Find out everything you need to know about risk adjustment and how it applies to your plan at this one-of-a-kind event!

 Join me November 17, 2014 at the RISE Risk Adjustment Academy - Risk Adjustment 101 Workshop!

The Risk Adjustment Forum is leading the way in risk adjustment education with a comprehensive main event covering some of today’s thorniest risk adjustment challenges and two concurrent, day-long pre-conference workshops – Risk Adjustment 101 & Risk Adjustment Master Class. 

Find out everything you need to know about risk adjustment and how it applies to your plan at this one-of-a-kind event!

Register for the All-Access Pass to attend your choice of pre-conference workshop AND the main event!

The Risk Adjustment Forum is designed to help your plan meet all of today’s risk adjustment challenges and maintain financial solvency in an uncertain marketplace. Examine RA from Medicare Advantage, Exchange/Non-exchange Commercial Plans, Medicaid & Duals perspectives.  This essential conference is a must–attend for plans who are ready to take their risk adjustment game to the next level!

Highlighted sessions include:

• Risk Adjustment Schemes across All Lines of Business
• Connecting the Dots – Applying an Organization-Wide Risk Adjustment Strategy  
• Medicaid Risk Adjustment – A Bird’s Eye View
• The New CMS-HCC Model  - Moving from Blended Scores to Full Integration
• Best Practices for Risk Adjustment Data Validation Audits
• ACA Risk Mitigation Programs and for Exchange and Non-Exchange Commercial Plans
• Leveraging Data from New Exchange Enrollees

The RISE Risk Adjustment Academy Pre-Conference Workshops With two separate all-day workshops with expert faculty, this is your opportunity to train your newly hired staff at the same time as your expert coding and documentation crew.  Be prepared for jam-packed and intensive learning.  These workshops are held the day prior to our Risk Adjustment Forum—attend one or the other to gain a solid foundation for the main conference to follow!
Highlights Include:

• Learn the CMS payment model and risk adjustment methodology
• Understand the purpose of risk adjustment and intended applications
• Learn about RADV audits – what they are about, the perils and the work involved
• Appreciate the linkage to HEDIS, Medicare Stars and care management
• Understand the differences in FFS versus Risk-Adjusted payment from the provider perspective
• Learn about the legal and compliance risks – documentation is the crucial skill set
• Understand what the changes are in documentation using ICD-9 and -10 code sets
• Learn lessons from the experts - Common mistakes and pitfalls in documentation

This program is eligible for up to 18 CPE credits in the Specialized Knowledge and Applications field of study for the workshop plus main conference.

• Which fees are LPs especially sensitive to and how should transaction fees and expense allocations be handled?
• What are some innovative tax-planning strategies that we should be mindful of?
• What are some effective approaches to the increasing demand for LP co-investments?
• Can the use of management fee waivers help promote better tax efficiency?
• How different is the SEC’s routine exam versus the presence exam and how can we be ready for when they pay their visit? 
• What should we be doing to ensure a stellar, cost-efficient compliance culture?
• What are the biggest issues on the SEC’s radar and are there any proposed new regulations that we should be aware of?
• How should we be handling our valuation policies in light of increasing SEC and LP demands?
• What types of waterfall models are successful funds using and are there any innovative new trends?
• What are some useful strategies when managing maturing and liquidating funds?

November 17 - 19, 2014

The Westin Colonnade Coral Gables
180 Aragon Avenue
Coral Gables, FL 33134
305-441-2600

http://www.westincoralgables.com/

We have a block of rooms reserved at a special rate of $199/night. This rate expires on October 27, 2014. Book early - we expect the block to sell out prior to this date. Mention the “Risk Adjustment Forum” when placing your room reservation to receive the negotiated rate. Upon sell out of the block room rate and availability will be at the hotel’s discretion. Please call 305-441-2600 to book your room.

