Wednesday, October 23, 2013

Navigating The Compliance Maze of Secure Text Messaging in Healthcare

Tuesday, October 22, 2013

Kaiser Permanente of the Mid-Atlantic States Ranks Number 1 in the Nation on Five HEDIS Measures

ROCKVILLE, Md., Oct. 22, 2013 /PRNewswire-USNewswire/ -- Yolanda "Lonny" Catalan is a breast cancer survivor. As a Kaiser Permanente member, Lonny has a physician who carefully tracks her preventive care including her breast cancer screenings. Lonny's lucky. Her doctor insisted she have her cancer screening, and her cancer was caught in time. But it's not just luck that saved Lonny's life. Kaiser Permanente of the Mid-Atlantic States is number 1 in the nation out of nearly 500 commercial health plans for breast cancer screening, according to the recently released 2013 National Committee for Quality Assurance's Quality Compass® data. This is the second year in a row that Kaiser Permanente of the Mid-Atlantic States was number 1 in the U.S. for breast cancer screening.

(Photo: http://photos.prnewswire.com/prnh/20131022/DC02084-INFO)

The Quality Compass data assesses the performance of national health plans on 43 important clinical and service standards. The Quality Compass database includes scores from the Healthcare Effectiveness Data and Information Set, or HEDIS, a tool that is used by more than 90 percent of America's health plans to measure performance on important dimensions of care and service.

"We know preventive medicine saves lives. In fact, if the rest of the country screened as well as Kaiser Permanente, there would be almost 12,000 fewer breast cancer deaths every year, reducing the annual mortality rate by nearly 30 percent," saidKim Horn, president, Kaiser Permanente of the Mid-Atlantic States. "HEDIS is the gold standard for measuring health care performance, and we're proud to be a national leader."

HEDIS results show that Kaiser Permanente of the Mid-Atlantic States is also number one in the nation for several other indicators:

Comprehensive Diabetes Care - Eye Exams
Comprehensive Diabetes Care - Medical Attention for Nephropathy
Childhood Immunization Status - Combo 4
Childhood Immunization Status - Hepatitis A

"It's not by chance that we lead the nation on these measures. Our physicians are among the highest rated doctors not only in the region, but also in the country," said Bernadette Loftus, MD, Associate Executive Director, The Permanente Medical Group. "Only the best physicians can become Kaiser Permanente doctors. That level of expertise, coupled with our smart use of electronic medical records, streamlines care and gives our members the best care experience possible – far better than what others provide."

In March, Kaiser Permanente of the Mid-Atlantic States was ranked "Highest Member Satisfaction among Commercial Health Plans in the Mid-Atlantic Region," for the fifth year in a row by J.D. Power.*

Additionally, the 2013 Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey results showed that Kaiser Permanente of the Mid-Atlantic States' members rated both their primary care doctors and specialists higher than any other health plan in Maryland, Virginia and Washington, D.C. This survey has become the national standard for measuring and reporting on consumers' satisfaction with their health plans.

As a member, Lonny Catalan can attest to Kaiser Permanente's effective model of care.

"I will never forget the doctors at Kaiser. They all saved my life," said Catalan, a resident of Prince George's County, Maryland. "They all worked together. It was like the system was put together to assist me when I needed it most. So I was able to go through this experience with ease."

For more information about 2013 HEDIS scores, click here. For more information about Kaiser Permanente of the Mid-Atlantic States, visit kp.org/midatlantic.

Thursday, October 17, 2013

Trust is the missing innovation factor

INNOVATE ON PURPOSE

OVO INNOVATION'S BLOG SITE DEDICATED TO IDEAS, CONVERSATIONS AND APPROACHES FOR SUSTAINABLE, REPEATABLE INNOVATION.

I've been pondering for a while how to bridge the gap between executives and their expectations of innovation, and the middle managers and staff and their ability to imagine, design and build new products and services. We've noted previously that a gap exists between what executives want and middle managers and staff can do. Paul Hobcraft and I developed the Executive Workmat to provide a framework for executives, so they can demonstrate their commitment to innovation and build the "environment" in which innovation can thrive.

