Report on Suspect Lab Claims Raises More Questions Than Answers
A government analysis of 2010 Medicare data estimates $1.7 billion in questionable claims for lab testing. However, lab advocacy groups have cast doubt on the scale of the problem, even in the face of headlines in The Wall Street Journal and other newspapers that framed the report in terms of rampant fraud and abuse.
In July, the Department of Health and Human Services Office of the Inspector General (OIG) released a report, Questionable Billing for Medicare Part B Clinical Laboratory Services, examining 13 measures of lab billing. OIG flagged labs that had claims with higher than average dollar amounts and other irregularities. More than 1,000 labs exceeded the thresholds for five or more measures. Adding all the claims that fell outside the norm produced the $1.7 billion price tag—about 20% of the $8.2 billion total 2010 claims.
Notably, OIG wrote in the report that the agency did not independently verify the accuracy of the data used for the study, and explained that the report was only designed to identify labs that warrant further review. More information is available from the OIG website, http://oig.hhs.gov.
NIH to Spend $14.5 Million to Research Latest DNA Sequencing Techniques
The National Human Genome Research Institute (NHGRI) is funding eight grants exploring several micro-sized DNA sequencing technologies, including nanopores and microfluidics. The grants aim to refine new methods that are both high quality and low cost.
The awards include several research projects directed at improving the use of nanopores in DNA sequencing, or creating nanopore arrays that enable large-scale DNA sequencing. Nanopore-based DNA sequencing entails threading single DNA strands through tiny pores in a membrane. Bases of DNA are read one at a time as they pass through the nanopore. The technique identifies DNA bases by measuring differences in their effect on electrical current flowing through the pore. Other projects are exploring microfluidics in DNA library preparation, and testing an enzyme method used to amplify signals that recognize DNA bases.
“While we continue to support many research projects centered on the development of nanopore technology, some of the new grants focus on additional unique approaches to sequencing DNA,” said NHGRI Genome Technology Program Director Jeffery Schloss, PhD. “Despite discussion about approaching the goal of sequencing a genome for only $1,000, many challenges remain in terms of containing costs and achieving a high quality of DNA sequencing data.” More information on the projects is available from the NHGRI website,www.genome.gov/ResearchFunding.
Medicare Steps Up Pay for Performance in 2015
The final hospital inpatient payment regulation from the Centers for Medicare and Medicaid Services (CMS) will step up several programs in 2015 designed to push hospitals to improve care quality
Under the hospital readmissions reduction program, the maximum reduction in payments for poor performers will increase from 2% to 3%. The rule also formally adds the 1% hospital-acquired condition penalty required by the Affordable Care Act, which covers central line-associated bloodstream infections, catheter-associated urinary tract infections, and serious complications. CMS plans to introduce methicillin-resistant Staphylococcus aureus and Clostridium difficile infections to the list by 2017.
A third initiative, the value-based purchasing program, will increase the penalty for failing to meet quality goals to 1.5% from 1.25%. This program rewards hospitals for a host of quality measures, including patient satisfaction.
Overall, even though CMS is boosting the topline Medicare payment rate by 1.4% in 2015, actual payments to hospitals are expected to fall 0.6% due to the various penalties and adjustments in the legislation, according to an analysis by The Advisory Board Company. The final rule is available on www.regulations.gov.