The Department of Health and Human Services (HHS) has released a final rule modifying the confidentiality of substance use disorder (SUD) patient record regulations, according to Revenue Cycle Advisor.

“Patient confidentiality is one of the bedrock principles in health care,” HHS Secretary Xavier Becerra said in a press release, “People who are struggling with substance use disorders must have the same ability to keep their information private as anyone else. This new rule helps to ensure that happens, by strengthening confidentiality protections and improving the integration of behavioral health with other medical records.”

Some of the important changes in the final rule include:

• Requiring the patient to consent only once for their records to be shared for treatment purposes
• Allowing records to be disclosed in accordance with HIPAA guidelines
• Giving patients the right to find out who accessed their records and request disclosure restrictions allowed under HIPAA
• Expanding prohibitions for using or disclosing patient records as part of civil, criminal, administrative, and legislative proceedings

The American Hospital Association (AHA) issued a statement in support of the changes, saying:

America’s hospitals and health systems care for individuals with SUDs every day, from reversing overdoses in emergency departments to providing counseling and recovery services to connecting patients with critical resources in their communities. The proposals in this rule would substantially improve hospitals’ and health systems’ ability to provide safer, better-coordinated care to patients with substance use disorder through vital information sharing.

However, the AHA additionally urged HHS to partner with Congress to “update the statutory framework to allow for more meaningful integration of behavioral and physical healthcare.”

Editor’s note:To read the Revenue Cycle Advisor coverage, click here. To read the HHS press release, click here. To read the AHA’s statement, click here.

A new study published in JAMA Open Network suggests that preemptive podiatric care decreases the risk of amputation in diabetic and kidney failure patients, according to JustCoding.

The study examined 14,935 Medicare beneficiaries with type 2 diabetes receiving dialysis from 2016 to 2019. The cohort was 55.4% male, 58.5% white, 35% Black, with a mean age of 59.3.

The researchers found that preemptive foot and ankle care was associated with an 11% lower likelihood of death and/or amputation and a 9% lower likelihood of major amputation (above or below knee) than those who did not receive such care.

Of the 14,935 patients whose claims were analyzed, 18.4% received foot and ankle care by podiatrists during the three months prior to diabetic foot ulcer (DFU) diagnosis.  

The care, which was represented by the presence of the CPT and HCPCS codes, was “associated with improvement in 3-year amputation-free survival, a reduced risk of major amputation, and a lower risk of the composite outcome of death and/or major amputation.”  

According to JustCoding, these findings attest that preventive care by trained podiatrists can lead to positive potential benefits and can help mitigate complications for patients with kidney failure and DFUs.  

Editor’s note:To read the JAMA Open Network study, click here. To read the JustCoding coverage, click here.

The Centers for Medicare and Medicaid Services (CMS) has finalized payment updates for the 2025 Medicare Advantage (MA) and Medicare Part D Programs, according to a recent press release.

Under the new CY 2025 rates, government payments to MA plans are expected to increase, on average, by approximately 3.7% ($16 billion) from the 2024 rates. CMS will also be finalizing improvements to the 2025 Medicare Part D drug benefit program that will “result in lower drug costs for millions of people with Medicare.”

“We are also pleased to finalize guidance on the new $2,000 out-of-pocket cap for prescription drugs under Medicare Part D in 2025, which was enacted in the President’s prescription drug law. This new provision will provide meaningful additional cost savings and relief to enrollees who have been facing high and rising drug costs,” said CMS Deputy Administrator and Director of the Center for Medicare Meena Seshamani, MD, Ph.D.

Here are some other features of the finalized payment updates for CY 2025:

• In CY 2025, CMS will continue the phase-in of the technical adjustment described in the CY 2024 rate announcement, applying 52% of the technical adjustment
• In CY 2025, CMS will continue to phase-in the updated risk adjustment model by “blending 67% of the risk score calculated using the updated 2024 MA risk adjustment model with 33% of the risk score calculated using the 2020 MA risk adjustment model”
• The Part D benefit Inflation Reduction Act updates—such as the elimination of the coverage gap, and the $2,000 out-of-pocket cap—will remain in place throughout CY 2025

Editor’s note: To read the CMS press release, click here. To read the CMS fact sheet on the MA and Part D rate announcement, click here.

The Centers for Medicare and Medicaid Services (CMS) has provided an update on their value-based specialty care initiatives, according to the American Hospital Association.

