Exclusive: Adventist Health System violated federal law on doc referrals

By: Abraham Aboraya

Adventist Health System violated federal laws on physician referrals, the Altamonte Springs-based health system told bondholders in documents released May 12.

In 2013, Adventist Health System realized the relationship it had with physicians weren’t in full compliance with the Stark Law. That law prohibits physician referrals between entities, such as a physician group referring patients to a hospital, if there is a financial relationship.

From the documents released May 12:

As a part of its compliance activities, the System determined that relationships with certain physicians were not in full technical compliance with the Stark Law and elected to make voluntary self-disclosures to the federal government in 2013. The System is engaged in discussions and is fully cooperating with the Department of Justice on this matter.

Related: Adventist Health spent $166.5M on new projects in 1Q

Adventist Health System officials declined to be interviewed. But Kevin Edgerton, Adventist Health System’s vice president of marketing and brand strategy, confirmed that the Stark violations are still under discussion with the Department of Justice and hasn’t been settled yet.

In the broader scheme of the health care ecosystem, a Stark Law violation can point to an imbalance in the economics: If doctors are improperly referring patients to Adventist Health System facilities, it can drain patient volume from other facilities in the area. Of course, all that is dependent on where the violations happened, and what kind of violation it is, questions that can't be answered yet.

So what's the potential fallout for Adventist Health System? The likely result is a fine: The question is how big. Reading between the lines of the bond disclosure document, it appears Adventist has at least an idea of what the settlement will cost, but that it could fluctuate.

For example, Adventist Health System West, which back in the 1980s was part of the same company but is now completely separate, on May 3 announced it would pay $14.1 million to settle a Stark Law violation. And a little closer to home, Halifax Hospital Medical Center back in March agreed to pay an $85 million fine to settle Stark Law violations, both of which pale to HCA Holdings Inc.'s $840 million fine in 2000 for Medicare fraud.

Adventist is a nonprofit health system, which owns Florida Hospital and has 43 hospitals in 10 states. Nationwide, it has about 79,000 employees, and Florida Hospital had 17,600 employees in metro Orlando in 2013.

http://www.bizjournals.com/orlando/blog/2014/05/exclusive-adventist-health-system-violated-federal.html?page=all

Saratoga And Glens Falls Hospitals Will Study Potential Partnerships

By LUCAS WILLARD

Two hospitals in the Southern Adirondack region have begun discussions to examine possible opportunities for collaboration and cooperation. 

Recently, the Saratoga Hospital Board of Trustees and Glens Falls Hospital Board of Governors agreed to begin to formally look for ways for possible future “alignment and collaboration.”

The two healthcare providers already cooperate in certain areas, including some medical specialties and comprehensive cancer care.

Angelo Calbone, president and CEO of Saratoga Hospital, said part of what’s driving the decision to pursue more options for collaborations are the changes in the way healthcare is delivered as seen on a statewide and national level.

“You know, less inpatinent-centered, the economics of healthcare of shrinking core hospital utilization, and squeezing payment rates.”

Calbone said it made sense for Saratoga Hospital, with 171 beds, to look to its neighbor in Glens Falls.

“We’re not starting with programmatic or specific ideas, it’s more about understanding our communities’ organizations, where are strengthens, where we see our collective futures, and try to develop a relationship and understanding of what we think the best future for both of us may be, then move to specific discussions,” said Calbone.

Dianne Shugrue, president and CEO of Glens Falls Hospital, said that after her organization experienced a more financially difficult 2013, the hospital is looking to the future.

“I’m happy to say that we’ve emerged in 2014 with a very strong operating plan coming to fruition having just posted our fourth consecutive operating game in a row as we finish up our financials for April,” said Shugrue

Over the past year, in addition to hiring new leadership positions within the organization, Glens Falls Hospital has made connections within the Adirondack region by joining the Adirondack Health Insitute, and the formation of Adirondacks ACO, or accountable care organization.

Glens Falls Hospital has 2600 employees and 27 health service locations, and is the largest employer in its region. As it looks for new ways to collaborate and improve, Shugrue said the company and Saratoga Hospital are now at the “beginning of an exploration.”

“They are challenged with the same challenges we are, in terms of the changing healthcare arena,” said Shugrue. “Both of us believe that it is important to our communities that we maintain a local presence for healthcare. We are community hospitals and that’s our mission.”

