News 3/18/14

From Soothsayer: “Re: Castlight Health fallout. Given Castlight’s tremendous IPO success, look for more HIT companies to follow suit. A few we might see within the year: Practice Fusion, CareCloud, and ZocDoc.” Castlight’s share price surged 149 percent during its Friday IPO, giving the company a valuation of more than $3 billion. That’s a pretty impressive debut, especially considering Castlight had $13 million in revenues and a $62 million net loss in 2013. There’s clearly a lot of interest in the HIT sector so I’m with Soothsayer on this one.

CMS wants to recoup improper payments made through its PQRS and e-prescribing incentive program and will launch a four-year program to look for potential errors, inconsistencies, and gaps related to data handling, program requirements, and clinical quality measure specifications. According to a Federal Register notice, CMS will survey 400 group practices, registries, and data submission vendors and perform a limited number of follow-up interviews.

Disturbing: researchers from the University of Illinois at Chicago find that transitioning from ICD-9 codes to ICD-10 could lead to a significant loss of data, based on an analysis 220 hematology-oncology and outpatient diagnostic codes. Specifically researchers found the transition affected eight percent of state Medicaid codes and one percent of codes in the University of Illinois Cancer center; potential costs associated with the information loss totaled $479,299. What’s particularly troubling is that the study focused on hematology-oncology codes, which involve fewer ICD-10 codes and thus less convoluted mappings than codes in other specialties.

The House passes legislation to permanently repeal Medicare’s SGR payment formula, but, full passage of the law is unlikely because it includes a provision to delay the ACA’s mandate requiring all individuals obtain health insurance. Without a repeal or a temporary patch, doctors face a 24 percent cut in Medicare reimbursements as of April 1.

UnitedHealthcare, Aetna, BlueCross BlueShield, and Humana tell the AAFP they’ll be ready for ICD-10 by the October 1 deadline, though some of the carriers express concerns that small, private practices are behind in their preparations.

What employed physicians like most about not being self-employed: not having to deal with the business of running an office and not having to deal with insurers and billing. According to a Medscape survey of 4,600 doctors, employed physicians complain about the lack of input into how they practice, but 70 percent of physicians who were once self-employed report being happier employed.

On the heels of a recent study questioning the effectiveness of the PCMH model in improving care and reducing costs, the NCQA previews 2014 PCMH recognition standards, which include more emphasis on team-based care. Other areas that NCQA is “raising the bar,” include:

• Care management focus on high-need populations
• Alignment of quality improvement activities
• Additional integration of behavioral health

Email Inga.