Meaningful Use Stage 2 – Electronic Health Records and HIPAA

To satisfy the new Meaningful Use Stage 2 requirements, providers must furnish patients with electronic copies of their health information upon request.  Providers should ensure that their systems are able to timely meet these requests and to satisfy the requirements of the HIPAA Privacy Rule.  The Meaningful Use Stage 2 standard requires that more than 50 percent of patients who request electronic copies of their health information must be provided that information within three business days.

When providing electronic copies of health information, providers should keep in mind that electronic data may be furnished in any format.  For example, information could be provided via a patient portal, CD, USB drive, or the like.  Providers should update their HIPAA compliance plans to include provisions relating to electronic media accordingly.  As under the HIPAA Privacy Rule, providers may only charge a reasonable, cost-based fee for a copy of the information.  It is important to remember that providers may withhold certain types of information from a patient’s electronic copies of health information.  Since the types of health information that can be withheld from patients or third parties is subject to a higher confidentiality standard, providers also need to review their HIPAA compliance plans to ensure that appropriate protocols for electronic disclosure are in place.

© 2012 Parsonage Vandenack Williams LLC

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Meaningful Use Stage 2—New Core Objectives

Now that the Stage 2 meaningful use standards are available, health care providers should start planning to implement attestation requirements.  Providers cannot begin to attest until 2014.  However, providers should consider two factors that indicate the need to plan.  First, the requirements for both stages of attestation are now more rigorous than before, and providers will no longer be able to count exclusions toward their non-core objectives.  Second, the number of core objectives that providers must meet has significantly increased.

In particular, providers should plan to meet one of two new Stage 2 core objectives.  Eligible physicians must use secure electronic messaging to communicate with patients on relevant health information.  Eligible hospitals and critical access hospitals must use automatic medication tracking from order to administration using assistive technologies and an electronic medication administration record.  Providers should also keep in mind that many of the objectives that carry over from Stage 1 to Stage 2 have significantly higher thresholds.  To meet these thresholds, providers should consider the use of external audits and implementation planning to meet Stage 2 requirements in 2014.

© 2012 Parsonage Vandenack Williams LLC

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Supreme Court Rules Drug Reps Exempt From Overtime Provisions

The Supreme Court ruled that pharmaceutical representatives of SmithKline Beecham Corp. were not entitled to overtime pay.  The court based its decision on a determination that the pharmaceutical representatives were “outside salesmen.”  Because outside salesmen do not have to be paid overtime under the Fair Labor Standards Act, the court determined that pharmaceutical representatives were also not entitled to overtime pay.  In making its decision, the Supreme Court rejected the Department of Labor position that stated pharmaceutical representatives were not outside salesmen.

© 2012 Parsonage Vandenack Williams LLC

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ICD-10 To Be Pushed Back

The U.S. Department of Health and Human Services (“DHHS”) has announced a proposed rule that would extend the deadline for healthcare providers to implement the new ICD-10 diagnosis coding system.  The proposed rule moves the ICD-10 deadline from October 1, 2013, to October 1, 2014.  The announcement of the proposed rule follows an earlier statement in February 2012 that DHHS was considering postponing the ICD-10 compliance date.

© 2012 Parsonage Vandenack Williams LLC

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Stage 2 Proposed Rules Published

CMS has published a proposed rule providing standards and guidance for Stage 2 of the Medicare and Medicaid EHR Incentive Program (the “Program”).  The CMS proposed rule explains the requirements that eligible professionals and hospitals must meet to qualify for meaningful use incentive payments under the Program.

The Office of the National Coordinator for Health Information Technology (“ONC”) has also issued Stage 2 certification standards.  The ONC standards establish the technical requirements that electronic health records (“EHR”) must meet to become certified as supporting Stage 2 meaningful use criteria.

Basically, the CMS proposed rule governs the requirements that providers must meet in order to qualify for meaningful use and successfully obtain EHR incentive payments.  The ONC certification standards govern the requirements that EHR must meet so that such EHR can be used by providers to qualify for meaningful use.

Stage 2 of the Program is set to begin no earlier than 2014 (for participants who met the Stage 1 requirements in 2011 or 2012).  Comments on both proposed rules are due by 5:00 p.m. on May 7, 2012.

© 2012 Parsonage Vandenack Williams LLC

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New Commission Formed to Analyze Physician Payments

The National Commission on Physician Payment Reform has been established by the Society of General Internal Medicine to make recommendations about physician payments.  The commission will meet over the next year to look at how doctors are paid, and to analyze how accountable care organizations, medical homes and other arrangements will affect healthcare financing.

The Robert Wood Johnson Foundation, the California HealthCare Foundation and the Sergei S. Zinkoff Fund for Medical Education and Research will provide funding for the commission, according to Family Practice News.

The commission plans to issue its own report on reforming the healthcare payment system by early 2013.

© 2012 Parsonage Vandenack Williams LLC

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House Votes to Repeal “CLASS Act” Program

The House of Representatives has voted to repeal a part of the health care reform bill that establishes a voluntary, long-term health care program.  The program is formally known as the Community Living Assistance Services and Supports (“CLASS”) program.

The Obama administration has taken the position that the CLASS program is not financially viable because it would depend on voluntary participation and could not receive taxpayer funds.  Republicans in the House argued that the CLASS program should be repealed because not implementing a program that is part of the health care reform bill could create legal challenges.

© 2012 Parsonage Vandenack Williams LLC

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Same Day Surgery Restrictions Removed for Ambulatory Surgical Centers

A new rule allows ambulatory surgical centers to provide patient notifications on the day of the surgery, effectively eliminating the so-called prior-day notification requirement.  Prior to this rule, same day surgeries were only allowed in emergencies.  The final rule is expected to take effect on December 23, 2011.

The rule, provided by the Center for Medicare & Medicaid Services, can be viewed at: Final Rule

© 2011 Parsonage Vandenack Williams LLC

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New Program Changes the Way Medicare Reimburses Health Care Providers

A pilot program called the Bundled Payments for Care Improvement Initiative (the “Bundling Initiative”) has recently been unveiled by The Department of Health and Human Services (the “Department”).  The program is designed to change the way Medicare reimburses health care providers. 

Under the current method, Medicare makes separate payments to each provider. In an effort to encourage better coordinated care and decreased costs, the Bundling Initiative calls for Medicare to pay one lump sum to the hospital for an “episode”, such as a hip replacement or heart bypass surgery, and the hospital would then distribute the payment to participating providers.  The concept is that if Medicare pays only one large payment, the individual providers will communicate with each other to promote efficient and high quality care.  Obviously, the Department is ignoring the possibilities of abuse by some providers, especially the recipient provider.

The Bundling Initiative is seeking applications for four defined models of care.  Three of the models involve retrospective bundled payments, and one model would pay providers prospectively.  Interested providers must submit a nonbinding letter of intent to the Department by September 22, 2011 for Model 1 and November 4, 2011 for Models 2-4. 

© 2011 Parsonage Vandenack Williams LLC

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SAME DAY SURGERY NOTIFICATION RULE FOR AMBULATORY SURGERY CENTERS

Ambulatory Surgery Centers (‘ASC’s”) may be required to notify patients of their rights and of the facility’s ownership before the day of surgery under a rule be considered by the Department of Health and Human Services (“HHS”).  An exception would be made when the referring physician indicates that it is medically necessary for the patient to undergo surgery that day.

Other regulations undergoing review include the ASC rules related to the list of operating room emergency equipment required to be available and a duplicative infection control program requirement.

© 2011 Parsonage Vandenack Williams LLC

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