Monday, November 29, 2010

Groups Weigh in on NCQA's Proposed ACO Standards

The Patient Protection and Affordable Care Act requires the creation of accountable care organizations (ACOs), which are defined as "an integrated group of providers that will be held accountable for the overall cost and quality of care for a defined set of patients. Under the law, ACOs that participate in the Medicare program would continue to be reimbursed under the fee-for-service system, but they would be eligible to share in any savings below benchmark cost levels, as long as they also meet quality performance standards."

NCQA released draft standards for ACOs. Various organizations such as the Federation of American Hospitals, American Medical Group Association, and the Campaign for Better Care commented on the standards, stating that until the government establishes rules for ACOs, any draft standards are prematurely developed. The groups also urged NCQA to draft standards that are focused on quality outcomes, rather than on how an ACO should be structured.

NCQA's draft standards can be found here:

AMGA's comments can be found here:

FAH's comments can be found here:

Source: BNA

Thursday, November 4, 2010

CMS Final Rule Cuts Physician Payments 24.9% in 2011

The Centers for Medicare and Medicaid Services (CMS) has released a final rule that will cut Medicare payments to physicians by 24.9 percent in 2011. CMS states that the reason for the cut is to provide a permanent fix for the sustainable growth rate and Medicare payment formula.

The rule also attempts to curb physician self-referral for services that may be obtained elsewhere in the area and implements rules on the expansion of preventative services, which went into effect as part of the Affordable Care Act.

The physician pay cut is effective January 1, 2011.

Source: Healthcare Finance News

Wednesday, November 3, 2010

Patient Deaths at CA Facility Allegedly a Result of Substandard Care

A discrimination lawsuit filed by a medical assistant and two cardiologists attributes a 2009 patient death to substandard care. Furthermore, the suit alleges that the level of substandard care was permitted to continue because they were "ignored, embarrassed, or terminated" for reporting problem.

The suit, filed against Santa Clara Valley Medical Center in California, alleges that after Dr. Geeta Singh suggested that a patient undergo a cardiac catherization rather than a stress test due to his history of heart attack. The patient was given a stress test and later died. After Singh and administrative assistant Theresa Walker submitted a report of substandard care to TJC, they claim that they were ignored by other members of the staff and abused through e-mail.

Dr. Kai Ihnken is also a plaintiff in the suit, alleging that administrators denied him the ability to perform cardiac surgery, leading to the patient's death. After reporting the incident, he claims that he was slandered and his contract was not renewed.

The Santa Clara County Executive stated that examiners have found no direct link indicating that negligence caused the patients' deaths; however, he did acknowledge that the hospital's cardiac department was prone to conflict and arguments.

This pending case sheds light on the importance of maintaining professional working relationships among members. It also calls on hospitals to look at their staff culture and to see if employees and members of the medical staff are provided with a comfortable environment that allows them to speak up if they witness an adverse event.