Meaningful Use may have been the top continuing news story of the year

With millions of dollars available for physician practices, the year 2010 started with the unveiling of the proposed rules for Meaningful Use last January.  February offered time for provides to understand the proposed rules and provide feedback to the Centers for Medicare and Medicaid Services (CMS).

In March, the healthcare reform bill, which includes benchmarks that emphasize quality care, was signed into law. Electronic health record that can be accessed by all providers within a system can coordinate patient care more effectively.

During April and May, the many regional extension centers around the country were providing physicians with critical customized advice to assist with the purchase and implementation of health information systems.

Seventeen Beacon awards were announced in June – they will serve as models for the broad use of healthcare information technology and help lead the way to lower cost healthcare through the use of electronic health records.

In July, offices around the country reviewed the final rule on meaningful use of health IT and Dr. Donald Berwick was sworn in as head of CMS. And in August, the nation’s health IT chief, Dr David Blumenthal, endorsed quality of care data collection as established under the HITECH act and was quoted as saying collecting data on care brings out the best in physicians.

In September, we learned the names of three entities authorized to certify electronic health record systems, and EHR vendors began the process of proving their systems met the meaningful use criteria.

By October, some larger healthcare practices were expressing concern that there would not be enough experienced IT personnel to help with all the necessary information technology changes. Speaking at a conference in Washington D.C., Dr Berwick shared his belief that all physicians involved in a patients’ episode of care need access to a single set of electronic health records.

In November, Kaiser Permanente put collaboration ahead of competition and announced it would share technology developed to achieve key meaningful use standards with other healthcare professionals.

CMS continued to plan for better care, better population health and reduction of per capita healthcare costs & placed many updates on their EHR incentive program website during the month of December.

Meaningful use will continue to be a top news story in 2011!  Registration for the Medicare and Medicaid incentive programs begins January 3, 2011; however, not all states will begin Medicaid incentives immediately.   CMS will continue to update their website as additional information about the program is developed. 

For more information, go to: http://www.cms.gov/EHRIncentivePrograms/20_RegistrationandAttestation.asp#TopOfPage

New Tools to Fight Health Care Fraud

CMS has taken their fight against health care fraud to a new level, announcing the start of a partnership with companies that provide predictive modeling to anticipate and prevent potentially wasteful, abusive or fraudulent payments before they occur.

Soon, every Medicare claim will be subject to a computerized analysis that reveals all claims paid to that provider.  By tracking billing patterns and other statistical information, real-time aberrant trends can be spotted that will alert CMS to locating fraudulent providers before they begin receiving Medicare funds. 

Predictive modeling tools are already used by banks and credit card companies to identify potential fraud before it occurs. CMS has used the tool in pilot projects, and has used those results to begin administrative actions against "false fronts" in several states.  

Historically, CMS relied on the "pay and chase" method to track down potential violators and then tried to recover the funds.  In 2010, the Department of Justice obtained settlements and judgements of more than $2.5 billion in False Claims Act matters alleging health care fraud.  Thanks to funding from a portion of the Affordable Care Act, CMS will be purchasing new tools and resources to track provider specific trends and quickly catch anyone attempting to steal taxpayer dollars.

AANEM calls on CMS to distribute overdue reimbursements

Two hundred million dollars has been included in the recently passed Medicare & Medicaid Extenders Act to address overdue Medicare reimbursements that should have been received by physicians under the Affordable Care Act (ACA ) of 2010.

ACA called on CMS to reimburse physicians retroactively to January 1, 2010 for calculation errors in the geographic practice cost index (GPCI) for work and practice expenses.   Additionally, miscalculations in professional liability insurance and practice expenses associated with some high risk procedures forced many physicians to accept payments 40% lower than they should have been.  

The short-term stop-gap measures enacted throughout 2010 caused payment uncertainties, delays and disruptions for many of our members.  Recognizing the need for relief, AANEM has joined with the American Medical Association to request CMS immediately announce how it intends to act to ensure all retroactive payment increases are distributed to physicians in a timely manner. 

Sales of neurostimulation devices under scrutiny

A Midwest maker of neurostimulation devices disclosed that it has received a subpoena from the US Attorney's office for the Western District of New York related to the sales of it's devices and reimbursement to physicians who use the products.  The subpoena is seeking information regarding sales, marketing and reimbursement and is related to the Health Insurance Portability and Accounting Act of 1996. 

The company, Medtronic, says it received the subpoena in October and is fully cooperating with the investigation.