HCPro.com - Daily Top Stories

Environmental services: Prevent infections and ensure safety

Tue, 01 Dec 2009 17:14:00 GMT

Even with initiatives such as hand hygiene awareness, respiratory etiquette, and standard and contact precautions hoarding much of the IC spotlight, environmental cleaning and disinfection have emerged as primary sources for infection prevention.

Do you share educational information?

Thu, 19 Nov 2009 18:33:00 GMT

Anne R. Buss, CPMSM, CPCS, is a medical staff consultant based in Fayetteville, AR.

Dear readers,

I noticed a newsletter from the NPDB-HIPDB on the desk of a manager I was working with and asked if I could borrow it. She said sure, and asked that after I finished with it if I could hole punch it and put it in a binder on the shelf in the break room with the other periodicals. She explained that she keeps these newsletters because she wants the credentialing professionals working in our medical staff office to be well informed. She said the group discusses the updates at department meetings; the binders were there for individual reading.

People take in information in many different ways, she said. Some listen to tapes, or speakers, and you see their heads nodding in agreement indicating that they understand. Then there are those people who learn best by reading and have to see it in black and white. Others have to have hands-on approach; they learn by doing.

There are two employees in the office studying for the certification exam. The facility where they work is not inclined to support the educational efforts of the medical staff office. Some facilities are like that; budgets are tight and travel and seminars are not a priority. To help fund important educational efforts, the local medical staff services association group uses a portion of the dues assessment to purchase CDs, study guides, videos, and periodicals that they loan to MSPs. To help the two employees study, the manager borrowed educational CDs that they could listen to as they commuted to work.

With the strides in technology, there are many ways that information can be shared. Up-to-date information is at our finger tips on an hourly basis. This is as true for MSPs’ educational materials as it is for medical staff information. No longer do we have to wait for the next edition of standards, rules and regulations, or best practices. We have gone from handing out copies of our bylaws and rules & regulations, to putting them on floppy disks, then CDs, and now flash drives. Knowledge is power. Spread it around.

Remember, those who are afraid to ask are afraid to learn.

All the best,

Anne R. Buss, CPMSM, CPCS

MSP tip of the week: Stay on top of legal issues

Wed, 18 Nov 2009 18:31:00 GMT

Whether you’re responsible for coordinating the peer review committee or perform credentialing duties, at some point in your medical staff services career, you will more than likely need to know certain aspects of legal issue. At minimum, legal considerations include the following:

The Health Care Quality Improvement Act of 1986 (HCQIA): Congress passed this statute to protect those who participate in good faith peer review. This Act also led to the establishment of the National Practitioner Data Bank (NPDB) and the Healthcare Integrity and Protection Data Bank (HIPDB). To learn more about the NPDB and the HIPDB, visit www.npdb-hipdb.hrsa.gov./ Also read “How to navigate National Practitioner Data Bank reports effectively: Legal experts offer tips for medical staffs and practitioners” in the November issue of Credentialing and Peer Review Legal Insider (subscription required).
Sharing of information: Due to recent law suits, hospitals need to be cautious when providing verifications to other entities. To learn more, read “Don’t be scared into silence: Affiliation letter safeguards allow you to disclose more” in the June issue of Credentialing and Peer Review Legal Insider (subscription required).
Attestations, acknowledgements, and release forms: All three of these forms are essential elements of the credentialing process. For more information, please see The Credentialing Coordinator’s Handbook, published by HCPro, Inc.
Criminal background checks: MSPs should have knowledge of how to implement criminal background checks and when they are appropriate. To learn more, read “Why, when, and how to conduct criminal background checks on the medical staff” in the January issue of Briefings on Credentialing (subscription required).
Disruptive and impaired practitioners: MSPs should know how to avoid lawsuits related to behavior and impaired practitioner-related issues. To learn more, read “Tips for writing an effective code of conduct policy” in the January issue of Medical Staff Briefing (subscription required). Also read “Sounding the alarm on disruptive behavior to meet Joint Commission standards” in the October 2008 issue of Medical Staff Briefing (subscription required).

This week’s tip is adapted from The Credentialing Coordinator’s Handbook by Anne Roberts, CPMSM, CPCS—now available at a reduced price!

Physician numbers down, recruitment up

Tue, 17 Nov 2009 19:25:00 GMT

The majority of hospital CEOs (95%) see the physician shortage worsening with the economic downturn, according to a study released this month, “Clinical Workforce Issues: 2009 Survey of Hospital Chief Executive Officers” by AMN Healthcare, Inc., a healthcare staffing agency. AMN Healthcare partnered with the research group, the Council on Physician and Nurse Supply, to complete the study.

