Thursday, July 4, 2013

NCAQ Transitions Measures to ICD-10, Seeks Comment

The National Committee for Quality Assurance, an accreditation firm, is soliciting public comments on proposed changes to HEDIS performance measures on providers and payers as the nation transitions to the ICD-10 codes.
The ICD-10 codes, effective in October 2014, will be part of the HEDIS 2015 measures, which NCQA will release in July 2014. “To accommodate this change, NCQA created a plan to identify a valid and appropriate set of ICD-10 codes for each HEDIS measure in time for inclusion in the HEDIS 2015 publications,” the organization explains. “This identification has been in progress for three years and is now completed. NCQA seeks public comment on all of the final recommendations for converting ICD-9 to ICD-10 codes in HEDIS measures.”
Because of the large number of codes being reviewed, NCAQ is offering a long comment period with a due date of Dec. 16, 2013. Details on the changes and comment procedures are available here.
NCQA also has released the 2014 edition of technical specifications for HEDIS measures, including a new measure on non-recommended cervical cancer screening in adolescent females. Changes also were made in existing measures covering breast cancer screening, cervical cancer screening for adult females, care for older adults, potential drug-disease interaction in the elderly and relative resource use. More information is at

VA inspected many times; results shared

Written by

Joe Battle

As the director of the G.V. (Sonny) Montgomery VA Medical Center, I wish all of our veterans and their families, service men and women, VA employees and volunteers a happy and safe Fourth of July holiday. We commemorate the Declaration of Independence on this day as our statement of shared values and beliefs which manifests itself in the young men and women who have served our country honorably for 237 years.
I spend my waking moments thinking about how the G.V. (Sonny) Montgomery VA Medical Center can better serve our veterans, and I think of recent events and how some folks are questioning our commitment. The past few months have seen some challenging times at the Jackson VA.
Recent publicity has captured the attention of oversight organizations charged with ensuring that health care facilities are taking care of their patients and providing a safe working environment for its employees. We welcome these organizations as a check to ensure we are providing the best quality of care to our veterans in a safe and clean environment. I’d like to share some results.
On April 1-9, an inspection team from the Occupational Health and Safety Administration visited and reviewed employee training records, inspected the equipment sterilization process, observed the sterilization process and spoke with employees. After almost 10 days, there were two minor findings — a power cord was “daisy-chained” together, which was corrected on the spot, and some employee training was not completed within a calendar year, which OSHA requires, but was completed within a fiscal year, which the VA requires. We retrained the employees while the inspector was still on site.
A few weeks later, on May 3, we had an initial (unannounced) survey by The Joint Commission for Accreditation of Healthcare Organizations for our new Psychosocial Rehabilitation and Recovery Center. That inspection yielded one indirect finding — an emergency light in the building had not been tested. We tested it on the spot.
Then, on June 3-4, TJC visited us again. This time to conduct a “mini” full survey of the hospital based on the Office of Special Counsel complaints which were filed. The survey team, consisting of a doctor and nurse, from the VA’s Office of Medical Inspector, reviewed records, spoke to employees and interviewed veterans. The result was only one indirect finding regarding precharted documentation on a quality log.
So, in short, we have had three major (unannounced) inspections over the past three months from oversight organizations in the health care industry and employee safety. The findings did not impact patient care.
While these are good results, we know we’re not finished. Recently, two more OSC complaints have been filed, one related to pharmacy and one related to credentialing and privileging of staff. When the results of these reviews are known we will quickly address any opportunities for improvement.
I have heard that a few wish to see the VA or the Jackson VA shut down. I am disappointed by such thoughts, and such actions would not serve veterans in Mississippi. I believe the VA is specifically equipped to meet the full array of services our veterans need. I want every eligible veteran in the state of Mississippi to use their earned medical benefits and be comfortable using the VA Medical Center. The (Sonny) Montgomery VA Medical Center has an annual operating budget of $350 million which significantly impacts the economic base of our community while employing more than 2,000 people. I want employees and veterans to know that my door is open to ideas, which will improve patient care.
Much has been accomplished during the past year. We were selected to be one of 15 National Pilots in Mental Health exploring partnerships with community mental health organizations to increase access for veterans. We’ve housed 244 homeless veterans and are providing them with critical health care and other support, we’ve co-sponsored two very successful job fairs and on Aug. 26 we’re opening our new women’s clinic. Female veterans are our fastest growing population, and I want the 9,000 plus women veterans in our catchment area to know that the G.V. (Sonny) Montgomery VA Medical Center is here for you.
While all these changes are good for veteran care, we recognize that we always will have work to do. This is a place of honor. More than 44 percent of our employees are veterans. Every eligible veteran in Mississippi deserves nothing less than our full devotion to their care. It is our commitment to this nation.

