Federal regulators had previously signaled that they would postpone implementation of the coding set known as ICD-10. Now the Department of Health and Human Services has come out with the actual date, as part of a broader proposed rule that includes assigning a new identifier to health plans that could be used in billing. The department says the entire proposal could save as much as $4.6 billion over ten years.

But the main headline for most hospitals, doctors and health insurers is the ICD-10 delay. In a press release, the department said the breather will give them “more time to prepare and fully test their systems to ensure a smooth and coordinated transition to these new code sets.”

ICD-10 is an update and expansion of diagnosis and procedure codes that are widely used in medical billing, as well as for research and other purposes. Some groups had said the health-care system wasn’t going to be ready for the 2013 date, and the American Medical Association has actually urged that the entire thing be scrapped, saying the new set of billing codes will burden the practice of medicine without improving care. The 10th iteration of the disease-classification system will expand the number of codes in use from around 18,000 in the current ICD-9 code set to about 140,000.  Source: Associated Press, April 12, 2012.

The study population consisted of 187,233 participants and was based on self-reported diabetes among adults 18 years of age and older.  Researchers used data collected through the National Health Interview Survey (NHIS).

“Those with less than a high school education were approximately 60% more likely to have diabetes than participants with at least a bachelor’s degree.”

The research team found that individuals with less than a high school diploma had the highest overall incidence of diabetes (10.2%), followed by those with a high school diploma or GED (6.2%), some college (4.5%), and at least a bachelor’s degree (3.4%).

The researchers also examined the effect of education on diabetes after controlling for variables such as survey year, age, gender, race/ethnicity, foreign birth, marital status, income, health insurance and body mass index.  They found that study participants with less than a high school education were approximately 60% more likely to have diabetes than study participants with at least a bachelor’s degree, while those with a high school diploma, GED or some college were approximately 30% more likely (all differences were statistically significant).

After adjusting for confounding variables, both non-Hispanic White and Hispanic participants with less than a high school education had statistically significantly higher odds of developing diabetes compared to their peers with at least a bachelor’s degree (70% more likely and 60% more likely, respectively).  Among non-Hispanic Black participants, however, the connection between diabetes and educational attainment was not statistically significant.

Additionally, the results revealed that compared to those with at least a bachelor’s degree, both women and men with less than a high school education had a greater incidence of diabetes.  However, the impact of education was greater among women than men (90% vs. 40% more likely to have diabetes, both statistically significant).

According to the authors, not checking the prevalence of diabetes by subgroup in each race/ethnicity presented a limitation in this study.  For instance, among Hispanic adults, Mexican Americans had the highest incidence of diabetes, so the authors believe that “it is possible that the estimates presented here are a better reflection of the prevalence of diabetes among Mexican Americans than among Hispanics as a whole.”

Source: Borrell, Luisa N., et al., Education and Diabetes in a Racially and Ethnically Diverse Population, American Journal of Public Health. Vol. 96 (2), Pgs. 1637-1642.
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Investigators from George Washington University and the Albert Einstein College of Medicine studied 488 participants who were predominately African-American with 62% reporting that the ED was their usual source of treatment for asthma.  Children in the intervention group were scheduled to have a follow-up appointment with a physician and an asthma educator two to fifteen days after being released from the ED.  The sixty to ninety minute sessions, which took place in the ED on weekday mornings, covered “asthma self-monitoring and management, environmental modification and trigger control, and linkages and referrals to ongoing primary care.”

“The average total number of unscheduled asthma visits was 40% lower among children in the intervention group.”

Of the children enrolled in the intervention group, 71% went to their follow-up visit.  The clinic supplied all attendees with a pillow cover, a mattress pad and an individualized asthma treatment plan.  Many also received prescriptions for inhaled corticosteroids (97%) and leukotriene antagonists (40%).  Subsequent to the appointment, every participant’s primary care physician (PCP), insurance asthma case manager and school nurse received an account of the follow-up session and a copy of the asthma treatment plan.  Children in the control group did not have a follow-up visit, but were given a pamphlet on asthma.

After adjusting for demographic and other differences between the two groups, the researchers found that after one month the intervention group was 53% more likely than the control group to use a written asthma plan.  They were also significantly more likely to use mattress pads and pillow covers, to have no daily smoking inside the home and to use inhaled corticosteroids and leukotriene antagonists.  The difference between the two groups continued after six months for some of these measures, including the use of inhaled corticosteroids.  However, the intervention group was not more likely to name a PCP as their primary source of asthma care.

