Proposed OPPS rule offers 1%-2% pay updates
The Centers for Medicare & Medicaid Services' (CMS) proposed payment policies and payment rate updates for services furnished to beneficiaries during calendar year 2010 in hospital outpatient departments under the outpatient prospective payment system (OPPS) should have no major impact on ED managers, according to Barbara K. Tomar, federal affairs director of the American College of Emergency Physicians, Washington, DC.
"In scanning the NPRM [notice of proposed rule making], I didn't see much that was exciting new policy or anything that would appear to have a negative impact on EDs," she says. "For the most part, there are small 1%-2% payment updates for ED APCs [ambulatory payment classifications].'"
Tomar did note that this year CMS proposes to add a Level V in the Type B visit series ($248 vs. $330 for Type A Level V). "Last year, Type B level V was paid the same as Type A Level V," she observes.
There is still no proposal for facility coding for ED visits, "and we are good with that," Tomar says. In addition, she points out, proposed payment for the relatively new APC 0618, critical care with trauma activation, is slated for a 14% reduction. "While that seems bad, one has to remember that payment went from $330 in 2008 to $935 in 2009, and $800 proposed for 2010," she explains. "That's probably based on additional claims and new median cost computations."
CMS will accept comments on the proposed rule until Aug. 31, 2009, and will respond to comments in a final rule to be issued by Nov. 1, 2009. To access the proposed rule, go to www.cms.hhs.gov/HospitalOutpatientPPS. If you wish to comment on the proposed rule, go to: www.regulations.gov/fdmspublic.
TJC to improve top 4 challenging requirements The Joint Commission (TJC) is conducting an extensive review of its National Patient Safety Goals (NPSGs) to identify how to increase the value of the requirements in helping organizations provide safe, quality care. According to recent field input on the NPSGs and the standards, the four most challenging requirements are:
Initial suggestions from the field for improving these requirements include making them less prescriptive and using clearer language. Specific feedback on the critical test results requirement included suggestions for a more limited scope. Feedback on the staffing effectiveness standard revealed that implementation is difficult and costly for organizations while yielding little value. The Joint Commission will engage focus groups on these issues and will invite field comment on proposed revised requirements via web-based surveys. |
TJC participates in safety alliance A public-private alliance of safety officials and technical experts known as the Commercial Aviation Safety Team (CAST) has significantly improved aviation safety since its creation in 1997. CAST is now working to create a similar alliance among health care stakeholders, including The Joint Commission (TJC), that could reduce medication and device errors and wrong-site surgeries, according to Peter Pronovost MD, PhD, professor in the Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, and co-author of an article on this topic published recently in the journal Health Affairs.1 Pronovost and his colleagues are working to establish a health care counterpart to CAST, which they call Public Private Partnership to Promote Patient Safety (P5S). Other stakeholders in addition to The Joint Commission include the Agency for Health Care Research and Quality (AHRQ), the Food and Drug Administration, U.S. Pharmacopeia, the ECRI Institute, insurers, and more than 15 large health systems. Initial planning is under way with a grant from the Robert Wood Johnson Foundation and another grant has been submitted to AHRQ. The planning group is co-chaired by Pronovost; Jerod Loeb, PhD, The Joint Commission's executive vice president of quality measurement and research; Eric Campbell, PhD, associate professor of medicine, Harvard Medical School; and Sara Singer, PhD, assistant professor of health care management and policy, Harvard School of Public Health. Reference
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