TWC News Update

Spotlight On: Diabetes

Children’s Hospital Nets $5 Million for Diabetes Center

  A $5 million donation from the Lift a Life Foundation has helped fund the launch of a $12 million comprehensive diabetes center at Kosair Children’s Hospital, Louisville, KY. A celebration to mark the building’s establishment was held March 6.   According to a report by Business First, the center offers diabetes and education, particularly for those suffering from type 1 diabetes. An inpatient portion of the center is reportedly set to open later this year, with an outpatient center is to be established in the coming years. Collectively, the facilities will be called the Wendy L. Novak Diabetes Center at Kosair Children’s Hospital. The gift will also support the hiring of additional staff, including a physician, diabetes educators, and nurse practitioner specialists. Funding will help enhance medical, educational, and technology resources as well as programs available to families and to improve inpatient and outpatient care facilities.

HHS Grant to Fund Diabetes Research

  A federal grant of more than $333,000 has been awarded to the University of Tennessee Health Science Center in Memphis for diabetes, endocrinology, and metabolic research.   According to the Associated Press, US Rep. Steve Cohen said the grant by the US Department of Health and Human Services will be distributed by the National Institute of Diabetes and Digestive and Kidney Diseases and is expected to give researchers the tools needed to help people in Memphis and across the country reduce risk factors, improve diabetes management, and increase quality of life.

New York Physicians Noted for Diabetes Care

  Two physicians on staff at Lake Erie Regional Health System of New York, Dunkirk, NY, are being honored nationally for providing quality diabetes care and meeting recognized standards. According to the Dunkirk Observer, Ronald Greco, MD, and Joel Yoviene, MD, have received honors from the National Committee for Quality Assurance (NCQA) and the American Diabetes Association (ADA). The recognition is reportedly valid for three years.   Greco provides services at Forestville Primary Care Center, Gowanda Medical Center, and Conewango Valley Medical Center. Yoviene is on staff at Forestville and Gowanda.   To receive recognition, data from the physicians were submitted that demonstrate performance that meets key diabetes-care measures, including eye exams, blood pressure tests, nutrition therapy, and patient satisfaction, among others.

Georgia Hospital Opens Wound Care & Hyperbaric Center

  Piedmont Newnan Hospital, Newnan, GA, has opened its Wound Care and Hyperbaric Center, which provides a variety of services including hyperbaric oxygen therapy, debridement, vascular testing, compression therapy, negative pressure, and the use of the most advanced dressing technology, according to hospital officials.   “The new center is a tremendous resource to the Coweta community,” said Michael Bass, president and CEO. “It offers the latest tools in both wound care and hyperbaric treatments, partnered with the excellent quality care our wound care and hyperbaric center team has always provided to its patients.”

Report Seeks to End Physician Fee-For-Service

  A recent report released by the National Commission on Physician Payment Reform calls for the elimination of fee-for-service payments to physicians by the end of this decade, according to MedPage Today. The commission was convened by the Society of General Internal Medicine in March 2012.   The report, published March 4, suggests replacing standalone fee-for-service with a blended payment system based on new delivery and reimbursement models. A number of recommendations to change the way doctors are paid and discourage incentives that may lead to higher cost as well as higher volumes of care were outlined.   “The commission concluded that our nation cannot control runaway medical spending without fundamentally changing how physicians are paid, including the inherent incentives built into the current fee-for-service pay system,” reads the 24-page report. Among the listed considerations:     • Including evaluation and management diagnostic codes, which are currently undervalued, in annual updates     • Eliminating higher payments for facility-based services that can be performed in a lower-cost setting     • Incorporating quality metrics into negotiated reimbursement rates of fee-for-service contracts     • Forming virtual relationships between small practices to share resources     • Including fixed payments where significant potential for cost savings exists, such as care for people living with multiple chronic conditions and in-hospital procedures and their follow-up     • Ensuring access to high-quality care and physician commitment for fixed payment models.   The report also named several factors that are driving healthcare costs, including reliance on technology and expensive care; high ratio of specialists to primary care physicians; and paying more for the same service when done in a hospital rather than outpatient setting. The commission also calls for eliminating Medicare’s sustainable growth rate (SGR) formula and suggests that an SGR repeal to be paid for with cost savings from the Medicare program, including physician payments and reductions in inappropriately used services. The commission’s work was reportedly funded by the Robert Wood Johnson Foundation and the California HealthCare Foundation. NEED TO KNOW: The growing toll of diabetes cost the nation a record $245 billion in 2012, a 41% increase from $174 billion in 2007, according to “Economic Costs of Diabetes in the U.S. in 2012, a study commissioned by the American Diabetes Association.

Ask the Board

In this exclusive column, Today’s Wound Clinic (TWC) offers our readers the chance to ask industry-related questions to our expert editorial board members. This month’s questions come from multiple sources.   Q: “How much attention should physicians pay to ICD-9-CM codes listed in Medicare Local Coverage Determinations (LCDs)?” A: By Kathleen D. Schaum, MS   This month, the TWC board received several questions regarding the ICD-9-CM codes that are listed in most Medicare LCDs. These wound care professionals asked: 1) If the physician did not use the specific ICD-9-CM codes listed in the LCD, would the service, procedure, and/or product be covered? 2) Is the sequence of ICD-9-CM codes on the claim form important? Here’s what you need to know:     1) If the Medicare Contractor provides a list of ICD-9-CM codes that are covered in the LCD, those are typically the only covered diagnoses for that service, procedure, and/or product.       • If the patient has one of the covered diagnoses, but the physician uses one of the non-specific ICD-9-CM codes, the physician may want to break that bad habit and begin using the most specific ICD-9-CM code(s) that pertain(s) to the patient.       • If the patient does not have one of the covered diagnoses, the physician should provide the patient with an Advanced Beneficiary Notice of Non-Coverage (ABN). The ABN will inform the patient: a) that the service, procedure, and/or product will most likely not be covered by Medicare and b) about the cost that the patient will incur to receive the non-covered service, procedure, and/or product. The patient will then have the choice of denying or accepting/paying for the service, procedure, and/or product.     2) If the LCD states the expected sequence of covered ICD-9-CM codes, the diagnosis codes should be listed on the claim form in that sequence. For example: One physician was upset that her claim for application of a cellular- and/or tissue-based product for wounds was denied for a diabetic foot ulcer. The physician knew the LCD listed the exact ICD-9-CM codes that were on the claim form. Unfortunately, the LCD stated the ulcer ICD-9-CM code was to be listed as the primary diagnosis and the diabetes ICD-9-CM code was to be listed as the secondary diagnosis. You guessed it, the physician’s claim form listed diabetes as the primary diagnosis and the ulcer as the secondary diagnosis! The claim was denied because the procedure and product is not a treatment for diabetes — they are treatments for an ulcer that is a result of diabetes. Some LCDs also describe ICD-9-CM codes that must be used in pairs. Wound care professionals should pay close attention to the required code pairs. These code pairs must be documented in the medical record by the physician and must be placed in the correct sequence on the claim form in order to receive payment for the service, procedure, and/or product and to keep your payment upon an audit. Kathleen D. Schaum can be reached for questions and consultations by calling 561-964-2470 or at kathleendschaum@bellsouth.net. For a full disclaimer related to the information in this column, please refer to Business Briefs on page 6.