House Call Physicians Ineligible for e-Prescribing Incentives

AAFP Efforts Fail to Reverse CMS Decision
By Sheri Porter 2/24/2009

The AAFP's efforts, in tandem with those of the American Academy of Home Care Physicians, or AAHCP, to correct an oversight in CMS' recently launched electronic-prescribing incentive program, recently resulted in a denial from the agency.

Rick Kellerman, M.D., of Wichita, Kan., an AAFP past president, is shown here checking on a nursing home patient.

In a Feb. 9 letter to CMS Acting Administrator Charlene Frizzera, AAFP Board Chair Jim King, M.D., of Selmer, Tenn., pointed out that, as currently implemented by CMS, Section 132 of the Medicare Improvements for Patients and Providers Act of 2008 "precludes physicians who practice predominantly, if not exclusively, as house call physicians from participation in the e-prescribing incentive program." On Feb. 23, however, AAFP News Now learned from AAHCP Executive Director Constance Row that CMS had declined to make the changes recommended by the two organizations.

Relevant CPT Codes Overlooked

The issue lies with the agency's choice of CPT codes that appear in the denominator of the e-prescribing legislation. As King pointed out in his letter to CMS, those CPT codes include services provided in the areas of psychotherapy, general ophthalmological services, health and behavior assessment and intervention, office and outpatient visits, and office consultations. However, CMS failed to include codes typically used by physicians who focus their practices on house call services, said King.

Those codes also include care provided to patients living in nursing homes. King argued that many house call physicians were early adopters of health information technology and e-prescribing. He said patients served by home care physicians usually have multiple comorbidities that call for an array of prescriptions that would be more efficiently handled electronically.According to Row, however, "CMS has decided definitively not to add these codes to the 2009 electronic-prescribing incentive program." She added that the letter from CMS indicated the agency may "consider changes for 2010 or beyond."

Statistics Reinforce Call for Inclusion

Row said that statistics provided by CMS only reinforce the argument that home health care physicians and other eligible providers should have the opportunity to benefit financially from the e-prescribing bonus program. She cited figures from CMS' Physician Supplier Procedure Summary Master Record that details Part B claims paid by Medicare carriers in 2007.According to those data, all Medicare providers combined logged 2,194,083 total house calls and 1,696,411 total domiciliary visits (i.e., house calls to patients residing in assisted living facilities) in 2007.

Family physicians alone logged 410,582 house call visits and 286,521 domiciliary visits in 2007. In his letter, King called on CMS to add home services CPT codes 99341 to 99350 and domiciliary/rest home visit CPT codes 99324 to 99337 to the denominator for eligibility in the e-prescribing incentive program.Row said that in light of CMS' rejection of that suggestion, her organization would continue to work closely with the AAFP for possible resolution of the issue in 2010.

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Kaiser Daily Health Policy Report

Health Care Marketplace Health Care Spending Will Account for One-Fifth of GDP in 2018; Federal Government Will Pay More Than 50% of Those Costs, According to CMS Report [Feb 24, 2009]

Overall U.S. health care spending will reach $2.5 trillion in 2009, a 5.5% increase from 2008, when health care spending increased by 6.1%, according to a CMS report published Tuesday in the journal Health Affairs, the Wall Street Journal reports (Zhang, Wall Street Journal, 2/24).

Total health care spending will account for 17.6% of the gross domestic product in 2009, a full percentage point higher than 2008, marking the largest one-year increase since CMS began tracking health care spending in 1960 (Dunham, Reuters/Boston Globe, 2/24). The rate of health care spending growth is expected to decline over the next five years in part because people will lose their jobs and health coverage as the recession continues, and they will forgo medical treatment; however, the economy will be shrinking and growing at a slower rate, which will increase health care spending's share of GDP (Young, The Hill, 2/24).

The study found that in 2009, government health care spending is expected to increase by 7.4% to $1.19 trillion, while private health spending is expected to increase by 3.9% to $1.32 trillion (Wall Street Journal, 2/24). CMS projects that in 2018 overall U.S. health care spending will reach $4.35 trillion, accounting for 20.3% of the GDP (The Hill, 2/24). The study estimates that health care costs will average $8,160 per U.S. resident in 2009, up $356 from 2008, and will reach $13,100 per U.S. resident by 2018 (Alonso-Zaldivar, AP/Boston Globe, 2/24).

The report forecasts that the government will pay for more than 50% of total health care spending by 2016 and 51.3% by 2018, as Medicaid enrollment increases and baby boomers start enrolling in Medicare (Pugh, McClatchy/St. Paul Pioneer Press, 2/24). According to the study, Medicaid spending will increase from $352 billion in 2008 to $801 billion by 2018. The report estimates that Medicare enrollment increases will drive up the spending growth rate in the program from 6.2% in 2011 to 8.6% in 2018.

CMS predicts that final Medicare figures will show spending of $466 billion for 2008, 8.1% higher than in 2007 (Reichard, CQ HealthBeat, 2/24). According to the report, Medicare's hospital trust fund could become insolvent by 2016 -- three years earlier than previous estimates -- because of lower tax revenue caused by the recession (AP/Boston Globe, 2/24).

