The Daily Briefing

News for Health Care Executives

Sebelius: ICD-10 will be delayed

February 16, 2012

Josh Gray Josh Gray, Financial Leadership Council

On Tuesday, Feb. 14, Marilyn Tavenner, acting head of CMS, announced to reporters that CMS would re-examine the timeline for ICD-10 implementation through its rulemaking process with an eye toward potentially delaying the ICD-10 compliance date.

She expressed concern that many providers are struggling with the workload necessary to fulfill meaningful use requirements, preparing for health exchanges, and transitioning to ICD-10, suggesting that they may need some relief. Tavenner stopped short of asserting that ICD-10 would definitely be delayed, but the statement indicated that a delay was quite possible.

On Feb. 16, the drama continued with a press release issued by Kathleen Sebelius, Secretary of Health and Human Services. Based on Sebelius’ announcement, we learned two important things that we did not know Tuesday.  

First, the ICD-10 compliance date, according to Sebelius, will be moved. According to the release, “HHS will announce a new [ICD-10] compliance date moving forward.” As the release further notes, “HHS will initiate a process to postpone the date by which certain health care entities have to comply with International Classification of Diseases, 10th Edition diagnosis and procedure codes (ICD-10).” This wording is a change relative to Tavenner’s statement that HHS would consider moving the ICD-10 compliance date. The question now is how long the delay will be and what form it will take—not whether it will occur.

Second, language about a “rulemaking process”—which was present in an early version of Sebelius’ statement that was removed from the CMS website shortly after its release—was removed from the final statement. A rulemaking process refers to a set of time-consuming, legally-required steps that need to be taken before a regulation is changed (such as the notification and comment period requirements). With that language deleted, it appears that CMS may be considering a less formal process for delaying the compliance date, which may provide more flexibility as to the timing of an ICD-10 delay. A final decision on ICD-10 postponement could therefore come sooner than was originally suggested.

Much still remains unresolved, and the current state of ambiguity is likely to persist for some time. In the meantime, though, we recommend that you maintain preparation activities for ICD-10 conversion. We continue to believe that the risk of being underprepared for ICD-10 (increased denials, increased AR days, etc.) far outweighs the risk of being ready ahead of the curve. If the conversion date is extended significantly, time frames can be adjusted once the situation is clarified.

We will continue to monitor the ICD-10 conversion issue as more information becomes available. Feel free to email me with questions at grayj@advisory.com.

Going for gold: Cleveland Clinic saves by boosting worker wellness

Employees say initiative 'kick started' their health

February 17, 2012

The Cleveland Plain Dealer recently examined the Cleveland Clinic's "Healthy Choice" program, which aims to cut costs by boosting employee wellness.

How the program works
Since 2010, more than 50% of Cleveland Clinic's 29,000 employees have participated in the Healthy Choice program. Participants are required to see a physician who assesses their health, including body mass index and smoking habits, as well as diagnoses chronic conditions, such as diabetes or asthma.

If the physician identifies any problems, they help the employee set individualized wellness goals and strategies for meeting them. Cleveland Clinic also supplies employees with various resources to help them meet their goals, such as no-cost Weight Watchers meetings, yoga classes, and gym memberships.

Rewards for employees
Cleveland Clinic employee health insurance premiums increased by 9% in 2010 and 17% in 2011, but workers enrolled in the Healthy Choice program who met their goals did not have to pay the hikes. This year, the Clinic has divided its employees into three insurance rate groups:

  • Gold group: Healthy Choice participants who met their program goals will see a 4% decrease in premiums over 2011;
  • Silver group: Healthy Choice participants who made progress but failed to meet their goals will see a 9% increase in premiums over 2011; and
  • Bronze group: Employees who did not participate in the Healthy Choice program will see a 21% increase in premiums over last year.

Employee reaction to the program
Many employees say they are pleased with the program, which they credit for helping them "jump start" their health. For example, one Cleveland Clinic employee has lost 30 pounds since March 2010 and now maintains a regular exercise schedule. In addition, her blood pressure and cholesterol levels have dropped. For her progress, she may be in the "gold" insurance category this year.

However, some workers have criticized the program, which they say takes a "big-brother" approach to health care. In online posts, some employees have said they would prefer their employer to be less involved in managing their diet and wellness.