Nearly half (46%) of the 284 hospital administrators surveyed said access to care was compromised because of a shortage of healthcare professionals. As a result, a quarter of CEOs said the downturn has caused them to boost physician recruitment efforts. Many indicated that they will are recruiting the same or greater number of clinical professionals in the next six months to fill numerous vacancies.

[via ACP Hospitalist]

Featured blog post: National Nurse Practitioner Week highlights primary care shortage

Thu, 12 Nov 2009 14:49:00 GMT

If you haven’t already heard about it from the nurse practitioners (NP) at your organization, this week is National Nurse Practitioner (NP) Week. NPs are harnessing their spotlight to shine the light on the shortage of primary care providers in America—and how their workforce can help combat that shortage.

Click here to visit our blog for more about nurse practitioners.

Guidance on HIPAA implications of H1N1

Mon, 09 Nov 2009 19:16:00 GMT

Following the recent declaration for H1N1 flu as a national health emergency, the government posted a number of documents that have HIPAA implications, says Frank Ruelas, director of compliance and risk management at Maryvale Hospital and principal, HIPAA Boot Camp, in Casa Grande, AZ.

Ruelas points to this document on the CDC Web site that summarizes other related documents online.

“Many of these documents help clear up questions on whether the subsequent 1135 waivers suspend HIPAA, the time frame related to these waivers, and those provisions of the HIPAA privacy rule where the Secretary of HHS may waive sanctions and penalties,” Ruelas says.

FHM designation gives hospitalists long-awaited recognition: What it takes to be a Fellow of Hospital Medicine

Sun, 01 Nov 2009 21:38:00 GMT

The Society of Hospital Medicine (SHM) earlier this year introduced the first class of fellows in hospital medicine (FHM), a designation that feels, to many, well deserved after more than a decade of fighting for their place in the medical community.

Joint Commission Alert puts leaders behind the wheel of patient safety: Steps for navigating the road ahead

Sun, 01 Nov 2009 21:34:00 GMT

With the release of Sentinel Event Alert #43, The Joint Commission is driving home a message that regulators have been sending to hospitals for years: leaders need to take an active role in preventing medical errors.

Bringing down infection rates quickly

Sun, 01 Nov 2009 20:42:00 GMT

On June 31, the New York State Health Department released a report detailing the HAI rates of hospitals in New York for 2008. SUNY Upstate University Hospital in Syracuse, NY, reported an alarming infection rate in the medical-surgical ICU. According to the report, University had a central line–associated bloodstream infection rate of 8.3 per 1,000 patient days in that particular ICU during the previous year. The state average in New York was 2.3.

Fire protection education: Relating better to caregivers will open up their eyes

Sun, 01 Nov 2009 19:32:00 GMT

Want to keep egress corridors clear of clutter? Go onto the units and talk to the nurses.

It’s not that simple, of course, but if you can learn to better relate to nurses, you stand a better chance of getting caregivers to respect Life Safety Code^® (LSC) requirements, said Brad Keyes, CHSP, life safety consultant at The Greeley Company, a division of HCPro, Inc., in Marblehead, MA.

Medical schools and teaching hospitals fuel economy, study says

Tue, 20 Oct 2009 17:50:00 GMT

Medical schools and teaching hospitals are doing more than training tomorrow’s physicians—they’re also a powerful force in local economies.

The Association of American Medical Colleges this month reported that medical schools and teaching institutions had a combined economic impact of more than $512 billion on their state economies and the nation overall in 2008.

The nation’s 131 accredited medical schools and nearly 400 major teaching hospitals (all represented by the AAMC) employs 1.86 million individuals in full-time jobs. These institutions are also directly or indirectly responsible for 3.3 million full-time jobs.

"U.S. medical schools and teaching hospitals are substantial economic engines in terms of jobs, state tax revenues, and economic growth," said AAMC President and CEO Darrell G. Kirch, MD, in an Oct. 8th press release.

Read the complete report, The Economic Impact of AAMC-Member Medical Schools and Teaching Hospitals, 2008.

New rules protect patients' genetic information

Mon, 05 Oct 2009 17:16:00 GMT

HHS released an interim final rule Thursday, October 1, that gives patients greater protections on their genetic information.

In part, the rule ensures that genetic information is not used to deny healthcare coverage and will “encourage more individuals to participate in genetic testing, which can help better identify and prevent certain illnesses,” according to an HHS press release.

