The CMS Blog

Ready for the 2012 SHIP Conference?

By Vicki Dufrene, Louisiana SHIP Director

Late spring means the annual SHIP conference is on its way—the 18th Annual SHIP Director’s Conference will be held June 4—7 in Atlanta.

It’s hard for me to believe that almost a year has passed since I found myself surrounded by dear friends and colleagues trying to absorb as much information as possible to help us better serve the aging network in our respective states.

This year’s theme is “Yesterday, Today and Tomorrow…Navigating Healthcare Changes Together.”  Health reform is on the horizon and this conference will give us insight and information to guide our staff, partners and volunteers through the maze of new challenges that will face us as we prepare for 2014.

It’s also a great opportunity to network, share best practices, talk about lessons learned, and learn about new Medicare programs and initiatives.

I’m looking forward to seeing my peers, friends and confidants, as they have proven to be a valuable asset—and even a source of comfort—over the past year.  At last year’s conference, I received a call from my office advising that two of my co-workers were killed in the line of duty.  As my staff and I gathered together to understand what was being told to us, the SHIP network extended their hearts, arms and prayers to comfort us when we needed it the most.  At this conference I hope to thank each one personally for their loving support and encouragement.

The need for a “Strong Start” in life

By Marilyn Tavenner, Acting Administrator for the Centers for Medicare & Medicaid Services

Like most of us, you probably know someone who had a baby born prematurely. These children are at greater risk for complications at birth as well as for developmental and health problems that can impact their quality of life as adults. Premature births are also an economic issue– preterm and premature births cost our country and hard-working families at least an estimated $26 billion each year.

Recently, a report from the World Health Organization, the March of Dimes, Save the Children, and the Partnership for Maternal, Newborn and Child Health found that more than half a million babies in the United States are born preterm each year. That’s more than 130 other countries– almost tying us with Somalia, Thailand, and Turkey. Moreover, early elective deliveries still account for 10-15% of all deliveries in the United States. While the United States excels at treating premature and preterm newborns, it would be better if more of our babies were born at full term.

To safely reduce preterm and premature births, the U.S. Department of Health and Human Services launched the Strong Start initiative earlier this year.  Strong Start builds on the work of American College of Obstetricians, the March of Dimes, and many others to reduce early elective deliveries.  Strong Start also involves change in prenatal care delivery to reduce premature and preterm births and improve outcomes for high-risk pregnant Medicaid beneficiaries and their newborns.

Decreasing early deliveries means:

• More mothers get safe, evidence-based care and infants improve their chances for good physical and developmental health.
• Public and private payers may see lower costs because providers are performing fewer caesarian sections for failed inductions, there are fewer neonatal intensive care unit admissions, and there are fewer associated complications for the newborns.

As a mother, I know there’s nothing more important for a child than getting off to a healthy start.  With the right resources and tools, we can make sure mothers and children around the country get the best care possible to give children a strong start in life.

Let’s get mothers and newborns off to a strong start.  Learn more about Strong Start and what you can do to reduce the rate of premature and preterm births.

Information on Implementation of the Physician Payments Sunshine Act

On December 19, 2011, the Centers for Medicare & Medicaid Services (CMS) published a proposed rule implementing the Physician Payments Sunshine Act, which was included as section 6002 of the Affordable Care Act of 2010.  This provision will provide important transparency in requiring reporting of payments or gifts to physicians, and physician ownership and investment interests.  During the 60 day comment period, CMS received over 300 comments from a wide range of stakeholders.

CMS is committed to addressing the valuable input received during the comment period, and to ensuring the accuracy of the data collected.  In order to provide time for organizations to prepare for data submission and to sufficiently address the important input we received during the rulemaking process, CMS will not require data collection by applicable manufacturers and applicable group purchasing organizations before January 1, 2013.

CMS intends to release the final rule later this year.  This timing will provide CMS with additional time to address operational and implementation issues in a thoughtful manner, and the ability to ensure the accuracy of the data that is collected.