Researchers also studied participants’ use of care over a six-month follow-up period.  The average total number of unscheduled asthma visits was 40% lower among children in the intervention group (1.39 vs. 2.34, adjusted for demographics and other variables).  In particular, they had 46% less visits to the ED (0.64 vs. 1.19).  However, the investigators did not find statistically significant differences in the number of hospital admissions or scheduled visits with a PCP for asthma.

“After one month, children in the intervention group were 74% more likely to have experienced no functional limitations in their quality of life, but only 33% more likely after 6 months.”

After one month, children in the intervention group were 74% more likely to have experienced no functional limitations in their quality of life during the prior four weeks.  They were also significantly more likely to be free of daytime and nighttime symptoms over a two week period (67% and 23% more likely, respectively).  After six months, however, differences between the two groups had declined; the intervention group was only 33% more likely to have no limitations in quality of life and the prevalence of daytime and nighttime symptoms was no longer significantly different.

Since the intervention did not increase patients’ interaction with their PCPs, the authors expressed concern that it could have “negatively impacted the role of the PCPs by establishing an effective ED-based system for short term asthma management.”   Nevertheless, the intervention did have a positive impact on behavior and outcomes, and the researchers identified several factors that may have contributed this success.  The sessions were individualized, covered a broad range of issues and occurred in a familiar setting.  Also, the families were approached during an ED visit, a time when they were particularly receptive to ways to improve care.

Source: Teach, Stephen J., MD, MPH, et al., Improved Asthma Outcomes in a High-Morbidity Pediatric Population, Archives of Pediatrics and Adolescent Medicine. Vol. 160, Pgs. 535-541.
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A 2008 survey by the National Association of Public Hospitals of 46 “medical home” programs initiated by its members revealed significant patient-care improvements that included improved care coordination and a resultant reduction in emergency department (ED) utilization, per-patient cost, and hospitalizations.  In addition, the various medical home programs were found to decrease inpatient days, increase the number of appropriate primary care visits, and increase patient appointment “show rates”.

Of the medical homes surveyed, 80% employed case managers and/or care coordinators.  Reasons given for implementing the programs included “improving patient health and increase access to high quality health care” (33%) and “explicitly working to reduce ED overcrowding and the inappropriate use of ED services for primary care” (20%).  Other reasons were to address “unmet medical needs of a growing uninsured patient population” and the establishment of programs “in anticipation of proposed federal health reform legislation, which includes language emphasizing primary care and medical home model.”

“More than three quarters (76%) of the programs were collaborative in nature, with the hospitals initiating these relationships in 69% of the cases.”

More than three quarters (76%) of the programs were collaborative in nature, with the hospitals initiating these relationships in 69% of the cases and community organizations being the initiators 31% of the time.

Most of the medical home programs were intended to target “specific vulnerable populations”, including: pediatric patients; the elderly; the uninsured, underinsured, and Medicaid patients; patients with no primary care physician; frequent users of the ED for primary care services; and the homeless.  Additionally, the researchers found that pediatric medical homes often targeted particular sub-groups, such as: children with chronic diseases or developmental delays; those in foster care; and those who are homeless.

Fully 80% of the medical homes offered specialty care, either on-site or through coordinated referrals with contracted specialists.  Further, 63% of the programs offered chronic disease management programs for conditions including: asthma, cardiovascular disease, chronic renal disease, diabetes, HIV/AIDS, hyperlipidemia, obesity, pain management, and substance abuse.  In order to improve access, 39% of the medical home programs offered “open-access” scheduling, allowing patients to make same- or next-day appointments.

While 57% of the respondent programs reported use of health information systems, a majority did not have fully-integrated electronic medical records (EMR), with 41% using or in the process of implementing EMRs.

The surveyed programs all shared universal characteristics of a medical home, however “each one was tailored to the needs of its patient population.”  For instance, a geriatric program relied heavily on social workers to health patients navigate the system.  A program targeting the homeless employed mobile medical vans to reach out across the community.  Another program for children in foster care coordinated all health care services, “regardless of a child’s placement with new foster families.”

With respect to specific improvements in care, “nearly 40% of programs could offer either anecdotal or quantitative evidence of reduced ED usage.”  The Broadlawns Medical Center in Des Moines, Iowa, reduced annual ED visits by 4,000 and resulted in a $190-per-patient reduction in cost of care.

“Nearly 40% of programs could offer either anecdotal or quantitative evidence of reduced ED usage.”

