AHA Looks Through Congress Towards CMS, Urges Transparency

The American Hospital Association (AHA) wrote a letter encouraging members of the Senate to increase access to health care data while maintaining patient privacy and the security of patient information. The letter seeks to uncover the currently unavailable wealth of CMS data, which AHA says can be used to improve upon the quality and value of health care. Through measures that are targeted at CMS, AHA believes data sets can be made into accessible, practical, and efficient tools for research and progress.

Data

The letter focuses on Medicare claims data that CMS, at present, makes only partially available. AHA recommends that CMS be required to make data from across the continuum of care accessible, so that opportunities for improvement in the quality of care can be identified for the whole continuum of care. To effectuate that goal, AHA says that the Part B Carrier and the Part B Durable Medical Equipment limited data set (LDS), the standard analytic files (SAF), and the Part D prescription drug data should be made accessible to interested parties and researchers. Part of the AHA recommendation is to have CMS streamline current practices. For example, AHA suggests that the access to research identifiable files (RIFs) be simplified from the current system, which requires a review board approval for each project, to a system where researchers are granted a “one-time clearance” from the review board for a specified period of time.

Transparency

The AHA also expresses in the letter its support for initiatives to improve price and quality transparency among providers. For example, the letter indicates AHA’s support for the Health Care Price Transparency Promotion Act (H.R. 1326), which would impose a requirement on states to have or establish laws requiring hospitals to disclose price data for certain services.As part of its involvement in a Healthcare Financial Management Association (HFMA) report, which the AHA attached to its letter, the AHA identified that health plans are best situated to pass along pricing data to insured patients. In keeping with that understanding, the letter recommends to congress that health plans should be the primary source of pricing information for insured patients. AHA also recommends that CMS publish additional quality data while maintaining awareness about the comparative usefulness and relevance of the data it provides.

Caution

In a separate section, the AHA sets out several cautionary statements regarding the need for prudence as data access grows. The letter emphasizes that “caution must be exercised to ensure privacy and security is maintained.” The AHA letter includes a reminder to congress that de-identified data can be reconnected to individuals with relative ease. In light of the ease of extrapolating protected information from health care data, the letter urges congress to exercise a heightened level of caution when considering making information available to entities that are not considered covered entities under the Health Insurance Portability and Accountability Act (HIPAA) (P.L. 104-191).

Sen. Kirk Sounds Off on Medicare IDs, Demands Military-Level Smart Cards

Senator Mark Kirk (R-Ill.) is spreading the word about new technology that would protect seniors’ identities when it comes to their Medicare cards. “With their social security number prominently displayed on the front of their Medicare cards… seniors are at a high risk of becoming a victim of identity fraud,” said Kirk in a recent press release, which announced the introduction of a new bill that would transform the current Medicare card design into a smartcard that mirrors the technology utilized by servicemen and women’s identification cards.

Smartcards

The Medicare Common Access Card Act of 2014, which was introduced by Kirk in July of this year, would, according to Kirk, “reform the current Medicare card design utilizing smart technology to protect seniors’ personal information and prevent continued abuse of the system.” Specifically, the Act calls for the creation of a Medicare identification card that contains an electronic chip that would store the cardholder’s personal information. This is the same type of technology that is used by the Department of Defense to create military identification. In the press release Kirk described meeting with senior citizens at an Illinois Supportive Living program facility as well as officials from the Illinois branch of the AARP. At the meeting, he discussed this new bill and related technology as he stated his desire for seniors “to have the same level of identification security as our servicemen and women.”

Related Legislation

As it was previously reported by Wolters Kluwer, other similar legislation, in the form of the Protecting the Integrity of Medicare Act of 2014, was recently released in draft form by the House Ways and Means Subcommittee on Health Chairman Kevin Brady (R-TX). The bill was created to prevent abuse and fraud within the Medicare program and included a provision that would remove seniors’ social security numbers from ID cards. The bill also included a provision that “recommends that the HHS Secretary investigate the technological viability of using smartcards to identify Medicare beneficiaries.”

According to Kirk’s press release, “Medicare fraud currently costs American taxpayers upwards of $60 million per year.” He further asserted that his bill would not only aim to reduce waste and abuse but also save taxpayers money.