But I think we need to go a bit deeper. When two parties agree on a big goal, they usually document the agreement in the form of a contract. I was thinking that a contract that called out what executives owe to the organization, and what the organization owes to the executives, would go a long way to clarifying innovation investments and activities, and may smooth the way for more innovation.

So I created these lists.

What executives owe to the organization when it comes to innovation:

Clear strategic direction
Long term engagement
Carefully defined goals and scope
Adequate, appropriate resources and funding
The delineation of acceptable risks
A willingness to override existing culture, processes, and resource commitments
The trust to allow teams to do new or unusual activities
The time it takes to do innovation well

What the organization owes to executives:

Focus
Commitment
The willingness to discover, investigate and learn
Optimism, not pessimism
Responsibility, not blame shifting
Energy and enthusiasm
Brevity where possible
Something new, valuable and relevant to customers
The chutzpah to make unusual recommendations

Can you imagine the commitment, the energy and the passion that would be unleashed if both parties to an innovation activity signed a contract that promised these factors? Of course there would need to be a monitoring or reporting mechanism to ensure both sides lived up to their agreements, but if executives promised to deliver the factors above, and innovation teams and the organization as a whole promised to deliver on their factors, innovation is then just a matter of good problem definition and effective tools and processes.

The Alchemist's Stone

As innovators, we are all seeking that one ingredient, that one magic formula that will eliminate obstacles and barriers and radically simplify innovation. What I know to be true is that ingredient isn't a technique or tool. It's not a person or a consultant. It's not an insight or a goal. Ultimately, innovation is about trust. Trust exhibited by the executives to try out some new methods, to fund unusual activities, to explore new markets or needs. Trust exhibited by innovation teams to discover, create and present unusual ideas and not get laughed out of the room. Trust that investments are valuable, and trust that time spent on ideas will be realized in new products and services.

Unfortunately there is in many organizations a lack of trust, in vertical hierarchies and across virtual organizational stovepipes. This lack of trust leads to constrained thinking, cynicism, reduced funding and tight organization definition with a focus on efficiency. When executives trust their teams, even when the teams are doing unusual and unfamiliar work, and when teams trust their executives that the work is valuable and will be implemented, everything else becomes secondary. Tools and processes will improve the state where none exist, but don't build trust. Expert idea generators and third party consultants can generate more ideas, but may reduce trust between executives and their teams. You can innovate without trust, but with trust innovation will accelerate.

If you don't have innate trust today, can you create and build trust through the use of my simplistic contract above? In the absence of deep trust, defining a project and carefully delivering that project, and then repeating that activity is the only way to build trust and establish that both sides are worthy of trust. Only then can innovation accelerate.

READ MORE:

http://innovateonpurpose.blogspot.com/2013/10/trust-is-missing-innovation-factor.html

Former RI doctor agrees to pay $1.2 million for improper Medicare, Medicaid billings

PROVIDENCE, R.I. -- Dr. Hafeez Kahn, a former Rhode Island doctor with offices in Smithfield and East Providence, has agreed to pay the government $1.2 million to make up for false billings to Medicare and Medicaid, federal and state authorities announced Thursday.

The sum is twice what he obtained illegally, according to U.S. Attorney Peter F. Neronha and other federal and state officials. In an agreement to settle civil litigation against him, Kahn did not admit liability but he agreed to pay twice the amount in question that he obtained.

Between August 2006 and December 2010, Kahn acknowledged that he and two corporations that he owned, U.S. Care Inc. and U.S. Care Pain Clinic LLC, overbilled the health insurance programs for services provided to some patients and falsely submitted claims for services never performed, officials said.

According to the agreement, Kahn must pay $500,000 initially and make annual payments of $175,000 plus interest for the next five years beginning on or before Sept. 1, 2014.

