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December 25, 2010, 4:28 pm
By
Julian Pecquet
The conviction rate for Medicare fraud is largely flat despite the millions recently spent to beef it up.
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December 23, 2010, 5:44 pm
By
Julian Pecquet
The Centers for Medicare and Medicaid on Thursday unveiled a 73-page plan to modernize its computer and data systems, as required by the healthcare reform law. The plan aims to help the massive agency, which pays about $800 billion in healthcare benefits to 100 million Americans every year, drive the transformation of the U.S. healthcare system into one that pays for quality rather than quantity of care. The agency, according to a summary of the plan, "is focusing efforts on two fronts: to obtain more robust analytics for quality of care in light of new health care delivery models and drive quality improvements by rewarding health care providers based on quality performance metrics." To achieve those goals, the plan calls for CMS to establish an "enterprise-level capability to capture and analyze data on resource utilization, health outcomes, and cost, even as the volume and scale of its programs and data rapidly increase."
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December 23, 2010, 3:06 pm
By
Jason Millman
Implementing electronic health records (EHRs) does not guarantee higher-quality hospital care, according to a new study released Thursday.
EHRs are widely believed to help doctors deliver better and more efficient care because they can be easily shared and, in result, reduce unnecessary medical treatment. But a new Rand Corporation study said EHRs produce mixed results.
The study of more than 2,000 hospitals found facilities with basic EHRs demonstrated significantly better quality care for patients being treated for heart failure. However, hospitals with advanced EHRs did not provide higher-quality care among patients treated for heart attack or pneumonia.
“The introduction of increasingly complex technology into already complex work environments may trigger various unintended interactions that undermine or outweigh the potential benefits of the new technology,” the report said.
Lawmakers included as much as $30 billion in last year’s stimulus act to incentivize the adoption of EHR technology in accordance with federal guidelines to improve quality of care and coordination among providers.
On Thursday, the Department of Health and Human Services announced that registration for Medicare EHR incentives would begin Jan. 3. Registration for Medicaid incentives begins on the same day for doctors and hospitals in Alaska, Iowa, Kentucky, Louisiana, Oklahoma, Michigan, Mississippi, North Carolina, South Carolina, Tennessee and Texas.
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December 23, 2010, 1:24 pm
By
Julian Pecquet
The bill passed the House by voice vote but died in the Senate this
week after anonymous Republicans placed a hold on the legislation.
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December 23, 2010, 11:48 am
By
Julian Pecquet
Skilled nursing facilities have been charging Medicare for more therapy and daily care over the past few years even though "beneficiary characteristics remained largely unchanged," according to a new report. The Health and Human Services Department's Office of Inspector General in particular found that payments for "ultra high therapy" — the highest level of therapy, with the highest per diem rates — increased 90 percent from 2006 to 2008 ($5.7 billion to $10.7 billion). Also, the report found that for-profit facilities were "far more likely than nonprofit or government" facilities to bill for higher paying categories of care, and "a number" of facilities had "questionable billing" in 2008. The report makes four recommendations to the Centers for Medicare and Medicaid Services: - monitor overall payments to skilled nursing facilities and adjust rates, if necessary;
- change the current method for determining how much therapy is needed to ensure appropriate payments;
- strengthen monitoring of facilities that are billing for higher-paying payment categories; and
- follow up on the facilities identified as having questionable billing.
The report adds that the agency agrees with three of the four recommendations. The agency did not concur with the recommendation to change the current method for determining how much therapy is needed but stated it is committed to pursuing additional improvements to the payment system.
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December 23, 2010, 10:29 am
By
Jason Millman
The Senate confirmed Michele Leonhart’s nomination to lead the Drug Enforcement Administration Wednesday night, giving the agency an official leader for the first time in more than three years.
Leonhart’s confirmation was in doubt as early as Wednesday morning until Sen. Herb Kohl (D-Wis.) allowed her nomination to go through. Kohl, who heads the Senate’s Aging Committee, released a block on her nomination after receiving assurances from Attorney General Eric Holder that the DEA will work with Congress to ease restrictions on administering painkillers to nursing home patients in emergency situations.
The Senate unanimously confirmed Leonhart before it adjourned for the rest of the year. Leonhart, who had been serving as the acting administrator, was first nominated to the agency’s top spot by President George W. Bush in 2008, but the Senate failed to confirm her before the 110th Congress adjourned.
Obama upset marijuana advocates by renominating her in January. They say Leonhart has taken too tough a stance against states that have legalized marijuana for medicinal purposes.
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December 23, 2010, 9:28 am
By
Jason Millman
Sen. Grassley pushed back after Reid said there'd been "too much piddling" on the panel and negotiations were handled "poorly."
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December 22, 2010, 7:00 pm
By
Jason Millman
Welcome to The Hill's evening roundup of the day's health policy news and advance look at tomorrow's schedule.
Wednesday’s health news: Congress approve 9/11 benefits: A $4.3 billion bill providing health benefits and compensation to Ground Zero first-responders passed through Congress Wednesday afternoon after Senate Democrats struck a last-minute deal with Sen. Tom Coburn (R-Okla.), who had been blocking the bill. Failure to pass the bill Wednesday would have doomed it in the lame duck, and its chances next year were thought to be slim in a Republican-controlled House. http://bit.ly/gBRRPB
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December 22, 2010, 6:33 pm
By
Alexander Bolton and Mike Lillis
In the final vote of the 111th Congress, House lawmakers approved legislation Wednesday providing healthcare services for 9/11 workers.
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December 22, 2010, 4:28 pm
By
Jason Millman
The Medicare agency and Senate Finance Committee leaders are calling for new guidelines on Medicare quality-of-care reviews after a new report said that federal dollars may be going to waste.
The Centers for Medicare and Medicaid Services (CMS) is unable to determine if Medicare quality-of-care budgets are excessive because CMS does not provide specific guidance on how much data should be recorded on quality reviews, according to a Government Accountability Office (GAO) report released Wednesday.
Medicare enters into three-year contracts with Quality Improvement Organizations (QIOs) in all 50 states, the District of Columbia, Puerto Rico and the U.S. Virgin Islands to review whether Medicare-financed medical services meet professionally recognized standards of care. The CMS QIO budget totals about $1.1 billion through July 31, 2011, with about one-fifth going toward reviews, including quality-of-care reviews.
“Without consistent information on the volume and costs for quality of care reviews, CMS cannot ensure that the budget for these reviews [...] for each QIO is appropriate,” the GAO report said.
A 2006 Institute of Medicine Report and a 2008 CMS report both identified weaknesses in CMS’s ability to compare costs across QIOs. CMS said it would work to implement GAO’s recommendations.
“The money we spend to ensure quality healthcare should make people healthier, and effective budget guidelines from Medicare will certainly contribute to making sure we meet that goal,” said Senate Finance Committee Chairman Max Baucus (D-Mont.)
“CMS has to do a better job of tracking this work so it can pay the appropriate amount and so taxpayers get what they’re paying for, which is better quality of care for Medicare beneficiaries,” said ranking member Chuck Grassley (R-Iowa).
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