June 2012 - American Association for Clinical Chemistry

new icD-10 Transition
Deadline announced
The Department of Health and Human
Services (HHS) announced that the
nation’s transition to the ICD-10 medical
coding set will be delayed for a second
time until October 1, 2014. The most recent
deadline was October 1, 2013, a 2-year
deferral from the original 2011 date. ICD-10
will introduce more than 100,000 new diagnostic
and procedure codes, affecting
everything from medical research to reimbursement.
Physician groups had turned up the
pressure in recent months to delay implementation,
criticizing HHS for requiring
too much from providers in a short timeframe,
such as the transition to electronic
health records. In addition, some in the
lab community had warned that payers
were not prepared for ICD-10, and that
labs could be stuck between physicians and
payers, both of whom appeared equally illprepared
for the transition to a new coding
scheme.
More information about ICD-10 is
available from the government’s ICD-10
website, www.cms.gov/Medicare/Coding/
ICD10.
medicare long-Term health at risk
report from the Medicare Trustees
a shows that the Hospital Insurance
(HI) trust fund may run out of money in
2024. In 2011, the HI trust fund expenditures
were lower than expected. However,
HI expenditures have exceeded income
annually since 2008 and are projected to
continue doing so under current law in all
future years.
The trust fund’s assets are projected to
cover annual deficits through 2023, with asset
depletion in 2024. At this point, if Con-
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p r o f i L e s
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gress were to take no further action, projected
revenue would be adequate to cover
87% of estimated expenditures in 2024 and
67% of projected costs in 2050. In practice,
Congress has never allowed a Medicare
trust fund to exhaust its assets. Medicare
has bought some time due to the Affordable
Care Act, which cut some payments.
Without this law, the trust fund would expire
8 years earlier, in 2016.
The full report is available from the
Centers for Medicare and Medicaid Services
website, www.cms.gov.
Proposed Payment rule for
hospitals Pushes Quality metrics
The Centers for Medicare and Medicaid
Services (CMS) issued a proposed rule
that would update Medicare payment policies
and rates for inpatient stays. According
to CMS, the proposed rule is a continuation
of efforts to promote improvements
in care designed to produce better patient
outcomes while slowing healthcare cost
growth.
The rule implements elements of the
Affordable Care Act, including value-based
purchasing programs and the hospital readmissions
reduction program. It also lays
groundwork for expanding Medicare’s
quality reporting requirements. These programs
will adjust hospital payments beginning
in 2013 and annually thereafter based
on how well they perform or improve their
performance on a set of quality measures.
Beginning in 2015, the value-based purchasing
program would include all Part A
and Part B payments from 3 days prior to
an inpatient hospital admission through
30 days post-discharge, with certain exclusions.
The proposed measure would be
risk-adjusted for the beneficiary’s age and
severity of illness.
In addition, the Hospital Readmissions
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Reduction Program will reduce payments
to certain hospitals that have excess readmissions
for three selected conditions:
heart attack, heart failure, and pneumonia.
The proposed rule includes a methodology
and the payment adjustment factors to
account for excess readmissions for these
three conditions.
Overall, CMS estimates that under the
proposed rule, rates to general acute care
hospitals will increase by 2.3% in 2013.
The 2.3% is a net update after inflation,
improvements in productivity, a statutory
adjustment factor, and adjustments for hospital
documentation and coding changes.
CMS will accept comments on the proposed
rule until June 25. The proposed rule
can be downloaded from the Federal Register,
https://federalregister.gov.
report: more oversight
needed of ehr Program
The Centers for Medicare and Medicaid
Services (CMS) should improve its
process for verifying that healthcare providers
qualify for incentive payments through
the meaningful use program of electronic
healthcare records (EHR), according to a
K-ASSAY ®
report by the Government Accountability
Office (GAO).
Under the 2009 federal economic stimulus
package, healthcare providers who
demonstrate meaningful use of EHRs can
qualify for incentive payments from CMS.
After 2015, providers will face cuts to reimbursement
if they fail to implement EHRs.
GAO found that CMS has implemented
proper systems to verify whether providers
have met eligibility requirements before
any incentive payments are processed.
However, GAO noted serious problems
with how exceptions are handled. CMS allows
providers to exempt themselves from
reporting certain measures if they report
that the measures are not relevant to their
patients or practices. However, GAO found
that among participants in the first year of
the Medicare EHR program, the majority
of providers chose to exempt themselves
from reporting on at least one meaningful
use measure. In addition, many providers
reported at least one clinical quality measure
based on less than seven patients. GAO
recommended that CMS collect more detailed
information about providers.
The full report is available from the
GAO website, www.gao.gov.
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