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| Medicare Proposes Payment Updates for Hospitals, New System for ASCs |
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ADOPTING INFORMATION TECHNOLOGY MAY BE EASIER now that the U.S. Department of Health and Human Services has established safe harbors and created self-referral exceptions to encourage physician adoption of electronic prescribing and electronic health records technology. "Electronic health records help doctors provide higher quality patient care, improved efficiency and with less hassle," says HHS Secretary Mike Leavitt in a statement. "By removing barriers, these regulation changes will help physicians get these systems in place and working for patients faster."
BLUE CROSS OF CALIFORNIA can continue to pay doctors differently for endoscopies performed at hospitals and outpatient surgery centers, a judge ruled last week. The insurer announced a policy change in July reimbursing doctors five percent more than the standard fee if the procedures were performed at outpatient facilities and 20 percent less if they took place in a hospital. The California Hospital Association sued to stop the policy change, arguing that it encouraged doctors' decisions on surgery location through financial incentives, not through patients' best interests. A judge denied the request, noting that it couldn't be proved that doctors' medical judgment would be affected.
MEN ARE TWICE AS LIKELY AS WOMEN to suffer recurring blood clots, according to a study published in July's The Lancet. Researchers discovered that men have a 50 percent higher risk of recurrent venous thromboembolism after stopping anticoagulant treatment. The study's authors believe that if these findings are confirmed by further prospective investigations, this difference in risk of recurrence should be considered when duration of anticoagulant treatment is determined in individual patients. |
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| Quality Reporting on Its Way for HOPDs; ASCs Next |
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ADOPTING INFORMATION TECHNOLOGY MAY BE EASIER now that the U.S. Department of Health and Human Services has established safe harbors and created self-referral exceptions to encourage physician adoption of electronic prescribing and electronic health records technology. "Electronic health records help doctors provide higher quality patient care, improved efficiency and with less hassle," says HHS Secretary Mike Leavitt in a statement. "By removing barriers, these regulation changes will help physicians get these systems in place and working for patients faster."
BLUE CROSS OF CALIFORNIA can continue to pay doctors differently for endoscopies performed at hospitals and outpatient surgery centers, a judge ruled last week. The insurer announced a policy change in July reimbursing doctors five percent more than the standard fee if the procedures were performed at outpatient facilities and 20 percent less if they took place in a hospital. The California Hospital Association sued to stop the policy change, arguing that it encouraged doctors' decisions on surgery location through financial incentives, not through patients' best interests. A judge denied the request, noting that it couldn't be proved that doctors' medical judgment would be affected.
MEN ARE TWICE AS LIKELY AS WOMEN to suffer recurring blood clots, according to a study published in July's The Lancet. Researchers discovered that men have a 50 percent higher risk of recurrent venous thromboembolism after stopping anticoagulant treatment. The study's authors believe that if these findings are confirmed by further prospective investigations, this difference in risk of recurrence should be considered when duration of anticoagulant treatment is determined in individual patients. |
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| Final Ruling on Specialty Hospitals Issued
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CMS will require specialty hospitals to disclose physician investment information and compensation arrangements to ensure that physician-owned facilities are not in violation of anti-kickback legislation. The ruling is part of the agency's Final Report to Congress, as mandated by the Deficit Reduction Act of 2005.
"Specialty hospitals often achieve high levels of service but, especially under current payment methods, there have been questions about whether they focus on profitable patients rather than quality of care," said CMS administrator Mark McClellan, MD, PhD, in a conference call. "This final report is a comprehensive review of the evidence on specialty hospitals and a path forward to address concerns that have been raised."
The release of the CMS report marks the end of the Medicare Modernization Act's 18-month moratorium on issuing new provider numbers to specialty hospitals.
Molly Gutierrez, executive director of the American Surgical Hospital Association, applauded the lifting of the moratorium and identifies CMS's announcement of programs to support hospital-physician collaboration as a positive turn. "We're encouraged by CMS's action to encourage partnership between hospitals and physicians through gain-sharing," she said.
CMS based its report on responses to a recent survey that addressed investment arrangements of physician-owners, the proportionality of investment return, evidence of bona fide investment and provision of charity care by specialty hospitals.
The report shows specialty hospitals demonstrated proportionate returns in comparison to physician investment, although only 53 percent of facilities responded to this section of the survey. In his conference call, Dr. McClellan said the lack of universal response warrants continued investigation and ongoing reporting of physician investment. CMS will seek out the facilities that did not respond to the initial survey and levy fines of up to $10,000 per day past its due date.
"We didn't find, on its face, any major issues in physician investments as reported in the survey we conducted, but we are going to get much more comprehensive information as a result of the enforcement of the survey responses," said Dr. McClellan.
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| News and Notes |
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CMS HAS PROPOSED TWO CHANGES FOR IMAGING PAYMENTS under the physician fee schedule for 2007. The first provision deals with payment for multiple imaging procedures on contiguous body parts during the same session; it calls for full payment for the first procedure and a 25 percent reduction for each additional procedure. "This is a smaller reduction than had previously been proposed," says CMS in a statement. Secondly, payments for the technical component will be capped at hospital outpatient department rates. "For imaging services subject to both the multiple imaging reduction policy and the outpatient hospital cap, we propose to first apply the multiple imaging adjustment and then apply the outpatient cap," says CMS, "This approach results in higher payments than if the cap were applied first."
RESEARCHERS ARE EXAMINING THE POSSIBILITY that a surgical glue may provide a better method for closing post-cataract corneal incisions than sutures or self-sealing. In a study published in the July 19 issue of the American Chemical Society's Biconjugate Chemistry, researchers from Boston University's departments of biomedical engineering and chemistry and from Duke University's ophthalmology department report that a biocompatible adhesive gel had the strength to seal a corneal incision. The gel sidestepped suturing's risks of infection, inflammation and blood vessel formation as well as self-sealing's risk of infection and fluid leakage, says the study.
MORBIDLY OBESE PATIENTS WITH POOR CARDIOPULMONARY FITNESS are more likely to suffer increased complications following bariatric surgery, research suggests. In a study published in the August issue of the journal Chest, researchers report that bariatric patients with low cardiopulmonary fitness levels experienced longer operative times and primary complications that included death, unstable angina, deep vein thrombosis, pulmonary embolism, renal failure, and stroke. The study's authors recommend a combination of medical weight loss and physical conditioning for patients presenting with low cardiopulmonary fitness levels. |
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