Sunday, November 28, 2010

Berwick Testifies to the Senate Finance Committee

On November 17th, Donald Berwick testified before the Senate Finance Committee. As you can imagine, there was a lot of political tension surrounding this event.

The video of the entire senate hearing is here: http://finance.senate.gov/hearings/watch/?id=280ebc81-5056-a032-5254-1010c1e9b945

Berwick's prepared statement can be found here: http://finance.senate.gov/imo/media/doc/FINAL%20Donald%20Berwick%20Testimony%2011.15.101.pdf

Bacus' prepared opening statement can be found here: http://finance.senate.gov/imo/media/doc/11172010%20Baucus%20Hearing%20Statement%20Regarding%20New%20Patient%20Protections%20to%20Strengthen%20Medicare%20and%20Medicaid1.pdf

Grassley's prepared opening statement can be found here: http://finance.senate.gov/imo/media/doc/health%20care%2011-17-10%20hearing%20with%20Dr.pdf

Kaiser Health News, a program of the Kaiser Family Foundation, consolidated a resource page about Dr. Donald Berwick. It contains both what he has said as well as what others have said about him (and what he said). It can be found here: http://www.kaiserhealthnews.org/Stories/2010/June/30/Donald-Berwick-Resource-Guide.aspx

Tuesday, November 9, 2010

RAC for Medicaid?

The following is a press release from CMS (Nov 5, 2010) announcing some of the details for the implementation of Medicaid RAC. Items of interest to quality professionals are in red.

MEDICAID RECOVERY AUDIT CONTRACTORS RULE ANNOUNCED TO HELP REDUCE IMPROPER PAYMENTS
CMS ANNOUNCES EDUCATION EFFORT TO SUPPORT PROGRAM

The Centers for Medicare & Medicaid Services (CMS) today proposed new rules to help states reduce improper payments for Medicaid health care claims through the use of Medicaid Recovery Audit Contractors (RACs) as part of the Affordable Care Act’s larger strategy to crack down on waste, fraud and abuse in the health care system. Medicaid RACs are contractors, working for States, that will audit payments made to health care providers to identify Medicaid payments that may have been underpaid or overpaid, and recover overpayments or correct underpayments, similar to the RAC program in Medicare.

“Reducing improper payments is a key goal of the Administration, and the tools provided by the Affordable Care Act will help us achieve that goal,” said CMS Administrator Donald Berwick, M.D. “We are using many of the lessons that we learned from the Medicare RAC program in the development and implementation of the Medicaid RACs, including a far-reaching education effort for health care providers and State managers.”

Under the Affordable Care Act, States must establish Medicaid RAC programs by submitting state plan amendments to CMS by December 31, 2010. The law allows CMS to provide extensions or exceptions to States, if necessary, and details regarding these processes are included in the proposed regulation. In addition, the proposed regulation issued by CMS today outlines the requirements that states must meet and the Federal contribution CMS will provide to assist in funding the state RAC programs.

Medicaid RACs will be paid by the States on a contingency basis to review Medicaid provider claims, identify and recover overpayments made for services provided under Medicaid State plans and Medicaid waivers. The proposed regulation allows States the discretion to determine whether to pay their Medicaid RACs on a contingency basis or under some other fee structure for identifying underpayments.

CMS is encouraging interested parties to comment on the proposals included in the regulation. These include the payment methodology for identifying overpayments and underpayments as well as the recovery of overpayments and correction of underpayments, and the requirement that RACs report fraud or criminal activity whenever they have reasonable grounds to believe such activity has occurred.

Under the regulation, as proposed, a State may use its current administrative appeals process or may modify its process for Medicaid RAC-related appeals. All fees paid to the Medicaid RACs must come from amounts recovered after all available appeals have been exhausted.

Because CMS has proposed to require States to implement their programs in a timely manner, CMS is providing educational programs to help States understand both the Medicare and Medicaid RAC programs. On October 1, 2010, CMS released a State Medicaid Director letter which provided initial guidance to the States regarding the RAC program. CMS issued an educational DVD entitled “Medicaid RACs: Are You Ready?” targeted to State Medicaid and Program Integrity Directors and held a webinar for states offering RAC procurement tips. Additionally, on November 4, 2010, CMS hosted an educational forum describing Lessons Learned from CMS’s experience with Medicare RACs.

A copy of the regulation may be viewed at the Federal Register’s website, http://www.ofr.gov/inspection.aspx. For Additional information on the Affordable Care Act can be accessed at, http://www.healthcare.gov/.


Sunday, November 7, 2010

Indiana Performs Well on HCAHPS

The following is a table of how States performed on the HCAHPS overall rating question from Jan 09 to Dec 09. The table is sorted from high to low based on the percentage of patients responding with a rating of 9 or 10 on this 10 point scale.

As you can see, the average of Indiana hospitals ranks 7th of all states for this question.

