June 2, 2008

NPI Update: Up To 37% Of Medicaid Claims Rejected
Reports Look At Uninsured, Medicare And Medicaid Spending
Dr. Davis And AMA Continue E-Prescribing Push
Congressional Researchers Rip Health Care IT Cost Savings Estimates
Bush Threatens Veto On Bills That Cut Medicare Advantage Plan
House To Vote On Health Center Reauthorization
Medidome Offers New Twist On Routine Procedure
WSUSOM New And Noteworthy

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NPI Update: Up To 37% Of Medicaid Claims Rejected

According to a report in Modern Healthcare, the rejection rates of claims bound for Blue Cross and Blue Shield plans appear to have returned to normal, but one-quarter or more of Medicare and Medicaid claims continue to be rejected one week after the National Provider Identifier program was implemented, according to Miriam Paramore, senior vice president of corporate strategy at Nashville-based claims clearinghouse Emdeon Business Services.

Paramore, who also serves as chairman of the Healthcare Information and Management Systems Society’s financial systems steering committee, a work group for claims clearinghouses, said “at least one of our (clearinghouse) peers is seeing a 25 percent Medicare rejection rate and a 37 percent Medicaid rejection rate.”

“We continue to be concerned about our customers on both sides, payers and providers,” Paramore said, but for providers, “even a small increase in rejections could mean millions and millions of dollars” in lost or delayed revenue. The impact on provider cash flow won’t be known until later, she said, adding that she has no solid numbers yet on the most-frequent specific causes of the heightened rejection rates.

“It’s too early to answer that,” she said. “Give me to the end of next week; we should have some good numbers.”

For more on the post-NPI claims rejection increase, see Claims processors see rejections spike with NPI .

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Report Looks At Uninsured, Medicare And Medicaid Spending

"Rite of Passage? Why Young Adults Become Uninsured and How New Policies Can Help," Commonwealth Fund: According to the updated report, the number of uninsured adults ages 19 to 29 in the United States increased to 13.7 million in 2006 from 13.3 million in 2005. The authors write that this age group typically loses coverage after age 19 as a result of being dropped from parents' policies or from public programs and that states could increase coverage rates by expanding Medicaid and SCHIP eligibility and ensuring that colleges and universities require health insurance and offer it to their full-time and part-time students (Commonwealth Fund release, 5/30).
"Accounting for Sources of Projected Growth in Federal Spending on Medicare and Medicaid," Congressional Budget Office: The issue brief states that the main cause of future Medicare and Medicaid spending will be rising per-beneficiary costs, rather than rising numbers of beneficiaries. According to CBO projections, federal spending on the two public programs will grow from 4 percent of gross domestic product in 2007 to 9 percent in 2032 and 19 percent in 2082. During the next 25 years, in which the baby boom generation will age and increase the number of Medicare and Medicaid beneficiaries, CBO estimates that more than half of growth in spending will result from cost growth (CBO, 5/28).

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Dr. Davis And AMA Continue E-Prescribing Push

This column was originally published in AMA eVoice on May 15, 2008. Dr. Davis is president of the American Medical Association and a prominent member of WCMSSM. His remarks have been edited.

The AMA had quite a presence in Washington, D.C. During a May 9 meeting at the Brookings Institution, AMA Trustee Steven Stack, MD, highlighted the AMA's support for electronic prescribing and pointed out a number of key steps that would lead to broader adoption among physicians of health information technology (HIT). The AMA has strong policies regarding HIT, but this marked the first time the AMA has shared an outline of what physicians would accept as part of e-prescribing legislation.

E-prescribing software allows for prescriptions to be transmitted electronically to a pharmacy's computer system. Through e-prescribing, physicians can manage patients' prescriptions electronically, view potential drug interactions and side effects, view prescription drug coverage and insurance information, receive electronic notification about the need to authorize refills or approve generic substitutions, and share simultaneous access to prescription histories and allergies with pharmacies. E-prescribing may be part of an electronic medical records (EMR) application or a stand-alone software system.

I believe e-prescribing can play an important role in transforming health care by improving patient safety, enhancing care coordination among health care providers, and reducing administrative burdens that take physicians away from patients. A number of physicians nationwide already are using e-prescribing or are in the process of implementing this technology.

To help more physicians take advantage of e-prescribing, financial incentives are needed to offset the costs of implementation. Grants, low-interest loans, increased reimbursement for the use of e-prescribing, and tax credits are economic incentives that would help physicians who find it difficult to afford implementing this software.

We also need a national framework that includes a uniform set of e-prescribing standards and a transitional period for physicians to adopt technology. Any e-prescribing requirement that triggers potential penalties should be deferred until two years after final standards are in place. This will allow physicians to acquire and implement e-prescribing tools and train their staff. In addition, any proposal should include exceptions for small practices and physicians in rural areas as well as emergency situations in which doctors may have to prescribe medications outside their normal offices.

