late-breaking news from your medical association volume XX / no. 3 MARCH 2013
local Onyx Pharmaceuticals Expands in South City After tripling its number of approved drugs over the past year, Onyx will expand its SSF headquarters, having only left Emeryville for SSF in 2011. Onyx represents a significant second generation of biotechnology companies that are commercializing breakthrough, high-impact products that will manage disease, and save lives, according to CEO Joel Marcus.
Seton Medical Centers Announces New President & CEO Joanne Allen has been named the new President & CEO of Seton Medical Center and Seton Coastside. Joanne has served as the President & CO of the Daughters of Charity Health Ministry in Gilroy at Saint Louise Regional Hospital for five years. Prior to joining Saint Louise, she served as COO/Chief Strategic Officer at O’Connor Hospital.
Practice Fusion and 100Plus Joined Together Ryan Howard, who founded Practice Fusion EMR company in 2005 and helped launch 100Plus in 2011 with co-founder Chris Hogg, has acquired the app that encourages consumers to take on healthier habits. Practice Fusion offers free EMR services to the 150,000 clinicians who use it. Practice Fusion has raised $64 million in venture capital money to date. It is likely to have a big IPO offering in the near future.
Kaiser CEO Halvorson Receives Health Care IT Lifetime Achievement Award George Halvorson, outgoing Chair and CEO of Kaiser Permanente, has received the Health Care IT Lifetime Achievement Award from HISTalk, a health IT blog. Kaiser also won the blog’s Best Provider of Health Care IT Award. HISTalk was started ten years ago by an anonymous health care tech executive. It gets 125,000 visits a month.
MedHelp Thrives Privately-funded MedHelp enables consumers to track health data, share information with doctors and other patients, and create online communities. Owner/President/EO John de Souza has invested more than $10 million in the company. The site hosts 13 million unique visitors a month. MedHelp also has 100 million data points from users in its “self-reported” medical database. MedHelp has licensing deals with General Electric, the Cleveland Clinic, and the San Francisco-based American Academy of Ophthalmology.
state Kaiser Permanente Operating Revenue Kaiser’s 2012 results were recently released, showing operating revenue at $50.6 billion; capital spending at $3.5 billion; and net income at $2.6 billion. Kaiser’s year-end membership across the country is 9,034,000.
Blue Cross Releases Results from Follow-up Coding Survey Blue Cross has released results of their follow-up study on doctors who showed usage at “considerably higher rates” utilizing E/M levels 4 and 5, as well as modifier -25. These doctors were warned that their claims data would be reviewed again in 90 days. Fortunately, 4,799 of those practices in the second study were notified that their usage had decreased. Only about 140 received audit letters noting that their usage had not decreased. Those who continue to reflect continued high usage may start receiving requests for records, and refunds will be sought if Blue Cross finds that the documentation does not support the coding. However, Blue Cross refuses to provide physicians with the claims data used to identify them as billing at “considerably higher frequencies” than their peers. AMA offers a webinar on how to use codes such as CPT modifier -25. View the webinar, Definitions and use of modifier -25, at www.ama-assn.org/go/psa-webinars.
national HCA CEO Compensation In 2012, the Hospital Corporation of American (HCA) paid its CEO, Richard Bracken, $48 million in salary and stock gains. Meanwhile the organizer behind a successful initiative to cap the pay of the CEO of El Camino Hospital at no more than double the Governor’s annual pay says he cannot afford to defend the hospital lawsuit challenging the measure’s legality. Although the electorate supported the initiative, the proponents (two hospital employees) have not been able to come up with the money or pro bono representation against the suit, which named them as co-defendants. Under the circumstances the Court will likely nullify the voter-passed measure since they cannot defend themselves against the hospital challenge. The hospital’s former CEO received $1 million in annual compensation. Nonetheless, there is growing controversy around the country over the amount of pay nonprofit hospital executives are making (between $800,000 to $4.76 million per year).
Specialty Societies Identify 90 Overused Tests, Treatments National groups representing 17 medical specialties have formed a campaign to raise awareness about commonly ordered tests and treatments that are not always necessary, and could even cause undue harm. Using the latest evidence about management and treatment options, the groups each released a list of five tests, procedures and medication therapies in their specialties that they believe should be very carefully considered before ordering. The lists are part of the American Board of Internal Medicine (ABIM) Foundation campaign, Choosing Wisely. To access the lists of tests and procedures, go to www.choosingwisely.org/doctor-patient-lists/
ACO Affiliation May Lower Doctor Productivity, Increase Costs According to a report in The Wall Street Journal, the Affordable Care Act is pushing more physicians out of private practice and into hospital employment. Although the move is intended to lower healthcare costs by funneling patients to accountable care organizations, most of which are hospital-owned, it is alleged that costs will rise because physician productivity drops by as much as 25 percent when doctors are employed by hospitals or hospital-owned health systems. A recent MGMA survey shows a 75 percent increase in active doctors employed by hospitals since 2000. By next ear the number will grow even higher.
Grim Backlog at Veterans Affairs The New York Times reports that based on previously unreleased data from the Department of Veterans Affairs paints a distressing portrait of an agency hopelessly buried in paperwork, with a claims backlog that has gotten far worse in the past four years. The average wait to begin receiving disability compensation and other benefits is 374 days, and up to 327 2
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days for veterans making claims for the first time. Those in big cities wait far longer—for example, up to 642 days in New York. The list of veterans with backlogged claims currently sits at about 900,00 and is expected to pass one million by the end of March and keep growing through 2013.
