AAPC VP of ICD-10 education and training Rhonda Buckholtz, CPC, CPMA, CPC-I recently wrote about ICD-10 and what practices can do now to prepare for the coding changeover in Diabetes Practice Options.
“In the administrative realm, all vendor contracts will need to be scrutinized and updates may need to be made,” she wrote. “Practice managers should check the language on government mandates and whether or not those mandates are covered in maintenance agreements. Working with vendors early will be crucial to a practice’s success in implementing the new codes.”
Read the full article here.
April 30th, 2012
AAPC member J. Paul Spencer, CPC recently discussed the highest risk small practices face on a daily basis in the April edition of Southern California Physician.
“Physicians find themselves in a new era of of audits by government and private payers,” he wrote. “Most of these audits begin with a written request of documentation of service. Understanding the different types of audit entities…goes a long way to mitigating your practice’s compliance risk.”
Read the full article here.
Under contract with the U.S. Department of Health & Human Services (HHS), the National Quality Forum (NQF) recently added four efficiency measures that “could be combined with quality metrics as part of the Medicare value-based purchasing plan set to start in 2015,” American Medical News reports.
Two of the new measures evaluate relative resource use for patients with asthma and chronic obstructive pulmonary disease (COPD), and a third looks at total costs for treating pneumonia. The final measure focuses on total costs for hip and knee replacement.
These four measures join four others, endorsed in January, which include metrics to examine resource use for patients with diabetes and cardiovascular conditions, and total resource use and total cost of care for all patients.
The central concept of value-based purchasing in health care is that buyers should hold providers accountable for both the cost and quality of care. Value-based purchasing seeks to reduce inappropriate care and to identify the best-performing providers. Ideally, those providers and health care systems that provide the best care at the best cost would be rewarded with greater numbers of patients.
By measuring resources used, rather than raw costs only, the NQF “is aiming to give apples-to-apples comparisons of physician efficiency that are not distorted by geographic price variations,” American Medical News continues.
The American Medical Association (AMA), among other groups, supports value-based purchasing initiatives, but has expressed concern whether such a system could be implemented without penalizing doctors who treat the most difficult cases.
April 27th, 2012
An IMS Institute for Healthcare Informatics survey released April 4 shows a drop in physician office visits and prescription use. As patients struggle with high deductibles, co-pays, and general economic issues they are more likely to ask their physician about cheaper alternatives for tests and prescriptions, or to find other alternatives rather than seeing their doctor.
IMS’ report findings are similar to reports from the Kaiser Family Foundation and Chase health industry analyst John Rex. Their reports also found a decline in office visits. Another survey report, released November 2011 by Commonwealth Fund, said 42 percent of “sicker” adults had more cost-related access problems than in the previous year.
IMS’ report found that from 2010 to 2011:
- Retail pharmacy prescription spending declined 1.1 percent.
- Prescription spending by insured patients ages 19-25 went up 2 percent.
- Patients 65 and older spent 3.1 percent less out-of-pocket for prescriptions.
- Ages 65-69 had the biggest prescription decline, with a 4.3 percent drop.
- The biggest prescription decline was for those treating hypertension.
- Non-emergency hospital admissions declined 0.1 percent.
- Emergency admissions went up 7.4 percent.
The increase in emergency admissions is an indicator that patients are reluctant to seek medical treatment from their physician office or to take medications because of financial concerns. Larry Levitt, senior vice president of the Kaiser Family Foundation said, “It suggests people are putting off care, and they’re showing up sicker.”
According to the survey, here are the statistics showing the number of office visit changes from prior years:
2002 – 1,503,225,000: 2.7%
2003 – 1,589,694,000: 5.8%
2004 – 1,565,978,000: -1.5%
2005 – 1,654,375,000: 5.6%
2006 – 1,670,502,000: 1.0%
2007 – 1,624,189,000: -2.8%
2008 – 1,627,786,000: 0.2%
2009 – 1,602,354,000: -1.6%
2010 – 1,535,506,000: -4.2%
2011 – 1,468,265,000: -4.7%
Advice for Physicians Who are Seeing a Decline
According to an amednews.com article, here’s what physicians can do to make it more likely that financially strapped patients will follow advice for prevention and treatment:
- Explain the value of the recommended medication, test, or procedure even if the patient doesn’t ask. Barry Make, MD, a pulmonologist with National Jewish Health in Denver, said, “Patients will only do something if they understand what it is for, but patients are often reluctant or ashamed or embarrassed to ask.”
- Make it clear that some negotiation is possible if cost is a significant concern. For example, see a patient every four months rather than every three.
- Steer patients to lower-cost prescription resources and write prescriptions for drugs to be filled cheaper at big pharmacies.
- Guide patients to drug assistance programs or discount programs.
Source: IMS Institute for Healthcare Informatics “The Use of Medicines in the United States: Review of 2011“
The Centers for Medicare & Medicaid Services (CMS) has given preliminary approval to change the supervision requirement for 27 hospital outpatient therapeutic services from direct supervision to general supervision, effective July 1, reports AHA News.
Most of the services deal with psychotherapy; the rest relate to bladder catheterization, immunization administration, and smoking and tobacco cessation counseling. CMS does not propose to accept the panel’s recommendation to add CPT® code 94640 Pressurized or nonpressurized inhalation treatment for acute airway obstruction or for sputum induction for diagnostic purposes (eg, with an aerosol generator, nebulizer, metered dose inhaler or intermittent positive pressure breathing [IPPB] device) as a non-surgical extended duration therapeutic service. Direct supervision is required for this service.
Before posting its final decision, CMS will accept comments on its preliminary decision through May 19. Comments may be emailed to HOPSupervisionComments@cms.hhs.gov.