The American Medical Association announced yesterday that, effective immediately, it has issued a new Current Procedural Terminology (CPT) code for vaccine administration, and revised existing code 90663 to include the H1N1 vaccine. The new code, 90470, includes H1N1 immunization administration (intramuscular, intranasal), including counseling when performed. AMA reports the new code will help to simplify and make more efficient physician and health care provider reporting and reimbursement procedures, as well as reporting and tracking H1N1 immunization and counseling services.
Read the AMA’s press release here.
The Federal Trade Commission (FTC) and the Department of Justice (DOJ) announced they will consider updates to the Horizontal Merger Guidelines. Intended to reduce the uncertainty associated with enforcement of the antitrust laws in the merger area, the Guidelines outline the merger enforcement policies of the FTC and the DOJ, including describing the analytical framework and specific standards normally used by the agencies in analyzing mergers. They have not undergone significant revision since 1992. Given legal and economic developments since that time, the FTC and the DOJ believe the time is ripe to solicit public comment and hold joint public workshops to determine whether the Guidelines take into account these developments and to determine whether the Guidelines accurately reflect the current practice of merger review at the FTC and the DOJ.
The agencies will issue a set of questions about the current Guidelines and possible revisions, allowing public comment and agency original research. Afterwards, the agencies will host a series of five workshops, open to the public and the press. The workshops are scheduled to occur in Washington, D.C. on December 3, 2009, and then Chicago, New York City, San Francisco, and a final workshop again in Washington, D.C., throughout the remainder of December and in January 2010. Additional information about the date, time, and exact location of the workshops will be provided at a later date.
The FTC will post a set of questions on its web site. The agencies are particularly looking for comments from attorneys, economists, academics, consumer groups, and the business community. Given the increase in hospital mergers and medical practice acquisitions, members of the health care community should be interested in the agencies’ updates to the Guidelines.
Medicare recently issued guidance to private health plans with Medicare contracts concerning mailings to Medicare beneficiaries about current health reform legislation’s potential impact on Medicare Advantage and prescription drug benefits. CMS is concerned that certain private health plans have sent or may send to Medicare beneficiaries information that violates Medicare rules concerning such benefit information, unless the information was first submitted to CMS for review. CMS is concerned that such mailings will confuse beneficiaries and think that such information is official communication about the Medicare Advantage program. CMS asks that plan sponsors refrain from mailing similar materials until CMS has investigated whether potential violations have occurred.
The President released a memorandum to the Secretary of Health and Human Services yesterday directing HHS to make demonstration grants available within 30 days to states and health systems “for the development, implementation, and evaluation of alternatives to our current medical liability system.” The President said in the memo that the starting point for malpractice reform should begin with The Joint Commission and the Institute of Medicine’s identified goals and core commitments. These priorities include patient safety, reducing preventable injuries, fostering better communication between doctors and their patients, ensuring fair and timely compensation for injured patients, reducing the incidence of frivolous lawsuits, and reducing liability premiums. Grants will fund “demonstration projects that can test a variety of medical liability models and determine which reforms work” to achieve the identified goals.
$25 million in grants will be awarded in amounts of up to $3 million for three years for states and health systems implementing and evaluating patient safety and medical liability demonstration programs, and one-year planning grants up to $300,000 for technical assistance for states and health systems wanting to plan demonstrations. Grant decisions will be made in early 2010.
You can read The Washington Post’s report on the White House release here.
The Wisconsin Hospital Association’s (WHA) CheckPoint web site, which provides information to the public concerning hospital quality and safety of care information, has announced that new information is now available. Through the Surgical Care Improvement Project (SCIP) measures, the public can now see information that reflects hospital care practices aimed at reducing the risk of infection and blood clots after surgery. SCIP measures, which are used by hospitals throughout the United States to monitor and improve care, include the following:
- Percent of surgery patients given an antibiotic within 1 hour before surgery
- Percent of surgery patients given the right kind of antibiotic
- Percent of surgery patients whose antibiotics were stopped within 24 hours after surgery
- Percent of heart surgery patients whose blood sugar is kept under control in the days right after surgery
- Percent of surgical patients that had their hair removed using a safer method
- Percent of surgical patients that had treatments ordered to prevent a blood clot
- Percent of surgical patients that received treatment to prevent a blood clot within 24 hours before or after surgery
Hospitals voluntarily report the information contained on CheckPoint. Currently, 128 Wisconsin hospitals report to CheckPoint, and CheckPoint’s web site explains that these 128 hospitals provide care to 99% of the state’s patients. CheckPoint may be accessed by clicking here.
