Alicia Ault

WASHINGTON — Medicare advisors unanimously voted to recommend increasing physician fees by 1.1% next year, while expressing dismay that their June 2008 recommendation to boost primary care pay has not yet been acted upon.

The Medicare Payment Advisory Commission—better known as MedPAC—is charged with advising Congress on setting payment rates for physicians, hospitals, and other health care providers. Its recommendations are included in twice-yearly reports issued in March and June.

Under current law, Medicare physician fees are due to be reduced by 21% in 2010. MedPAC initially considered recommending that physician fees be updated by the projected change in input prices, minus an overall productivity goal that was established by the U.S. Bureau of Labor Statistics. The formula translated into a 1.1% increase, but many MedPAC commissioners were uncomfortable with the language and the possibility that it could be used to reduce fees.

Some even suggested that the panel should be considering a larger increase than 1.1%, but Chairman Glenn Hackbarth said he would not vote to approve a higher number, partly because Medicare has a statutory obligation to keep beneficiaries' Part B premiums for physician services in check. As fees rise, so do Part B premiums. And even small increases in physician fees can translate into billions more in Medicare spending, at a time when Congress is struggling to revive the faltering U.S. economy.

There seems to be no indication that Medicare reimbursement policy is leading to access problems for beneficiaries, according to reports from MedPAC staff members. A survey conducted in the early fall of 2008 found that 76% of beneficiaries said they “never” had a delay in getting an appointment for routine care, and 84% never had a delay when seeking an illness-related appointment. This is better than what has been reported by privately insured patients, said MedPAC staff member Cristina Boccuti.

Medicare fees are about 80% of private pay fees, she said.

Commissioner Nancy Kane, an associate dean of education at the Harvard School of Public Health in Boston, said that the 1.1% increase in fees would not be enough for primary care. “Primary care is in a huge state of crisis,” said Ms. Kane. She asked about the progress of the federal medical home demonstration project, and expressed concern that it could be 7–10 years before Medicare rewarded physicians for participation in medical homes. “That may not be fast enough,” she said, adding that the demonstration is a “drop in the pond. We need to move a whole ocean.”

Mr. Hackbarth pointed out that MedPAC had recommended the pilot project to help move the process along, but acknowledged that “we're talking about a significant amount of time, still.” He said he expected that interim data might support quicker action.

The panel also voted unanimously to again include its June 2008 recommendation that Congress establish a budget-neutral payment adjustment for primary care services.

Primary care could get another boost if Congress follows MedPAC's recommendation to change the equipment use rate for imaging machines that cost more than $1 million. Currently, CMS pays physicians based on an estimate that magnetic resonance imaging, computed tomography, and positron emission tomography are used an average 25 hours per week, but data suggest that 45 hours per week is a more accurate and better target, said MedPAC staff member Ariel Winter. The goal is to push physicians to be more efficient with use of the devices. Adopting the new rate would reduce the practice expense relative value unit by almost 8%.

That change would provide a savings of about $900 million annually, said Mr. Winter. The money could be reallocated to primary care pay and other physician services, if the recommendation is adopted.

MedPAC commissioners also voted to increase hospital payments by the projected increase in the market basket, and to reward high-quality, high-performing facilities with a larger, unspecified increase.

They agreed to reduce the indirect medical education (IME) payment by 1%, which would put it at 4.5% per 10% increment in the resident:bed ratio. MedPAC staff said that the IME payment was a roughly $3 billion subsidy with little required accountability in return. The staff also said that the current rate was set at more than twice the impact of teaching on hospital costs, allowing academic centers to reap higher profits.

The American Hospital Association said it was happy with the vote to increase payments overall. But the IME reduction would “negatively affect the education, clinical care and research missions of teaching hospitals, including their ability to train high-quality physicians,” said AHA Vice President for Policy Don May in a statement.

MedPAC recommended that ambulatory surgery center payments increase by 0.6% in 2010, but also that the facilities be required to report on cost and quality data so that the CMS can better evaluate the adequacy of payments.

WASHINGTON — Medicare advisors unanimously voted to recommend increasing physician fees by 1.1% next year, while expressing dismay that their June 2008 recommendation to boost primary care pay has not yet been acted upon.

The Medicare Payment Advisory Commission—better known as MedPAC—is charged with advising Congress on setting payment rates for physicians, hospitals, and other health care providers. Its recommendations are included in twice-yearly reports issued in March and June.

Under current law, Medicare physician fees are due to be reduced by 21% in 2010. MedPAC initially considered recommending that physician fees be updated by the projected change in input prices, minus an overall productivity goal that was established by the U.S. Bureau of Labor Statistics. The formula translated into a 1.1% increase, but many MedPAC commissioners were uncomfortable with the language and the possibility that it could be used to reduce fees.

Some even suggested that the panel should be considering a larger increase than 1.1%, but Chairman Glenn Hackbarth said he would not vote to approve a higher number, partly because Medicare has a statutory obligation to keep beneficiaries' Part B premiums for physician services in check. As fees rise, so do Part B premiums. And even small increases in physician fees can translate into billions more in Medicare spending, at a time when Congress is struggling to revive the faltering U.S. economy.

There seems to be no indication that Medicare reimbursement policy is leading to access problems for beneficiaries, according to reports from MedPAC staff members. A survey conducted in the early fall of 2008 found that 76% of beneficiaries said they “never” had a delay in getting an appointment for routine care, and 84% never had a delay when seeking an illness-related appointment. This is better than what has been reported by privately insured patients, said MedPAC staff member Cristina Boccuti.

Medicare fees are about 80% of private pay fees, she said.

Commissioner Nancy Kane, an associate dean of education at the Harvard School of Public Health in Boston, said that the 1.1% increase in fees would not be enough for primary care. “Primary care is in a huge state of crisis,” said Ms. Kane. She asked about the progress of the federal medical home demonstration project, and expressed concern that it could be 7–10 years before Medicare rewarded physicians for participation in medical homes. “That may not be fast enough,” she said, adding that the demonstration is a “drop in the pond. We need to move a whole ocean.”

Mr. Hackbarth pointed out that MedPAC had recommended the pilot project to help move the process along, but acknowledged that “we're talking about a significant amount of time, still.” He said he expected that interim data might support quicker action.

The panel also voted unanimously to again include its June 2008 recommendation that Congress establish a budget-neutral payment adjustment for primary care services.

Primary care could get another boost if Congress follows MedPAC's recommendation to change the equipment use rate for imaging machines that cost more than $1 million. Currently, CMS pays physicians based on an estimate that magnetic resonance imaging, computed tomography, and positron emission tomography are used an average 25 hours per week, but data suggest that 45 hours per week is a more accurate and better target, said MedPAC staff member Ariel Winter. The goal is to push physicians to be more efficient with use of the devices. Adopting the new rate would reduce the practice expense relative value unit by almost 8%.

That change would provide a savings of about $900 million annually, said Mr. Winter. The money could be reallocated to primary care pay and other physician services, if the recommendation is adopted.

MedPAC commissioners also voted to increase hospital payments by the projected increase in the market basket, and to reward high-quality, high-performing facilities with a larger, unspecified increase.

They agreed to reduce the indirect medical education (IME) payment by 1%, which would put it at 4.5% per 10% increment in the resident:bed ratio. MedPAC staff said that the IME payment was a roughly $3 billion subsidy with little required accountability in return. The staff also said that the current rate was set at more than twice the impact of teaching on hospital costs, allowing academic centers to reap higher profits.

The American Hospital Association said it was happy with the vote to increase payments overall. But the IME reduction would “negatively affect the education, clinical care and research missions of teaching hospitals, including their ability to train high-quality physicians,” said AHA Vice President for Policy Don May in a statement.

MedPAC recommended that ambulatory surgery center payments increase by 0.6% in 2010, but also that the facilities be required to report on cost and quality data so that the CMS can better evaluate the adequacy of payments.

WASHINGTON — Medicare advisors unanimously voted to recommend increasing physician fees by 1.1% next year, while expressing dismay that their June 2008 recommendation to boost primary care pay has not yet been acted upon.

The Medicare Payment Advisory Commission—better known as MedPAC—is charged with advising Congress on setting payment rates for physicians, hospitals, and other health care providers. Its recommendations are included in twice-yearly reports issued in March and June.

Under current law, Medicare physician fees are due to be reduced by 21% in 2010. MedPAC initially considered recommending that physician fees be updated by the projected change in input prices, minus an overall productivity goal that was established by the U.S. Bureau of Labor Statistics. The formula translated into a 1.1% increase, but many MedPAC commissioners were uncomfortable with the language and the possibility that it could be used to reduce fees.

Some even suggested that the panel should be considering a larger increase than 1.1%, but Chairman Glenn Hackbarth said he would not vote to approve a higher number, partly because Medicare has a statutory obligation to keep beneficiaries' Part B premiums for physician services in check. As fees rise, so do Part B premiums. And even small increases in physician fees can translate into billions more in Medicare spending, at a time when Congress is struggling to revive the faltering U.S. economy.

There seems to be no indication that Medicare reimbursement policy is leading to access problems for beneficiaries, according to reports from MedPAC staff members. A survey conducted in the early fall of 2008 found that 76% of beneficiaries said they “never” had a delay in getting an appointment for routine care, and 84% never had a delay when seeking an illness-related appointment. This is better than what has been reported by privately insured patients, said MedPAC staff member Cristina Boccuti.

Medicare fees are about 80% of private pay fees, she said.

Commissioner Nancy Kane, an associate dean of education at the Harvard School of Public Health in Boston, said that the 1.1% increase in fees would not be enough for primary care. “Primary care is in a huge state of crisis,” said Ms. Kane. She asked about the progress of the federal medical home demonstration project, and expressed concern that it could be 7–10 years before Medicare rewarded physicians for participation in medical homes. “That may not be fast enough,” she said, adding that the demonstration is a “drop in the pond. We need to move a whole ocean.”

Mr. Hackbarth pointed out that MedPAC had recommended the pilot project to help move the process along, but acknowledged that “we're talking about a significant amount of time, still.” He said he expected that interim data might support quicker action.

The panel also voted unanimously to again include its June 2008 recommendation that Congress establish a budget-neutral payment adjustment for primary care services.

Primary care could get another boost if Congress follows MedPAC's recommendation to change the equipment use rate for imaging machines that cost more than $1 million. Currently, CMS pays physicians based on an estimate that magnetic resonance imaging, computed tomography, and positron emission tomography are used an average 25 hours per week, but data suggest that 45 hours per week is a more accurate and better target, said MedPAC staff member Ariel Winter. The goal is to push physicians to be more efficient with use of the devices. Adopting the new rate would reduce the practice expense relative value unit by almost 8%.

That change would provide a savings of about $900 million annually, said Mr. Winter. The money could be reallocated to primary care pay and other physician services, if the recommendation is adopted.

MedPAC commissioners also voted to increase hospital payments by the projected increase in the market basket, and to reward high-quality, high-performing facilities with a larger, unspecified increase.

They agreed to reduce the indirect medical education (IME) payment by 1%, which would put it at 4.5% per 10% increment in the resident:bed ratio. MedPAC staff said that the IME payment was a roughly $3 billion subsidy with little required accountability in return. The staff also said that the current rate was set at more than twice the impact of teaching on hospital costs, allowing academic centers to reap higher profits.

The American Hospital Association said it was happy with the vote to increase payments overall. But the IME reduction would “negatively affect the education, clinical care and research missions of teaching hospitals, including their ability to train high-quality physicians,” said AHA Vice President for Policy Don May in a statement.

MedPAC recommended that ambulatory surgery center payments increase by 0.6% in 2010, but also that the facilities be required to report on cost and quality data so that the CMS can better evaluate the adequacy of payments.

