Professional Standards Committee / November 2004
Sheila Davenport

AHIMA Advantage e-alert

CMS Updates Vendors and Others on Plans for Physician EHRs
In its first public session since May, the Centers for Medicare & Medicaid Services (CMS) last week updated health information technology vendors and others, including AHIMA, on its project to make electronic health record (EHR) software available to physicians’ offices. The new doctors office quality information technology plan will make physician office software available based on the Veterans Health Administration’s (VHA) office EHR. CMS plans to release version 1.0 in July 2005. The VHA software will be modified to handle the non-VA environment of a general practice.

CMS provided attendees with several reasons vendors would benefit. Among them assisting physician offices adopt and implement the new software or to enhance or add functionality to the software for physician office use. CMS also hopes to have the software reviewed by the new Certification Commission for Health Information Technology. CMS further indicated that quality improvement organizations would be involved in the projects. This is important because it was CMS’s goal to not only see EHRs improve physician offices’ process and quality, but also because a standard EHR would be able to provide data on quality to CMS. Information and future project updates will be posted on the CMS Web site at: http://www.hhs.gov. .  (Volume 6, Issue 42)

CMS Hosts Free HIPAA Implementation Roundtable
CMS will be hosting the National HIPAA Implementation Roundtable conference call focusing on HIPAA security standards on Wednesday, November 10. The call will take place from 2-3:30 p.m. ET, the call-in number is 1-877-203-0044, and the passcode is 1347026. Please note that because of the volume of callers wishing to participate, CMS requests that you dial in 15 minutes before the start of the meeting. The meeting is free and no registration is required.  .  (Volume 6, Issue 42)

CMS Open Door Forum on HCPCS Code Changes
As noted in last week’s e-alert, CMS has changed its method of updating HCPCS codes. A special open door forum will take place Thursday, October 28, from 2-4 p.m. EST time to discuss expansion of the public meetings, the appeals process, public notices of decisions, revision of the HCPCS code application form, elimination of requirement for marketing data for drugs, reduction in marketing data for non-drug items, and consideration of national Medicaid program operating needs. For additional information on how to access this public forum, go to: http://www.cms.hhs.gov/opendoor/102004/HCPCS102704.pdf.  .  (Volume 6, Issue 42)

New Acute Care Documentation Book Ready to Ship
Documentation for Acute Care
Jean S. Clark, technical editor

There is finally a current and authoritative replacement for the Huffman text. Professionals, students and educators alike will discover a comprehensive and up-to-date resource for documentation procedures in acute care settings. This text brings you new and established guidance so you know how to successfully develop forms and meet standards and documentation requirements. A wide array of forms and sample EHR screens is included so that users can boost their practical knowledge.

Order Information
AHIMA product number: AB100704
AHIMA Member Price: $60
416 pages and 2 CD-ROMs

For more information or to order, call toll free 1-800-335-5535 or visit AHIMA’s online bookstore at: https://imis.ahima.org/orders/productDetail.cfm?pc=AB100704&bURL=%2
Forders%2FproductByCategory%2Ecfm%3Ft%3D4.   .  (Volume 6, Issue 42)

Experts Needed for AHIMA’s New Practice Council
AHIMA is announcing the creation of three practice councils to advise on critical issues for the HIM profession and association members. The practice councils are a new AHIMA tool to work with member experts and leaders to help shape policy, research, and education. Three practice councils will be developed in 2005 comprised of up to 20 members with demonstrated expertise in the areas of:

• electronic health records
• privacy and security
• clinical terminology and classification

Apply by submitting a summary of knowledge, skills, and leadership related to one of the three Practice Council topics. For more information on the charter and responsibilities for Council members and how to apply, visit: https://www.ahimanet.org/COP/AHIMA/ and access the Community Resources section of the AHIMA CoP. Select the document titled “Call for Volunteers – Practice Councils” under the category practice council information. Please note the application deadline is November 8. If you are not logged into the CoP, you will be prompted to login by entering your member ID number and password. If you have any questions about logging in, contact Pam Garcia, volunteer services coordinator, at: pamela.garcia@ahima.org. .  (Volume 6, Issue 41)

HRSA Announces Funds for 2005
The Health Resources and Services Administration (HRSA) has announced the availability of funds in the FY 2005 HRSA preview, a comprehensive review of HRSA’s competitive programs (69FR61026). The purpose of the preview is to provide a single source of program and application information related to the agency’s competitive grant offerings. A printer-friendly copy of the preview is available at: http://www.hrsa.gov/grants/preview/default.htm. The October 14 Federal Register is available at: http://www.access.gpo.gov/su_docs/fedreg/a041014c.html.  .  (Volume 6, Issue 41)

CMS Regional Offices to Hold HIPAA Security Implementation Sessions
The Centers for Medicare & Medicaid Services (CMS) Atlanta and Dallas regional offices have announced a series of sessions on the implementation of the HIPAA security rule in November and December.

November 4—New Orleans, LA
November 9—Atlanta, GA
November 15—Memphis, TN
November 18—Oklahoma City, OK
December 1—San Antonio, TX
December 9—Orlando, FL

The series will deliver an in-depth review and analysis of the HIPAA security rule and the process for adopting and using the new national provider identifier. Emphasis will be on the practical implementation aspects of the new regulations. For more information, visit: http://mche.us.com/cms04hipaa.cfm..  (Volume 6, Issue 41)

HHS Awards $139 Million in HIT Grants
On October 13, the Department of Health and Human Services announced $139 million in grants and contracts for promoting the use of health information technology. The awards are being released from the Agency for Healthcare Research and Quality. For a fact sheet explaining each of the awards, visit: http://www.ahrq.gov/research/hitfact.htm.