• Get comprehensive and up to date information on risk adjustment
• Define the difference between prospective and retrospective/concurrent assessments and how they apply to your risk adjustment program
• Get tips to help you avoid transfer payments
• Learn the about the differences and similarities between MA, Medicaid, and commercial risk adjustment models
• Discover best practices for CMS RADV audits
• Acquire a business-based context on how risk adjustment contributes to the viability of the organization, including RADV and legal risk management
• Discover how diagnostic coding for FFS differs from risk-based programs, including how E&M procedures are treated
• Learn how optimal documentation is the most bullet-proof strategy for minimizing RADV audit risks

This conference is designed for: Medicare Advantage, Medicaid managed care, and exchange and non-exchange commercial plan executives and providers operating at-risk from the following areas:

• Risk Adjustment
• HCC
• Actuarial staff
• Pricing & valuation
• Compliance & audit personnel
• Plan design
• Provider engagement & education
• Finance/Revenue
• Medicare/Government Programs

As well as:

• Provider groups
• State/Government Agencies
• Risk Adjustment & Predictive Modeling vendors
• Actuarial and consulting firms

Register Now: Space is Limited!

For more information and to register, contact Whitney Betts at 704-341-2445 or wbetts@healthcare-conferences.com. Group Discounts Available!

[+] Register Now

Learn More:

https://www.healthcare-conferences.com/conference.aspx?ccode=H239

What can mHealth Games do for your Managed Care Organization?

 Kameron Gifford, CPC

Staff Training

Automate and track all frontline training and development initiatives with one easy-to-use solution.

• Reduce your Organization’s ICD-10 Training costs up to 88%.
• Build custom learning plans and automate HIPPA, HITECH and FWA Training.
• Manage multiple certifications, including renewal and expiration processing.
• Audit proof your education programs with the xAPI and prove mastery.
• Build a virtual learning environment (VLE) to launch fun and interactive learning programs.

Clinical Documentation Improvement

Clinical Documentation Improvement or CDI — a process in which care providers receive feedback from specialists who review clinical documents —   delivers clinical and financial benefits for healthcare organizations.  

·       Fill the gaps in care including those found in documentation, coding, quality, and many other aspects involved with the overall care management of a patient.

·       Improve processes, eliminate errors, reduce costs, and increase revenue.

Risk Adjustment Education

·       Identify gaps in coding and documentation that lead to inaccurate risk profiles.

·       Utilize multiple sources of information to transition providers into a prospective system.

·       Provide education and training specific to the needs of each individual practice.

·       Implement and monitor improvement plans to ensure 95% accuracy of claims.

·       Design and initiate compliance plans to ensure protection against state and federal penalties.

·       Analyze, collect and improve HEDIS measurements across every practice.

·       Increase member awareness and understanding of chronic diseases through outreach programs.

·       Documentation and revenue risk assessments proceeding transition into ICD-10.

·       Provide comprehensive ICD-10 transition services that include planning, education, implementation and monitoring

·       Average return on investment is 300+%

  

Patient Generated Health Data (PGHD)

Patient engagement is one of the five goals of the federal government's meaningful use program. PGHD is just one tool in the spectrum of care for patients and caregivers.  PGHD can be a powerful tool in the efforts to achieve the Triple Aim.

·       Work collaboratively with providers, care teams, patients and caregivers to bring PGHD into the care plan.

·       Create tools to improve the patient experience, improve population health and lower health care costs.

·       Utilize innovative methods such as personality assessments to assign members to Primary Care Physicians.

Contact mHealth Games today!

Email  KGifford@mhealthgames.com

Clinical Documentation Improvement Helps Providers with ICD-10 Transition

 

July 14, 2014, 10:41:56 AM

Katie Sullivan, MA

 

 

Most providers associate clinical documentation improvement (CDI) with the transition to ICD-10 coding, however, CDI — a process in which care providers receive feedback from specialists who review clinical documents — may also deliver clinical and financial benefits for healthcare organizations.

The main benefit of CDI is the feedback loop that it creates. It can fill the gaps in care including those found in documentation, coding, quality, and many other aspects involved with the overall care management of a patient.

Georges Feghali, MD, Chief Medical Officer and Chief Quality Officer at TriHealth Medical health system, said that his organization adopted CDI to develop consistency between the clinical and coding language that physicians use.