WASHINGTON — Data from the first 6 months of the Physician Quality Reporting Initiative are spurring improvements for the upcoming year, a Medicare official testified at a meeting of the Practicing Physicians Advisory Council.

In the summer of 2008, the Centers for Medicare and Medicaid Services paid $36 million in bonuses to 56,000 physicians for their 2007 reporting, said Dr. Michael T. Rapp, director of the quality measurement and health assessment group at the CMS. The average payment was $600 for 6 months' of data; for 2008 reports, the 1.5% bonus is likely to be around $800 on average, he said.

There will be a number of changes for reporting in 2009. In all, there will be 153 reportable measures, of which 52 are new, and 18 are reportable only through registries. There are seven measures groups: diabetes mellitus, chronic kidney disease, preventive care, coronary artery bypass graft surgery, rheumatoid arthritis, perioperative care, and back pain. Each group contains a number of measures; physicians can report these only as groups.

There will be nine ways for physicians to qualify for the 2% PQRI bonus in 2009, and they also can receive 2% bonus for satisfying requirements under the separate e-prescribing incentive program.

Under last year's Medicare Improvements for Patients and Providers Act, the CMS is required to eventually post on its Web site the names of physicians who satisfactorily report quality measures for 2009. That proposal has been controversial.

PPAC panelist Dr. Frederica Smith, an internist and rheumatologist in Albuquerque, N.M., called the idea a “terrifying concept,” given that it might appear that physicians who were not on the list did not care about quality.

And physicians had many problems complying with the CMS process for reporting measures in 2007, she noted.

Dr. Rapp agreed that the first phase of the program had been frustrating. But “the way it was for 2007 doesn't mean that's the way it will be for 2008,” he said. The agency posted a detailed report on the 2007 experience at its Web site last month (www.cms.hhs.gov/PQRI/Downloads/PQRI2007ReportExperience.pdf

Overall, there were submissions from 109,349 national provider identifier/tax identification numbers with at least one quality data code. Of those, about 93% (101,138) submitted at least one valid code. More than 14 million codes were reported; more than 50% of those (7.3 million) were validly submitted.

There were three major reasons for code nonvalidity: the provider did not adhere to the measure specification; the codes were not submitted with the same claim as the billing and diagnosis code submitted for the procedure; or there was no national provider number (NPI) on the claim.

Many of the submission errors were for patients who did not meet the reporting specifications regarding gender, age, or diagnosis or procedure code for a particular measure. For instance, the PQRI does not accept reports for diabetes measures on patients over age 75, said Dr. Rapp.

CMS plans to rerun reports for providers who did not qualify for the bonus, with the idea that mistakes could have been made and some providers could be found eligible for the bonus on reanalysis. If that is the case, the CMS will issue checks retroactively, he said.

The agency also aims to make some changes to reduce the number of rejected reports. It said it would continue conducting provider education and outreach to ensure physicians understand the specifications for reporting each measure.

The agency also is working with local Medicare carriers to ensure that when claims are split—where the quality codes are separated—they will be “reconnected and counted,” said the agency.

Claims that were submitted to carriers for payment in 2008 without an NPI were automatically rejected. As a result, in the first half of 2008, less than 1% of claims submitted were missing an NPI, said the report. The CMS expects less than 0.5% of PQRI claims to be without an NPI.

Physicians can qualify for the 2% PQRI bonus in 2009 in nine different ways, with an extra 2% for e-prescribing. DR. RAPP

WASHINGTON — Data from the first 6 months of the Physician Quality Reporting Initiative are spurring improvements for the upcoming year, a Medicare official testified at a meeting of the Practicing Physicians Advisory Council.

In the summer of 2008, the Centers for Medicare and Medicaid Services paid $36 million in bonuses to 56,000 physicians for their 2007 reporting, said Dr. Michael T. Rapp, director of the quality measurement and health assessment group at the CMS. The average payment was $600 for 6 months' of data; for 2008 reports, the 1.5% bonus is likely to be around $800 on average, he said.

There will be a number of changes for reporting in 2009. In all, there will be 153 reportable measures, of which 52 are new, and 18 are reportable only through registries. There are seven measures groups: diabetes mellitus, chronic kidney disease, preventive care, coronary artery bypass graft surgery, rheumatoid arthritis, perioperative care, and back pain. Each group contains a number of measures; physicians can report these only as groups.

There will be nine ways for physicians to qualify for the 2% PQRI bonus in 2009, and they also can receive 2% bonus for satisfying requirements under the separate e-prescribing incentive program.

Under last year's Medicare Improvements for Patients and Providers Act, the CMS is required to eventually post on its Web site the names of physicians who satisfactorily report quality measures for 2009. That proposal has been controversial.

PPAC panelist Dr. Frederica Smith, an internist and rheumatologist in Albuquerque, N.M., called the idea a “terrifying concept,” given that it might appear that physicians who were not on the list did not care about quality.

And physicians had many problems complying with the CMS process for reporting measures in 2007, she noted.

Dr. Rapp agreed that the first phase of the program had been frustrating. But “the way it was for 2007 doesn't mean that's the way it will be for 2008,” he said. The agency posted a detailed report on the 2007 experience at its Web site last month (www.cms.hhs.gov/PQRI/Downloads/PQRI2007ReportExperience.pdf

Overall, there were submissions from 109,349 national provider identifier/tax identification numbers with at least one quality data code. Of those, about 93% (101,138) submitted at least one valid code. More than 14 million codes were reported; more than 50% of those (7.3 million) were validly submitted.

There were three major reasons for code nonvalidity: the provider did not adhere to the measure specification; the codes were not submitted with the same claim as the billing and diagnosis code submitted for the procedure; or there was no national provider number (NPI) on the claim.

Many of the submission errors were for patients who did not meet the reporting specifications regarding gender, age, or diagnosis or procedure code for a particular measure. For instance, the PQRI does not accept reports for diabetes measures on patients over age 75, said Dr. Rapp.

CMS plans to rerun reports for providers who did not qualify for the bonus, with the idea that mistakes could have been made and some providers could be found eligible for the bonus on reanalysis. If that is the case, the CMS will issue checks retroactively, he said.

The agency also aims to make some changes to reduce the number of rejected reports. It said it would continue conducting provider education and outreach to ensure physicians understand the specifications for reporting each measure.

The agency also is working with local Medicare carriers to ensure that when claims are split—where the quality codes are separated—they will be “reconnected and counted,” said the agency.

Claims that were submitted to carriers for payment in 2008 without an NPI were automatically rejected. As a result, in the first half of 2008, less than 1% of claims submitted were missing an NPI, said the report. The CMS expects less than 0.5% of PQRI claims to be without an NPI.

Physicians can qualify for the 2% PQRI bonus in 2009 in nine different ways, with an extra 2% for e-prescribing. DR. RAPP

WASHINGTON — Data from the first 6 months of the Physician Quality Reporting Initiative are spurring improvements for the upcoming year, a Medicare official testified at a meeting of the Practicing Physicians Advisory Council.

In the summer of 2008, the Centers for Medicare and Medicaid Services paid $36 million in bonuses to 56,000 physicians for their 2007 reporting, said Dr. Michael T. Rapp, director of the quality measurement and health assessment group at the CMS. The average payment was $600 for 6 months' of data; for 2008 reports, the 1.5% bonus is likely to be around $800 on average, he said.

There will be a number of changes for reporting in 2009. In all, there will be 153 reportable measures, of which 52 are new, and 18 are reportable only through registries. There are seven measures groups: diabetes mellitus, chronic kidney disease, preventive care, coronary artery bypass graft surgery, rheumatoid arthritis, perioperative care, and back pain. Each group contains a number of measures; physicians can report these only as groups.

There will be nine ways for physicians to qualify for the 2% PQRI bonus in 2009, and they also can receive 2% bonus for satisfying requirements under the separate e-prescribing incentive program.

Under last year's Medicare Improvements for Patients and Providers Act, the CMS is required to eventually post on its Web site the names of physicians who satisfactorily report quality measures for 2009. That proposal has been controversial.

PPAC panelist Dr. Frederica Smith, an internist and rheumatologist in Albuquerque, N.M., called the idea a “terrifying concept,” given that it might appear that physicians who were not on the list did not care about quality.

And physicians had many problems complying with the CMS process for reporting measures in 2007, she noted.

Dr. Rapp agreed that the first phase of the program had been frustrating. But “the way it was for 2007 doesn't mean that's the way it will be for 2008,” he said. The agency posted a detailed report on the 2007 experience at its Web site last month (www.cms.hhs.gov/PQRI/Downloads/PQRI2007ReportExperience.pdf

Overall, there were submissions from 109,349 national provider identifier/tax identification numbers with at least one quality data code. Of those, about 93% (101,138) submitted at least one valid code. More than 14 million codes were reported; more than 50% of those (7.3 million) were validly submitted.

There were three major reasons for code nonvalidity: the provider did not adhere to the measure specification; the codes were not submitted with the same claim as the billing and diagnosis code submitted for the procedure; or there was no national provider number (NPI) on the claim.

Many of the submission errors were for patients who did not meet the reporting specifications regarding gender, age, or diagnosis or procedure code for a particular measure. For instance, the PQRI does not accept reports for diabetes measures on patients over age 75, said Dr. Rapp.

CMS plans to rerun reports for providers who did not qualify for the bonus, with the idea that mistakes could have been made and some providers could be found eligible for the bonus on reanalysis. If that is the case, the CMS will issue checks retroactively, he said.

The agency also aims to make some changes to reduce the number of rejected reports. It said it would continue conducting provider education and outreach to ensure physicians understand the specifications for reporting each measure.

The agency also is working with local Medicare carriers to ensure that when claims are split—where the quality codes are separated—they will be “reconnected and counted,” said the agency.

Claims that were submitted to carriers for payment in 2008 without an NPI were automatically rejected. As a result, in the first half of 2008, less than 1% of claims submitted were missing an NPI, said the report. The CMS expects less than 0.5% of PQRI claims to be without an NPI.

Physicians can qualify for the 2% PQRI bonus in 2009 in nine different ways, with an extra 2% for e-prescribing. DR. RAPP

It's Tough Being a Woman

The number of female cardiologists and fellows has doubled since 1996, but women are still vastly underrepresented and likely to report discrimination and difficulties because of family responsibilities, according to a survey commissioned by the American College of Cardiology's Women in Cardiology Council. Despite equal numbers of male and female medical school graduates, women account for fewer than 20% of cardiologists. The survey was initially conducted online in 1996 and repeated in 2006. In the latest version, 1,595 women and 1,950 age-matched male colleagues responded. Women were less likely to describe themselves as interventional cardiologists (11%, compared with 29% of male colleagues), and were more likely to practice in an academic setting. Marriage and family life seemed to be problematic for female cardiologists: They were less likely to be married (73% vs. 91% of men) and more likely to say that family responsibilities had a negative effect on ability to work (40% vs. 22% of men). In all, 69% of women said that they had faced discrimination, compared with only 22% of men. These figures were relatively unchanged since 1996. The new results were published in the Journal of the American College of Cardiology (2008;52:2215–26).

$60 Billion for CV Hospitalizations

The cost of treating patients with cardiovascular disease in hospitals was close to $60 billion in 2006, which was an almost 40% increase from the previous major study of the costs in 1997, according to the Agency for Healthcare Research and Quality. Most of the increase occurred between 1997 and 2003, as there has been a slight decline in cases and slower increase in cost per case since 2003, said the federal agency. The largest annual cost increase—10% a year—was for treating chest pain, which hit $3.9 billion in 2006. Cardiovascular disease treatments accounted for 18% of what hospitals spent on patient care in 2005, said the AHRQ.

