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D.C. Report: ED Patients Addressed in FAQ, Direct Project, Medicare Payment Fix Approved

December 6, 2010
by Sharon Canner
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Sharon CannerSr. Director of Advocacy

ED Patients Addressed in FAQ. A number of measures for meaningful use objectives for eligible hospitals and critical access hospitals (CAHs) include patients admitted to the Emergency Department (ED). To clarify which ED patients can be included in the denominators, CMS yesterday released a clarification. This came after some confusion around a CMS 9/17 FAQ on ED patients. Questions since that time have focused on observation patients and on the language of the regulation that would allow for a reading that counts all emergency department visits, and not just those identified in the September 17th FAQ.

The FAQ issued yesterday allows eligible hospitals and CAHs, as an alternative for Stage 1 of meaningful use, to use a method that is consistent with the plain language of the regulation. Hospitals will now have a choice of which emergency department patients to consider when demonstrating that they have met the "meaningful use" requirements. The first option—the "Observation Services method"—is consistent with previous guidance and includes patients admitted directly to inpatient departments, patients presenting to the ED and subsequently admitted, and patients treated in the ED and provided observation services. The new option— "All ED Visits method"—includes those patients plus patients treated and discharged directly from the ED.

HIT Standards Committee Hearing on Early Adopters. As the January registration date nears for the incentive program, the Standards Committee Implementation Workgroup wants to hear about both successes and barriers to achieving meaningful use. Hearings—“Real World Experiences Working with Meaningful Use”—set for January 10-11 will feature panels of eligible professionals and large and small integrated delivery networks (IDNs) seeking attestation; regional extension centers and certifiers; meaningful use criteria with feedback on workforce issues, metrics, and vendors. Witnesses will include both those seeking to attest for MU in 2011 and those not expecting to participate next year. The workgroup wants to hear about successes as well as the barriers, challenges and how hospitals and EPs have addressed these issues. Of special interest are real-world user stories and examples. CHIME is expected to provide a witness for the hearings.

Also announced at the Standards Committee meeting earlier this week, was a re-naming of NHIN Direct to “The Direct Project.” The latter is designed to be a secure, scalable, standards-based way for participants to send authenticated, encrypted health information directly to known, trusted recipients over the Internet. The Nationwide Health Information Network (NHIN), on the other hand, will provide a foundation for the exchange of health information across diverse entities, within communities and across the country.

One-Month Medicare Payment Fix Approved. Earlier this week, the House approved legislation that will delay for one month a scheduled 23 percent cut to Medicare physician payment rates. Given approval by the Senate in November, the administration has indicated that the president would sign the bill before the scheduled cut takes place on Wednesday. The measure includes a 2.2 percent payment increase at a cost of $1 billion. This will be fully offset through Medicare reimbursement cuts for certain outpatient therapy services. A one-month reprieve will allow Congress time to come up with a longer term solution. Cost of a longer-term fix will be expensive, however, estimated at $19 billion for 12 months.