AHIMA strongly encourages members to review this list and to become involved with the projects in their area. For a copy of the full press announcement, go to: http://www.hhs.gov/news/press/2004pres/20041013.html.  . 
(Volume 6, Issue 41)

OIG Publishes 2005 Work Plan
The Office of Inspector General (OIG) of the Department of Health and Human Services (HHS) has released its fiscal year 2005 work plan. This plan sets forth various projects to be addressed during the fiscal year by the office of audit services, office of evaluation and inspections, office of investigations, and office of counsel to the inspector general. Projects slated for 2005 include diagnosis related group coding, coronary artery stents, imaging and laboratory services in nursing homes, cardiography and echocardiography services, coding of evaluation and management services, billing service companies, and smart card technology. The complete 2005 work plan is available at: http://www.oig.hhs.gov/publications/workplan.html#1..  (Volume 6, Issue 41)

CMS Requests Comments on Hospital Quality Reporting Process
CMS has posted a request for comments (69FR61257) on its process for collecting hospital quality measures known as form CMS-10109 (OMB#0938-0918). Copies of the supporting statement and related forms can be accessed at the CMS Web site at: http://www.cms.hhs.gov/regulations/pra/. More information can be found in the October 15 Federal Register at: http://www.access.gpo.gov/su_docs/fedreg/a041015c.html. Please note comments are due by November 14.  .  (Volume 6, Issue 41)

CMS Revamps HCPCS Maintenance Process
CMS has announced they are revising the process for updating the Healthcare Common Procedure Coding System (HCPCS) code set. These changes are intended to improve the development of codes for new technologies and make it easier to make decisions on coverage and payment for items and services identified by HCPCS codes. The public meetings related to durable medical equipment will be expanded to include all public requests for HCPCS products, supplies and services. All preliminary decisions regarding HCPCS code changes will be published on the CMS Web site prior to public meetings. An appeals process will be implemented in the 2007 coding cycle, whereby denied applicants will be allowed to appeal the decision and have their application reconsidered during the same coding cycle. The revised HCPCS coding process will be phased in over the next 18 months. The complete press release, as well as detailed information about the HCPCS maintenance process, can be obtained at: http://www.cms.hhs.gov/medicare/hcpcs. .  (Volume 6, Issue 41)

New Site Creates Greater Awareness of ICD-10
One of AHIMA's key advocacy efforts is to secure the adoption and implementation of ICD-10. The current system, ICD-9, is obsolete and needs to be replaced immediately. HIM professionals need to be strong advocates for the adoption of ICD-10 by informing the healthcare industry about the urgent need for a better coding classification system and the benefits of making the upgrade. To help this effort, a new ICD-10 section of the AHIMA Web site is now available. The site provides a clear picture of the issues surrounding the adoption of ICD-10 and the resources available to the healthcare industry to learn more. The Web site can be found under "HIM Resources" or at: https://secure.ahima.org/icd10. .  (Volume 6, Issue 41)

CMS Announces Privacy Act of 1974 Record Changes
Privacy advocates may find an October 18 Federal Register notice of interest (69FR61388). Besides explaining a redesign of electronic processing of some Medicare data, the notice proposes to add some new routine uses that would permit the release of information on some CMS beneficiaries. The approval for the changes is effective in 40 days. For further information on the proposed changes and where to comment, go to: http://www.access.gpo.gov/su_docs/fedreg/a041018c.html. .  (Volume 6, Issue 41)

Patient Safety Legislation Still Bottlenecked in Congress
With Congress recessed until mid-November, many are wondering about the fate of the easily passed House and Senate versions of the “Patient Safety and Quality Improvement Act.” What once seemed sure now seems stalled over minor differences. The bills are:

• HR 663, which passed the House 418-6 on March 12, 2003
• S. 720, which passed the Senate by unanimous consent on July 22

For further information on this legislation, you can visit the “Issues and Legislation” section in the Advocacy Action Center of the AHIMA Advocacy Assistant at: https://secure.ahima.org/dc/aa. .  (Volume 6, Issue 41)

Certification Commission Launches Site
The Certification Commission for Healthcare Information Technology has launched its Web site. Formed by AHIMA, the Healthcare Information and Management Systems Society (HIMSS), and The Alliance (formerly NAHIT), the commission aims to create an efficient, credible, sustainable mechanism for the certification of healthcare information technology products. The site includes a list of commissioners, meeting minutes, and press releases. For more information, go to http://www.cchit.org. .  (Volume 6, Issue 41)

April 1 ICD-9-CM Update
Public law 108-173, section 503(a) requires ICD-9-CM to be updated twice a year, but the diagnosis related group assignments will change only once. The final inpatient prospective payment system (PPS) rule of August 11 (see pages 48,954-48,957) discusses these changes. It is recommended that facilities review this information, which can be found at: http://www.access.gpo.gov/su_docs/fedreg/a040811c.html.

Patricia Brooks, RHIA, technical advisor for the Centers for Medicare & Medicaid Services (CMS) discussed this change during the national coding update session at the October 9 Coding Community meeting in Washington, DC. According to Brooks, “the April updates will be restricted to new technology and a strong and convincing case must be presented that the code is needed.” A five-month lead time is needed for notification of changes, so the coordination and maintenance (C&M) meetings next year will be held in March and September. At the October 7-8 C&M meeting, none of the presenters identified issues requiring an April 1, 2005, implementation date. Please note there will be no ICD-9-CM changes made April 1, 2005. .  (Volume 6, Issue 41

Brailer to Meet with Leading Healthcare IT Companies at AHIMA Convention
Executives from the top healthcare IT companies from around the country will gather on October 11 to meet with the new national coordinator for health information technology, David J. Brailer, MD, PhD, during AHIMA’s National Convention and Exhibit in Washington, DC. The meeting will take place after Brailer’s keynote speech on the same day. This invitation-only event will provide a forum for discussion and private industry collaboration on the HIT initiatives laid out by the federal government in the framework for strategic action, “The Decade of Health Information Technology,” released in July at the secretary’s Summit on HIT.