Xience YouTube Ads Attacked

The Prescription Project has petitioned the Food and Drug Administration to require medical device makers, including Abbott Laboratories, to remove ads promoting their products on YouTube. The ads violate the FDA's direct-to-consumer rules because they do not include brief statements about the products' use, side effects, and contraindications, said the Boston-based health-industry watchdog. Abbott has posted four videos promoting its Xience V drug-coated stent. The petition also asks the agency to review online ads and videos, and to clarify how FDA rules apply to Internet advertising. Abbott said in a statement that it had provided links to the pertinent information, and that going forward, it would embed the side effect and use data in the videos.

Incentive Exception May Reappear

Under current Medicare and Medicaid rules governing patient referrals, physicians can't share incentive payments for quality improvement. But a proposal to make an exception may reappear, a Centers for Medicare and Medicaid Services official told the Practicing Physicians Advisory Council (PPAC) in December. The CMS proposed an exception under rules governing physician payment for 2009, but opposition—mainly from medical device manufacturers—killed it, said Lisa Ohrin, acting director of the division of technical payment policy at the CMS's Center for Medicare Management. She said, however, that allowing incentive payments is a priority for the CMS, so the agency will again propose allowing physicians to share the payments.

RAC Program Heavily Criticized

Medicare's effort to recover overpayments made to physicians and hospitals and to make good on underpayments—dubbed the Recovery Audit Contractor program—was lambasted by members of the PPAC. The program is currently on hold while the Government Accountability Office studies whether CMS has properly implemented it. During a demonstration project, however, RAC auditors found $1 billion in improper payments among $317 billion worth of claims, a CMS official reported to PPAC. As of July 2008, about 7% of those determinations were overturned on appeal. Once the program is restarted—expected by February—there will be limits on the number of years of claims an auditor can examine and how many records can be requested from practices of various sizes. Even with those plans, PPAC panelists recommended further limits.

Much Psoriasis Goes Undiagnosed

Current estimates are that 5 million adults have been diagnosed with psoriasis. But an analysis of the National Health and Nutrition Examination Survey for 2003–2004 published online Nov. 18 in the Journal of the American Academy of Dermatology indicates that between 600,000 and 3.6 million more have active disease that hasn't been diagnosed or treated. In a separate report, a panel of cardiologists and dermatologists said that because psoriasis is a risk factor for cardiovascular disease, patients with moderate to severe psoriasis should be told they are at risk and screened. The panel's consensus statement, published online in the American Journal of Cardiology, made 13 major recommendations on evaluating and treating the psoriasis-cardiovascular disease connection.

It's Tough Being a Woman

The number of female cardiologists and fellows has doubled since 1996, but women are still vastly underrepresented and likely to report discrimination and difficulties because of family responsibilities, according to a survey commissioned by the American College of Cardiology's Women in Cardiology Council. Despite equal numbers of male and female medical school graduates, women account for fewer than 20% of cardiologists. The survey was initially conducted online in 1996 and repeated in 2006. In the latest version, 1,595 women and 1,950 age-matched male colleagues responded. Women were less likely to describe themselves as interventional cardiologists (11%, compared with 29% of male colleagues), and were more likely to practice in an academic setting. Marriage and family life seemed to be problematic for female cardiologists: They were less likely to be married (73% vs. 91% of men) and more likely to say that family responsibilities had a negative effect on ability to work (40% vs. 22% of men). In all, 69% of women said that they had faced discrimination, compared with only 22% of men. These figures were relatively unchanged since 1996. The new results were published in the Journal of the American College of Cardiology (2008;52:2215–26).

$60 Billion for CV Hospitalizations

The cost of treating patients with cardiovascular disease in hospitals was close to $60 billion in 2006, which was an almost 40% increase from the previous major study of the costs in 1997, according to the Agency for Healthcare Research and Quality. Most of the increase occurred between 1997 and 2003, as there has been a slight decline in cases and slower increase in cost per case since 2003, said the federal agency. The largest annual cost increase—10% a year—was for treating chest pain, which hit $3.9 billion in 2006. Cardiovascular disease treatments accounted for 18% of what hospitals spent on patient care in 2005, said the AHRQ.

Xience YouTube Ads Attacked

The Prescription Project has petitioned the Food and Drug Administration to require medical device makers, including Abbott Laboratories, to remove ads promoting their products on YouTube. The ads violate the FDA's direct-to-consumer rules because they do not include brief statements about the products' use, side effects, and contraindications, said the Boston-based health-industry watchdog. Abbott has posted four videos promoting its Xience V drug-coated stent. The petition also asks the agency to review online ads and videos, and to clarify how FDA rules apply to Internet advertising. Abbott said in a statement that it had provided links to the pertinent information, and that going forward, it would embed the side effect and use data in the videos.

Incentive Exception May Reappear

Under current Medicare and Medicaid rules governing patient referrals, physicians can't share incentive payments for quality improvement. But a proposal to make an exception may reappear, a Centers for Medicare and Medicaid Services official told the Practicing Physicians Advisory Council (PPAC) in December. The CMS proposed an exception under rules governing physician payment for 2009, but opposition—mainly from medical device manufacturers—killed it, said Lisa Ohrin, acting director of the division of technical payment policy at the CMS's Center for Medicare Management. She said, however, that allowing incentive payments is a priority for the CMS, so the agency will again propose allowing physicians to share the payments.

RAC Program Heavily Criticized

Medicare's effort to recover overpayments made to physicians and hospitals and to make good on underpayments—dubbed the Recovery Audit Contractor program—was lambasted by members of the PPAC. The program is currently on hold while the Government Accountability Office studies whether CMS has properly implemented it. During a demonstration project, however, RAC auditors found $1 billion in improper payments among $317 billion worth of claims, a CMS official reported to PPAC. As of July 2008, about 7% of those determinations were overturned on appeal. Once the program is restarted—expected by February—there will be limits on the number of years of claims an auditor can examine and how many records can be requested from practices of various sizes. Even with those plans, PPAC panelists recommended further limits.

Much Psoriasis Goes Undiagnosed

Current estimates are that 5 million adults have been diagnosed with psoriasis. But an analysis of the National Health and Nutrition Examination Survey for 2003–2004 published online Nov. 18 in the Journal of the American Academy of Dermatology indicates that between 600,000 and 3.6 million more have active disease that hasn't been diagnosed or treated. In a separate report, a panel of cardiologists and dermatologists said that because psoriasis is a risk factor for cardiovascular disease, patients with moderate to severe psoriasis should be told they are at risk and screened. The panel's consensus statement, published online in the American Journal of Cardiology, made 13 major recommendations on evaluating and treating the psoriasis-cardiovascular disease connection.

It's Tough Being a Woman

The number of female cardiologists and fellows has doubled since 1996, but women are still vastly underrepresented and likely to report discrimination and difficulties because of family responsibilities, according to a survey commissioned by the American College of Cardiology's Women in Cardiology Council. Despite equal numbers of male and female medical school graduates, women account for fewer than 20% of cardiologists. The survey was initially conducted online in 1996 and repeated in 2006. In the latest version, 1,595 women and 1,950 age-matched male colleagues responded. Women were less likely to describe themselves as interventional cardiologists (11%, compared with 29% of male colleagues), and were more likely to practice in an academic setting. Marriage and family life seemed to be problematic for female cardiologists: They were less likely to be married (73% vs. 91% of men) and more likely to say that family responsibilities had a negative effect on ability to work (40% vs. 22% of men). In all, 69% of women said that they had faced discrimination, compared with only 22% of men. These figures were relatively unchanged since 1996. The new results were published in the Journal of the American College of Cardiology (2008;52:2215–26).

$60 Billion for CV Hospitalizations

The cost of treating patients with cardiovascular disease in hospitals was close to $60 billion in 2006, which was an almost 40% increase from the previous major study of the costs in 1997, according to the Agency for Healthcare Research and Quality. Most of the increase occurred between 1997 and 2003, as there has been a slight decline in cases and slower increase in cost per case since 2003, said the federal agency. The largest annual cost increase—10% a year—was for treating chest pain, which hit $3.9 billion in 2006. Cardiovascular disease treatments accounted for 18% of what hospitals spent on patient care in 2005, said the AHRQ.

Xience YouTube Ads Attacked

The Prescription Project has petitioned the Food and Drug Administration to require medical device makers, including Abbott Laboratories, to remove ads promoting their products on YouTube. The ads violate the FDA's direct-to-consumer rules because they do not include brief statements about the products' use, side effects, and contraindications, said the Boston-based health-industry watchdog. Abbott has posted four videos promoting its Xience V drug-coated stent. The petition also asks the agency to review online ads and videos, and to clarify how FDA rules apply to Internet advertising. Abbott said in a statement that it had provided links to the pertinent information, and that going forward, it would embed the side effect and use data in the videos.

Incentive Exception May Reappear

Under current Medicare and Medicaid rules governing patient referrals, physicians can't share incentive payments for quality improvement. But a proposal to make an exception may reappear, a Centers for Medicare and Medicaid Services official told the Practicing Physicians Advisory Council (PPAC) in December. The CMS proposed an exception under rules governing physician payment for 2009, but opposition—mainly from medical device manufacturers—killed it, said Lisa Ohrin, acting director of the division of technical payment policy at the CMS's Center for Medicare Management. She said, however, that allowing incentive payments is a priority for the CMS, so the agency will again propose allowing physicians to share the payments.

RAC Program Heavily Criticized

Medicare's effort to recover overpayments made to physicians and hospitals and to make good on underpayments—dubbed the Recovery Audit Contractor program—was lambasted by members of the PPAC. The program is currently on hold while the Government Accountability Office studies whether CMS has properly implemented it. During a demonstration project, however, RAC auditors found $1 billion in improper payments among $317 billion worth of claims, a CMS official reported to PPAC. As of July 2008, about 7% of those determinations were overturned on appeal. Once the program is restarted—expected by February—there will be limits on the number of years of claims an auditor can examine and how many records can be requested from practices of various sizes. Even with those plans, PPAC panelists recommended further limits.

Much Psoriasis Goes Undiagnosed

Current estimates are that 5 million adults have been diagnosed with psoriasis. But an analysis of the National Health and Nutrition Examination Survey for 2003–2004 published online Nov. 18 in the Journal of the American Academy of Dermatology indicates that between 600,000 and 3.6 million more have active disease that hasn't been diagnosed or treated. In a separate report, a panel of cardiologists and dermatologists said that because psoriasis is a risk factor for cardiovascular disease, patients with moderate to severe psoriasis should be told they are at risk and screened. The panel's consensus statement, published online in the American Journal of Cardiology, made 13 major recommendations on evaluating and treating the psoriasis-cardiovascular disease connection.

WASHINGTON — Data from the first 6 months of the Physician Quality Reporting Initiative (PQRI) are spurring improvements for the upcoming year, a Medicare official testified at a meeting of the Practicing Physicians Advisory Council.

In the summer of 2008, the CMS paid $36 million in bonuses to 56,000 physicians for their 2007 reporting, said Dr. Michael T. Rapp, director of the quality measurement and health assessment group at the Centers for Medicare and Medicaid Services. The average payment was $600 for 6 months' of data; for 2008 reports, the 1.5% bonus is likely to be around $800 on average, he said.

There will be a number of changes for reporting in 2009. In all, there will be 153 reportable measures. Fifty-two are new, and 18 are reportable only through registries. There are seven measures groups: diabetes mellitus, chronic kidney disease, preventive care, coronary artery bypass graft surgery, rheumatoid arthritis, perioperative care, and back pain. Each group contains a number of measures; physicians can report these only as groups.

There will be nine different ways physicians can qualify for the 2% PQRI bonus in 2009, said Dr. Rapp. Physicians also can receive an additional 2% bonus for satisfying requirements under the separate e-prescribing incentive program.

