Home News Briefs September 2006 News Briefs

September 2006 News Briefs

September 2006

Published in the September 2006 issue of Today’s Hospitalist

Proposed changes in work values would boost payments to hospitalists

The Centers for Medicare and Medicaid Services (CMS) has proposed sweeping changes to work relative value units (RVUs) for inpatient and outpatient visits and consultations.

If approved, the changes would constitute the biggest work-RVU increase since the physician fee schedule was instituted in 1992. They would also dramatically increase payments for many hospitalist services.

According to an analysis by the Society of Hospital Medicine (SHM), the changes would result in the following percentage RVU increases:

“¢ Work RVUs for initial hospital care codes (99221-99223) would rise between 20 percent and 47 percent.

“¢ Work RVUs for subsequent hospital visit codes (99231-99233) would go up between 19 percent and 32 percent.

“¢ Work RVUs for hospital discharge codes (99238-99239) would increase by up to 9 percent.

In addition, work RVUs for initial consultation codes (99251-99255) would jump between 10 percent and 52 percent.

Changes in work RVUs affect more than 50 percent of the total payment for each service. Hospitalists could see their payment for CPT 99223 increase by nearly $16, for example, while the payment for CPT 99233 would rise by almost $12.

Because of budget neutrality requirements, the CMS is proposing to decrease the work RVU by 10 percent for each service. Despite that reduction, however, the CMS is estimating that payments to internists in 2007 “if proposed changes take effect “will rise by about 5 percent.

The CMS will publish its final rule on work RVU changes in November.

Final hospital payments for 2007 not as harsh as expected.

In other reimbursement news, the CMS issued good news for hospitals last month when it dramatically scaled back proposed cuts in its final 2007 prospective payment rule.

The agency had previously proposed cutting payments for some inpatient treatments and procedures “including reimbursement for cardiac procedures “by as much as 20 to 30 percent. The CMS now estimates that only 2 percent of American hospitals next year will face cuts in payment.

The final rule establishes much smaller cuts for hospitals, and it even proposes increases for many of those same procedures and treatments. The final rule also scales back on increases that were originally proposed for such conditions as chronic obstructive pulmonary disease and pneumonia.

The rule, which takes effect Oct. 1, marks the beginning of a major revision in how patients are classified. By taking into account patients’ severity of illness, the changes are intended to produce a more accurate payment system that is based on actual costs, not hospital charges. The new classification system is expected to be phased in over the next three years.

The CMS announced that it had made other changes in releasing details of the final rule. The agency, for example, had proposed changing the current DRG payment system to institute more than 300 new diagnostic categories.

The final rule for next year, however, includes only 20 new diagnostic categories to better reflect illness severity. In addition, changes have been made to more than 30 other categories.

The final rule also includes a 3.4 percent market basket update for hospitals that report quality measure data. To receive the full update, hospitals must submit data on 11 additional measures that target care for heart attack, pneumonia, heart failure and surgical care, as well as on 10 previously required quality measures. (See “New items on the CMS list of quality measures.") [LINK TO NEXT ITEM] Hospitals that don’t report the quality measure data will receive an update of only 1.4 percent.

The CMS estimates that hospital payments in 2007 will increase by 3.5 percent, or more than $3.4 billion.

New items on the CMS list of quality measures

To receive a full fee update in 2007, hospitals will have to report data to the Centers for Medicare and Medicaid Services on 21 quality measures, which represents an increase of 11 measures over last year. Measures in bold are new for fiscal 2007:

Heart attack
“¢ Aspirin at arrival
“¢ Aspirin prescribed at discharge
“¢ Beta-blocker at arrival
“¢ Beta-blocker at discharge
“¢ ACE inhibitor or ARB for left ventricular systolic dysfunction
“¢ Thrombolytic agent received within 30 minutes of hospital arrival
“¢ Percutaneous coronary intervention received within 120 minutes of hospital arrival
“¢ Adult smoking cessation advice/counseling

Heart failure
“¢ Left ventricular function assessment
“¢ ACE inhibitor or ARB for left ventricular systolic dysfunction
“¢ Discharge instructions
“¢ Adult smoking cessation advice/counseling

Pneumonia
“¢ Initial antibiotic received within 4 hours of hospital arrival
“¢ Oxygenation assessment
“¢ Pneumococcal vaccination status
“¢ Blood culture performed before first antibiotic received in hospital
“¢ Adult smoking cessation advice/counseling
“¢ Appropriate initial antibiotic selection
“¢ Influenza vaccination

Surgical infection prevention
“¢ Prophylactic antibiotic received within 1 hour prior to surgical incision
“¢ Prophylactic antibiotics discontinued within 24 hours after surgery end time
Source: Centers for Medicare and Medicaid Services, Premier Inc.

New 2007 patient safety goals

The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) recently released its list of 2007 national patient safety goals and requirements, expanding those goals for accredited hospitals and critical access facilities.

New 2007 JCAHO goals and requirements include the following:

“¢ a new requirement to define and communicate the means patients and families can use to report safety concerns;

“¢ a new requirement that hospitals and critical access facilities identify patients at risk for suicide; and

“¢ two new requirements under the existing medication reconciliation goal to provide patients with a complete list of current medications on discharge.

A complete list of JCAHO’s 2007 patient safety goals and requirements is online.

JCAHO launches inpatient diabetes care certification program

The American Diabetes Association is working with the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) to establish the country’s first inpatient diabetes care certification program.

In announcing the program this summer, officials said they hoped it would lead to greater standardization and monitoring of hospital diabetes care. Hospitals seeking certification will undergo an on-site review of their compliance with national care standards and clinical guidelines for managing diabetes patients.

The review will also assess hospitals’ performance measurement and quality improvement activities, as well as clinician qualifications, processes to encourage patient self-management and the use of information technology to monitor patient management.

More than $40 billion is spent every year on hospital care for the 14 million Americans with diabetes.