Dear NVOS Members,
The articles contained in this e-newsletter are excerpted from AAOS newsletters and other media sources to help our members stay current on national issues.
The NVOS Staff |
New Online Database Compiles Hospital Inspection Reports
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 The Association of Health Care Journalists has launched a free, searchable news application that compiles thousands of federal inspection reports for hospitals around the nation since January 2011. The database includes results of government inspections of acute-care hospitals and critical-access hospitals resulting from complaints. It does not include reports of deficiencies found at psychiatric hospitals or at long-term care hospitals, nor does it include the results of routine hospital inspections or the hospitals' plans of correction-required if a hospital is to continue to receive reimbursement for care of Medicaid and Medicare patients. The database was produced collaboratively with the U.S. Centers for Medicare & Medicaid Services.
Read more...
View the database website...
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JAMA: Physicians Should Be Educated In Billing And "Program Integrity."
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An opinion piece published in the March 20 issue of the Journal of the American Medical Association (JAMA) argues that physicians should be formally educated in "program integrity"-an insurance industry term that describes program losses due to inefficiency, inappropriate payments, and exploitation. Although the authors state that few physicians intentionally abuse or defraud the billing system, the U.S. Centers for Medicare & Medicaid Services identified an 8.6 percent overall Medicare fee-for-service payment error rate during 2011, with insufficient documentation, lack of medical necessity, and coding errors identified as the prime drivers for improper payments.
Read an excerpt...
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CMS Reverses Policy On Denied Hospital Reimbursements For Medically Necessary Care
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HealthLeaders Media reports that the U.S. Centers for Medicare &  Medicaid Services (CMS) has announced an interim rule that changes the agency's policy of denying reimbursements to hospitals that provide medically necessary care determined by auditors to have been delivered inappropriately in an inpatient setting. Hospitals have complained about a process that allows private recovery audit contractors to comb hospital records years after care is delivered to flag questionable payments. In a suit filed last year, the American Hospital Association and four health systems claimed that CMS had violated the Medicare Act by declining to reimburse the audited claims of hospitals, even though the claims were ultimately acknowledged by CMS to be reasonable and medically necessary. Although the move is seen as a victory for hospitals, a spokesperson for AHA says the lawsuit will continue because "the proposed rule then threatens to undermine the progress made on this important issue."
Read more...
Read the interim rule (PDF)...
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Survey Finds Physicians Concerned About Future Of Profession
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Survey data released by the Deloitte Center for Health Solutions suggest that many U.S. physicians are concerned about the future of the medical profession and fear that it may be in jeopardy as it loses clinical autonomy and compensation. The research team surveyed a random sample of 613 primary care and specialty physicians selected from the American Medical Association's (AMA) master file of physicians. Findings of the survey include the following:
- Four in 10 physicians responded that their take-home pay decreased from 2011 to 2012.
- Nine in 10 respondents said that inadequate pay and being penalized for factors out of their control are their greatest concerns about financial viability under an episode-based (bundled) payment structure.
- Eight in 10 respondents agreed that the wave of the future in medicine over the next decade involves interdisciplinary teams and care coordinators.
Read more...
Read the complete survey (PDF)...
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Congress Considers Increased Limits On Hydrocodone Painkillers
|  According to The Hill, bills under consideration in both houses of the U.S. Congress would, if enacted, move hydrocodone medications from Schedule III to Schedule II under the Controlled Substances Act. Such a move would put those drugs in the same category with other painkillers such as morphine, fentanyl, and oxycodone, and among other things, would require patients to present a written prescription in order to obtain the medication.
Read more...
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IOM Finds Deeply Embedded Geographic Variation In Healthcare Spending
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An interim report on geographic variation in healthcare spending released by the Institute of Medicine (IOM) observes that, even after adjusting for variables such as wages, rents, and attributes of Medicare patient populations, including age and health status, a significant amount of regional variation in Medicare payments remains unexplained. Overall, differences in Medicare patients' age, sex, and health contribute to, but do not fully explain all the variation. The authors of the report also note that the magnitude of spending on post-acute care in some areas raises concerns about potential fraud, and state that any amount of fraud would weaken the effectiveness of a geographic value index by reducing reimbursement to legitimate providers.
Read more...
Read the IOM press release...
Read the complete report...
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Study: Many Providers Use "Workarounds" To Adapt To Limits Of EMR Systems
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A study published online in the Journal of the American  Medical Informatics Association examines provider habits and the ways they use or circumvent (work around) electronic medical records (EMR) systems. The authors collected qualitative data on 120 staff and providers across 11 primary care outpatient clinics and found that EMR users engaged in workarounds in 10 of 11 previously identified categories. All 10 categories applied to paper-based workarounds, and five applied to computer-based workarounds as well. The most consistent reasons for workarounds were efficiency, memory, and awareness. The authors write that an examination of workarounds provides insight into how providers adapt to the limits of EMR systems, and argue that the design process for computer interfaces should include user-centered methods particular to providers and healthcare settings to ensure uptake and usability. Read more...
Read the abstract...
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OIG Issues Fraud Alert Regarding PODs; Considers Them "Inherently Suspect."
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The U.S. Department of Health and Human Services Office of Inspector General (OIG) has issued a Special Fraud Alert regarding physician-owned distributorships (PODs). The office states that it considers PODs "inherently suspect under the anti-kickback statute," and lists a series of POD characteristics it finds "suspect," including but not limited to the following:
- The size of the investment offered to each physician varies with the expected or actual volume or value of devices used by the physician.
- Distributions are not made in proportion to ownership interest, or physician-owners pay different prices for their ownership interests.
- Physician-owners condition their referrals to hospitals or ambulatory surgery centers on the purchase of devices from the POD through coercion or promises.
- The POD does not maintain continuous oversight of all distribution functions.
OIG states that, should a POD, or an actual or potential physician-owner, have questions about the structure of a particular POD arrangement, the OIG Advisory Opinion process remains available.
Read more...
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The NVOS Website Format Has Been Updated!
NVOS Website |
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Save the Date
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2013 NVOS Annual Meeting
April 26-27, 2013
Tropicana
Las Vegas, NV
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2012-2013 Board of Directors
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President
Eric Boyden, MD
Immediate Past President
Hugh Bassewitz, MD
Vice-President
Abdi Raissi, MD
Secretary
Colby Young, MD
Treasurer
Gregg Lundeen, MD
Members At Large
Chad Hanson, MD
Ronald Hillock, MD
Jedediah Jones, MD
Dan Lee, MD
Terrence Orr, MD
James Rappaport, MD
AAOS Board of Councilors
Hugh Bassewitz, MD,
Nevada Representative
Fred Redfern, MD,
Chair
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