The case was investigated by the U.S. Attorney's Office, the Rhode Island Attorney General's Medicaid Fraud Control Unit and the Inspector General's Office of the U.S. Department of Health and Human Services.

http://www.providencejournal.com/breaking-news/content/20131017-former-ri-doctor-agrees-to-pay-1.2-million-for-improper-medicare-medicaid-billings.ece

United States: Hospice Face 2 Face Audit Update

Last Updated: October 17 2013

Article by Brian M. Daucher

Sheppard Mullin Richter & Hampton

Effective April 2011, CMS implemented the Affordable Care Act requirement that hospices conduct a face to face visit as part of any recertification of any beneficiary in the third or later benefit period. With the forthcoming hospice and home health RAC auditor, hospices will face increasing audits on face to face compliance. In this post, Sheppard Mullin examines some of the key requirements of the face to face requirement.

Palmetto reported recently that 49% of its ADR denials for hospice and home health stem from the face to face requirement. Although the statutory requirement is fairly straightforward, specific regulatory timing and compliance requirements create significant pitfalls for hospice providers and, in turn, opportunity for Medicare contractors to recover alleged overpayments.

MEDPac originated the requirement in an effort to constrain expense by requiring closer doctor scrutiny before recertification. But, Medicare contractors see the face to face requirement as an opportunity to make simple denials of claims.

While prior hospice auditing required complex review of the six month diagnosis (a subjective doctor's determination), the face to face requirements provide contractors with objective, verifiable means to attempt to deny or recoup reimbursement (even where services are medically necessary).

Outside the government context, medical providers and other contracting parties can assert substantial compliance as a defense to small, technical breaches that cause trifling harm. Wisconsin Dept. of Revenue v. Wrigley Co., 505 U.S. 214, 231 (1992) (noting general applicability of "venerable maxim de minimis non curat lex ("the law cares not for trifles")).

There are also principles in both Federal case law and Medicare policy manuals that suggest that technical violations should not lead to payment forfeitures. United States v. Bajakajian, 524 U.S. 321 (1998) (setting aside as constitutionally excessive full forfeiture of $230,000 in cash as a civil fine for failure to report cash in excess of $10,000 to customs officials); Medicare Program Integrity Manual, § 3.1 ("When an error has been validated through MR, the corrective action imposed by the MACs should match the severity of the error");Medicare Benefit Policy Manual, §20.1 (allowing face to face to occur up to 2 days late in cases of documented emergency admission; waiving face to face where patients dies within 2 days of admission).

But, Congress, following MEDPac's lead, made the face to face visit a "condition of payment." Under the statute, the failure to conduct a face to face can be grounds for payment denial. Medicare contractors will ground payment denials and/or repayment demands not only upon the failure to conduct the face to face but also upon arguably minor variances from the specific face to face requirements.

Here is an updated checklist of the technical requirements that could lead to repayment demands:

Timing. The face to face visit must be conducted in the window 30 days prior to and including the first day of the benefit period. Because the face to face is to be utilized in recertification, the face to face should occur on or before the day the certification is executed. If a certification is signed before the face to face, the hospice should redo the certification after the face to face.
Who. Unlike home health where any doctor can conduct the required face to face, in hospice, Medicare only allows a hospice doctor (either employed or contracted to the hospice) or an employed W2 nurse practitioner to conduct the face to face. Medicare's rational is that: (a) hospices have medical directors on hand; and (b) these doctors/NPs alone have sufficient experience to collect the right information from the face to face.
Where. There is no requirement that the face to face be conducted at the beneficiary's home. However, Medicare has cautioned that beneficiaries should not be required to travel for a face to face encounter if such travel would constitute any hardship.
Attestation/Signature. The face to face must be signed by the doctor or NP that performs the face to face. "Immediately above" the signature, there must be an attestation confirming that the face to face was performed, such as: "I certify that I performed a face to face visit with this beneficiary for purposes of assessing potential recertification of hospice care on the date indicated above."
Special Requirements for Nurse Practitioner face to face. Where an NP conducts the face to face, Medicare requires the further attestation that the NP has provided the results of the face to face to the certifying physician (NPs cannot execute the certification). Because many hospices use a single form for the face to face, this additional NP attestation could constitute a risk point.
Face to Face Findings Notes. There is no specific requirement that doctors/NPs document the detailed findings from the face to face; however, because it is expected that face to face findings will be considered in the certification decision, face to face findings should be documented. Such findings will bolster a hospice's defense of medical necessity in more traditional medical necessity audits.
Date Requirements. In addition to including date of execution of the face to face attestation, the face to face form must also identify the date of the face to face visit as well as the dates of the upcoming benefit period. Each of these dates is required by the regulation. It may also be useful to identify the benefit period by number; but, benefit period should not be considered a substitute for benefit period dates.
Certification/Narrative Requirements. Information gathered at the face to face is intended to be taken account in the subsequent certification decision. Ideally, the certification narrative should cross-reference such face to face information. Where a doctor performs the face to face, ideally that same doctor should write the narrative and sign the certification. Such best practices remove any potential doubt as to whether face to face information has been considered in the decision to recertify.

As can be seen, there are many specific requirements that Medicare has set forth for the face to face. Given Medicare's forthcoming nationwide RAC specifically for hospice and home health, providers should expect scrutiny on face to face documentation.

Although providers can contest denials that are more technical in nature, it is useful for providers to ensure that they are in full compliance to avoid otherwise lengthy, costly, and uncertain appeals processes.

The content of this article is intended to provide a general guide to the subject matter. Specialist advice should be sought about your specific circumstances.

http://www.mondaq.com/unitedstates/x/269548/Healthcare/Hospice+Face+2+Face+Audit+Update

Tuesday, October 15, 2013

Aetna Announces Major Expansion Of Medicare Advantage Network

by MATTHEW STURDEVANT

Aetna is expanding its network of doctors to treat Medicare Advantage customers into new territory, growing its geographic reach and physician base in 22 states, including Connecticut.

The expansion applies to more than 450,000 people in the U.S. who have Aetna’s employer-sponsored Medicare Advantage group health plans, which some businesses offer to their retirees. Aetna also has about 480,000 customers in its individually sold Medicare Advantage plans, for which there will be a network change announced in the near future, the company said.

Aetna and other health insurers have made major investments in recent years to bolster their services for Baby Boomers, who are increasingly reaching the Medicare eligibility age of 65.

The announcement Monday comes less than two weeks after one of Aetna’s major competitors, UnitedHealthcare, sent notices to Connecticut doctors saying they have been cut from the company’s Medicare Advantage network for next year. A UnitedHealthcare spokesman on Friday said the network cuts will “ultimately provide better outcomes for people in Connecticut while we and others manage through the severe government funding cuts in Medicare Advantage.”

Aetna said it is growing its network of doctors by 59 percent next year and expanding its territory from 442 counties to 703.

The expanded territory includes 87 additional counties in Texas — about one third of the state’s total. Aetna is broadening its Medicare Advantage reach by 49 counties in Indiana; 43 counties in Georgia; and 22 counties in Illinois.

The Hartford health insurer also is adding doctors to its networks in Arizona, Connecticut, Kentucky, Maine, Maryland, Michigan, Missouri, New Mexico, New York, North Carolina, Ohio, Oklahoma, Pennsylvania, Rhode Island, Tennessee, Virginia, Washington and Wisconsin.

“We’re very excited about this network expansion, which is one of our biggest ever,” Nancy Cocozza, president of Medicare Business for Aetna, said in a prepared statement. “Strengthening our network in group Medicare is important as it enables nationwide coverage for large, national employers, and it lets retirees continue receiving care from doctors they used and trusted while they were employed.”