Under last year's Medicare Improvements for Patients and Providers Act, the CMS is required to eventually post on its Web site the names of physicians who satisfactorily report quality measures for 2009. That proposal has been controversial.

PPAC panelist Dr. Frederica Smith, an internist and rheumatologist in Albuquerque, N.M., called the idea a “terrifying concept,” given that it might appear that physicians who were not on the list did not care about quality.

And physicians had many problems complying with the CMS process for reporting measures in 2007, she noted.

Dr. Rapp agreed that the first phase of the program had been frustrating. But “the way it was for 2007 doesn't mean that's the way it will be for 2008,” he said. The agency has posted a detailed report on the 2007 experience at its Web site (www.cms.hhs.gov/PQRI/Downloads/PQRI2007ReportExperience.pdf

Overall, there were submissions from 109,349 national provider identifier/tax identification numbers with at least one quality data code. Of those, about 93% (101,138) submitted at least one valid code. More than 14 million codes were reported; more than 50% of those (7.3 million) were validly submitted.

There were three major reasons for code nonvalidity: The provider did not adhere to the measure specification; the codes were not submitted with the same claim as the billing and diagnosis code submitted for the procedure; or there was no national provider identification (NPI) number on the claim.

Many of the submission errors were for patients who did not meet the reporting specifications regarding gender, age, or diagnosis or procedure code for a particular measure. For instance, the PQRI does not accept reports for diabetes measures on patients over age 75, said Dr. Rapp.

He said that the CMS plans to rerun reports for providers who did not qualify for the bonus, with the idea that mistakes could have been made and some providers could be found eligible for the bonus on reanalysis. If that is the case, the CMS will issue checks retroactively, he said.

The agency also aims to make some changes that will hopefully reduce the number of rejected reports going forward. The CMS said that it would continue to conduct provider education and outreach to make sure that physicians understand the specifications for reporting each measure.

The agency also is working with local Medicare carriers to ensure that when claims get split—where the quality codes are separated—they will be “reconnected and counted,” according to the agency.

Also, claims that were submitted to carriers for payment in 2008 without an NPI were automatically rejected. As a result, in the first half of 2008, less than 1% of claims submitted under the PQRI program were missing an NPI, according to the agency's report. The CMS expects less than 0.5% of PQRI claims to be without an NPI.

Dr. Rapp said that the agency would make it easier to get PQRI reports for 2008 and that they would be more meaningful to providers. The feedback reports are being redesigned and will better explain what percentage of quality codes are accepted, indicate why the provider did not earn an incentive, and provide information on how well they performed on each measure.

The PPAC panel recommended that the CMS find a way to make the quality reports available to physicians on a real-time basis so that they can perform more timely adjustments of their data collection and reporting.

WASHINGTON — Data from the first 6 months of the Physician Quality Reporting Initiative (PQRI) are spurring improvements for the upcoming year, a Medicare official testified at a meeting of the Practicing Physicians Advisory Council.

In the summer of 2008, the CMS paid $36 million in bonuses to 56,000 physicians for their 2007 reporting, said Dr. Michael T. Rapp, director of the quality measurement and health assessment group at the Centers for Medicare and Medicaid Services. The average payment was $600 for 6 months' of data; for 2008 reports, the 1.5% bonus is likely to be around $800 on average, he said.

There will be a number of changes for reporting in 2009. In all, there will be 153 reportable measures. Fifty-two are new, and 18 are reportable only through registries. There are seven measures groups: diabetes mellitus, chronic kidney disease, preventive care, coronary artery bypass graft surgery, rheumatoid arthritis, perioperative care, and back pain. Each group contains a number of measures; physicians can report these only as groups.

There will be nine different ways physicians can qualify for the 2% PQRI bonus in 2009, said Dr. Rapp. Physicians also can receive an additional 2% bonus for satisfying requirements under the separate e-prescribing incentive program.

Under last year's Medicare Improvements for Patients and Providers Act, the CMS is required to eventually post on its Web site the names of physicians who satisfactorily report quality measures for 2009. That proposal has been controversial.

PPAC panelist Dr. Frederica Smith, an internist and rheumatologist in Albuquerque, N.M., called the idea a “terrifying concept,” given that it might appear that physicians who were not on the list did not care about quality.

And physicians had many problems complying with the CMS process for reporting measures in 2007, she noted.

Dr. Rapp agreed that the first phase of the program had been frustrating. But “the way it was for 2007 doesn't mean that's the way it will be for 2008,” he said. The agency has posted a detailed report on the 2007 experience at its Web site (www.cms.hhs.gov/PQRI/Downloads/PQRI2007ReportExperience.pdf

Overall, there were submissions from 109,349 national provider identifier/tax identification numbers with at least one quality data code. Of those, about 93% (101,138) submitted at least one valid code. More than 14 million codes were reported; more than 50% of those (7.3 million) were validly submitted.

There were three major reasons for code nonvalidity: The provider did not adhere to the measure specification; the codes were not submitted with the same claim as the billing and diagnosis code submitted for the procedure; or there was no national provider identification (NPI) number on the claim.

Many of the submission errors were for patients who did not meet the reporting specifications regarding gender, age, or diagnosis or procedure code for a particular measure. For instance, the PQRI does not accept reports for diabetes measures on patients over age 75, said Dr. Rapp.

He said that the CMS plans to rerun reports for providers who did not qualify for the bonus, with the idea that mistakes could have been made and some providers could be found eligible for the bonus on reanalysis. If that is the case, the CMS will issue checks retroactively, he said.

The agency also aims to make some changes that will hopefully reduce the number of rejected reports going forward. The CMS said that it would continue to conduct provider education and outreach to make sure that physicians understand the specifications for reporting each measure.

The agency also is working with local Medicare carriers to ensure that when claims get split—where the quality codes are separated—they will be “reconnected and counted,” according to the agency.

Also, claims that were submitted to carriers for payment in 2008 without an NPI were automatically rejected. As a result, in the first half of 2008, less than 1% of claims submitted under the PQRI program were missing an NPI, according to the agency's report. The CMS expects less than 0.5% of PQRI claims to be without an NPI.

Dr. Rapp said that the agency would make it easier to get PQRI reports for 2008 and that they would be more meaningful to providers. The feedback reports are being redesigned and will better explain what percentage of quality codes are accepted, indicate why the provider did not earn an incentive, and provide information on how well they performed on each measure.

The PPAC panel recommended that the CMS find a way to make the quality reports available to physicians on a real-time basis so that they can perform more timely adjustments of their data collection and reporting.

WASHINGTON — Data from the first 6 months of the Physician Quality Reporting Initiative (PQRI) are spurring improvements for the upcoming year, a Medicare official testified at a meeting of the Practicing Physicians Advisory Council.

In the summer of 2008, the CMS paid $36 million in bonuses to 56,000 physicians for their 2007 reporting, said Dr. Michael T. Rapp, director of the quality measurement and health assessment group at the Centers for Medicare and Medicaid Services. The average payment was $600 for 6 months' of data; for 2008 reports, the 1.5% bonus is likely to be around $800 on average, he said.

There will be a number of changes for reporting in 2009. In all, there will be 153 reportable measures. Fifty-two are new, and 18 are reportable only through registries. There are seven measures groups: diabetes mellitus, chronic kidney disease, preventive care, coronary artery bypass graft surgery, rheumatoid arthritis, perioperative care, and back pain. Each group contains a number of measures; physicians can report these only as groups.

There will be nine different ways physicians can qualify for the 2% PQRI bonus in 2009, said Dr. Rapp. Physicians also can receive an additional 2% bonus for satisfying requirements under the separate e-prescribing incentive program.

Under last year's Medicare Improvements for Patients and Providers Act, the CMS is required to eventually post on its Web site the names of physicians who satisfactorily report quality measures for 2009. That proposal has been controversial.

PPAC panelist Dr. Frederica Smith, an internist and rheumatologist in Albuquerque, N.M., called the idea a “terrifying concept,” given that it might appear that physicians who were not on the list did not care about quality.

And physicians had many problems complying with the CMS process for reporting measures in 2007, she noted.

Dr. Rapp agreed that the first phase of the program had been frustrating. But “the way it was for 2007 doesn't mean that's the way it will be for 2008,” he said. The agency has posted a detailed report on the 2007 experience at its Web site (www.cms.hhs.gov/PQRI/Downloads/PQRI2007ReportExperience.pdf

Overall, there were submissions from 109,349 national provider identifier/tax identification numbers with at least one quality data code. Of those, about 93% (101,138) submitted at least one valid code. More than 14 million codes were reported; more than 50% of those (7.3 million) were validly submitted.

There were three major reasons for code nonvalidity: The provider did not adhere to the measure specification; the codes were not submitted with the same claim as the billing and diagnosis code submitted for the procedure; or there was no national provider identification (NPI) number on the claim.

Many of the submission errors were for patients who did not meet the reporting specifications regarding gender, age, or diagnosis or procedure code for a particular measure. For instance, the PQRI does not accept reports for diabetes measures on patients over age 75, said Dr. Rapp.

He said that the CMS plans to rerun reports for providers who did not qualify for the bonus, with the idea that mistakes could have been made and some providers could be found eligible for the bonus on reanalysis. If that is the case, the CMS will issue checks retroactively, he said.

The agency also aims to make some changes that will hopefully reduce the number of rejected reports going forward. The CMS said that it would continue to conduct provider education and outreach to make sure that physicians understand the specifications for reporting each measure.

The agency also is working with local Medicare carriers to ensure that when claims get split—where the quality codes are separated—they will be “reconnected and counted,” according to the agency.

Also, claims that were submitted to carriers for payment in 2008 without an NPI were automatically rejected. As a result, in the first half of 2008, less than 1% of claims submitted under the PQRI program were missing an NPI, according to the agency's report. The CMS expects less than 0.5% of PQRI claims to be without an NPI.

Dr. Rapp said that the agency would make it easier to get PQRI reports for 2008 and that they would be more meaningful to providers. The feedback reports are being redesigned and will better explain what percentage of quality codes are accepted, indicate why the provider did not earn an incentive, and provide information on how well they performed on each measure.

The PPAC panel recommended that the CMS find a way to make the quality reports available to physicians on a real-time basis so that they can perform more timely adjustments of their data collection and reporting.

WASHINGTON — Data from the first 6 months of the Physician Quality Reporting Initiative (PQRI) are spurring improvements for the upcoming year, a Medicare official testified at a meeting of the Practicing Physicians Advisory Council.

In the summer of 2008, the CMS paid $36 million in bonuses to 56,000 physicians for their 2007 reporting, said Dr. Michael T. Rapp, director of the quality measurement and health assessment group at the Centers for Medicare and Medicaid Services. The average payment was $600 for 6 months' of data; for 2008 reports, the 1.5% bonus is likely to be around $800 on average, he said.

There will be a number of changes for reporting in 2009. In all, there will be 153 reportable measures. Fifty-two are new, and 18 are reportable only through registries.

There are seven measures groups: diabetes mellitus, chronic kidney disease, preventive care, coronary artery bypass graft surgery, rheumatoid arthritis, perioperative care, and back pain. Each group contains a number of measures; physicians can report these only as groups.

There will be nine different ways physicians can qualify for the 2% PQRI bonus in 2009, said Dr. Rapp. Physicians also can receive an additional 2% bonus for satisfying requirements under the separate e-prescribing incentive program.

Under last year's Medicare Improvements for Patients and Providers Act, the CMS is required to eventually post on its Web site the names of physicians who satisfactorily report quality measures for 2009. That proposal has been controversial.

PPAC panelist Dr. Frederica Smith, an internist and rheumatologist in Albuquerque, N.M., called the idea a “terrifying concept,” given that it might appear that physicians who were not on the list did not care about quality.

And physicians had many problems complying with the CMS process for reporting measures in 2007, she noted.