Additional Findings The study predicts that private health insurance enrollment will drop from 195.5 million in 2008 to 189.5 million in 2010 (CQ HealthBeat, 2/24). Private health spending is expected to increase as the economy improves, growing to 4.2% in 2010 and reaching 6.1% by 2018 (Reuters/Boston Globe, 2/24). The report also estimates spending growth rates for overall health spending in 2008 of 7.2% for hospitals, 6.2% for physician and clinical services, 9.1% for home health care, and 4.6% for nursing homes (CQ HealthBeat, 2/24). The rate of prescription drug spending increased by 3.5% in 2008, down from 4.9% in 2007, which study co-author Andrea Sisko attributes to U.S. residents' being more willing to use generics and less inclined to fill prescriptions as the economy declines.

The report projects that the recession would begin to improve in 2010 and health spending growth would surge again in 2011 (Reuters/Boston Globe, 2/24). The study did not examine the impact of the recently enacted stimulus package, which includes $87 billion in increased Medicaid aid, nor did the report take into account the expansion of CHIP (Wall Street Journal, 2/24). The estimate includes a scheduled 21% cut to Medicare physician payment rates, but Congress and President Obama are expected to block the cuts. The Congressional Budget Office has estimated that blocking the cut will cost at least $100 billion over 10 years (The Hill, 2/24).

The study is available online.

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NGS Notification regarding debit/credit issue

National Government Services is experiencing an issue whereby some Part A debit/credit adjustments were assigned duplicate DCNs and are therefore being rejected by HIGLAS. This is primarily impacting home health and hospice providers, since home health final claims process as debit/credit adjustments if they are tied to a RAP. National Government Services is working with CMS, IBM, and FISS to resolve this issue and expects a resolution on April 6. No action is required by providers at this time.

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Revised Home Health Prospective Payment System Fact Sheet

See the latest information at http://www.cms.hhs.gov/MLNProducts/downloads/HomeHlthProspPymtfctsht09-508.pdf.
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Change for the Country = Change for the Bidens

Vice President's Family Faces Same Decision as Millions: How to Care for Mom?

SUNRISE, Fla., Jan. 23 /PRNewswire-USNewswire/ -- While Michelle Obama's mother, Marian Robinson, moves into the White House to help with childcare, Joe Biden's sprightly mother, Jean, is in for some life changes of her own. Ms. Biden, who is in her early nineties, has lived with her son and his family at their Delaware home for years. With Joe Biden moving to Washington, D.C. to take on the demanding job of Vice President, the family has decided that Ms. Biden will remain in Delaware. They will face additional transition as they determine how to continue providing her with care that meets her needs.

The Bidens are the most visible example of a life-changing decision that millions of families must make each year. For many, the sensitive topic of how to care for an aging parent can be daunting, with no clear roadmap on how to make the best decision.

One thing is clear: the worst thing to do is to deny the need or avoid the discussion. "If you wait until your parent is having a health crisis, you are forced to make crucial decisions without the benefit of research or interviews with prospective caregivers - maybe not even reliable information about your parent's health conditions or medications," says Kathleen Gilmartin, RN, President and CEO of Interim HealthCare (http://www.interimhealthcare.com/), a leading provider of health care personnel at all skill levels in all settings. "The sooner you open dialogue with your parent, the easier the transition will be for them and for you."

Read the full article.

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Look Back - Obama Experiences Home Health Care

After mopping kitchen and bathroom floors in the home of 86-year-old John Thornton in East Oakland, Calif., with health care worker Pauline Beck, Obama told reporters, "I'm not going to lie to you. It's been awhile" (Chicago Tribune, 8/9/2008).

Obama used the experience, which was attended by a television crew and photographers, to highlight the importance of home health care workers and promote benefits including paid sick leave and vacation for service workers -- neither of which Beck receives, according to the AP/Houston Chronicle (AP/Houston Chronicle, 8/9/2008).

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NEWS RELEASE: Joint Commission - Jan 20, 2009

The Joint Commission to Include Patient Satisfaction Data on Quality Check™
Web site provides new information to help patients make decisions

(OAKBROOK TERRACE, Ill. – January 20, 2009) People seeking information about how patients perceive the care they received at a particular hospital can now find this information on The Joint Commission’s Quality Check™ Web site, http://www.qualitycheck.org/.

The Hospital Consumer Assessment of Health Providers and Systems (HCAHPS) data from the Centers for Medicare & Medicaid Services’ (CMS) Hospital Compare Web site is posted on Quality Check™ beginning this month. This information will be updated quarterly.

HCAHPS information comes from patient ratings of communication with doctors, communication with nurses, responsiveness of hospital staff, cleanliness and quietness of the hospital, pain management, communication about medications, and discharge information. In addition to information about patient satisfaction, Quality Check also includes data from CMS on 30-day mortality rates for heart attack, heart failure and pneumonia.

Thousands of people use Quality Check each month to find information about the more than 15,000 accredited health care organizations that have earned The Joint Commission “Gold Seal of Approval.” Quality Check provides details about an organization’s accreditation status, efforts to prevent medical mistakes by complying with National Patient Safety Goals, and comparison information about how hospitals comply with National Quality Improvement Goals such as giving heart attack patients aspirin within a specified timeframe.
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