Paul Terpeluk, the medical director of the Clinic's Employee Health Services, says the program aims to help employees "embrace health, not be punished." He notes that the system is "not forcing people to do anything, but as a health care institution, we do feel this is the right thing to do" (Theiss [1], Plain Dealer, 2/12; Theiss [2], Plain Dealer, 2/12).


Aneesh Chopra to return to the Advisory Board

Nation's first Chief Technology Officer to advise on health tech strategy

February 17, 2012

Aneesh Chopra, the nation's first Chief Technology Officer, will return to The Advisory Board Company as Senior Advisor, Health Care Technology Strategy.

Chopra had served for the past three years in the White House, before stepping down as CTO last month.

"I am excited to return to The Advisory Board Company, where I spent close to a decade of my career," Chopra said. "The firm has always been dedicated to identifying and disseminating best practice research, and I am thrilled about how the Advisory Board has grown to offer best-in-class technology products. This combination of research-driven insights and innovative software is creating groundbreaking change in the health care industry by equipping members to capitalize on the power of technology to improve health outcomes while reducing costs."

In this role, Chopra will consult with member hospitals on integral technology and open data issues, as well as contribute to the company's business development and strategic planning efforts.

"As the federal government's first CTO, Aneesh drove sweeping change with his signature optimism and passion for the transformative power of technology," according to Advisory Board CEO Robert Musslewhite. "We are thrilled to tap into his unique insights and experience to spur innovation and benefit our members."


Dr. Microchip: Implantable device effectively delivers drugs

Device treated osteoporosis patients as successfully as injections

February 17, 2012

In a finding that could revolutionize drug delivery, a new study in Science Translational Medicine showed that a wireless, implantable microchip successfully administered medication to a small group of osteoporosis patients.

The fingertip-sized chip—developed by Massachusetts-based MicroChips Inc.—is designed to release medication in large amounts on demand, much like an injection. The chip can be activated remotely by phone or computer using a dedicated radiofrequency.

Chip keeps pace with standard treatment regimen
For the study, Massachusetts Institute of Technology researchers and colleagues implanted the microchip near the waistline of seven women—between the ages of 65 and 70—who had been treating their osteoporosis with daily injections of teriparatide. Overall, the researchers instructed the device to deliver 20 timed doses of treatment.

According to the findings—which were presented at the American Association for the Advancement of Science annual meeting this week—the chip delivered the drug as effectively as injections and produced similar bone formation results after 12 months. Compared with the typical 24-month osteoporosis treatment regimen, the researchers said the microchip increased patient compliance from 25% to 100%.

"The major advantage of the chip is that the patient takes every dose that is prescribed," says Robert Neer, a study coauthor and director of Massachusetts General Hospital's Bone Density Center. "The chip is more reliable than the patient."

Looking ahead
Robert Farra, president of MicroChips and lead author of the study, said the company expects to develop a chip with 365 reservoirs—enough to deliver medication daily for one year—within roughly two years and win regulatory approval for the device by the end of the decade.

In addition to treating osteoporosis, the company says the chip also could be used to deliver medication in multiple sclerosis and chronic pain patients. However, the chip may not be ideal for treating diabetes, since patients typically require more insulin daily than what will fit in the device's reservoirs, the Wall Street Journal reports (Steenhuysen, Reuters, 2/16; Brown, Los Angeles Times, 2/16; Winslow, Wall Street Journal, 2/17; Salamon, HealthDay, 2/16).


AHA blasts 'doc fix' deal

Group says proposal will add 'unnecessary strain' to hospitals

February 17, 2012

The American Hospital Association (AHA) on Thursday criticized this week's finalized doc fix deal, saying the proposal makes "arbitrary" reductions to hospitals and jeopardizes seniors' access to care.

Details of the package
The final payroll tax agreement includes a 10-month "doc fix," which would allow Medicare to maintain current physician reimbursement rates, delaying a 27.4% reduction in fees slated to start on March 1.

