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CMS Launches Enrollment Campaign for LIS Beneficiaries HHS
Awards Nearly $900 Million in Funding for Public Health Preparedness
and Emergency Response New AHRQ Resources to Help with Disaster Planning
and Response Involving Nursing Homes Demos in LA and Houston Target
Home Health Agency Fraud QIO Selected To Develop First Ever Quality
Measures for Hospital Outpatient Settings EHR Evaluation Manual: A New
Resource Available for Objectively Evaluating EHRs Low income Medicare beneficiaries are the target of the most recent
partnership outreach effort from the Centers for Medicare & Medicaid
Services (CMS). At a recent event in Washington, CMS Acting Deputy Director
Herb Kuhn announced a new initiative to get beneficiaries who qualify
for low-income subsidies (LIS) enrolled in Medicare’s Part D drug
benefit. Ninety percent of Medicare beneficiaries have signed up to take advantage
of the new drug benefit since enrollment began in late 2005. Many of
the remaining 10% are beneficiaries who also qualify for LIS and will
receive the most benefit from enrollment in the new Medicare benefit. The outreach effort is similar in structure to the Healthier U.S. Initiative,
which aims to get more beneficiaries to take advantage of the preventive
benefits offered by Medicare. A toolkit of materials has been developed
and regional offices are prepped to work locally with stakeholders. The tools and resources that CMS’ network of national partners
can use to locate and reach out to LIS beneficiaries include an interactive
map on the CMS Web site that allows users to drill down to the county
or zip code level to identify where LIS residents live. “This technology
is going to give us all the tools we need to find the needle in the haystack
[the 10% of beneficiaries not yet enrolled],” said Mr. Kuhn. The
maps combine Medicare data with other federal and state data as well
as census information to identify pockets of low income beneficiaries
across the nation. CMS hopes partners, including faith-based and community groups, will
be able to use these materials on a local level to bring outreach efforts
to LIS beneficiaries in their own environment. Some examples of typical
outreach efforts Mr. Kuhn mentioned include: notices in grocery stores
that take food stamps, information placed in school backpacks for children
to take home to relatives, and mass transit advertising. Best practice
information on outreach activities is being collected and will be provided
to partner organizations. Some of the resources currently available for partners include a photo
novella written at the elementary school level, which is available in
English and Spanish; other versions are in the works. CMS has also developed
a list of ideas on innovative outreach tactics that partners may wish
to use. The Department of Health and Human Services (HHS) has awarded $896.7
million to states, territories, and four metropolitan areas to improve
and sustain their ability to respond to public health emergencies such
as terrorism, pandemic influenza, and other naturally-occurring events. The Centers for Disease Control and Prevention (CDC) will coordinate
the funding, which includes: These funds are in addition to the $430 million made available late
last month to strengthen the ability of hospitals and other health care
facilities to respond to bioterror attacks, infectious diseases, and
natural disasters that may cause mass casualties. “The funding represents another step in our nation’s effort
to increase our state and local public health preparedness and emergency
response capabilities,” HHS Secretary Leavitt said. “It allows
state, local, territorial, and tribal public health jurisdictions to
build upon preparedness gains that have been made over the past five
years of federal funding.” The Agency for Healthcare Research and Quality (AHRQ) recently released
two new resources designed to support local/regional planning and response
efforts specific to the elderly population in the event of a bioterrorism
or other public health emergency. The “Emergency Preparedness Atlas: U.S. Nursing Home and Hospital
Facilities” includes six case studies from North Carolina, Oregon,
Pennsylvania, southern California, Washington, and Utah. Each case study
includes a series of maps depicting the locations and capacity of nursing
homes and hospitals as well as their geographic relationship to a variety
of emergency management and bioterrorism preparedness regions such as
HAZMAT response regions, emergency management regions, and Red Cross
chapters. In addition to the case studies, the Atlas includes maps with
the location and size of hospitals and nursing homes in all 50 states
and the District of Columbia. Representatives of the six case study states also participated in a
series of focus groups to discuss disaster- and bioterrorism-related
planning activities in nursing homes. The results are available in the
companion report, “Nursing Homes in Public Health Emergencies,” which
addresses the roles that nursing homes could play in regional preparedness. “States, local communities and other planners need accurate and
reliable information about nursing homes and other facilities that care
for some our nation’s most vulnerable citizens,” said AHRQ
Director Carolyn M. Clancy, MD. “This new resource can help stimulate
productive discussions among planners to further our nation’s preparation
and response efforts.” The Atlas and report were developed for AHRQ by RTI International. Both
can be found online at More information about AHRQ’s emergency preparedness resources
is available at: http://www.ahrq.gov/prep/ Department of Health and Human Services (HHS) Secretary Michael Leavitt
recently announced a demonstration project in Los Angeles and Houston
designed to protect Medicare beneficiaries from fraudulent Home Health
Agency (HHA) providers. Over the past year, the Centers for Medicare & Medicaid Services
(CMS) and the HHS Office of Inspector General have identified and documented
a significant number of problems involving HHAs in the greater Los Angeles
and Houston areas. Under the rules of the demonstration project, HHAs
in those areas are required to immediately resubmit applications to be
considered a qualified Medicare HHA. Those who fail to reapply within
60 days will have their Medicare billing privileges revoked. Also, home health care providers that fail to report a change in ownership
or change of address; have owners, partners, directors, or managing employees
who have had a felony conviction within the last 10 years; or no longer
meet each and every provider enrollment requirement will have their billing
privileges revoked. In addition the demonstration will require a State
survey for any HHA that changed ownership within the last two years. “HHS is working to protect the public from fraud by stopping it
before it happens,” Secretary Leavitt said. “Our joint effort
with the Department of Justice shows that we have zero tolerance for
those who would prey on the system. This demonstration project works
to bar unlawful Home Health Agencies from entering the Medicare billing
system.” Under a new contract with the Centers for Medicare & Medicaid Services
(CMS) the Oklahoma Foundation for Medical Quality (OFMQ) will collaborate
with The Joint Commission to develop the first national standardized
quality measures to assess performance in hospital outpatient facilities.
