Wednesday, September 20, 2017

UPDATE: New Guidelines Released as Telemedicine Services Expand

Update: The Joint Commission has retracted the draft standards for telemedicine outlined below, announcing that "At this time, we have closed the field review and decided not to move forward with the proposed telehealth standards." The proposed changes had garnered pushback from some in the industry who were concerned that the standards would be more restrictive than current requirements from the Centers for Medicare & Medicaid Services and state regulators. A spokesperson from TJC told FierceHealthcare that internal review had determined TJC's existing requirements for accreditation adequately applied to telehealth services and that further requirements would be unnecessary. In the future, TJC plans to address enhancements for survey guidance examining telehealth practices and quality and safety issues with telehealth provision.

Telemedicine continues to expand into the healthcare delivery system, and the recent natural disasters across the country have demonstrated just how useful telemedicine can be in a crisis and beyond. As federal and state governments, accrediting organizations, and other healthcare stakeholders recognize the growth and potential of these services, new rules, regulations, and guidelines are beginning to be released. Two major telemedicine efforts were released this month by The Joint Commission and the National Quality Forum.

First, The Joint Commission released proposed revisions to their hospital accreditation standards for hospitals providing “direct-to-patient telehealth services.” TJC, one of the largest and most widely accepted accreditation organizations for hospitals in the United States, introduced changes to two existing standards (Provision of Care Standard 01.01.01 and Rights & Responsibilities of the Individual Standard 01.03.01) and introduced a new standard, Ri.01.08.01. The proposed changes, which are examined in detail here, include requirements for informed consent for patients about the nature of the telehealth services and the provider. The National Law Review article linked above examines how the proposed standards go beyond statutory requirements in some cases, and how they may affect hospitals and other telehealth providers.

The National Quality Forum, an organization contracted by the federal government to develop healthcare performance measures, recently released a report developing a framework for a telehealth quality measurement program. NQF’s Telehealth Committee recommended various methods to measure telemedicine as a care delivery system along four basic categories: access to care, financial impact to patients and providers, patient and clinician experience, and clinical and operations effectiveness. The report, analyzed here by mHealthIntelligence, also highlights specific existing measures that can be applied to telehealth, as well as examining how telehealth activities can fit into the Merit-based Incentive Payment System (MIPS) introduced in the Medicare Access and CHIP Reauthorization Act (MACRA).


NAMSS will continue to monitor developments in telemedicine and their impacts on MSPs. Specifically, NAMSS recently formed a working group in partnership with the American Telemedicine Association to examine the issue of credentialing by proxy for hospitals attempting to credential telemedicine providers at other locations. The group will be developing a packet of educational and instructional materials to introduce MSPs who may not be as familiar with telemedicine to the topic and provide guidelines for developing credentialing by proxy programs at their own facilities. 

Monday, September 11, 2017

CMS Clarifies Guidance on Hospital Definitions

The Centers for Medicare and Medicaid Services recently released a memo clarifying guidance under Appendix A of the State Operations Manual (SOM). This guidance is meant to shed light on the definition of a hospital under the Social Security Act.

With the rise of “microhospitals,” small facilities that operate like acute care hospitals with a low number of inpatient beds, there has been some confusion regarding the certification process for such facilities. A variety of other facility models have run into the same issues, as care providers attempt new innovations in care and locations that may stray from the traditional idea of a hospital facility.

The CMS memo clarifies that the federal Medicare definition of a hospital under the Social Security Act may not always mesh perfectly with state requirements for the same certification. That is, “a facility may have a license from a state to operate as a hospital,” but “that facility may still not meet the Medicare definition of a hospital.” Hospitals approved, certified, and licensed by state or local authorities are still required to fit the Medicare criteria, including Conditions for Coverage (CfCs), Conditions of Participations (CoPs), and observations by the CMS Regional Office in order to be approved to accept Medicare patients. The details of these observations are described in the memo, linked above.

To read more about microhospitals and their growing role in the care delivery system, click here

Thursday, August 17, 2017

Illinois Blockchain Initiative to Pilot Credentials Verification Program

On August 8th, 2017, the Illinois Blockchain Initiative announced a pilot program in partnership with Hashed Health to use blockchain technology to streamline the medical credentialing process in the state. By exploring opportunities through distributed ledger technologies, the program could be able to reduce the complexity of licensing and credentialing. The program will look to provide a new blockchain-based registry to act as a repository for credentialing data.