As we move forward, we will continue to embrace the tenets of ICARE (integrity, commitment, advocacy, respect and excellence) and seek to improve every facet of our health care. So on this July 4, we will be thinking of our veterans and their families. And if you’re traveling down Woodrow Wilson, you will see the G.V. (Sonny) Montgomery VA Medical Center, on the high ground, where all the American flags are flying.

IN-DEPTH: Boosting care, managing costs are health care challenges

Written by
Lisa Bernard-Kuhn

Region tests models ushered in by federal law, some of which are already saving money and raising quality

While debate lingers about the Patient Protection and Affordable Care Act, some key pieces of the federal health care law are already saving hundreds of thousands of dollars and improving patient care locally.
At Mercy Health, a year-old accountable care organization is teaming nurses with patients before they are discharged from the hospital and at home to help manage their health and prescription regimes.
In Over-the-Rhine, patients at Crossroads Heath Center are getting help organizing their medicines, reminders for appointments, and phone calls from nurses to make sure they have a way to get to the doctor.
Within TriHealth, at least 19 physician practices receive monthly payments from large employers, health insurers and Medicare for each patient that receives enhanced coordinated care at one of its new patient-centered medical homes.
And more than 14 physician practices that are part of St. Elizabeth Healthcare receive monthly payments from large employers, health insurers and Medicare for each patient that receives enhanced coordinated care at one of its new patient centered medical homes.
Ushered in by Obamacare, the models mark the region as one of the few in the country where so many new approaches for delivering health care and paying for it are being tested. Each model has a different name and a slightly different approach. But at their core, all try to curb costs and improve patient care by focusing on primary care and managing the health of the sickest among us.
“We’re moving away from fee-for-service payments into a world where providers are recognized for taking better care of their patients and keeping them healthy,” said Craig Brammer, vice president of the Greater Cincinnati Health Council, the Health Collaborative and HealthBridge.
In the short run, several of the programs are yielding promising results by producing fewer costly trips to the emergency rooms for Medicare patients and improving the health of diabetic patients and others with chronic conditions.
But longer term, the jury is still out as to which models will have staying power. “This is the starting point, not the end point,” said Brammer.
Boosting outcomes, payments via 'accountable care'
Locally, Mercy Health is the region’s first and only health system to take the path of becoming an accountable care organization, in which it shares the financial risk of keeping patients healthy.
Roughly 1,200 health-care providers across the country have signed on to the program, aimed at managing the health of some of the most vulnerable and costly patients: elderly and disabled patients on Medicare.
Nationally, savings from the new model are expected to be as much as $1.9 billion by 2015, according to the federal government.
Mercy says it’s seen impressive results since launching its accountable care group, Mercy Health Select, a year ago. Though the data are not final, the improvements are on pace to show a nearly 50 percent reduction in hospital admissions for the more than 25,000 patients served by the program. It’s also expecting a 35 percent reduction in re-admissions for patients and roughly the same decline in emergency room visits overall.
“In the past, we were used to taking care of the patients who came to our door, or patients who showed up in our emergency room, but that is such reactive medicine,” said Dr. Amy Frankowski, medical director of Mercy Health Select.
Mercy’s system includes 35 patient-centered medical homes, which includes a team-based care approach with larger roles for physician assistants, nurse practitioners and other staff who help coordinate more comprehensive care for patients.
Across those practices, Mercy’s 18 nurse care coordinators employed by the accountable care organization focus their time first on the top 5 percent of the most chronically ill patients. These roughly 1,200 patients have conditions that are most severe, complicated and, if left unmanaged, become the most costly to treat.
The nurse care coordinators work one-on-one with each patient, helping manage their diets and tackling any barriers – such as transportation – that might keep them from follow up appointments.
