Americans Newly Insured Under ObamacareA new study reports that an estimated 10.3 million American adults have gained health insurance coverage under the Affordable Care Act (ACA) since open enrollment started last October, with the major gains among young adults and Hispanics.

The study was jointly funded by researchers from the Harvard School of Public Health, Brigham, Women’s Hospital in Boston, and the federal government. The researchers’ findings are based data indicating a 5.2 percentage drop in the U.S. uninsured rate since last September for Americans aged 18-64 years.

The key findings of the study are as follows

  • States that expanded eligibility for Medicaid had the biggest gains. Under Obamacare, it was not mandatory for states to expand eligibility
  • The percentage of uninsured people aged 18-64 fell from 21 percent in 2013 to 16 percent in 2014
  • The study found vital evidence that substantiates that more than 4.4 million American adults had access to a personal doctor
  • It was found that 5.3 million adults encountered difficulties in paying for a medical care within the first six months of achieving health coverage

The Patient Protection and Affordable Care Act (ACA) focuses on expanding health coverage to millions of Americans and the study by the Harvard researchers seems to reaffirm that the country is on the path to achieving this goal. Expanding Medicaid seems crucial for coverage expansion, with 26 states moving forward with the federal insurance program for the poor.

The researchers compared national survey results with Census data as well as government figures on marketplace enrollment in private insurance and Medicaid. However, some industry watchers point out that the data analyzed was not comprehensive enough to display a casual relationship between the ACA and the uninsured rate, and that it found only “suggestive associations”. Moreover, the data did not include about 3 million young adults estimated to have achieved coverage by joining their parents’ insurance policies under the ACA.

SchizophreniaSchizophrenia is a brain disorder that affects the way a person acts, thinks, and sees the world. Several observational studies have investigated the association between vitamin D status and schizophrenia. The November 2013 issue of Schizophrenia Research carries a study that found vitamin D deficiency to be linked to the first episodes of psychosis (FEP).

Another very recent study, published online on July 22, 2014 in the Journal of Clinical Endocrinology and Metabolism highlights the role of vitamin D in psychiatric health. The researchers found a strong association between vitamin D deficiency and schizophrenia.

More than 2800 participants were included, showing that those with vitamin D deficiency were more than twice as likely to be diagnosed with schizophrenia compared to their counterparts who were not vitamin D deficient. The study also found that 65% of the patients who had the condition also had lower levels of vitamin D.

Most cases of schizophrenia appear in the late teens or early adulthood. In rare cases, schizophrenia can even affect young children and adolescents with slightly different symptoms.

ICD-9-CM Codes that are used to report this diagnosis for medical billing purposes are as follows:

  • 295.10 Disorganized type schizophrenia, unspecified
  • 295.20 Catatonic type schizophrenia, unspecified
  • 295.30 Paranoid type schizophrenia, unspecified
  • 295.40 Schizophreniform disorder, unspecified
  • 295.60 Schizophrenic disorders, residual type, unspecified
  • 295.80 Other specified types of schizophrenia, unspecified
  • 295.90 Unspecified schizophrenia, unspecified

The findings support the importance of vitamin D in brain function and psychological health. According to the authors, “As vitamin D deficiency is a global issue, more attention should be drawn to the assessment of serum vitamin D levels in order to screen and support individuals that are at higher risk of having deficiencies. Moreover, our findings might help psychiatrists in the healing process of patients with schizophrenia”, It was also noted that more randomized clinical trials are required to confirm the findings.

How Americans Evaluate Physician QualityThe Affordable Care Act focuses on expanding health insurance coverage to millions of Americans. Americans while getting enrolled in specific health benefit plans and choosing physicians, must consider whether the physician will be able to provide high-quality care.

Often, when it comes to defining a quality healthcare provider there is considerable difference between how experts and consumers actually define it. Being licensed doesn’t necessarily mean that a doctor is capable and up-to-date on all best practices.

