agency for Healthcare Research and Quality’s Medical Expenditure Panel Survey.

Group issues plan for modernizing public health   10/21/2008
Trust for America ’s Health today released recommendations for improving the nation’s public health system. Among other actions, the report calls for the next administration and Congress to invest in disease prevention, preventive services and emergency preparedness; a national strategy to combat obesity and lower disease rates; an emergency health benefit for uninsured and underinsured Americans during major disasters and disease outbreaks; and an independent national board to oversee the public health system. “This Blueprint reflects ideas from the best and the brightest minds in public health for ways to prevent disease, prepare for disasters, and bring down health care costs,” said Jeff Levi, TFAH executive director.

Study: Unique patient IDs would improve quality, efficiency   10/20/2008
Creating a unique patient identifier for every U.S. resident could cost as much as $11 billion, but would likely return even more in benefits to the nation’s health care system, according to new RAND Corp. study. Such a system would help reduce medical errors, simplify the use of electronic medical records, increase overall efficiency and help protect patient privacy, the authors conclude. “Establishing a system of unique patient identification numbers would help the nation to enjoy the full benefits of electronic medical records and improve the quality of medical care,” said lead author Richard Hillestad, a senior principal researcher at RAND.

BCBS: Consumer-driven health plan enrollment up 25%   10/20/2008
Enrollment in consumer-directed health plans grew 25% in 2007 to 12.5 million people, according to data reported today by the Blue Cross and Blue Shield Association. CDHPs were defined as high-deductible health plans that include a health reimbursement arrangement or health savings account option. A BCBS survey of adults under age 65 with private health coverage found enrollees with HSA-eligible plans were 30% more likely to track their health expenses than those in more traditional health insurance plans, and 27% more likely to ask their doctors about the cost of treatment. They also were more likely to participate in health or wellness programs, and slightly more likely to have regular check ups and preventive screenings. Collectively, the 39 independent Blue Cross and Blue Shield companies served 4.4 million CDHP members in 2007, up 50% from 2006.

Health reform leads to more and better coverage in MA   10/20/2008
Fewer working-age adults are uninsured or underinsured in Massachusetts since the state mandated health insurance coverage in 2006, according to a report released last week by the Robert Wood Johnson Foundation. The proportion of uninsured adults fell from 18.7% in fall 2006 to 14.5% in fall 2007, while the proportion of underinsured adults fell from 7.3% to 5.6%. Low-income and young adults and small business employees saw the largest gains in coverage, a related analysis found. Massachusetts Hospital Association President and CEO Lynn Nicholas said the reports “clearly demonstrate the success of Massachusetts health care reform in reaching the people most in need of obtaining adequate and affordable health care.” She added, “The hardest work may still be in front of us as we strive to sustain these successes in the midst of very difficult economic conditions. We have to find a way to ensure that we keep covering people while avoiding both the underinsurance pitfall and the self-defeating trap of underpaying providers who are needed to care for the insured and underinsured alike.”

AHRQ announces process for approving patient safety organizations    10/09/2008
The Agency for Healthcare Research and Quality yesterday issued interim guidance allowing organizations to immediately apply for listing as a patient safety organization. The guidance describes eligibility and certification requirements for PSOs until the agency issues a final rule. Effective with the interim guidance, patient safety data submitted by a health care provider to a listed PSO and data developed by a listed PSO are privileged and confidential under the Patient Safety Act. AHRQ recently released common formats that health care professionals can use to collect and track patient safety information. The interim guidance and common formats can be found at www.pso.ahrq.gov.