On September 15, CMS announced a proposed rule for a new prospective payment system (“PPS”) for outpatient end-stage renal disease dialysis facilities (“ESRDs”). The PPS would bundle items and services (e.g. dialysis treatment, prescription drugs and clinical laboratory tests) provided during the dialysis services into a single payment. The bundle would thus include items and services that are currently paid separately (e.g. drugs) from the current composite rate payment made to ESRDs. CMS would pay a base bundled rate of $198.64 for all of the services related to a dialysis session, with case-mix adjustments for certain patient characteristics (e.g. age and time on dialysis), conditions and co-morbidities. Comments to the proposed rule are due to CMS by November 16, 2009. You can view CMS’s press release here and the proposed rule here.
Senate Finance Committee Chairman Max Baucus has introduced the America’s Healthy Future Act of 2009.
It is scheduled for a full Committee markup on September 22.
The bill includes a proposal for the expansion of Medicaid and the creation of state co-operatives to provide consumers with options outside of private insurers. Employers would not be required to provide coverage to workers; however, employers who have 50 or more workers and do not offer coverage by 2013 will have to reimburse the government for every full-time worker receiving tax benefits through the government’s health care exchange system.
The $856 billion to fund coverage will be obtained through initiatives such as reductions in Medicare and Medicaid spending; taxes on insurers offering high-cost, high-premium health plans; and fees on providers such as device manufacturers.
The bill also directs the Secretary of Health and Human Services (HHS) to create a national strategic plan for improving the quality of care. The strategy will focus on goals such as reducing medical errors, maintaining hospital infection-control, addressing preventable hospital admissions, and an overall look at increasing efficiency and quality in the healthcare system.
A new initiative by the Joint Commission will help hospitals put an end to identified practices that endanger or inhibit quality patient care. The Joint Commission announced yesterday that it has launched the Center for Transforming Healthcare, and will team up with top hospitals and healthcare systems across the country to identify the causes that harm patient care and develop solutions to eliminate those causes. The Center’s first targeted initiative will focus on hand-washing failures as a critical patient safety problem. The next challenge will focus on patient “hand-offs,” i.e., transferring patient responsibilities from one provider to another in the hospital, such as during staff changes.
Center representatives believe that its initiatives, along with the help and collaboration of some of the top hospitals and healthcare systems in the country, will lead to “the development and testing of targeted, long-lasting patient safety solutions” that can “help transform American health care into a high-reliability industry that ensures patients receive the safest, highest quality care they expect and deserve.”
For more information on the Center for Transforming Healthcare, click here.
The IRS announced that user fees will increase for all exempt organization applications postmarked after Jan 3, 2010. The increases involve IRS Forms 1023, 1024, and 1028 and are as follows:
- $400 for organizations whose gross receipts are $10,000 or less annually over a 4-year period
- $850 for organizations whose gross receipts exceed $10,000 annually over a 4-year period
- $3,000 for group exemption letters.
Also, the IRS noted that “Cyber Assistant,” a Web-based software program designed to help Code Sec. 501(c)(3) applicants properly complete the Form 1023 application, will become available sometime in 2010. When Cyber Assistant becomes available, the user fees will change again as follows:
- $200 for organizations using Cyber Assistant (regardless of size) to prepare their Form 1023
- $850 for all other organizations not using Cyber Assistant (regardless of size) to prepare their Form 1023.
Detailed information is available on the IRS web site.
On September 4, 2009, the Department of Justice announced that it will not challenge a proposal between two hospitals to enter into an exclusive joint purchasing agreement with respect to the purchase of certain medical and surgical supplies. Under the agreement the hospitals will jointly evaluate medical and surgical products, designate suppliers and negotiate prices and other terms.
The Department said that the joint purchasing agreement may yield volume discounts and reduced transaction costs for the hospitals and ultimately could result in lower costs and increased hospital services for consumers.
Click here to read more.
