October 5, 2012
By Allison Cohen*
CMS Revises Hospital Readmission Penalties
Kaiser Health News (10/2) reports that the Centers for Medicare & Medicaid Services made changes to readmission penalties required by the Affordable Care Act after the agency discovered that, contrary to the statutory requirement, claims from before July 1, 2008, were inadvertently included in their evaluations. The modifications resulted in reimbursements that averaged .02% of typical Medicare reimbursements.
Prevalence of Missing Data is Compromising Integrity of Medical Research
MedPage Today (10/4) reports that a National Research Council has identified missing data as a serious problem that must be addressed to protect the integrity of clinical trials. The problem generally arises when investigators lose touch with trial participants who stop treatment before completion of the study and then try to fill in the data gaps with estimates of how the participants would have performed if they had remained in the clinical trial. Panel members presented recommendations that would help modify trial design and conduct to reduce the risk of missing data. The New England Journal of Medicine has also indicated that it will be stricter about manuscripts that attempt to use statistical methods in lieu of missing data.
MedPAC Considers Further Efforts to Equalize Reimbursement Rates
Congressional Quarterly (10/4) reports that the Medicare Payment Advisory Commission (MedPAC) is evaluating whether they can equalize reimbursements in outpatient hospital departments and stand-alone doctors' offices for ambulatory care services. This comes after Congress seemed receptive to MedPAC's recommendation in March to lower and equalize payments to outpatient departments for evaluation and management services. MedPAC claims the rate adjustment would save $1 billion to $5 billion for Medicare over five years. Reasons cited for maintaining the different reimbursement rates include the idea that hospitals have to shoulder the costs of additional services they must provide to the uninsured and underinsured, and that they have to treat sicker patients. Therefore, additional cuts to reimbursement could negatively impact access to services for low-income patients. (Note: registration is required to access this article.)
The Role of Networks in Avoiding Readmissions
Kaiser Health News (10/2) reports that in order to avoid readmission penalties that the Centers for Medicare & Medicaid Services imposed this week, hospitals need to have the resources and infrastructure to connect with outpatient settings. Denver Health is one example of a hospital that currently does not admit many patients and coordinates patient care through a network of neighborhood clinics.
The ACGME Expands International Program
American Medical News (10/1) reports that the Accreditation Council for Graduate Medical Education (ACGME) established an international program to accredit graduate medical education programs abroad. The goal is to raise standards and training in other countries in order to improve quality of care. ACGME will work with countries to modify the U.S. model to suit their patient populations. The initiative started in Singapore, and in its second phase, it is focused on countries in the Middle East. International accreditation is on a voluntary basis, but ACGME has received many requests from institutions and countries all over the world. Other important purposes of the international program are to help other countries retain doctors and to address concerns that there will be less opportunities for international medical graduates to train in the United States.
*We would like to thank Allison M. Cohen, Esquire (Arlington, VA), for providing this week's update.