Accenture Survey Reveals Most Doctors Oppose Full Patient Access to EHR Records A new survey published by Accenture Health shows that most U.S. doctors (82 percent) want patients to actively participate in their own healthcare by updating their electronic health records. However, less than a third of physicians surveyed (31 percent) believe their patients should have access to their full health record. Accenture surveyed doctors in eight countries (Australia, Canada, England, France, Germany, Singapore, Spain and the U.S.), with findings consistent among all doctors surveyed. Some U.S. responses were inconsistent—for example, 49 percent of doctors believe that giving patients access to their records is crucial to providing more effective care, but only 21 percent of doctors currently allow patients to have online access to their medical summary or patient chart.
medicare CMS Changes Course on Rebilling RAC-Denied Claims CMS has announced that it will change its contentious policy of flatly denying any reimbursements to hospitals that provide medically necessary care determined by auditors to had been delivered inappropriately in an inpatient setting. The interim rule is a major victory for hospitals, which had claimed that the existing rule prevented them from collecting hundreds of millions of dollars in reimbursements. The American Hospital Association and four health systems claimed, in a suit filed in November, that CMS Medicare Act by declining to reimburse the audited claims of hospitals, even though the claims were ultimately acknowledged by CMS to be reasonable and medically necessary. Hospitals have long complained about the process that allows private recovery audit contractors to comb hospital records to flag questionable payments months and even years after care is delivered. RAC Contractors are paid a percentage of the money they recover. CMS reported in spring 2012 that RACs collected $1.86 billion in overpayments from October 2009 through March 2012, but identified only $245.2 million in underpayments. A CMS study found that about 40 percent of RAC filings are appealed, but providers win those appeals about 75 percent of te time. Unfortunately, the appeal process is costly and cumbersome.
No More Delays to ICD-10 CMS will be moving forward without any further delays, meaning that physician practices must start using the new diagnosis codes for billing patient services by October 1, 2014. The transition to ICD-10 will require physician practices filing claims to select from a universe of diagnosis codes that are more specific. In 2013d, the current IICD-9 set had 14,567 codes, while ICD-10 offered 69,832. For coding multiple injections provided to patients with pain, for example, ICD-9 has two codes - one for knee pain (719.46) and one for limb pain (729.5). The ICD-10 library wold offer significantly more options, including: pain to right knee (M25.561); pain in left knee (M25.562); pain in right arm (M79.601); pain in left arm (M79.602); pain in right leg (M79.604); and pain left leg (M79.605).
DOJ to Decide Medicare MAC Contract Protest In September CMS announced that Noridian had been named the new Medicare Administrative Contractor (MAC) for Medicare Parts A and B in Jurisdiction E (previously Jurisdiction 1). Two protests were filed challenging the award (Palmetto GBA and CGS. In January the GAO denied the challenges, so the protestors filed complaints with the U.S. Court of Federal Claims challenging the Jurisdiction E MAC (California, Hawaii, Nevada, and the Pacific Territories) contract award. The DOJ is representing CMS before the court. In the mean time (perhaps three months) physicians will continue to file their claims with Palmetto.
MedPAC Considers Equalizing Payments Between Hospital Outpatient Depts and ASCs The Medicare Payment Advisor Commission (MedPAC), the federal body that advises the U.S. Congress on issues related to Medicare payments, last week discussed equalizing payments between hospital outpatient departments and ASCs for many services commonly provided in ASCs. Currently ASCs receive on average about 58 percent of the reimbursement hospital outpatient departments receive for performing the same procedures. There is a concern, however, that MedPAC may propose capping the hospital outpatient department rates to ASC levels to encourage appropriate surgical services to migrate from the hospital to the surgery center.
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malpractice New Oregon Law Offers Med-Mal Alternative In another display of bipartisan healthcare reform, Oregon Gov. John Kitzhaber (a former emergency room physician), signed a bill this past week that creates a process in which adverse healthcare incidents can be resolved without patients and providers going to court. The bill was approved by a 26-3 vote in the state Senate on March 5, and was then passed 55-1 by the state House of Representatives on March 12. “To really improve the system and patient safety, healthcare providers and patients need to have open, frank discussions about the patient’s care,” Dr. William “Bud” Pierce, president of the Oregon Medical Association. This legislation is not liability reform in the traditional sense, but it is a big step in the right direction and has tremendous potential to improve the practice environment and patient safety in Oregon while providing an alternative to the expensive and protracted court process that currently serves neither patients nor physicians. Similar successful programs are in place in Illinois and Michigan. “This bill will help resolve many serious medical events before they go to court by allowing healthcare providers and patients to have early discussions in a confidential setting,” Kitzhaber said in a news release. Representatives from the OMA and the Oregon Trial Lawyer Association convened an advisory group last May and submitted a draft proposal for a discussion and resolution process the next month. “This bill is not a perfect solution for medical liability,” Rep. Jason Conger, a co-sponsor of the House version of the bill, said in a news release. “Nobody I know has claimed it is. But it is a first step. And it will, I hope, make progress toward achieving its objectives—increase patient safety, reduce costs and decrease defensive medicine.” Last year, Oregon passed bipartisan legislation to reform the state Medicaid system. The state House at the time was split 30-30 between Democrats and Republicans, and the measure passed by a 53-7 vote.
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