“The problem is that when physicians write in clinical terms that they understand, they assume everybody else understands those terms.  But they don’t. For example, 1 term that is very commonly used is urosepsis. What urosepsis means to a physician is that somebody’s septic and the origin of the sepsis is urinary. But the coding interpretation of urosepsis is a urinary tract infection. With a urinary tract infection, you treat the patient with antibiotics for a couple of days and the problem is gone. No big deal. But actual urosepsis has a 25% mortality rate to it,” said Dr Feghali. “So in the physician and clinician’s mind, this translates to a very, very sick patient that’s in the ICU and has a 1 out of 4 chance of dying, and the coders are interpreting that as somebody who has a bladder infection, and walking around and should take 2 days of antibiotics. On 1 hand, you have somebody that looks like they should be in the outpatient setting. On the other hand, somebody’s going to die. If you end up measuring them in the same way, you’re left with wondering why our patients are dying when they look like they’re very healthy 20-year-olds.”

They found that correctly coding urosepsis and UTIs also saved money — an estimated cost difference of $7,000 when they conditions were appropriately coded.

For many physicians, though, the transition to ICD-10 can seem burdensome. They translate the additional or new codes as extra work and documentation.  CDI specialists can serve an important role in training physicians because they can show providers how they can integrate coding into their work flows.

“As a physician, I don’t want too many things when it comes to documentation. Don’t make me lie; don’t make me do it for financial purposes. Tell me why we do it, and I will change the behavior,” said Dr Feghali. “I don’t think there’s a physician on earth who is going to say, ‘I don’t care how I look, so I’m going to keep writing it the wrong way.’”

http://www.ajmc.com/focus-of-the-week/0714/Clinical-Documentation-Improvement-Helps-Providers-with-ICD-10-Transition
 

Decision Aids for Advance Care Planning: An Overview of the State of the Science

Annals of Internal Medicine

Mary Butler, PhD, MBA; Edward Ratner, MD; Ellen McCreedy, MPH; Nathan Shippee, PhD; and Robert L. Kane, MD

Ann Intern Med. Published online 29 July 2014 doi:10.7326/M14-0644

Advance care planning honors patients' goals and preferences for future care by creating a plan for when illness or injury impedes the ability to think or communicate about health decisions. Fewer than 50% of severely or terminally ill patients have an advance directive in their medical record, and physicians are accurate only about 65% of the time when predicting patient preferences for intensive care. Decision aids can support the advance care planning process by providing a structured approach to informing patients about care options and prompting them to document and communicate their preferences. This review, commissioned as a technical brief by the Agency for Healthcare Research and Quality Effective Health Care Program, provides a broad overview of current use of and research related to decision aids for adult advance care planning. Using interviews of key informants and a search of the gray and published literature from January 1990 to May 2014, the authors found that many decision aids are widely available but are not assessed in the empirical literature. The 16 published studies testing decision aids as interventions for adult advance care planning found that most are proprietary or not publicly available. Some are constructed for the general population, whereas others address disease-specific conditions that have more predictable end-of-life scenarios and, therefore, more discrete choices. New decision aids should be designed that are responsive to diverse philosophical perspectives and flexible enough to change as patients gain experience with their personal illness courses. Future efforts should include further research, training of advance care planning facilitators, dissemination and access, and tapping the potential opportunities that lie in social media or other technologies.

---

Advance care planning is a way to inform care choices for a patient who cannot express a preference and a planning tool that helps patients begin to prioritize their treatment goals. The preferences of seriously ill patients for life-sustaining interventions depend on their care goals. Some prioritize living longer to achieve life goals, whereas others may not wish to be kept alive when meaningful recovery or a particular quality of life is no longer possible (1–3). Religious and spiritual values and beliefs also affect goals of care (4–5). Advance care planning helps to honor patient preferences and goals if incapacitating illness or injury prevents adequate communication (6).

