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Public Policy Committee Update: ACMA goes to Washington

Bills would count observation toward SNF benefit, reform the RAC, and aid highest risk patients

Posted on: 10/8/2014

By: Steven J. Meyerson, M. D.

On September 30, a cadre of 15 case management professionals, including members of ACMA’s Public Policy Committee, descended upon Washington, DC for two days to promote three specific pieces of legislation. Since Congress had taken an earlier than expected recess to go home and campaign for the upcoming midterm elections, ACMA representatives were happy to meet with the legislative assistants who specialized in healthcare issues in the offices of their respective Congressmen and Senators. This “trek to Washington” is an annual event for ACMA and serves to educate legislators on issues important to Medicare beneficiaries and hospitals and urge lawmakers to support key pieces of legislation. The delegation reported that the Congressional aides were uniformly well-informed, engaged, and receptive to their message regardless of their political party. The meetings clearly stimulated interest in the targeted legislation, and ACMA members will follow-up with Congressional staff regarding their specific requests related to the following bills:

The Medicare Audit Improvement Act would provide RAC transparency and accountability

The second bill, the Medicare Audit Improvement Act2 (HR-1250 in the House where there are 231 cosponsors and S-1012 which has 16 cosponsors in the Senate) would reform the Medicare Recovery Audit (RAC) program by increasing transparency and accountability. The bill calls for public reporting of each contractor’s denial rate as well as the rate at which its denials are overturned in the appeal process. It would impose penalties on the recovery auditors for overturned denials and for failing to meet prescribed timelines. The bill would cap the number of additional documentation requests to 500 per 45 days or 2% of Medicare claims and would require physician validation of denials, which are currently at the discretion of nurse reviewers.

The Better Care, Lower Cost Act would provide just that for the chronically ill

The third bill has a name which is hard to argue with; it’s the Better Care, Lower-Cost Act3 (HR-3890 and S-1932). This new bill has only one cosponsor in each house and would establish a novel integrated chronic care delivery system designed for Medicare beneficiaries with multiple comorbidities. These Medicare patients, who consume a disproportionate share of Medicare resources, represent a significant challenge to individual providers, networks, and Medicare advantage plans. They tend to be on multiple medications and see a variety of specialist physicians as well as other skilled providers such as physical and occupational therapists, have frequent hospital admissions and readmissions, and often have no coordination of their care. The Better Care Program (BCP), as it’s called would be a capitated risk-adjusted network designed to promote quality care and cost containment.

According to Congress. gov, the bill “promotes accountability and better care management for chronically ill patient populations and coordinates items and services under Medicare parts A (Hospital Insurance), B (Supplementary Medical Insurance), and D (Voluntary Prescription Drug Benefit Program), while encouraging investment in infrastructure and redesigned care processes that result in high quality and efficient service delivery for the most vulnerable and costly populations. [It] requires the program to include specified elements and focus on long-term cost containment and better overall health of the Medicare population by implementing through qualified BCPs strategies that prevent, delay, or minimize the progression of illness or disability associated with chronic conditions.” The bill would fund “at least three Chronic Care Innovation Centers” and establish “new curricula requirements for direct and indirect graduate medical education payments that address the need for team-based care and chronic care management, including palliative medicine, chronic care management, leadership and team-based skills and planning, and leveraging technology as a care tool.

General Motors Recalls Another 7 Million Vehicles, Some Dating Back To 1997

Beleaguered automaker General Motors General Motors announced Monday afternoon that its string of recalls is not over yet: the company is recalling another 7 million vehicles. some of which date all the way back to 1997.

GM said Monday that it is issuing another six safety recalls that involve 7.6 million vehicles in the U. S. from the 1997 to 2014 model years; including GM vehicles worldwide, Monday’s recall accounts for 8.4 million vehicles. Among these recalled vehicles, GM said it is aware of seven crashes, eight injuries and three fatalities. The company said that the fatal crashes occurred in older model full-size sedans that are now being recalled for “inadvertent ignition key rotation.”

Vehicles included in this latest recall include the 1997-2005 Chevrolet Malibu, 1998-2002 Oldsmobile Intrique, 1999-2005 Pontiac Grand Am and the 2003-14 Cadillac CTS CTS. These models were recalled for the faulty ignition switch that is linked to at least 13 deaths but potentially many more — as many as 100, by some estimates. Other vehicles recalled Monday include the 2007-11 Chevrolet Silverado HD (for an “overload in the feed [that] may cause the underhood fusible link to melt due to electrical overload”) and teh 2005-07 Buick Rainier (for a “possible electrical short in the driver’s door module”).

“We have worked aggressively to identify and address the major outstanding issues that could impact the safety of our customers,” GM CEO Mary Barra said in a statement Monday afternoon. “If any other issues come to our attention, we will act appropriately and without hesitation.”

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GM said it expects to take a charge of up to approximately $1.2 billion in the second quarter for the cost of recall-related repairs, a figure that includes a previously-disclosed $700 million charge for recalls already announced during the quarter .

This latest recall brings GM’s total recalls to more than 28 million this year.

Earlier on Monday, GM announced that it will not cap the amount it will pay to victims of the faulty ignition switch, and that payments will start at $1 million. The director of GM’s compensation fund is Kenneth Feinberg, who also led the 9/11 compensation fund. In a statement released earlier on Monday, Barra said that GM is “pleased that Mr. Feinberg has completed the next step with our ignition switch compensation program to help victims and their families:” and that “we are looking forward to Mr. Feinberg handling claims in a fair and expeditious manner.”

GM stock, which halted at 2:26 pm EDT following news of the 7.6 million recalls (and was up 0.63% at that time), reopened for trading 30 minutes later down more than 1%. The stock is currently down 0.7%.

Watch: Inside The Numbers: GM’s Recall Woes

Telephone exchange

A telephone operator manually connecting calls with cord pairs at a telephone switchboard.

A telephone exchange is a telecommunications system used in the public switched telephone network or in large enterprises. An exchange consists of electronic components and in older systems also human operators that interconnect ( switch ) telephone subscriber lines or virtual circuits of digital systems to establish telephone calls between subscribers.

In the public telecommunication networks a telephone exchange is located in a central office (CO), typically a building used to house the inside plant equipment of potentially several telephone exchanges, each serving a certain geographical exchange area . Central office locations are often identified in North America as wire centers . designating a facility from which a telephone obtains dial tone. [ 1 ] For business and billing purposes, telephony carriers also define rate centers . which in larger cities may be clusters of central offices, to define specified geographical locations for determining distance measurements.

In the United States and Canada, the Bell System established in the 1940s a uniform system of identifying each telephone exchange with a three-digit exchange code, or central office code, that was used as a prefix to subscriber telephone numbers. All exchanges within a larger region, typically aggregated by state, were assigned a common area code. With the development of international and transoceanic telephone trunks, especially driven by direct customer dialing, similar efforts of systematic organization of the telephone networks occurred in many countries in the mid-20th century.

For corporate or enterprise use, a private telephone exchange is often referred to as a private branch exchange (PBX), when it has connections to the public switched telephone network. A PBX is installed in enterprise facilities, typically collocated with large office spaces or within an organizational campus to serve the local private telephone system and any private leased line circuits. Smaller installations might deploy a PBX or key telephone system in the office of a receptionist.