Hospitals Lose Millions to Cancelled Appointments

24 May


While patients may not think much of not showing up for an appointment or canceling, it can have serious long-term consequences for hospitals and their bottom line. According to researchers involved in a 2009 study at Tulane University Medical Center, 327 of 4,876 (6.7 percent) scheduled elective outpatient surgeries were cancelled, which ended up costing the hospital almost $1 million for the year.
Since surgeries are responsible for about 60 percent of the hospital’s revenue, that loss had a major financial effect, says study author Sabrina Bent, MD, MS, clinical associate professor of anesthesiology and director of research at the Tulane University Department of Anesthesia, in New Orleans.
However, the researchers pointed out that patients who have a preoperative visit with an anesthesiologist are considerably more likely to keep their appointment in the operating room.
“People need to recognize that there is a cost to cancelled surgeries that is not insignificant,” said Dr. Bent, who presented the findings at this year’s American Society of Anesthesiologists Conference on Practice Management.
Much of cost associated with cancelled surgery stems from the fact that hospitals can’t fill in those slots with other surgical on short notice. 
One step in minimizing surgery cancellations is understanding why they happen in the first place. According to Dr. Bent, 30 percent of patients in the study didn’t show for their surgery due to transportation problems, confusion over the appointment date, forgetting about the appointment, among other reasons.
While those issues may be difficult to remedy, about a third of the cancellations were actually due to internal hospital issues, including a lack of beds or equipment and scheduling errors. Sometimes equipment is needed in two operating rooms at once, equipment fails, or there is no room in the ICU.
Researchers’ Recommendations
  • Dr. Bent and her colleagues recommend that hospitals make sure all patients have a preoperative visit with an anesthesiologist, since they found those patients had a 7 percent advantage in the cancellation rate (11 percent vs. 4 percent).
  • Make sure patients are medically ready for surgery and that they receive the proper preoperative instructions for the day of the procedure.
  • Improve equipment and resource allocation.
  • Hospitals should focus on areas they can have the biggest impact, such as the specialities with the highest cost associated with their cancellations. The top two were neurosurgery and urology, with an average cost per case of 5,962 and $4,758 respectively.
“I think this study suggests that it is reasonable for medical centers to bear a significant cost to maintain the anesthesia preoperative clinic,” said Dr. Glick, MD, MBA, associate professor of anesthesia and critical care at the University of Chicago. “It enables them to save more money down the line, when surgeries are not cancelled.”

CMS Proposes 2013 Pay Rate Hike for Hospitals

30 Apr


The Centers for Medicare & Medicaid Services (CMS) just issued a proposed rule to update 2013 Medicare, which includes a payment rate increase of 2.3 percent for inpatient stays at general acute care hospitals. The increase would raise total Medicare spending for inpatient hospital care by about $175 million.
According to a CMS statement: “The rate increase, together with other policies in the proposed rule and projected utilization of inpatient services, would increase Medicare’s operating payments to acute care hospitals by approximately 0.9% in fiscal year 2013.”
However, there is also a provision to reduce payments by two percentage points beginning in fiscal 2013 for hospitals that have excess readmissions for MI, heart failure, and pneumonia.
CMS is also proposing medical coding additions to the existing Vascular Catheter-associated Infection HAC category, ICD-9:
– 999.32 Bloodstream infection due to central venous catheter
– 999.33 Local infection due to central venous catheter
Those LTCHs that fail to meet the quality measures will see payment rates cut starting in 2016.
The proposed rule would also include a one-year extension of the existing moratorium on the “25 percent threshold” policy, pending results of an ongoing research initiative to redefine the role of LTCHs in the Medicare program. Currently, the legislative moratorium expires at the end of 2012.
The American Hospital Association (AHA) responded by saying: “While we commend CMS for delaying the full implementation of the 25 percent rule for long-term care hospitals (LTCHs), we are troubled that the delay does not fully apply to all LTCHs this year. Leaving the proposal as is could arbitrarily prohibit some patients from receiving needed long-term care.”
A final version of the proposal is expected to arrive on August 1. CMS will accept comments on the proposed rules until June 25.