A new poll conducted by the Associated Press-NORC Center for Public Affairs Research shows that Americans do not think that information about the quality of healthcare providers is easy to come by and they lack trust in information sources that tend to produce such quality indicators. It was found that most people focus on the doctor – patient relationship and interactions in the physician offices and very few of them think about the effectiveness of treatments or their own health outcomes.

The United States spends at least two and a half times more on healthcare than most developed countries across the globe. Reports suggest that they forego 30% of the care recommended to prevent or treat common conditions. Moreover, lots of unneeded medical testing and outmoded or inappropriate therapies are also undergone.

The survey was conducted to better understand the Americans’ perception about quality provider (their meaning of provider quality, how information is accessible, how much they trust such information and the link between provider quality and cost). As part of the study, interviews were conducted with 1,002 adults aged 18 years and above. Other key findings of the survey include:

  • About 6 out of 10 people said that they trusted doctor recommendations from family or friends and about half consider referrals from their regular physician. It was found that very less number of people believe details generated from online patient reviews, website ratings, health insurers, media and government.
  • More than half of Americans consider that top quality healthcare comes at a higher cost and are willing to pay higher amount for quality physicians. On the other hand, 37% says that there is no direct association between quality and cost.
  • Consumers agree that requiring doctors to report the effectiveness of their treatments and patient satisfaction with care would enhance the quality of care provided in the US.

By the end of 2014, Medicare plans to release quality measurements for about 160 large group practices and information on smaller clinics along with patient feedback. It is expected that this major move would improve care quality as doctors need to publicly report their patient health outcomes and level of satisfaction.

When it comes to choosing a provider, consumers weigh a number of factors. Majority of people rate the quality of care provided as a prominent factor. About 1 in 5 Americans recall comparing the quality of providers during the previous year. About 8 out of 10 consider doctors experience with a particular medical procedure, treatment or surgery in their choice. Some of the other important factors considered are –

  • Board certification of the doctor along with other additional training and testing in their area of specialty
  • Total time to get an appointment
  • Total time spent with each patient
  • Ratings on patient review websites or local media
  • Patient rating on provider communication
  • Length of time in the waiting room
  • If prescribed treatments are effective
  • Helpful staff
  • Convenient hospital location
  • Comparison of charges from other providers
  • Bedside manner (impression in face-to-face meeting)
  • Any disciplinary action or malpractice suit charged against the doctor

While making an analysis of the total number of people covered by a health benefit plan, nearly 88% say that whether or not a provider accepts their insurance is an extremely crucial factor in their choice of physicians.

Despite the fact that an increased number of Americans are getting insured as a result of the ACA, those without insurance coverage face more challenges in finding details about provider quality and cost. Simultaneously, they are more likely than the insured to think that public reporting of such information would improve the overall quality of care offered.

EbolaDefined as the largest, most severe and most complex outbreak, the World Health Organization (WHO) declared the Ebola outbreak in West Africa as a Public Health Emergency of International Concern (PHEIC).

Since 2007, the organization has only declared such emergencies two other times: for the 2009 swine flu pandemic and for polio in May 2014. According to Margaret Chan, MD, director-general of WHO, “The current Ebola outbreak in West Africa is the largest, most severe, and most complex outbreak in the nearly 4-decade history of this disease. [It's] moving faster than we can control it”.

At least 932 deaths and 1,711 cases have been reported throughout Guinea, Liberia, Sierra Leone and most recently, Nigeria since December. However, the organization is not recommending general bans on travel or trade.

The U.S. Centers for Disease Control and Prevention (CDC) has also stated clearly that physicians should query patients presenting with symptoms of Ebola about recent travel to affected parts of Africa. Symptoms for this virus infection may include – sudden fever, often as high as 103º-105º F, intense weakness, sore throat, headache and profuse vomiting and diarrhea (occurs 1-2 days after the aforementioned symptoms). More severe symptoms can develop in as soon as 24-48 hours, leading to bleeding from the nasal or oral cavities, along with hemorrhagic skin blisters.