Eric Fish, senior vice president of legal services at the Federation of State Medical Boards, praised the initiative, remarking that, “If successful, this effort may prompt other state medical boards, as well as others within healthcare, to investigate potential benefits that can be derived from the use of distributed ledgers, and may ultimately result in a more efficient regulatory process without any sacrifice to patient safety.”

To read more on the pilot program, see the full story at Health IT Analytics.

Blockchain technology is a decentralized peer-to-peer system through which digital transactions are created, shared, verified, and stored. This technology consists of three main components: a distributed network, a shared ledger, and digital transactions. The network is the basic skeleton of the blockchain: individual network members generate, verify, and store data on the blockchain, instead of contributing to one central database. The ledger provides a mechanism to share and verify information in the network, protecting the data from tampering and ensuring quick and easy verification of the information within. Finally, a digital transaction is the actual act of generating or verifying data.

NAMSS is continuing to monitor the development of blockchain technology in healthcare, especially with regards to the credentialing process. In May, we hosted our 4th annual Government Relations Industry Roundtable, entitled Building Blocks for the Future. A panel of NAMSS staff, stakeholders and strategic partners discussed the impact of blockchain and its potential applications for the industry. Be on the lookout for further information from NAMSS on blockchain technology and its potential impacts on MSPs!

Friday, July 28, 2017

Obamacare Repeal and Replace Dead, For Now

In the early hours of the morning on July 28, 2017, the Senate held its final vote on Republican efforts to repeal and replace the Affordable Care Act (ACA). The Health Care Freedom Act, referred to by some as “skinny repeal,” fell 51-49, with Republican Senators John McCain (R-AZ), Lisa Murkowski (R-AK), and Susan Collins (R-ME) joining all Democrats in voting against the bill.

The path towards repeal in the Senate had been winding at best. After multiple delays, the Senate narrowly voted to proceed to debate on the House version of the bill, the American Health Care Act (H.R. 1628). Sens. Murkowski and Collins were opposed to the motion, requiring Vice President Mike Pence to provide the tiebreaking vote. The Senate then considered several different options on the repeal efforts, which were all defeated. Senate Republican’s own original plan, the Better Care Reconciliation Act, was soundly defeated, with 9 Republicans from the conservative and moderate wings voting against (57-43).

[Republicans voting against the BCRA were Susan Collins, Lisa Murkowski, Bob Corker (TN), Tom Cotton (AR), Lindsey Graham (SC), Dean Heller (NV), Mike Lee (UT), Jerry Moran (KS), and Rand Paul (KY)]

Next, Senate Majority Leader Mitch McConnell brought up a partial repeal bill, the Obamacare Repeal and Reconciliation Act, which would have repealed essential ACA provisions like the individual mandate, Medicaid expansion, and premium subsidies after a period of two years, during which the Senate hoped to draft a replacement plan. This was voted down 55-45, with Sens. Collins, Murkowski, Heller, McCain, Shelley Moore Capito (R-WV), Rob Portman (R-OH), and Lamar Alexander (R-TN) voting against.

The “skinny repeal” bill was brought up as a last-ditch effort to garner consensus from the Republican caucus on repeal efforts, with the intention of passing a bare-bones bill in order to come up with a fuller plan in conference with the House of Representatives. It would have repealed selected provisions of the ACA, including the individual mandate, delay the employer mandate until 2025, extend the moratorium on the medical device excise tax through December 31, 2020, and modify ACA State Innovation Waivers, among other provisions. For the moment, Republican efforts to repeal the ACA are dead, and Senate leadership has expressed a desire to move onto other business. However, some House Republicans, including Rep. Tom MacArthur (R-NJ), Greg Walden (R-OR) and Freedom Caucus Chairman Mark Meadows (R-NC) have stated they will continue in their efforts to take down the ACA. 

Monday, June 26, 2017

Senate Republicans Release Draft Healthcare Bill

On June 22, 2017, Senate Republicans released the Better Care Reconciliation Act (BCRA), their much-anticipated version of the House’s American Health Care Act (AHCA), which repeals and replaces the Affordable Care Act (ACA).  Here’s a breakdown of how the Senate and the House versions align and how they break away from the ACA.

