A Medicare Update

Hello Everyone,

Please enjoy the information contained in this edition of Frontier Focus. Please be sure to share it with your members, colleagues, providers and office billing staff. Thank you for your continued efforts to broadcast Medicare information to the providers in Region VIII.





Table of Contents



1. Health Information Technology News -- A Message from Dr. Blumenthal on Meaningful Use



2. CMS Updates Hospital Outpatient Department Payment Information for Value-Driven Health Care October 2009 Average Sales Price (ASP) File Is Now Available



3. Nursing Home Five-Star Quality Rating System – October News



4. Version 2.7 of the MREP Software Is Now Available for Download



5. Fistula First Breakthrough Initiative Provides Roadmap to Reach Goal of 66%



6. October Flu Message



7. Extra Help for Beneficiaries Paying for Prescription Drugs









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1. Health Information Technology News -- A Message from Dr. Blumenthal on Meaningful Use



The Office of the National Coordinator for Health Information Technology (ONC) has distributed this message through their communication channels and posted it on their website at the following link: http://healthit.hhs.gov/portal/server.pt?open=512&objID=1350&parentname=CommunityPage&parentid=5&mode=2&in_hi_userid=11113&cached=true# .

"Meaningful" Progress Toward Electronic Health Information Exchange

A Message from Dr. David Blumenthal, National Coordinator for Health Information Technology

I recently reported on our announcement of State Health Information Technology Grants and grants to establish Health Information Technology Regional Extension Centers, as authorized under the Health Information Technology for Economic and Clinical Health (HITECH) Act provisions of the American Recovery and Reinvestment Act of 2009 (the Recovery Act).

Today I want to discuss the important term “meaningful use” of electronic health records (EHRs) – both as a concept that underlies the movement toward an electronic health care environment and as a practical set of standards that will be issued as a proposed regulation by the end of 2009.

The HITECH Act provisions of the Recovery Act create a truly historic opportunity to transform our health system through unprecedented investments in the development of a nationwide electronic health information system. This system will ultimately help facilitate, inform, measure, and sustain improvements in the quality, efficiency, and safety of health care available to every American. Simply put, health professionals will be able to give better care, and their patients’ experience of care will improve, leading to better health outcomes overall.

As many of you are aware, the HITECH Act provides incentive payments to doctors and hospitals that adopt and meaningfully use health information technology. Eligible physicians, including those in solo or small practices, can receive up to $44,000 over five years under Medicare or $63,750 over six years under Medicaid for being meaningful users of certified electronic health records. Hospitals that become meaningful EHR users could receive up to four years of financial incentive payments under Medicare beginning in 2011, and up to six years of incentive payments under Medicaid beginning in October 2010.

The HITECH Act’s financial incentives demonstrate Congress’ and the Administration’s commitment to help those who want to improve their care delivery, and will serve as a catalyst to accelerate and smooth the path to HIT adoption by more individual providers and organizations. The dollars are tangible evidence of a national determination to bring health care into the 21st century.

The Office of the National Coordinator for Health Information Technology (ONC) is charged with coordinating nationwide efforts to implement and use the most advanced health information technology and the electronic exchange of health information. ONC is working with the Centers for Medicare & Medicaid Services (CMS), through an open and transparent process, on efforts to officially designate what constitutes “meaningful use.”

ONC has already engaged in a broad range of efforts to support the development of a formal definition of meaningful use. The HITECH Act designated a federal advisory committee, the HIT Policy Committee, with broad representation from major health care constituencies, to provide recommendations to ONC on meaningful use. The HIT Policy Committee has provided two sets of recommendations, informed by input from a variety of stakeholders. ONC and CMS have also conducted a series of listening sessions to solicit feedback from more than 200 representatives of various constituent groups and an open comment period where over 800 public comments were submitted and reviewed. The second set of recommendations on meaningful use was issued at a July 16 HIT Policy Committee meeting and details can be found at healthit.hhs.gov/policycommittee.

CMS is expected to publish a formal definition of meaningful use, for the purposes of receiving the Medicare and Medicaid incentive payments, by December 31, 2009. At that time, the public will be able to comment on the definition, and such comments will be considered in reaching any final definition of the term.

By focusing on “meaningful use,” we recognize that better health care does not come solely from the adoption of technology itself, but through the exchange and use of health information to best inform clinical decisions at the point of care. Meaningful use of EHRs, we anticipate, will also enable providers to reduce the amount of time spent on duplicative paperwork and gain more time to spend with their patients throughout the day. It will lead us toward improvements and sustainability of our health care system that can only be attained with the help of a reliable and secure nationwide electronic health information system.

The concept of meaningful use is simple and inspiring, but we recognize that it becomes significantly more complex at a policy and regulatory level. As a result, we expect that any formal definition of “meaningful use” must include specific activities health care providers need to undertake to qualify for incentives from the federal government.