The WHO committee also recommends that:

  • For countries with ongoing active transmission, the head of state should declare a national emergency
  • People who are leaving a country with active Ebola transmission should be screened for symptoms that may be consistent with Ebola infection
  • People with this infection should be in treatment and kept in isolation for 30 days
  • Contacts of infected people should be monitored for 21 days, and during that period, they should not travel
  • Probable or suspect cases of Ebola should also be isolated until they have 2 blood tests at least 48 hours apart that are negative

Medical Coding for Ebola

Physicians providing treatment for this infection can use ICD-9 code to bill the service under Fever, hemorrhagic, Ebola:

  • 065.8 – Other specified arthropod-borne hemorrhagic fever
  • 078.89 – Other specified diseases due to viruses

The specific code is available in ICD-10

  • A98.4 – Ebola virus disease.

EHRs Medical BillingThe main objective behind the federal government’s initiative to provide incentives to push hospitals and physicians to use electronic health records (EHR) was to improve efficiency and patient safety thereby reducing total healthcare costs. Inappropriate use of the EHR system has been a strong concern since 2012 with the Departments of Justice and Health and Human Services alerting hospitals about the wrong use of this system. Hospitals that used this system were billing Medicare for a significantly more amount than hospitals using paper records. They were charging higher for a large number of expensive procedures.

However, a recent study reveals that there is no need to worry about hospitals using their new electronic health records to make huge medical bills and boost their income.

As part of the study, researchers compared the medical billing records of about 393 hospitals using an EMR system with 782 other hospitals still using paper billing format. The hospitals compared were in line with each other in terms of size and status.

While analyzing the inpatient records (of those patients who spent at least one night in the hospital), it was found that the EHR system did not make a considerable change in the billing practices.

However, Dr. Donald Simborg, a pioneer in the field of electronic health records, says that the ERs and outpatient clinics of which an increasing number are owned or run by hospitals are the real areas of concern.

Physicians in emergency rooms and outpatient clinics are using digital record keeping tools that prompt them to over-document. Physicians could accidentally document procedures that were not provided to patients. Generally, electronic records that automatically enter standard protocols for certain type of procedures or visits like a well-child check or a Medicare annual physical help physicians to be more efficient. However, doctors can end up generating a higher bill if they don’t delete things that they do not perform during a visit. There are even systems that suggest methods as to how to modify patient visits thereby allowing physicians to charge more.

The survey results emphasize the need for federal regulators to focus more on this aspect and create guidelines to reduce the inappropriate use of EMR systems to create higher medical bills. On-going vigilance needs to be implemented against the inappropriate use of electronic health records.

US Medicaid Enrollment Reaches 6.7 Million

Posted by on August 18, 2014 8:46 am

Medicaid EnrollmentThe Affordable Care Act (ACA) aims to expand the health insurance coverage to millions of Americans through a combination of public programs and private-sector health insurance expansions. A recent report reveals that the new enrollments in Obamacare’s Medicaid expansion and other healthcare programs aimed for the poor people have reached 6.7 million after the implementation of healthcare reforms last year.

The new figure that mainly comprises state Medicaid plans (that existed before Obamacare) and the Children’s health insurance plan, showed an enrollment increase by about 920,000 people during the month of May. New enrollments are up 11.4% since last October’s Obamacare rollout.

About 8 million people have opted for private health benefit plans via the new state-based Obamacare market places. Even though private enrollment ended, Medicaid enrollment still continues.

However, the Centers of Medicare and Medicaid Services (CMS) did not reveal the total number of people enrolled state wise and that have expanded their insurance under the ACA, which makes the benefits available to low-income group individuals having earnings up to 133 % of the federal poverty level. It was found that enrollment in these programs has increased to 17% in about 25 states (including the District of Columbia that has expanded Medicaid). Moreover, new enrollments were just 3% higher in states that have not expanded the same.