I urge Congress to direct the Centers for Medicare and Medicaid Services (CMS) to release final e-prescribing standards by the end of 2009. CMS issued three standards last month and plans three more, and their completion would help create uniformity around functionality, which would help ensure connectivity. These standards also would help make sure that this technology does not become obsolete.

One of the main concerns about e-prescribing is that the privacy and confidentiality of patient information could be put at risk. Earlier this week, the Coalition for Patient Privacy and 25 of its member organizations asked Congress not to pass an e-prescribing mandate unless it includes privacy provisions. Last year, as part of a statement to a U.S House subcommittee, the AMA encouraged Congress to make privacy and confidentiality a top priority when developing an HIT infrastructure.

Congress must also remove a barrier in place under the Drug Enforcement Administration's prohibition on e-prescribing controlled substances, which account for about 20 percent of all prescriptions.

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Congressional Researchers Rip Health Care IT Cost Savings Estimates

CBO recently issued an analysis on the likely (or unlikely) cost savings from the use of health IT in the United States’ health care system. The report says that the use of health IT by itself is unlikely to produce the significant cost savings projected by some. CBO also said that “in some instances, health IT appears to have reduced the cost of providing health care, helped eliminate inappropriate services, and improved the quality of care…. But by itself it typically does not produce a reduction in costs.” CBO also challenged a RAND report that estimated annual savings of about $77 billion from widespread adoption. Some in Congress already are responding to the CBO analysis. The study comes just weeks before National Health IT Week (June 9-13, 2008).

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Bush Threatens Veto On Bills That Cut Medicare Advantage Plan

HHS Secretary Mike Leavitt in a May 22 letter wrote that President Bush's senior advisers would recommend he veto any legislation that "would result in the loss of access to additional benefits or choices in the Medicare Advantage program," the AP/San Francisco Chronicle reports (Freking, AP/San Francisco Chronicle, 5/29). The letter was sent to Senate Finance Committee ranking member Chuck Grassley (R-Iowa) after bipartisan discussions on a Medicare bill halted last week (Edney, CongressDaily, 5/29).

Finance Committee Chair Max Baucus (D-Mont.) last week said he will move forward with a Medicare package developed by Democrats that likely will be opposed by Republicans and the Bush administration. Baucus said he is retreating from crafting a bipartisan Medicare package that would delay for 18 months a 10.6 percent cut to physician fees. Although both parties want to halt the cut, which is scheduled to go into effect on July 1, they have been unable to agree on offsets to pay for the bill, among other issues (Kaiser Daily Health Policy Report, 5/22).

According to the AP/Chronicle, lawmakers must find at least $9 billion in offsets over the next five years from other Medicare programs. The AP/Chronicle reports that Democrats and some Republicans favor making cuts to payments for MA plans, which cover about 9.5 million beneficiaries. Baucus spokesperson Carol Guthrie said advisory commissions have said the government on average pays MA plans 13 percent more than it would spend on comparable patients enrolled in traditional Medicare. Guthrie said, "Congress has a duty to Medicare beneficiaries and to all taxpayers to modify payments when they are found to be out of line" (AP/San Francisco Chronicle, 5/29).

According to CongressDaily, reducing MA plan payments is an "attractive fundraiser" to offset the delay in physician fee reductions, especially with Democrats, "who are not as supportive of private-sector participation in Medicare." Grassley and Senate Minority Leader Mitch McConnell (R-Ky.) last week offered a Medicare package that would cut $8.7 billion in MA payments for indirect medical education (CongressDaily, 5/29).

Administration 'Strongly Opposes' MA Cuts
The Bush administration has said reducing MA payments would result in reduced benefits for beneficiaries (AP/San Francisco Chronicle, 5/30). Leavitt wrote, "To protect the interest of these beneficiaries, the administration strongly opposes any policies that would reduce payments for MA plans or target a subset of those plans for funding reductions, program restructuring, marketing restrictions or enhanced state regulation" (CongressDaily, 5/29). Leavitt wrote that offsets should be found through cuts to traditional Medicare fee-for-service plans (AP/San Francisco Chronicle, 5/30). According to CongressDaily, although Leavitt's letter did not specifically mention MA IME cuts, the "sweeping" opposition to MA payment reductions combined with Leavitt's letter "conjures up doubt that any reductions in the IME payments would pass muster" (CongressDaily, 5/29).

Letter 'Complicates Efforts' To Find Offsets
According to the AP/Chronicle, Leavitt's letter "complicates efforts" by lawmakers to find offsets to maintain or slightly raise current physician payment rates. Already it is "tough to find enough votes to cut payments to any health care provider in the Medicare program, let alone find enough support to overcome a presidential veto," the AP/Chronicle reports (AP/San Francisco Chronicle, 5/29).

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House To Vote On Health Center Reauthorization

After nearly two years of advocacy and grassroots work by health centers, the House of Representatives will again take up the reauthorization of the Health Centers Program when Congress reconvenes after the Memorial Day recess, according to the National Association of State Legislatures. The Health Centers Renewal Act, which would reauthorize funding for the program for five years and grant liability protection for physicians who volunteer at the centers or travel to provide services in emergencies, will be considered by the full House on Tuesday, June 3rd.