Dr. Rapp agreed that the first phase of the program had been frustrating. But “the way it was for 2007 doesn't mean that's the way it will be for 2008,” he said. The agency posted a report on the 2007 experience at its Web site last month (www.cms.hhs.gov/PQRI/Downloads/PQRI2007ReportExperience.pdf

Overall, there were submissions from 109,349 national provider identifier/tax identification numbers with at least one quality data code. Of those, about 93% (101,138) submitted at least one valid code. More than 14 million codes were reported; more than 50% of those (7.3 million) were validly submitted.

There were three major reasons for code nonvalidity: the provider did not adhere to the measure specification; the codes were not submitted with the same claim as the billing and diagnosis code submitted for the procedure; or there was no national provider number (NPI) on the claim.

Many of the submission errors were for patients who did not meet the reporting specifications regarding gender, age, or diagnosis or procedure code for a particular measure. For instance, the PQRI does not accept reports for diabetes measures on patients over age 75, said Dr. Rapp.

He said the CMS plans to rerun reports for providers who did not qualify for the bonus, with the idea that mistakes could have been made and some providers could be found eligible for the bonus on reanalysis. If that is the case, the CMS will issue checks retroactively.

The agency also aims to make some changes that will hopefully reduce the number of rejected reports going forward. The CMS said that it would continue to conduct provider education and outreach to make sure that physicians understand the specifications for reporting each measure.

It also is working with local Medicare carriers to ensure that when claims get split—where the quality codes are separated—they will be “reconnected and counted,” said the agency.

Also, claims that were submitted to carriers for payment in 2008 without an NPI were automatically rejected. As a result, in the first half of 2008, less than 1% of claims submitted under the PQRI program were missing an NPI, according to the agency's report. The CMS expects less than 0.5% of PQRI claims to be without an NPI.

Dr. Rapp said that the agency would make it easier to get PQRI reports for 2008 and that they would be more meaningful to providers. The feedback reports are being redesigned and will better explain what percentage of quality codes are accepted, indicate why the provider did not earn an incentive, and provide information on how well they performed on each measure.

The PPAC panel recommended CMS find a way to make the quality reports available to physicians on a real-time basis so that they can perform more timely adjustments of their data collection and reporting. The CMS should also work toward greater transparency with the PQRI program, including measurement development, the panel said.

'The way it was for 2007 doesn't mean that's the way it will be for 2008.' DR. RAPP

WASHINGTON — Data from the first 6 months of the Physician Quality Reporting Initiative (PQRI) are spurring improvements for the upcoming year, a Medicare official testified at a meeting of the Practicing Physicians Advisory Council.

In the summer of 2008, the CMS paid $36 million in bonuses to 56,000 physicians for their 2007 reporting, said Dr. Michael T. Rapp, director of the quality measurement and health assessment group at the Centers for Medicare and Medicaid Services. The average payment was $600 for 6 months' of data; for 2008 reports, the 1.5% bonus is likely to be around $800 on average, he said.

There will be a number of changes for reporting in 2009. In all, there will be 153 reportable measures. Fifty-two are new, and 18 are reportable only through registries.

There are seven measures groups: diabetes mellitus, chronic kidney disease, preventive care, coronary artery bypass graft surgery, rheumatoid arthritis, perioperative care, and back pain. Each group contains a number of measures; physicians can report these only as groups.

There will be nine different ways physicians can qualify for the 2% PQRI bonus in 2009, said Dr. Rapp. Physicians also can receive an additional 2% bonus for satisfying requirements under the separate e-prescribing incentive program.

Under last year's Medicare Improvements for Patients and Providers Act, the CMS is required to eventually post on its Web site the names of physicians who satisfactorily report quality measures for 2009. That proposal has been controversial.

PPAC panelist Dr. Frederica Smith, an internist and rheumatologist in Albuquerque, N.M., called the idea a “terrifying concept,” given that it might appear that physicians who were not on the list did not care about quality.

And physicians had many problems complying with the CMS process for reporting measures in 2007, she noted.

Dr. Rapp agreed that the first phase of the program had been frustrating. But “the way it was for 2007 doesn't mean that's the way it will be for 2008,” he said. The agency posted a report on the 2007 experience at its Web site last month (www.cms.hhs.gov/PQRI/Downloads/PQRI2007ReportExperience.pdf

Overall, there were submissions from 109,349 national provider identifier/tax identification numbers with at least one quality data code. Of those, about 93% (101,138) submitted at least one valid code. More than 14 million codes were reported; more than 50% of those (7.3 million) were validly submitted.

There were three major reasons for code nonvalidity: the provider did not adhere to the measure specification; the codes were not submitted with the same claim as the billing and diagnosis code submitted for the procedure; or there was no national provider number (NPI) on the claim.

Many of the submission errors were for patients who did not meet the reporting specifications regarding gender, age, or diagnosis or procedure code for a particular measure. For instance, the PQRI does not accept reports for diabetes measures on patients over age 75, said Dr. Rapp.

He said the CMS plans to rerun reports for providers who did not qualify for the bonus, with the idea that mistakes could have been made and some providers could be found eligible for the bonus on reanalysis. If that is the case, the CMS will issue checks retroactively.

The agency also aims to make some changes that will hopefully reduce the number of rejected reports going forward. The CMS said that it would continue to conduct provider education and outreach to make sure that physicians understand the specifications for reporting each measure.

It also is working with local Medicare carriers to ensure that when claims get split—where the quality codes are separated—they will be “reconnected and counted,” said the agency.

Also, claims that were submitted to carriers for payment in 2008 without an NPI were automatically rejected. As a result, in the first half of 2008, less than 1% of claims submitted under the PQRI program were missing an NPI, according to the agency's report. The CMS expects less than 0.5% of PQRI claims to be without an NPI.

Dr. Rapp said that the agency would make it easier to get PQRI reports for 2008 and that they would be more meaningful to providers. The feedback reports are being redesigned and will better explain what percentage of quality codes are accepted, indicate why the provider did not earn an incentive, and provide information on how well they performed on each measure.

The PPAC panel recommended CMS find a way to make the quality reports available to physicians on a real-time basis so that they can perform more timely adjustments of their data collection and reporting. The CMS should also work toward greater transparency with the PQRI program, including measurement development, the panel said.

'The way it was for 2007 doesn't mean that's the way it will be for 2008.' DR. RAPP

WASHINGTON — Data from the first 6 months of the Physician Quality Reporting Initiative (PQRI) are spurring improvements for the upcoming year, a Medicare official testified at a meeting of the Practicing Physicians Advisory Council.

In the summer of 2008, the CMS paid $36 million in bonuses to 56,000 physicians for their 2007 reporting, said Dr. Michael T. Rapp, director of the quality measurement and health assessment group at the Centers for Medicare and Medicaid Services. The average payment was $600 for 6 months' of data; for 2008 reports, the 1.5% bonus is likely to be around $800 on average, he said.

There will be a number of changes for reporting in 2009. In all, there will be 153 reportable measures. Fifty-two are new, and 18 are reportable only through registries.

There are seven measures groups: diabetes mellitus, chronic kidney disease, preventive care, coronary artery bypass graft surgery, rheumatoid arthritis, perioperative care, and back pain. Each group contains a number of measures; physicians can report these only as groups.

There will be nine different ways physicians can qualify for the 2% PQRI bonus in 2009, said Dr. Rapp. Physicians also can receive an additional 2% bonus for satisfying requirements under the separate e-prescribing incentive program.

Under last year's Medicare Improvements for Patients and Providers Act, the CMS is required to eventually post on its Web site the names of physicians who satisfactorily report quality measures for 2009. That proposal has been controversial.

PPAC panelist Dr. Frederica Smith, an internist and rheumatologist in Albuquerque, N.M., called the idea a “terrifying concept,” given that it might appear that physicians who were not on the list did not care about quality.

And physicians had many problems complying with the CMS process for reporting measures in 2007, she noted.

Dr. Rapp agreed that the first phase of the program had been frustrating. But “the way it was for 2007 doesn't mean that's the way it will be for 2008,” he said. The agency posted a report on the 2007 experience at its Web site last month (www.cms.hhs.gov/PQRI/Downloads/PQRI2007ReportExperience.pdf

Overall, there were submissions from 109,349 national provider identifier/tax identification numbers with at least one quality data code. Of those, about 93% (101,138) submitted at least one valid code. More than 14 million codes were reported; more than 50% of those (7.3 million) were validly submitted.

There were three major reasons for code nonvalidity: the provider did not adhere to the measure specification; the codes were not submitted with the same claim as the billing and diagnosis code submitted for the procedure; or there was no national provider number (NPI) on the claim.

Many of the submission errors were for patients who did not meet the reporting specifications regarding gender, age, or diagnosis or procedure code for a particular measure. For instance, the PQRI does not accept reports for diabetes measures on patients over age 75, said Dr. Rapp.

He said the CMS plans to rerun reports for providers who did not qualify for the bonus, with the idea that mistakes could have been made and some providers could be found eligible for the bonus on reanalysis. If that is the case, the CMS will issue checks retroactively.

The agency also aims to make some changes that will hopefully reduce the number of rejected reports going forward. The CMS said that it would continue to conduct provider education and outreach to make sure that physicians understand the specifications for reporting each measure.

It also is working with local Medicare carriers to ensure that when claims get split—where the quality codes are separated—they will be “reconnected and counted,” said the agency.

Also, claims that were submitted to carriers for payment in 2008 without an NPI were automatically rejected. As a result, in the first half of 2008, less than 1% of claims submitted under the PQRI program were missing an NPI, according to the agency's report. The CMS expects less than 0.5% of PQRI claims to be without an NPI.

Dr. Rapp said that the agency would make it easier to get PQRI reports for 2008 and that they would be more meaningful to providers. The feedback reports are being redesigned and will better explain what percentage of quality codes are accepted, indicate why the provider did not earn an incentive, and provide information on how well they performed on each measure.

The PPAC panel recommended CMS find a way to make the quality reports available to physicians on a real-time basis so that they can perform more timely adjustments of their data collection and reporting. The CMS should also work toward greater transparency with the PQRI program, including measurement development, the panel said.

'The way it was for 2007 doesn't mean that's the way it will be for 2008.' DR. RAPP

WASHINGTON — Internet-based brief screening and self-help interventions for addictions provide an option for people who otherwise might not make it in to see a clinician in person, according to an addiction specialist who has been piloting such programs for alcohol and tobacco abuse.

Studies have shown that problem drinkers and gamblers, for instance, have ready access to the Internet and may be more likely to first seek help online rather than in a face-to-face encounter, said John A. Cunningham, Ph.D., a senior scientist at the Centre for Addiction and Mental Health, teaching hospital affiliated with the University of Toronto.

Dr. Cunningham, who spoke at the Association for Medical Education and Research in Substance Abuse, has worked as a consultant with Toronto-based V-CC Systems Inc., a company that develops and supports community-based interactive disease management programs.

One such tool can be found at www.checkyourdrinking.net

V-CC Systems has tried to evaluate whether using the screen changes behavior. The company recruited study participants through random dialing, from which 185 people were selected. They were contacted 3 and 6 months after taking the brief screen. It was determined that those who had access to the Web site had reduced the number of drinks by 6 to 7 a week. It seemed that the screen was effective for people who had a drinking problem, but not as much so for other [addictions], said Dr. Cunningham.

WASHINGTON — Internet-based brief screening and self-help interventions for addictions provide an option for people who otherwise might not make it in to see a clinician in person, according to an addiction specialist who has been piloting such programs for alcohol and tobacco abuse.

Studies have shown that problem drinkers and gamblers, for instance, have ready access to the Internet and may be more likely to first seek help online rather than in a face-to-face encounter, said John A. Cunningham, Ph.D., a senior scientist at the Centre for Addiction and Mental Health, teaching hospital affiliated with the University of Toronto.

