CMS Renames "Meaningful Use" to "Promoting Interoperability"
In its latest Inpatient Prospective Payment System and Long-Term Care Hospital Prospective Payment System rule changes announced April 24, CMS
renamed its meaningful use program again in an attempt to reflect its emphasis on achieving interoperability. Meaningful use, which CMS changed to
"advancing care information" and rolled out under the Medicare Merit-based Incentive Payment System, will
now be called "promoting interoperability." To advance data-sharing in healthcare, CMS is requiring that hospitals make patients' EHRs
available to them on the day they leave the hospital starting in 2019.
CMS hopes to make the program more flexible and less burdensome, in part
by adding "measures that require the exchange of health information between providers and patients, and incentivize providers to make it
easier for patients to obtain their medical records electronically," the announcement states. Specifically, it is replacing six measures with
four: E-prescribing; Health information exchange; Provider-to-provider exchange; and Public health and clinical data exchange.
Meanwhile, former ONC chief Farzad Mostashari, MD, pointed out in a tweet April 24
that buried deep in the rule change, on page 1,475, that CMS proposed to use hospital conditions of participation to ensure interoperability and
patient access. CMS suggested it may consider revising the current CoPs for hospitals to mandate they electronically transfer medically necessary information to
another facility upon a patient transfer or discharge, require hospitals to send required discharge information to a community provider via
electronic means if possible, and necessitate hospitals make certain information available to patients or a specified third-party application
electronically upon request.
CMS is accepting comments on the proposed rule until June 25.
(Click for Full Article:
Becker's Hospital Review, 4/25/18)
Medicare Will Require Hospitals to Post Prices Online
Medicare will also require hospitals to post their standard prices online
so they are more readily available to patients,
officials have announced. CMS head Seema Verma said the new requirement for online prices reflects the Trump administration's ongoing efforts to
encourage patients to become better-educated decision makers in their own care. Hospitals are required to disclose prices publicly, but the latest
change would put that information online in machine-readable format that can be easily processed by computers. (Click for Full Article:
New York Times, 4/24/18)
OIG: 31% of Telehealth Claims Didn't Qualify
CMS paid about $3.7 million on telehealth claims that did not meet Medicare requirements, according to a report from the Office of the Inspector
General. The OIG reviewed 191,118 distant-site telehealth claims from 2014 and 2015 totaling $13.8 million in payments. In a random sample of 100 claims,
31 claims should have failed to qualify for Medicare reimbursement. Of the 31 disallowed claims, 24 were because the patient received services at non-rural sites.
Other claims showed the use of inappropriate means of communication, services outside the U.S., and billing for non-covered services.
The OIG recommends that CMS implement post-payment review of claims to identify errors, as well as training providers on Medicare telehealth
requirements. (Click for Full Report:
"Give Paramedics Power to Make Better Choices on Behalf of Vulnerable People"
If a person is intoxicated or suffering from a mental health crisis, a crowded hospital ER may not be the right place to get treatment. Yet
homeless people are often taken there when they may just need a place to sober up or be seen by a mental health professional. That's because, in
California, paramedics don't have the option to take homeless people, or anyone else, to a sobering center or a behavioral health facility. Under
state law, paramedics (unlike police or sheriff's deputies in L.A. County) summoned through 911 calls are legally obligated to take an
individual needing treatment to a hospital emergency room. (Click for Full Article:
Los Angeles Times, 4/24/18)
California Online Community College Would Offer Medical Coding Program
The first program under Gov. Jerry Brown's proposed all-online community college would provide workers with an entry point into the growing
healthcare field. The California Community Colleges Chancellor's Office is developing a four- to eight-month certificate program to train
medical and healthcare coders in a partnership with the Service Employees International Union - United Healthcare West Joint Employer
Education Fund. Unionized healthcare coders, who assign alphanumeric codes to medical procedures and services for billing purposes, earn about $30 per hour to
start. Proponents of the program anticipate annual openings for 1,600 medical coding positions across the state. (Click for Full Article:
Sacramento Bee, 4/27/18)
"All Healthcare is Local" to be Replaced With "All Healthcare is Social"
In a recent Forbes article -
All Health Care Is Social: The Increasing Significance Of Social Interaction And Health - Sachin H. Jain, MD, President and CEO of CareMore Health System, writes
that a growing number of healthcare organizations, particularly those focused on senior care, have recognized the importance of social interaction to health. In
addition to medical appointments, diagnostic tests and studies, and medical prescriptions, these organizations prescribe and deliver social interaction with other seniors.
Some interactions, such as education classes, have a health issue at their center, but just as often do not. Social interaction is seen as a medicine in itself - and is often a
key engagement tool, getting patients further engaged in their health, and is an integral part of the clinical delivery model. Some healthcare organizations have identified
generating greater social connection as a clinical goal. At Cerritos, CA-based CareMore Health, the lack of social connection or loneliness has been deemed a "treatable disease"
and patients can enroll in a "Togetherness Program." Every CareMore patient undergoes a Healthy Start screening during which
they are asked about their level of social connection to others. Patients who are identified as suffering from social isolation or loneliness are connected with a "Togetherness Connector"
who makes a weekly phone call to check up on the patient. (Click for Full Article:
Million-Dollar Cancer Treatment: Who Will Pay?
