AMA letter to CMS: Repeal ICD-10

Written by Jill Raykovicz

On Wednesday, the American Medical Association wrote a letter to the US Department of Health and Human Services calling for a repeal of the ICD-10 implementation, slated to be required by all covered entities October 1st, 2014.  AMA Executive Vice President and CEO, Dr. James L. Madara, reasoned ICD-10  “is not expected to improve the care physicians provide their patients and, in fact, could disrupt efforts to transition to new delivery models.”

Financial Burdens and Vendor Readiness

Dr. Madara voiced particular concern for smaller sized practices, where some estimates of the ICD-10 price tag could reach over $225,000, which, he writes, merely compounds other financial hardships such as costs to comply with Stage 2 Meaningful Use, overcoming any impending ePrescribe and PQRS penalties, as well as mitigating the 2 percent across-the-board sequestration cuts now pushed into 2023.

The letter released the results of a report by Nachimson Advisors, which revealed fewer than half (47 percent) of physicians say their practice management system vendor plans on delivering an ICD-10 software upgrade. Of those who are expecting an upgrade, 26 percent expect to receive it before April, 24 percent before July, 13 percent before October, and 1 percent after the October 1st deadline.  These timelines, the AMA argues, is insufficient to perform the necessary testing to ensure the software is working as intended.

Dr Madara also implored Medicare to conduct true end-to-end testing with at least 100 different physician practices of varying size and specialties.  Dr. Madara writes, “We believe end-to-end testing is essential for ensuring the health industry will not suffer massive disruptions in claims and payment processing and ultimately risk physicians’ ability to care for their patients.”

Advance Payment
 Options

Dr. Madara also appeals for an “Advance Payment” policy for the more serious cases that would jeapordize a provider’s ability to treat Medicare patients due to non-payment of services. This would apply to those services that have been submitted but not yet paid for date of service after October 1st, 2014, where the provider has already tried unsuccessfully to recoup payment from their contractor but is still weeks or months away from receiving reimbursement.  Dr. Madara reminds CMS a similar policy went into effect after the implementation of the National Provider Identifier (NPI) in 2008, and proposed the following parameters where advance payment would be afforded to providers:

1. When a physician has submitted claims but is having problems getting the claim paid to reach the contractor due to problems on the contractor’s end
2. When a physician has not been paid for at least 90 days
3. When they attest that at least 25 percent of their patients are Medicare and;
4. When they attest that at least 25 percent of their reimbursements are from Medicare.

Two-Year Implementation Grace Period

To battle the learning curve physicians and coders will experience as they gain a better understanding of the specificity required for ICD-10, Dr Madara proposes a two-year “implementation period” during which Medicare will not be allowed to deny payment based on the specificity of the ICD-10 code, and provide feedback to the physician on any coding concerns.  Medicare would also agree not to recoup payment due to lack of ICD-10 specificity during this grace period.

Conclusion

While the AMA confirms their commitment to the successful transtion to new payment and delivery models, and the adoption of technology to promote care coordination,  the letter concludes that  ICD-10 is “unlikely to improve the care physician provide to their patients and takes valuable resources away from implementing delivery reforms and health information technology”.

Coming to a Medical Practice Near You: HIPAA and Hi-Tech Audits

On December 26, 2013, the U.S. Health and Human Services Office of Civil Rights (“OCR”) announced its first settlement with a covered entity for not having policies and procedures in place to address the breach notification provisions of the Health Information Technology for Economic and Clinical Health (“HITECH”) Act. Adult & Pediatric Dermatology, P.C., (“the Practice”) of Concord, Massachusetts agreed to settle potential violations with a $150,000 penalty and corrective action plan.

In 2011, the Practice notified OCR that an unencrypted thumb drive containing the electronic protected health information (“ePHI”) of approximately 2,200 individuals was stolen from a staff member’s vehicle. OCR launched a subsequent investigation and found that the Practice had failed to conduct an accurate and thorough analysis of the potential risks and vulnerabilities of confidential ePHI as part of its security management process.  Further, the Practice did not fully comply with requirements of the Breach Notification Rule to have in place written policies and procedures and train workforce members.

The Final Omnibus Rule has been discussed at length on this blog and compliance was mandated by September 23, 2013. Providers should already have policies and procedures implemented to correspond with the Final Rule, reflect current technology, and address ePHI. The OCR’s December settlement, however, serves as a startling reminder that providers of every size are being audited. No entity is too small and medical practice practitioners are gravely mistaken if they think they are off OCR’s radar.

The importance of HIPAA risk analysis cannot be stressed enough. The Practice failed to have a risk analysis and paid the costly consequences. Not only is an analysis required as the first step in HIPAA Security Rule compliance, but it is also a Core Measure of Stage 1 and 2 “Meaningful Use.”

The Practice’s troubles began over a lost thumb drive. Does your practice use thumb drives? How about laptops? Mobile phones? Have you accounted for the use and misuse of these devices in your HIPAA risk analysis?

 
Originating Source

Independent Physicians Lag Behind with EHRs

Adoption and use of health IT increased significantly from 2009 to 2012, though there is a sizable gap between the adoption levels of large and small practices.

A study by The Commonwealth Fund measured changes in health IT use over that four-year period. The study found that the percentage of physicians able to electronically send prescriptions to pharmacies rose from 34% to 66% and electronic prescribing increased from 40% to 64% over that timeframe. Adoption of electronic records is where the difference between practice sizes was most pronounced: Only half of solo physicians use EMRs, while more than 90% of physicians in practices with 20 or more physicians do so.

A lack of resources is one explanation why independent physicians and smaller practices aren’t turning to health IT solutions at the same rate as larger ones. Independent physicians’ responses to an athenahealth Inc. survey reflected this sentiment. Fewer than half of independent physicians not associated with hospitals felt the financial and care benefits of EHRs exceeded the costs, while greater than half of their employed peers felt the same.

Independent physicians’ unwillingness to take on major business costs (including those associated with EHRs) is likely contributing to the shrinking number of independent doctors in the U.S. Statistics from Accenture show the percentage of independents sunk from 57% in 2000 to just 39% in 2012. A large majority (87%) of doctors cited business costs and expenses as a top concern and a reason why they’d consider abandoning their independent status.

A data brief from the National Center of Health Statistics (NCHS) focused on physicians’ widespread use of EHR technology. The NCHS data showed that in 2013 78% of all office-based physicians were using some type of EHR, an increase from  18%  in 2001 — something Karen Desalvo, national coordinator for health IT, noted in a recent blog post. Meaningful use incentives are driving many providers to adopt EHR systems. The NCHS brief reported that 69% of physicians intend to participate in the Medicaid or Medicare EHR incentive programs, though only 13% of them had EHR systems in place to support 14 of the 17 stage 2 core objectives. Those statistics represent a fear of independent physicians — adopting an EHR system without qualifying for reimbursement payments.