Lawyer: Providers not ready for HITECH compliance

Mon, 05 Oct 2009 17:12:00 GMT

Andrew E. Blustein, Esq., responded quickly when asked what he came away with after talking to providers at the 17th annual HIPAA Summit at the Wardman Park Hotel in Washington, DC. September 15-18.

“People are shell-shocked,” says Blustein, partner and co-chair of Garfunkel Wild & Travis, PC’s Health Information and Technology Group in Great Neck, NY, and Hackensack, NJ.

Blustein and David A Mebane, Esq., senior vice president for legal affairs at Saint Barnabas Health Care System in West Orange, NJ, presented on the steps to take before, during, and after a breach at the event.

Read more on our HIPAA Update blog.

OIG Gets Proactive in 2010 Work Plan

Mon, 05 Oct 2009 13:44:00 GMT

Hospital readmissions, adverse events, and issues related to the American Recovery and Reinvestment Act of 2009 are some of the highlights of the 2010 OIG Work Plan.

"These are relatively new issues so this is pretty proactive on the OIG's part," says Steve Miller, JD, chief compliance and privacy officer at Capital Health in Trenton, NJ.

In previous years, many of the OIG's planned reviews were on topics that have been around for a while, such as bad debt, Medicare secondary payer, and wage indices.

"They're getting a jump on these newer issues right away," Miller says. This is a good move, he adds, because newer issues tend to present a higher opportunity for errors.

In the 2010 Work Plan, the OIG grouped ongoing and planned reviews into two major parts:

CMS: Reviews related to Medicare, Medicaid, information systems controls, the Children's Health Insurance Program, and related investigation and legal counsel to OIG.
Public Health and Human Services Programs and Department-wide Issues: Reviews related to agencies, such as the Centers for Disease Control and Prevention, the Food and Drug Administration, the National Institutes of Health, the Administration on Aging, and the Administration for Children and Families. This part also describes department-wide issues, such as financial accounting and information systems management.

Hospital readmissions
In 2004, CMS implemented an edit to reject subsequent claims for beneficiaries whom the hospital readmitted on the same day. According to the Medicare Claims Processing Manual, if a same-day readmission occurs for symptoms related to or for evaluation or management of the prior stay's medical condition, the hospital is entitled to only one DRG group payment and should combine the original and subsequent stays in a single claim. The OIG plans to test the effectiveness of this edit and determine the extent of oversight of readmission cases.

"It's interesting because this is an issue that is getting more attention from CMS this year," Miller says. In fact, in April, CMS announced a pilot program "Care Transitions" to focus on eliminating unnecessary hospital readmissions.

This is not only a quality of care concern, but also a hospital efficiency problem, says Marta G. Hernandez, BPS, HSA, CHC, RHIT, senior auditor in Miami.

"Most facilities that are efficient have been found to have a higher standard of patient care," she says. "This then results in better patient outcomes and less readmissions for the same conditions."

Adverse events
In the 2009 Work Plan, the OIG included a review of payments for and incidences of never events, focusing on CMS' administrative processes regarding detection of never events and payment. This year, it included five different reviews, using the term "adverse" events instead, to include hospital-acquired conditions (HAC). These reviews include:

Hospitals: National incidence among Medicare beneficiaries—The OIG will employ a panel of physicians with expertise in patient safety to estimate the national incidence of adverse events, identify the type of event, and assess if the event was preventable.
Hospitals: Methods to identify events—This review will examine methods of identifying adverse events, including:
- Medical records reviews by both nurses and physicians
- Administrative data analysis using the Agency for Healthcare Research and Quality's patient safety indicators and present on admission (POA) indicators
- Hospital incident reports
- Interviews with Medicare beneficiaries or their representatives
Hospitals: Early implementation of Medicare's policy for HACs—The OIG will review CMS' administrative process, including how it identifies HACs and denies reimbursement for related care.
Hospitals: Responses by Medicare oversight entities—In this review, the OIG will look at how state survey and certification agencies, state licensure boards, and Medicare accreditors responded to adverse events in hospitals.
Public disclosure of adverse event information—This is another review of CMS policy and procedure, as well as selected patient safety organizations. The OIG will look at how these organizations handled the disclosure of information and patient privacy.

These detailed reviews show that the OIG is serious about analyzing how many adverse events are occurring across the nation and how all involved parties are handling the events from beginning to end, Miller says.