Carolinas Medical Center reduced hospitalizations and ED visits by 80% among their targeted group of high-risk patients.  Further, the Carolinas program increased patient appointment show rates by 39% between 2001 and 2005 through the use of “open access scheduling”.  In addition, diabetic patients not participating in the Carolinas medical home program “cost the hospital 31% more per day and 67% more per admission than their counterpart medical home patients.”

Finally, the research team noted that recently passed health care reform legislation calls for “new federal financial assistance to community-based collaborative care networks that operate as medical homes… seeking to reduce unnecessary ED use, strengthen care coordination for patients with chronic illness, and increase access to primary care.”

Source: Safety Net Hospitals Establish “Medical Homes”, Research Brief, National Association of Public Hospitals and Health Systems, February 2010.
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“67.6% of the centers had at least one infection control lapse.”

As background, the authors note that the use of ASCs has increased dramatically.  Between 2001 and 2008, the number of ASCs certified by Medicaid has more than doubled, with the current number exceeding 5,000.  In 2007 more than 6 million procedures were performed in these centers nationally.

Findings included the following:

-  46 of the 68 centers had at least one infection control lapse (67.6%)

-  12 ASCs were found to have at least 3 infection control deficiencies (17.6%)

-  the most common findings were reuse of single-dose medication vials (28.1%), improper equipment reprocessing (28.4%), and mishandling blood glucose monitoring equipment (46.3%)

The research team speculated that misuse of the single-dose vials was a cost-saving measure, whereby “facilities have purchased single-dose medications in packaging larger than that required for single-patient use and then used the contents for multiple patients.”

In an accompanying editorial, Philip Barie, M.D. from New York-Presbyterian Hospital/Weil Cornell Medical Center calculates that an extrapolation of the study’s findings reveals that “several million U.S. patients may be at risk for infections in ASCs.”

Source:  Infection Control Assessment of Ambulatory Surgical Centers, Journal of the American Medical Association, 2010;303(22):2273-2279.

The researchers’ analysis showed the following:

-  ”Medicaid expansions will significantly increase coverage and reduce the number of uninsured”

-  ”The federal government will pay a very high share of new Medicaid costs in all states”

-  ”Increases in state spending are small compared to increases in coverage and federal revenues and relative to what states would have spent if reform had not been enacted”

In their conclusion the study’s authors state that, “There will be large increases in coverage and federal funding

in exchange for a small increase in state spending.  States with low coverage levels and high uninsured rates will

see the largest increases in coverage and federal funding.”  The researchers also note that higher levels of Medicaid coverage will allow states to reduce their uncompensated care costs.

The authors note that since state implementation of the new health care reforms are, in effect, voluntary, “some states may not aggressively implement health

reform and therefore not see significant reductions in the uninsured while other states will have higher levels of

participation because of effective outreach and enrollment strategies and see greater reductions in the number

of uninsured.”

Here is a link to the study on the Kaiser Commission site:  http://www.kff.org/healthreform/upload/Medicaid-Coverage-and-Spending-in-Health-Reform-National-and-State-By-State-Results-for-Adults-at-or-Below-133-FPL-Executive-Summary.pdf

Also, you can download the PDF directly by clicking here:  PDF
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Investigators from the University of North Carolina at Chapel Hill have conducted a study showing that black adults in the rural south were more likely than their white counterparts to report encountering barriers to care, even though they used a comparable or greater number of health services.

The researchers used data from the 2002-2003 Southern Rural Access Program survey and examined health outcomes and satisfaction, controlling for age, gender, health status, socioeconomic status (SES) and county health resources.

“Overall, 17.4% of black adults found it difficult to get routine health services, compared to 10.1% of white adults.”

Reported barriers to outpatient care were more common for black adults than for their white counterparts.  Overall, 17.4% of black adults found it difficult to get routine health services, compared to 10.1% of white adults.  While 23.5% of white adults under 65 lacked health insurance, a significantly higher 37.5% of black adults were uninsured.  Black adults were also more likely to be without a usual source of care (16.1% vs. 11.0%), to usually seek care in an emergency room (10.6% vs. 3.9%) and to believe there are too few doctors in their community (56.0% vs. 44.0%).  In most cases, adjusting for confounding variables caused these differences to shrink, but not disappear.

There were, however, some barriers to care that were not significantly more common among black adults than their white peers.  These included reporting that costs of care were more than a minor problem and that it was difficult to get a needed appointment within one or two days.