Dr. Cunningham, who spoke at the Association for Medical Education and Research in Substance Abuse, has worked as a consultant with Toronto-based V-CC Systems Inc., a company that develops and supports community-based interactive disease management programs.

One such tool can be found at www.checkyourdrinking.net

V-CC Systems has tried to evaluate whether using the screen changes behavior. The company recruited study participants through random dialing, from which 185 people were selected. They were contacted 3 and 6 months after taking the brief screen. It was determined that those who had access to the Web site had reduced the number of drinks by 6 to 7 a week. It seemed that the screen was effective for people who had a drinking problem, but not as much so for other [addictions], said Dr. Cunningham.

WASHINGTON — Internet-based brief screening and self-help interventions for addictions provide an option for people who otherwise might not make it in to see a clinician in person, according to an addiction specialist who has been piloting such programs for alcohol and tobacco abuse.

Studies have shown that problem drinkers and gamblers, for instance, have ready access to the Internet and may be more likely to first seek help online rather than in a face-to-face encounter, said John A. Cunningham, Ph.D., a senior scientist at the Centre for Addiction and Mental Health, teaching hospital affiliated with the University of Toronto.

Dr. Cunningham, who spoke at the Association for Medical Education and Research in Substance Abuse, has worked as a consultant with Toronto-based V-CC Systems Inc., a company that develops and supports community-based interactive disease management programs.

One such tool can be found at www.checkyourdrinking.net

V-CC Systems has tried to evaluate whether using the screen changes behavior. The company recruited study participants through random dialing, from which 185 people were selected. They were contacted 3 and 6 months after taking the brief screen. It was determined that those who had access to the Web site had reduced the number of drinks by 6 to 7 a week. It seemed that the screen was effective for people who had a drinking problem, but not as much so for other [addictions], said Dr. Cunningham.

The Food and Drug Administration is considering changing the warning labels on indoor tanning beds to be shorter and more forceful, according to a report that the agency submitted to Congress and posted on its Web site in early December.

Congress required the FDA to take a closer look at the warning labels as part of the FDA Amendments Act of 2007. Legislators were concerned that the current labeling does not effectively communicate the risks of skin and eye damage and skin cancer. The FDA missed the statutorily imposed September deadline, but did fulfill Congress' request to study the issue.

Currently, every “sunlamp product” is required to carry the warning paragraph established by the FDA in 1985. It contains various statements about the potential for damage, the need to wear protective eyewear (which is bolded), and a caution that a physician should be consulted if the tanner is using medications or has a history of skin problems. It also states, “Repeated exposure may cause premature aging of the skin and skin cancer.”

The agency was directed to use consumer testing to determine whether these statements have had any impact. It conducted focus group meetings in October 2007 in Baltimore and Rockville, Md., with 48 participants. Each meeting was attended by “experienced indoor tanners” and those who had never used the devices. Participants were split into three groups: high-school teenagers aged 14-17 years; adults with a college degree; and adults without a college degree.

The groups were asked to review the current warning and a new, shortened version, and they were asked questions about each. The participants also were asked to look at a photo of a tanning bed and to state where they would be most likely to notice a warning.

According to the FDA's report, most of the participants said the new, alternate warning was easier to understand and they would be more likely to pay attention to it. The newer warning had a clearer format with bullet points stating, among other things, that ultraviolet radiation causes skin cancer, injury to the eyes and skin, and skin aging. It also said to avoid overexposure, wear protective eye wear, read instructions carefully, and to consult a physician before tanning.

The participants suggested placing the warning next to the control panel or on the head side of the canopy of the tanning bed and said that it should be away from other labels so “as not to detract from the label's importance.”

The FDA would need to propose a rule to require new labels. According to the report, it “is considering amending the warning label requirements for sunlamp products to include specific formatting requirements to more clearly and effectively convey the risks that these devices pose for the development of irreversible damage to the eyes and skin, including skin cancer.” It has also begun consumer education efforts, primarily through its Web site.

The Food and Drug Administration is considering changing the warning labels on indoor tanning beds to be shorter and more forceful, according to a report that the agency submitted to Congress and posted on its Web site in early December.

Congress required the FDA to take a closer look at the warning labels as part of the FDA Amendments Act of 2007. Legislators were concerned that the current labeling does not effectively communicate the risks of skin and eye damage and skin cancer. The FDA missed the statutorily imposed September deadline, but did fulfill Congress' request to study the issue.

Currently, every “sunlamp product” is required to carry the warning paragraph established by the FDA in 1985. It contains various statements about the potential for damage, the need to wear protective eyewear (which is bolded), and a caution that a physician should be consulted if the tanner is using medications or has a history of skin problems. It also states, “Repeated exposure may cause premature aging of the skin and skin cancer.”

The agency was directed to use consumer testing to determine whether these statements have had any impact. It conducted focus group meetings in October 2007 in Baltimore and Rockville, Md., with 48 participants. Each meeting was attended by “experienced indoor tanners” and those who had never used the devices. Participants were split into three groups: high-school teenagers aged 14-17 years; adults with a college degree; and adults without a college degree.

The groups were asked to review the current warning and a new, shortened version, and they were asked questions about each. The participants also were asked to look at a photo of a tanning bed and to state where they would be most likely to notice a warning.

According to the FDA's report, most of the participants said the new, alternate warning was easier to understand and they would be more likely to pay attention to it. The newer warning had a clearer format with bullet points stating, among other things, that ultraviolet radiation causes skin cancer, injury to the eyes and skin, and skin aging. It also said to avoid overexposure, wear protective eye wear, read instructions carefully, and to consult a physician before tanning.

The participants suggested placing the warning next to the control panel or on the head side of the canopy of the tanning bed and said that it should be away from other labels so “as not to detract from the label's importance.”

The FDA would need to propose a rule to require new labels. According to the report, it “is considering amending the warning label requirements for sunlamp products to include specific formatting requirements to more clearly and effectively convey the risks that these devices pose for the development of irreversible damage to the eyes and skin, including skin cancer.” It has also begun consumer education efforts, primarily through its Web site.

The Food and Drug Administration is considering changing the warning labels on indoor tanning beds to be shorter and more forceful, according to a report that the agency submitted to Congress and posted on its Web site in early December.

Congress required the FDA to take a closer look at the warning labels as part of the FDA Amendments Act of 2007. Legislators were concerned that the current labeling does not effectively communicate the risks of skin and eye damage and skin cancer. The FDA missed the statutorily imposed September deadline, but did fulfill Congress' request to study the issue.

Currently, every “sunlamp product” is required to carry the warning paragraph established by the FDA in 1985. It contains various statements about the potential for damage, the need to wear protective eyewear (which is bolded), and a caution that a physician should be consulted if the tanner is using medications or has a history of skin problems. It also states, “Repeated exposure may cause premature aging of the skin and skin cancer.”

The agency was directed to use consumer testing to determine whether these statements have had any impact. It conducted focus group meetings in October 2007 in Baltimore and Rockville, Md., with 48 participants. Each meeting was attended by “experienced indoor tanners” and those who had never used the devices. Participants were split into three groups: high-school teenagers aged 14-17 years; adults with a college degree; and adults without a college degree.

The groups were asked to review the current warning and a new, shortened version, and they were asked questions about each. The participants also were asked to look at a photo of a tanning bed and to state where they would be most likely to notice a warning.

According to the FDA's report, most of the participants said the new, alternate warning was easier to understand and they would be more likely to pay attention to it. The newer warning had a clearer format with bullet points stating, among other things, that ultraviolet radiation causes skin cancer, injury to the eyes and skin, and skin aging. It also said to avoid overexposure, wear protective eye wear, read instructions carefully, and to consult a physician before tanning.

The participants suggested placing the warning next to the control panel or on the head side of the canopy of the tanning bed and said that it should be away from other labels so “as not to detract from the label's importance.”

The FDA would need to propose a rule to require new labels. According to the report, it “is considering amending the warning label requirements for sunlamp products to include specific formatting requirements to more clearly and effectively convey the risks that these devices pose for the development of irreversible damage to the eyes and skin, including skin cancer.” It has also begun consumer education efforts, primarily through its Web site.

Psych Disorders in Young People

Almost half of Americans aged 18–24 could be diagnosed with a psychiatric disorder in a given 12-month period, according to an analysis of the 2001–2002 National Epidemiologic Survey on Alcohol and Related Conditions. The face-to-face survey found that alcohol use disorder was more prevalent in college students, affecting 20% of the 2,188 respondents in this group, compared with 16% of the 2,904 respondents who had not attended college. Nicotine dependence was more common in noncollege youths (21% vs. 15%), as was personality disorder (22% vs. 18%). Few of the young people had sought treatment, especially for alcohol and drug disorders, reported researchers at Columbia University and the National Institute on Alcohol Abuse and Alcoholism. Only 5% of college students and 10% of nonstudents with alcohol or drug disorders had sought treatment in the past year. The researchers published their analysis in the December issue of the Archives of General Psychiatry.

Project Examines Early-Onset AD

Researchers are recruiting the adult children of individuals diagnosed with inherited Alzheimer's disease. The volunteers will undergo genetic analysis, cognitive testing, and neuroimaging, and will provide blood and cerebral spinal fluid samples for an international database. The Dominantly Inherited Alzheimer's Network study is a 6-year, $16 million effort aimed at identifying the sequence of brain changes in the early-onset form of the disease before symptoms occur. Funded by the National Institutes of Health, researchers in the United States, England, and Australia will participate. “By sharing data within the network, we hope to advance our knowledge of the brain mechanisms involved in Alzheimer's,” Dr. Richard J. Hodes, director of the NIH's National Institute of Aging, said in a statement. More information about the study is at

www.dian-info.org

IOM Sets Health Indicators

The Institute of Medicine said that policy makers, the media, and the public should focus on 20 “health indicators” for Americans. In a report issued last month, the IOM proposed the indicators and said that the new nonprofit organization, State of the USA Inc., would use them to monitor the nation's progress. The measures include such usual gauges as life expectancy, infant mortality, and smoking, but also some departures such as unhealthy days, serious psychological distress, excessive drinking, and condom use. The IOM also suggested monitoring Americans' insurance coverage and their unmet medical, dental, and prescription drug needs. Copies of the report are available from the IOM, and the monitoring project may be followed at

www.stateoftheusa.org

Generic Growth Slowed

The market research company IMS reported that the worldwide sales growth of generic drugs slowed to 3.6% in the year ended in September. In the previous year, ending September 2007, generic sales grew 11.4%. In a statement, IMS Senior Vice President Murray Aitken attributed the slowdown to price competition among generic companies. The year's $78 billion worth of generics was sold largely in the United States, Germany, France, the United Kingdom, Canada, Italy, Spain, and Japan. Sales were actually down 2.7% in the United States, which accounts for 42% of global sales. On the other hand, generics made up about two-thirds of the U.S. pharmaceutical market, with about $33 billion in sales in the 12 months ending Sept. 30. In the next few years, generics can go after $139 billion in sales of products losing their patents, said IMS.

Incentive Exception May Reappear

Under current Medicare and Medicaid rules governing patient referrals, physicians can't share incentive payments for quality improvement. But a proposal to make an exception may reappear, a Centers for Medicare and Medicaid Services official told the Practicing Physicians Advisory Council in December. The CMS proposed an exception under the physician payment rules for 2009, but opposition–mainly from medical device manufacturers–killed it, said Lisa Ohrin, acting director of the division of technical payment policy at the CMS's Center for Medicare Management. She said, however, that allowing incentive payments is a priority for the CMS, so the agency will again propose allowing physicians to share the payments.

