New information to improve patient safety at America’s hospitals

MEDICARE NEWS

For Immediate release                                           Contact: CMS Office of Media Relations

April  6, 2011                                                                       (202) 690-6145

New information to improve patient safety at America’s hospitals

Hospital Compare website offers new data about hospital acquired conditions

 at more than 4,700 hospitals across the nation

             

For the first time, Medicare patients can see how often hospitals report serious conditions that develop during an inpatient hospital stay and possibly harm patients with important new data about the safety of care available in America’s hospitals added today to the Centers for Medicare & Medicaid Services’ (CMS) Hospital Compare website.

The Hospital Compare website can be accessed at www.HealthCare.gov/compare.

“Any potentially preventable complication of care is unacceptable,” said CMS Administrator Donald Berwick, MD. “We at CMS are working together with the hospital and consumer community to bring hospital acquired conditions into the forefront and do all we can to eliminate harm from the very healthcare system intended to heal us.”

These serious conditions, also known as hospital acquired conditions (or HACs), often result from improper procedures followed during inpatient care. Today’s data release shows the number of times a HAC occurred for Medicare fee-for-service patients between October 2008 and June 2010. The numbers are reported as number of HACs per 1,000 discharges, and are not adjusted for hospitals’ patient populations or case-mix.

Independent data from the Institute of Medicine estimates that as many as 98,000 people die in hospitals each year from medical errors that could have been prevented through proper care. Although not every HAC represents a medical error, the HAC rates provide important clues about the state of patient safety in America’s hospitals. In particular, HACs show how often the following potentially life-threatening events take place:

·        Blood infections from a catheter placed in the hospital;

·        Urinary tract infections from a catheter placed in the hospital;

·        Falls, burns, electric shock, broken bones, and other injuries during a hospital stay;

·        Blood transfusions with incompatible blood;

·        Pressure ulcers (also known as bed sores) that develop after a patient enters the hospital;

·        Injuries and complications from air or gas bubbles entering a blood vessel;

·        Objects left in patients after surgery (such as sponges or surgical instruments);

·        Poor control of blood sugar for patients with diabetes.

            In total, CMS reports HAC rates for 8 measures, which were selected because they incur high costs to the Medicare program or because they occur frequently during inpatient stays for Medicare patients. Furthermore, HACs usually result in higher reimbursement rates for hospitals when they occur as complications for an inpatient stay because they require more resources to care for the patient with the complication. Lastly, CMS considers HACs to be conditions that could have reasonably been prevented through the use of evidence-based guidelines for appropriate hospital inpatient care.

            CMS has gathered HAC rates from hospitals since 2007. Since 2008, Medicare has not provided additional reimbursement for cases in which one of the HACs was reported as having developed through the course of a patient’s hospital stay.

Rates for the 8 HAC rates reported on Hospital Compare vary among hospitals.  The most common HAC reported was injury from a fall or some other type of trauma, which occurred just once for every 2,000 discharges. Over 70 percent of hospitals reported at least one fall or trauma during the reporting period.

Rates for infection were also relatively common, with about 45 percent of hospitals reporting at least one blood or urinary tract infection developed during the hospital stay. Nationwide, a blood or urinary tract infection was reported once for every 3,300 discharges.  Rates were lowest for instances of blood incompatibility, which was reported by less than 1 percent of hospitals and occurred once for every 1,000,000 discharges.

CMS is working with the members of the Hospital Quality Alliance—a national private-public partnership of hospital, consumer, provider, employer, payer, and government agencies—to make HAC data accessible to the public in meaningful, relevant, and easily understood ways that encourage healthcare quality improvement.  Later this year, CMS will work with the Alliance and directly with consumers about how to fold HAC data directly into the Hospital Compare framework.  For now, HAC data is available through a downloadable file linked to the Hospital Compare website.

CMS is also working with its Quality Improvement Organization (QIO) contractors and to give hospitals the resources they need to eliminate HACs as much as possible.  For instance, QIOs have been working since 2008 with providers across the country to reduce rates of hospital-associated infections, slow rates of pressure ulcers in nursing homes and hospitals, and improve safety and reduce infection for surgery patients.  More information about QIOs’ efforts is online at http://www.cms.gov/qualityimprovementorgs.

In addition to information about HACs, Hospital Compare reports 25 inpatient and 5 outpatient process of care measures, readmission and mortality rates for certain conditions, three children’s asthma care measures, and 10 measures that capture patient satisfaction with hospital care.  The site also features information about the volume of certain hospital procedures performed and conditions treated for Medicare patients and what Medicare pays for those services.