To fund the $18 billion doc fix, the agreement includes several health-related offsets that would save $21.2 billion over a decade. Specifically, the agreement would:

  • Reduce Medicaid payments to hospitals with a disproportionate number of uninsured patients (saving about $4.1 billion);
  • Reduce payment rates for clinical laboratory services by 2% in 2013 (saving about $2.7 billion);
  • Reduce Medicare "bad debt" payments to hospitals (saving about $6.9 billion); and
  • Extend the current outpatient therapy caps and exceptions process through Dec. 31, 2012.

"While we are pleased a number of expiring hospital provisions were extended, we need to ensure that all of the policies are maintained for the remainder of 2012," said Richard Umbdenstock, president and CEO of AHA. "This [proposal] is shortsighted and overlooks the critical role hospitals play in supporting a broad range of services to the elderly."

He added that the package "would add unnecessary strain to hospitals that care for vulnerable populations…We need thoughtful approaches to improving health care not indiscriminate cuts that harm patients' access to care."

The House on Friday voted 293-132 to approve the legislation, and the measure passed the Senate by a vote of 60-36. It now heads to President Obama, who has promised to sign it (Kane/Pershing, Washington Post, 2/16; Bendavid, Wall Street Journal, 2/17; AP/U-T San Diego, 2/16; AHA News, 2/16; Zigmond [1], Modern Healthcare, 2/16 [subscription required]; Zigmond [2], Modern Healthcare, 2016 [subscription required]; Fram, AP/Google News, 2/17).).


NQF endorses 14 palliative and end-of-life care measures

Measures address range of concerns, such as pain management and care transitions

February 16, 2012

The National Quality Forum (NQF) this week approved 14 palliative and end-of-life care measures.

The measures cover a wide range of concerns, including pain management, psychosocial needs, care transitions, and care experiences. For example, one measure addresses advanced cancer patients assessed for pain at outpatient visits. Another addresses patients admitted to the ICU who have documented care preferences.

To determine the measures, NQF solicited care measures that would evaluate patients' experience with palliative and end-of-life care. A panel of providers, metrics experts, and consumer representatives considered 22 measures using NQF endorsement criteria.

Overall, the panel approved 12 new measures for palliative and end-of-life care. NQF previously had endorsed two measures included in the new palliative and end-of-life care standards.

According to NQF President and CEO Janet Corrigan, "palliative and end-of-life care services are needed more than ever" as the U.S. population continues to age.

The new measures are intended to provide "the right measurement tools to help ensure patients receive safe, high-quality, and compassionate care," says June Lunney, who chairs NQF's Palliative Care and End-of-Life Care Endorsement Maintenance Steering Committee (McKinney, Modern Healthcare, 2/14 [subscription required]; NQF release, 2/14).


In the cloud: UnitedHealth launches data exchange, health app platform

Apps to target hospitals, physicians, and health plans

February 17, 2012

UnitedHealth Group plans to launch a new cloud-computing platform that will allow for the exchange of electronic health data across multiple devices and locations, the Wall Street Journal reports.

According to UnitedHealth's Optum health-services unit, the platform will allow health providers and insurers to share data, as well as access health applications from outside developers.

Initially, the apps will be aimed at hospitals, physicians, and health plans. For example, the Cleveland Clinic is helping to develop an app that aids health providers with bundled payments.

Optum eventually might allow apps designed for consumers, government health care payers, or pharmaceutical manufacturers.

It plans to charge for data storage, as well as collect fees for putting developers' apps in the cloud. Optum said it plans to launch a beta version of the service in June and intends to expand it more broadly later this year (Wilde Mathews, Journal, 2/14).


Editor's picks

Our reads for the weekend

February 17, 2012

The Daily Briefing editorial team highlights several studies and articles that got us talking this week.

Holiday weight gain plagues the active, too. A study in the American Journal of Clinical Nutrition explains why exercise alone won’t save you from packing on the pounds. More.

The Wall Street Journal this week examined efforts to turn ambulances into EDs on wheels. More.

Reuters this week explained how a Grateful Dead keyboardist invented a device to help sleep apnea sufferers. More.

For some, getting your genome sequenced opens a Pandora’s Box. Bloomberg News tells one man’s story. More.

Twenty years ago, conservatives conceived the individual mandate—what has changed since then? The New York Times examines the Republican Party's evolving stance on the issue. More.