Decision aids help patients consider health care options. Such aids for advance care planning support the 3 key components of the process: learning about anticipated conditions and options for care; considering these options; and communicating preferences for future care, either orally or in writing. The most important information a decision aid can provide to a decision maker depends on the patient's current health status and the predictability of illness trajectories (Figure). A healthy person may benefit most from general decision aids focused on choice of health care proxies and goals of care for hypothetical catastrophic situations, such as after loss of function or cognition or terminal illness. For patients with a life-threatening illness, appropriate aids focus on decisions to accept, withhold, or terminate specific treatments. Advance care planning with decision aids takes place in various settings; it is often done outside clinical settings, particularly among healthy older adults. Nonclinical partners in shared decision making may include family members, caregivers, or attorneys or other professionals.

Read more:

http://annals.org/article.aspx?articleid=1891307

New ICD-10 Compliance Date - Final Rule

Centers for Medicare and Medicaid Services has announced a final rule establishing October 1, 2015, as the new ICD-10 compliance date.

The final rule, scheduled to be published in the Federal Register on August 4, implements Section 212 of the Protecting Access to Medicare Act (PAMA) of 2014 which became law on April 1 delaying the ICD-10 implementation deadline from October 1, 2014 to October 1, 2015.

The final rule not only establishes October 1, 2015, as the new ICD-10 compliance date but also requires the continued use of ICD-9-CM through September 30, 2015.

The one-year delay in the ICD-10 code switchover will take a financial toll on the healthcare industry, according to CMS, which estimates the cost to HIPAA covered entities will be $1.1 billion to $6.8 billion. However, the final rule from CMS concludes that a one-year delay--as opposed to a longer delay--will be the “least costly and most fiscally responsible way to implement the requirements of section 212 of PAMA." Because a delay of longer than one year would slow or even stop progress towards ICD-10 implementation, the final rule establishes the “shortest delay permitted by law, which is one year.”

http://www.healthdatamanagement.com/news/Final-Rule-Establishes-New-ICD-10-Compliance-Date-48526-1.html

Medicare, Medicaid, and Children's Health Insurance Programs: Extended Temporary Moratoria on Enrollment of Ambulance Suppliers and Home Health Agencies in Designated Geographic Locations

Action

Extension of temporary moratoria.

Summary

This document announces the extension of temporary moratoria on the enrollment of new ambulance suppliers and home health agencies (HHAs) in specific locations within designated metropolitan areas in Florida, Illinois, Michigan, Texas, Pennsylvania, and New Jersey to prevent and combat fraud, waste, and abuse.

Dates

Effective Date: July 29, 2014.

For Further Information Contact

August Nemec, (410) 786-0612.

News media representatives must contact CMS' Public Affairs Office at (202) 690-6145 or email them at press@cms.hhs.gov.

Supplementary Information

I. Background

A. CMS' Imposition of Temporary Enrollment Moratoria

Section 6401(a) of the Affordable Care Act added a new section 1866(j)(7) to the Social Security Act (the Act) to provide the Secretary with authority to impose a temporary moratorium on the enrollment of new Medicare, Medicaid or CHIP providers and suppliers, including categories of providers and suppliers, if the Secretary determines a moratorium is necessary to prevent or combat fraud, waste, or abuse under these programs. For a more detailed explanation of these authorities, please see the July 31, 2013 notice (78 FR 46339) or February 4, 2014 extension and establishment of a temporary moratoria document (hereinafter referred to as the February 4, 2014 moratoria document) (79 FR 6475).

Based on this authority and our regulations at § 424.570, we have implemented two phases of the moratoria to date. In the notice issued on July 31, 2013 (78 FR 46339), we imposed moratoria on the enrollment of home health agencies in Miami-Dade County, Florida and Cook County, Illinois and surrounding counties and on the enrollment of ground ambulance suppliers in the Harris County, Texas area and surrounding counties. Then, in the document published on February 4, 2014 (79 FR 6475), we imposed moratoria on the enrollment of home health agencies in Broward County, Florida, Dallas County, Texas and Wayne County, Michigan and surrounding counties and on the enrollment of ground ambulance suppliers in Philadelphia, PA and surrounding counties.

