OIG calls for action to improve RAC performance   09/04/2013
The Centers for Medicare & Medicaid Services should develop additional performance evaluation metrics to improve the performance of Recovery Audit Contractors and ensure they are evaluated on contract requirements, the Department of Health and Human Services’ Office of Inspector General recommended in a report today. “These metrics should include accuracy targets for RAC determinations of improper payments or similar measures (e.g., effectiveness ratings),” OIG said. In the report, CMS concurred with the recommendation. The OIG analysis looked at CMS activities to address vulnerabilities resulting from RAC-identified improper payments and referrals of potential fraud in fiscal years 2010 and 2011, but did not assess the accuracy of improper payment determinations by RACs, nor the burden that RAC requests for claims documentation place on health care providers. In a letter last year to HHS Inspector General Daniel Levinson, AHA Executive Vice President Rick Pollack recommended halting inappropriate payment denials by RACs, streamlining CMS integrity programs and eliminating duplicative audits, among other actions. Last month, the Government Accountability Office recommended that CMS increase consistency in review requirements across auditors to improve the efficiency and effectiveness of the audit process and simplify compliance for providers.
Hospitals reduce time to cardiac treatment, but short-term mortality unchanged   09/04/2013
While hospital “door-to-balloon” times for heart attack patients undergoing primary percutaneous coronary intervention declined to an average 67 minutes from 83 minutes between 2005 and 2009, in-hospital and 30-day mortality for these patients remained virtually unchanged, according to a study in the Sept. 5 New England Journal of Medicine. “Our data suggest that further efforts to reduce door-to-balloon time may not reduce mortality,” the authors write, noting that results from previous studies have been inconsistent. “These data, together with our own, show that remarkable results are achievable through multidisciplinary collaboration aimed at improving an important process of care yet leave open the question of why overall mortality has not declined in the two more recent studies.” Clinical guidelines recommend a door-to-balloon time of 90 minutes or less. The Centers for Medicare & Medicaid Services began publicly reporting hospital performance on the measure in 2005.
CDC: About one in four deaths from cardiovascular disease avoidable   09/04/2013
At least 200,000 deaths from heart attack and stroke could be prevented each year through healthier habits and living spaces, access to preventive screenings and early treatment for high blood pressure and high cholesterol, according to a new Vital Signs report from the Centers for Disease Control and Prevention. CDC estimates that preventable deaths from heart disease, stroke and hypertensive disease declined 29% between 2001 and 2010 due to improvements in risk factors and changes in cardiac treatments, although improvement varied by age and state. To help reduce preventable deaths, CDC recommends health care providers counsel patients to make healthy lifestyle choices such as exercising and maintaining a healthy diet and weight, and refer patients to community resources such as smoking quitlines and blood pressure self-management programs. Cardiovascular disease is the leading cause of U.S. deaths, accounting for about 800,000 deaths annually.
CMS webinar tomorrow on Health Insurance Marketplace   09/04/2013
The Centers for Medicare & Medicaid Services will host a Sept. 5 webinar on the Health Insurance Marketplace, where uninsured individuals and families and small businesses may enroll in health coverage beginning Oct. 1. The webinar will provide an overview of the marketplace and describe the assortment of consumer tools available to the public. To participate in the webinar, from 1-2:30 p.m. Eastern Time, register at https://overviewofhim9-5.eventbrite.com.