Discussions will take place throughout the year, and will involve administrators and physicians, as well as community stakeholders in the Glens Falls and Saratoga regions.

In 2013, Saratoga Hospital also opened its Emergent Care Center located off Exit 12 in Malta, a collaboration with Albany Medical Center.

http://wamc.org/post/saratoga-and-glens-falls-hospitals-will-study-potential-partnerships

Boston Scientific join hands with Optum Labs as Founding Medical Device Partner

Natick, Massachusetts Thursday, May 08, 2014, 10:00 Hrs  [IST]

Boston Scientific Corporation, a global medical technology leader, has joined Optum Labs as the Founding Medical Device Partner to help pioneer new research into effective treatments for heart failure and related cardiac conditions. Optum Labs is an open collaborative healthcare research and innovation centre founded in 2013 by Optum, Mayo Clinic and also joined by AARP as founding consumer advocate organisation. Optum Labs brings together major national health care leaders dedicated to improving patient care through the sharing of information, technologies, knowledge tools and scientific expertise. With access to an unprecedented, high-quality pool of de-identified claims and clinical information covering millions of lives, Optum Labs innovators are focusing on many of the biggest challenges and opportunities in health care today. More than 20 different research initiatives are currently under way. Boston Scientific's initial focus with Optum Labs will be to champion a body of research that addresses the complexities, unmet needs and challenges facing patients with heart failure. The research will consider innovative practice patterns, performance measures, management of co-morbid conditions, processes of care and economic implications. The research will also leverage Optum Labs' scientific and analytical resources to help understand points in the patient care continuum where existing or potential new products and services could improve the efficiency of care delivery, the value of care and overall population health management. "As a global leader in medical devices and related solutions, Boston Scientific is excited to serve as Founding Medical Device Partner at Optum Labs, and to collaborate with other health care leaders to help accelerate the pace of innovation across our industry," said Mike Mahoney, president and chief executive officer of Boston Scientific. "We believe there are many other areas of common interest that could be addressed through Optum Labs and look forward to collaborating with the other partners." "Boston Scientific brings extensive expertise in heart failure and related cardiac conditions, which is of tremendous interest and value to Optum Labs and our partners," said Paul Bleicher, managing director, and chief executive officer of Optum Labs. "We are grateful for the support of industry leaders such as Boston Scientific, in addition to our existing partners, all of whom share our commitment to accelerating the pace of innovation for the ultimate benefit of improved patient care." As Founding Medical Device Partner of Optum Labs, Boston Scientific joins a research collaborative that includes academic medical centres, care providers, research centres and other stakeholders. Optum Labs' charter partners include the American Medical Group Association; Boston University School of Public Health; Lehigh Valley Health Network; Pfizer, Inc.; Rensselaer Polytechnic Institute (RPI); Tufts Medical Centre; and the University of Minnesota School of Nursing. These are in addition to founding partners Mayo Clinic and Optum, and Founding Consumer Advocate Organization, AARP. Research at Optum Labs is linked to the clinical environment through prototyping and testing in actual care settings.  The goal is to help drive the discovery of new applications, test new care pathways and drive innovation in wellness and care delivery that improve health care delivery and patient outcomes. http://www.pharmabiz.com/NewsDetails.aspx?aid=81755&sid=2

New HHS data show quality improvements saved 15,000 lives and $4 billion in health spending

FOR IMMEDIATE RELEASE May 7, 2014

Contact: HHS Press Office (202) 690-6343

Hospital Readmissions Fall by 8 percent among Medicare beneficiaries

Today, the Department of Health and Human Services announced that new preliminary data show an overall nine percent decrease in hospital acquired conditions nationally during 2011 and 2012.  National reductions in adverse drug events, falls, infections, and other forms of hospital-induced harm are estimated to have prevented nearly 15,000 deaths in hospitals, avoided 560,000 patient injuries, and approximately $4 billion in health spending over the same period.

The Affordable Care Act is also helping reduce hospital readmissions.  After holding constant at 19 percent from 2007 to 2011 and decreasing to 18.5 percent in 2012, the Medicare all-cause 30-day readmission rate has further decreased to approximately 17.5 percent in 2013.  This translates into an 8 percent reduction in the rate and an estimated 150,000 fewer hospital readmissions among Medicare beneficiaries between January 2012 and December 2013. 