The “Innovation Center,” launched in 2021, aims to have “100 percent of Traditional Medicare beneficiaries and the vast majority of Medicaid beneficiaries in accountable care relationships by 2030.”

Accountable care, according to CMS, indicates “that a doctor, group of health care providers, or hospitals take responsibility for improving quality of care, care coordination, and health outcomes for a defined group of patients based on a series of population-based metrics and cost based on a financial benchmark.”

The CMS Innovation Center is characterized by four elements:

• Element 1: Enhance specialty care performance data transparency
• Element 2: Maintain momentum on acute episode payment models and condition-based models
• Element 3: Create financial incentives within primacy care for specialist engagement
• Element 4: Create financial incentives for specialists to affiliate with population-based models and move to value-based care

Editor’s note: To read the AHA press release, click here. To read the CMS Innovation Center 2024 update, click here.

According to The Office of Inspector General’s (OIG) recent Work Plan March update, it will be reviewing Medicare inpatient hospital billing for sepsis.

Sepsis is diagnosis that is frequently billed in Medicare. Its multiple definitions and clinical requirements between the World Health Organization, CMS, and Centers for Disease Control and Prevention provide extra complication for CDI specialists and coders.

“This study will analyze Medicare claims to assess patterns in the inpatient hospital billing of sepsis in 2023 and describe how the billing of sepsis varied among hospitals,” the Work Plan summary explains.

OIG continues to explain its concern that hospitals are taking advantage of the various sepsis definitions and criteria to receive financial incentives. It also intends to estimate the costs to Medicare associated with each definition and criteria.

Editor’s note: This article was republished from JustCoding and can be found here.

Last week, the FDA granted marketing authorization of an artificial intelligence (AI) software tool for rapid diagnosis and risk assessment of sepsis, Prenosis announced in a press release. The AI sepsis diagnostic is called “the Sepsis ImmunoScore” and uses a combination of 22 biomarkers and patient parameters to provide a risk score and four discrete risk categories that indicate a patient’s risk of deterioration, in-hospital mortality, and escalation of care within 24 hours of patient assessment, MedPage Today reported.

The FDA authorized the tool with a “De Novo Classification,” meaning that the device provides reasonable assurance of safety and effectiveness for its intended use, but for which there is no legally marketed predicate device. It was designed using a biobank and dataset consisting of more than 100,000 blood samples from over 25,000 patients. In a 2021 study published in the ASCPT Journal, researchers collected samples from 1,400 adult patients in emergency departments suspected of sepsis to evaluate the machine-learning algorithm and found the tool accurately identified sepsis and other related secondary outcomes.

“Given that diagnostic performance alone does not address the entire dilemma facing healthcare providers today, we now present a more holistic analysis of a subset of NOSIS, a large, multi-center, novel data set comprised of three plasma proteins (procalcitonin [PCT], interleukin-6 [IL-6], and C-reactive protein [CRP]) and routinely measured EMR parameters,” researchers explained in the study.

They found a higher score accurately predicted less favorable outcomes regarding discharge time, 30-day mortality, and 30-day inpatient readmissions. Predicted risk scores for patients were higher for those with septic shock and infection and organ dysfunction compared with those with sepsis but without those conditions.

Editor’s note:To read MedPage Today’s coverage of this story, click here. To read the ASCPT Journal study, click here.

More than 20 million people have been disenrolled from Medicaid, according to a recent study cited by the American Hospital Association (AHA).

According to the AHA, the remarkable drop in enrollees is due to the expiration of a provision in the Families First Coronavirus Response Act (FFCRA), which “requir[ed] state Medicaid programs to keep people enrolled, in change for additional federal funding.” This continuous enrollment provision ended on March 31, 2023, and stipulated that states could disenroll people who

1. No longer met the eligibility requirements
2. Did not complete the renewal process beginning on April 1, 2023

According to the Kaiser Family Foundation (KFF), this process of “Medicaid unwinding” has had a seriously detrimental effect on the overall physical and mental health of dis-enrollees. Here are some highlights from the KFF study:

• 75% of Medicaid dis-enrollees say they were worried about their physical health, while 60% they were worried about their mental health
• 56% of Medicaid dis-enrollees “skipped or delayed” getting health services or prescriptions while attempting to renew their coverage
• 36% of uninsured Medicaid dis-enrollees say they are still trying to get Medicaid coverage with 54% of those citing costs as the reason why they haven’t gotten private coverage
• Of those who were able to receive private coverage after being disenrolled (8%), 50% now worry about affording their monthly premium, and 76% are worried about affording the cost of healthcare services

Editor’s note:To read the AHA summary, click here. To read the KFF study, click here.

