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Health Management Technology News
  March 7, 2014
In this issue:
 

► GAO: Participation has increased, but action needed to achieve goals

► GAO: Actions needed to improve administration and oversight of Veterans' Millennium Act Emergency Care Benefit

► Obama administration rewrites some health-care policies

► Physician groups urge congress to fix Medicare and repeal SGR formula

► As health care clock ticks, a surge for signups

► Lower Medicaid signups seen in health law study

► Research shows how patient experiences can be used to improve healthcare


GAO: Participation has increased, but action needed to achieve goals

Based on the number of providers awarded incentive payments, participation in the Department of Health and Human Services' (HHS) Medicare and Medicaid Electronic Health Record (EHR) programs increased substantially from their first year in 2011 to 2012. For hospitals, participation increased from 45 percent of those eligible for 2011 to 64 percent of those eligible for 2012. For professionals, such as physicians, participation increased from 21 percent of those eligible for 2011 to 48 percent of those eligible for 2012. While increases occurred, a substantial percentage of providers that participated in 2011 did not participate in 2012. Officials who oversee the programs at the Centers for Medicare & Medicaid Services (CMS) noted there could be several reasons for this, such as challenges in demonstrating meaningful use, and are monitoring the issue. Various program changes make future participation difficult to estimate. For example, increased stringency of requirements for the programs' second phase beginning in 2014—Stage 2—may slow participation, while the introduction of penalties in 2015 for some providers may motivate participation.

Read the full GAO report here ► 

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GAO: Actions needed to improve administration and oversight of Veterans' Millennium Act Emergency Care Benefit

The Veterans Millennium Health Care and Benefits Act (Millennium Act) authorizes the Department of Veterans Affairs (VA) to cover emergency care for conditions not related to veterans' service-connected disabilities when veterans who have no other health plan coverage receive care at non-VA providers. However, GAO identified a number of instances where VA staff who processed claims did not comply with applicable requirements of the Millennium Act, its implementing regulations, or VA policies when they denied the claims. Specifically, at the four VA facilities included in this review, GAO found 66 instances of noncompliance among the 128 denied claims reviewed, which led some claims to be inappropriately denied. VA facilities subsequently reconsidered and paid 25 of these claims. GAO also found that VA facilities may not be notifying veterans as required that their Millennium Act claims have been denied. Eighty-three claims out of 128 that GAO reviewed lacked documentation that the veteran was notified of the denial or of his or her appeal rights. These findings suggest that veterans whose claims have been inappropriately denied may have been held financially liable for emergency care that VA should have covered, and they may not be aware of their rights to appeal these denials.

Read the full GAO report here ► 

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Obama administration rewrites some health-care policies

The Obama administration announced Wednesday that it has rewritten an array of far-reaching rules under the Affordable Care Act, the most significant of which will let people keep bare-bones health insurance policies for three more years.

The rule changes will touch essentially every sector affected by the 2010 health-care law. It will buffer more health plans in insurance exchanges from high patient costs, give states more time to decide whether to run their own marketplaces, and spare certain unions from a fee they have resented.

The administration also is raising the possibility that small-business workers in some states might not be given a choice of health plans — potentially undermining a significant aspect of the law that federal health officials already have delayed once.

In announcing many rules at the same time, senior administration officials portrayed it as a move to address early in the year every major issue that needed to be resolved about how exactly the health-care law will work for 2015 — in contrast to the chaos and lurching policy shifts that surrounded the launch of the exchanges last fall.

“I think we have turned the corner on that,” one official told reporters, speaking at the White House’s insistence on the condition of anonymity. “We are putting out the policies early. They are clear. People can rely on them.”

Read the full Washington Post article here ► 

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Physician groups urge congress to fix Medicare and repeal SGR formula

More than 600 organizations joined the American Medical Association (AMA) to call on Congress to pass legislation to permanently repeal Medicare's flawed Sustainable Growth Rate (SGR) formula and strengthen Medicare for America's seniors. State organizations representing internists, surgeons, cardiologists, oncologists, radiologists, orthopedics and emergency physicians are among the 626 that signed a letter to House and Senate leaders that was released at the AMA's National Advocacy Conference.

The letter praises lawmakers for developing a bipartisan, bicameral agreement for a permanent solution that addresses Medicare's troubled payment system to ensure continued care for America's seniors. The legislation, HR 4015 and S 2000, repeals the flawed SGR formula and establishes a pathway to developing and implementing new health care delivery and payment models to improve the quality and effectiveness of care.

"We are optimistic that our collective voices will make a difference so Congress will end the flawed SGR policy and build a more stable practice environment for doctors and better healthcare for patients," said AMA President Ardis Dee Hoven, M.D. "Congress will never have a better opportunity to eliminate the SGR formula than it does right now. We urge lawmakers to listen and take action before April 1."

Read the full AMA press release here ► 

Return to the table of contents ► 


As health care clock ticks, a surge for signups

It's crunch time for Obamacare: With less than four weeks left to sign up for coverage this year through the health law's insurance marketplaces, consumer groups, insurers, hospitals and state and federal officials are ratcheting up their enrollment campaigns to deliver more people — particularly young adults.

  • Enroll America, a non-profit group with ties to the Obama administration, is sending buses to Texas and Ohio to talk up new coverage options.
  • Tenet Healthcare Corp., a large national hospital chain, is reaching out to people without insurance who frequent their emergency rooms.
  • The federal government will air ads during the "March Madness" college basketball playoffs that start March 16, and during shows popular with young people, such as Family Guy, The Vampire Diaries and The X Factor.

After months of emphasizing low-cost deals and the value of coverage, officials running federal and state marketplaces are stressing the March 31 deadline to enroll. By that date, for the first time, most Americans will be required to have health insurance or risk paying a penalty of $95, or 1% of income, whichever is greater. Though previous implementation deadlines have been extended, officials say there are no plans to do that with the enrollment deadline.

Read the full USA Today article here ► 

Return to the table of contents ► 


Lower Medicaid signups seen in health law study

It’s one of the most impressive statistics about the new health care law. The Obama administration says more than 8.9 million people have been, quote ‘‘determined eligible’’ for Medicaid from Oct. 1 through the end of January.

But a new study Monday from Avalere Health estimates the actual number of new sign-ups could be much lower, between 2.4 million and 3.5 million.

The administration’s statistic also includes many people renewing existing coverage.

Read the full Boston.com article here ► 

Return to the table of contents ► 


Research shows how patient experiences can be used to improve healthcare

A research project led by Oxford University is showing how patient experiences can be used to improve healthcare - not through targets and surveys, but by getting doctors, nurses and patients talking together about care on the ward.

The new approach has been used in pilot projects at two UK hospital trusts - Royal Brompton & Harefield NHS Foundation Trust in London and the Royal Berkshire in Reading. Videos of patients talking about care they received at various hospitals are used to trigger a discussion between NHS staff, managers, patients and family members about the ward where they are. Ideas for change are prioritised and staff and patients work together as partners to introduce them. The research is funded by the UK National Institute of Health Research Health Services and Delivery Research (NIHR HS&DR) Programme.

The researchers have published the findings of the project in the journal Health Services and Delivery Research.

Many of the changes that come out of the process may be small. But after a year of headlines in the UK that have focused on scandals of poor care in hospitals and social care, the approach brings compassion and dignity to the fore.

Simple examples included putting clocks on the wall where patients in intensive care can see them, where previously they may have had no sense of what time of day it is. Having teeth brushed more often and changing the time for patients' main wash were also important, while more comfortable V-shaped pillows for post-operative patients were also introduced. A lot of the changes involved providing better information to patients.

Read the full News Medical article here ► 

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