(Editor’s note: This guest blog was written by Jill Hoffman, managing editor at Executive Insight.)

Health and Human Services (HHS) Secretary Kathleen Sebelius has announced significant steps to reduce unnecessary, obsolete or burdensome regulations on American hospitals and healthcare providers. These steps will help achieve the key goal of President Obama’s regulatory reform initiative to reduce unnecessary burdens on business and save nearly $1.1 billion across the healthcare system in the first year and more than $5 billion over 5 years.

The new rules are being issued today by the Centers for Medicare & Medicaid Services (CMS). The first rule revises the Medicare Conditions of Participation (CoPs) for hospitals and critical access hospitals (CAHs). CMS estimates that annual savings to hospitals and CAHs will be approximately $940 million per year. The second, the Medicare Regulatory Reform rule, will produce savings of $200 million in the first year by promoting efficiency. This rule eliminates duplicative, overlapping, and outdated regulatory requirements for health care providers.

Among other changes, the final rules will:

·   Increase flexibility for hospitals by allowing one governing body to oversee multiple hospitals in a single health system,

·   Let CAHs partner with other providers so they can be more efficient and ensure the safe and timely delivery of care to their patients;

·   Require that all eligible candidates, including advanced practice registered nurses and physician assistants, be reviewed by medical staff for potential appointment to the hospital medical staff and then be granted all of the privileges, rights, and responsibilities accorded to appointed medical staff members; and

·   Eliminate obsolete regulations, including outmoded infection control instructions for ambulatory surgical centers, outdated Medicaid qualification standards for physical and occupational therapists, and duplicative requirements for governing bodies of organ procurement organizations. 

Under the new Medicare Shared Savings Program (Shared Savings Program), 27 Accountable Care Organizations (ACOs) have entered into agreements with CMS, according to a press release issued today. The Shared Savings Program and other initiatives related to Accountable Care Organizations are made possible by the Affordable Care Act, the health care law of 2010. Participation in an ACO is purely voluntary for providers and beneficiaries and people with Medicare retain their current ability to seek treatment from any provider they wish.

The first 27 Shared Savings Program ACOs will serve an estimated 375,000 beneficiaries in 18 States. This brings the total number of organizations participating Medicare shared savings initiatives on April 1 to 65, including the 32 Pioneer Model ACOs that were announced last December, and six Physician Group Practice Transition Demonstration organizations that started in January 2011. In all, as of April 1, more than 1.1 million beneficiaries are receiving care from providers participating in Medicare shared savings initiatives.

Their models for coordinating care and improving quality vary in response to the needs of the beneficiaries in the areas they are serving. CMS is reviewing more than 150 applications from ACOs seeking to enter the program in July.

To ensure that savings are achieved through improving and providing care that is appropriate, safe, and timely, an ACO must meet strict quality standards. For 2012, CMS has established 33 quality measures relating to care coordination and patient safety, appropriate use of preventive health services, improved care for at-risk populations, and the patient and caregiver experience of care.

CMS also announced that five ACOs are participating in the Advance Payment ACO Model beginning April 1. This model will provide advance payment of expected shared savings to rural and physician-based ACOs participating in the Shared Savings Program that would benefit from additional start-up resources. These resources will help build the necessary care coordination infrastructure necessary to improve patient outcomes and reduce costs, such as new staff or information technology systems. CMS is reviewing more than 50 applications for Advance Payments that start in July.

To learn more about the ACOs announced today, visit:

http://www.cms.gov/apps/media/fact_sheets.asp.

For more information on the Advanced Payment ACO Model, including the participating ACOs, visit:

http://innovations.cms.gov/initiatives/ACO/Advance-Payment/.

Secretary of Health and Human Services Kathleen Sebelius reviewed significant achievements in the fight against health care fraud during a speech at the Chicago Fraud Prevention Summit today.

In his introduction, U.S. Attorney General Eric Holder noted that during the last fiscal year alone, efforts by the Justice Department and HHS recovered nearly $4.1 billion in funds stolen or taken improperly from federal health programs across the country. Holder called this accomplishment "unprecedented."

The agencies' ability to collaborate and analyze claims and other data to identify emerging fraud patterns though a joint initiative known as HEAT - the Health Care Fraud Prevention and Enforcement Action Team - has given the nation's health care fraud prosecution and prevention efforts much needed momentum.