Specific topics to be discussed at the meeting will include:

• interoperability and the forthcoming request for information seeking public comment on the national health information infrastructure network
• reducing the risk of EHR investment and developing market agents such as the newly formed Certification Commission for Health Information Technology
• financial and non-financial incentives to promote EHR adoption and use such as reimbursement for EHR use, regional grants and contracts, low rate loans, and pay for performance
• regional strategies for health information exchange—regional health information organizations (RHIOs)

To view “The Decade of Health Information Technology,” visit: http://www.hhs.gov/onchit/framework/hitframework.pdf. .  (Volume 6, Issue 40)

GAO Issues Report on First-year Experiences Under HIPAA
The US government accountability office (GAO) has issued a report (GAO-04-965) to the Senate Health, Education, Labor, and Pensions Committee entitled “Health Information: First-year Experiences Under the Federal Privacy Rule.” The report focuses on interviews conducted with a number of groups, including AHIMA. In its recommendations and comments the GAO cited concerns regarding the “reporting for disclosures” as the number one burden associated with the rule that needed action.

To meet this concern the GAO suggests informing patients to whom information will be released (therefore eliminating the need for a disclosure reporting), and to have the Department of Health and Human Services conduct a public information campaign to improve awareness of patient’s rights under the privacy rule. The GAO report can be found at: http://www.gao.gov/cgi-bin/getrpt?GAO-04-965 and the highlights can be found at: http://www.gao.gov/highlights/d04965high.pdf. .  (Volume 6, Issue 40)

CMS Announces Clinical Laboratory Information Resource
The Centers for Medicare & Medicaid Services (CMS) has announced the creation of a comprehensive Web site for laboratory suppliers and providers. The Web site includes links to specific clinical laboratory information in various categories including billing and payment, regulations, educational publications, demonstrations, coding, national coverage determinations, and CMS manual references.

CMS has developed provider and supplier-specific Web pages to allow more effective use of the site. By focusing on the informational needs and interests of Medicare fee-for-service providers, CMS continues to achieve its objective to improve communications with and service for physicians, other healthcare professionals, providers, and suppliers. To view the new Web site, go to: http://www.cms.hhs.gov/suppliers/clinlab/default.asp. .  (Volume 6, Issue 40)

CCI Announces Hospital OPPS Edits
CMS has posted the next version of the correct coding initiative (CCI) edit files for outpatient prospective payment system (OPPS). Version 10.2 is effective October 1–December 31. The CCI edits for OPPS are a modified subset of the national correct coding initiative (NCCI) edits. They are specifically for Medicare Part B hospital outpatient services paid under OPPS. For more information on NCCI edits that apply to Medicare Part B services paid by Medicare carriers, go to: http://www.cms.hhs.gov/physicians/cciedits/.

The CCI edits include Column 1 and Column 2 CC edits (formerly known as comprehensive and component edits) and the mutually exclusive edits. Information on the background of CCI edits and a Q&A section is also available. To view the edits go to: http://www.cms.hhs.gov/providers/hopps/cciedits/default.asp. .  (Volume 6, Issue 40)

TRICARE Issues DRG Update
The TRICARE civilian health and medical program of the uniformed services has issued it revised diagnosis related group rules and rates reflecting the Medicare prospective payment system changes, effective October 1. Those affected by the TRICARE changes can find the information in the October 4 Federal Register at: http://www.access.gpo.gov/su_docs/fedreg/a041004c.html. .  (Volume 6, Issue 40)

Chairman of Commission on Systemic Interoperability Announced
Scott Wallace, president and CEO of the National Alliance for Health Information Technology, was recently named chairman of the National Commission on Systemic Interoperability. The commission has been charged by Congress to develop a strategic plan for the nation’s healthcare information technology infrastructure. In the coming year the commission intends to create a comprehensive plan for adopting and implementing technology standards to make healthcare IT systems across the country work together. For more information on the alliance, visit: http://www.nahit.org. .  (Volume 6, Issue 40)

PHIM Articles Focus on Research, Knowledge Management
Two recently published articles in Perspectives in Health Information Management, AHIMA’s online research journal, examine the expanding areas of research and knowledge management.

“The Expanding Role of the HIM Professional: Where Research and HIM Roles Intersect,” by Jessica Bailey, PhD, RHIA, CCS, and William Rudman, PhD, describes three research projects that demonstrate the broad range of knowledge and skills both HIM professionals and educators bring to the research process, including writing a grant proposal and planning a research project. The article urges HIM professionals to make connections with clinicians who are active in research, volunteer to participate in research, and be willing to learn new skills or improve old skill sets and become involved in quality improvement projects. To read the article, go to: http://library.ahima.org/xpedio/groups/public/documents/ahima/bok1_024632.cfm.