“We applaud the nationwide network of hospital systems and providers that are working together to save lives and reduce costs,” said HHS Secretary Kathleen Sebelius.  “We are seeing a simultaneous reduction in hospital readmissions and injuries, giving patients confidence that they are receiving the best possible care and lowering their risk of having to be readmitted to the hospital after they get the care they need.”

These improvements reflect policies and an unprecedented public-private collaboration made possible by the Affordable Care Act.  The data demonstrates that hospitals and providers across the country are achieving reductions in hospital-induced harm experienced by patients.  These major strides in patient safety are a result of strong, diverse public-private partnerships and active engagement by patients and families, including efforts from the federal Partnership for Patients initiative and Hospital Engagement Networks, Quality Improvement Organizations, the Centers for Medicare & Medicaid Services, the Agency for Healthcare Research and Quality, the Centers for Disease Control and Prevention, the Administration on Community Living, the Indian Health Services , and many others.  

The public-private partnerships are working collaboratively – along with health care providers – to identify and spread best practices and solutions to reducing hospital acquired conditions and readmissions.

HHS will continue to accelerate delivery system reform efforts by working with nationwide partners to capitalize on these promising results so that the nation continues on the path of increasing patient safety and reducing health care costs while providing the best, safest possible care to patients.  

To view the report, please visit: http://innovation.cms.gov/Files/reports/patient-safety-results.pdf.

Socioeconomic factors may make Medicare’s hospital readmissions data more useful

Barnes-Jewish Hospital

By Diane Duke Williams

Some hospitals facing financial penalties from Medicare for readmitting too many patients soon after discharge have said they are being unfairly penalized. Hospitals that treat a large number of patients with limited income and education are more likely to face such penalties.

A new study shows that if socioeconomic factors related to patients’ income and education are taken into account, differences in readmission rates among hospitals may not be as great as Medicare data indicate. Those factors were gleaned from census data.

The study, published today in the May issue of the journal Health Affairs, was conducted by researchers at Washington University School of Medicine in St. Louis and BJC HealthCare. BJC operates Barnes-Jewish andSt. Louis Children’s hospitals, which are staffed by Washington University physicians.

“We still need to better understand which social factors contribute to patients being readmitted,” said senior author William C. Dunagan, MD, professor of medicine and vice president of quality for BJC. “But we think models that do not include social factors deprive hospitals of valuable data that will help them determine how to use limited resources to help the most vulnerable patients.”

The formula Medicare uses to calculate readmission rates and levy fines against hospitals does not include socioeconomic factors, which can affect patients’ health after they leave the hospital. Poorer patients may not be able to afford prescription medicines or have transportation to doctors’ offices for follow-up care. Patients with limited education may have a hard time understanding hospitals’ instructions for care at home.

Hospitals are paying a lot of attention to their readmission rates, which are being used by the federal government as a measure of hospital performance. In October 2012, Medicare began reducing payments to hospitals that have a higher than average share of patients who return within a month of being treated and discharged.

A concern is that not adjusting readmissions data for poverty or other socioeconomic factors could mislead the public into thinking that hospitals with a large share of disadvantaged patients provide lower-quality care than hospitals with more affluent patients.

For the current study, first author Elna Nagasako, MD, PhD, and her colleagues looked at hospital readmissions for nearly 60,000 patients treated for heart attacks, heart failure or pneumonia at acute care hospitals in Missouri from 2009 to 2012.

They compared two different models for calculating hospital readmission rates within 30 days of discharge. One is the same model used by the Centers for Medicare and Medicaid Services. The other is a similar model that adds socioeconomic information drawn from census tract data. That model linked a patient’s most recent address to poverty rate, level of educational attainment and housing vacancy rate in the census data. The housing vacancy rate can be a measure of neighborhood stability.

The model that incorporated socioeconomic data substantially narrowed the differences in readmission rates among the hospitals. For example, for patients treated for heart attacks, the model used by Medicare shows that readmission rates for Missouri hospitals ranged from 14 percent to nearly 21 percent.

The model that incorporates socioeconomic data showed a much narrower range of readmissions, 15.3 percent to 17.1 percent.

