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Opioids a National Public Health Emergency: A Presidential Declaration, a Comprehensive Report

November 8, 2017


Following on the heels of President Trump’s declaration of the opioid epidemic as a national public health emergency, the president’s commission on the opioid crisis last week issued its final report containing more than 50 recommendations for addressing what has been called the most serious drug problem in U.S. history.  The report, the heightened focus on opioid addiction and overdose deaths spurred by the president’s directive, and actions by the Centers for Medicare and Medicaid Services (CMS) and other agencies are sure to impact healthcare providers in several spheres, including prescribing, treatment, prevention, documentation and compliance, diversion prevention, fraud and abuse detection, and reimbursement.


Consumers Expect More from their Healthcare Experience

November 1, 2017


The level of respect, compassion and sensitivity to healthcare consumers is increasingly being used to judge patient satisfaction regarding quality of care and is an important component of a healthcare system’s care delivery.


A Refresher for Healthcare Providers on Business Associate Agreements: Are Your Contracts in Order?

October 25, 2017


Under the HIPAA Omnibus Rule, failure to have written business associate agreements in place can lead to sizable fines and penalties for covered entities. In 2015, for example, Raleigh Orthopaedic Clinic, PA, of North Carolina paid $750,000 to settle charges that it potentially violated the HIPAA Privacy Rule by sharing patient protected health information (PHI) with a potential business partner without executing a business associate agreement. The vendor had agreed to transfer x-ray images to electronic media in exchange for harvesting the silver from the films.


Hospitals Take on ‘Food Insecurity’ to Impact Population Health

October 11, 2017


As healthcare delivery shifts toward population health management, hospitals and health systems are beginning to understand—and take steps to address—the connections between a wide range of socioeconomic factors and the health and well-being of the communities they serve.  One of these factors is “food insecurity,” which the U.S. Department of Agriculture defines as a household-level economic and social condition of limited or uncertain access to adequate food with either disrupted eating patterns or reduced food intake.  The USDA reported that this social determinant of health affected more than 15.8 million (12.7 percent) households in 2015.


Final Two Deadlines Loom for Medicare Quality Payment Program

October 4, 2017


The Medicare Quality Payment Program (QPP) began on January 1, 2017, and required that eligible physicians and certain non-physician practitioners participate in either the Merit-Based Incentive Payment System (MIPS) or an advanced Alternative Payment Model (APM).  MIPS-eligible clinicians who do not participate in either track in 2017 will receive a four percent penalty in their 2019 Medicare reimbursement.


OIG Zeroes in on Opioid Misuse, Abuse, Diversion and Fraud

September 27, 2017


Addiction experts report that the opioid epidemic is shifting more to the illicit trade of heroin and fentanyl.  However, that doesn’t diminish the central role that prescription painkillers continue to play in this public health crisis.  Nor does it diminish the responsibility of physicians, nurse practitioners, physician assistants and healthcare facilities to ensure that opioids, when they are prescribed, are prescribed judiciously and used carefully, and that patients are closely monitored and educated early on about the risk of opioid dependence.  (See Centers for Disease Control and Prevention Guideline for Prescribing Opioids for Chronic Pain.)  In 2015, the number of opioid-related deaths exceeded 33,000 for the first time.  Nearly half of these deaths were related to prescription opioids.


How Has Natural Language Processing Technology Changed Healthcare?

September 20, 2017


When you search on your smartphone for something by saying “OK Google,” or call on iPhone’s Siri for assistance, or ask Amazon’s Alexa for help, the system knows that “CA” means “California.”  But when you search for something on SharePoint, or in a clinical record, or even across multiple systems, does the system recognize the intent of your search?  Unless you are using some sort of Natural Language Processing (NLP), the answer is “no.”  NLP was created to understand the meaning of any text, interpret the user’s request, and match the answer to the intent.


Emergency Waivers Help Providers Care for Hurricane-Affected Patients

September 13, 2017


Healthcare providers, if you serve Medicare, Medicaid and Children’s Health Insurance Program (CHIP) patients in the counties and geographical areas impacted by Hurricane Irma and Hurricane Harvey, or see patients who have been displaced from their homes in these areas who are in need of care, you need to know how government payers are responding to the crises, as well as the compliance implications of their actions for your facilities.


Hurricane Harvey’s Public Health Crisis

September 6, 2017


Hurricane Harvey wreaked havoc in southeastern Texas last week.  The tropical cyclone or what is called a category four hurricane caused unprecedented and catastrophic flooding in the southeastern part of the state.  It was the first major hurricane in the U.S. since Wilma in 2005, a category five hurricane with winds of up to 185 mph.


Tips to Make the Most of Your Community Health Needs Assessment

August 30, 2017


Non-profit hospitals must conduct a community health needs assessment (CHNA) every three years and submit a report detailing the CHNA’s findings in order to comply with Section 501(r) of the Internal Revenue Service tax code and maintain their non-profit status.  The following compendium of recommendations and reminders will help your organization derive the most benefit from a CHNA and keep you on track.