“Toward a Conceptual Knowledge Management Framework in Health,” describes key concepts and case studies for knowledge management (KM). Positing that “The notions of KM are not well established in the health setting,” the author, Francis Lau, PhD, associate professor at the University of Victoria, British Columbia, offers concepts, methods, and tools for implementing KM in healthcare. The article also includes case studies that highlight issues and challenges in implementing a KM framework. Read the article here: http://library.ahima.org/xpedio/groups/public/documents/ahima/bok1_024634.cfm. .  (Volume 6, Issue 40)

Highlights from Friday Letter, Alabama Hospital Association

News Release: Special Session to Begin Nov. 8
In an Oct. 28 news release, Gov. Riley announced he is calling members of the Alabama Legislature to Montgomery for a special session to begin at noon on Nov. 8. The official proclamation, which will detail the issues to be addressed in the session, has not yet been released; however, the news release states the focus of the session will be strictly for reforming the health insurance system for teachers and state employees.

The governor's five-bill package is described as a "tentative" agreement based on recommendations from the task force he appointed last April to address the rising cost of health insurance for public employees. Drafts of the proposed legislation have not yet been released but are expected to be available sometime next week. A bullet point summary of the task force recommendations can be found on the AlaHA Web site, www.alaha.org, or contact the AlaHA Government Relations office at (334) 834-3477.

Officials report the special session will cost taxpayers around $100,000 per week. The administration maintains this cost is well worth the savings the state will realize upon successful passage of the proposed reforms. If enacted, the proposals would be expected to save approximately $50 million within the first full year of implementation and at least $300 million over the next five years. According to the administration, the cost to the state for public employees' health benefits is currently around $1 billion annually.

Be on the lookout for legislative updates via e-mail and fax as the session proclamation and draft legislation are released. Reminder: legislation outside of the official call is often introduced in a special session. With the time constraints associated with a special session (12 meeting days within 30 calendar days), issues can move quickly. Your prompt attention to legislative alerts will be critical to our ability to respond to issues as they develop.  
(October 29, 2004)

BHS Billing Lawsuit Dismissed
On Oct. 21, the U.S. District Court in Birmingham ruled in favor of Baptist Health System, Inc., and the American Hospital Association (AHA) in the first decision on a motion to dismiss in the not-for-profit litigation against hospitals and the AHA. The court said earlier court settlements regarding their hospital bills barred the plaintiffs from bringing this lawsuit forward. The court also dismissed the Emergency Medical Treatment and Labor Act counts because there were no claims the plaintiff failed to receive appropriate screening, emergency stabilization or sustained any personal injury.   (October 29, 2004)

Medicare Covers Flu Shots Given by Non-enrolled Providers
Medicare providers are generally required to submit claims for beneficiaries; however, in order to increase access to flu shots for Medicare beneficiaries, Medicare carriers will reimburse beneficiaries for flu shots administered by non-enrolled providers, regardless of whether the claim is submitted by the beneficiary or provider. This is effective for claims with dates of service on or after August 1, 2003, through May 31, 2005. Questions and answers regarding payment of beneficiary submitted flu claims have been posted on the Medicare.gov Web site. A recent program transmittal provides instructions for carriers on the payment of beneficiary- and provider-submitted flu claims for services provided by nonenrolled providers. It is at www.cms.hhs.gov/manuals/pm_trans/R334CP.pdf.
(October 29, 2004)

New Web Site Highlights Hospitals
The American Hospital Association (AHA) recently announced a new Web site that highlights how hospitals care for their communities. According to AHA, the public Web site is, among other things, intended to serve as an alternative destination to the Web site maintained by plaintiffs' attorneys in the hospital billing lawsuits. Log on to the new site at www.caringforcommunities.org. Once there, you can access facts and figures that illustrate how hospitals care for their communities, read about issues hospitals are facing, read hospitals' responses to the lawsuit and read what patients and other people are saying about hospital. The Web site also includes the latest news related to the lawsuits and the uninsured.  (October 29, 2004)

HHS Posts Flu Vaccine Price Gouging Brief On-line
The U.S. Department of Health and Human Services (HHS) recently sent letters to every state attorney general informing them that the HHS filed a brief in Broward County court in Florida to support the State of Florida's prosecution of price gouging by distributors of flu vaccine. HHS offered similar assistance and support to all states as they crack down on any price gouging or other irregularities regarding flu vaccine. The full text of the brief is available on-line at www.hhs.gov/flu.   (October 29, 2004)

Women's Right to Know Act
AlaHA staff has recently received questions regarding The Woman's Right to Know Act litigation brought by, and on behalf of, abortion centers in Alabama. The abortion centers had originally sought to obtain an injunction, which would delay or permanently stop enforcement of this legislation. The parties, after extended litigation, entered into a final settlement agreement on the materials to be distributed prior to an abortion. The materials include a brochure, resource directory, videotape, and forms to be signed by women receiving abortions.

The Alabama Department of Public Health has promulgated the final regulations for abortion centers. Although the abortion center rules do not apply to hospitals, The Woman's Right to Know Act does apply to hospitals where abortions are performed. The parties have agreed that ectopic pregnancies, in all cases, are to be considered emergency medical abortions, and as such, all of the material does not have to be provided prior to these abortions. Where there is no emergency, the woman must be provided a copy of the brochure and the resource directory, asked to view the videotape, and to sign permission/consent forms.

Even in those cases where it is determined that the abortion is an emergency situation, there is still a form that will have to be signed by the physician.

It is the intent of the health department to distribute these materials only upon request. You may access information about ordering the materials on-line at www.adph.org. Go to "fast find" then to "provider services" and select "abortion forms and materials." You may also call the Division of Provider Services at (334) 206-5175.