RAC Program Is Heavily Criticized

Medicare's effort to recover overpayments made to physicians and hospitals and to make good on underpayments–dubbed the Recovery Audit Contractor program–was lambasted by members of the Practicing Physicians Advisory Council in December. The program is on hold while the Government Accountability Office studies whether the CMS has properly implemented it. During a demonstration project, however, RAC auditors found $1 billion in improper payments among $317 billion worth of claims, a CMS official reported to PPAC. But as of July 2008, about 7% of those determinations were overturned on appeal. Once the program is restarted–expected to occur by February–there will be limitations on the number of years of claims an auditor can examine and how many records can be requested from practices of various sizes. Even with those plans, PPAC panelists recommended further limits and suggested that the CMS require auditors to reimburse providers for fulfilling records requests.

Psych Disorders in Young People

Almost half of Americans aged 18–24 could be diagnosed with a psychiatric disorder in a given 12-month period, according to an analysis of the 2001–2002 National Epidemiologic Survey on Alcohol and Related Conditions. The face-to-face survey found that alcohol use disorder was more prevalent in college students, affecting 20% of the 2,188 respondents in this group, compared with 16% of the 2,904 respondents who had not attended college. Nicotine dependence was more common in noncollege youths (21% vs. 15%), as was personality disorder (22% vs. 18%). Few of the young people had sought treatment, especially for alcohol and drug disorders, reported researchers at Columbia University and the National Institute on Alcohol Abuse and Alcoholism. Only 5% of college students and 10% of nonstudents with alcohol or drug disorders had sought treatment in the past year. The researchers published their analysis in the December issue of the Archives of General Psychiatry.

Project Examines Early-Onset AD

Researchers are recruiting the adult children of individuals diagnosed with inherited Alzheimer's disease. The volunteers will undergo genetic analysis, cognitive testing, and neuroimaging, and will provide blood and cerebral spinal fluid samples for an international database. The Dominantly Inherited Alzheimer's Network study is a 6-year, $16 million effort aimed at identifying the sequence of brain changes in the early-onset form of the disease before symptoms occur. Funded by the National Institutes of Health, researchers in the United States, England, and Australia will participate. “By sharing data within the network, we hope to advance our knowledge of the brain mechanisms involved in Alzheimer's,” Dr. Richard J. Hodes, director of the NIH's National Institute of Aging, said in a statement. More information about the study is at

www.dian-info.org

IOM Sets Health Indicators

The Institute of Medicine said that policy makers, the media, and the public should focus on 20 “health indicators” for Americans. In a report issued last month, the IOM proposed the indicators and said that the new nonprofit organization, State of the USA Inc., would use them to monitor the nation's progress. The measures include such usual gauges as life expectancy, infant mortality, and smoking, but also some departures such as unhealthy days, serious psychological distress, excessive drinking, and condom use. The IOM also suggested monitoring Americans' insurance coverage and their unmet medical, dental, and prescription drug needs. Copies of the report are available from the IOM, and the monitoring project may be followed at

www.stateoftheusa.org

Generic Growth Slowed

The market research company IMS reported that the worldwide sales growth of generic drugs slowed to 3.6% in the year ended in September. In the previous year, ending September 2007, generic sales grew 11.4%. In a statement, IMS Senior Vice President Murray Aitken attributed the slowdown to price competition among generic companies. The year's $78 billion worth of generics was sold largely in the United States, Germany, France, the United Kingdom, Canada, Italy, Spain, and Japan. Sales were actually down 2.7% in the United States, which accounts for 42% of global sales. On the other hand, generics made up about two-thirds of the U.S. pharmaceutical market, with about $33 billion in sales in the 12 months ending Sept. 30. In the next few years, generics can go after $139 billion in sales of products losing their patents, said IMS.

Incentive Exception May Reappear

Under current Medicare and Medicaid rules governing patient referrals, physicians can't share incentive payments for quality improvement. But a proposal to make an exception may reappear, a Centers for Medicare and Medicaid Services official told the Practicing Physicians Advisory Council in December. The CMS proposed an exception under the physician payment rules for 2009, but opposition–mainly from medical device manufacturers–killed it, said Lisa Ohrin, acting director of the division of technical payment policy at the CMS's Center for Medicare Management. She said, however, that allowing incentive payments is a priority for the CMS, so the agency will again propose allowing physicians to share the payments.

RAC Program Is Heavily Criticized

Medicare's effort to recover overpayments made to physicians and hospitals and to make good on underpayments–dubbed the Recovery Audit Contractor program–was lambasted by members of the Practicing Physicians Advisory Council in December. The program is on hold while the Government Accountability Office studies whether the CMS has properly implemented it. During a demonstration project, however, RAC auditors found $1 billion in improper payments among $317 billion worth of claims, a CMS official reported to PPAC. But as of July 2008, about 7% of those determinations were overturned on appeal. Once the program is restarted–expected to occur by February–there will be limitations on the number of years of claims an auditor can examine and how many records can be requested from practices of various sizes. Even with those plans, PPAC panelists recommended further limits and suggested that the CMS require auditors to reimburse providers for fulfilling records requests.

Psych Disorders in Young People

Almost half of Americans aged 18–24 could be diagnosed with a psychiatric disorder in a given 12-month period, according to an analysis of the 2001–2002 National Epidemiologic Survey on Alcohol and Related Conditions. The face-to-face survey found that alcohol use disorder was more prevalent in college students, affecting 20% of the 2,188 respondents in this group, compared with 16% of the 2,904 respondents who had not attended college. Nicotine dependence was more common in noncollege youths (21% vs. 15%), as was personality disorder (22% vs. 18%). Few of the young people had sought treatment, especially for alcohol and drug disorders, reported researchers at Columbia University and the National Institute on Alcohol Abuse and Alcoholism. Only 5% of college students and 10% of nonstudents with alcohol or drug disorders had sought treatment in the past year. The researchers published their analysis in the December issue of the Archives of General Psychiatry.

Project Examines Early-Onset AD

Researchers are recruiting the adult children of individuals diagnosed with inherited Alzheimer's disease. The volunteers will undergo genetic analysis, cognitive testing, and neuroimaging, and will provide blood and cerebral spinal fluid samples for an international database. The Dominantly Inherited Alzheimer's Network study is a 6-year, $16 million effort aimed at identifying the sequence of brain changes in the early-onset form of the disease before symptoms occur. Funded by the National Institutes of Health, researchers in the United States, England, and Australia will participate. “By sharing data within the network, we hope to advance our knowledge of the brain mechanisms involved in Alzheimer's,” Dr. Richard J. Hodes, director of the NIH's National Institute of Aging, said in a statement. More information about the study is at

www.dian-info.org

IOM Sets Health Indicators

The Institute of Medicine said that policy makers, the media, and the public should focus on 20 “health indicators” for Americans. In a report issued last month, the IOM proposed the indicators and said that the new nonprofit organization, State of the USA Inc., would use them to monitor the nation's progress. The measures include such usual gauges as life expectancy, infant mortality, and smoking, but also some departures such as unhealthy days, serious psychological distress, excessive drinking, and condom use. The IOM also suggested monitoring Americans' insurance coverage and their unmet medical, dental, and prescription drug needs. Copies of the report are available from the IOM, and the monitoring project may be followed at

www.stateoftheusa.org

Generic Growth Slowed

The market research company IMS reported that the worldwide sales growth of generic drugs slowed to 3.6% in the year ended in September. In the previous year, ending September 2007, generic sales grew 11.4%. In a statement, IMS Senior Vice President Murray Aitken attributed the slowdown to price competition among generic companies. The year's $78 billion worth of generics was sold largely in the United States, Germany, France, the United Kingdom, Canada, Italy, Spain, and Japan. Sales were actually down 2.7% in the United States, which accounts for 42% of global sales. On the other hand, generics made up about two-thirds of the U.S. pharmaceutical market, with about $33 billion in sales in the 12 months ending Sept. 30. In the next few years, generics can go after $139 billion in sales of products losing their patents, said IMS.

Incentive Exception May Reappear

Under current Medicare and Medicaid rules governing patient referrals, physicians can't share incentive payments for quality improvement. But a proposal to make an exception may reappear, a Centers for Medicare and Medicaid Services official told the Practicing Physicians Advisory Council in December. The CMS proposed an exception under the physician payment rules for 2009, but opposition–mainly from medical device manufacturers–killed it, said Lisa Ohrin, acting director of the division of technical payment policy at the CMS's Center for Medicare Management. She said, however, that allowing incentive payments is a priority for the CMS, so the agency will again propose allowing physicians to share the payments.

RAC Program Is Heavily Criticized

Medicare's effort to recover overpayments made to physicians and hospitals and to make good on underpayments–dubbed the Recovery Audit Contractor program–was lambasted by members of the Practicing Physicians Advisory Council in December. The program is on hold while the Government Accountability Office studies whether the CMS has properly implemented it. During a demonstration project, however, RAC auditors found $1 billion in improper payments among $317 billion worth of claims, a CMS official reported to PPAC. But as of July 2008, about 7% of those determinations were overturned on appeal. Once the program is restarted–expected to occur by February–there will be limitations on the number of years of claims an auditor can examine and how many records can be requested from practices of various sizes. Even with those plans, PPAC panelists recommended further limits and suggested that the CMS require auditors to reimburse providers for fulfilling records requests.

WASHINGTON – Data from the first 6 months of the Physician Quality Reporting Initiative (PQRI) are spurring improvements for 2009, a Medicare official testified at a meeting of the Practicing Physicians Advisory Council.

In the summer of 2008, the CMS paid $36 million in bonuses to 56,000 physicians for their 2007 reporting, said Dr. Michael T. Rapp, director of the quality measurement and health assessment group at the Centers for Medicare and Medicaid Services. The average payment was $600 for 6 months of data; for 2008 reports, the 1.5% bonus is likely to be around $800 on average, he said.

There will be a number of changes for reporting in 2009. In all, there will be 153 reportable measures. Fifty-two are new, and 18 are reportable only through registries. There are seven measures groups: diabetes mellitus, chronic kidney disease, preventive care, coronary artery bypass graft surgery, rheumatoid arthritis, perioperative care, and back pain. Each group contains a number of measures; physicians can report these only as groups.

There will be nine different ways physicians can qualify for the 2% PQRI bonus in 2009, said Dr. Rapp. Physicians also can receive an additional 2% bonus for satisfying requirements under the separate e-prescribing incentive program.

Under last year's Medicare Improvements for Patients and Providers Act, the CMS is required to eventually post on its Web site the names of physicians who satisfactorily report quality measures for 2009. That proposal has been controversial.

PPAC panelist Dr. Frederica Smith, an internist and rheumatologist in Albuquerque, called the idea a “terrifying concept,” given that it might appear that physicians who were not on the list did not care about quality.

And physicians had many problems complying with the CMS process for reporting measures in 2007, she noted.

Dr. Rapp agreed that the first phase of the PQRI program had been frustrating. But “the way it was for 2007 doesn't mean that's the way it will be for 2008,” he said. The agency posted a detailed report on the 2007 experience at its Web site last month (www.cms.hhs.gov/PQRI/Downloads/PQRI2007ReportExperience.pdf

Overall, there were submissions from 109,349 national provider identifier/tax identification numbers with at least one quality data code. Of those, about 93% (101,138) submitted at least one valid code. More than 14 million codes were reported; more than 50% of those (7.3 million) were validly submitted.

There were three major reasons for code nonvalidity: the provider did not adhere to the measure specification; the codes were not submitted with the same claim as the billing and diagnosis code submitted for the procedure; or there was no national provider identification (NPI) number on the claim.

Many of the submission errors were for patients who did not meet the reporting specifications regarding gender, age, or diagnosis or procedure code for a particular measure. For instance, the PQRI does not accept reports for diabetes measures on patients over age 75, said Dr. Rapp.