The information contained on Hospital Compare is available for consumers to use in making health care decisions.  However, consumers should gather information from multiple sources when choosing a hospital.  For example, patients and caregivers could use the Web site to help them discuss plans of care with their trusted health care providers. In an emergency situation, patients should always go to the nearest, most easily accessible facility.

Consumers have relied on Hospital Compare since 2005 to provide information about the quality of care provided in over 4,700 of America’s acute-care, critical access and children’s hospitals.  Hospital Compare is one of CMS’ most popular websites, receiving about 1 million page views each month.

CMS issues final 2012 policies for Medicare drug and health plans

FOR IMMEDIATE RELEASE                                   Contact: CMS Office of Media Affairs

Monday, April 5, 2011                                                                           (202) 690-6145

CMS issues final 2012 policies for Medicare drug and health plans
Most policy and technical changes effective in 60 days   

Background

This final rule implements provisions of the Affordable Care Act that are related to the Medicare Advantage (MA, or Part C) and Prescription Drug Benefit (Part D) Programs. This final rule also sets forth programmatic and operational changes to the Medicare Advantage and Prescription Drug Benefit programs for contract year 2012 based on our continued experience with the administration of the Parts C and D programs. The Centers for Medicare & Medicaid Services (CMS) released this final rule on April 4, 2011, in time for plans to prepare their bids for the 2012 contract year. Most provisions will be in effect 60 days after the release of the final rule (see Tables 1 and 2 in the final rule for provisions with different effective dates).

FINAL RULE

The final rule addresses the following:

• Implementing provisions of the Affordable Care Act;

• Clarifying various program participation requirements;

• Strengthening beneficiary protections;

• Strengthening Medicare’s ability to identify strong applicants for Medicare Parts C and D program participation and to remove consistently poor performers; and

• Implementing other clarifications and technical changes.

Implementing the Provisions of the Affordable Care Act

Key Affordable Care Act provisions addressed in this final rule include:

• Limiting cost-sharing under Medicare Advantage and section 1876 cost plans for specified services (administration of chemotherapy services, renal dialysis services, and skilled nursing care) to Original Medicare levels.

• Prohibiting Medicare Advantage and section 1876 cost plans from charging cost-sharing for in-network preventive services for which there is no cost sharing under Original Medicare.

• Clarifying that the Secretary is not required to accept all Part C and D bids and clarifying the Secretary’s authority to deny bids that propose significant increases in cost-sharing or decreases in benefits.

• Codifying the new beneficiary election periods, including the new annual election period that begins on October 15, 2011.

• Codifying the voluntary de minimis policy for subsidy-eligible individuals enrolled in MA-PD Plans and standalone prescription drug plans.

• Codifying the new requirement that higher income Part D beneficiaries pay an Income Related Monthly Adjustment Amount (Part D-IRMAA).

• Eliminating Part D cost-sharing for Medicare beneficiaries who are eligible for full Medicaid benefits and who are receiving home- and community-based waiver services instead of being institutionalized.

• Codifying statutory changes to close the Part D coverage gap.

•Codifying changes to the Medicare Advantage benchmark calculation and rebate amounts.

• Describing the methodology for using quality ratings to determine Medicare Advantage bonus payments provided for in section 1102 of the Reconciliation Act.

• Reducing waste of Part D drugs in long-term care facilities by requiring dispensing of brand-name prescription drugs in increments of 14 days or less, effective January 1, 2013.

• Establishing policies to implement the ACA’s requirement for a more uniform Part D exceptions and appeals process.

Clarifying program participation requirements

These clarifications include:

• Prohibiting Part C and D program participation by Medicare Advantage organizations and Part D sponsors whose owners or directors served in a similar capacity with another organization that terminated its Medicare contract within the previous 2 years.

• Requiring that Part C and Part D organizations (1) use physicians or other appropriate health care professionals with sufficient medical and other expertise, including knowledge of the Medicare program, to review organization determinations involving medical necessity, and (2) employ a Medical Director who is responsible for ensuring the clinical accuracy of all organization determinations and appeals involving medical necessity.

Strengthening beneficiary protections

These provisions include:

•          Requiring that Medicare Advantage organizations and Part D sponsors provide interpreters in their customer call centers for all non-English speaking and limited English proficient callers.

•          Requiring that Medicare Advantage organizations and Part D sponsors translate key plan marketing materials into any primary language spoken by at least five (5) percent of the population in a given service area.

•          Establishing new authority for CMS to require Medicare Advantage plans to periodically mail enrollees an explanation of benefits for their medical benefits.  This will help ensure that beneficiaries receive regular updates on their health care usage and out-of-pocket costs so that they can effectively evaluate their options for health care coverage.  We will implement a pilot program in 2012 to test a model Part C explanation of benefits document for broader implementation in future years. 