B. Determination of the Need for Extending a Moratorium

In extending these enrollment moratoria, CMS considered both qualitative and quantitative factors suggesting a high risk of fraud, waste, or abuse. CMS relied on law enforcement's longstanding experience with ongoing and emerging fraud trends and activities through civil, criminal, and administrative investigations and prosecutions. CMS' determination of a high risk of fraud, waste, or abuse in these provider and supplier types within these geographic locations was then confirmed by CMS' data analysis, which relied on factors the agency identified as strong indicators of risk. (For a more detailed explanation of this determination process and of these authorities, see the July 31, 2013 notice (78 FR 46339) or February 4, 2014 moratoria document (79 FR 6475)).

1. CONSULTATION WITH LAW ENFORCEMENT

In consultation with the HHS-OIG and the Department of Justice (DOJ), CMS identified two provider and supplier types in nine geographic locations that warrant a temporary enrollment moratorium. For a more detailed discussion of this consultation process, see the July 31, 2013 notice (78 FR 46339) or February 4, 2014 moratoria document (79 FR 6475).

2. BENEFICIARY ACCESS TO CARE

Beneficiary access to care in Medicare, Medicaid, and CHIP is of critical importance to CMS and its state partners, and CMS carefully evaluated access for the target moratorium locations. Prior to imposing and extending these moratoria, CMS consulted with the appropriate State Medicaid Agencies and with the appropriate State Department of Emergency Medical Services to determine if the moratoria would create an access to care issue for Medicaid and CHIP beneficiaries in the targeted locations and surrounding counties. All of CMS' state partners were supportive of CMS analysis and proposals, and together with CMS, determined that these moratoria will not create access to care issues for Medicaid or CHIP beneficiaries. CMS also reviewed Medicare data for these areas and found there are no current problems with access to HHAs or ground ambulance suppliers.

3. LIFTING A TEMPORARY MORATORIUM

In accordance with § 424.570(b), a temporary enrollment moratorium imposed by CMS will remain in effect for 6 months. (For a more detailed explanation of how CMS can lift a temporary moratorium, see the July 31, 2013 notice (78 FR 46339) or February 4, 2014 moratoria document (79 FR 6475).) If CMS deems it necessary, the moratorium may be extended in 6-month increments. CMS will evaluate whether to extend or lift the moratorium before any subsequent moratorium periods. If one or more of the moratoria announced in this document are extended or lifted, CMS will publish a document to that effect in theFederal Register.

Once a moratorium is lifted, the provider or supplier types that were unable to enroll because of the moratorium will be designated to CMS' high screening level under § 424.518(c)(3)(iii) and § 455.450(e)(2) for 6 months from the date the moratorium was lifted.

II. Extension of Home Health and Ambulance Moratoria—Geographic Locations

As noted earlier, we previously imposed moratoria on the enrollment of new HHAs in Broward county, Miami-Dade and Monroe and their surrounding counties in Florida, the Illinois counties of Cook, DuPage, Kane, Lake, McHenry, and Will, the Michigan counties of Macomb, Monroe, Oakland Washtenaw, and Wayne and the Texas counties of Brazoria, Chambers, Collin, Fort Bend, Galveston, Dallas, Harris, Liberty, Denton, Ellis, Kauffman, Montgomery, Rockwall, Tarrant, and Waller. Further, we previously imposed moratoria on the enrollment of new ground ambulance suppliers in the Texas Counties of Brazoria, Chambers, Fort Bend, Galveston, Harris, Liberty, Montgomery, and Waller and the Pennsylvania counties of Bucks, Delaware, Montgomery; and Philadelphia and the New Jersey counties of Burlington, Camden, and Gloucester. These moratoria became effective upon publication in theFederal Registerof a notice on July 31, 2013 (78 FR 46340)and a moratoria document on February 4, 2014 (79 FR 6475).

In accordance with § 424.570(b), CMS may deem it necessary to extend previously-imposed moratoria in 6-month increments. Under its authority at § 424.570(b), CMS is extending the temporary moratoria on the Medicare enrollment of HHAs and ground ambulance suppliers in the geographic locations discussed herein. Under regulations at § 455.470 and § 457.990, these moratoria also apply to the enrollment of HHAs and ground ambulance suppliers in Medicaid and CHIP. Under § 424.570(b), CMS is required to publish a document in theFederal Registerannouncing any extension of a moratorium, and this extension of moratoria document fulfills that requirement.