Ultimately, we believe “meaningful use” should embody the goals of a transformed health system. Meaningful use, in the long-term, is when EHRs are used by health care providers to improve patient care, safety, and quality.

What’s next?

As stated above, the next step in our process is a notice of proposed rulemaking in late 2009 with a public comment period in early 2010. As this process unfolds, we will continue to talk and share experiences about transitioning to EHRs, and to help deepen understanding among physicians and hospitals about the use of EHRs. We will also present programs designed to help smooth the transition process, and identify activities physicians and hospitals can engage in now to promote adoption of EHRs. As efforts advance, we will turn our attention to other necessary supporting programs, some of which you will hear more about in the coming weeks, including defining what constitutes a “certified” EHR, which is one of the requirements to qualify for Medicare and Medicaid incentives.

In the meantime, what can providers do to move toward becoming “meaningful users” – even in the absence of a formal definition? Naturally, while understanding that the final definition will be adopted through a formal rulemaking process, it will be helpful to be as familiar as possible with the discussion of meaningful use criteria to date. (You will find that information posted at healthit.hhs.gov/meaningfuluse.)

Armed with an understanding of the discussion of meaningful use as it unfolds, providers can begin to consider how their own practices or organizations might be reshaped to enhance the efficiency and quality of care through the use of an electronic health record system. Be assured you will not be alone as you seek to adopt an EHR system. Through our recently announced collaborative HITECH grants programs and others to be initiated later this year, we will continue to support providers in moving forward. Additional details about the grants are also available in my previous update and at healthit.hhs.gov/HITECHgrants.

To some providers, particularly small or already stretched physician practices or small, rural hospitals, the path toward meaningful use may still seem arduous. To others, who would just prefer to stick with the “status quo,” it may seem like an unwanted intrusion. We believe that the time has come for coordinated action. The price of inaction – in adverse events, lost patient lives, delayed or improper treatments, unnecessary procedures, excessive costs, and so on – is just too high, and will only get worse.

There is much at stake and much to do. We must relieve the crushing burden of health care costs in this country by improving efficiency, and assuring the highest level of patient care and safety regardless of geography or demographics. By using current technologies in a meaningful way, as well as technology to be developed in the future, we will take great strides toward solving some of the most vexing problems facing our health care system and creating a new platform for innovative solutions to health care.

I look forward to providing periodic updates, and to continued interactions with all the communities that have so much to gain from this profound transformation.


Sincerely,

David Blumenthal, M.D., M.P.P.
National Coordinator for Health Information Technology
U.S. Department of Health & Human Services

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2. CMS Updates Hospital Outpatient Department Payment Information for Value-Driven Health Care October 2009 Average Sales Price (ASP) File Is Now Available



To support the delivery of high-quality, efficient health care and enable consumers to make more informed health care decisions, the U.S. Department of Health and Human Services is making cost and quality data available to all Americans. As part of this initiative, Medicare posted information in 2007 and 2008 about the payments it made during the previous year for common and elective procedures and services provided by Hospitals, Ambulatory Surgery Centers (ASCs), Hospital Outpatient Departments, and Physicians.

The Hospital information is posted on the Hospital Compare Website where it can be viewed along with hospital quality information. The Hospital compare website may be found at www.medicare.gov.

On August 28, 2009, Medicare posted an update to the Ambulatory Surgery Center data. An update to the Physician payment data was posted on September 25, 2009 and an update to the Hospital Outpatient Department data was posted on October 14, 2009. The information is being displayed in the same format as in previous years, updated with calendar year (CY) 2008 data. The posting updates may be found at: www.cms.hhs.gov/HealthCareConInit/.

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3. Nursing Home Five-Star Quality Rating System – October News



1. The Five-Star provider preview reports will be available beginning Monday, October 12, 2009. Providers can access the report from the Minimum Data Set (MDS) State Welcome pages available at the State servers for submission of Minimum Data Set data.

Provider Preview access information:

· Visit the MDS State Welcome page available on the State servers where you submit MDS data to review your results.

· To access these reports, select the Certification and Survey Provider Enhanced Reports (CASPER) Reporting link located at the bottom of the login page.

· Once in the CASPER Reporting system,

i. Click on the 'Folders' button and access the Five-Star Report in your 'st LTC facid' folder,

ii. Where st is the 2-digit postal code of the state in which your facility is located, and

iii. Facid is the state assigned facid of your facility.

2. The helpline will be open beginning Monday, October 12, 2009 for questions and concerns about the July data. Alternatively, providers can write to BetterCare@cms.hhs.gov.

3. Nursing Home Compare will update with October’s Five-Star data on Thursday, October 22, 2009.

4. Please visit (http://www.cms.hhs.gov/CertificationandComplianc/13_FSQRS.asp) for the latest Five-Star Quality Rating system information.