The open enrollment period for Medicare plans starts Tuesday and ends Dec. 7. In addition to Medicare Advantage, Aetna has about 341,000 customers of its Medicare Supplement plans. Separately, the insurer also sells stand-alone prescription drug plans to Medicare-aged customers.

Medicare is federal government-funded health insurance primarily for people 65 and older. Medicare Advantage is a version of Medicare Parts A and B, hospital and medical coverage, administered by private insurers. The insurers are paid by the federal government to provide coverage. Often, private insurers compete for market share by offering additional benefits, such as discounts on dental coverage, eyewear or hearing-aid services, in addition to exercise programs or gym memberships.

UnitedHealthcare Cuts Back

Last week, the Fairfield County Medical Association said doctors were calling the organization to say they received letters notifying they had been cut from UnitedHealthcare’s network. The association says UnitedHealthcare is cutting 810 primary care physicians and 1,440 specialists. The insurer declined to say how many doctors have been cut, but UnitedHealthcare has said it will have an adequate network that includes more than 1,500 primary care physicians and more than 4,000 specialists.

UnitedHealthcare’s decision drew criticism from the Connecticut State Medical Society, American Medical Association, U.S. Sen. Richard Blumenthal, D-CT, and U.S. Rep. Joe Courtney, D-2ndDistrict. State Attorney General George Jepsen inquired on Friday about the matter, though Jepsen’s spokeswoman said Medicare Advantage is a federally regulated matter.

Many of the questions about UnitedHealthcare’s decision to cut its network can only be answered by the federal Centers for Medicare & Medicaid Services, which manages Medicare Advantage. However, a federal government shutdown has left most of the federal Medicare employees furloughed.

http://courantblogs.com/ct-insurance/aetna-announces-major-expansion-of-medicare-advantage-network/

Robstown Doctor Accused of Medicare and Medicaid Fraud

Posted: Oct 14, 2013 2:26 PM by Jessica Holley - jholley@kristv.com
Updated: Oct 14, 2013 7:05 PM

Robstown Doctor Accused of Medicaid Fraud

ROBSTOWN - A Robstown doctor is facing nine decades behind bars after a Grand Jury indicted him on nine counts of Medicare and Medicaid fraud and five counts of mail fraud and identify theft.

Authorities on Friday arrested Dr. Roque Ramirez, owner of Calallen-based Health Resolutions Inc., and charged him with filing 4,970 false claims over a three and a half year period starting in December, 2008.

The Texas Attorney General's Office says the claims were worth more than $1.4 million and that in some instances, the doctor filed claims for dead patients.

Officials say Ramirez was also out of the state and country on the days he wrote on the forms. The indictment says his billing, in some cases, would have required him to work more than a 24 hour day.

Ramirez will be arraigned Wednesday morning at the Federal Courthouse. He asked the court to provide him an attorney.

No one answered the door to his home, listed in Robstown, on Monday and his clinic was vacant.

http://www.kztv10.com/news/robstown-doctor-accused-of-medicare-and-medicaid-fraud/#_

Pay For Hospital CEOs Linked More To Technology, Patient Satisfaction Than Quality, Study Finds

TOPICS: HOSPITALS, DELIVERY OF CARE, HEALTH COSTS, MARKETPLACE, QUALITY

By Jordan Rau

KHN Staff Writer

OCT 14, 2013

What do hospital boards value in a chief executive? A new study of CEO pay at nonprofit hospitals finds that executives at institutions that have a lot of fancy medical technology and high patient satisfaction are paid more than their peers. But running a hospital that scores well on keeping more patients alive or providing extensive charity care does not translate into a compensation bump.

"The finding on quality is disappointing: It says that most boards are more focused on the fanciest technology around," said Dr. Ashish Jha, a professor at the Harvard School of Public Health and one of the study’s authors. "This paper suggests that maybe we need to pay a little more attention to other more important outcomes, such as whether your patients are dying at a high rate or not."

CEOs of technology-laden nonprofit hospitals earned on average $136,000 more than those with little advanced machinery, according to the study published Monday in the journal JAMA Internal Medicine. CEOs at places with high patient satisfaction scores earned on average $52,000 more than those with poor reviews.