CMS Picks First Medicare Shared Savings Program ACOs

19 Apr


The first 27 accountable care organizations (ACOs) to fall under the Medicare Shared Savings Program have been chosen by the Centers for Medicare & Medicaid Services (CMS). Accountable care organizations are one of the more talked about items in healthcare reform. They are being created to bring about financial incentives for doctors, hospitals, and other healthcare providers to better coordinate care, lower their costs, and improve the health of Medicare beneficiaries.
Among the 27 healthcare entities in 18 states are more than 10,000 physicians, 10 hospitals, and 13 smaller physician-led entities. They are estimated to serve more than 375,000 beneficiaries. According to the CMS, this most recent ACO announcement increases the number of Medicare beneficiaries participating in various shared-savings initiatives to 1.1 million. In January, the modified Pioneer Model ACOs (32 healthcare groups) and six Physician Group Practice Transition Demonstration organizations were launched.
“There were some people who feared that the only entities that would participate would be hospital-dominated systems,” said Jonathan Blum, Director of the Center for Medicare at the CMS. “That has not happened.”
It was announced by the CMS last summer that 7 out of 10 physician groups that participated in the their Physician Group Practice Demonstration achieved benchmarks on all 32 performance measures in the fifth year of the project. However, a January Congressional Budget Office report on 10 ACOs and disease management initiatives found insufficient savings to offset cost.
Blum expects the new ACOs to have more success controlling healthcare costs than similar payment and delivery reform pilot projects previously authorized within Medicare. 
“We are encouraged by this strong start and confident that by the end of this year, we will have a robust program in place, benefitting millions of seniors and people with disabilities across the country,” said acting CMS administrator Marilyn Tavenner in a written statement.
No Comments

Posted in Medicare


AMA Lobbies Sebelius to Stop ICD-10

07 Feb

The American Medical Association is doing what it can to halt implementation of the ICD-10 code sets. They are doing so by sending a letter to Health and Human Services Secretary Kathleen Sebelius.

Signed by AMA executive vice president and CEO James Madara, M.D., the letter also asks Sebelius to reexamine penalty timelines associated with multiple Medicare health IT initiatives that are underway.

“The timing of the ICD-10 transition that is scheduled for October 1, 2013, could not be worse as many physicians are currently spending significant time and resources implementing electronic health records into their practices,” says Madara.

Madara points out that adoption of the ICD-10 codes is an unfunded mandate that will cost medical practices between $83,000 to $2.7 million to implement (depending on their size). He also invoked President Obama’s executive order that calls for federal agencies to reassess and streamline regulations.

“This is a perfect opportunity for HHS to make good on its commitment to improve the regulatory climate for physicians,” says Madara.

Madara noted that physician investments in government-sponsored EHR meaningful use, electronic prescribing and quality reporting programs coincide with falling Medicare payment rates and tough penalty programs for failing to comply.

“Physicians are being required to meet separate requirements under these three overlapping health IT programs and have been and will be unfairly penalized if they decide to participate in one program over the other.”

Madara had just issued a similar appeal to House Speaker John Boehner.


ASA President Gives Anesthesiology Forecast for 2012

02 Feb

We’re already a month into 2012, but it’s not too late to take a look at what the year has in store for the world of anesthesiology. Dr. Jerry A. Cohen, President of the American Society of Anesthesiologists, recently wrote an article about what he thinks 2012 will bring, entitled “A 2012 forecast for anesthesiology.” In reality, it’s more of a longview forecast. Regardless, here are some of the highlights:

– Drug shortages will continue to pose a serious challenge for anesthesiologists. Here’s the scary truth: According to an ASA survey from last year, more than 90 percent of physicians say they experienced at least one anesthetic drug shortage. The University of Utah Drug Information Service also reported a record 267 drug shortages. What’s worse is this shortage problem is only expected get worse this year.

“It is essential that all parties, including manufacturers, distributors, pharmacists and others, come together to solve this problem to reduce the negative impact shortages have on patients,” says Dr. Cohen. “ASA will continue its support for legislative and executive efforts aimed at stifling the drug shortages pandemic.”

– As the population continues to grow and the elderly numbers also continue to rise, physician demand will be on the rise. This includes an increase in the number of patients who will who undergo surgical procedures, putting particular demand on anesthesiologists.