Closing racial and ethnic gaps in access to care

By Cara V. James, Director of the Office of Minority Health

Did you know that 31% of Hispanics are uninsured, compared to 12% of non-Hispanic whites?  Or that less than one-third of African American adults with diabetes receive the recommended services?  Or that fewer than 40% of American Indian and Alaska Native adults over 50 have gotten screened for colorectal cancer?

April is National Minority Health month. Although we continue to make strides in improving health outcomes, it’s clear that racial and ethnic minorities, low-income Americans, and other underserved populations still lag behind the general population.  Racial and ethnic minorities often have higher rates of serious diseases, are less likely to get preventive care, and have fewer treatment options and less access to quality health care. They’re also less likely to have health insurance than the general population.

The Affordable Care Act is improving access to care for minority populations and other underserved groups in a variety of ways. The Affordable Care Act fills in current gaps in coverage for the poorest Americans by creating a minimum Medicaid income eligibility level across the country.  Beginning in January 2014, individuals under 65 with incomes below 133 percent of the federal poverty level will be eligible for Medicaid, so for the first time, low-income adults without children will be guaranteed coverage through Medicaid in every state.  Medicaid and Children’s Health Insurance Program eligibility and enrollment will be much simpler and will be coordinated with the newly created Affordable Insurance Exchanges.

Starting in 2014, Affordable Insurance Exchanges will make buying health coverage easier and more affordable. These new Exchanges will offer one-stop shopping so individuals can compare prices, benefits and health plan performance on easy-to-use websites. Financial help will be provided to low-income populations, which will help ensure that all Americans have access to quality, affordable health coverage, even if they lose a job, switch a job, move, or become ill.

The Affordable Care Act is also improving access to preventive care services. Research shows that use of preventive services is traditionally lower for minority populations, but now all people with Medicare can get a range of recommended preventive serviceswithout paying part B coinsurance or meeting the deductible.  These include certain tests for breast, colorectal, and other cancers, diabetes, cardiovascular disease screening, and intensive behavioral therapy for obesity.  A new benefit, a yearly wellness visit with your qualified and participating doctor, has also been added, and is also available without part B cost sharing. These free preventive services can help reduce health disparities and give everyone the chance to enjoy better health and a better quality of life.

People with Medicare also get a 50 percent discount on covered brand-name drugs while in the prescription drug coverage gap (known as the “donut hole”), and by 2020, the donut hole will be closed. This change will help relieve the financial burden for millions of seniors and people with disabilities across the country.

The health of racial and ethnic minorities is one of the focus areas for the Office of Minority Health at CMS.  OMH works not only to serve as a resource and liaison within and outside of CMS, but to help improve CMS minority health data, report on CMS progress in reducing disparities, and represent minority health interests in all CMS activities.

The gaps in health outcomes won’t change overnight. But with free preventive services, yearly wellness visits, and more affordable prescription drugs, we’re helping to increase access to care, reduce health disparities, and strive for health equity.

7 Ways to Protect Yourself from Medical Identity Theft

Peter Budetti, MD, JD, Deputy Administrator for Program Integrity

Fraud affects everyone. We’ve said it before – but this time we’re not just talking about people with Medicare. As my colleague Dr. Shantanu Agrawal and I pointed out in a recent article in the Journal of the American Medical Association, physicians are also vulnerable to a type of fraud called “medical identity theft.”

Medical identity theft happens when a fraudster uses your unique medical identifiers to bill insurance for items or services that you never provided or prescribed. Examples of these medical identifiers could be your National Provider Identifier (NPI), Tax ID Number (TIN), and medical licensure information. You pay for this kind of fraud with increased financial liabilities – you may be expected to pay taxes on earnings you never received, or repay insurance companies for payments on items or services that you never provided. You may also become the physician of record for services you had nothing to do with.