Among the patients is 76-year-old Kathy Calhoun of Reading. Twice a week she gets a call or visit from her nurse care coordinator, who also helps manage the health of Calhoun’s 78-year-old husband, Paul.
The coordinator is “on top of everything,” said Kathy Calhoun. “She’s great about making sure I’m taking my medication correctly and she talks to me about my diet. Until her, I never had a nurse call me.”
In all, the health system says it has seen a “5 to 1” return on its investment, saving more than $500,000 in the first year the model was tested, with just 310 patients. Should savings stay continue to track as they have, they could total in the millions.
Accountable care programs offer hospitals two options for incentives.
Hospitals can take on risk immediately, in which case they get 60 percent of any savings, and potentially face losses.
The other option, which Mercy Health has taken, allows health systems to receive a payment worth half of the money it saved Medicare during the three year trial. Mercy will decide in 2015 if it wants to continue.
“These are important learnings, and if they’re successful we can expand them,” said Frankowski.
Creating 'medical homes' at St. E., TriHealth, Christ
Other large health systems in the region including St. Elizabeth, TriHealth and Christ Hospital have taken the path of transitioning their physician practices to patient-centered medical homes.
Roughly 75 area practices, including 19 offices at TriHealth, are participating in a national pilot known as the Comprehensive Primary Care Initiative.
Collectively, the practices are getting up to $60 million more from Medicare through 2016 to improve primary care. The Greater Cincinnati and Dayton region was one of seven nationally last spring to receive grants from the Center for Medicare and Medicaid Innovation to help doctors afford more comprehensive medical care, including follow ups.
“The theory is, if we can invest more on the front end with primary care, and really engage and coordinate care, then we’ll all save money down stream,” said Dr. Will Groneman, executive vice president of system development at TriHealth.
The practices receive monthly fees that average about $20 per Medicare patient. Those incentives are matched with similar programs from large employer-sponsored plans and insurers including Humana, Anthem Blue Cross & Blue Shield or United Healthcare.
In 2015 and 2016, the monthly incentives will decrease, but doctors can share in any savings to Medicare from the experiment.
The test is entering is its second year locally, and analysts are reviewing data to determine how successful it’s been, Groneman said. “We’ve heard from large employers that it has been successful in saving costs,” he added.
Using U.S. buying power to bring broader change
Some of this has been tried before. But many of the programs were headed by health insurance companies, and even some employers.
But the fundamental difference this time around is making it pay to give better care.
Because Medicare is the single largest purchaser of U.S. health care services, the way the program chooses to pay out its benefits is followed by the private insurer market.

“To change payment policy, it literally took an act of Congress,” Brammer said. “With federal health reform, it provides opportunities to test new payment models and to scale that up in a way that will work.”

EHR Meaningful Use Dropout Rate Soars in 2012

AAFP Works to Identify, Correct Barriers
July 03, 2013 12:45 pm Sheri Porter – As U.S. physicians continue to embrace electronic health records (EHRs), data on CMS' EHR incentive program holds both positive and troubling news regarding family physicians' participation and success in achieving meaningful use of their EHRs. 

According to CMS' recently published EHR meaningful use attestation data(, 23,636 family physicians became first-time meaningful users in 2012. The number represents a 180 percent increase compared to 2011 EHR statistics.
In an interview with AAFP News Now, Jason Mitchell, M.D., director of the AAFP's Center for Health IT, said the latest report confirms family medicine "still has the greatest participation both by percentage and by the numbers."
However, the report also revealed a drop in the retention rate of attesting physicians. In fact, of the 11,578 family physicians who attested to meaningful use in 2011, only 9,188 did so in 2012, a 21 percent drop in participation.
Mitchell and Steven Waldren, M.D., the center's senior strategist for health care IT, crunched the raw numbers -- buried deep in the April attestation data -- and determined that the overall meaningful use dropout rate among all physician specialties was 20 percent. 