Senator Schumer Takes More Shots at Powdered Alcohol

U.S. Senator Charles E. Schumer (D-NY) has reinvigorated his fight against Palcohol®, the innovative powdered form of alcohol that is pending label approval by the Alcohol and Tobacco Tax and Trade Bureau (TTB). Senator Schumer has announced two new efforts to stop the sale and production of a product that Schumer calls “Kool-Aid for underage binge drinking.” On the heels of the FDA’s announcement that it will not investigate the health risks of Palcohol, Schumer has issued a press release announcing his intention to push through legislation banning the powdered substance and his plan to urge retailers not to sell the product once it is approved.

Palcohol

The controversial substance, manufactured by Lipsmark LLC, is freeze dried alcohol packaged in a powder form. On its website, Lipsmark recommends a variety of uses for the strange product, including applications in food, beverages, as an antiseptic in remote locations, and even as a fuel source. As fast as critics are combatting its use as unsafe and improper, the manufacturer is updating its site to allegedly limit misinformation and educate the public about a product that it claims poses no more risks than liquid alcohol.

Although early versions of the website reportedly included a widely criticized claim that the substance could be snorted, the website now responds to comments about snorting by saying that “it’s painful to snort due to the alcohol. Second, it’s impractical. It takes approximately 60 minutes to snort the equivalent of one shot of vodka. Why would anyone do that when they can do a shot of liquid vodka in two seconds?” The TTB already approved Lipsmark’s product, but later rescinded its label approval citing inconsistency in powder levels as the reason. New labels are now before the TTB awaiting approval.

Hurried Efforts

Senator Schumer is working fast to put in place a roadblock that the FDA was unwilling to deploy. In May, Senator Schumer sent a letter to the FDA asking it to step in and investigate Palchol. Despite the FDA’s refusal to take action, Senator Schumer is not content with those who say the product is safe. With his language focused on those under the drinking age, the senator is taking aim at the “obvious health concerns” he says the substance poses as well the “access, concealment, and abuse” of alcohol that the he claims the substance will promote among underage drinkers.

The Two-Part Plan

Senator Schumer is first looking to Long Island and national retailers to be what he calls “responsible citizens.” The senator is asking retailers to sign onto a pledge to boycott the sale of Palcohol. It is just one of “all possible avenues” that Senator Schumer says he will pursue to stand in the way of the powdered alcohol. Senator Schumer urges that the action is necessary to stave off alcohol related hospitalizations and deaths that he says will increase with the sale of Palcohol. Acknowledging that many retailers will not willingly refuse to ban an approved product, Senator Schumer is also turning to New York lawmakers to help him. The second tactic Senator Schumer is employing is to make powdered alcohol illegal by amending existing legislation, the Sober Truth on Preventing Underage Drinking Act (STOP Act) (P.L. 109-422).

Approval

Whether Senator Schumer will win his fight against the novel alcohol product remains to be seen. Yet, while Senator Schumer is steaming over the “disturbing concept” of alcohol in a powdered form, the TTB is busy making a decision about whether Lipsmark’s second attempt at labeling will pass muster. Senator Schumer’s urgency may be met by a sobering reality if, as Lipsmark predicts, the TTB approves its new labels and Palcohol hits shelves this fall.

Telehealth Expansion Gets Bipartisan Congressional Support

July 2014 has brought a lot of activity toward expanding telehealth services to improve access to health care for seniors and others and lower the costs of health care for federal health care programs. Members of both houses of Congress and both political parties have introduced bills that would require Medicare to expand telehealth services provided to Medicare and Medicaid beneficiaries. Moreover, CMS’ 2015 Physician Fee Schedule Proposed rule includes a proposal to add annual wellness visits, psychotherapy services, and prolonged evaluation and management services to the Medicare telehealth benefit. In announcing its appreciation for the efforts of legislators to push for improvements in telemedicine coverage, the American Telemedicine Association (ATA) stated that the “bills are instrumental in demonstrating widespread congressional support.”

Telehealth Parity Act of 2014 

On July 31, 2014, House of Representatives members Mike Thompson (D-Calif.), Gregg Harper (R-Mississippi), and Peter Welch (D-Vermont) introduced the Medicare Telehealth Parity Act of 2014 (HR 5380) (Discussion Draft) , which “creates a [three] phase approach over four years to expand coverage of telemedicine-provided services and removes arbitrary barriers that limit access to services for Medicare beneficiaries,” according to an ATA press release. Thompson explained that the bill puts telehealth services under Medicare on the path toward parity with in-person health care visits. The legislation has been referred to the House Energy and Commerce Committee and the House Committee on Ways and Means.