OIG releases 2010 Work Plan

Thu, 01 Oct 2009 21:09:00 GMT

The OIG released its 2010 OIG Work Plan, giving healthcare compliance professionals an idea of what types of audits and reviews to expect in the coming fiscal year.

The annual Work Plan describes the various projects that different departments of the OIG plan to do, as well as projects that are in process. These departments include the Office of Audit Services, Office of Evaluation and Inspections, Office of Investigations, and Office of Counsel to the Inspector General.

In the 2010 Work Plan, the OIG grouped ongoing and planned reviews into two major parts:

CMS – Reviews related to Medicare, Medicaid, information systems controls, the Childrens Health Insurance Program, and related investigation and legal counsel to OIG.
Public Health and Human Services Programs and Department-wide Issues – Reviews related to agencies such as the Centers for Disease Control and Prevention, the Food and Drug Administration, the National Institutes of Health, the Administration on Aging, and the Administration for Children and Families. This part also describes department-wide issues, such as financial accounting and information systems management.

The Work Plan also includes reviews related to the American Recovery and Reinvestment Act of 2009, described in Appendix A of the document.

Stay tuned for further coverage and analysis from our compliance experts of the 2010 OIG Work Plan.

Note: CMS clarifies RACs' "exception authority"

Tue, 22 Sep 2009 13:28:00 GMT

Editor’s note: Debbie Mackaman, RHIA, CHCO, regulatory specialist for HCPro, Inc., is the author of this week’s note from the instructor.

On September 11, CMS published Transmittal 302 that updated the Program Integrity Manual on Local Coverage Determination (LCD) exceptions. When specific authorized contractors conduct a complex medical review, they have the authority (in rare and unusual circumstances) to apply an exception to the “reasonable and necessary” requirements described in an LCD to approve or deny a claim. However, they cannot make exceptions to National Coverage Determinations (NCDs). In addition, and unless otherwise directed by CMS, RACs can only use the exceptions process to not deny a claim. This is a good time to review the difference between a national and a local coverage determination policy.

Click over to the MedicareMentor Blog to read more.

Pfizer to pay $2.3 billion for largest healthcare fraud settlement in history

Wed, 09 Sep 2009 05:00:00 GMT

Pharmaceutical giant Pfizer Inc. and its subsidiary Pharmacia & Upjohn Company Inc. will pay $2.3 million for the largest healthcare fraud settlement in the history of the Department of Justice (DOJ). According to a DOJ press release, Pfizer has agreed to pay a fee of $2.3 billion to amend criminal and civil liabilities arising from the illegal promotion of four medications – Bextra, an anti-inflammatory drug; Geodon, an anti-psychotic drug; Zyvox, an antibiotic; and Lyrica, an anti-epileptic drug.

Pfizer submitted false claims about the prescriptions to government healthcare programs that were either not accepted or covered. The provisions of the FDA state that a company must specify the intended uses of a product and products may not be marketed for any non-listed uses.

Six whistleblowers spurred the investigation by filing lawsuits under the qui tam provisions of the False Claims Act and will receive compensation totaling more than $102 million. Part of the $2.3 billion settlement will resolve allegations that Pfizer supplied kickbacks to healthcare providers to persuade them to prescribe these drugs.

The individual criminal fine of $1.195 billion is the greatest criminal fine ever procured in the United States for any matter. Kathleen Sebelius, Secretary of the Department of Health and Human Services estimates that nearly $1 billion will be allocated to Medicare, Medicaid, and other government insurance programs.

CMS posts ICD-10 fact sheet

Tue, 08 Sep 2009 05:00:00 GMT

CMS recently posted a fact sheet regarding ICD-10 that summarizes structural differences between the new system and its predecessor, ICD-9. It also explains how organizations and facilities should plan for the change and provides a list of helpful Web sites.

CMS releases billing instructions for H1N1 vaccine

Mon, 07 Sep 2009 19:40:00 GMT

CMS recently release an MLN Matters article outlining the instructions for billing the administration of the H1N1 virus vaccine. Medicare will reimburse providers for the administration of the H1N1 vaccine at the same rate established for the administration of influenza virus vaccine, according to the MLN Matters article. Medicare will not reimburse providers for the cost of the vaccine since it will be made available at no charge.

The HCPC codes for the H1N1 vaccine are as follows:

G9141 – Influenza A (H1N1) immunization administration (includes the physician counseling the patient/family)
G9142 – Influenza A (H1N1) vaccine, any route of administration

To view the MLN Matters article about billing for the administration of the H1N1 virus vaccine, visit the Resources page on MDSCentral.