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4. Version 2.7 of the MREP Software Is Now Available for Download



Version 2.7 of the Medicare Remit Easy Print (MREP) software is available for download at http://www.cms.hhs.gov/AccesstoDataApplication/02_MedicareRemitEasyPrint.asp on the CMS website. For a description of the changes in this version, see the “What’s New” section of the MREP User Guide – Version 2.7 at http://www.cms.hhs.gov/AccesstoDataApplication/Downloads/EasyPrintUserGuide.pdf.

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5. Fistula First Breakthrough Initiative Provides Roadmap to Reach Goal of 66%



The Centers for Medicare & Medicaid Services (CMS) is pleased to announce that the Fistula First Breakthrough Initiative (FFBI) has released a strategic plan that aims to achieve CMS’ goal that two-thirds (66%) of prevalent hemodialysis patients will use an arteriovenous (AV) fistula as their primary method of vascular access.



The FFBI Strategic Plan focuses on seven strategies and two policy recommendations. The plan was developed by conducting a root-cause analysis that identified the underlying barriers to AV fistula placement and use. A technical expert panel identified potential solutions to address the root causes.



Led by the FFBI Coalition, with support from the End-stage Renal Disease (ESRD) Network Organizations and the Quality Improvement Organizations (QIOs) under CMS’ leadership, the Strategic Plan includes the following concepts:



1. Nephrologist as Leader: Encourage and support nephrologists to take a leadership role and be accountable for vascular access management in all hemodialysis patients.

2. Leveraging Partnerships: Partner with organizations to improve AV fistula placement and utilization rates.

3. Hospital Systems: Modify hospital systems to promote AV fistula placement.

4. Patient Self-Management: Promote patient self-management through the stages of Chronic Kidney Disease.

5. Addressing Access Problems: Promote fast-track protocols for rapid identification and referral of vascular access problems, which include failure to mature, revisions of the failing AV fistula, and failure to place an AV fistula.

6. Practitioner Training and Credentialing: Promote training, experience, and credentialing of healthcare professionals in the area of hemodialysis vascular access management.

7. FFBI Change Concepts: Expand and endorse the current Change Concepts for education and promotion throughout the renal, surgical, and interventional communities.



The percentage of prevalent hemodialysis patients in the U.S. with an AV fistula as their primary vascular access was 32.4% (87,344 patients) at the beginning of 2003. By May 2009, this percentage had increased to 52.6% (179,113 patients). As a result, nearly 92,000 additional patients experienced improved adequacy, fewer hospitalizations, fewer infections, and a lowered mortality risk than those with other forms of vascular access. The dramatic change in practice patterns that produced the improvement was due to the targeted efforts of many organizations and individuals, facilitated by the Fistula First Breakthrough Initiative. However, the CMS goal, based upon achievable practice, is a prevalent AV fistula utilization rate of 66%, which means that there are additional opportunities for improvement.



The FFBI Strategic Plan presents recommendations for accountability and organizational, behavioral, and infrastructural changes across healthcare systems which, if implemented, will result in sustainable outcomes improvement.



To read the FFBI Strategic Plan online, please visit http://www.fistulafirst.org on the internet. To learn more about the portfolio of CMS’ ESRD quality projects online visit, http://www.cms.hhs.gov/ESRDQualityImproveInit/ on the CMS website.

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6. October Flu Message



Flu Season is upon us! CMS encourages providers to begin taking advantage of each office visit to encourage your patients with Medicare to get seasonal flu shots. Flu shots are their best defense against combating flu this season. And don’t forget—health care workers also need to protect themselves.

Medicare provides coverage of the flu vaccine without any out-of-pocket costs to the Medicare patient as a part B benefit. No deductible or copayment/coinsurance applies. Note that influenza vaccine is NOT a Part D covered Drug.



For more information about Medicare’s coverage of the seasonal influenza vaccine and its administration, as well as related educational resources for health care professionals, please go to http://www.cms.hhs.gov/MLNProducts/35_PreventiveServices.asp on the CMS website.



For information on Medicare policies related to H1N1 influenza, please go to http://www.cms.hhs.gov/H1N1 on the CMS website. Additional information can also be found in the attached “Weekly H1N1 Influenza Bulletin.”

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7. Extra Help for Beneficiaries Paying for Prescription Drugs



Do You Know Someone Who Is Having Trouble Paying For Prescription Drugs?

Medicare Can Help!



If an individual has limited income and resources, they may qualify for extra help from Medicare. It could be worth over $3,300 in savings on prescription drug costs per year.
Encourage people with Medicare to file for Extra Help online: https://s044a90.ssa.gov/apps6z/i1020/main.html or by calling Social Security at 1-800-772-1213 to apply over the phone.
State Health Insurance Information Program (SHIP) offices can assist with the application. Find contact information for a local SHIP Counselor at http://www.medicare.gov/contacts/static/allStateContacts.asp or by calling
1-800-MEDICARE.

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Lucretia James

Division for Medicare Health Plans Operations
Centers for Medicare & Medicaid Services
Region VIII
1600 Broadway, Suite 700
Denver, CO 80202
(303) 844-1568
lucretia.james@cms.hhs.gov