The phase-in begins in rural areas and gradually removes geographic restrictions to patient care. The bill also provides for telehealth services furnished by diabetes educators as well as outpatient therapists, including speech language therapist, audiologists, respiratory therapists, and physical therapists; allows remote patient management services for chronic health conditions such as diabetes, congestive heart failure, and chronic obstructive pulmonary disease, including patient monitoring, patient training, clinical observation, assessment, treatment and other services; and expands home telehealth, hospice, and home dialysis.  The bill requires Government Accountability Office (GAO) to conduct a study of the effectiveness of remote patient monitoring on decreasing hospital readmissions for the chronic conditions included in the bill and the savings to Medicare as well as the implications of greater use of patient monitoring with respect to payment and delivery system transformations. The bill is discussed in more detail in a post by Bryant Storm titled, “Bill Would Stretch Telemedicine to Physical Therapy, Bigger Populations.”

Telehealth Enhancement Act of 2014

The Telehealth Enhancement Act of 2014 (S. 2662), which was introduced by Senators Thad Cochran (R. Mississippi) and Roger Wicker (R-Mississippi), would expand the use of telehealth technology to improve health care for seniors and other patients in underserved areas as well as help lower health care costs. The legislation would waive statutory Medicare restrictions on telehealth services to encourage greater use of telehealth technologies and would extend telehealth coverage to all critical access and sole-community hospitals regardless of metropolitan status. The legislation also covers home-based video services for hospice care, home dialysis, and homebound seniors. Medicare home health payments would be adjusted. In addition, the bill would allow states to modify Medicaid coverage to include telehealth services for women with high-risk pregnancies. The bill has been referred to the Senate Finance Committee. According to the ATA, the bill “includes several provisions that may see significant budget savings and build on recent payment innovations such as accountable care organizations and other incremental budget-sensitive proposals.”

This Senate bill is a companion to legislation introduced by Harper, Thompson, Welch, and Devin Nunes (R-Calif.) last year, known as the Telehealth Enhancement Act of 2013 (HR3306). Many of the provisions of HR 3306 are reflected in S. 2662. The ATA Hub summarized the provisions of HR 3306, stating that such provisions include incentive for reducing hospital readmissions, advancing a health home approach as found in the Medicaid program, care coordination for chronic illness such as Parkinson’s, flexibility for accountable care organizations to offer telehealth services, expansion of geographic locations, coverage of home-based video services, and coverage of Medicaid telehealth services for high-risk pregnancies. HR 3306 is pending in the House Ways and Means Committee and House Energy and Compliance Commerce. According to Wicker, “Telehealth cuts down travel time and increases access to specialists for residents in many rural areas who do not live near these essential health care resources.”

CMS Proposed Rule

CMS proposed to add the following services to the list of services that can be furnished to Medicare beneficiaries under the telehealth benefit: annual wellness visits, including a personalized prevention plan of service, initial visit, and subsequent visit; psychotherapy services, including family psychotherapy with and without patient present; and prolonged evaluation and management services requiring direct patient contact beyond the usual service. CMS found that these services meet the criteria for being on the Medicare telehealth list and are sufficiently similar to psychiatric diagnostic procedures or office outpatient visits currently on the telehealth list to qualify for coverage.

Conclusion

“Telehealth  is one of the most promising aspects of the health care field,” according to Harper. The use of telehealth technology and services may be the answer for improving access to health for seniors and others in underserved areas and lowering health care costs; however, Wayne Caswell, member of ATA and Founder of Modern Health Talk, sees this as “a step in the right direction” but “just a baby step” and noted that he thinks “much more is needed.”  In an article, written in response to the introduction of the Telehealth Enhancement Act of 2013 bill, Caswell cautioned that the telehealth bills introduced in Congress may get resistance from states seeking to “preserve the status quo and the authority of state medical boards.” Other risks related to the expansion of telemedicine services such as privacy, confidentiality, credentialing, and failure of technology for health care providers are discussed in the post, “Growth of Telemediccine Services Brings the Need to Address Associated Risk.