OIG Report Shows CMS' Failure to Report Adverse Actions to HIPDB

A report from the Department of Health and Human Services Office of the Inspector General (OIG) shows that although the Centers for Medicare & Medicaid Services (CMS) took adverse actions against providers, it failed to report all of these actions to the Healthcare Integrity and Protection Data Bank (HIPDB).

The HIPDB is a repository of "all final adverse actions against health care practitioners, providers, and suppliers." The purpose of the HIPDB is to provide states, federal agencies, and health plans with a resource to help them prevent dealings with practitioners, providers, and suppliers with a history of fraud and abuse.

The report, titled "CMS Reporting to the Healthcare Integrity and Protection Data Bank," revealed that CMS failed to properly report actions taken against laboratories, DME suppliers, and nursing homes. These adverse actions either went unreported even when final action was taken, or were reported outside of the required reporting timeframe, which is about 30 days from the date action was taken, or the date that the reporting entity discovered the action.

The OIG recommended that CMS resolve the problem by providing staff and contractors with better education on reporting requirements. CMS agreed with the findings and pledged to work with the Health Resources and Services Administration (HRSA) to determine what actions are reportable.

This report reminds us that MSPs must be diligent when performing credentialing functions. The data we rely upon is only as good as the reporting source. You cannot evaluate data pulled from one source with a "vacuum mindset." When pulling reports, compare the information you collect along with other reports as well as the provider's history. This investigative step may help you to disclose adverse actions that may not be found in database reports.

To read the full OIG report, click here:
http://www.oig.hhs.gov/oei/reports/oei-07-09-00290.pdf


Source: Department of Health and Human Services, Office of the Inspector General

Report Encourages Disclosure of Large-Scale Medical Mistakes

The Department of Health and Human Services' Agency for Healthcare Research and Quality (AHRQ) recommends that large-scale adverse events and medical mistakes should be reported by facilities, even though they do not result in patient harm. This recommendation was noted in a study titled, "The Disclosure Dilemma -- Large Scale Adverse Events," which was published in the New England Journal of Medicine.

The AHRQ encouraged facilities to personally contact all patients that may be affected by a large-scale error such as the use of improperly sterilized medical tools and equipment malfunctions, even if the patients suffered no effect. Facilities are concerned that reporting these events will cause psychological distress on patients that would have had no worries had the event gone undisclosed. They are also concerned that reporting events will place a burden of negative press on facilities.

The AHRQ recommends that facilities have a policy in place that sets a structure for reporting errors and reaching out to all affected patients with follow-up care and compensation.

To read the full study, click here: http://www.nejm.org/doi/full/10.1056/NEJMhle1003134


Source: BNA

Resident Suspected of Altering Performance Records

Dr. Eric George Batterson of the University of Michigan Health System is accused of accessing computers without authorization to alter his performance records.

Batterson allegedly used a program that tracks the typing of a computer's user. He used this information to obtain passwords for computers and e-mail accounts so he could alter his performance records and lower the performance records of his colleagues. Batterson's activities were discovered when employees realized that their computers and e-mails had been accessed without their permission.

A preliminary court hearing is scheduled for Sept. 29. Batterson is charged with "nine counts each of unauthorized access of computers and using computers to commit a crime, as well as one count of possessing a Taser."


Source: annarbor.com
http://www.annarbor.com/news/man-accused-of-illegally-accessing-records-at-u-of-m-hospital/

Map Highlights "Doctors Behaving Badly" Nationwide

RepoortingOnHealth.com features a project focused on a map of disciplinary actions taken against doctors nationwide. For each state, the map features a news story of a misbehaving doctor and how the state's medical board took disciplinary action.

The creators of the map are also studying each state medical board's website to determine whether or not the public is given enough information to make a quality judgment on a provider. The study is not complete, but they currently rate California's site as one of the best since it provides visitors with detailed provider histories. Illinois is ranked as one of the worst sites when it comes to providing visitors with information.

To view the map and comments on the medical boards assessed so far, click here:
http://www.reportingonhealth.org/blogs/doctors-behaving-badly-medical-boards-should-drop-stone-tools-join-digital-age

OIG Report Evaluates Adverse Event Reporting Methods in Hospitals

A report by the Department of Health and Human Services Office of Inspector General (HHS OIG) finds that reviewing medical records made by nurses and physicians may be the most effective way to monitor the occurrence of adverse events in hospitals.

The report, titled Adverse Events in Hospitals: Methods for Identifying Events, implemented five screening methods to a random sample of 278 Medicare beneficiary hospitals over a 2-week period in 2008. The case study was performed in accordance with the Tax Relief and Health Care Act of 2006, which requires OIG to publish regular reports on efforts to better identify adverse medical events.

The five methods employed in the case study were:

• Nurse reviews of medical records;
• Interviews of Medicare beneficiaries;
• Two types of billing data analysis;
• and Reviews of internal hospital incident reports.

Each flagged event identified using one of the above methods was later reviewed by physicians. OIG determined that the most effective screening method was the nurse review, which identified the most adverse events.

OIG has recommended that the Centers for Medicare & Medicaid Services (CMS) and the Agency for Healthcare Research and Quality (AHRQ) continue to research methods for identifying adverse events in the review of medical records.

To read the full report, click here:
http://www.oig.hhs.gov/oei/reports/oei-06-08-00221.pdf.