Medical Device Daily Washington Editor

The controversy between CMS and two members of the Senate over the plan to hold processing of Medicare Part B claims may not be over even as two associations prepare to hit the mainstream media over the Medicare funding issue.

Sens. Chuck Schumer (D-New York) and John Rockefeller (D-West Virginia) penned a June 30 letter to Secretary of Health and Human Services Mike Leavitt decrying the administration's proposal to suspend reimbursing for Part B claims from doctors' offices for ten business days as "misleading" and an attempt to "give the appearance of being helpful to doctors in the Medicare program" (Medical Device Daily, July 1, 2008).

However, Jeff Nelligan, a spokesman for the Centers for Medicare & Medicaid Services, told MDD that the 13-day hold on reimbursement cited by the senators refers only to the total elapsed time between submission of a claim and reimbursement, not to claims processing. "We would ordinarily take a claim and process it immediately," Nelligan said, but hold the funds until the 13 days had elapsed. The administration's proposal is to hold off on processing those claims while Congress and the White House rehash the Medicare bill. This would allow CMS to pay doctors without invoking the 10.6% reduction imposed by SGR cuts, assuming Congress and the White House can make a deal.

Nelligan said that he expects that even with the 10-day hold on claims processing which will run to July 15 because of weekends and the July 4 holiday the agency expects to process those claims in between two and seven days, and that doctors' offices can expect to see their money within the standard 13-day turn-around despite the hold.

According to wire service reports, both America's Health Insurance Plans (AHIP; Washington) and the American Medical Association (AMA; Washington) plan to roll out ads to influence voter reaction to the standoff. AHIP's ads are expected to run on national cable television through the weekend, but no specific geographic areas are discussed. The AMA ads are slated to run in six states that are homes to senators who voted against the Medicare reauthorization that would have cut funding for MA plans.

Calls to Schumers' and Rockefeller's offices for comment were not returned.

RFID problematic in hospitals?

One of the questions asked about radio frequency identification (RFID) technology for drugs and devices is whether that technology will interfere with a hospital suite that is increasingly wired. This kind of track-and-trace technology is not just important for ensuring drug and device pedigree, but also for locating items within hospitals.

A recent article in the Journal of the American Medical Association indicates that interactions between RFID units and hospital equipment are potentially problematic. The article, which appears in the June 25 edition of JAMA, details a brief study of how two RFID systems work in a hospital mock-up. One of the systems operates passively at 868 megahertz (MHz) and the other actively at 125 kilohertz (kHz).

According to the authors, led by Remko van der Togt of Vrije Universiteit (Amsterdam), they tested 41 medical devices against the two RFID technologies and encountered 34 incidents of electromagnetic interference (EMI), 22 of which "were classified as hazardous, two as significant, and 10 as light."

However, the authors note that the passive RFID signal "induced a higher number of incidents ... compared with the active 125-kHz RFID signal" by a score of 26 to eight (out of 41 tests for each). The distance between the RFID-generating devices and the equipment against which it was tested was about 30 cm, or less than a foot.

If all this sounds like a business opportunity to you, you have company.

Awarepoint (San Diego), a vendor of RFID solutions, published a white paper on real-time location systems (RTLS) based on RFID technology, but using an existing information technology infrastructure such as wireless (Wi-Fi) digital transmission systems. The undated paper states that hospitals see the use of Wi-Fi "as a possible solution" to device tracking needs, but states that "the requirements of sensor data collection conflict with the original design goals of Wi-Fi."

Still, the paper's author, Ron Hegli, VP engineering at Awarepoint, insists that "complimentary wireless networks can co-exist within the healthcare environment" if the vendor sets up the system to use three specific channels within the 802.11 or 802.15.4 data transmission protocols.

Listing channels 1, 6 and 11 as "three non-overlapping channels," Hegli states that using different channels for adjacent access points allows mobile nodes to "cleanly associate with one access point in any given area."

However, vendors have to carefully match the power requirements of all the equipment because power levels can interfere with hospital equipment. Hegli writes that the company's ZigBee system can get by on one milliwatt for tracking devices, which is 100 times lower than the power typically required to access 802.11 wireless systems. Also, the use of batteries to power the RFID chip in active signals is feasible, especially when the RFIDed unit transmits to the node infrequently.