These requirements went into effect July 25, 2004. If you have any questions, please feel free to call Gregg Everett at (800) 489-2542.  (October 29, 2004)

Panel Denies Consolidation of Billing Lawsuits
A judicial panel in Philadelphia ruled against the consolidation of federal lawsuits that have been brought against 70 not-for-profit hospitals and health care systems in 43 states and the District of Columbia. The American Hospital Association (AHA), which is named as a defendant in many of the lawsuits, had joined all the defendant hospitals in opposing the motion by a national team of trial lawyers, arguing that asking the court to consolidate the cases was simply a legal maneuver to benefit trial lawyers at the expense of hundreds of local hospitals. The court said that consolidation "would neither serve the convenience of the parties and witnesses nor further the just and efficient conduct of this litigation," and added that the trial attorneys had "failed to persuade us that these actions share sufficient common questions of fact to warrant" consolidation. The AHA said it hopes the panel's decision will lead to a speedy and fair conclusion of the cases. (AHA News Now)  (October 22, 2004)

CMS Announces Home Health Payment Update
The Centers for Medicare & Medicaid Services (CMS) recently announced a 2.3-percent increase in Medicare payment rates to home health agencies for calendar year 2005. The increase would bring an extra $250 million in payments to home health agencies next year. Visit www.cms.hhs.gov/media/press/release.asp?Counter=1234 for more information.
(October 22, 2004)

Flu Vaccine, Medicine Supply Will Help Keep People Safe
About 60 million doses of influenza vaccine combined with enough antiviral medicines for more than 40 million people should provide sufficient protection during the upcoming flu season, according to the U. S. Department of Health and Human Services (HHS).

The flu vaccine supply includes about 58 million doses of Aventis vaccine (including 2.6 million doses available in January) and 2 million doses of FluMist nasal spray.

The federal government has purchased and stockpiled antiviral medicines to treat more than 7 million people. Supplies also exist in the private sector, and manufacturers indicate they have the ability to significantly ramp up production. All told, it is estimated there could be enough medicine to treat nearly 40 million people through the heart of flu season. The Centers for Disease Control and Prevention (CDC) recently issued interim guidance on the use of antiviral medicines for preventing and treating the flu, which are available on its Web site.

Recently, more than 2 million doses of influenza vaccine were shipped by Aventis Pasteur to health care providers throughout the country who serve the high-priority groups recommended by the CDC to receive influenza vaccine. After pairing CDC information on geographic locations of high-priority risk groups and Aventis Pasteur US information on providers scheduled to receive vaccine for the high-risk populations, this round of influenza vaccine went to:

• Department of Veterans Affairs
• Long-term Care Facilities/Acute Care Hospitals
• State Public Health Officials
• Vaccines for Children Program
• Private Providers Who Care for Young Children

More doses of vaccine will be going out over the next six to seven weeks. For more information about the flu and this year's recommendations, visit www.cdc.gov/flu.   (October 22, 2004)

BCBS Announces Coverage for FluMist
Due to the expected shortage of the injectable influenza vaccine, Blue Cross and Blue Shield (BCBS) of Alabama will implement the following policy effective for dates of service on or after Oct. 11, 2004:

For the 2004 through 2005 influenza season, FluMist will be covered for all groups that currently have coverage for routine influenza vaccines. It will be covered only when the injection is not available. To determine patient eligibility and benefits, be sure to use one of the following methods:

• e-Practice Management
• PCEMC+
• ProviderAccess

If you need access to one of these methods, contact your electronic vendor or Blue Cross and Blue Shield of Alabama's Network Data Operations Department.   (October 22, 2004)

AHA, Others Urge Americans to Join Fight Against Flu Infection
The American Hospital Association (AHA), Joint Commission on Accreditation of Healthcare Organizations (JCAHO), Centers for Disease Control and Prevention (CDC) and other national organizations today launched a campaign urging Americans to take three simple steps to limit the spread of flu and other respiratory infections. The infection control campaign reminds Americans to wash their hands frequently and thoroughly, cover their mouth and nose when sneezing or coughing, and avoid close contact with others when sick by staying home from work or school. For more on the campaign, or to download a brochure for patients, visit www.jcaho.org/news+room/press+kits/infection+control/ic_index.htm. (AHA News Now)  (October 22, 2004)

Alabama Receives Grants to Help Reduce Minority Health Disparities
Two Alabama universities are recipients of four grants totaling nearly $500,000 to encourage research to reduce health disparities among minority populations. The grants were awarded under the Centers for Medicare & Medicaid Services' (CMS') Historically Black Colleges and Universities Research Grants Program to Alabama A&M University in Normal and Tuskegee University in Tuskegee.

The grants support research regarding access to care, utilization and quality of services, and activities related to health screening, prevention and education. The grants also examine racial disparities, social and economic differences, and other barriers affecting the design and operation of programs that deal with health care issues of minority communities.

The $125,000 grant to Alabama A&M University will fund the university's colorectal cancer screening project. Tuskegee University, also the recipient of $125,000, will focus on improving prostate cancer screening rates among African-American men in rural black belt counties through education intervention with its funds.  (October 22, 2004)

Grants Will Help Create Community Health Centers in Alabama
Two Alabama communities are among the 76 nationwide recipients of grants to help create new community health centers. The grants awarded by the U.S. Department of Health and Human Services (HHS) total $49 million, with Quality of Life Health Services, Inc., in Gadsden receiving $816,667 and Mobile County Health Department receiving $900,000. Together, these two grants will help an estimated 11,450 Alabamians.