Three years ago, the nation was "falling behind" the scammers who made "easy money" by submitting false claims and collecting payments, often at the expense of vulnerable seniors, Sebelius said. Today, the HHS has a comprehensive database that systematically screens current and prospective providers against provider licensing and criminal records.

"I am proud to announce today that we have already removed 3,000 ineligible providers from the Medicare program identified in just the first month of these new screening procedures," Sebelius said.

She also cited new data analysis tools that allow HHS to analyze claims in real time and freeze questionable payments as another line of defense against those criminals who do find their way into the system.

Educated and informed consumers are on the frontlines of fighting fraud, Sebelius emphasized, and she praised the outreach efforts of Senior Medicare Patrol volunteers who give communities tools they need to recognize, resist, and report fraud.

"No one group, agency, or business owns all of the resources or expertise we need to keep criminals out of the healthcare system," Sebelius said. "Because we all have a stake in preventing health care fraud, we're all doing our part."

(Editor's Note: This guest blog was written by Michael LaMagna.)

In what may prove to be a model for the Medicaid system and healthcare in general, Oregon Governor John Kitzhaber signed a new Health Care Initiative aimed at significantly decreasing Medicaid expenditures.

The new law, known as Bill 1580, provides legislative approval to start creating local coordinated care organizations. The network of providers will deliver more comprehensive mental, physical and dental care for the state's 600,000 Medicaid clients.

The new health plan utilizes an Accountable Care Organization approach, by using the coordination of care amongst many providers, including physicians, nurses, mental, dental and health providers, to ensure better communication and outcomes. In addition, those providers who save Medicaid money will be financially compensated for keeping their patients healthy, especially those with chronic illnesses, which costs millions of dollars to the Medicaid system each year.

Unlike the federal healthcare law, the Oregon law does not have mandates for the uninsured or for private insurers, but it does create oversights for the program. The new law is expected to save Oregon Medicaid $155 million in the next year, and by 2017, as much as $4.6 billion. If successful, this bill may very well be the future healthcare model.

This article is provided for informational purposes only. Nothing in this article shall be construed as legal advice or should be relied upon as such. Michael LaMagna is a partner at Timins & LaMagna, LLP, practicing Health Care Regulatory, Elder /disability/veteran's law, trusts and estates, Social Security and general legal practice in both New York and Connecticut. Michael was just appointed to the ACO Task Force of the American Health Lawyers Association. Email him at Mlamagna@nyandctlaw.com, call him at 914-819-0663 or visit Attorney LaMagna's website at www.nyandctlaw.com for more information.

The Centers for Medicaid & Medicaid Services (CMS) announced yesterday it will partner with Text4Baby, a free national health texting service, to promote enrollment in both Medicaid and the Children’s Health Insurance Program (CHIP) and provide pregnant women and new mothers free text messages on important healthcare issues.

The announcement is part of activities marking the anniversaries of both the signing of the Children’s Health Insurance Program Reauthorization Act of 2009 (CHIPRA) and the launch of Text4Baby, whose partners include Healthy Mothers, Healthy Babies Coalition, Voxiva, which provides the mobile health platforms, and a host of wireless carriers.

“As a mother, I know how important health coverage and health information is for pregnant women and new moms,” said HHS Secretary Kathleen Sebelius in a release. “Through CHIPRA, the healthcare law and this partnership, we are helping more and more women across the country have the insurance and information they need to have healthy babies and keep them healthy as they grow up.”

Organizations across the country are using the CHIPRA and Text4Baby anniversaries to highlight how access to both health coverage and health information is critical for families.

Activities are already taking place in locations in California, Florida, Illinois, Michigan, New Jersey, Oklahoma and others.  For example, applicants using an online application to apply for Medicaid and CHIP in San Diego will now be able to enroll with Text4Baby directly; the Florida Department of Health will place contact information for both Text4Baby and Florida Healthy Kids (the State’s children’s health insurance program) on the envelopes used to send birth certificates to families with newborns; and Oklahoma hospitals are being encouraged to connect new mothers to Text4Baby when they enroll newborns in Medicaid right after birth.

“The partnership will help encourage eligible mothers and children to enroll in Medicaid and CHIP,” said Marilyn Tavenner, CMS acting administrator. “Text4Baby users will be alerted to the availability of health insurance options, and we are encouraging our partners and other organizations working to help get children enrolled in health coverage to make sure new moms know how to sign up with Text4Baby for all kinds of health tips and reminders.”