“A narrower range suggests that socioeconomic factors could explain a substantial portion of the observed differences in hospital readmission rates,” said Nagasako, an instructor of medicine.

The researchers found a similar narrower range of readmissions for patients treated for heart failure or pneumonia.

For heart failure, the Medicare model showed readmissions ranged from 14.5 percent to 28.5 percent, while the other model showed a range of 17.6 percent to 25 percent.

And for pneumonia, the Medicare model pinned hospital readmissions at 11.2 percent to 18.6 percent, compared with 13.4 percent to 17.1 percent for the model that incorporated socioeconomic data.

The study’s results also support the conclusions of an expert panel commissioned by the Obama administration that recommended a closer look at the effects of socioeconomic factors on performance measures. The panel also pointed out that financial penalties levied against hospitals may have the unintended consequence of transferring money away from hospitals that treat large numbers of disadvantaged patients.

Because the study used socioeconomic information from census tract data, which is easily obtained, rather than patients’ actual data on income, education and housing, the study can’t make specific recommendations about which patients are most likely to be readmitted. And, because the study looked only at Missouri hospitals, it is not known whether these findings extend to other areas of the country.

Rather, given the debate over whether Medicare should include socioeconomic factors in its formula to calculate hospital readmissions, the study raises questions about whether Medicare’s readmission rates reflect social factors related to the hospital’s patient mix as well as hospital performance and quality.

“We want to make sure that all patients, regardless of their social circumstances, receive the support they need after they are discharged,” Nagasako said. “For some patients, this may prevent returning to the hospital, but for others, the best support may mean being readmitted to the hospital for care. So, in addition to tracking the readmission rates themselves, we also need to better understand why patients return.”

http://news.wustl.edu/news/Pages/26885.aspx

Health Law Requires Medicare To Cover Dementia Evaluation

By Michelle Andrews

MAY 06, 2014

For the millions of seniors who worry that losing their keys may mean they’re losing their minds, the health law now requires Medicare to cover a screening for cognitive impairment during an annual wellness visit.

But in a recent review of the scientific research, an influential group said there wasn’t enough evidence to recommend dementia screening for asymptomatic people over age 65.

What’s a worried senior to think?

Dementia screening tests are typically short questionnaires that assess such things as memory, attention and language and/or visuospatial skills. One of the most common, the mini-mental state examination, consists of 30 questions (such as “What month is this?” and “What country are we in?”) and may be completed in about 10 minutes.

In its review, the U.S. Preventive Services Task Force, an independent panel of medical experts, evaluated the evidence of the benefits, harms and clinical utility of various screening instruments for cognitive impairment. It concluded that the evidence for routine population-based screening was insufficient. While declining to recommend the practice for everyone older than 65, the reviewers noted that some screening tools can be useful in identifying dementia.

“Clinicians need to use their judgment,” says Albert Siu, professor and chair of geriatrics and palliative care at Mount Sinai School of Medicine in New York who was co-vice chair of the task force on dementia screening. “The evidence isn’t clear that there is a net benefit to screening for individuals that are asymptomatic.”

The risk of dementia increases with age: its prevalence is 5 percent in people aged 71 to 79, rising to 37 percent of those older than 90. Mild cognitive impairment has many definitions, but the term generally refers to people whose impairment isn’t severe enough to hamper their ability to manage their daily lives. By some estimates up to 42 percent of people older than 65 have it. Mild cognitive impairment is a warning sign, but it may not progress to Alzheimer’s disease, says Dean Hartley, director of science initiatives at the Alzheimer’s Association.  

Alzheimer’s is the most common form of dementia, accounting for up to 80 percent of cases. Other types include vascular dementia, many cases of Parkinson’s disease and Huntington’s disease.

Someone without symptoms who does poorly on a screening test may have other medical conditions, such as depression or sleep apnea, that can cause memory or other problems, says Hartley. That’s why it’s important that people take the tests in a medical setting with a trained professional who can evaluate them and take a good medical history from patients and their family members, he says.

One-time screenings at shopping malls or health fairs should be avoided, experts agree. Taking a quick test without any accompanying medical evaluation may raise more questions than it answers.

But seniors may want to consider having an evaluation for cognitive impairment as part of their annual wellness visit with their health provider. It is covered with no out-of-pocket charge.

