American Association for Clinical Chemistry
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August 2011 Clinical Laboratory News: Regulatory Profiles

Regulatory Profiles

5.5 Million Have Used New Medicare Preventive Benefits

As of June, 2011, approximately 5.5 million individuals or 16% of people with traditional Medicare used one or more of the free preventive benefits added by the healthcare reform law, including mammograms, bone-density screenings, and screenings for prostate cancer, according to the Centers for Medicare and Medicaid Services (CMS). CMS developed a special program to monitor the use of preventive services using near-real time data as part of a campaign to educate more Americans about these new benefits and the importance of prevention.

Under the Affordable Care Act, beginning January 1, 2011 Part B coinsurance and deductibles for recommended preventive services were eliminated, including many cancer screenings and immunizations. The law also added a free annual wellness visit. More than 780,000 beneficiaries received an annual wellness visit between January 1 and June 10.

More information about preventive services under Medicare is available online.

MedlinePlus Connects with EHRs

The National Library of Medicine, the world’s largest medical library and a component of the National Institutes of Health (NIH), has launched a new free service called MedlinePlus Connect that allows health organizations and health information technology providers to link patient portals and electronic health record (EHR) systems to Long a trusted source of authoritative, up-to-date health information, MedlinePlus brings together information from NIH, other federal agencies, and health information providers.

Patients using portals or EHRs that have implemented MedlinePlus Connect will have access to special, easy-to-understand health information on MedlinePlus that is directly related to their diagnoses, medications, or lab tests. To use MedlinePlus Connect, organizations can contact their EHR vendors or work with their in-house technical staff to follow the instructions in the technical documentation. MedlinePlus Connect accepts the coding standards already in the organization’s system, such as ICD-9-CM, SNOMED CT CORE Problem List Subset, RxNorm, NDC, and LOINC. MedlinePlus Connect only needs to be set up once and NLM regularly maintains the vocabulary mappings and topic links.

Since MedlinePlus Connect helps EHRs identify patient-specific education resources, MedlinePlus Connect may assist eligible health care providers in meeting one of the criteria for meaningful use of certified EHR technology. This will enable them to qualify for Medicare or Medicaid EHR incentive payments under the Health Information Technology for Economic and Clinical Health (HITECH) Act provisions of the American Recovery and Reinvestment Act.

More information, including an online demonstration, is available online.

Nearly 20% of Insurers’ Claims Inaccurate

The overall rate of inaccurate claims payments increased since last year among leading commercial health insurers, according to the American Medical Association’s (AMA) fourth annual National Health Insurer Report Card. Commercial health insurers have an average claims-processing error rate of 19.35%, a 2% percent increase over last year, amounting to an extra $3.6 million in erroneous payments. This added an estimated $1.5 billion in unnecessary administrative costs to the health system, according to AMA. The report estimates that eliminating health insurer claim payment errors would save $17 billion.

Most of the health insurers measured by AMA failed to improve their accuracy rating since last year, with UnitedHealthcare alone demonstrating improvement in claims-processing accuracy. UnitedHealthcare came out on top of commercial health insurers with an accuracy rating of 90.23%, while Anthem Blue Cross Blue Shield scored the worst, with an accuracy rating of 61.05%.

The Report Card is available online.

Federal Healthcare Spending to Hit 10% of GDP by 2035

Due to an aging population that will demand more benefits from Social Security, Medicare, and Medicaid, the federal government’s spending on these programs is projected to grow from roughly 10% of gross domestic product (GDP) today to 15% of GDP 25 years from now under current law, according to a recent analysis from the Congressional Budget Office (CBO). The combined increase of approximately 5 percentage points of GDP equals about $750 billion today. By comparison, all federal spending over the past 40 years has averaged 18.5% GDP.

“The retirement of the baby-boom generation is a key factor in the nation’s long-term fiscal outlook. It portends a significant and sustained increase in the share of the population receiving benefits from Social Security, Medicare, and Medicaid,” said CBO director Douglas Elmendorf. “Moreover, under current law, per capita spending for healthcare is likely to continue rising faster than spending per person on other goods and services.”

The projected increase in spending comes despite the many provisions of the federal healthcare reform law intended to control rising healthcare spending. CBO also reiterated its prediction that the Medicare Hospital Insurance Trust Fund would become unsustainable by 2020, and that the gap between revenue from payroll taxes and Medicare spending will keep growing for at least 75 years.

CBO’s 2011 Long Term Budget Outlook is available on the CBO website.