• The Advocacy Committee serves an ongoing role in the public policy arena, focusing on four priority areas. Online tools useful for local advocacy are provided on the Advocacy Resources page.
• The Society raises awareness of critical care professionals and quality care each May as part of National Critical Care Awareness and Recognition Month (NCCARM).
• Legislative and regulatory developments relevant to critical care patients and their caregivers are outlined on the corresponding Web pages.
• The Society is the key source for ensuring critical care readiness in preparing for and responding to disasters.  Information for the public is available on the Disaster Resources Web pages, and for clinicians and administrators via the Fundamentals of Disaster Management (FDM) course, part of FCCS.
• Regulations affect critical care practice management and relevant information is detailed on the Coding & Billing Web pages.
• Alerts and customized messages to decision makers regarding critical care are delivered through the Online Advocacy Tool.  Contacting your elected officials has never been easier, and every contact elevates the profile of quality critical care.
• eNewsletter Economic Stimulus Articles

Current News

Office for Human Research Protections (OHRP) Activity

The Office for Human Research Protections’ (OHRP) decision to put a halt to ongoing improvement efforts in Michigan’s Keystone Project galvanized the group. In response to this decision, the Quad Societies met with the deputy secretary of Health and Human Services (HHS). This meeting at HHS headquarters came about as the result of a letter from the Quad Societies expressing concern about OHRP’s action. The rapid response from HHS, which was pushed along by a June 26, 2008 letter, has been surprising, and the ultimate resolution has been gratifying. It also illustrates the power of speaking with one voice in a collaborative effort. Essentially, HHS agreed with most of the concerns raised by the Quad Societies both in the letter and the face-to-face meeting that ensued. Our actions served to inform the clarification that came from HHS to OHRP, which led to the ultimate resolution of this issue.

Stimulus Offers Incentives for Health Information Technology

SCCM calls CMS’ attention to errors in billing for critical care services

A transmittal, originally issued on June 6, 2008, by the Centers for Medicare and Medicaid Services (CMS), regarding the proper billing for critical care services was issued erroneously. Dr. George Sample, an SCCM Member and a member of the Advocacy Committee, discussed these errors with CMS and the transmittal was changed and reissued, which became effective on July 1, 2008. The transmittal, which became effective July 1, is a clarification of existing CMS policy. Therefore, it should not be viewed by local Medicare carriers or physicians as a change in policy. The transmittal uses language from the CPT definition of critical care services, as well as language from prior CMS correspondence with respect to critical care. We believe the revised transmittal should be helpful to critical care practitioners for both ongoing billing questions, as well as in defending any audits of past billings.

Key points in the transmittal:

• The critical care codes are not limited to only when a patient is crashing but, rather, can be used when the patient is critically ill and the practitioner's care is preventing further deterioration and is based on the threat of imminent deterioration.
• Within Section B, "Therefore, although critical care may be delivered in a moment of crisis or upon being called to the patient's bedside emergently, this is not a requirement for providing critical care service.  The treatment and management of the patient's condition, while not necessarily emergent, shall be required, based on the threat of imminent deterioration . . . ."
• There are a number of examples of critical care given, including examples where the critical care is provided several days after initial admission into the ICU. Also noteworthy is the example of where a dermatologist cannot bill critical care for treating the rash on a patient in the ICU, which is nothing new, but within that example, CMS implies that a patient on a ventilator and nitroglycerine infusion is critically ill and that might be helpful in defending some critical care services.
• Within Section F, CMS clarifies that the same physician cannot bill an ED visit and critical care services for the same patient on the say day. The time in the ED should be billed as critical care and, if the same physician follows the patient to the ICU, that time should be added to possibly reach a 99292 as well.
• In Section G, the time units were changed in this transmittal compared to the one issued in June to match the time units in the CPT book. The June transmittal incorrectly required additional time than necessary to bill the 99292 code.
• In Section I, CMS tries to clarify the situation of a physician sharing critical care services with a non-physician practitioner (NPP). The physician and NPP cannot share a visit in order to bill an initial 99291, even if they are in the same practice group. Either the physician or the NPP can meet the threshold time requirement of 30 minutes or more, but they cannot share time to reach the initial 30 minutes. If the NPP spends the initial 30 minutes or more, then they are paid at 85% of 99291. After the threshold for 99291 is met, there might be "staff coverage" or "follow-up" provided by NPP or physicians in the same group practice as the practitioner providing the initial 99291 service.  This follow-up care should be billed using 99292, with the appropriate individual National Provider Identifier (NPI) reported on the claim.
• Within Section K, critical care may be billed during a global surgical period if the critical care service is billed with modifier 25 to indicate that the critical care is a significant, separately identifiable evaluation and management service that is above and beyond the usual pre- and post-operative care associated with the procedure that is performed.
• Section M describes the teaching physician criteria, which is that the teaching physician must be present for at least 30 minutes to bill a 99291 service and the documentation must support that. However, the teaching physician can refer to a resident's note with respect to the patient's history, physical findings, and medical assessment. The teaching physician's note must document the teaching physician's time and that the patient was critically ill during that time, what made the patient critically ill, and the nature of the treatment and management provided by the teaching physician.

Centers for Medicare & Medicaid Services (CMS) announces nine new "preventable" complications that are scheduled for non-payment in 2009.

