CMS
Proposes Coverage Determinations on ‘Never Events’
The
Centers for Medicare & Medicaid Services (CMS) on Tuesday
proposed three national coverage determinations (NCD) to establish
uniform national policies that will prevent Medicare from
paying for certain “never events,” as identified
by CMS from the National Quality Forum’s (NQF) list
of Serious Reportable Events. CMS has issued NCDs for: wrong
surgical or invasive procedures performed on a patient; surgical
or invasive procedures performed on the wrong body part; and
surgical or invasive procedures performed on the wrong patient.
Cardiology-related procedures, including angioplasty and catheterizations,
also would be included in the noncovered procedures. As defined
by CMS, surgical or invasive procedures would include all
procedures described by the surgery section codes in the Current
Procedural Terminology (CPT), including “minimally invasive
procedures involving biopsies or placement of probes or catheters
requiring the entry into a body cavity through a needle or
trocar."
The final
NCDs could affect payments to hospitals, physicians and any
other health care providers and suppliers involved in the
erroneous surgeries. This is separate from the current group
of never events addressed by the Hospital-Acquired Conditions
provisions in the Inpatient Prospective Payment System final
rule, which only affect payments to hospitals for inpatient
stays. CMS will accept public comments regarding the proposed
coverage policies until Jan. 1, 2009. Following the close
of the comment period, CMS will issue final NCDs within 60
days. The proposed decision memo can be viewed here.
New
Health IT Resources Available
The
Centers for Medicare and Medicaid Services (CMS) and Agency
for Healthcare Research and Quality (AHRQ) recently released
new tools to assist medical practitioners in adopting health
information technology (HIT) and to participate in the new
CMS e-prescribing incentive program. CMS released “Medicare’s
Practical Guide to the E-Prescribing Incentive Program,”
which provides an overview of the program and how to participate.
CMS also released the technical
specifications for e-prescribing systems that must be
present to qualify for the program. Under new Medicare law,
beginning on Jan. 1, 2009, physicians who successfully e-prescribe
will receive incentive payments of 2 percent of Medicare-allowed
charges. The size of the payment will decrease to 1 percent
in 2011 – 2012 and 0.5 percent in 2013. Those who have
not adopted e-prescribing by 2012 will be penalized by 1 percent
of Medicare-allowed charges, with the penalties size growing
in 2013 and beyond.
Meanwhile, AHRQ’s “Health
IT Adoption Toolbox,” which is in a question-and-answer
format, includes information on planning, executing and evaluating
the implementation of HIT. More information and tools to assist
physicians participating in this program are available on
the ACC Web site at: http://www.acc.org/HealthIT.
QUALITY
Thomson
Reuters Releases “Top 100” CV Hospitals
Thomson
Reuters recently released its top 100 U.S. hospitals for cardiovascular
care, based on an analysis of clinical outcomes in 970 hospitals
for heart attack, heart failure, coronary bypass surgery and
angioplasties. The mortality rate for bypass surgery was 26
percent lower in the 100 best hospitals. The top 100 hospitals
demonstrated higher performance on the evidence-based core
measures published by the Centers for Medicare and Medicaid
Services and cost $1,542 less per case, on average, according
to the report. For more coverage, visit
ACC’s online forum, The Lewin Report, or read
more at Cardiovascular Business Magazine.
NYT
Examines Comparative Effectiveness Institute
The
New York Times last week examined the growing number
of advocates lobbying Congress to create an Institute for
Comparative Effectiveness Research, which would be responsible
for conducting research into medical treatments and filling
gaps in current evidence. According to the Times,
although many current studies “can help a drug acquire
approval or answer a restricted research question,”
they “may no longer be enough, particularly when care
has become so expensive and real evidence more crucial.”
Robert Califf, M.D., F.A.C.C., of Duke University School of
Medicine, said that only 15 percent of ACC/American Heart
Association guidelines are based on “good clinical evidence,”
which is especially noteworthy considering other specialties
have less clinical evidence than cardiology. To read the New
York Times article in full, click
here.
