ICD-10 Compliance Date Confirmed as Oct. 1, 2015
Key Takeaway: After the surprise inclusion of an ICD-10 delay in the Sustainable Growth Rate (SGR) patch by Congress in March, the healthcare industry now has an official compliance date: Oct. 1, 2015.
Why it Matters: Healthcare organizations and providers now can move forward with testing and training to meet the new ICD-10 compliance date.
This Department of Health and Human Services (HHS) final rule ends the debate about the adoption of ICD-10 coding because of the language included in the SGR patch, which stipulated that Centers for Medicare and Medicaid Services (CMS) could not implement ICD-10 until "at least" Oct. 1, 2015. CMS had unofficially confirmed the compliance date at the end of April through the inpatient prospective payment system proposed rule, but had yet to release a final rule until now. The Centers for Medicare & Medicaid Services released an announcement late Thursday, July 31, on the final rule.
AHRQ Asked to Study How Health IT Affects Medication Reconciliation
Key Takeaway: The lack of integration of computerized physician order entry (CPOE) and electronic health record (EHR) systems is hindering medication reconciliation, preventing physicians from following up with patients who aren't filling prescriptions, negating caregivers' ability to ensure patients are prescribed the right medication, and more.
Why It Matters: The Meaningful Use program may be influencing the way physicians approach medication reconciliation.
Last week during a National Advisory Council for Healthcare Research and Quality (NAC) meeting, the Agency for Healthcare Research and Quality's (AHRQ) advisory board, the board concluded that medication reconciliation requirements within Meaningful Use are unsophisticated and thus need to be studied. Stage 1 of meaningful use requires that eligible professionals (EPs) perform medication reconciliation "for more than 50 percent of transitions of care in which the patient is transitioned into the care of the EP."
Based on this requirement and the issues associated with current practices for medication reconciliation, the NAC wants AHRQ to study how physicians understand medication reconciliation and how EHR systems are used to capture and reconcile medication lists. This adds to the list of other AHRQ health IT research projects, including clinical decision support, health IT-enabled quality measurement, and privacy and security.
National Coordinator Estimates Information Exchange Capability Will Cost $500M
Key Takeaway: The Office of the National Coordinator for Health IT (ONC) and other agencies are starting to address interoperability issues. Hospitals, providers and researchers have been frustrated with the lack of interoperability between systems, even as more providers implement EHRs to participate in the EHR Incentive Program.
Why It Matters: Despite the investment in health information exchanges across the country, interoperability issues remain in the healthcare system.
At an AHRQ meeting last week, Karen DeSalvo, M.D. national coordinator for health IT, stated that a national health information exchange infrastructure would cost $500 million, and she added that physicians should not be expected to pay for it because that will discourage them from participating. "You want it to be free so you are encouraged to use it all the time," she added.
She acknowledged that policymakers had pushed policy changes quickly, and unfortunately many hospitals and providers have not seen a return from their investment in EHRs. She wants to continue to make changes to ensure that the exchange of information is seamless, but privacy and security issues, as well as other concerns, would have to be addressed first.
Regional Extension Centers (RECs) also were discussed at the meeting. DeSalvo said she believes that most RECs could be sustainable without federal funding, but only if other forms of investment continue. One thing is certain for RECs, EHRs and interoperability - more work and funding will be needed to achieve the ultimate goal of the programs of improving care quality, lowering healthcare costs and improving outcomes.
Legislation & Politics
VA Reform Bill Includes $10 Billion for Vets to Seek Care Outside of VA System
Key Takeaway: In response to the scandal surrounding waiting times at Department of Veterans Affairs (VA) facilities, House and Senate leaders reached an agreement this week to allow veterans to receive healthcare from private providers and hospitals.
Why it Matters: Before adjourning for summer recess, the House and Senate are expected to pass the conference report accompanying HR 3230, the Veterans Access, Choice, and Accountability Act of 2014, which provides $10 billion for veterans to seek care outside the VA system. The legislation establishes a program allowing veterans who have been unable to obtain care from the VA within 30 days of seeking an appointment to receive care from certain private and federally sponsored health providers.
According to the bipartisan agreement, the VA can enter into contracts or intergovernmental agreements with private providers that participate in Medicare, federally qualified health centers, Defense Department medical facilities or clinics operated by the Indian Health Service.
Covered services will include all follow-up treatments and services associated with the specific medical episode; the length of such treatment is limited to 60 days. Negotiated reimbursements for services provided at non-VA healthcare facilities will be capped at existing Medicare rates, unless care is provided in a remote rural area. The program will terminate after three years or when funding is exhausted.
In addition to establishing an electronic waiting list that would be made available to veterans through the VA's personal health records website, the VA also will need to share health quality metrics within 180 days of the law's enactment and provide updates annually. The quality metrics for VA facilities also will be made available via the Hospital Compare website.
The bill also will extend the authorization of the Project ARCH (Access Received Closer to Home) pilot program for two years from the bill's enactment. Under the program, the VA contracts with private healthcare organizations to provide care to veterans who reside in a pilot area and live more than a 60-minute drive from the nearest VA health facility. The current Project ARCH pilot areas include Northern Maine; Farmville, Va.; Pratt, Kan.; Flagstaff, Ariz.; and Billings, Mont.
Additionally, the bill requires the VA to expand telemedicine. It instructs the VA to revisit plans for how its 300 vet centers use 70 centers equipped with mobile technologies to reach veterans in rural and underserved areas.
The legislation is expected to pass both the House and Senate before they adjourn for summer recess.