– The growing demand for anesthesiologists coincides with a shortage of anesthesiologists. According to a 2010 study by the RAND Corporation, there was a shortage of 3,800 anesthesiologists and 1,282 nurse anesthetists. If these trends continue, a dramatic shortage of anesthesiologists is projected by 2020.


Bar Codes Improves Anesthesia Safety

13 Jan

Ludwik Fedorko, MD, PhD, staff anesthesiologist at the University Health Network’s (UHN) Toronto General Hospital in Canada, recently referred to the operating room as a “black hole of medication safety.” He did so last month at a session on OR drug safety at the 2011 American Society of Health-System Pharmacists.

Dr. Fedorko made a point of highlighting the fact that anesthesiologists are the only health care professionals in a hospital setting who can dispense, premix, repackage, relabel and administer medications without independent verification. Also, according to Fedorko the postanesthesia care unit has accounted for 81 percent of all medication error reports in hospitals.

That said, anesthesia errors are quite rare, with a rate between 0.1 to 0.85 percent, or one of every 1,000 drug-dose administrations. Most of these errors can be reversed.

“We can almost always dig ourselves out of a hole,” Dr. Fedorko said. “The event is charted, but it doesn’t always show up as an error.”

That’s not to say hospitals wouldn’t welcome improvements, especially given the uniqueness of the OR.

“Throughout the hospital, there are safety steps in place to prevent medication errors, but not in the OR.”

So an initiative was started, led by Esther Fung, RPh, director of pharmacy operations at UHN, with a pharmacy–anesthesia collaboration exploring a point-of-care, computer-aided syringe labeling, bar-coding and verification process. The system, which came about with the help of funding from the Canadian Patient Safety Institute and sponsors in the drug industry, was implemented in January 2010.

During the process, the anesthesiologist scans every drug ampoule and syringe label to verify accuracy throughout drug dispensing, premixing, administration and documentation. In five months, the bar-coding system had been used for over 60,000 doses in more than 4,000 surgeries.

Anonymous surveys were performed with the participating anesthesiologists, and 21 of the 41 surveyed reported 29 medication errors which were all intercepted by bar-code scanning. About 97 percent said they preferred using the bar-code scanning system.

Some of the benefits beyond catching medication errors were time-savings and low costs for implementing.

“They understood that it would not only prevent them from making drug errors, but also that it improved and automated workflow in terms of easier charting and documentation because they would no longer have to do it manually,” said Dr. Fedorko.


CMS Proposes 2012 Changes to Payment Policy and Rates

02 Jan

The Centers for Medicare & Medicaid Services (CMS) has made public their proposed rules that will affect doctors, hospital outpatient departments (HOPD), ambulatory surgical centers (ASC), and suppliers of renal dialysis services in 2012.

Highlights from the proposed rule changes include updates to payment policies and rates for 2012 and measures being taken to continue to implement the provisions of the Affordable Care Act meant to improve the quality of care, but also reduce government spending.

Under the law as it is today, Medicare payment rates for physician services face a 29.5 percent reduction in 2012 based on the Sustainable Growth Rate (SGR) formula. Along with other advocates, CMS is against this reduction, which means it is unlikely that physicians will receive such a drastic pay cut.

“Today, the Centers for Medicare & Medicaid Services (CMS) issued proposed rules that spell out how this cut is calculated and warned that if Congress does not act in time, doctor fees will be slashed come January 1. We cannot – and will not – let this happen,” wrote CMS Administrator Donald Berwick, MD on

The Medicare Physician Fee Schedule rule proposed for next year would also update a number of physician incentive programs, including the Physician Quality Reporting System, the e-Prescribing Incentive Program, and the Electronic Health Records Incentive Program.

You can view the proposed changes to these physician incentive programs over at the
Centers for Medicare & Medicaid Services website. Some of the highlights include:

– Expansion of its multiple procedure payment reduction to the professional interpretation of advance imaging services to recognize the overlapping activities that go into valuing these services

– Revision of the criteria for a health risk assessment (HRA) to be used in conjunction with annual wellness visits (AWVs)

– Expanding of the list of services that can be furnished through Telehealth to include smoking cessation servicesRevisions to the quality and cost measures that would be used in establishing a new value-based modifier that would reward physicians for providing higher quality and more efficient care.

