Study: Providers face disincentives to share data
Local health information exchanges (HIEs) continue to face barriers to community-wide clinical data exchange, according to a recent study of four HIEs by the Center for Studying Health System Change.
The study found provider organizations still face substantial disincentives to share data with unaffiliated organizations. In addition, neither health plans nor employers were willing to fund core clinical data exchange as a benefit for patients.
The two more mature exchanges, based in Cincinnati and Indianapolis, have achieved some viability by meeting a specific need for more efficient delivery of hospital test results to physicians, the study authors said. However, the newer exchanges, serving portions of Tennessee, Virginia, and Florida, have struggled to identify and finance initial services.
Stakeholder concerns about loss of competitive advantage and data misuse are compounded by a lack of consensus on how to finance health information exchange, according to one of the authors.
CMS issues guidance on payment denials
The Centers for Medicare & Medicaid Services (CMS) has, as required by law, issued guidance effective July 1, 2008, for hospitals that are appealing payment denials by the agency and its contractors.
The guidance, authorized by the 2003 Medicare Modernization Act, affects all Medicare appeals activity, including appeals of medical necessity review denials by fiscal intermediaries and Medicare administrative contractors, and appeals of payment denials by recovery audit contractors.
It prevents funds from being recouped during the first two stages of the five-stage appeals process. Interest on denied payment will continue to accrue, but will not be assessed if the denial is overturned in favor of the provider.
The vast majority of appeals are concluded during the first three levels of the appeals process. t
States face reductions in Medicaid payments
A report released in March by the House Committee on Oversight and Government Reform estimates that seven Medicaid regulations issued without authorization from Congress would reduce federal payments to states by at least $49.7 billion over the next five years, more than three times the $15 million estimated by the administration.
The report's estimate is based on responses from 43 states and the District of Columbia. It says the regulations would reduce federal spending by shifting costs, not through greater efficiencies; threaten the financial stability of hospitals that treat the uninsured; and disrupt existing systems of care for fragile populations.
"As the economy tips into recession, the last thing we should be doing is taking federal funds from states, especially funds that are supposed to help people with their health and medical expenses," said Committee Chairman Henry Waxman (D-CA).
Pneumonia top reason adults admitted from ED
Pneumonia was the top reason adults were admitted to the hospital from the emergency department in 2005, according to a recent report from the Agency for Healthcare Research and Quality.
The report presents data on adult ED visits in 23 states from the Healthcare Cost and Utilization Project. About 19% of ED visits in those states resulted in hospital admission.
Other leading reasons for admission from the ED were congestive heart failure, chest pain, heart attack and chronic obstructive pulmonary disease. The poorest communities had nearly twice the rate of ED visits as the wealthiest communities.Study: Providers face disincentives to share data
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