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Medidome Offers New Twist On Old Procedure

Editor’s note: The following item was found at www.medgadget.com , a website that features interesting technological innovations and reports on new clinical studies.

Christopher Holden, a 21 year old student, thinks he has the answer to an old medical combo of needle and syringe. His little design project called MediDome has been getting accolades from RSA (Royal Society for the Encouragements of Arts, Manufactures and Commerce), and is now being patented by his school, Northumbria University in Newcastle.

RSA explains how the device works:

Christopher's project, 'MediDome', redesigns the needle and syringe. It aims to eliminate needlestick injuries and the fear of needles and injections, simplify the process and speed up patient treatment. The product's aesthetics show a softer, friendlier and less threatening form, and MediDome has a unique tester to ensure that a vein has not been ruptured during intramuscular or subcutaneous injection. A sterile cover is removed to expose adhesive wings that stick the MediDome to the required area for injection. The person administering the injection removes the blister cap and presses down on the top of MediDome until a little resistance is felt. A bubble on one of the wings is checked for blood - if it fills up the injection is halted. If all is well, they then give a small firm press until a click is heard, then softly compress and hold the dome. On release, MediDome returns to its original shape (but cannot be compressed again), is removed from the arm and disposed of for incineration. It is a fail safe single use design - once used it can never be used again, so syringes cannot be shared, and viruses such as HIV or blood born diseases cannot be passed on. It is made from a soft flexible plastic, pre-filled with a measured drug dose (eliminating the need for priming), all manufactured in one factory as one product, which means lower cost production. MediDome uses a universal color coding drug system - the ring is a different color depending on which drug is in the pre-filled reservoir. Minimal packaging reduces the product's carbon footprint, and a large label area contains all necessary information, such as drug name and dosage. The peel off adhesive cover also acts as a tamper alarm - it changes color if the product has been ruptured or tampered with. A companion product, the Absorption MediDome, works in the same way for drugs such as painkillers and certain antibiotics but without the needle. During his research, Christopher consulted the Head of Clinical Governance and Risk, the Chief of Electronics and Medical Engineering, and the Head of Health and Safety Adviser (the latter also a former nurse) at the Newcastle upon Tyne Hospitals NHS Foundation Trust. MediDome would also bring benefits when used in military and natural disaster situations, and mass immunization in developing countries.

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WSUSOM New And Noteworthy

Kudos to the following newsmakers at the WSU School of Medicine:

Diane Chugani, PhD, professor of Pediatrics and Radiology at the Wayne State University School of Medicine, was recently awarded a $5.79 million grant from the National Institute of Neurological Disorders and Stroke of the National Institutes of Health for a study that may open doors to finding a treatment for improving those afflicted with autism.

The grant, “Early Pharmacotherapy Guided by Biomarkers in Autism,” will continue earlier research that showed that the brain serotonergic system is abnormal during critical periods of brain development in children with autism.

In this study, Dr. Chugani and her team demonstrated that serotonin synthesis capacity in children younger than 6 was significantly altered when compared to non-autistic children.

Denise G.K. Gray, MD, assistant professor in the Wayne State University School of Medicine Department of Radiology, has been awarded Fellow status in the American College of Radiology.

Dr. Gray, a 1975 graduate of the Wayne State University School of Medicine, was inducted as a new Fellow on May 18 in Washington, D.C., at the annual meeting of the ACR. She is the only Fellow from Michigan inducted this year.

Dan Barkmeier recently received a Pre-doctoral Research Training Fellowship from the Epilepsy Foundation of America. The fellowship includes $20,000 to continue his work in research that could lead to promising new seizure medications.

“This is a major milestone for me because it is the first time I have successfully received an external funding award,” said Mr. Barkmeier, 26. “The goal of this project is to better understand the molecular aspects of epilepsy and to use that knowledge to develop new therapeutics for the disease.”

Originally from Champaign, Ill., and now living in Romulus, Mr. Barkmeier is a MD/PhD student working in the laboratory of Dr. Jeffrey Loeb, in the Department of Neurology, Comprehensive Epilepsy Program.

Phillip D. Levy, MD, MPH, an assistant professor in the School of Medicine’s Department of Emergency Medicine, has received a prestigious award that will assist him in continuing his work to identify preemptive signs of congestive heart failure.

Dr. Levy, who also serves as associate director of clinical research in the department, has been selected as a recipient of a Robert Wood Johnson Physician Faculty Scholar Award. The award, which includes a grant of $300,000 over three years, was one of 15 awarded. Sixty medical schools submitted applications for consideration.

Jun Li, MD, PhD, associate professor in the Wayne State University School of Medicine Department of Neurology, recently received the 2007-2008 Junior Faculty Award for Science from the Wayne State University Academy of Scholars.

Each year the academy selects a junior faculty member to represent the sciences. Dr. Li was selected from among non-tenured faculty members who are in the process of building careers through the publication of papers and have received national or international recognition early in their careers.

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