“Text-messaging is a part of the culture in terms of how we communicate,” added U.S. Surgeon General, Regina Benjamin. “Using text-messaging to help conduct outreach to families about health coverage for their children is just one more way that the appropriate use of technology is enhancing how we make sure pregnant women and children get the health care they need.”

In 2011, Medicaid and CHIP covered 43.5 million children. Under CHIPRA, CMS has awarded a total of $90 million in grants to states, Tribes, nonprofit groups, schools, healthcare providers and others to conduct activities to ensure eligible children are enrolled in health coverage and remain enrolled for as long as they qualify.

More than 184,000 current Text4Baby users are receiving a new message alerting them to the availability of free and low-cost health coverage through Medicaid and CHIP.  The message will provide a connection to the InsureKidsNow phone number and website for information about how to sign up. Additional messages will be periodically texted to provide Text4Baby users information about the importance of prenatal visits for women and the value of health coverage for keeping children healthy and getting the care they need when they’re sick.   

This week Congress and the Senate passed legislation that will have an immediate effect on healthcare payments to most providers, including: hospitals, physicians, rehabilitation specialists and laboratories. The new legislation, which is called the Middle Class Tax Relief and Job Creation Act of 2012, extends the payroll tax cut and unemployment benefits, as well as makes the following adjustments to the healthcare system:

• Freezes the current reimbursement rate that Medicare pays physicians, preventing the proposed 27.4% cut in payments, which was to begin on March 1, 2012. The cuts are now postponed to Dec. 31, 2012;
• Extends the outpatient therapy cap exception process, whereby Medicare beneficiaries can exceed the caps on obtaining therapy as long as the physician certifies that the therapy is medically necessary; and
• Stops a planned reduction in hospital payments for evaluation and management services in outpatient departments.

To assist paying for the cuts in reimbursement, the bill reduces the amount of money hospitals and nursing facilities are reimbursed for bad debt. Under current law, Medicare reimburses hospitals and nursing facilities for 70% of what they are unable or unwilling to collect and 100% of the nursing facility bad debt resulting from the treatment of the dual eligibles (those with Medicare and Medicaid).

This provision would reduce the reimbursement to 65% within a 3 year period, saving approximately $7 billion to the Medicare system; however, it would cause unknown harm to the providers, who have razor thin margins already.

(Editor’s note: This guest blog was written by Michael LaMagna)

Consumers concerned about the quality of care they will receive at their next hospital visit, can turn to the Internet. Armed with the knowledge that hospital acquired infections are one of the leading causes of death in this country, approximately 100,000 deaths a year, more than car crashes or breast cancer, utilizing a free and easy online tool is a necessity prior to scheduling surgery. By accessing www.hospitalcompare.hhs.gov, consumers can access clinical, patient outcome and satisfaction data that can assist them with making an informed decision.

Hospital Compare is a consumer friendly website that provides data through the joint efforts of CMS and the Hospital Quality Alliance (HQA), a public and private partnership. The clinical and performance related data includes variables such as the rates of:

· Surgery patients who were given an antibiotic at the right time to prevent infection;

· Surgery patients whose doctors ordered treatments to prevent blood clots after certain types of surgery;

· Appropriate initial antibiotic selection for pneumonia;

· Death rates for heart attacks, heart failure and pneumonia;

· Hospital readmission rates for heart attacks, heart failure and pneumonia; and

· Central-line associated bloodstream infections (information available next year).

The website allows the reader to compare up to three hospitals against national benchmarks as well as the individual hospitals. At the very least, if the hospital being used by your physician did not measure up to the standards of care, you can ask for clarification and the measures undertaken to improve the quality of care or patient satisfaction.

This article is provided for informational purposes only. Nothing in this article shall be construed as legal advice or should be relied upon as such. Michael LaMagna is a partner at Timins & LaMagna, LLP, practicing Health Care Regulatory, Elder /disability/veteran’s law, trusts and estates, Social Security and general legal practice in both New York and Connecticut. Michael was just appointed to the ACO Task Force of the American Health Lawyers Association. Email him at Mlamagna@nyandctlaw.com, call him at 914-819-0663 or visit Attorney LaMagna’s website at www.nyandctlaw.com for more information.

(Editor's Note: This guest blog was written by Michael LaMagna.)