•          Extending the mandatory maximum out-of-pocket amount requirements to regional preferred provider organizations (RPPOs).

•          Requiring pharmacies to provide a printed notice at the point of sale to beneficiaries explaining how to contact their plan to request a coverage determination.

•          Requiring Medicare Advantage organizations' and Part D sponsors' agents and brokers to receive training and testing via a CMS-endorsed or approved training program.

Strengthening CMS’ ability to distinguish for approval stronger applicants for Parts C and D program participation and to remove consistently poor performers

These provisions include:

• Setting requirements for fiscal solvency of plans participating in Part C or D.

• In the absence of 14 months performance history, denying a new application or service area expansion request based on a lack of information available to determine an applicant's capacity to comply with the requirements of the Part C or Part D program.

Cost and savings analysis

• Taking into account both costs and savings estimated as a result of implementation of all 50 proposals in this final rule, CMS estimates a net savings to the Medicare program of about $76 billion as a result of the provisions in this proposed rule for fiscal years (FYs) 2011 through 2016. Most of these savings are due to the ACA’s reforms to Medicare Advantage payments.

Quote of the Day

How Facebook’s recent changes will benefit your business

How Facebook’s recent changes will benefit your business 

BY Amy McIlwain

Published 3/30/2011   

 In addition to the major Facebook profile and pages updates that occurred in the past month, Facebook has tacked on a few more changes you and your organization should know. Here are the four updates:

Fan page like buttons: A change in the functionality of the like button essentially gives it the same basic functionality as the share button. In the past, when you would press like for a fan page, it would give you the option to edit what it posted to your wall. The editing option is gone and now when you “like” a page it is shared with your network via a post on your wall. 

This can be beneficial for business fan pages because once someone likes your page, a link leading back to your page or website is shared on your new fan’s newsfeed. This new function is a great medium for exposure and a way to drive traffic back to your Facebook fan page. 

Messaging system: The new messaging system allows users the ability to communicate through whatever vehicle they choose, be it SMS, email or IM, all in real-time. All users are offered an @facebook.com username that matches their public usernames. Mark Zuckerberg, CEO of Facebook, listed seven characteristics of the new messaging system, which are modeled less like mail and more like chat: seamless, informal, immediate, personal, simple, minimal and short. 

This is beneficial to you and your business because of its immediate and simple way of communicating.  Think – if there is a comment made on your fan page wall, you can be notified immediately and quickly respond and create conversations. You can also add your clients’ @facebook.com email addresses to your Outlook, Gmail or other address books and use it to communicate. By using real-time vehicles to communicate with your connections you increase the ability to stay in contact with not only your current followers but also with potential clients and leads.

Conversation history: Each and every chat you’ve ever had with a user now appears as a single conversation. It is also archived in your Facebook account. This is a great way to track your organization’s conversations, whether it is client relations, staff relations or simply general communication. It’s also a great addition to your compliance management strategy by tracking and archiving each and every conversation. Take note: It is easy to delete your chat history, and you can do so by managing your conversation history through Facebook messages.

Social inbox: An email system setup to filter only the messages you wish to see. You can create folders and decide from which users you’d like specific messages to land. This can be beneficial to you and your business because, much like Facebook lists, it allows you to filter your personal professional messages into separate folders. That way, you can organize and manage your personal and professional relations more successfully.

It would seem the majority of the changes are working in our favor. The like box updates should give your brand more exposure, and the messaging system changes give you the ability to stay in better contact with your current and prospective clients. Take advantage of the conversation history changes and use them to enhance your compliance management strategy. Finally, use the social inbox filter to manage your personal and professional relations. Check out Financial Social Media’s Facebook fan page and contact us if you have any questions.

New Medicare Supplement policies climb in 2010 

Ginny Kipling

Published 4/4/2011 

According to Debra Donahue of Mark Farrah Associates, new Medicare Supplement memberships are on the rise, with new policies (those issued in the last three years) increasing by almost 6 percent in 2010, compared to a 1.3 percent increase in 2009. Donahue says the surge in memberships result from the ending of Medicare Advantage private-fee-for-services plans in many parts of the country and new options offered for Plans N and M.
“Though total membership declined from 9,508,000 in 2009, attrition was primarily due to erosion of the older policy base," Donahue said, but as of Dec. 31 of last year the number of all plans totaled almost 9.5 million.

Donahue also said that 2010 saw continued industry consolidation, with 177 carriers staying in the Medicare Supplement market and only 114 carriers reported writing new policies in the last three years.