The Society of Critical Care Medicine (SCCM) together with the American College of Chest Physicians, (ACCP) American Association of Critical - Care Nurses, (AACN), American Thoracic Society , (ATS) and Society of Hospital Medicine (SHM) are actively engaged in a joint effort to respond to a list of nine complications or so called  "never events" that CMS has scheduled for non-payment in 2009. SCCM is currently working with our sister organizations on a joint comment letter to CMS asking whether the nine complications listed are truly preventable and requesting clarification where appropriate. The letter, which will be signed by all the organizations, will be submitted by the end of the comment period, which is Friday, June 13, 2008. If members want to comment on an individual basis, the easiest way to submit comments is electronically. SCCM members may go to http://www.regulations.gov and follow the instructions for "Comment or Submission" and enter the file code CMS-1390-P. Members may also submit and original and two copies by express, overnight or regular mail. Your comments must be submitted no later than 5 p., EST on Friday, June 13, 2008.

If by express or overnight mail, the address is:

Centers for Medicare and Medicaid Services
Department of Health and Human Services
Attn: CMS-1390-P
Mail Stop C4-26-05 
7500 Security Boulevard
Baltimore, MD 21244-1850

If by regular mail, the address is:

Centers for Medicare and Medicaid Services
Department of Health and Human Services
Attn: CMS-1390-P
P.O. Box 8011
Baltimore, MD 21244-1850

FOOD AND DRUG ADMINISTRATION HEPARIN RECALL FOR ALL PROVIDER TYPES

MEDICARE PAYMENT ISSUES: WHAT CRITICAL CARE PHYSICIANS CAN EXPECT IN 2008

PAYMENT REFORMS FOR INPATIENT HOSPITAL SERVICES FINALIZED FOR 2008

PHYSICIAN QUALITY REPORTING INITIATIVE (PQRI)  

• Intensivists may possibly use 34 of 119 measures. These include measures 5-8; 20-23; 28-36; 43-45; 51-65; 75-76; 111; and 114-115 Click here

2008 Physician Quality Reporting Initiative (PQRI) Tool Kit

The Tool Kit consists of the following:

o 2008 PQRI Physician Quality Measures

o 2008 Coding for Quality Handbook

o 2008 PQRI Single Source Code Master

o MLN Matters Article 5640 – Coding & Reporting Principles

o 2008 PQRI Measure Finder Tool and User Guide

o 2008 Data Collection Worksheets

 
Frequently Asked Questions (FAQs)

The CMS has posted a growing roster of FAQs about PQRI on its website.  Click here to access these FAQs. 

The Patient-Focused Critical Care Enhancement Act - On February 28, 2007, Senator Richard Durbin (D-IL) and Senator Mike Crapo (R-ID) introduced the Patient-Focused Critical Care Enhancement Act (S.718).  On October 18, 2008, Representatives Janice Schakowsky (D-IL) and Eric Cantor (R-VA) introduced an identical bill, H.R. 3886. The bipartisan-supported bill addresses the critical care workforce shortage by calling for appropriations for research and projects that will take first steps toward optimizing the delivery of critical care medicine and expanding the critical care workforce.

The bill responds to the May 2006 report from the Department of Health & Human Services, Health Resources and Services Administration (HRSA) confirming projections of an increased demand for intensivist services of 129 percent over current supply by the year 2020.  This demand will result in an imminent shortage of critical care providers and shortages.   

The Society of Critical Care Medicine, American Association of Critical-Care Nurses, American College of Chest Physicians, and the American Thoracic Society worked closely together to get this bill introduced. Click here for press release. 

For more information, choose from the following links:

• Download the Patient-Focused Critical Care Enhancement Act
• Learn about the process of bill introduction
  

Click here to e-mail your Senator to address the critical care workforce shortage by urging them to pass this legislation.

Pandemic and All-Hazards Preparedness Act becomes Law - The lame-duck session of Congress was productive in one respect: it passed legislation, signed by President Bush, designed to streamline government response to disasters.  The Society will work with the Department of Health and Human Services and other appropriate agencies to establish a national demonstration project for its Fundamentals of Critical Care Support course. 

The public law is not yet available from the Government Publishing Office, but a recent Senate report provides the full text of the law.  Details on FCCS and its disaster-related courses are available from the LearnICU site, here.

SCCM JOINS quality care effort - The Society recently announced a cooperative effort to promote healthy work environments that foster safe, quality care. The Society joined the American Association of Critical-Care Nurses (AACN) in embracing the AACN Standards for Establishing and Sustaining Healthy Work Environments as essential in overcoming circumstances and conditions that, among other things, contribute to medical errors and put patients at risk.

The full press release is available here.  A copy of the agreement can be downloaded as a PDF file, here.

Newsletter Article - Wendy Wright, MD, an Advocacy Committee member, has written an article in Currents, the Neurological Newsletter. The article, titled Advancing Neurocritical Care in the Public Arena (page 5), highlights the Society's Advocacy Committee and advocacy online tool CapWiz. Please click here to view the newsletter.

Medical Errors - Legislation was introduced in the Senate outlining grants and incentives available to hospitals, physicians, and other healthcare organizations when fully disclosing medical errors.  It is part of a national trend arguing that both patients and caregivers benefit when everyone is adequately informed about medical errors.