With an estimated 26 percent of U.S. adults experiencing a mental disorder at some point in their lives, mental illness affects most people and almost every family. In 2008, a law was passed, the Mental Health Parity and Addiction Equity Act (MHPAEA), which required large group health insurance plans (those with more than 50 insured employees) that provide mental health services to provide coverage on the same level as other medical and surgical benefits. This includes a prohibition on charging separate coinsurance, deductibles or limiting out-of-network coverage. In addition, many states have parity laws aimed at providing mental health benefits and protections beyond MHPAEA. The federal parity law makes clear that state laws that provide greater protections than the federal law continue to remain in effect.

As expected, when funding gets tight, there has been a reduction in many mental health coverage options, especially regarding plans not covered under MHPAEA. In Iowa, California, Pennsylvania and Connecticut, there are proposed bills, viewed as national models, which will redesign how services to the mentally ill are provided and require insurers to cover the diagnosis and treatment of mental illnesses, and developmental disorders such as autism. Moreover, pilot programs are being developed that would utilize thousands of community help workers to hit the streets to aid the mentally ill, which very often are in the shadows.

More specifically, the proposed legislation will increase coverage for the mentally ill, including funding for:

• Self-help centers run by other people with mental illness or disability;
• Crisis services for people with psychiatric needs;
• Residential services for people who need assistance, but don't need hospitalization;
• Jail-diversion efforts to keep people from being jailed for behaviors sparked by mental illness;
• Community treatment, support services, case management, and supported community living and family services;
• Employment and education services; and
• Transportation.

Although the status of the legislation is unsure, at least the conversation at a State and national level has started.

This article is provided for informational purposes only. Nothing in this article shall be construed as legal advice or should be relied upon as such. Michael LaMagna is a partner at Timins & LaMagna, LLP, practicing Health Care Regulatory, Elder /disability/veteran's law, trusts and estates, Social Security and general legal practice in both New York and Connecticut. Michael was just appointed to the ACO Task Force of the American Health Lawyers Association. Email him at Mlamagna@nyandctlaw.com, call him at 914-819-0663 or visit Attorney LaMagna's website at www.nyandctlaw.com for more information.

The i2 Initiative is a new effort to spur innovations in health IT. The program utilizes prizes and challenges to facilitate innovation and obtain solutions to intractable health IT problems. Aligned with the Obama administration's innovation agenda, i2 is the first federal program to operate under the authority of the America COMPETES Reauthorization Act of 2010.

The challenge aims to stimulate the use of simple, IT-enabled processes and tools to make transitions easier and safer for patients, caregivers and providers, particularly when a patient is discharged from a hospital. The first health IT challenge, Ensuring Safe Transitions from Hospital to Home http://www.hhs.gov/ExternalLink.htmlhttp://www.hhs.gov/ExternalLink.html, called upon developers to create a web-based application that could empower patients and caregivers to better navigate and manage a transition from a hospital.

This latest challenge was announced during the recent Care Innovations Summit. The Summit is co-hosted by the ONC, the Centers for Medicare & Medicaid Services, the West Wireless Health Institute and Health Affairs to call attention to importance of care transitions and address the gaps in care coordination with a focus on better care and better health at a lower cost.

The scheduling of follow-up appointments and post-discharge testing before leaving the hospital helps ensure safer and more effective transitions. Unfortunately, most patients across the country continue to leave the hospital without confirmed appointments and many providers remain frustrated by a highly manual and unreliable system. The Discharge Follow-Up Appointment challenge will focus on promoting effective care transitions.

"This challenge is an enormous opportunity for software developers to develop solutions, and pursue models that can be adopted across a community," said Farzad Mostashari, MD, ScM, national coordinator for health IT. "Scheduling post-discharge follow-up appointments is critical, but not easy for patients or providers and we're excited by the possibilities that will stem from this challenge."

For additional information about ONC or on the i2 program, visit http://healthit.hhs.gov/.

For more information about Health 2.0, which helps support the i2 challenge program, visit http://www.health2con.com/ http://www.hhs.gov/ExternalLink.htmlhttp://www.hhs.gov/ExternalLink.html.

For more information about Partnership for Patients, which also supports the i2 challenge program, visit http://www.healthcare.gov/compare/partnership-for-patients/index.html .

For more information about U. S. Department of Health and Human Services' Recovery Act programs, see www.hhs.gov/recovery.