The measures will be used by CMS for public reporting, performance-based
financial incentives, and quality improvement. The Tax Relief and Health Care Act of 2006 provides for the development
of measures to assess the quality of care furnished by hospital outpatient
settings, which may include emergency rooms, hospital-affiliated clinics,
and ambulatory surgery facilities. Adding performance measures for the
hospital outpatient setting is part of the continual trend toward transparency
in health care, making information on quality and cost available to the
public. “We are pleased to contribute our expertise in such a significant
way to health care quality improvement,” said Claudette Greenway,
RN, MBA, and Chief Operations Officer at OFMQ. “Part of our role
is to facilitate collaboration among experts to ensure appropriate and
effective measurement. We appreciate working in concert with The Joint
Commission to establish consensus-based measures,” she said. “The Joint Commission welcomes the opportunity to formally collaborate
on measure development with Oklahoma Foundation for Medical Quality,” said
Jerod M. Loeb, PhD, The Joint Commission’s Executive Vice President
for Quality Measurement and Research. “This project is a critical
component in the evolving national performance measurement landscape,” he
said. The contract calls for the development of technical specifications and
pilot test of an initial set of five measures to be released this summer.
These measures were prioritized from a list of CMS-proposed measures
based on several criteria, including their importance to quality performance,
scientific reliability and validity, usefulness to consumers and purchasers
in decision making, and feasibility of data collection. “We like to see alignment with existing measures that have proven
to be effective,” said Dale Bratzler, DO, MPH, QIOSC Medical Director
for OFMQ. “We’re looking at populations and conditions that
we can easily identify and where opportunity for improvement exists,
such as in heart failure, pneumonia, and surgical infection. Improving
quality of care in these areas has the potential to impact millions of
Americans,” he added. Inpatient hospitals have publicly reported performance data on heart
and pneumonia care since 2004, and in 2006 added measures for surgical
infection prevention. A new book published by the American Health Information Management Association
(AHIMA) captures more than four years worth of resources developed by
Advocates for Documentation Integrity and Compliance (ADIC) on medical-legal
pitfalls for electronic health records and how to avoid them. ADIC principals Dr. Reed Gelzer and Patricia A. Trites have been researching,
presenting, and publishing on these topics for four years. The resulting
book entitled “How to Evaluate Electronic Health Record Systems,” is
a step-by-step manual for evaluation, including test vignettes, grading
and scoring tools, as well as tools for managing the comparative assessment
of multiple EHRs in a rigorous due-diligence process intended to provide
users with means and referenced criteria for creating objective comparisons
of EHRs on the basis tested functions. All these tools are also provided
in electronic form so that users can input their own priorities and requirements
in their evaluation or assessment processes. The book is intended to address the current difficulty of both selecting
EHRs and also making sure that EHRs are used correctly and properly.
Even the best designed EHR can be used in a way that can cause difficulty
if the documentation is ever challenged by a payer for validity or in
court. Some EHRs do not yet even have the basic functions present to
support basic validity requirements and so require additional steps to
comply with current regulations. The primary criteria for validity are
the Federal Rules of Civil Procedure (recently updated in December 2006)
that determine what constitutes a valid business record (of which a medical
record is one type) for purposes of admissibility. Also highlighted in
the book are references to CMS and other payer guidance on the appropriate
(or warnings about inappropriate) use of EHRs. Audit, authorship, amendment/correction, and coding functions are covered
in depth and additional areas are covered in overview. The first four
are emphasized because the authors found that if these functions (in
order of importance) were well supported in an EHR, the likelihood that
the rest of the functions were sound were higher. While EHR product certification
will eventually include these basic functions, they don’t currently,
which makes it critical that EHR purchasers and users include this in
their due diligence processes and in the practice compliance procedures
as well. Further information about the book can be found at the Bookstore section
of the American Health Information Management Association website at
http://www.ahima.org/ under Professional Development.
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