The Alzheimer’s Association recommends seniors undergo cognitive impairment screening and evaluation to establish a baseline for comparison, and then have regular follow-up assessments in subsequent years.

There is no cure for Alzheimer’s disease. Some drugs, such as Aricept, may improve memory or other symptoms temporarily, but no medical treatment halts or reverses the disease.

That is a key argument against large-scale routine screening of people older than 65, says Ariel Green, a geriatrician at Johns Hopkins Bayview Medical Center. “We don’t have studies that show that such a screening program improves the care of people with dementia,” she says.

Still, if an individual has concerns about dementia because of a family history of Alzheimer’s or memory lapses, for example, a medical professional should evaluate the person and a screening test may be appropriate.

And although research hasn’t yet shown that large-scale screening is effective at improving dementia care overall, screening may help individuals and their families identify a cognitive impairment or dementia early on. The drugs that are available are most effective in the early stages of the disease. In addition, Green says, “it’s helpful for people to hear a diagnosis of dementia, if it’s an accurate diagnosis, because it can help people anticipate their future needs and plan for that.”

Please send comments or ideas for future topics for the Insuring Your Health column to questions@kaiserhealthnews.org.

http://www.kaiserhealthnews.org/Stories/2014/May/06/health-law-requires-medicare-to-cover-dementia-evaluation.aspx

Health watchdog finds 20 services need to improve

Health watchdog, the Care Quality Commission, has criticised 20 areas of care at hospitals in Hull, following inspections in February.

In his first report on the quality of services provided by Hull and East Yorkshire Hospitals NHS Trust, England's Chief Inspector of Hospitals rated both the Hull Royal Infirmary and Castle Hill Hospital at Cottingham as Requiring Improvement.

While end of life care, critical care and maternity and family planning services were rated Good - the inspection concluded that all other services were below required standards.

Inspectors found that both hospitals were facing staff shortages and insufficient capacity to deal with the increasing numbers of admissions.

Staffing levels and skill mix did not always meet national guidance, the report found, although the trust board had agreed to invest in recruiting more nurses, and was in the process of recruiting for doctors' posts.

Press Association image

At the Hull Royal Infirmary, the accident and emergency department was found not to have enough facilities or staff to deal with the numbers of patients attending. There was a lack of appropriate senior clinicians and the children's accident and emergency department could not provide a dedicated 24-hour service.

In response, the Trust says it was aware of some of the issues raised in the report, and is already actively making improvements.

We welcome the CQC's inspection report as a way of holding a mirror up to the Trust and understanding what works well and where the real pressure points are in the system. The most serious of the findings are clearly the breaches in regulation. We have already developed an action plan to address these, with actions directly assigned to members of the Executive Team to ensure immediate action is taken, and this plan will be monitored regularly by the Trust Board.

Intensified by an increasing demand for hospital care and a population which is living longer, we are very clear that we cannot implement long-term, effective solutions to these challenges alone. Instead, working with local commissioners and providers of health and social care, we must press forward with plans to align all parts of the care system, ensuring patients are able to access hospital care when they need it and then continue their recovery in the safest and most suitable place, which isn't always in hospital.

– HULL AND EAST YORKSHIRE HOSPITALS NHS TRUSThttp://www.itv.com/news/calendar/2014-05-07/health-watchdog-finds-20-services-need-to-improve/

mHealth Games Seeks Funding Support via Indiegogo to Create the Next Generation of Healthcare

This project is about creating fluency in the language of diseases.

Miami, FL -- (SBWIRE) -- 05/05/2014 -- A unique opportunity currently exists for stake holders to improve the way the nation delivers care to its citizens. The current environment of regulatory reform, shrinking budgets and increasing patient populations has created the “the perfect storm”, thus setting the stage for the greatest disruption in the history of the healthcare industry. 

There has to be a delivery system that is flexible enough to meet to the needs of every consumer on their own terms. How is it possible to provide a valuable solution for the 26 year old waitress with health insurance for the first time, the 46 year-old single mom who can't miss another day at work, and the 63 year old caring for her husband recently diagnosed with diabetes? mHealth Games is the solution. 