The study found no difference in CEO compensation depending on publicly available measures of quality, including mortality rates, readmissions rates and how consistently hospitals followed a number of publicly reported guidelines for recommended care. This results are in line with a report last year that focused on New Hampshire hospitals and also found no relationship between CEO pay and quality of care.

For some time, nonprofit hospitals have been under scrutiny for paying lavish salaries to CEOs while giving little back to their communities. Dr. Karen Joynt, the study's lead author, said that since nonprofit hospitals do not have to pay any property taxes, the researchers wanted to see if there was any evidence hospital boards gave financial rewards to CEOs to provide more charity care, such as treating lots of low-income patients and discounting or waiving bills for those who had trouble paying. "We didn't see a signal at all," she said.

The study is the first to use federal tax returns of hospitals to assess CEO pay and the factors that are associated with it. The researchers examined records for 2,581 hospitals, more than 98 percent of private nonprofit hospitals. For-profit hospitals, which are a minority of America’s acute care hospitals, were not included in the analysis. The analysis identified 1,877 executives, with some running more than one hospital.

The researchers compared the highest performing hospitals with the lowest performing hospitals after adjusting for all other factors, such as the size, whether the hospital was located in an expensive part of the country and whether it was an academic medical center or community hospital. They also adjusted for CEOs who ran more than one hospital.

The average CEO compensation was $595,781 in 2009, the most recent year for which the tax returns were publicly available when the study began. As would be expected, the study found that CEOs who ran bigger hospitals were paid more -- an average of $550 more per bed. CEOs of academic medical centers were paid $425,000 more than CEOs running nonteaching hospitals.

The researchers employed a technology index that assessed the number of advanced machines such as MRIs and positron-emission technology, also called PET scans. The index also factored in whether the hospital performed complex operations such as transplants and open-heart surgery. The researchers divided the hospitals into four groups, based on this index. The average CEO compensation at hospitals in the group with the most technology—after all other factors were taken into account —was $664,000, while the average compensation for CEOs at hospitals in the group with least amount of sophisticated technology was $528,000, 26 percent lower.

Dr. Warren Browner, the CEO of the California Pacific Medical Center in San Francisco, questioned the paper’s conclusions in a commentary that the journal also published. He wrote: "Their conclusion that advanced technology drives CEO pay might be right, but an observational design cannot rule out alternatives, such as CEOs at fancier hospitals earn more because they are worth more, or because the members of the board compensation committees at glitzy hospitals are more accustomed to higher incomes."

Browner disputed the researchers' suggestion that hospital boards need to place more emphasis on quality when setting compensation, saying that already is a widespread practice. He suggested that hospital boards may be judging CEOs using internal metrics that are different than those available to the Harvard researchers.

The researchers acknowledged that possibility, but said that the public measures, such as mortality, should be relevant in assessing any hospital leader. "It's hard to argue that death rates after a heart attack don't matter," Jha said.

They found that on average, the group of hospitals with the highest patient satisfaction scores paid their CEOs nearly $626,000 while CEOs of hospitals in the group with the lowest scores earned $574,000. Patient satisfaction is considered one marker of quality, although there is disagreement about how much it is influenced by extraneous factors such as the lavishness of the hospital facilities.

Browner wrote that it would not be surprising if hospitals used the public patient satisfaction measures as a metric, but wrote that it was “unclear” whether those reflect medical quality. "Indeed, at our hospital, overall patient satisfaction is markedly higher among those who were in private rooms," he wrote. "So, too, is their satisfaction with the physicians, nurses, tests and treatments, and even the food! Talk about a halo effect."

http://www.kaiserhealthnews.org/Stories/2013/October/14/study-finds-ceo-pay-linked-to-technology-and-patient-satisfaction-not-quality.aspx

Alabama Pain Center undergoing months-long audit to close Nov. 15 unless Medicare payments resume