  • Recent EHR meaningful use attestation data published by CMS show family physicians participate in the program at higher rates than physicians in other specialties.
  • Among all specialties, about 20 percent of first-time meaningful use attesters in 2011 did not attest to meaningful use in 2012.
  • Reasons for the tumble in numbers could include a change in the reporting period from 30 days to one year and misunderstanding about -- or lack of attention to -- the two-month attestation period in early 2013.
Why the Tumbling Numbers?
The new data raise a key question: Why were a good number of physicians unable to maintain meaningful user status, especially since no changes were made in the meaningful use stage one requirements from 2011 to 2012?
Although there's no way to know for sure, Mitchell and Waldren cited some possible reasons for the decline.
Looming large on their list is the length of the reporting period. In 2011, physicians only had to report on measures for 90 consecutive days and could start, stop and shift dates to make that happen. However, during year two, the reporting period stretched to a full year. The extra reporting burden may have discouraged physicians. Others simply may have lost track of their progress during the year.
"For some physicians, the issue likely was a lack of ongoing monitoring of their meaningful use numbers throughout that entire year," said Mitchell.
And unfortunately, some physicians simply missed the two-month attestation window for 2012 reporting that ran from Jan. 1 to Feb. 28, 2013. "A physician could have been a meaningful user the whole year and then missed the attestation deadline," said Mitchell.
"Don't be that guy in the next round," said Waldren. "It's very important to check the timeline for 2013( and understand the deadlines for meaningful use."
In addition, 2012 saw a decrease in function of the federally funded regional extension center (REC) programs. According to Mitchell, the state-based organizations were designed to sign physicians on with a REC, assist physicians with EHR implementation, and then help them become meaningful users and successfully attest to MU.
The first year, the RECs were offered incentives to get physicians on board, but there was no built-in incentive for RECs to maintain physicians through the second year, and many of the RECs already were running out of funding to sustain their work, said Mitchell.

The AAFP wants to hear from family physicians who are among the 21 percent of FPs who failed to qualify for a meaningful use bonus in 2012 even though they successfully attested in 2011.
If that sounds like you, send a quick e-mail to Jason Mitchell, M.D., or Steven Waldren, M.D., with details of your particular situation. Identifying meaningful use barriers will help the AAFP in its work with CMS and other stakeholders to resolve those issues in the future. 
AAFP Working to Resolve Issues
To help ensure family physicians' future success with the meaningful use program, the AAFP already is working with CMS and the Office of the National Coordinator for Health IT to investigate, find answers and fix problems.
"Is there one particular measure that is tripping up physicians? If so, let's look at changing that," said Waldren. "Is the 12-month reporting period an obstacle? Do physicians need software that provides a 'dashboard' to enable them to track their progress?
"Let's work on identifying the problems and see what corrections can be made, because we want to be sure that 20 percent of our 2012 meaningful users don't drop off in 2013," said Waldren.
Mitchell and Waldren said physicians could ease the meaningful use burden by taking a few steps. For example, they encouraged members to
  • plan ahead by checking requirements and deadlines and then stay on top of those obligations,
  • crank out electronic meaningful use reports on a continuous basis to show progress toward meeting standards, and
  • ensure that an EHR's internal tracking mechanism for certain measures, such as the drug formulary and interaction features, are turned on for the entire reporting period.
"Such features could inadvertently be turned off by the vendor during a routine system update," said Waldren.
Mitchell expressed concern about physicians' desire to stay in the game when meaningful use two rules are applied in 2014. "The rules do change significantly, and technology has to be more sophisticated," said Mitchell.

And although the reporting period window collapses back down to three months for the first year of meaningful use two, the reporting must be done quarterly, so there can be no "shifting and shuffling" of dates to attain a consecutive 90-day reporting period. In 2015, meaningful use stage two will once again shift users to that full year of reporting, said Mitchell.