Source: NAMSA, Mark Farrah Associates

Senate Okays Repeal of 1099 Provision in Healthcare Law 

 

By ARTHUR D. POSTAL

Published 4/5/2011 

 

The Senate today passed legislation repealing the much-criticized 1099 reporting provision in the healthcare reform law and sent the bill to President Obama for his signature.

President Obama is expected to sign the bill despite concerns raised by the President and other Democrats that the measure is a $25 billion tax on the middle class.

The 1099 provision would have raised $19 billion to help pay for health reform.

The provision would have required business owners, starting in 2012, to file a tax reporting document for all vendors from which they buy $600 worth of goods or services within a year.

The National Association of Insurance and Financial Advisors lauded the Senate decision. NAIFA also urged Congress as a next step to pass legislation that would exempt agent commissions from the medical loss ration of the healthcare reform bill, the Patient Protection and Affordable Care Act.

But, the bill’s chief Senate sponsor, Sen. Mike Johannes, R-Neb., cautioned in comments after the vote that repealing other provisions of the law may be an uphill climb.

In an interview with Politico, a political website, immediately after the vote, Sen. Johanns said, “This was a provision in the health care law that pretty quickly everybody agreed was foolish.“And yet we had over a dozen votes to get to this point.

“Can you imagine what kind of battle you would have on a key part of the health care bill?,” he added.

“Once something becomes law in the federal government, it is very hard to amend it or tweak it unless there is unanimous agreement.”

The bill, H.R. 4, passed the Senate 87-12 after an effort by Democrats to strip the $25 billion measure failed, 41-58.

A bill passed by the Senate earlier this year called for paying for the $21.9 billion increase in the deficit through repeal of the provision by giving the Office of Management and Budget the ability to take away nearly $44 billion of discretionary budget authority – except from the Departments of Defense, Veterans Affairs and Social Security – to offset the loss from the 1099 repeal.

The House version, by contrast, would pay for the repeal by making consumers repay all of their insurance subsidies under the health care law once their income rises beyond 400% of the federal poverty line. House Democrats called that a tax increase on the middle class. And the administration agreed in a policy statement disclosed Tuesday night.

The revised legislation also repeals an additional Form 1099 information reporting requirement, imposed on owners of rental real estate.

In his statement, NAIFA President Terry Headley said the trade group “is happy with today’s Senate vote and commends the bipartisan effort in Congress to repeal the 1099 provision.”

He added it demonstrates that members from both sides of the aisle are able to come together to fix the parts of the PPACA that would hurt consumers and small business.

 “Many NAIFA members are small business owners providing consumers with much-needed insurance and financial services in communities across America,” he said.

 “The 1099 reporting rules would have required them to expend scarce time and resources on recordkeeping and paperwork rather than serving the needs of their middle-income clients,” Headley said.

But, he added, “Next, we would encourage Congress to consider the Rogers/Barrow legislation, H.R. 1206, which would remove agent commissions from the medical loss ratio calculation.”

He said the MLR provision “is another part of health reform that needs to be revisited in order to preserve consumer service.”

He added that many agents have seen commissions slashed by 50% or more. And they have had to curtail the customer services their individual and small-group clients have come to expect.

Kaiser Study: Raising Medicare Age Would Shift Costs

   

By NU ONLINE NEWS SERVICE

Published 4/4/2011 

A new study finds that raising the Medicare age under the healthcare reform law to 67 by 2014 would save the federal government an estimated $7.6 billion. But the change would also increase out-of-pocket costs for 65 and 66 year-olds by $5.6 billion and by $4.5 billion in employer retiree health care costs.

The Kaiser Family Foundation, Menlo Park Calif., published this finding in a summary of results from a study on the effects of raising Medicare’s age of eligibility to 67 from 65. The report was authored by researchers from the Kaiser Family Foundation and the Actuarial Research Corp., Columbia, Md.

The report adds the change in the Medicare age of eligibility would also raise premiums by 3% for individuals who stay on Medicare as well as those who purchase coverage through insurance exchanges mandated in the law.

If the health care reform does not become law, raising the age would of eligibility would result in a spike in the number of the uninsured, the report says. With the health reform law, 65 and 66 year-olds would be legally required to purchase coverage until they reach the age of eligibility.

The report adds that gross saving of $31.1 billion would be found in 2014, although those savings would be offset by increases in spending on Medicaid ($8.9 billion), tax credits for those purchasing through exchanges ($7.5 billion) and $7 billion in lost premium receipts from 65 and 66 year-olds that would be ineligible.

Health care costs for employers would also rise by $4.5 billion as they would have to cover a newly ineligible population.