Risk Watch e-column
September 2005
A monthly update of risk management news, issues and items of interest
Medicare Claims Must Be HIPAA-Compliant
Effective October 1, 2005, the Centers for Medicare & Medicaid Services (CMS) will not process incoming electronic Medicare claims submitted for payment that do not meet standards required by the Health Insurance Portability and Accountability Act of 1996 (HIPAA).
Noncompliant claims will be returned to the filer for resubmission as compliant claims. Claims in a noncompliant electronic format will continue to be paid until October 1.
“We are firmly committed to an interoperable electronic health care system, and the close-to-100% compliance with HIPAA standards for claims shows that the healthcare industry shares this commitment,” said CMS Administrator Mark B. McClellan, MD, PhD.
As of June 2005, only about 0.5% of Medicare fee-for-service providers submitted non-HIPAA-compliant electronic claims. The highest rate of noncompliant claims — 1.72% — was from clinical laboratories. Only 0.45% of claims from physicians and 1.45% from hospitals were noncompliant.
(Source: CMS)
Physician Home Visits Increase
According to an analysis of Medicare data by the American Academy of Home Care Physicians (AAHCP), the number of house calls made by physicians and nurses in the United States increased from 1.5 million in 2000 to more than 2 million in 2004.
The number of physicians making house calls began climbing after 1998, when the federal government raised reimbursement rates by 50%. Now, more physicians — particularly primary-care physicians — are dropping out of insurance networks in general, according to the Center for Studying Health System Change.
The AAHCP has posted a list of members who make house calls on its website at www.aahcp.org. Patients and family members who need a physician or other practitioner to come to their home can go to the website and click on “Locate a Provider” to access the database, which is arranged by state. Once the appropriate ZIP code is located, the site visitor has access to a provider’s name and contact information. Thirty-eight states, Puerto Rico, and Japan are represented on the site.
(Source: The Washington Post)
Study: Solo Physicians Less Likely to Offer Preventive Care
A new study has found that physicians in solo practice are less likely to provide routine preventive services than physicians in larger practices.
“The more resources in a practice, the higher the chances the patient will receive quality care,” said study author Hoangmai Pham, a senior health researcher at the Center for Studying Health System Change.
Board-certified physicians in medium- and large-sized practices with access to health information technology and with more than 15% of revenue derived from Medicaid were more likely to offer eye exams for diabetic patients, hemoglobin monitoring, mammograms, colon-cancer screening and flu and pneumonia vaccinations.
Overall, the proportion of beneficiaries receiving services was below national goals, researchers found. The study was published in the July 27 Journal of the American Medical Association.
(Source: Modern Healthcare)
Jury Awards $253 Million in First Vioxx Case
A Texas jury on Aug. 19 awarded $253.4 million in damages to the widow of a 59-year-old man who had used the controversial painkiller Vioxx. It was the first lawsuit — in either state or federal court — involving the withdrawn painkiller, part of a family of drugs called Cox-2 inhibitors.
Robert Ernst died suddenly in 2001 after taking Merck & Co.'s pain drug for eight months. His family sued the company, claiming the drug contributed to his death.
Vioxx was the first of two highly popular Cox-2 inhibitor medications to be pulled from drugstore shelves since last September, after a major clinical trial linked its long-term use to an increased incidence of cardiovascular problems. The other drug withdrawn from the market is Pfizer's Bextra. The third Cox-2 drug, Pfizer's Celebrex, remains available to consumers but carries a heightened warning about potential heart risks.
What should physicians tell their heart patients who need pain relief? Advice from Muhammad Mamdani, PharmD, MPH — who heads the drug research group at the Institute for Clinical Evaluative Sciences and is an associate professor at the University of Toronto, Ontario — includes the following:
- Try Tylenol (acetaminophen).
- People with no risk of heart disease, kidney disease, or stomach side effects should try ibuprofen.
- Patients who are at risk of heart disease, kidney disease and stomach side effects might try Celebrex.
- Physical therapy is an option for some patients.
(Sources: HealthDay News, WebMD)