Under an initiative launched by President Bush in 2002, 1,200 new and expanded health center sites will be added across the nation, increasing the number of people served annually from about 10 million to 16 million by 2006. So far, HHS has funded nearly 700 new or expanded health centers. (October 22, 2004)

Nov. 6 Deadline to Preview Quality Data
Hospitals participating in the national quality initiative have until Nov. 6 to visit www.qnetexchange.org and preview their first-quarter 2004 data before it is publicly displayed. Those receiving a full market basket update for participating in the initiative, which is now being called the "Hospital Quality Alliance," will not have the option of withholding their data from public display, but every effort will be made to correct substantive errors, according to the Centers for Medicare & Medicaid Services (CMS). Hospitals that have difficulty accessing their data or find significant errors should contact the Alabama Quality Assurance Foundation (AQAF). If a hospital has not contacted AQAF by Nov. 6, CMS has said it will assume the hospital's data is correct and approved.  (October 15, 2004)

Senate Passes Bill Extending J-1 Visa Program
The Senate passed American Hospital Association- (AHA-) backed legislation (S. 2302) to reauthorize and extend by two years a visa program that helps staff medically underserved rural and urban communities with foreign physicians. The State 30/J-1 Visa Waiver program, which expired May 31, authorizes state departments of health to annually hire up to 30 foreign physicians to practice in medically underserved rural or inner-city communities. The physicians, who have completed U.S. medical residency programs, are granted J-1 visa waivers enabling them to remain in the country provided they commit to practice medicine for three years in underserved areas. Like a companion bill passed by the House Oct. 6, the Senate bill clarifies that foreign physicians selected for J-1 waivers are exempt from caps on H1-B visas, temporary work visas used by highly skilled foreign workers. It also adds a provision allowing foreign physicians selected for J-1 waivers to practice in primary care or specialty medicine, if a local shortage of health professionals in the requested specialty can be demonstrated. The House would have to accept the Senate version during the upcoming lame duck session before the bill can be signed into law. (AHA News Now)  (October 15, 2004)

JCR Publishes Updated Comprehensive Accreditation Manuals
The following 2005-2006 comprehensive accreditation manuals are now available from Joint Commission Resources (JCR): ambulatory care, laboratory and point-of-care testing and long term care.

More information is at www.jcrinc.com or call (877) 223-6866.   (October 15, 2004)

Free Clinic Workers Could Get Medical Malpractice Immunity
Health care providers volunteering at free clinics gain some protection from medical malpractice lawsuits under the Health Insurance Portability and Accountability Act (HIPAA). Through Section 194 of HIPAA, Congress enacted the "Free Clinics Federal Tort Claims Act (FTCA) Medical Malpractice Program." If a volunteer health care professional meets certain requirements, the related free clinic can sponsor him/her to be a "deemed" federal employee for the purpose of FTCA medical malpractice coverage. FTCA deemed status provides immunity from medical malpractice lawsuits resulting from subsequent performance of medical, surgical, dental or related functions within the scope of work at the free clinic.

More information is on the member portion of the AlaHA Web site, www.alaha.org, or you may call (301) 594-0818 or e-mail FreeClinicsFTCA@hrsa.gov.   (October 15, 2004)

Licensure Advisory Board Approves Proposed Changes to Facility Rules
At its recent meeting, the Licensure Advisory Board approved the following:

·         Proposed amendments to the rules for assisted living facilities and specialty care assisted living facilities. Changes to the rules include defining incident reporting and the type of incidents that must be reported to the Alabama Department of Public Health.

·         Proposed amendments to the rules for hospitals. Revisions change the number of beds a critical access hospital may have. This change coincides with the federal regulations for critical access hospitals.

The proposed rules will now go to the State Committee of Public Health for approval and will then be available for public comment.  (October 15, 2004)

Alabama to Host Listening Session Re. National Aging Policies
The Alabama Department of Senior Services will host an official listening session for the 2005 White House Conference on Aging (WHCoA) on Oct. 18, 2-4 p.m., at the Birmingham Sheraton Hotel. The purpose of the listening session is to gain input regarding U.S. aging policies. Comments from the listening session will be considered as the WHCoA continues its preparation for the conference to be held Oct. 23-26, 2005, in Washington, D.C. For more information call (877)-425-2243 or visit www.AGELINE.net.   (October 15, 2004)

AlaHA Offers Important Wage Index Workshops
Hospitals have until Nov. 29 to submit their corrected wage index data to the Centers for Medicare & Medicaid Services (CMS).

To assist in the process, AlaHA is offering a Medicare wage index workshop in two locations: Birmingham on Oct. 19 and in Montgomery the second week in November (specific date TBA), both beginning at 1 p.m. and lasting approximately three hours. The workshop is designed for CEOs, CFOs, controllers, budget and reimbursement personnel and human resources and payroll personnel. CEUs will be available.

Important upcoming issues related to the Medicare wage index, which will be discussed at the workshop, include:

• The occupational mix adjustment did not work right and CMS only implemented 10 percent of the adjustment.
• CMS has announced that forms will be modified to allow collection of contract dietary, housekeeping and administrative and general cost centers for probable inclusion in the wage index computation. Contract employee documentation requirements will continue to be an issue.
• Contract labor for RNs appears to be computed in a manner different than other contract labor. The implications of this are important to member hospitals.
• CMS has clarified that includable wage related costs must be cost based (as opposed to the write off of charges). New interpretations by fiscal intermediaries in early 2003 allow considerable latitude in how hospitals recorded "domestic claims" on a cost basis.
• There is a substantial increase in Provider Reimbursement Review Board (PRRB) appeal activity that could impact AlaHA member hospitals.
• The Medicare Modernization Act (MMA) established one-time appeals that impacted many hospitals throughout the country.
• MMA implemented an out commute adjustment affecting many hospitals.
•  CMS implemented the 2000 Census data, which affected several local Metropolitan Statistical Areas (MSAs), now Core-Based Statistical Areas (CBSAs).

