December 2007 Clinical Laboratory News: Washington Profiles

December 2007: Volume 33, Number 12

San Diego Area First Location for CMS Competitive Bidding Demonstration; Fires Force Conference Postponement

In mid-October, CMS announced it had selected the San Diego–Carlsbad–San Marcos, Calif. metropolitan area as the first of two locations for a competitive bidding demonstration for clinical laboratory services. The 3-year demonstration, required by the Medicare Modernization Act of 2003, will help determine if competitive bidding can be used to provide laboratory services under Medicare Part B at fees below current Medicare payment rates, while maintaining quality and access to care.

A Bidders’ Conference, scheduled for October 31, was canceled due to the fires in the area. At press time, CMS had not yet announced a new date for the event, which will help laboratories in the region understand the purpose of the demonstration project and how it will be implemented, as well as provide a forum to address questions. More information about the Bidders’ Conference can be found at the CMS Web site , click on “Demonstration.”

CDC Awards $35 Million to Increase HIV Testing
 Among African Americans

As part of a $45 million program to expand access to HIV testing, the CDC announced in September it has earmarked $35 million of these funds for state and local health departments to increase HIV testing opportunities among African Americans. The program is being targeted to 23 states and major metropolitan areas in which African Americans have been most severely affected by HIV/AIDS.

The states receiving funding are: California, Connecticut, Florida, Georgia, Louisiana, Maryland, Massachusetts, Michigan, Missouri, New Jersey, New York, North Carolina, Ohio, Pennsylvania, South Carolina, Tennessee, and Virginia. Washington, D.C. also will receive support. Other cities receiving funding are: Chicago, Houston, Los Angeles, Philadelphia, and New York City. Awards will range from $690,000 to $5.4 million and are based on the percentage of AIDS cases among African Americans in each locale. Disbursement of funds began on September 30.

A focus of the program will be to integrate HIV testing with screening and prevention activities for other infections, such as hepatitis, other sexually transmitted diseases, and tuberculosis. Additional information on HIV prevention is available on the CDC Web site.

New Healthcare Codes for Reporting Alcohol, Substance Abuse Screening

New Current Procedural Terminology codes—99408 and 99409—issued in October by the American Medical Association and scheduled to become effective as of January 1, 2008 will allow U.S. physicians to screen their patients for substance abuse and provide an appropriate intervention. The new AMA Level 1 CPT Codes for medical services are expected to streamline reporting and the reimbursement procedure for physicians who perform structured screening for alcohol and/or substance (other than tobacco) abuse and brief intervention. Current codes do not identify performance of evidence-based screening and brief intervention (SBI), which primarily is a general medical service provided by physicians who are not psychiatrists or behavioral health specialists.

New SBI codes specify that discrete, protocol-driven procedures are appropriately coded by general medical practitioners. According to the Office of National Drug Control Policy (NDCP), using these new codes will be cost-effective because screening and intervention generally provide for shorter in-patient visits, fewer emergency room visits, improvements in overall health, and reduced substance use. Additional information can be viewed at the NDCP Web site.

Joint Commission Begins Study of Rapid Tests for Influenza

A 3-year project begun by The Joint Commission’s Division of Quality Research and Measurement in October and funded by the CDC will study how rapid tests for influenza are implemented in outpatient medical settings, including solo and group practice physician offices, community health centers, and acute care hospital emergency departments. The project will examine the types of rapid tests in use and how they are selected; the training and competency of individuals performing testing; the extent to which good laboratory practices and testing guidelines are being followed; the impact of rapid test use on antiviral and antibiotic prescribing practices; and the perceived advantages and disadvantages of using rapid influenza testing.

The first phase of the project involves surveying 5,000 outpatient medical settings to determine how rapid tests for influenza are implemented. In a future phase, 300 of these participants will be interviewed to identify factors that influence adoption of these tests, barriers to implementation, and strategies to overcome these barriers.

Recent accreditation surveys by The Joint Commission found: test controls are not always used as directed by the manufacturer; test kits may be improperly stored and used past their expiration dates; individuals conducting the tests are not always trained to use the test; people conducting or interpreting the tests are not always evaluated with regard to their competence in these areas; staff are confused about the use of confirmatory tests and whether the test is used as a screening or diagnostic tool; and insufficient policies and procedures in place to support conducting the tests. Additional information can be found at The Joint Commission Web site.

HHS Announces Health IT, Electronic Records Storage Projects

The move toward using methods to store and exchange medical information electronically took two steps forward in October when Department of Health and Human Services Secretary Michael Leavitt announced two new initiatives. In one, HHS awarded contracts totaling $22.5 million to nine organizations representing state and regional health information exchanges to begin trials of the Nationwide Health Information Network (NHIN). In the other, Leavitt announced a 5-year demonstration project that will offer extra compensation from Medicare to 1,200 physician practices for using electronic health records in lieu of paperwork.

In a statement Secretary Leavitt said, “These trial implementations are taking place in communities across America that are leading the way to healthcare transformation using secure, interoperable health information technology. Trial implementations of the NHIN will bring us steps closer to a health IT system that will improve quality of care, increase efficiencies in healthcare, and improve disease prevention.” More details on these contracts are available at the HHS Web site.

The second initiative, conducted by CMS, will begin in 2008 and will provide financial incentives to physician groups using certified electronic health records (EHRs) to complete certain tasks online, such as recording laboratory test results. Bonuses also will be available. “We want to revolutionize the way vital health data is managed and maintained, so we are taking steps to change from a paper-based medical record to an electronic health record,” said CMS Acting Administrator Kerry Weems. “This project will appropriately align incentives to reward doctors in small physician practices who use certified EHRs as tools to deliver higher quality care.” CMS also is encouraging private insurers to offer similar incentives for adopting EHRs. Additional information can be viewed at the CMS Web site.


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