% State
73 SD
72 KS
72 LA
72 IA
71 NE
71 ME
71 IN
70 VT
70 ID
70 NH
70 WI
69 CO
69 UT
69 MN
69 NC
68 AL
68 MI
68 OK
68 KY
68 TX
68 SC
67 MO
67 MS
67 MA
67 OH
67 OR
67 TN
66 WA
66 AZ
66 AR
66 GA
65 CT
64 AK
64 WV
64 VA
64 PA
64 IL
64 RI
63 WY
63 MT
63 CA
62 DE
62 NV
62 ND
62 FL
61 MD
61 NM
60 NJ
59 HI
58 NY
58 DC

Indiana Hospitals HCAHPS Performance

The following is a table of the performance of Indiana hospitals (Jan 09 to Dec 09) on the HCAHPS overall rating question. The table is sorted from high to low based on the percentage of patients providing a response of 9 or 10 on this 10 point scale.

% Hospital and City
94 SURGICAL HOSPITAL OF MUNSTER of MUNSTER
89 INDIANA ORTHOPAEDIC HOSPITAL LLC of INDIANAPOLIS
87 ST VINCENT HEART CENTER OF INDIANA LLC of INDIANAPOLIS
87 WOMEN'S HOSPITAL THE of NEWBURGH
86 PHYSICIANS' MEDICAL CENTER LLC of NEW ALBANY
85 INDIANA HEART HOSPITAL THE of INDIANAPOLIS
82 HENDRICKS REGIONAL HEALTH of DANVILLE
80 CLARIAN NORTH MEDICAL CENTER of CARMEL
80 ST VINCENT CARMEL HOSPITAL INC of CARMEL
80 PARKVIEW LAGRANGE HOSPITAL of LAGRANGE
79 ST FRANCIS HOSPITAL MOORESVILLE of MOORESVILLE
79 SCHNECK MEDICAL CENTER of SEYMOUR
78 GOOD SAMARITAN HOSPITAL of VINCENNES
78 DEKALB MEMORIAL HOSPITAL INC of AUBURN
78 PARKVIEW WHITLEY HOSPITAL of COLUMBIA CITY
78 TIPTON HOSPITAL of TIPTON
78 PARKVIEW NOBLE HOSPITAL of KENDALLVILLE
78 DUPONT HOSPITAL LLC of FORT WAYNE
77 COMMUNITY HOSPITAL of MUNSTER
77 ST MARY'S MEDICAL CENTER OF EVANSVILLE INC of EVANSVILLE
77 MEMORIAL HOSPITAL AND HEALTH CARE CENTER of JASPER
77 MARGARET MARY COMMUNITY HOSPITAL INC of BATESVILLE
77 ST VINCENT FRANKFORT HOSPITAL INC of FRANKFORT
76 FRANCISCAN PHYSICIANS HOSPITAL LLC of MUNSTER
76 ST VINCENT DUNN HOSPITAL INC of BEDFORD
76 WITHAM HEALTH SERVICES of LEBANON
76 PARKVIEW HUNTINGTON HOSPITAL of HUNTINGTON
75 SAINT JOSEPH'S REGIONAL MEDICAL CENTER - PLYMOUTH of PLYMOUTH
75 THE ORTHOPAEDIC HOSPITAL OF LUTHERAN HEALTH NETWOR of FT WAYNE
75 ORTHOPAEDIC HOSPITAL AT PARKVIEW NORTH LLC of FORT WAYNE
75 MEMORIAL HOSPITAL OF SOUTH BEND of SOUTH BEND
75 MONROE HOSPITAL of BLOOMINGTON
75 CLARIAN WEST MEDICAL CENTER of AVON
74 LUTHERAN HOSPITAL OF INDIANA of FORT WAYNE
74 BLUFFTON REGIONAL MEDICAL CENTER of BLUFFTON
74 COMMUNITY HOSPITAL OF ANDERSON AND MADISON COUNTY of ANDERSON
74 CLARK MEMORIAL HOSPITAL of JEFFERSONVILLE
74 ST VINCENT WILLIAMSPORT HOSPITAL INC of WILLIAMSPORT
74 GOSHEN GENERAL HOSPITAL of GOSHEN
74 ST VINCENT HOSPITAL & HEALTH SERVICES of INDIANAPOLIS
74 PARKVIEW HOSPITAL of FORT WAYNE
74 FLOYD MEMORIAL HOSPITAL AND HEALTH SERVICES of NEW ALBANY
73 JAY COUNTY HOSPITAL of PORTLAND
73 MAJOR HOSPITAL of SHELBYVILLE
73 ST MARY MEDICAL CENTER INC of HOBART
73 BEDFORD REGIONAL MEDICAL CENTER of BEDFORD
73 RIVERVIEW HOSPITAL of NOBLESVILLE
73 ST FRANCIS HOSPITAL AND HEALTH CENTERS-INDIANAPOLI of INDIANAPOLIS
73 ST VINCENT MERCY HOSPITAL of ELWOOD
73 ST JOSEPH HOSPITAL & HEALTH CENTER INC of KOKOMO
72 SAINT JOSEPH REGIONAL MEDICAL CENTER of MISHAWAKA