The emergence of genetics-based medicines is pushing the cost of treating certain diseases to new levels, forcing hospitals and health
insurers to reckon with how to cover total costs per patient approaching a million dollars. The therapies deliver new genes or genetically
altered cells to tackle some of the hardest-to-treat diseases, including in children. They come at a high price: Novartis AG listed its newly
approved cell therapy for cancer at $475,000, while Gilead Sciences Inc. priced its rival drug at $373,000. But the price of the drugs is just
the beginning, hospitals and insurers say. Administering these therapies can add hundreds of thousands of dollars to the tab, including lengthy
hospital stays and use of other services and medicines. (Click for Full Article:
Wall Street Journal, 4/26/18)
A Royal Baby is Cheaper to Deliver than Average US Baby
Kate Middleton, the Duchess of Cambridge, gave birth to a baby boy,
Louis, April 23, and delivering the new prince likely cost less than the average U.S.
delivery, according to The Economist. The Duchess gave birth at the Lindo Wing, a private, upscale maternity
ward in London often used by royals. In 2015, the maternity ward charged $8,900 for a non-caesarean delivery and a 24-hour stay in a deluxe
patient room, according to data from London-based St. Mary's Hospital. In contrast, the average fee for the same delivery in the U.S. was
$10,808 in 2015, according to The International Federation of Health Plans. When accounting for pre- and postnatal care, this figure jumps to
about $30,000. Although insurance will cover most of this cost, parents are still left with an average bill of about $3,000, according to Truven
Health Analytics data cited by The Economist. (Click for Full Article:
Becker's Hospital CFO Report, 4/24/18)
Family Caregivers Finally Get a Break - and Extra Coaching
In California, Dignity Health Systems is partnering with the nonprofit Santa Barbara
Foundation to provide caregiver coaches to help caregivers transition their patients to home care. At any given time, 1,000 caregivers are
being coached. Across the country, community groups, hospitals, government agencies, and nonprofits are doing more to support at least
some of the estimated 42 million people who are the primary caregivers of adults and children who have disabilities, are recovering from
surgeries and illnesses, or are coping with Alzheimer's and other chronic diseases. (Click for Full Article:
California Healthline, 4/30/18)
How a Stationary Bike + Google Street View Helps Seniors with Dementia
Residents at an Oshawa, Ontario, Canada retirement home are among the first people in that country to try an innovative therapy for Alzheimer's and dementia
- called the BikeAround. The device combines a stationary bicycle, a dome-shaped projector, and Google Street View technology.
Users sit on the bike and are able to pedal through video of meaningful destinations - a childhood home, a vacation destination, the spot they
were married projected onto the screen in front of them. The experience helps recall memories, inspire conversation, and improve
mood, according to researchers. (Click for Full Article:
Bare-Bones Health Policies: Cheaper than ACA Plans - and Riskier
Sales are growing for a type of bare-bones health policy that offers a cheaper alternative to traditional insurance but leaves buyers risking big bills if they have
major medical needs. Known as fixed indemnity plans, the products offer limited help, typically paying set amounts toward the cost of doctor visits, hospital
days or other services. They generally carry restrictions on people with pre-existing conditions, and they aren't considered true health insurance under the
Affordable Care Act. But insurance agents say individuals are increasingly purchasing the plans as a substitute for ACA coverage,
which has become far more costly for many people who don't get federal subsidies.
Isaiah Alicea, a 29-year-old refrigeration technician in San Antonio, last year bought a
product called "Core Health Insurance," mostly because of the low price of around $200 a month. The plan pays $70 each for up to 10 doctor
visits if he is sick, and up to $500 a day for a hospital stay, up to 31 days, along with payments toward certain other services. The product
doesn't pay toward hospital care related to pre-existing conditions for the first 12 months it's in effect. (Click for Full Article:
Wall Street Journal, 4/18/18)
MDs' Undergrad Education Another Reason We Spend 18% of GDP on Healthcare
One contributing factor to the high U.S. spend on healthcare is the high cost, in time and money, of becoming a physician. A recent paper for the Mercatus Center argues that the amount of time it takes to become a doctor in the U.S.- four years in college before med school (another
four years) and then residencies, almost always at least a decade - constrains the supply, driving up prices. Physician incomes in the U.S.
well exceed those in Europe; American generalists earn twice as much as Dutch ones (although most emerge from med school in debt - a median of
$195,000 in 2017). Europeans can begin studying medicine immediately after high school - usually with a five- or six-year course. The U.S.
has a much smaller proportion of medical doctors graduating each year: 7.5 per 100,000 residents, compared with 11.3 in Germany, 12.8 in
Britain, 9 in France, and 14.6 in the Netherlands. Only Canada, which has undergraduate requirements and high physician costs comparable to
America's, comes close, with 7.8 per 100,000. (Click for Full Article:
Wall Street Journal, 4/23/18)