1 Comment

Posted in Medicare


CMS Delays Version 5010 Compliance Enforcement

30 Dec

The Centers for Medicare & Medicaid Services announced last month that it will delay its requirement for the adoption of a more-robust set of claims transmission standards.

Originally, the switch the ASC X12 Version 5010 standards required of hospitals, physician practices, health plans and claims clearinghouses was set for January 1, 2012. But the CMS announced it would push it back to March 31, 2012.

The announcement came after a significant amount of protest within the medical industry and their inability to be ready to make the upgrade from the Version 4010 standards currently in use. The CMS respond accordingly.

According to the CMS, its decision to push back their enforcement deadline was “based on industry feedback revealing that, with only about 45 days remaining before the January 1, 2012 compliance date, testing between some covered entities and their trading partners has not yet reached a threshold whereby a majority of covered entities would be able to be in compliance by January 1.”

The switch to the Version 5010 standards is consider a necessary precursor to adoption of ICD-10. Those who do not comply by the deadline face hefty penalties. According to the CMS website, “The HIPAA legislation permits civil monetary penalties of not more than $1.5 million per calendar year for a violation of an identical provision.”

According to a Medical Group Management Association member survey, only one in 50 physician group practices has completely implemented the software changes  that are necessary to make the switch to Version 5010.


More Doctors Using Telehealth Solutions

28 Dec

In these challenging times in healthcare, physicians and policymakers alike are looking for ways to streamline the way they deliver care. So-called “telehealth” is having a major impact on multiple fronts: health outcomes in patients, financial health of medical practices, and even potentially the environment when considering less travel time to doctors’ offices.

One way virtual doctor visits can save lives and improve care is with the growing elderly population who often have difficulty going to and from appointments.

“We do a lot of chronic disease management in primary care, which is where telehealth is the most valuable to me,” said Ronald Dixon, a practicing general internist and director of the Center for Integration of Medicine and Innovative Technology in Boston.

A 2010 survey by Intel found that an overwhelming majority of health care decision makers – 89 percent – believe telehealth will transform health care over the next decade. The survey found that about two-thirds of all physicians currently use telehealth solutions, with 87 percent of those being happy with results. Among those healthcare providers not currently using telehealth solutions, 50 percent say they will by next year.

Many third party payers, including Medicare and private health insurance plans, are starting to pay providers for online visits, usually at a lower rate than with traditional office visits.

London-based market research firm Datamonitor estimates the market for telehealth services in the U.S. and Europe will grow to $8 billion by next year, up from $3 billion in 2009.


AMA Fights Against ICD-10

27 Dec

Medical professionals already have their hands full with healthcare reform, they don’t have ample time or resources to comply to changes that come with ICD-10. That’s, in essence, what The American Medical Association’s House of Delegates is saying in their opposition to the demands associated with the mandatory switchover to the International Classification of Diseases 10th Revision family of diagnostic and procedural codes.

The association voted to “work vigorously to stop implementation” of ICD-10, not only due to healthcare reform, but also the federal push for doctors to adopt electronic health-record systems.

“The implementation of ICD-10 will create significant burdens on the practice of medicine with no direct benefit to individual patients’ care,” said AMA President Dr. Peter W. Carmel in a written statement from the association’s nearly week-long policy meeting in New Orleans.

“At a time when we are working to get the best value possible for our healthcare dollar, this massive and expensive undertaking will add administrative expense and create unnecessary workflow disruptions,” said Mr.Carmel. “The timing could not be worse as many physicians are working to implement electronic health records into their practices. We will continue working to help physicians keep their focus where it should be – on their patients.”

Without giving a name, the AMA cited a study from 2008 that found that a three-physician practice would spend $83,290 to implement ICD-10, and a 10-physician practice would spend $285,195.

With the Medicare and Medicaid electronic health record initiative, there are incentive payment programs under the American Reinvestment and Recovery Act of 2009 for doctors. However, with the transfer from ICD-9 to ICD-10 there are no funds made available to offset costs.

The deadline for the switch to ICD-10 is October 1, 2013. That date has already been pushed back once. The CMS continues to stand by its stance that they have given healthcare providers enough time to make the transition to ICD-10.

“Implementation of this new coding system will mean better information to improve the quality of healthcare and more accurate payments to providers,” said a CMS spokesman. “We will continue to work with the healthcare community to ensure successful compliance.”