CMS consulted with both the HHS-OIG and DOJ regarding the extension of the moratoria on new HHAs and ground ambulance suppliers in all of the moratoria counties, and both HHS-OIG and DOJ agree that a significant potential for fraud, waste, and abuse continues to exist in these geographic areas. The circumstances warranting the imposition of the moratoria have not yet abated, and CMS has determined that the moratoria are still needed as we monitor the indicators and continue with administrative actions such as payment suspensions and revocations of provider/supplier numbers. (For more information regarding the monitored indicators, see section I.B. of the February 4, 2014 moratoria document (79 FR 6475).)

Based upon CMS' consultation with the relevant State Medicaid Agencies, CMS has concluded that extending these moratoria will not create an access to care issue for Medicaid or CHIP beneficiaries in the affected counties at this time. CMS also reviewed Medicare data for these areas and found there are no current problems with access to HHAs or ground ambulance suppliers. Nevertheless, the agency will continue to monitor these locations to ensure that no access to care issues arise in the future.

Based upon our consultation with law enforcement and consideration of the factors and activities described previously, CMS has determined that the temporary enrollment moratoria should be extended for an additional 6 months.

III. Summary of the Moratoria Locations

CMS is executing its authority under sections 1866(j)(7), 1902(kk)(4), and 2107(e)(1)(D) of the Act to extend these moratoria in the following counties for these providers and suppliers:

Table 1—HHA Moratoria

State	City/metro area	Counties
FL	Fort Lauderdale	Broward.
FL	Miami	Monroe.
		Dade.
IL	Chicago	Cook.
		DuPage.
		Kane.
		Lake.
		McHenry.
		Will.
MI	Detroit	Macomb.
		Monroe.
		Oakland.
		Washtenaw.
		Wayne.
TX	Dallas	Collin.
		Dallas.
		Denton.
		Ellis.
		Kaufman.
		Rockwall.
		Tarrant.
TX	Houston	Brazoria.
		Chambers.
		Fort Bend.
		Galveston.
		Harris.
		Liberty.
		Montgomery.
		Waller.

Table 2—Part B Ambulance Moratoria

State	City/metro area	Counties
PA/NJ	Philadelphia	Bucks.
		Burlington (NJ).
		Camden (NJ).
		Delaware.
		Gloucester (NJ).
		Montgomery.
		Philadelphia.
TX	Houston	Brazoria.
		Chambers.
		Fort Bend.
		Galveston.
		Harris.
		Liberty.
		Montgomery.
		Waller.

IV. Collection of Information Requirements

This document does not impose information collection and recordkeeping requirements. Consequently, it need not be reviewed by the Office of Management and Budget under the authority of the Paperwork Reduction Act of 1995 (44 U.S.C. 35).

V. Regulatory Impact Statement

CMS has examined the impact of this document as required by Executive Order 12866 on Regulatory Planning and Review (September 30, 1993), Executive Order 13563 on Improving Regulation and Regulatory Review (January 18, 2011), the Regulatory Flexibility Act (RFA) (September 19, 1980, Pub. L. 96-354), section 1102(b) of the Social Security Act, section 202 of the Unfunded Mandates Reform Act of 1995 (March 22, 1995; Pub. L. 104-4), Executive Order 13132 on Federalism (August 4, 1999) and the Congressional Review Act (5 U.S.C. 804(2)).

Executive Orders 12866 and 13563 direct agencies to assess all costs and benefits of available regulatory alternatives and, if regulation is necessary, to select regulatory approaches that maximize net benefits (including potential economic, environmental, public health and safety effects, distributive impacts, and equity). A regulatory impact analysis (RIA) must be prepared for major regulatory actions with economically significant effects ($100 million or more in any 1 year). This document will prevent the enrollment of new home health providers and ambulance suppliers in Medicare, and new home health providers and ambulance suppliers in Medicaid and CHIP. Though savings may accrue by denying enrollments, the monetary amount cannot be quantified. After the imposition of the moratoria on July 30, 2013, 231 HHAs and 7 ambulance companies in all geographic areas affected by the moratoria had their applications denied. We have found the number of applications that are denied after 60 days declines dramatically, as most providers and suppliers will not submit applications during the moratoria period. Therefore, this document does not reach the economic threshold and thus is not considered a major action.