How to Protect Yourself

1. Keep your medical information up-to-date. Report any changes to Medicare, Medicaid, and other insurance companies, such as opening and closing of offices and moving between group practices.
2. Review billing notices. Actively review your Medicare remittance notices to make sure there are no items or services listed that you didn’t provide, including payments to you for services you didn’t provide.
3. Protect your medical information. There are things you can do to better protect your information. For example, before giving out your medical identifiers to potential employers or other organizations, check them out to be sure they’re legitimate. Only give your information to trusted sources.
4. Train your staff. Make sure your employees know the proper way to use and distribute your medical information, such as on prescription pads, electronic health records, and on other important documentation.
5. Educate your patients. Patients are victims, too. Medical identity theft leads to higher insurance costs. Also, if patients are charged for items or services they never received, they may be denied in the future when they really need them. Tell patients to be on the lookout for fraudulent activity on their explanation of benefits statements, and how to report fraud when they see it.
6. Report any suspected medical identity theft. If you believe you may have been the victim of identity theft, call the CMS program integrity investigative contractor in your region,which you can find at this location: http://www.cms.gov/MedicareProviderSupEnroll/downloads/ProviderVictimPOCs.pdf You may also report any suspected cases of medical identity theft to the Office of the Inspector General.
7. Protect your prescription pads. Keep your prescription pads in a safe and secure environment, so they can’t be used by fraudsters to obtain prescriptions you never prescribed.

Medicare fraud and identity theft affects everyone. That’s why it’s very important for all of us to work together to stop it.

2012: the Year of Meaningful Use

Marilyn Tavenner and Farzad Mostashari

Health IT plays a central role in building a 21^st century health care system—where care is safer, better coordinated and patient-centered, where we pay for the right care, not just more care. Increasing the adoption and use of Health IT is crucial, so we’ve set an ambitious goal for 2012: get 100,000 health care providers paid under the Medicare and Medicaid Electronic Health Records (EHR) Incentive Programs by year’s end. For us to succeed, we need you—the states and our many other health IT partners—to join us in this effort.

The EHR incentive programs, which began in 2011, give payments to eligible professionals, eligible hospitals, and critical access hospitals as they adopt, implement, upgrade, or demonstrate meaningful use of certified EHR technology. “Meaningful use” means providers need to show they’re using certified EHR technology in ways that improve care.

Health IT systems, including EHRs, help providers communicate better with each other about patient care, which reduces medical errors, helps cut down on paperwork, and cuts out needless duplicate screenings and tests. These all lead to better coordinated patient care and lower health care costs.

Thanks to the invaluable work of Health IT coordinators, Medicaid programs, Health IT regional extension centers (RECs), leading hospitals, public health departments, and other stakeholders, CMS and ONC made significant progress in getting providers to adopt and use EHRs during 2011:

• Over $2 billion in Medicare EHR Incentive Program payments were made between May 2011 and the end of February 2012.
• More than $1.8 billion in Medicaid EHR Incentive Program payments were made between January 2011 (when the first set of states launched their programs) and the end of February 2012.
• More than 59,000 eligible professionals and over 2,000 eligible hospitals have been paid by the Medicare and Medicaid EHR Incentive Programs.
• More than 120,000 providers, representing approximately 40 percent of primary care providers nationwide, enrolled with the RECs to get program information and help in adopting EHRs.

There’s every reason to expect that together we can increase these numbers greatly this year to reach our target of 100,000 providers. Working together with state Medicaid programs and CMS Regional Offices, many states are partnering with local stakeholder organizations to make sure providers get the help and encouragement to achieve “meaningful use,” and assistance with overcoming any barriers that are blocking their progress. Several states have already set ambitious targets:

•  Ohio has set a goal of having 10,000 providers receive EHR incentive payments in 2012, representing nearly 40 percent of all eligible professional and eligible hospitals in the state.
•  Washington State aims to have more than 7,000 providers receive EHR Incentive payments this year representing about 40 percent of the state’s eligible professionals and eligible hospitals.
•  California has set goals of 10,000 eligible providers receiving Medicaid payments and $500 million in incentive payments coming to the state by June.
•  New York State has set an initial target of over 6,000 eligible providers receiving incentive payments in calendar year 2012.

Many of our provider partners have stepped up to the challenge as well.  The National Association of Community Health Centers, the American Academy of Pediatrics, and the American Association of Family Physicians have engaged their memberships in achieving meaningful use in 2012.  The American College of Cardiology has set its own goal of 8,000 cardiologists by 2012 – one third of its membership!

By working together, the health IT community can make 2012 the Year of Meaningful Use.