Payor Mix Stable, Volume Up

From the EM-Blog:

As the healthcare reform debate rages on, it is once again enlightening to observe the rhetoric on patients visiting the Emergency Department.  There continues to be the misguided notion that ED care reflects care that is poor quality, expensive, resulting from failure of the healthcare system, and responsible for the national debt.  Recently, it was proposed that the ED payor mix was deteriorating as the uninsured flocked to receive their still poor quality care.

We queried the members of the ED Benchmarking Alliance, a national group of leading EDs.  The simple questions were:  Where is your year to date volume; when did it begin to pick up; and have there been any changes in payor mix.

Far from being scientific research, but results are important to guide discussions at the national level as well as with the local healthcare decision-makers.

The members of the ED Benchmarking Alliance represent about 165 EDs that saw 6.7 million patients in 2008.  Of those responders, essentially no one is reporting decreased volume, and the usual response is a 5 to 10% increase in ED patient volume year to date.  Typical time for increase in volume was March or April.  This matches the time when the novel H1N1 patients began to circulate across the country.

Of importance to the media pundits, no one is reporting significant change in payor mix.  Certainly ED and hospital leaders are concerned that unemployment rates are rising, many companies continue to shrink workforces, and the overall economic climate is marginal.

HITECH Breach Notification Interim Final Rule

From HHS:

HHS issued regulations requiring health care providers, health plans, and other entities covered by the Health Insurance Portability and Accountability Act (HIPAA) to notify individuals when their health information is breached.

These “breach notification” regulations implement provisions of the Health Information Technology for Economic and Clinical Health (HITECH) Act, passed as part of American Recovery and Reinvestment Act of 2009 (ARRA).

The regulations, developed by OCR, require health care providers and other HIPAA covered entities to promptly notify affected individuals of a breach, as well as the HHS Secretary and the media in cases where a breach affects more than 500 individuals.  Breaches affecting fewer than 500 individuals will be reported to the HHS Secretary on an annual basis. The regulations also require business associates of covered entities to notify the covered entity of breaches at or by the business associate.

“This new federal law ensures that covered entities and business associates are accountable to the Department and to individuals for proper safeguarding of the private information entrusted to their care.  These protections will be a cornerstone of maintaining consumer trust as we move forward with meaningful use of electronic health records and electronic exchange of health information,” said Robinsue Frohboese, Acting Director and Principal Deputy Director of OCR.

The regulations were developed after considering public comment received in response to an April 2009 request for information and after close consultation with the Federal Trade Commission (FTC), which has issued companion breach notification regulations that apply to vendors of personal health records and certain others not covered by HIPAA.

To determine when information is “unsecured” and notification is required by the HHS and FTC rules, HHS is also issuing in the same document as the regulations an update to its guidance specifying encryption and destruction as the technologies and methodologies that render protected health information unusable, unreadable, or indecipherable to unauthorized individuals.  Entities subject to the HHS and FTC regulations that secure health information as specified by the guidance through encryption or destruction are relieved from having to notify in the event of a breach of such information.  This guidance will be updated annually.

The HHS interim final regulations are effective 30 days after publication in the Federal Register and include a 60-day public comment period.

View the Breach Notification Interim Final Regulation (74 FR 42740) – August 2009.

CMS issues EMTALA guidance for H1N1 flu

The Centers for Medicare & Medicaid Services recently issued a memo and fact sheet clarifying permissible options under the Emergency Medical Treatment and Labor Act for hospitals handling a surge in patients with H1N1 flu. For example, hospitals may set up alternative screening sites on campus or at off-campus, hospital-controlled sites, and that communities may set up screening clinics at sites not under the control of a hospital. Further, the law provides for waivers of certain EMTALA requirements in a declared public health emergency, the memo notes.