Games drive engagement through consumer activation. They are a fantastic way to challenge learners and keep them engaged and interacting with the content at hand. mHealth Games improved on something that is already awesome by embedding it in a learning ecosystem that drives improvement through partnerships with all stakeholders. This new learning environment sets the stage for providers, patients and caregivers to connect and communicate - anytime, anywhere, any place and on any device.

As the country moves towards a healthcare system that reimburses for value instead of volume, there will be a greater need for tools that can capture this next generation of care. We will need to automate the processes of education and learning much like the electronic claims people send today. 

What if they can do this through fun, engaging, and cost effective learning games? The future of healthcare depends on empowering consumers to take a more active role in their health. mHealth Games provides the tools they need to understand and engage with all stakeholders.

Here is what they need to get these into the hands of more consumers:

- Funding for clinical trials to collect more data.
- Funding for application fees to expand CEU offerings.
- Tablets for seamless integration of games into learning system.

Indiegogo Page: http://bit.ly/1naRNUB

Under Siege: Encouraging patients to become active members of their health care team!

Clear communication is the foundation for patients to be able to understand and act on health information. Ask Me 3 is a patient education program designed to improve communication between patients, caregivers and health care providers.

Created by the National Patient Safety Foundation, Ask Me 3, encourages patients to become active members of their health care team, and promote improved health outcomes. The program encourages patients to ask their health care providers three questions:

      

1.       What is my main problem?

2.       What do I need to do?

3.       Why is it important for me to do this?

Studies show that people who understand health instructions make fewer mistakes when they take their medicine or prepare for a medical procedure. They may also get well sooner or be able to better manage a chronic health condition.

The Impact of Low Health Literacy

Low health literacy is an enormous cost burden on the American healthcare system – annual health care costs for individuals with low literacy skills are 4 times higher than those with higher literacy skills.

Problems with patient compliance and medical errors may be based on poor understanding of health care information. Only about 50% of all patients take medications as directed.

Patients with low health literacy and chronic diseases, such as diabetes, asthma, or hypertension, have less knowledge of their disease and its treatment and fewer correct self-management skills than literate patients.

Patients with low literacy skills were observed to have a 50% increased risk of hospitalization, compared with patients who had adequate literacy skills.

Research suggests that people with low literacy:

• Make more medication or treatment errors

• Are less able to comply with treatments

• Lack the skills needed to successfully negotiate the health care system

• Are at a higher risk for hospitalization than people with adequate literacy skills

Download the full article HEALTH LITERACY: STATISTICS AT-A-GLANCE.

mHealth Games  is a member of the National Patient Safety Foundation, and we are committed to improving the health literacy of all consumers through fun, interactive games at the point of care. 

In support of the National Patient Safety Foundation and their Ask Me 3 campaign, mHealth Games is proud to release their newest game, Under Siege.

Support health literacy and play today!

To play without creating an account, click here

Virtual reality games may improve stroke recovery

Virtual reality games that challenge balance may speed recovery after a stroke, a new study suggests.

The exercises appear to be a relatively inexpensive way to improve people’s ability to balance and walk following a stroke, Dr. Hillel Finestone, the study’s senior author, told Reuters Health.

  

Finestone directs Stroke Rehabilitation Research at Elisabeth Bruyere Hospital in Ottawa, Ontario, Canada. His small study found that stroke rehabilitation patients who played virtual reality games while on their feet could walk a little farther and maneuver a little faster than patients who sat through the exercises.

“We showed that people do improve,” Finestone said. “We saw improvements in balance. It’s not the be-all, end-all, but we see a good potential.”

For their study, the researchers randomly divided 59 patients who had recently suffered a stroke into two groups.

With the help of therapists, people in both groups participated in a series of 10 to 12 virtual reality gaming sessions lasting 20 minutes each over three weeks.

One group stood to play the games and the other sat. Games included soccer goaltending and snowboarding and were designed so that people standing needed to shift their weight by leaning and reaching to succeed.

The mobility of participants in both groups improved, but the standing participants saw larger gains. Following the therapy, people in the sitting group added 70 feet to the distance they could walk in two minutes, while the standing players added 111 feet, on average, the authors found.

Finestone said that difference could mean a recovering stroke patient being able to walk from his or her living room into the kitchen.

Standing virtual reality participants also shaved more time off a standard test of mobility that requires a participant to get up out of a chair, walk to a line on the floor and then return to the chair.

