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CMS Issues Final Rules
on Health IT Donations CMS Reforms Inpatient Payment System Consumer Reports Investigates Nursing
Homes Measures Reported on Hospital Compare to Expand Commonwealth’s
Framework for a High Performing Health System Brief Analyzes Disparities
and Preventable Hospitalization The House of Representatives recently passed the Health Information
Technology Promotion Act of 2006 (HR 4157) introduced last fall by Nancy
Johnson (R-CT). Unlike the Wired for Health Care Quality Act (S 1418),
which the Senate passed last year, HR 4157 establishes safe harbors for
health IT donations to physicians – a critical component for small
physician practices. AHQA supports both proposals to accelerate health
IT adoption. In addition to safe harbors, HR 4157 would also provide $20 million
in grants to help health providers adopt health IT in fiscal years 2007
and 2008. Though the Senate measure does not provide safe harbors, it
does allocate more than $250 million over fiscal years 2007 and 2008
to help providers adopt health IT -- and directs Congress to commit additional
funding for the following three years. S. 1418 also calls for the development,
adoption, and use of quality measures and data for quality improvement
purposes. CMS and the Office of the Inspector General (OIG) also recently released
new regulations creating exceptions to the Stark and Anti-Kickback laws
that have prohibited hospitals and others from providing physicians with
health IT. HR 4157 contains several provisions related to Stark and Anti-kickback
that go beyond the recently released CMS and OIG regulations. HR 4157
permits hospitals, group plans, and prescription drug sponsors to supply
health IT and includes a more expansive definition of health IT to include
hardware and equipment. The bill also institutes a mandatory evaluation of the impact and efficacy
of exceptions to the Stark and Anti-kickback laws within three years
of implementation. This study will assess: Other provisions of HR 4157 include replacement of the current ICD-9
billing codes with ICD-10 codes by October 2010, effectively increasing
the number of codes physicians can use to bill Medicare from about 24,000
to 200,000. HR 4157 also includes several amendments to address disparate
care. It would: Both HR 4157 and S 1418 call for: codifying (making permanent) the position
of National Coordinator for Health Information Technology reporting to
the Secretary of Health and Human Services, a position previously held
by Dr. David Brailer; and studying state laws and federal technology
standards to ensure protection of the security and confidentiality of
patient health information. “I am pleased the House approved its own version of an electronic
medical records bill last week and I believe Congress will be able to
send President Bush a final version of the legislation by the end of
the year,” Bill Frist (R-TN), Senate majority leader wrote in an
August 2, 2006, Op Ed in The Washington Times. “The legislation
gives the government the responsibility for helping to set standards,
establishes a federal structure to oversee federal health information
technology efforts, removes barriers in outdated laws, and includes some
modest support for new information technology infrastructure. In addition,
it will begin monitoring the quality of care so we can reward doctors
and hospitals that provide the best care” Senator Frist continued. It is expected that legislators in both the House and Senate will work
to reconcile both measures when they return from August recess. For more
information: CMS Issues Final Rules on Health IT Donations In the August 8 Federal Register, the Centers for Medicare & Medicaid
Services (CMS) and the Office of the Inspector General (OIG) published
final regulations defining exceptions and safe harbors to two federal
fraud and abuse laws in order to support physician adoption of health
IT. The regulations involve CMS’ physician self-referral law, which
prohibits a physician from referring Medicare patients to entities with
which the physician has a financial relationship and that entity from
billing Medicare for services rendered, and the OIG’s anti-kickback
statute, which prohibits arrangements involving the provision of items
and services to physicians. The exceptions and safe harbors establish the conditions under which: The scope of donors and recipients under the final rules is considerably
broader than in the proposed rules. In addition, recipients are required
to pay 15% of the cost of the electronic health records technology items
and services. The exceptions and safe harbors will sunset on December
31, 2013. “These final rules will improve care by giving doctors and other
health care providers needed support for interoperable health records
that enable them to increase quality and improve efficiency,” said
CMS Administrator Mark B. McClellan, MD, PhD. CMS’ new regulations: http://frwebgate1.access.gpo.gov/cgi-bin/waisgate.cgi?WAISdocID=156528260245+15+0+0&WAISaction=retrieve OIG regulations: http://frwebgate1.access.gpo.gov/cgi-bin/waisgate.cgi?WAISdocID=156528260245+14+0+0&WAISaction=retrieve CMS Reforms Inpatient Payment System The Centers for Medicare & Medicaid Services (CMS) has issued a
final rule that aligns payment for Medicare beneficiary inpatient hospital
stays more closely with the actual hospital costs. The rule also provides
for increased reporting of quality data and accounting for severity of
illness. The rule consists of two main payment reforms: Neither is expected to save money; rather they will balance out by increasing
payment for some services while decreasing payment for others. Other
provisions of the new rule include: Medicare’s inpatient rates for operating expenses will increase
by 3.4 percent in FY 2007 for those hospitals that report quality data
to CMS. Overall, the final rule is estimated to increase payments to
acute care hospitals by $3.4 billion. “These payment reforms respond to many constructive public comments
to assure that hospitals get fair and appropriate financial support for
all patients, with a smooth and gradual transition to more accurate payments.
