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April 2013 Clinical Laboratory News: Volume 39, Number 4


HHS Takes Big Step in Affordable Care Act Implementation

The U.S. Department of Health and Human Services (HHS) issued a final rule that implements five key consumer protections from the Affordable Care Act, and makes broad changes to expand the health insurance market for individuals, families, and small businesses.

The final rule lays out what employers and individuals can expect from the Affordable Care Act in 2014. Nearly all health insurance companies offering coverage to individuals and employers will be required to sell health insurance policies to all consumers. No one can be denied health insurance because they have or had an illness.

HHS will also enforce caps on premiums. Health insurance companies offering coverage to individuals and small employers will only be allowed to vary premiums based on age, tobacco use, family size, and geography. Basing premiums on other factors will be illegal, and insurance companies will also have to renew coverage without regard to health status.

The long-standing practice of risk pools for insurers will also change. Health insurance companies will no longer be able to charge higher premiums to higher cost enrollees by moving them into separate risk pools. Insurers are required to maintain a single state-wide risk pool for the individual market and single state-wide risk pool for the small group market.

Finally, catastrophic plans will be available to young adults and to people for whom coverage would otherwise be unaffordable. Catastrophic plans generally will have lower premiums, protect against high out-of-pocket costs, and cover recommended preventive services without cost sharing.

More information on the rights and protections guaranteed by the healthcare law are available from the government’s healthcare website.

National Committee for Quality Assurance Begins Accrediting ACOs

In what could become the norm for the many new Accountable Care Organizations (ACO) popping up around the country, the National Committee for Quality Assurance (NCQA) has announced that six organizations have achieved ACO accreditation from NCQA: Kelsey-Seybold Clinic, Houston; Billings Clinic, Billings, Mont.; Crystal Run Healthcare, Middletown, NY; Health Partners, Bloomington, Minn.; Children’s Hospital of Philadelphia; and Essential Health, Duluth, Minn.

According to NCQA, the accreditation program will set a high standard for organizations that call themselves ACOs. Many organizations use the term ACO even when not participating in the official Medicare system, called the Shared Savings Program. The accreditation program evaluates ACOs based on 14 standards and 65 elements that include: ACO structure and operations; access to needed providers; patient-centered primary care; care management, care coordination, and transitions; patient rights and responsibilities; and performance reporting and quality improvement.

According to NCQA, being named an accredited ACO helps purchasers and providers identify effective partners and helps patients find physicians who are committed to providing the quality care they need, when they need it.

NCQA has also been successful in moving closer to achieving deemed status by Medicare. This would mean that NCQA accreditation automatically qualifies an organization as an ACO under Medicare.

More information is available online from NCQA.

Report Released on Meaningful Use, EHR Adoption

The Office of the National Coordinator for Health IT (ONC) released a data brief that shows acute care hospitals are making solid progress on adopting electronic health records (EHR) and achieving meaningful use of health information technology under Medicare’s incentive program that began in 2009.

According to ONC, nearly 45% of U.S. acute care hospitals had a basic EHR system in 2012, compared with only 12.2% in 2009. But hospital adoption of EHR systems varied significantly across states. Rates of hospital adoption of at least a basic EHR system were significantly above the national average in 12 states and significantly below the national average in 11 other states. South Dakota had the highest rate of adoption at 70.6%, and New Hampshire had the lowest, 21.1%. Overall, 85% of acute care hospitals could meet at least some meaningful use objectives in 2012. That’s up from 72% only 1 year earlier.

In addition, adoption of EHR systems by non-federal acute care hospitals has steadily increased since 2009. In 2012, 44% of non-federal acute care hospitals had adopted at least a basic EHR system with clinician notes. That’s a 61% increase from the previous year and a more than three-fold increase in EHR adoption since 2009.

Looking narrowly at meaningful use, ONC also reported significant progress. From 2008 to 2012, hospitals’ capability to meet each of seven meaningful use objectives grew significantly, with increases ranging from 32% to 167%. One area in particular where hospitals made significant progress is computerized physician order entry (CPOE) for medication orders, which increased from 27% in 2008 to 72% in 2012. Drug interaction checks and clinical decision support rules increased as well.

The high achievement in CPOE may bode well for laboratories. Stage 2 begins as early as 2014 for some providers, and will require that CPOE be used for laboratory orders as well as medications. More information is available online.

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