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From the November ACP-ASIM Observer, copyright © 2002 by the American College of Physicians-American Society of Internal Medicine.

ACP-ASIM seeks Senate support of liability reform

The College and more than 35 other medical, business and liability insurer groups asked Senate leader Thomas Daschle (D-S.D.) for his support in passing the Help Efficient, Accessible, Low-cost, Timely Healthcare (HEALTH) Act of 2002. The House passed similar legislation in September.

In an Oct. 9 letter, the groups pointed out that a lack of affordable liability insurance was already causing access problems and the suspension of certain services—such as trauma and prenatal services—throughout the country.

The letter also noted that adverse consequences reach beyond the health care profession. Liability problems, for example, can affect communities' ability to attract new businesses and quality employees.

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College opposes new hepatitis B codes

ACP-ASIM is objecting to CMS's decision to replace the five existing hepatitis B vaccine CPT codes with three new "Q" codes.

In an Oct. 1 letter to CMS administrator Thomas A. Scully, the College said that the new codes will further complicate the coding system and give the agency less information about the services physician provide. Unlike the old codes, the new "Q" codes will not provide information about chemical formulation, dosage or route of administration. This will make using the information for quality improvement and other public health purposes more difficult.

The new codes also violate the Health Information Portability and Accountability Act (HIPAA) because they will force health care providers to use elements from both the HCPCS and CPT coding systems.

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ACP-ASIM urges Congress to fund new nursing legislation

The College and 50 other organizations have written to Congress asking legislators to fully fund the Nurse Reinvestment Act, which was passed earlier this year.

In an Oct. 8 letter, the organizations—representing physicians, nurses and long-term care facilities—pointed out that only full funding of the measure will help reverse the current nursing shortage. There are currently more than 126,000 unfilled nursing positions.

The nursing shortage will only intensify, the letter stated, as baby boomers age and start using more hospital and long-term care services.

The Nurse Reinvestment Act expands nurse scholarship and loan repayment programs while establishing new grants for geriatric training, career ladder programs and loans for nurse educators.

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College warns HHS about new inpatient coding system

The College joined 46 other medical organizations in asking HHS to refrain from introducing a complex new system of medical coding for inpatient care.

HHS is currently considering a new system, ICD-10-PCS, to replace the ICD-9-CM system for inpatient coding. The change would apply only to inpatient services.

In a Sept. 24 letter to HHS Secretary Tommy G. Thompson, ACP-ASIM and the letter's co-signers asked the department to investigate using the Current Procedural Terminology (CPT) system for inpatient coding.

The organizations explained that implementing ICD-10-PCS would add to the regulatory burden faced by hospitals, physicians and other health care providers. Because the system is so different from ICD-9-CM, the letter said, providers would have to spend a significant amount of money educating physicians and other health care professionals.

Adopting the new system could also lead to more data and reporting errors for inpatient coding, producing payment problems.

While the current ICD-9-CM system contains about 4,000 codes, the new ICD-10-PCS contains nearly 200,000 codes. In addition, the letter points out, it has not been proven in any clinical settings.

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ACP-ASIM gives HHS recommendations on new strategic plan

The College weighed in on the HHS' newest strategic plan, providing recommendations to help the department meet what ACP-ASIM termed "ambitious" goals.

In the draft version of its strategic plan for 2003-2008, HHS identifies eight goals, including improving access to health care for children and adults, improving quality by focusing on patient safety and improving the nation's ability to respond to bioterrorism.

In its recommendations, the College identified several steps from its seven-year plan on access that HHS could take to achieve universal health care. Among other measures, the College recommended that Congress standardize national eligibility criteria for Medicaid, expand the income-related premium subsidy program to all uninsured individuals with incomes above 200% of the poverty level, and authorize states to request waivers to provide their own coverage. (For more information on the College's seven-year plan, see Acheiving Affordable Health Insurance Coverage for all withing Seven Years.)

To improve health care quality and patient safety, the College recommended creating a nonpunitive culture to encourage physicians to report errors, protect the confidentiality of everyone involved and encourage information sharing among health care reporting systems.

To improve how HHS manages itself, the College recommended the department streamline its regulations by compiling all Medicare directives into a single accessible source. ACP-ASIM also recommended revising the methods used to determine Medicare payments, streamlining documentation requirements, improving the carrier medical review process, rescinding the office of civil rights requirements for persons with limited English proficiency, refining EMTALA and delaying the implementation of HIPAA rules.

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