The Alabama Pain Center on 600 Whitesport Drive. S.W. in Huntsville. (Lucy Berry | lberry@al.com)

By Lucy Berry | lberry@al.com
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on October 14, 2013 at 6:34 PM, updated October 14, 2013 at 6:51 PM

HUNTSVILLE, Alabama – The suspension of Medicare payments in late August and a dwindling supply of financial reserves will force the Alabama Pain Center to close its doors Nov. 15 unless payments resume, the clinic announced late Monday afternoon.
The Alabama Pain Center, which operates clinics on 600 Whitesport Drive. S.W. in Huntsville and 1701 Main Ave. S.W. in Cullman, plans to meet with patients and their families from 6-8 p.m. Tuesday at Trinity United Methodist Church to discuss anongoing audit of their Medicare accounts by AdvanceMed, a Zone Program Integrity Contractor.
Since January, AdvanceMed has conducted an audit of the pain clinic. Officials were informed in late August that all Medicare payments to the clinic would be suspended while the review continued. Despite presenting evidence that "the clinic has been adhering closely to all appropriate guidelines provided to them by CMS," officials said the outside contractor conducting the audit on behalf of CMS/Medicare chose to stop payments anyway.
The Alabama Pain Center, which receives about 80 percent of its total revenue from Medicare, filed a rebuttal of the auditor's decision to suspend payments in September. The clinic learned last week that CMS/Medicare dropped all but one claim against the pain center but did not lift AdvanceMed's order to stop Medicare payments.
Dr. Dean Willis, chief medical officer and founder of the Alabama Pain Center, said he will continue to appeal the decision, but that process could take more than a year. The Alabama Pain Center, which serves more than 2,700 patients and employs 124 staff members, only has enough reserves to continue operating through November.
"We are bitterly disappointed that this action by CMS and AdvanceMed will force our clinic to close resulting in the inability for our patient's (sic) to receive the care they need," he said in a written statement. "For over 20 years, the one goal of the Alabama Pain Center has been to provide the highest quality state of the art treatments for the thousands of patients who have come to us for help from across our region. It is heartbreaking that this action will no longer allow us to achieve that goal."
Attempts to reach NCI, which acquired AdvanceMed in 2011, on Monday afternoon were unsuccessful. Serving CMS/Medicare since 1999, AdvanceMed is an integrity services provider based in Virginia that works to detect and prevent fraud, waste and abuse in healthcare programs in 38 states.
Willis said Alabama Pain Center patients and staff will continue to work with the Congressional Delegation to stop this decision, and officials are preparing an appeal "based on the danger to life and health that closure of this practice presents to patients." On Tuesday, the Medical Association of the State of Alabama will meet to discuss what options are available to keep the pain center open.
Approximately 322 patients who have received customized spinal medication through the clinic's implantable pain pump therapies will be most affected by the closure.
"They depend on it in order to perform normal daily activities like walk, stand, sit and smile," an announcement said. "These patients are among the most severe of chronic pain sufferers. Each of them have received care from multiple other physician specialists and have tried many other pain therapies, including pain medications, pain blocks, counseling, physical therapy and surgery with no relief."
Willis said the impending closure of the clinic because of a "misguided, bureaucratic review like this" has been upsetting to his staff.
"It is still my hope and my prayer that someone at CMS will put the needs of these patients first," he said. "These patients truly are our family and it is heartbreaking to our entire staff that a misguided bureaucratic review like this can needlessly cause them such pain and suffering. As always, we welcome any audit or review and will participate willingly just as we have done for each of the seven previous reviews. Our desperate plea is for Medicare to allow us to continue the excellent care we have been providing for these past 26 years while this review continues."
During the last five years, the clinic has been audited by three different government agencies or contractors, and none of the reviews resulted in negative findings, the Alabama Pain Center told AL.com in September.

http://www.al.com/business/index.ssf/2013/10/alabama_pain_center_undergoing.html