The Senate and House Similarities:

  • Eliminate the ACA’s controversial individual mandate, which required all Americans to have health insurance.
  • Eliminate the ACA’s unpopular employee mandate, which required most employers to offer employees health insurance.
  • Enable payers to implement age-based pricing determinations for health insurance.
  • End the ACA’s Medicaid state-expansion and reduces overall Medicaid funding (although the Senate version proposes a deeper rate than the House version). 
  • Enable states to waive the ACA’s requirement that payers cover the following 10 essential health benefits: 1) ambulatory patient services; 2) emergency services; 3) hospitalization; 4) maternity and newborn care; 5) mental health and substance abuse; 6) prescription drugs; 7) rehabilitative and habilitative  services; 8) laboratory services; 9) preventive and wellness services and chronic disease management; 10) some pediatric services.
  • Defund Planned Parenthood for one year. 
  • Repeal most of the ACA’s taxes. 
  • Continues the ACA’s policy that enabled children to remain beneficiaries of their parents’ health plans until age 26.
The Senate and House Differences:

  • Tax Credits: The Senate version lowers the income eligibility level for tax credits.  The House version fixed tax credit eligibility to age.
  • Pre-Existing Conditions: The Senate version maintains the ACA’s requirement that payers cover individuals with pre-existing conditions without charging these individuals higher rates.  The House version would enable states to allow payers to opt out of mandating coverage for preexisting conditions.  In lieu of this requirement, the House version would provide states funding to establish high-risk pools to cover individuals with pre-existing conditions.
Key Medicaid Points

Medicaid Expansion

The BCRA would overhaul the current Medicaid expansion system by phasing out the Federal Medical Assistance Percentages (FMAP) to states by 15 percentage points between 2020 and 2023 (90-percent funding in 2020 to 75-percent funding in 2023).  In 2024, FMAP reductions would continue until they matched the state rate for other benficiaries, which is, on average, 57 percent.

Traditional Medicaid Funding

While both the Senate and House versions would reduce federal funding to the Medicaid program, the Senate version replaces the program’s current open-ended entitlement with individual beneficiary caps. Beginning in 2020, states would be eligible to receive federal block grants instead of the proposed funding cap if they meet specific requirements and agree to cover 14 essential services.  States may also begin to implement optional work requirements for non-disabled, non-elderly, and non-pregnant beneficiaries.

Looking Back—and Ahead

The ACA’s collapsing state exchanges shows just how difficult and costly it is to expand and ensure coverage.  Theoretically, the ACA’s individual and employer mandates would alleviate the burden to payers by requiring young and healthy Americans to buy health insurance.  The ensuing support from these mandates did not come through as expected, causing payers to leave state exchanges—and leaving many Americans with little or no insurance options.  Coverage and care are two critical—but distinct—components to healthcare.  Policymakers’ efforts to provide insurance to all Americans is misguided if that coverage does not equate to quality care.

The Congressional Budget Office, which provides price estimates to legislation, is currently assessing BCRA.  This cost assessment will shed more light on who would pay more or less for premiums and how the bill would affect the market stability of insurance companies.

Healthcare reform is a complex and complicated process that will impact the way we provide and receive healthcare.  A lot needs to happen before we see these changes—including enough support among Senate Republican to pass BCRA.  The process continues to be partisan and Republicans are finding that repealing and replacing the ACA is not easy.  Stay tuned.

Monday, March 27, 2017

Efforts to Repeal Affordable Care Act Halted

Late last week, the U.S. House of Representatives decided to halt further pursuit of legislation - the American Health Care Act (AHCA) - that would have repealed and replaced large portions of the Affordable Care Act, more commonly referred to as "Obamacare."

After several weeks of intense debate between Republicans and Democrats - and concerns from the conservative House Freedom Caucus that the AHCA did not go far enough - House Speaker Paul Ryan and President Donald Trump pulled the bill from being voted on by the House of Representatives once it became clear that it would not garner enough "Yes" votes to pass.

Becker's Hospital Review provides a good overview of this decision and the course of events that led to it. For now, the Affordable Care Act will remain in place - as the path forward for a repeal and replace by Republicans in Congress is uncertain at this time.

So what would the AHCA have done to change American healthcare? The Kaiser Family Foundation has made available a point-by-point tool to compare provisions in this legislation with current law under the Affordable Care Act. Some of the main provisions in the GOP bill were a repeal of the individual mandate for health insurance coverage, an end to Medicaid expansion and a cap on future federal funding for Medicaid, a repeal of tax subsidies to help cover the cost of health insurance, and a repeal of multiple taxes included in the Affordable Care Act - such as the medical device tax.

Tuesday, February 28, 2017

NAMSS Membership Surpasses 6,000

NAMSS is proud to announce that our membership has grown to over 6,000 members! This continued growth is the result of countless hours of work from devoted volunteer MSPs all across the nation to make NAMSS a leader in advancing patient safety and ensuring the efficient and effective credentialing of healthcare providers.

Thank you all for your continued support and we look forward to even greater growth in 2017 and beyond!