ABC News tells the story of a patient who took her first wedding photos in her hospital bed as she fought off leukemia. Now, she has a second chance at beautiful wedding photos. More

Kid-sized clothes and furniture are becoming too small for increasingly obese U.S. children, CNN reports. More.


How to improve your health in one-minute intervals

Research highlights a quicker way to get in shape

February 17, 2012

How little exercise do we really need to stay in shape? The New York Times this week highlighted a recent study that found that performing one-minute bursts of exercise could be just as effective as longer fitness routines.

For the study, researchers at McMaster University in Hamilton, Ontario, compared the maximum heart rates and power peaks for two groups of men and women. In one group, the participants were middle-aged and generally healthy but inactive, while the second group consisted of middle-aged and older patients diagnosed with cardiovascular disease. Both groups were instructed to begin a cycling intervals program, which consisted of repeated, one-minute bursts of strenuous activity alternating with one-minute periods of rest, for a total of 20 minutes.

After several weeks, the study showed that members of both groups exhibited significant improvements in their health and fitness. For the cardiovascular disease patients, blood vessel and heart function also improved significantly.

According to Martin Gibala, a professor of kinesiology at McMaster, people with busy schedules could benefit from shorter, high-intensity workout routines. "It's very potent exercise," Gibala says, adding, "And then, very quickly, it's done." However, he notes that people who have time for the recommended 30-minute or longer exercise routines should continue with their workouts (Reynolds, Times, 2/15).


How a physician needs assessment can improve your strategy

February 17, 2012

Going beyond data, a well-conducted physician needs assessment serves as the foundation for physician alignment strategy. 

Join us in a complimentary webconference on Feb. 28 as we discuss engaging physicians, community, and leadership in medical staff development. More.


Daily roundup: Feb. 17, 2012

Bite-sized hospital and health industry news

February 17, 2012

  • Massachusetts: State lawmakers have passed legislation allowing certified nurse-midwives to practice without a physician's supervision. The law instead requires nurse-midwives to practice as part of a health care system and to maintain a clinical relationship with an obstetrician-gynecologist. The Massachusetts Medical Society opposed the legislation. According to Bill Ryder, state legislative and regulatory counsel at the group, the law is ambiguous about how nurse-midwives should interact with their health care system (Barr, "Capsules," Kaiser Health News, 2/9).
  • Minnesota: The Minneapolis Star Tribune this week examined banks' efforts to open branches in hospitals. For example, the Star Tribune detailed the opening of Minnesota's first full-service, in-hospital U.S. Bank at the Hennepin County Medical Center in Minneapolis (Bjorhus, Star Tribune, 2/13).
  • New Hampshire: State lawmakers this week debated a bill that would repeal a state review board's authority to determine whether a new hospital can be built. According to the Concord Monitor, legislators also may consider revising the board's authority to make its approval process fairer and more useful (Timmins, Concord Monitor, 2/15).
  • Pennsylvania: UPMC Health Plan this week announced that enrollment for its six Medicare Advantage plans reached 92,617 beneficiaries on Jan. 1, a 13.6% increase over 2011. The plan—called UPMC for Life—is the third largest Medicare Advantage plan in Pennsylvania (Nixon, Pittsburgh Tribune-Review, 2/15).
  • Wisconsin: Community health centers in Wisconsin have expanded at a slower pace than initially expected, partly because of a decrease in federal funding. The centers provided care for 277,000 state residents in 2011, up from 201,000 residents in 2008 (Boulton, Milwaukee Journal Sentinel, 2/14).


HHS: Health law helped 86M U.S. residents access preventive services

More than 86 million U.S. residents in 2011 gained access to a range of preventive care benefits under the federal health reform law, according to a pair of HHS reports released on Wednesday.

The overhaul requires Medicare and all new health plans to provide preventive care services, such as vaccinations, some cancer screenings, and wellness visits for children, at no cost to consumers.

One report estimated that about 32.5 million Medicare beneficiaries benefited from the law's preventive services provisions.

The second report, from the HHS assistant secretary for planning and evaluation, found that an additional 54 million individuals with private health insurance took advantage of expanded coverage for preventive services (Pecquet, "Healthwatch," The Hill, 2/15; National Journal, 2/15 [subscription required]).