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From the editor

Dear Healthcare Intelligence Network Client,

HIN Content Editor Cheryl Miller

CMS has postponed enforcement of its regulations requiring the use of the 5010 standards in all electronic healthcare transactions until June 30, 2012. It is two weeks before all healthcare providers and payors could have been penalized if they failed to comply and were not yet using the 5010 transaction set. Reaction to the news will be mixed, but there seems to be consensus that the delay is a welcome one.

In other CMS-related news, a new demonstration program to expand access to emergency psychiatric care for Medicaid beneficiaries could significantly cut state and hospital healthcare costs, reduce general acute care ED visits and help vulnerable patients get proper care. Federal law has prohibited Medicaid from paying for mental health services provided to Medicaid enrollees between the ages of 21 and 64. As a result, these patients have had to seek services in general hospital ERs, where they may not get the right care, or go to psychiatric hospitals where the care is appropriate but reimbursement is not provided, which has been a continued drain on healthcare resources.

Medicaid patients are the focus of another story, which details the barriers they face seeking treatment in primary care, making them twice as likely to visit the ED as their privately insured counterparts, according to a study published in the Annals of Emergency Medicine. Even those Medicaid enrollees who have primary care report significant barriers to seeing their doctor, and given that many of them are in poor health, they tend to visit the ER more. Researchers hope their study will bring about change in this area.

Changes in the rates of hospital-acquired infections could be imminent, given a new study that found that hospitals with board-certified infection prevention and control directors have significantly lower rates of bloodstream infections (BSI) than those that are not led by a certified professional. It is the first such report to study the association between certified program directors and rates of healthcare-associated infections, researchers say.

And lastly, location plays an important role when it comes to healthcare quality, cost, accessibility and outcomes, says a new, extensive study from the Commonwealth Fund. But these factors vary greatly not only from one community to the next, but within and across states, depending on the performance of the healthcare system available to residents.

Your colleague in the business of healthcare,
Cheryl Miller
Editor, Healthcare Business Weekly Update

Please send comments, questions and replies to cmiller@hin.com.

HIN Associate Editor Jessica Papay
Associate Editor:
Jessica Papay, jpapay@hin.com

Publisher:
Melanie Matthews, mmatthews@hin.com

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March 19, 2012
Vol. XIV, No. 10

Sponsored by:
Physician Pay-for-Performance: Refining the Bonus Structure To Meet Market Realities

This week's industry news:

  1. Location Matters When it Comes to Healthcare Quality and Access: Study
  2. Roadmap to ICD-10 Readiness
  3. 5 Benchmarks to Monitor Case Manager Productivity
  4. Case Management Answer Book Vol. II
  5. Healthcare Business White Paper: 2011 Benchmarks in Registry Use for Quality Improvement
  6. Medicaid Patients Twice as Likely to be Denied PCP Access, and to Visit ER Instead
  7. New Chart: Who's Responsible for Improving Diabetes Management?
  8. 5 Interventions to Reduce Avoidable ER Use by the Medicaid Population
  9. Certification Leads to Lower Hospital Infection Rates
  10. Infection Prevention Manual for Home Health Care
  11. CMS Demo Aims to Expand Access to Emergency Psychiatric Care for Medicaid Beneficiaries
  12. Telephonic Case Management
  13. Physician Incentives Go Beyond the Paycheck, Finds New Survey
  14. HealthSounds Podcast: Mapping the Way to ICD-10 Readiness
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This week's industry news

1.) Location Matters When it Comes to Healthcare Quality and Access: Study

Location plays an important role when it comes to healthcare quality, cost, accessibility and outcomes, says a new study from the Commonwealth Fund. But these factors vary greatly not only from one community to the next, but within and across states, depending on the performance of the healthcare system available to residents.

Get the full story.

>>Return to this week's industry news


2.) Roadmap to ICD-10 Readiness: Best Practices from BCBS-Michigan

Roadmap to ICD-10 Readiness This 24-page report documents the process BCBSM has established to resolve discrepancies between ICD-9 and ICD-10 codes, a milestone that has allowed the payor to complete its version of the General Equivalence Mappings (GEMs) — referred to as the Blue GEM Encyclopedia.

Learn more about this resource.

>>Return to this week's industry news


3.) 5 Benchmarks to Monitor Case Manager Productivity

Monitoring patientsí visits and no-shows are some of the ways embedded or co-located case manager productivity can be assessed, explains Robert Fortini, PNP, vice president and chief clinical officer at Bon Secours Health System.

