AHA comments on CMS' two-midnights proposal   06/19/2013
The AHA today urged the Centers for Medicare & Medicaid Services to issue new instructions to its recovery audit and other contractors explaining how to review the medical necessity of Medicare Part A inpatient hospital stays, instead of finalizing its proposed “time-based presumption” policy. Proposed in the fiscal year 2014 inpatient prospective payment system rule issued in May, the policy would instruct Medicare medical review contractors to presume an inpatient hospital admission is reasonable and medically necessary if a beneficiary requires more than one Medicare utilization day, which the agency defines as an encounter crossing two midnights. “We appreciate CMS’ effort to clarify what is required for payment of inpatient hospital services under Medicare Part A, particularly in light of the focus by Medicare [RACs] on the medical necessity of short inpatient stays,” wrote AHA Executive Vice President Rick Pollack. “Unfortunately, CMS’ proposed time-based presumption of medical necessity is not reflective of the way hospitals function today: while it might address some problems, it likely would generate others.” AHA suggested that, rather than adopt a time-based presumption, the agency instead make three changes to the RAC program. First, AHA urged CMS to limit RAC review to only the information in the medical record that was known to the physician at the time of the decision to admit. Second, AHA urged CMS to instruct the RACs to focus their audits on those other factors that the agency has said are relevant to the admission decision, instead of only factors like the patient’s length of stay and outcome. Finally, AHA called on CMS to penalize RACs for “incorrectly denying an inpatient stay – not just to recoup their contingency fee – to provide some check on the strong financial incentive RACs have to conclude that beneficiaries should not have been admitted.” AHA will submit separate comments on CMS’ hospital inpatient and long-term care hospital PPS proposals.
Congress seeks input on post-acute care reform   06/19/2013
Leaders of the House Ways and Means and Senate Finance committees have solicited input from stakeholders, including the AHA, on proposals to reform Medicare payment for post-acute services, including long-term care hospitals, inpatient rehabilitation facilities, skilled nursing facilities and home health agencies. Specifically, the committee leaders seek stakeholder comments by Aug. 19 on proposals by the Medicare Payment Advisory Commission, Obama administration, Bipartisan Policy Center and Simpson-Bowles Commission for market-basket cuts, site-neutral payment, the IRF 75% Rule, SNF readmission penalties, and bundled payments. Other topics of interest include quality measures, patient assessment tools, value-based purchasing and reducing hospital readmissions, as well as questions raised by alternatives to fee-for-service payment. In a statement submitted last Friday to the Ways and Means Health Subcommittee, AHA expressed deep concern with certain budget and regulatory proposals that would further reduce Medicare payments for post-acute providers.
CMS extends IPF quality reporting waiver request deadline for Hurricane Sandy   06/19/2013
The Centers for Medicare & Medicaid Services has extended to June 28 the deadline for individual inpatient psychiatric facilities affected by Hurricane Sandy to request an extension or waiver of data submission requirements under the IPF quality reporting program. CMS expects to officially notify hospitals of the extension via email this week. To access the extension or waiver request form, visit www.qualitynet.org. CMS said it plans to respond to all requests for an extension or waiver by mid-July. Last month, the AHA and hospital associations in Connecticut, New Jersey and New York urged CMS to waive the fiscal year 2014 data reporting requirements for all IPFs affected by Hurricane Sandy, and to give storm-affected hospitals relief from additional federal quality reporting and payment requirements. CMS said it intends to respond to the associations’ blanket IPF waiver request separately in writing.
Earlier tPA treatment improves outcomes for stroke patients   06/19/2013
Patients with acute ischemic stroke who receive early tPA therapy to help dissolve a blood clot are more likely to survive their hospital stay, walk without help, and be discharged home rather than to post-acute care, according to a study in today’s Journal of the American Medical Association. Patient outcomes improved for every 15-minute-faster interval of treatment. The study included data from nearly 60,000 patients treated with intravenous tissue-type plasminogen activator (tPA) within 4.5 hours of symptom onset in 1,395 hospitals participating in the Get With The Guidelines-Stroke Program. “These findings support intensive efforts to accelerate patient presentation and to streamline regional and hospital systems of acute stroke care to compress [onset to treatment] times,” the authors conclude.
AMA awards grants for innovation in medical education   06/19/2013
The American Medical Association recently awarded $1 million each to 11 medical schools for projects to transform undergraduate medical education. The projects include models for competency-based student progression, student immersion within the health care system, and increased use of health information technology and virtual patients. The schools, which will participate in a learning consortium to help disseminate best practices to other schools, are: Indiana University School of Medicine; Mayo Medical School; NYU School of Medicine; Oregon Health & Science University School of Medicine; Penn State College of Medicine; The Brody School of Medicine at East Carolina University; The Warren Alpert Medical School of Brown University; University of California, Davis School of Medicine; University of California, San Francisco School of Medicine; University of Michigan Medical School; and Vanderbilt University School of Medicine.