Last week, CMS released the hospital Inpatient Prospective Payment System (IPPS) proposed rule for fiscal year (FY) 2025, according to a press release.

Under last year’s proposed rule, acute care hospitals reporting quality data and meaningfully using EHRs saw a net 2.8% increase in payments in FY 2024 (compared to 2023), an expected increase of $3.3 billion; however, this year, hospitals meeting such requirements will only see a projected 2.6% increase for FY 2025.

The press release also noted that “hospitals [in FY 2025] may be subject to other payment adjustments under the IPPS,” such as:

• Payment reductions for excess readmissions under the Hospital Readmissions Reduction Program (HRRP).
• Payment reduction (1%) for the worst-performing quartile of hospitals under the Hospital Acquired Condition (HAC) Reduction Program. 
• Upward or downward adjustments under the Hospital Value-Based Purchasing (VBP) Program. 

“Overall,” CMS noted, “the proposed changes in operating and capital IPPS payment rates—in addition to other changes—will generally increase hospital payments by $3.2 billion.”

Here are some other noteworthy aspects of the new proposed rule:

• Social determinant of health (SDOH) codes: “CMS is proposing to change the severity designation of the seven ICD-10-CM diagnosis codes that describe inadequate housing and housing instability from non-complication or comorbidity (Non-CC) to complication or comorbidity (CC), based on the higher average resource costs of cases with these diagnosis codes compared to similar cases without these codes.” This change would be in addition to the three SDOH codes related to homelessness that were given CC designations in FY 2024.
• Essential medicines: “CMS is proposing a separate payment under the IPPS for small, independent hospitals to establish and maintain a buffer stock of essential medicines for use during future shortages.”
• Wage index disparities: “CMS proposes to extend a temporary policy finalized in the FY 2020 IPPS/LTCH PPS final rule that addresses wage index disparities affecting low-wage index hospitals, which includes many rural hospitals. Specifically, [CMS] is proposing that this policy would be effective for at least three more years, beginning in FY 2025.”

The full FY 2025 IPPS proposed rule, as well as the FY 2025 Long-Term Care Hospital Prospective Payment System (LTCH PPS) proposed rule, is available on the Federal Register for public comment.

Editor’s note:To read the full proposed rule, click here. To read the CMS fact sheet, click here.

The Lancet Breast Cancer Commission recently concluded that access inequities in breast cancer prevention, detection, treatment, and supportive care have left many patients “systematically left behind and forgotten,” MedPage Today reported.

"Recent improvements in breast cancer survival represent a great success of modern medicine. However, we can't ignore how many patients are being systematically left behind," said Charlotte Coles, PhD, of the University of Cambridge in England, the report's lead author, in a statement quoted in MedPage.

The commission found that inequities in breast cancer care were especially apparent in those with metastatic disease.

Because the commission found that the overwhelming cost of cancer treatments was the number one barrier in such receiving treatment, the commission recommended that

universal health coverage of breast cancer should be expanded "across the continuum of care" in order to eliminate the potential of financial catastrophe for families that experience breast cancer and that at least 20% (with an ultimate goal of 100%) of patients and families with the lowest incomes receive public financing and an essential package of supportive and palliative care across the breast cancer pathway.

Editor’s note:To read the MedPage Today coverage, click here. To read the Lancet journal article, click here.

It’s hip to be a health information professional during Health Information Professionals Week (HIP Week)!

From April 15-19, we ask you to join ACDIS and AHIMA in raising awareness about the wonderful work the health information profession contributes to healthcare.

Are you looking to celebrate HIP Week? Check out these activities and resources to learn more about how you can celebrate your organization’s HIM professionals:

• Check out this AHIMA specialized tip sheet packed with ideas for how you can make your HIP week celebrations special.
• Do you have questions about the profession? Check out this FAQ guide!
• Lastly, looking for some HIP swag? Check out the HIP Week 2024 online store.

We hope you’ll take the time this week to reach out to your HIM colleagues and tell them you appreciate them!