CMS Modifies Bundled Payment Programs, Seeks Comments

August 23, 2017


The proposed rule change posted to the Federal Register on August 10, 2017 indicates the Centers for Medicare and Medicaid Services (CMS) will rescind the regulations governing two mandatory bundled payment programs, the Advancing Care Coordination through Episode Payment Models (EPMs) and Cardiac Rehabilitation Incentive (CRI) Payment Models, which were scheduled to start in 2018. It also proposes to revise certain aspects of the Comprehensive Care for Joint Replacement (CJR) model, including:


CMS New Rule Aims to Boost Flexibility, Innovation

August 16, 2017


On August 2, 2017 the Centers for Medicare & Medicaid Services (CMS) issued the Fiscal Year (FY) 2018 Inpatient Prospective Payment System (IPPS) final rule that updates Medicare payment and polices when patients are discharged from hospitals.  The changes, which will apply to approximately 3,330 acute care hospitals and approximately 420 long-term care hospitals (LTCHs), will affect discharges occurring on or after October 1, 2017.


Data Breach Website Helps Providers and Patients Research and Report

August 9, 2017


Among other things, the HITECH Act of 2009 requires the Department of Health and Human Services (HHS) to publish information about breaches of protected health information (PHI) involving 500 or more patients.  Following recent changes to the agency’s website, that information still appears, but if the breach is 24 months old or older, it now appears in an archive rather than on the main page.  The website now includes a front page featuring a list of more recent incidents that are still under investigation by the Office of Civil Rights (OCR) as well as a separate archive of older, resolved breaches.


Industry Groups Fuming about OPPS Proposed Rule Cuts of 340B Payments

August 2, 2017


The Centers for Medicare & Medicaid Services (CMS) is pursuing changes that would cut 340B payment rates to hospitals and may impair safety-net hospitals' ability to treat low-income patients.


OIG Announces New Work Plan Process

July 26, 2017


The Department of Health and Human Services, Office of Inspector General (OIG) has announced that it is converting to a "dynamic, web-based Work Plan" format.  Under this new policy effective June 15, 2017, Work Plan updates that have historically been released once or twice each year will now be released monthly in order to "enhance transparency around OIG's continuous work planning efforts" and more effectively "respond to emerging issues."


Six Cybersecurity Imperatives: National Task Force Maps a Cohesive Plan for Healthcare

July 19, 2017


Healthcare’s uniquely and inherently open and sharing culture enables healthcare professionals and facilities to carry out their very important work.  But this same openness, which includes an increasing number of disparate but connected health information systems, also makes healthcare uniquely vulnerable to myriad types of intrusions on the privacy and security of its information, and puts the sector at risk for harmful, even life-threatening criminal misuses of that information.


25 Keys to a Patient-Centric Revenue Cycle

July 12, 2017


Optimizing your revenue cycle management process is a key component for addressing a multitude of industry trends such as changes in regulations, consumerism and new reimbursement structures.


Medicare Reimbursement Policy Changes Under the 21st Century Cures Act

July 5, 2017


The 21st Century Cures Act (CCA) has been proclaimed by some policymakers to be “the most important legislation” Congress passed in 2016.  Among many important provisions relating to precision medicine, drug innovation, telemedicine and mental health reform, the CCA also includes several potentially high-impact Medicare reimbursement policy changes set to take effect starting this year and into 2019.  Those policy changes include site-neutral payment exceptions, adjustments to the penalty calculation formula under the Hospital Readmissions Reduction Program, new codes to bridge outpatient and inpatient surgical procedures, and suspension of the 25 Percent Rule for long-term care hospitals.


CMS Actuary and Congressional Budget Office Differ on Predictions for Costs and Uninsured for the AHCA

June 28, 2017


The Centers for Medicare and Medicaid Services (CMS) Office of the Actuary has estimated that the House-passed American Health Care Act (AHCA) would reduce insurance coverage by 13 million people by 2026—10 million less than the Congressional Budget Office's (CBO's) prediction.


How Physician Compare’s New Five-Star Ratings Will Impact Clinicians and Healthcare Organizations

June 21, 2017


In late 2017, the Centers for Medicare and Medicaid Services (CMS) will implement a new benchmark and five-star quality rating system for clinicians and group practices on Physician Compare, the website mandated by the Affordable Care Act (ACA) to help patients, families and caregivers make more informed choices regarding healthcare services.  The changes will ramp up the level of information readily available to patients and others about individual clinician and group practice performance on clinical quality measures, and push healthcare providers into a new phase of accelerated transparency.  Healthcare consumer sites such as Healthgrades and Vitals are likely to incorporate the information into their own portals.


CHRONIC Care Act Proposes Big Boost in Home, Telehealth Services

June 14, 2017


On May 18th, the Senate Finance Committee unanimously approved a bill designed to improve care for Medicare beneficiaries with chronic conditions.  The Creating High-Quality Results and Outcomes Necessary to Improve CHRONIC Care Act (CCA) of 2017 would increase access to telehealth services for Medicare beneficiaries with chronic illnesses—including those in Medicare Advantage (MA) plans—as well as provide more incentives for enrollees to receive care through accountable care organizations (ACOs).


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