In an attempt to measure the experience of people with ACA, a new poll was conducted by the Commonwealth Fund which found that people enrolled in the same are satisfied. On the whole, 73% people bought health plans and 87% of people who opted for Medicaid were rated as satisfied with their new policies. About 74% of newly insured people liked their plans. Further, 77% of people who had taken insurance earlier (including members of the much-publicized group whose plans got canceled last year) were quite happy with their new coverage.

Total Knee ArthroplastyKnee replacement is an effective orthopedic operative procedure for people with severe knee damage from arthritis or injury. This procedure is proven to relieve pain, correct leg deformity, and helps people quickly resume normal activities. According to the Agency for Healthcare Research and Quality, more than 600,000 knee replacements are performed each year in the United States.

The study, published in the June issue of Journal of Bone and Joint Surgery, found that total knee replacements more than tripled between 1993 and 2009. An increase in the prevalence of overweight and obesity in the U.S. accounted for 95 percent of the higher demand for knee replacements, with younger patients affected to a greater degree. This study also noted that hospital reimbursement, length of hospital stay and in-hospital mortality for this procedure also comparably declined between 1995 and 2009.

An article published online in Arthritis & Rheumatism, a journal of the American College of Rheumatology finds that approximately a third of total knee arthroplasty (TKA) surgeries were judged to be inappropriate. This is the first US study to compare validated appropriateness criteria with actual cases of knee replacement surgery.

The study was led by researchers from the Department of Physical Therapy, Department of Orthopedic Surgery, and Department of Radiology, Virginia Commonwealth University, Richmond. Data from 205 knee replacement patients was examined, and was classified as appropriate, inconclusive, or inappropriate.

A modified version of the appropriateness classification system developed by Escobar et al., and the Western Ontario and McMaster Universities Arthritis Index (WOMAC) Pain and Physical Function scales were used to assess participants enrolled in the Osteoarthritis Initiative – a prospective 5-year study funded in part by the National Institutes of Health (NIH).

The mean age for the surgery was 67 years and 60% of the group was female. Analyses showed that:

  • 44% of surgeries was appropriate
  • 21.7% was inconclusive
  • 34.3% deemed inappropriate

The study highlights the need for consensus on patient selection criteria among U.S. medical professionals treating those with the potential need of knee replacement surgery.

New Study Findings on EHR Switching Trends

Posted by on August 11, 2014 8:38 am

EHR Switching TrendsElectronic health record (EHR) adoption rate continues to rise in the United States with many hospitals and physician practices progressing strongly towards meaningful use and the implementation of this system. Even with the growing rates of implementation, clinician dissatisfaction remains a prominent issue.

As per Physician Practice 2014 Technology survey, EHR implementation continues to be the most critical technology issue for physician practices. Reports suggest that about 17% of practices reveal that adoption and implementation of this system is a critical issue, about 16% say it lacks interoperability while 13% quote implementation cost and use of new technology as a problem.

The survey results found that more than 50% of practices had already implemented this digital health record system and were satisfied with the same. About 20% don’t have an EHR at all and another 10% are in the process of installing the same. Those practices that have not yet implemented this system plan to launch the same within 12 months. The other two thirds have several reasons for holding out from the implementation process and these include -

  • 25% find it too expensive
  • About 16% are not able to find an EMR that perfectly suits their specific needs
  • 11% have heard too many horror stories
  • 13% are struggling to get buy-in from all providers

The role of EMR becomes crucial with the reimbursement practices changing and shifting towards value-based models. In addition, the transition process from ICD-9 to ICD-10 medical codes will be more challenging without this system, and in general having an EMR can improve the medical billing and reimbursement process as well.

EHR implementation will also offer several benefits in the clinical side such as reduced prescription errors and the need to reorder lab tests. It can enhance patient compliance by providing physicians with the right tools to educate patients and give them summaries of their care and treatment plan.

Polio, or poliomyelitis, is an infectious viral disease which mainly affects young children. The condition upsets a person’s nervous system and can cause paralysis. Thanks to the polio vaccine, dedicated healthcare professionals, and parents who vaccinate their children on schedule, polio has been eradicated from this country for more than 30 years.