There is no cost to attend this AlaHA-sponsored workshop; however, attendees must register. To register or for more information, please contact Peggy Carstens at your earliest convenience at (800) 489-2542 or pcarstens@alaha.org.
(October 15, 2004)

JCAHO, ASHE Collaborate
The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) and the American Society for Healthcare Engineering (ASHE) have collaborated to produce an application for survey form and surveyor training materials. In addition, JCAHO will augment the surveyor cadre with experienced health care engineers beginning in 2005 to be a part of the survey team at selected facilities.

If you have questions or would like additional information about Alabama's Continuous Service Readiness program, contact our Alabama representative, Norma Kay Sprayberry, RN, MSN, at nsprayberry@jcrinc.com or (630) 268-7489, ext. 7510.   (October 15, 2004)

GAO Looks at First-year Experiences Under HIPAA Privacy
A new federal report reviews providers' experiences in the implementation of the Health Insurance Portability and Accountability Act (HIPAA) privacy stands. The report, issued by the Government Accountability Office (GAO), also looks at the experiences of health plans, public health entities and others, as well as patients' awareness of their rights under HIPAA.

In the report, the GAO recommends the Department of Health and Human Services (HHS) require patients be informed of mandatory disclosures to public health authorities in privacy notices and exempt such disclosures from the accounting requirement. It also recommends HHS conduct a public information campaign to improve patients' awareness of their rights. The GAO remained concerned about the burden of accounting for disclosures to public health authorities and believes it is important that HHS more effectively disseminate information about the privacy rule.

The report is at www.hipaadvisory.com/news/newsarchives/2004/gaofirstyearprivacy.pdf.   (October 15, 2004)

JCAHO to Clarify Information Re. Media and Release Forms
Several months ago, the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) issued guidance that appeared to require hospitals to have a separate confidentiality form for media to sign when they film patients, in addition to the form the patient signs. After hearing from the American Hospital Association (AHA) and state quality representatives, JCAHO has agreed the patient form will suffice. The AHA is currently working with JCAHO to develop a set of questions and answers on this issue. We will share this document once it's published.  (October 8, 2004)

Medicare Premium Increases Affect More than Beneficiaries
As if Alabama's Medicaid program was not already suffering from a lack of funds, the new 17-percent increase in premiums for Medicare Part B will mean the state has to come up with an additional $5 million each year. The Medicaid Agency pays the premiums and deductibles for low-income Medicare patients, about 167,000 of them.

Medicaid Commissioner Carol Herrmann stated in a news article that the agency had only budgeted for a 2-percent to 3-percent increase in Medicare premiums and is already expecting a shortfall in the 2005-2006 budget year of $160 million, due in large part to a lowering of federal matching dollars and inflation.  (October 8, 2004)

ADPH: Providers Should Target Flu Vaccine to High Risk Patients
The Alabama Department of Public Health is requesting all health care providers restrict their supplies of influenza vaccine to those individuals at highest risk of severe complications of influenza. The recommendation is prompted by unexpected flu vaccine shortages due to a major manufacturer having its license temporarily suspended. More information can be found at www.adph.org and www.cdc.gov.  (October 8, 2004)

CMS Announces HIPAA Roundtable Call
The Centers for Medicare & Medicaid Services (CMS) announced the 17^th National HIPAA Implementation Roundtable conference call will be held on Wednesday, Nov. 10, 2- 3:30 p.m., EDT, focusing on the HIPAA Security Standards. The toll-free number is (877) 203-0044. The conference identification number is 1347026. CMS requests that callers dial in 15 minutes before the start of the meeting. No registration is required. (October 8, 2004)

Producer to Take on Health Industry
Michael Moore, the moviemaker who produced the controversial "Fahrenheit 9/11," is said to be working on a similar piece on health care. In a recent Chicago Tribune article, Moore's spokesman is quoted as saying the movie, tentatively titled "Sicko," is expected to focus on health care industry business practices, specifically those of the managed care and pharmaceutical industries. Miramax, the company reported to be financing and distributing the film, claims a deal is forthcoming but has yet to be finalized.  (October 8, 2004)

Studies Look at Medical Practice Variation Among Nation's Hospitals
Medicare patients with similar chronic conditions receive strikingly different care, even among hospitals identified as "best" for geriatric care by the magazine U.S. News & World Report, according to Dartmouth Medical School studies released this week. The studies, featured in the Oct. 7 Web-exclusive edition of the journal Health Affairs, show that the frequency of physician visits, the number of diagnostic tests, and rate of hospital and intensive care unit (ICU) stays vary markedly. The studies show that a higher intensity of care and higher level of spending are not associated with better quality or longer survival times even in the most renowned teaching hospitals.

The study, funded by the WellPoint Foundation, features 20 articles and analyses on medical practice variation by some of the nation's leading health care experts, and describes variation by hospital, not just geographic region, as has been the case in previous reports. The study also looks at racial and ethnic disparities and states, while disparities exist, there is no simple explanation for the variation and the differences can vary by region and by procedure.

In its comments, the American Hospital Association claims the report raises important questions about variations in health care but does not answer the key question: what is the right care?

The study is on-line at www.healthaffairs.org under "latest findings and commentary on variations." (October 8, 2004)

New Program Gives Seniors, Disabled More Independence
Within the next three years, 200 Alabama Medicaid beneficiaries will have the opportunity to direct their own personal care services and live more independently through a program to be administered by the Alabama Department of Senior Services (ADSS). Alabama, which has received a $250,000 grant from the Robert Wood Johnson Foundation, is one of 11 new states to participate in the expansion of the successful "Cash & Counseling" program, aimed at giving Medicaid recipients more choice and control over the personal care services they are eligible to receive.

