February 2009: Volume 35, Number 2
Final Contractors Picked for Medicare Claims
CMS announced it has completed its selection of Medicare Administrator Contractors (MAC), adding five new contractors that will process and pay Part A and Part B claims under Medicare’s fee-for-service program in 14 states, mostly in the South and Midwest.
Once these and other MACs are fully up and running, they will replace the current scheme that splits the processing of Medicare Part A and Part B between two systems. This existing arrangement relies on fiscal intermediaries to process claims for Part A providers (such as hospitals), and carriers to process claims for Part B providers (including physicians and labs). The MAC contracts have an approximate value of $1.4 billion over the next 5 years, and will fulfill the requirements of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA). In accordance with MMA, all MAC contracts will be recompeted and up for grabs at least every 5 years. More information is available at online.
ABCC Exams Approved for Licensure in California
The California Department of Public Health Laboratory Field Services (LFS) has approved Part B of American Board of Clinical Chemistry (ABCC) Examinations in clinical chemistry and toxicology for licensure of doctorate-level scientists in California. The state is shifting from administering its own exam to accepting those from other organizations, such as ABCC.
ABCC exams in clinical chemistry and toxicology have two parts. Part A is biochemical calculations and Part B is analytical and clinical issues. The ABCC Part B exam covers most closely the content that the California exam originally covered.
Applicants for California licensure must apply to the State of California. Applicants who meet requirements and are approved for examination may choose from the state-approved credentialing boards to take their exam. Once they pass the exam, they still have to take an oral exam administered by the state on California law.
Individuals interested in California licensure must make application to the LFS and obtain a letter of qualification to take a state-approved certification examination. More information is available online.
NRC Report Pans Current Healthcare IT Approaches
A new report from the National Research Council (NRC) says that current efforts to deploy national healthcare IT aren’t enough to achieve the goals for 21st century healthcare laid out by the Institute of Medicine (IOM) in 2001. Based partially on visits to eight medical centers considered leaders in health IT, the NRC report concluded that greater emphasis should go to IT that gives healthcare workers and patients “cognitive support,” such as help with decision-making and problem-solving.
The report noted that physicians still spend a lot of time sifting through large amounts of raw data, such as labs test results, trying to integrate it with their medical knowledge to piece together a complete picture of the patient’s condition. Ideally, IT should put this raw data into context of current medical knowledge and offer physicians “virtual patients” via computer models, according to the report. The computer models would depict how different organ systems are interacting, give epidemiological insights on the local prevalence of disease, and recommend patient-specific treatment regiments. This will prevent clinicians from “drowning in data.”
To improve healthcare IT, the report recommends that IT vendors and other stakeholders embrace measurable improvements in quality of care as the driving rationale for adopting healthcare IT. The report is available online from the National Academies Press.