Oral poliovirus vaccine (OPV) that is administered orally can be given by volunteers and does not require trained health workers or sterile injection equipment. A new research published in The Lancet reveals that giving an extra dose of inactivated poliovirus vaccine (IPV) to all children under the age of 5 could help to speed up eradication efforts.

Funded by Bill & Melinda Gates Foundation, the study highlights that although OPV is highly effective, easy to administer, and relatively inexpensive, its ability to generate a strong intestinal immunity to infection wanes with time, thus permitting the transmission of infection by immunized children. At the same time, inactivated poliovirus vaccine (IPV) does not induce an intestinal mucosal immune response, but could boost protection in children who are mucosally primed through previous exposure to OPV.

For the study purpose, an open-label, randomized controlled trial was done in children aged 1-4 years, who were healthy. They had not received IPV before and had had their last dose of OPV at least 6 months before enrolment. 450 children were enrolled and randomly assigned into study groups. 225 children received IPV and 225 no vaccine.

It was found that the additional IPV dose substantially boosted levels of protective antibodies in the blood and intestinal immunity against poliovirus compared with no vaccine. One week after challenge with OPV, 43 (19%) and 57 (26%) children given no vaccine shed serotype 1 or 3 poliovirus compared with 27 (12%) and 17 (8%) of those receiving IPV. Among children in the no vaccine group, the first dose of bivalent OPV did not reduce poliovirus shedding following a second challenge dose of this vaccine.

According to the senior author of the study, “The substantial benefit of using IPV rather than further doses of OPV to boost intestinal immunity in children within the typical age range for mass vaccination supports its use as part of the global eradication program”.

Though U.S is free from poliovirus, it is still a threat in some countries. It is crucial to get each child vaccinated on schedule. IPV is given as a series of four shots, at 2 months, 4 months, 6 to 18 months, and again at 4 to 6 years of age. Most health insurance plans cover the cost of vaccines. The vaccine is billed under CPT code 90713 – Poliovirus vaccine (IPV), inactivated, for subcutaneous or intramuscular use.

Pharmacist ServicesAccording to the communication between the American Academy of Family Physicians (AAFP) and the Centers for Medicare & Medicaid Services (CMS), Physicians may bill for pharmacist services as part of the “incident to” services provided to Medicare patients. Medical billing regulations are often complex, even those applicable to family physicians.

Physicians frequently rely on the incident-to method to obtain reimbursement for the work of nurse practitioners and physician assistants. Pharmacists often work directly with patients at both large and small integrated health systems. Their duties range from providing medication reconciliation and patient education to administrating immunizations and tests such as spirometry. When billing for these services is concerned, questions arise as to whether incident to rules apply to situations in which a pharmacist employed by the physician’s practice also engages with patients.

To clarify this, the AAFP (American Academy of Family Physicians) sent a letter to the administrator of the Centers for Medicare & Medicaid Services (CMS), asking whether pharmacists qualified for incident-to billing just as much as other clinical team members, particularly because their face-to-face encounters with patients had all the trappings of an office visit. The response from CMS was that the physicians could indeed bill Medicare for a pharmacist’s work under their own provider number.

CMS also mentioned that:

  • The services of supporting personnel are eligible for “incident-to” only if they lie within the scope of their state license.
  • Medication management services, covered by billing codes 99605 to 99607, are not covered in Medicare’s Part B program, which includes physician reimbursement. However, a beneficiary’s Medicare Advantage plan or Part D medication plan can pay for medication management, and incident-to requirements do not apply.

AAFP officials have also recommended that if an established patient had an office visit with a pharmacist without seeing his or her supervising physician, the practice would probably be limited to the lowest paying CPT code for such an evaluation and management (E/M) service – 99211. However, an office visit with a physician that included time spent with a pharmacist may entitle the physician to a higher E/M code.

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