But Dr. Kara Flavin, from the Stanford School of Medicine in California, told Reuters Health the study didn’t convince her that investing in a virtual reality program would pay off in significant improvements for stroke patients.

“I definitely would want to see more data before I would incorporate it into my practice,” said the physical medicine and rehabilitation specialist, who wasn’t involved in the new research. “If I brought this study to the hospital administration, they wouldn’t be jumping to buy it for me.”

More than 795,000 Americans have a stroke each year, and nearly 130,000 of them die, according to the Centers for Disease Control and Prevention. Stroke is a leading cause of serious long-term disability, and survivors often battle paralysis, speech problems and confusion.

Once just toys for kids and teenagers, videogames have been incorporated into a variety of physical rehabilitation programs. Prior studies found virtual reality exercises improved recovery among people with traumatic brain injury and adolescents with cerebral palsy, the authors of the current study write in Stroke.

A 2011 Canadian review on virtual reality technology hinted that it might help stroke patients recover (see Reuters Health story of May 4, 2011 here: reut.rs/1nDzk5D).

Finestone and his team hypothesized that patients who stood and participated in the intensive virtual reality exercise program would recover movement faster than patients who sat through the exercises.

“We did show some improvement, and it was safe and feasible,” Finestone said. “It’s giving people hope that we can do this.”

Stroke patients might be able to play videogames at home, but they would need to be specially designed to help them recover, he said.

“We’re hoping we can put this into communities,” Finestone said. “We need to organize it and package it properly.”

SOURCE: bit.ly/1fB9TtF Stroke, online April 24, 2014.

CMS: We intend to set ICD-10 date for October 1, 2015

Author Name Jennifer Bresnick

In an email update, CMS has finally broken its silence on the ICD-10 delay with a message that will provide some relief for providers still questioning the future of the new code set: the department intends to release guidance officially mandating October 1, 2015 as the new implementation date.

“On April 1, 2014, the Protecting Access to Medicare Act of 2014 (PAMA) (Pub. L. No. 113-93) was enacted, which said that the Secretary may not adopt ICD-10 prior to October 1, 2015,” the short news update says. “Accordingly, the U.S. Department of Health and Human Services expects to release an interim final rule in the near future that will include a new compliance date that would require the use of ICD-10 beginning October 1, 2015. The rule will also require HIPAA covered entities to continue to use ICD-9-CM through September 30, 2015.”

While many stakeholders suspected that CMS would indeed set the new date for October 1, the confirmation is the first real communication from CMS, whose silence has sparked a whirlwind of speculation and a great deal of frustration.  Providers and professional organizations alike have expressed disappointment and trepidation over the surprise delay, snuck into HR 4302 with no discussion or debate.

In the weeks since Congress enacted the ICD-10 delay, CMS has had to recalibrate its timelines, adjust its guidance, set a new direction, and deal with the undoubtedly significant sting of having the rug pulled out from under them.  Up until the very moment President Obama signed the bill, CMS was pushing hard for industry-wide compliance by 2014.

Perhaps the most interesting feature of the new announcement is the language that will require healthcare entities to continue using ICD-9 all the way up until ICD-10 comes into effect.  Many providers have expressed a wish to voluntarily move to ICD-10 before the mandated date in order to make best use of their resources and reduce the burden on organizations that prepared for 2014 in good faith.  If providers are not allowed to move forward according to the new plans formed during CMS’s silent period, the department may be facing even more discontent than they are at the moment.

The pushback is also expected to be a financial blow to providers who have already allocated resources to the transition, but may give vendors more opportunities to prepare their products and ensure a more successful switch.

“In 2012, CMS estimated the cost to the health care industry of a one year delay to be as much as $6.6 billion, or approximately 30% of the $22 billion that CMS estimated had been invested or budgeted for ICD-10 implementation,” the Coalition for ICD-10 wrote in a letter to CMS earlier in April, urging Administrator Marilyn Tavenner to announce the new compliance date.

“A 30% cost increase due to a one-year delay is consistent with the experience and observations of the coalition members. Continued uncertainty relative to the ICD-10 implementation date will add significant demands on limited resources and will measurably increase the overall cost of completing the transition.”

http://ehrintelligence.com/2014/05/01/cms-we-intend-to-set-icd-10-date-for-october-1-2015/