72 HARRISON COUNTY HOSPITAL of CORYDON
72 CLARIAN-ARNETT HEALTH SYSTEM INC of LAFAYETTE
72 WABASH COUNTY HOSPITAL of WABASH
71 CAMERON MEMORIAL COMMUNITY HOSPITAL INC of ANGOLA
71 GIBSON GENERAL HOSPITAL of PRINCETON
71 HANCOCK REGIONAL HOSPITAL of GREENFIELD
70 REID HOSPITAL & HEALTH CARE SERVICES of RICHMOND
70 FAYETTE REGIONAL HEALTH SYSTEM of CONNERSVILLE
70 TERRE HAUTE REGIONAL HOSPITAL of TERRE HAUTE
70 COLUMBUS REGIONAL HOSPITAL of COLUMBUS
70 SAINT JOHN'S HEALTH SYSTEM of ANDERSON
70 HENRY COUNTY MEMORIAL HOSPITAL of NEW CASTLE
70 ST VINCENT JENNINGS HOSPITAL INC of NORTH VERNON
69 COMMUNITY HOSPITAL NORTH of INDIANAPOLIS
69 SULLIVAN COUNTY COMMUNITY HOSPITAL of SULLIVAN
69 ST CATHERINE HOSPITAL INC of EAST CHICAGO
69 SAINT ANTHONY of CROWN POINT
69 MARION GENERAL HOSPITAL of MARION
68 ST ANTHONY MEMORIAL HEALTH CENTERS of MICHIGAN CITY
68 UNION HOSPITAL CLINTON of CLINTON
68 DEACONESS HOSPITAL INC of EVANSVILLE
68 ST ELIZABETH CENTRAL of LAFAYETTE
68 LAPORTE HOSPITAL AND HEALTH SERVICES of LA PORTE
68 JOHNSON MEMORIAL HOSPITAL of FRANKLIN
68 DAVIESS COMMUNITY HOSPITAL of WASHINGTON
68 KING'S DAUGHTERS' HOSPITAL AND HEALTH SERVICESTHE of MADISON
68 WILLIAM N WISHARD MEMORIAL HOSPITAL of INDIANAPOLIS
67 ST FRANCIS HOSPITAL AND HEALTH CENTERS of BEECH GROVE
67 WESTVIEW HOSPITAL of INDIANAPOLIS
67 BLOOMINGTON HOSPITAL of BLOOMINGTON
67 DECATUR COUNTY MEMORIAL HOSPITAL of GREENSBURG
67 BALL MEMORIAL HOSPITAL INC of MUNCIE
67 ST VINCENT CLAY HOSPITAL INC of BRAZIL
66 SCOTT COUNTY MEMORIAL HOSPITAL AKA SCOTT MEMORIAL of SCOTTSBURG
66 ELKHART GENERAL HOSPITAL of ELKHART
66 UNION HOSPITAL INC of TERRE HAUTE
66 ST JOSEPH HOSPITAL of FORT WAYNE
66 HOWARD REGIONAL HEALTH SYSTEM of KOKOMO
65 COMMUNITY HOSPITAL SOUTH of INDIANAPOLIS
64 DEARBORN COUNTY HOSPITAL of LAWRENCEBURG
64 MEMORIAL HOSPITAL of LOGANSPORT
63 ST VINCENT RANDOLPH HOSPITAL INC of WINCHESTER
63 CLARIAN HEALTH PARTNERS INC D/B/A METHODIST IU RIL of INDIANAPOLIS
62 KOSCIUSKO COMMUNITY HOSPITAL of WARSAW
61 ST MARGARET MERCY HEALTHCARE CENTERS of DYER
61 STARKE MEMORIAL HOSPITAL of KNOX
60 DUKES MEMORIAL HOSPITAL of PERU
60 ST ELIZABETH EAST of LAFAYETTE
59 COMMUNITY HOSPITAL EAST of INDIANAPOLIS
57 MORGAN HOSPITAL AND MEDICAL CENTER of MARTINSVILLE
55 ST CLARE MEDICAL CENTER of CRAWFORDSVILLE
55 PORTER VALPARAISO HOSPITAL of VALPARAISO
55 ST MARGARET MERCY HEALTHCARE CENTERS of HAMMOND
48 SAINT CATHERINE REGIONAL HOSPITAL of CHARLESTOWN
41 METHODIST HOSPITALS INC of GARY

Note that the following hospitals were tagged as "Survey results are not available for this reporting period".


WHITE COUNTY MEMORIAL HOSPITAL
UNITY MEDICAL AND SURGICAL HOSPITAL
THE HEART HOSPITAL AT DEACONESS GATEWAY LLC
ST MARY'S WARRICK HOSPITAL INC
PUTNAM COUNTY HOSPITAL
PINNACLE HOSPITAL
PERRY COUNTY MEMORIAL HOSPITAL
KENTUCKIANA MEDICAL CENTER LLC
JASPER COUNTY HOSPITAL
GREENE COUNTY GENERAL HOSPITAL
COMMUNITY HOSPITAL OF BREMEN INC
ADAMS MEMORIAL HOSPITAL