The Alabama Cash & Counseling program will be developed by the Alabama Department of Senior Services in collaboration with the Alabama Medicaid Agency, the Alabama Department of Rehabilitation Services and the Alabama Department of Public Health. It is designed as a demonstration grant to be conducted through the West Alabama Regional Commission Area Agency on Aging that covers Bibb, Fayette, Greene, Hale, Lamar, Pickens and Tuscaloosa counties. (October 8, 2004)

Hospitals Not Required to Report Immigration Status
Hospitals will not be required to report a patient's immigration status to receive funding for uncompensated emergency care provided to undocumented immigrants, the Centers for Medicare & Medicaid Services (CMS) told the American Hospital Association (AHA) recently. The Medicare Modernization Act included $250 million for each of the next four years to offset the costs of providing care to undocumented immigrants. But to qualify for that funding, CMS' proposed implementation plan posted in July would have required hospitals to obtain direct evidence of emergency patients' immigration status. AHA, hospitals and patient advocates expressed concern the requirement would deter patients from seeking needed emergency care. In an Oct. 1 letter to AHA, CMS Administrator Mark McClellan said "providers will not be asked - and should not ask - about a patient's citizenship status in order to receive payment under this program." CMS is expected to release formal guidance on the policy soon. (AHA News Now)  (October 8, 2004)

Status of Medicare Litigation
In July, nearly 100 hospitals filed suit again the U.S. Department of Health and Human Services (HHS) in federal district court in Washington, D.C. The suit claims HHS Secretary Tommy Thompson did not follow congressional intent to adjust the labor component of the Medicare payment formula based on data, but instead arbitrarily developed a formula that overstates the percentage-of-wages-to-total-costs and thus severely penalizes hospitals in states like Alabama, Mississippi and Louisiana.

HHS has until Oct. 8 to file a response to the hospitals' complaint. The response could be in the form of: (1) an answer, in which the government admits or denies our specific allegations; (2) a summary judgment motion, in which the government asks the court to affirm the validity of the regulations; or (3) a motion to dismiss the complaint based on an argument that the complaint is purportedly defective in some way.

The next steps and the time frame for taking those steps will depend on how the government reacts to the complaint. We should know more after Oct. 8. (October 1, 2004)

AlaHA Asks Members to Encourage Employees to Vote
As a part of AlaHA's Operation Healthy Vote (www.alaha.org/vote), the association's first attempt to activate the hospital vote during election cycles, the government relations staff has prepared payroll stuffers we hope you will include in the payroll cycle just before the Nov. 2 general election.

The payroll stuffers DO NOT include candidate endorsements. They are simply a reminder to vote. Therefore, all hospitals, regardless of ownership, may use them.

Be on the lookout for your supply to arrive during the week of Oct. 4 and forward them to the appropriate department for inclusion in your next payroll cycle.

Also, posters are on the way. To compliment and promote the Operation Healthy Vote effort, staff has designed posters for display in common areas of member hospitals. Your supply of posters will be shipped separate from the payroll stuffers.

It is our hope that this effort will grow in the coming years so that the hospital/health care vote will become as powerful in strength as it is in number. (October 1, 2004)

AlaHA Provides Medicare Inpatient Rule Summary
A comprehensive summary of the final Medicare Hospital Inpatient Prospective Payment System (PPS) rule for the 2005 federal fiscal year was mailed to hospital CEOs this week. The provisions of this rule are effective Oct. 1, 2004, unless otherwise noted in the summary. Items of particular importance are changes to the wage index and reclassification rules, a methodology to redistribute unused graduate medical education resident slots, several provisions related to critical access hospitals, and implementation of mandates from the Medicare Prescription Drug, Improvement, and Modernization Act of 2003. Probably the most significant changes are related to the calculation of wage indexes, which include: updates to the wage data, use of the new Office of Management and Budget geographic areas, inclusion of an occupational mix adjustment, changes to wage area reclassifications, the new out-migration adjustment, and hold-harmless and transition provisions. A copy of the final summary can be found on the member portion of the AlaHA Web site, www.alaha.org.  (October 1, 2004)

Fall Conference Focuses on Medicaid
Mark your calendars for the AlaHA Fall Conference in SanDestin, Nov. 3-5. The resort is fully operational and ready for the AlaHA Fall Meeting. Please call the hotel at (800) 320-8115 before Oct. 8 to reserve a room at the AlaHA group rate.

This year's conference will focus on the Alabama Medicaid Agency. On Nov. 4, Commissioner Carol Herrmann and Vernon Smith, Health Management Associates, will provide an in-depth look at Alabama's program compared to programs in other states. In addition, legislative leadership from the House and Senate Health and Finance committees will participate in a panel discussion concerning protecting and expanding Medicaid's budget. On Nov. 5, Governor Bob Riley and Speaker Seth Hammett will provide insight into the political climate for the coming year. (October 1, 2004)

California Governor Vetoes Bill Mandating Discounts for Uninsured
Last week, California Gov. Arnold Schwarzenegger vetoed a bill that would mandate reduced-payment policies for low-income uninsured Californians, opting instead to give newly implemented voluntary guidelines a chance. In February, the California Healthcare Association (CHA) adopted voluntary guidelines for assisting low-income uninsured patients that recommend member hospitals provide financial assistance for patients at or below 300 percent of the federal poverty level. The guidelines also recommend hospitals limit expected payments from such patients to amounts received from Medicare and other government-sponsored health programs, do not garnish wages or place liens on primary residences to collect unpaid bill, and clearly post and communicate their financial assistance policies to patients. (AHA News Now)  (October 1, 2004)