News in brief - May 9, 2011

Medicare hospital pay-for-performance set to launch in 2012

Hospitals and other facilities will be rewarded for improving the quality of care they provide to patients starting in October 2012, the Centers for Medicare & Medicaid Services announced on April 29.

An estimated $850 million has been allocated for hospitals that meet quality measures under the new value-based purchasing system. The Medicare agency plans to offset the bonus pool by reducing the total pay to all hospitals under the inpatient prospective payment system by 1% next year, said CMS Administrator Donald M. Berwick, MD.

CMS outlined at least four targets hospitals must hit to qualify for bonuses. They are:

• Ensure that patients who may have had a heart attack receive care within 90 minutes.
• Provide care to surgery patients to prevent blood clots within a 24-hour window.
• Communicate discharge instructions to heart failure patients.
• Ensure that hospital facilities are clean and well-maintained.

Starting in 2014, hospitals will face reductions in pay for not meeting quality objectives, Dr. Berwick said.

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CVS agrees to $17 million Medicaid fraud settlement

CVS Pharmacy Inc. will pay the government more than $17 million to resolve allegations that the company filed false claims with 10 state Medicaid programs, according to a settlement announced April 15 by the Dept. of Justice.

The agency accused CVS of submitting inflated prescription claims to Medicaid programs in Alabama, California, Florida, Indiana, Massachusetts, Michigan, Minnesota, Nevada, New Hampshire and Rhode Island. The claims led to CVS being paid more than it was owed by Medicaid, the Justice Dept. said.

Under a separate settlement between the Dept. of Health and Human Services Office of Inspector General and CVS over an unrelated false billing investigation in 2008, the government said, CVS billing procedures will be monitored for three years. Officials also will conduct regular audits of CVS compliance to the agreement.

In a statement, CVS said it did not intentionally overcharge any state's Medicaid program and that the settlement was not an admission of any wrongdoing.

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Former AMA president to advise CMS innovations center

Nancy H. Nielsen, MD, PhD, past president of the American Medical Association, has been named to serve a one-year appointment as an adviser to a new federal health innovations office.

Dr. Nielsen will be senior adviser for stakeholder engagement at the Center for Medicare and Medicaid Innovation, an office created at the Centers for Medicare & Medicaid Services by the health system reform law. The internist, who served as AMA president from June 2008 to June 2009, said the office is about identifying best practices for improving the programs.

"The goals of the center have been termed a 'triple aim' of better health for communities, better care when people need care and lowering of costs," Dr. Nielsen said in a statement. "And we think there's plenty of ways to do that. It's not a matter of withholding health care benefits; it's a matter of giving doctors tools and empowering them to deliver care in a way that they know is better for their patients and actually gives them more joy in their work."

When Dr. Nielsen's one-year appointment at the CMMI is up, she will return to the University at Buffalo's School of Medicine and Biomedical Sciences in New York to serve as senior associate dean for health policy, the university said in a statement.

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Work-based coverage declined by record percentage in 2009

The percentage of Americans covered by employer-sponsored health insurance decreased to 52% in 2009, down from 53.3% in 2008. This is the largest one-year decline in two decades, according to "The Impact of the 2007–2009 Recession on Workers' Health Coverage" by the Employee Benefit Research Institute, a nonpartisan research organization based in Washington, D.C. The percentage of people with dependent coverage also fell in 2009 to 16.3%, a drop of 0.7 percentage points.

"As we start to examine the data from 2010, we will be able to determine whether the economic recovery has started to have an effect on health benefits among workers who lost coverage during the recession," said Paul Fronstin, PhD, report author and director of EBRI's Health Research and Education Program.

Employee-sponsored health insurance is still the single-largest type of health coverage Americans have. In 2009, 16.7% of Americans were covered by Medicaid or the Children's Health Insurance Program; 6.3%, by individual coverage; and 3%, by Medicare or military coverage. Almost 19% were uninsured.

The report is available online (www.ebri.org/pdf/briefspdf/ebri_ib_04-2011_no356_rccsn-hlthcvg.pdf).

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HHS certifies Indian Health Service EMR for meaningful use

The Indian Health Service's electronic medical record system has been certified for meaningful use -- making it the first federal system to meet requirements under the Dept. of Health and Human Services' EMR incentive program.

The IHS Resource and Patient Management System is used for 2 million American Indians and Alaska Natives at 280 facilities in 35 states. Hospitals and health professionals in the system now will be eligible for EMR bonuses authorized by the 2009 economic stimulus law.

"Our certified electronic health record will help us provide quality health care delivery to patients in the Indian health system," said IHS Director Yvette Roubideaux, MD, MPH. "The monetary incentives made available by this certification will also benefit IHS, tribal and urban Indian health facilities."

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