Hospital payments should promote the best care for all patients, not
the treatments that happen to be most profitable, and we are now on a
path to making sure that happens,” said HHS Secretary Mike Leavitt. CMS also recently announced that it would increase payments to nursing
homes by about $560 million in 2007. On July 27, the agency proposed
a 3.1% increase in payments to home health agencies – a $460 million
increase in 2007. Consumer Reports Investigates Nursing Homes In a special feature of its September issue, Consumer Reports investigates
nursing homes and finds that many state agencies are lax in oversight;
that non-profit, independently-run nursing homes are more likely than
for-profit chains to provide good care; and consumer information on Nursing
Home Compare is unreliable. The publication also offers consumer tips
on how to choose a good nursing home. Financed by a grant from The Commonwealth Fund, Consumer Reports set
out to update its “Nursing Home Quality Monitor,” a list
of the best and worst performing nursing homes in each state. The investigation
revealed “little evidence that the quality of care has improved” since
2000, when the first such list was published. Consumer Reports noted
that many of the nursing homes rated as poor performers in this investigation
also appeared on previous lists. Poor staffing levels, watered-down legislation designed to protect nursing
home residents, and lack of enforcement for care violations on the part
of state agencies’ – and to some extent CMS -- allow poorly
performing nursing homes to remain operable Consumer Reports concluded.
The special series provides consumers a list of nursing homes to avoid,
tips on how to find a good nursing home, how to observe care at the facility,
and how to keep the quality of care as good as possible after admission. Consumer Reports also cautions readers not to rely on data from CMS’ Nursing
Home Compare website. The site, it says, is “difficult for the
average person to interpret,” and the data “gloss over much
of the variation among nursing home residents that can affect care.” Instead,
consumers should review a nursing home’s Form 2567, a state inspection
report that provides more detailed information. The publication suggests
that CMS make complete Form 2567’s available online. In a statement on the report, Larry Minnix, President & CEO of the
American Association of Homes and Services for the Aging, said his organization
is joining with provider organizations, consumer groups, federal government
agencies, and The Commonwealth Fund in a consumer-focused, multi-year
quality improvement campaign. CMS is actively encouraging QIOs to participate
as local resources for nursing homes involved in the campaign. “This campaign, in conjunction with our Quality First initiative,
will help us move to the day when there will be two types of nursing
homes: the excellent and the non-existent,” Minnix said. Read the special report at: Measures Reported on Hospital Compare to Expand The Hospital Quality Alliance (HQA) announced that it will take the
next step in providing consumer education about quality of care by increasing
the number of quality measures reported on the Hospital Compare (www.HospitalCompare.hhs.gov)
website. More than 4,000 hospitals – including virtually all acute care
hospitals – are already voluntarily submitting quality information
on an initial set of conditions for heart attack, heart failure, and
pneumonia. Between 2007 and 2009, HQA will ask hospitals to provide: Some of the new measures are endorsed by the National Quality Forum
and others will be reviewed and considered for endorsement. Commonwealth’s Framework for a High Performing Health
System The August 2006 report, “Framework for a High Performance Health
System for the United States,” issued by the Commonwealth Fund
Commission on a High Performance Health System, analyzes shortcomings
of the US health care system and proposes a new vision of a “uniquely
American, high performance health system.” The report defines a high performing health care system as one that:
has a clear national strategy to improve; delivers coordinated and integrated
care; and promotes accountability by determining metrics for health outcomes,
quality of care, access to care, population-based disparities, and efficiency.
The Commission also identified key failures of the US health care system
with the aim to “chart a course for a health care system that provides
significantly expanded access, higher quality, and greater efficiency
for all Americans, especially the most vulnerable members of society.” Key sources of failure in the current health care system include: The report suggests that a successful “uniquely American” high
performing health system would likely include both market forces and
public policy efforts. Key elements of the Commission’s vision
include: Making the necessary changes to achieve this vision, the Commission
wrote, will require “significant departures from current practice” and “an
accelerated rate of innovation and improvement.” But change is
critical to avoid “needless mortality and morbidity, excess costs
and unnecessary expenditures, and, potentially, significantly diminished
economic output,” the report continues. Read the report at: http://www.cmwf.org/usr_doc/Commission_framework_high_performance_943.pdf Brief Analyzes Disparities and Preventable Hospitalization Agency for Healthcare Research and Quality researchers analyzed the
impact of race and ethnicity on avoidable hospitalizations in the July
2006 statistical brief, “Racial and Ethnic Disparities in Potentially
Preventable Hospitalizations, 2003.” They found that African American
individuals experienced the greatest rates of potentially preventable
hospitalizations followed closely by Hispanic individuals. “Higher rates of ‘preventable hospitalizations’ identify
areas where potential improvements in the health care delivery system
and process of care can be made to improve health outcomes and decrease
costs,” the authors wrote. “Racial and ethnic differences
in these rates may signal disparities in the quality of ambulatory care,
as well as disparities in access to timely and effective treatment of
certain conditions for specific populations.” The report’s findings include: Data for the statistical brief was compiled from the Healthcare Cost
and Utilization Project (HCUP) 2003 State Inpatient Databases disparities
analysis file, which consists of hospital reporting of race and ethnicity
in 23 states. Read the report at:  Home :: Inside AHQA :: For The Media :: Public Policy :: Advancing Quality :: Quality Connections :: SiteMap
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