The RFA requires agencies to analyze options for regulatory relief of small entities. For purposes of the RFA, small entities include small businesses, nonprofit organizations, and small governmental jurisdictions. Most hospitals and most other providers and suppliers are small entities, either by nonprofit status or by having revenues of $7.0 million to $35.5 million in any one year. Individuals and states are not included in the definition of a small entity. CMS is not preparing an analysis for the RFA because it has determined, and the Secretary certifies, that this document will not have a significanteconomic impact on a substantial number of small entities.

In addition, section 1102(b) of the Act requires us to prepare a regulatory impact analysis if an action may have a significant impact on the operations of a substantial number of small rural hospitals. This analysis must conform to the provisions of section 604 of the RFA. For purposes of section 1102(b) of the Act, CMS defines a small rural hospital as a hospital that is located outside of a Metropolitan Statistical Area for Medicare payment regulations and has fewer than 100 beds. CMS is not preparing an analysis for section 1102(b) of the Act because it has determined, and the Secretary certifies, that this document will not have a significant impact on the operations of a substantial number of small rural hospitals.

Section 202 of the Unfunded Mandates Reform Act of 1995 also requires that agencies assess anticipated costs and benefits before issuing any regulatory action whose mandates require spending in any 1 year of $100 million in 1995 dollars, updated annually for inflation. In 2014, that threshold is approximately $141 million. This document will have no consequential effect on state, local, or tribal governments or on the private sector.

Executive Order 13132 establishes certain requirements that an agency must meet when it promulgates a proposed regulatory action (and subsequent final action) that imposes substantial direct requirement costs on state and local governments, preempts state law, or otherwise has Federalism implications. Since this document does not impose any costs on state or local governments, the requirements of Executive Order 13132 are not applicable.

In accordance with the provisions of Executive Order 12866, the Office of Management and Budget reviewed this document.

Authority

Sections 1102 and 1871 of the Social Security Act (42 U.S.C. 1302 and 1395hh) and 44 U.S.C. Chapter 35; Sec. 1103 of the Social Security Act (42 U.S.C. 1302).

Dated: July 2, 2014.

Marilyn Tavenner,

Administrator, Centers for Medicare & Medicaid Services.

[FR Doc. 2014-18174 Filed 7-29-14; 4:15 pm]

BILLING CODE 4120-01-P

http://www.regulations.gov/#!documentDetail;D=CMS_FRDOC_0001-1525

Study Finds Pediatric Telemedicine Improves Patient Outcomes

Following a comprehensive study of 1,000 pediatric telemedicine consultations available throughout Latin America, researchers at Children’s Hospital of Pittsburgh discovered physicians there were highly satisfied with the services and believed they had improved patient outcomes.

The study, covered in Healthcare IT News, showcased Children’s multi-center experience in telemedicine at three hospitals in Colombia and one in Mexico from July 2011 to June 2013.

Children’s physicians provided 1,040 consultations for 476 patients, with a real-time intervention taking place in 23% of those encounters. In 6% of the tele-consultations, a different diagnosis was suggested based on the interpretation of cardiac or imaging studies.

Relevant patient data was provided in a secure database and telemedicine hardware was used for real-time consultations.

We’re told that a CICU physician from Children’s participated in all encounters.

Based on anonymous surveys of physicians participating at the international centers, 96% of respondents reported being satisfied or highly satisfied with the telemedicine service, while 58% rated the promptness and time dedicated by the tele-intensivists as very high. Physicians reported that they sometimes changed their clinical practice in relation to the telemedicine encounters, with changes in surgical management noted most frequently.

“Now we know that the physicians we assist internationally consider this technology to be useful for patient outcomes and education. We will continue to expand access to the world’s best healthcare for children around the world,” said lead investigator Ricardo A. Muñoz, M.D.

The study is available for review here.

http://mhealthwatch.com/study-finds-pediatric-telemedicine-improves-patient-outcomes-23702/