Get the full story.

>>Return to this week's industry news


4.) Case Management Answer Book Vol. II: FAQs on Launching, Supporting and Evaluating Embedded Case Management

Case Management Answer Book Vol. II In this 30-page report, industry thought leaders provide answers to more than 50 questions on the practicalities of embedded case managers, from preparing a practice for the arrival of a case manager to hiring and training guidelines to measuring satisfaction with embedded case management initiatives.

Learn more about this resource.

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5.) Healthcare Business White Paper: 2011 Benchmarks in Registry Use for Quality Improvement

Registries are a straightforward tool for creating realistic views of clinical practices, patient outcomes, safety and comparative effectiveness. Results from the Healthcare Intelligence Network August 2011 e-survey on Using Registries for Quality Improvement captures current and planned uses of registries by 105 healthcare organizations and registries' impact on healthcare quality, efficiency and cost.

Download this complimentary white paper.

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6.) Medicaid Patients Twice as Likely to be Denied PCP Access, and to Visit ER Instead

Twice as many people insured by Medicaid as by private insurance report barriers to primary care and Medicaid patients are twice as likely to visit the ED as their privately insured counterparts, according to a study published in the Annals of Emergency Medicine.

Get the full story.

>>Return to this week's industry news


7.) New Chart: Who's Responsible for Improving Diabetes Management?

Improving Diabetes Management The total cost of diagnosed diabetes in the United States in 2007 amounted to $174 billion, estimates the American Association of Diabetes. Adults with diabetes are more at risk for strokes and heart disease than those without diabetes. We wanted to see who holds the most responsibility to improve diabetes management in a population.

Click here to view the chart.

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8.) 5 Interventions to Reduce Avoidable ER Use by the Medicaid Population

5 Interventions to Reduce Avoidable ER Use by the Medicaid Population This 25-page resource looks at the collaborative effort among five regions of Ohio to target the key reasons for avoidable ER visits among Medicaid beneficiaries and roll out test interventions in a rapid cycle quality improvement approach.


Learn more about this resource.

>>Return to this week's industry news


9.) Certification Leads to Lower Hospital Infection Rates

Hospitals with board-certified infection prevention and control directors have significantly lower rates of bloodstream infections (BSI) than those that are not led by a certified professional, according to a new study in the American Journal of Infection Control.

Get the full story.

>>Return to this week's industry news


10.) Infection Prevention Manual for Home Health Care

Infection Prevention Manual for Home Health Care This guide provides facilities with a comprehensive resource for policies and procedures reflecting the most current standards for infection prevention. The policies are written for compliance with OBRA regulations, OSHA regulations, CDC recommendations, JCAHO standards for home healthcare and current national standards of practice.

Learn more about this resource.

>>Return to this week's industry news


11.) CMS Demo Aims to Expand Access to Emergency Psychiatric Care for Medicaid Beneficiaries

A new demonstration program to expand access to emergency psychiatric care for Medicaid beneficiaries could significantly cut state and hospital healthcare costs, reduce general acute care ED visits and help vulnerable patients get proper care, says the CMS.

Get the full story.

>>Return to this week's industry news


12.) Telephonic Case Management: Protocols for Behavioral Healthcare Patients

Telephonic Case Management In this 45-minute webinar, Jay Hale, director of quality improvement and clinical operations at Carolina Behavioral Health Alliance, shares the case management protocol developed by his organization, including using scripts and surveys to assess patients' engagement in the treatment process and identify patients at-risk.

Learn more about this resource.

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13.) Physician Incentives Go Beyond the Paycheck, Finds New Survey

Want to attract good physicians to your practice and retain them? Make part-time scheduling and flexible workweeks part of the incentives mix, recommends a new survey on physician retention trends.

Read this blog post.

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14.) HealthSounds Podcast: Mapping the Way to ICD-10 Readiness — Blue Cross Blue Shield of Michigan's Approach

Dennis Winkler The mapping between ICD-9 and ICD-10 code sets will have two major impacts on healthcare, predicts Dennis Winkler, ICD-10 technical program director for Blue Cross Blue Shield of Michigan, which has created a roadmap for the transition that it is sharing with the industry. Winkler describes where health plans should be on the ICD-10 timeline at the start of 2012, and defines the two major challenges the health plan expects to face as it enters the testing phase of the transition.

Listen to this podcast.

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