Practice Management Alert

Plus, CMS decides to pay for obesity prevention services.

If you bill for a hospital in Rhode Island, you may see some additional money coming your way if you meet newly implemented quality standards. Blue Cross Blue Shield (BCBS) of Rhode Island launched a new program with local network hospitals in November called the Hospital Quality Program.

According to a press release from the payer, "the program, which uses standard, 'evidence-based' performance metrics, also realigns financial incentives so that hospitals that provide high-quality patient care receive more compensation." The goal, according to BCBS, is to "improve the quality, safety and efficiency of healthcare received by its members."

Thus far, 90 percent of the hospitals in the payer's network have agreed to participate in the program for 2011. BCBS hopes to achieve 100 percent participation by the end of next year, the press release states. The program also hopes to help moderate long-term healthcare costs through patient health improvements and hospital readmission reductions.

"Ironically, healthcare is one of the few industries today where financial incentives are linked to the volume of services provided, not the quality of those services," explained Gus Manocchia, M.D., BCBSRI's senior vice president and chief medical officer. "If you own a restaurant and you serve food that tastes bad, you're going to lose customers. If you're a car manufacturer and your car doesn't perform well in crash tests, you're going to lose customers. But the United States spends more per capita on healthcare than most other developed nations, and we aren't any healthier."

On Nov. 30, CMS said that Medicare "is adding coverage for preventive services to reduce obesity" in an effort to prevent 1 million heart attacks and strokes over the next five years.

"Obesity is a challenge faced by Americans of all ages, and prevention is crucial for the management and elimination of obesity in our country," CMS's Donald M. Berwick said in a statement.

Under the new decision, primary care providers who screen patients positive for obesity with a BMI of 30 kg/m2 or greater will be eligible for a face-to-face counseling visit each week for a month, followed by face-to-face counseling visits every other week for another five months. If the patient loses at least 6.6 pounds over the first six months, the patient can continue to see the physician for additional obesity counseling once a month for another six months, totaling 12 months of counseling.

To read CMS's coverage decision, visit www.cms.gov/medicare-coverage-database/details/nca-decision-memo.aspx?&NcaName=Intensive%20Behavioral%20Therapy%20for%20Obesity&bc=ACAAAAAAIAAA&NCAId=253&.