Published 3/1/2018

Second Look – Advocacy

These items originally appeared in AAOS Headline News Now, a thrice-weekly enewsletter that keeps AAOS members up to date on clinical, socioeconomic, and political issues, with links to more detailed information. Subscribe at www.aaos.org/news/news.asp (member login required).

Texting and HIPAA
The U.S. Centers for Medicare & Medicaid Services (CMS) has issued a clarification to its policy on texting by healthcare providers. A recent report from the Health Care Compliance Association suggested that CMS was requiring healthcare providers to halt all texting. In response, the agency says that it "recognizes that the use of texting as a means of communication with other members of the healthcare team has become an essential and valuable means of communication among the team members." However, the agency states that the "practice of texting orders from a provider to a member of the care team is not in compliance with the Conditions of Participation (CoPs) or Conditions for Coverage (CfCs)," and goes on to note that, in order to be compliant with the CoPs or CfCs, "all providers must utilize and maintain systems/platforms that are secure, encrypted, and minimize the risks to patient privacy and confidentiality as per HIPAA [Health Insurance Portability and Accountability Act] regulations and the CoPs or CfCs. It is expected that providers/organizations will implement procedures/processes that routinely assess the security and integrity of the texting systems/platforms that are being utilized, in order to avoid negative outcomes that could compromise the care of patients."

Medical liability
The American Medical Association (AMA) has released three trend reports examining the issue of medical liability. The first report analyzes medical liability claims frequency and finds that 34 percent of physicians have had a medical liability claim filed against them and 49.2 percent of physicians aged 55 years and older have been sued. The second report examines indemnity payments, expenses, and claim disposition from 2006 to 2015 and finds that the average expense incurred on medical liability claims that closed in 2015 was $54,165—an increase of 64.5 percent since 2006. The third report looks at annual changes in medical liability insurance premiums from 2008 to 2017 and finds that since 2010, 12 percent to 17 percent of medical liability premiums have increased from the previous year.

Physician economic value
A report released by AMA estimates that physicians generate $2.3 trillion per year in the U.S. economy and support the employment of nearly 12.6 million people. The report calculates the direct and indirect economic impact of physicians. Other findings include the following:

  • Physicians supported an average of 182,370 total jobs at the individual state level, including their own and other direct positions, as well as indirect employment.
  • The average state-level value of physician-supported wages and benefits was $16.7 billion.
  • Nationally, physicians supported $92.9 billion in state and local tax revenues during 2015.

New voluntary payment bundle
The CMS Center for Medicare and Medicaid Innovation (CMMI) has launched a new voluntary bundled payment model. Under the Bundled Payments for Care Improvement (BCPI) Advanced model, participants will be expected to redesign care delivery to keep Medicare expenditures within a defined budget while maintaining or improving performance on specific quality measures. Participants will bear financial risk, have payments under the model tied to quality performance, and be required to use Certified Electronic Health Record Technology. The 32 types of clinical episodes in BPCI Advanced add outpatient episodes to inpatient episodes offered in the existing BCPI initiative. BPCI Advanced will be an Advanced Alternative Payment Model under the Medicare Access and CHIP Reauthorization Act. The Model Performance Period for BPCI Advanced is scheduled to run from Oct. 1, 2018, through Dec. 31, 2023.

MIPS recommendation
The Medicare Payment Advisory Commission (MedPAC) voted 14-2 in favor of ending the Merit-based Incentive Payment System (MIPS) and replacing it with an alternative reimbursement model. MIPS combines portions of the Physician Quality Reporting System, the Value-based Payment Modifier, and Meaningful Use into a single program based on quality, resource use, and clinical practice improvement. Last month, the agency finalized a recommendation for repeal, which was recently passed.

QPP successes and penalties
CMS states that 20,481 clinicians will receive an additional 6.6 percent to 19.9 percent on their 2018 Medicare physician fee schedule payments under the Quality Payment Program (QPP) as a result of high performance on quality and cost measures in 2016. However, the agency also notes that 834,397 clinicians received no payment adjustment, and 296,475 received penalties. Under the QPP, providers who meet minimum quality reporting requirements receive positive or neutral payment adjustments based on performance.

Medicaid work requirements
CMS has issued guidance on allowing states to impose work or job training requirements for those who seek to obtain health insurance under Medicaid. The agency states that it received numerous requests to test programs through Medicaid demonstration projects under which work or participation in other community engagement activities—including skills training, education, job search, volunteering, or caregiving—would be a condition for Medicaid eligibility for able-bodied, working-age adults. CMS states that such programs would exclude individuals eligible for Medicaid due to a disability, elderly beneficiaries, children, and pregnant women.

Hand hygiene violations
Modern Healthcare reports that The Joint Commission (TJC) will now cite healthcare organizations if surveyors witness an employee who fails to follow correct hand hygiene guidelines. TJC already requires healthcare organizations to have a hand hygiene program and to demonstrate improvements in compliance. Poor hand hygiene of healthcare employees is considered by many experts to be a major contributor to hospital-acquired infections (HAIs). The U.S. Centers for Disease Control and Prevention has estimated that approximately 722,000 HAIs occurred in the U.S. during 2011, with about 75,000 associated inpatient deaths.

Patient communication
A study published in the International Journal for Quality in Health Care (online) suggests that the way diagnostic uncertainty is communicated may affect patient perceptions of trust and physician competence. The researchers surveyed 71 participants regarding their responses to three vignettes, each of which demonstrated a different strategy for communicating diagnostic uncertainty. They found that explicit expression of uncertainty was associated with lower perceived technical competence, less trust and confidence, and lower patient adherence, while implicit strategies, such as broad differential diagnoses or most-likely diagnoses, were linked to increases in perceived physician competence, physician confidence and trust, and intention to adhere to instructions.

Open Payments
CMS has updated the Open Payments database to reflect changes that have taken place since the last publication on June 30, 2017. The update includes changes to nondisputed records made on or before Nov. 15, 2017; dispute resolutions completed on or before Dec. 31, 2017; and records with active disputes that remained unresolved as of Dec. 31, 2017, which are displayed as disputed.