The percentage of black adults who were not content with their health care overall was higher compared to white adults (9.7% vs. 5.6%).  They were also more likely to be unsatisfied with the concern shown by their providers (7.5% vs. 4.2%) and to lack confidence in their doctor’s ability to help (25.4% vs. 15.4%).  However, satisfaction with quality of care was similar among the two groups.  After adjusting for SES variables, only confidence in their providers remained significantly different.

“While 23.5% of white adults under 65 lacked health insurance, a significantly higher 37.5% of black adults were uninsured.”

As for preventive health services, black adults were significantly more likely to fail to receive flu shots (49.5% vs. 25.5%) and tobacco use counseling (44.9% vs. 28.5%).  Rates of sigmoidoscopies/colonoscopies, mammograms, and Pap smears were similar for the two groups.

In addition to variations in socioeconomic factors, the authors identified several factors that might have caused reported differences in barriers to outpatient medical care even though black adults received similar or greater quantities of care.  Since black adults were more likely to frequent emergency rooms, they may have been less likely to benefit from ongoing provider relationships.

Source: Pathman, Donald E. et al., Differences in Access to Outpatient Medical Care for Black and White Adults in the Rural South, Medical Care. Vol. 44 (5), Pgs. 429-438.
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A research team from University of Rochester and Centers for Disease Control and Prevention conducted a study which showed that telephone reminders had a limited impact on urban adolescents’ rates of immunization and health care visits.

Intervention participants were 11 to 14 years of age, including 1,496 study group adolescents and 1,510 control group adolescents.  The study was carried out at two urban private practices, a hospital-based clinic and a neighborhood health center in Rochester, NY.  Researchers used autodialer, an automated telephone message reminder system to contact study group adolescents in need of a tetanus booster (Td), a hepatitis B vaccination (3 doses) or an annual well-child care (WCC) visit.

“The impact of telephone reminders diminished over the study period; little benefit was found for WCC visits after 2 months or for vaccinations after 4 months.”

Telephone reminders were discontinued if the phone numbers were inaccurate, “the adolescent had left the practice, or the parents requested calls to be stopped.”  In addition, telephone reminders were temporarily suspended if phone numbers were “unresponsive” (no scheduled health care visit following 5 calls within 30 days).

At the start of the intervention, study and control adolescents had similar rates of hepatitis B vaccination (45.1% vs. 44.0%), Td vaccination (24.7% and 23.8%), and WCC visits (52.3% vs. 54.2%).  By the end of the intervention, study and control groups still had analogous rates of Td vaccination (52.0% vs. 49.9%) and WCC visits (53.1% vs. 54.3%).  However, hepatitis B vaccination was slightly higher among the study group (62.0%) compared to the control group (57.8%).  The rates of hepatitis B immunization appeared significantly different, but when researchers took into account the fact that some participants were ineligible for vaccinations, the results were no longer significant.

The study showed that the impact of telephone reminders did not vary based on participants’ age, race/ethnicity or insurance.  The researchers also found that the impact of telephone reminders diminished over the study period; little benefit was found for WCC visits after 2 months or for vaccinations after 4 months.

However, adolescents whose telephone numbers changed were less likely to receive immunizations or health care visits than families with a single phone number.  Over the course of the study, 69% of the study group had multiple telephone numbers.  Those with multiple numbers were significantly less likely to have a WCC visit (25%) than those with a single number (71%).  Differences in hepatitis B vaccinations were also significant.

“Those with multiple numbers were significantly less likely to have a WCC visit (25%) than those with a single number (71%).”

The researchers suggested that patient phone numbers and immunization records be updated at all health care visits.  They also recommended collecting alternate telephone numbers when possible.  Finally, the authors suggested that given the declining impact of the reminders over the course of the study, urban adolescents might benefit from a more concise intervention.

The authors concluded that “with emerging new adolescent vaccines, aggressive strategies will be needed to ensure high adolescent vaccination coverage as well as receipt of preventative adolescent services.”

Source: Szilagyi, Peter G., et al., Effect of Telephone Reminder/Recall on Adolescent Immunization and Preventive Visits, Archives of Pediatrics and Adolescent Medicine. Vol. 160, Pgs. 157-163.
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Medicaid Specialist
Welcome to Genesis HealthCare! Were setting the standard for clinical excellence and responsiveness in meeting the unique needs of every resident and patient in our care. Were focused on becoming the recognized leader in clinical quality and customer satisfaction in every market we serve.

Interested candidates please fax your resume to:  410-636-1250, Attn: Karen Jenkins