He said that the CMS plans to rerun reports for providers who did not qualify for the bonus, with the idea that mistakes could have been made and some providers could be found eligible for the bonus on reanalysis. If that is the case, the CMS will issue checks retroactively, he said.

The agency also aims to make some changes that will hopefully reduce the number of rejected reports going forward. The CMS said that it would continue to conduct provider education and outreach to make sure that physicians understand the specifications for reporting each measure.

The agency also is working with local Medicare carriers to ensure that when claims get split–where the quality codes are separated–they will be “reconnected and counted,” according to the agency.

Also, claims that were submitted to carriers for payment in 2008 without an NPI were automatically rejected. As a result, in the first half of 2008, less than 1% of claims submitted under the PQRI program were missing an NPI, according to the agency's report. The CMS expects less than 0.5% of PQRI claims to be without an NPI.

Dr. Rapp said that the agency would make it easier to get PQRI reports for 2008 and that they would be more meaningful to providers. The feedback reports are being redesigned and will better explain what percentage of quality codes are accepted, indicate why the provider did not earn an incentive, and provide information on how well they performed on each measure.

The PPAC panel recommended that the CMS find a way to make the quality reports available to physicians on a real-time basis so that they can more quickly adjust their data collection and reporting. The agency should also work toward greater transparency with the PQRI program, including measurement development, the panelists said.

There will be nine different ways that physicians can qualify for the 2% PQRI bonus in 2009. DR. RAPP

WASHINGTON – Data from the first 6 months of the Physician Quality Reporting Initiative (PQRI) are spurring improvements for 2009, a Medicare official testified at a meeting of the Practicing Physicians Advisory Council.

In the summer of 2008, the CMS paid $36 million in bonuses to 56,000 physicians for their 2007 reporting, said Dr. Michael T. Rapp, director of the quality measurement and health assessment group at the Centers for Medicare and Medicaid Services. The average payment was $600 for 6 months of data; for 2008 reports, the 1.5% bonus is likely to be around $800 on average, he said.

There will be a number of changes for reporting in 2009. In all, there will be 153 reportable measures. Fifty-two are new, and 18 are reportable only through registries. There are seven measures groups: diabetes mellitus, chronic kidney disease, preventive care, coronary artery bypass graft surgery, rheumatoid arthritis, perioperative care, and back pain. Each group contains a number of measures; physicians can report these only as groups.

There will be nine different ways physicians can qualify for the 2% PQRI bonus in 2009, said Dr. Rapp. Physicians also can receive an additional 2% bonus for satisfying requirements under the separate e-prescribing incentive program.

Under last year's Medicare Improvements for Patients and Providers Act, the CMS is required to eventually post on its Web site the names of physicians who satisfactorily report quality measures for 2009. That proposal has been controversial.

PPAC panelist Dr. Frederica Smith, an internist and rheumatologist in Albuquerque, called the idea a “terrifying concept,” given that it might appear that physicians who were not on the list did not care about quality.

And physicians had many problems complying with the CMS process for reporting measures in 2007, she noted.

Dr. Rapp agreed that the first phase of the PQRI program had been frustrating. But “the way it was for 2007 doesn't mean that's the way it will be for 2008,” he said. The agency posted a detailed report on the 2007 experience at its Web site last month (www.cms.hhs.gov/PQRI/Downloads/PQRI2007ReportExperience.pdf

Overall, there were submissions from 109,349 national provider identifier/tax identification numbers with at least one quality data code. Of those, about 93% (101,138) submitted at least one valid code. More than 14 million codes were reported; more than 50% of those (7.3 million) were validly submitted.

There were three major reasons for code nonvalidity: the provider did not adhere to the measure specification; the codes were not submitted with the same claim as the billing and diagnosis code submitted for the procedure; or there was no national provider identification (NPI) number on the claim.

Many of the submission errors were for patients who did not meet the reporting specifications regarding gender, age, or diagnosis or procedure code for a particular measure. For instance, the PQRI does not accept reports for diabetes measures on patients over age 75, said Dr. Rapp.

He said that the CMS plans to rerun reports for providers who did not qualify for the bonus, with the idea that mistakes could have been made and some providers could be found eligible for the bonus on reanalysis. If that is the case, the CMS will issue checks retroactively, he said.

The agency also aims to make some changes that will hopefully reduce the number of rejected reports going forward. The CMS said that it would continue to conduct provider education and outreach to make sure that physicians understand the specifications for reporting each measure.

The agency also is working with local Medicare carriers to ensure that when claims get split–where the quality codes are separated–they will be “reconnected and counted,” according to the agency.

Also, claims that were submitted to carriers for payment in 2008 without an NPI were automatically rejected. As a result, in the first half of 2008, less than 1% of claims submitted under the PQRI program were missing an NPI, according to the agency's report. The CMS expects less than 0.5% of PQRI claims to be without an NPI.

Dr. Rapp said that the agency would make it easier to get PQRI reports for 2008 and that they would be more meaningful to providers. The feedback reports are being redesigned and will better explain what percentage of quality codes are accepted, indicate why the provider did not earn an incentive, and provide information on how well they performed on each measure.

The PPAC panel recommended that the CMS find a way to make the quality reports available to physicians on a real-time basis so that they can more quickly adjust their data collection and reporting. The agency should also work toward greater transparency with the PQRI program, including measurement development, the panelists said.

There will be nine different ways that physicians can qualify for the 2% PQRI bonus in 2009. DR. RAPP

WASHINGTON – Data from the first 6 months of the Physician Quality Reporting Initiative (PQRI) are spurring improvements for 2009, a Medicare official testified at a meeting of the Practicing Physicians Advisory Council.

In the summer of 2008, the CMS paid $36 million in bonuses to 56,000 physicians for their 2007 reporting, said Dr. Michael T. Rapp, director of the quality measurement and health assessment group at the Centers for Medicare and Medicaid Services. The average payment was $600 for 6 months of data; for 2008 reports, the 1.5% bonus is likely to be around $800 on average, he said.

There will be a number of changes for reporting in 2009. In all, there will be 153 reportable measures. Fifty-two are new, and 18 are reportable only through registries. There are seven measures groups: diabetes mellitus, chronic kidney disease, preventive care, coronary artery bypass graft surgery, rheumatoid arthritis, perioperative care, and back pain. Each group contains a number of measures; physicians can report these only as groups.

There will be nine different ways physicians can qualify for the 2% PQRI bonus in 2009, said Dr. Rapp. Physicians also can receive an additional 2% bonus for satisfying requirements under the separate e-prescribing incentive program.

Under last year's Medicare Improvements for Patients and Providers Act, the CMS is required to eventually post on its Web site the names of physicians who satisfactorily report quality measures for 2009. That proposal has been controversial.

PPAC panelist Dr. Frederica Smith, an internist and rheumatologist in Albuquerque, called the idea a “terrifying concept,” given that it might appear that physicians who were not on the list did not care about quality.

And physicians had many problems complying with the CMS process for reporting measures in 2007, she noted.

Dr. Rapp agreed that the first phase of the PQRI program had been frustrating. But “the way it was for 2007 doesn't mean that's the way it will be for 2008,” he said. The agency posted a detailed report on the 2007 experience at its Web site last month (www.cms.hhs.gov/PQRI/Downloads/PQRI2007ReportExperience.pdf

Overall, there were submissions from 109,349 national provider identifier/tax identification numbers with at least one quality data code. Of those, about 93% (101,138) submitted at least one valid code. More than 14 million codes were reported; more than 50% of those (7.3 million) were validly submitted.

There were three major reasons for code nonvalidity: the provider did not adhere to the measure specification; the codes were not submitted with the same claim as the billing and diagnosis code submitted for the procedure; or there was no national provider identification (NPI) number on the claim.

Many of the submission errors were for patients who did not meet the reporting specifications regarding gender, age, or diagnosis or procedure code for a particular measure. For instance, the PQRI does not accept reports for diabetes measures on patients over age 75, said Dr. Rapp.

He said that the CMS plans to rerun reports for providers who did not qualify for the bonus, with the idea that mistakes could have been made and some providers could be found eligible for the bonus on reanalysis. If that is the case, the CMS will issue checks retroactively, he said.

The agency also aims to make some changes that will hopefully reduce the number of rejected reports going forward. The CMS said that it would continue to conduct provider education and outreach to make sure that physicians understand the specifications for reporting each measure.

The agency also is working with local Medicare carriers to ensure that when claims get split–where the quality codes are separated–they will be “reconnected and counted,” according to the agency.

Also, claims that were submitted to carriers for payment in 2008 without an NPI were automatically rejected. As a result, in the first half of 2008, less than 1% of claims submitted under the PQRI program were missing an NPI, according to the agency's report. The CMS expects less than 0.5% of PQRI claims to be without an NPI.

Dr. Rapp said that the agency would make it easier to get PQRI reports for 2008 and that they would be more meaningful to providers. The feedback reports are being redesigned and will better explain what percentage of quality codes are accepted, indicate why the provider did not earn an incentive, and provide information on how well they performed on each measure.

The PPAC panel recommended that the CMS find a way to make the quality reports available to physicians on a real-time basis so that they can more quickly adjust their data collection and reporting. The agency should also work toward greater transparency with the PQRI program, including measurement development, the panelists said.

There will be nine different ways that physicians can qualify for the 2% PQRI bonus in 2009. DR. RAPP

WASHINGTON — Data from the first 6 months of the Physician Quality Reporting Initiative are spurring improvements for the upcoming year, a Medicare official testified at a meeting of the Practicing Physicians Advisory Council.

In the summer of 2008, the CMS paid $36 million in bonuses to 56,000 physicians for their 2007 reporting, said Dr. Michael T. Rapp, director of the quality measurement and health assessment group at the Centers for Medicare and Medicaid Services. The average payment was $600 for 6 months' of data; for 2008 reports, the 1.5% bonus is likely to be around $800 on average, he said.

There will be a number of changes for reporting in 2009. In all, there will be 153 reportable measures. Fifty-two are new, and 18 are reportable only through registries.

There are seven measures groups: diabetes mellitus, chronic kidney disease, preventive care, coronary artery bypass graft surgery, rheumatoid arthritis, perioperative care, and back pain. Each group contains a number of measures; physicians can report these only as groups.

There will be nine different ways physicians can qualify for the 2% PQRI bonus in 2009, Dr. Rapp said. Physicians also can receive an additional 2% bonus for satisfying requirements under the separate e-prescribing incentive program.

Under last year's Medicare Improvements for Patients and Providers Act, the CMS is required to post on its Web site the names of physicians who satisfactorily report quality measures for 2009. That proposal has been controversial.

PPAC panelist Dr. Frederica Smith, an internist and rheumatologist in Albuquerque, N.M., called the idea a “terrifying concept,” given that it might appear that physicians who were not on the list did not care about quality.

And physicians had many problems complying with the CMS process for reporting measures in 2007, she noted.

Dr. Rapp agreed that the first phase of the program had been frustrating. But “the way it was for 2007 doesn't mean that's the way it will be for 2008,” he said. The agency posted a detailed report on the 2007 experience at its Web site last month (www.cms.hhs.gov/PQRI/Downloads/PQRI2007ReportExperience.pdf

Overall, there were submissions from 109,349 national provider identifier/tax identification numbers with at least one quality data code. Of those providers, about 93% (101,138) submitted at least one valid code. More than 14 million codes were reported; more than 50% of those (7.3 million) were validly submitted.

There were three major reasons for code nonvalidity: the provider did not adhere to the measure specification; the codes were not submitted with the same claim as the billing and diagnosis code submitted for the procedure; or there was no national provider number (NPI) on the claim.

Many of the submission errors were for patients who did not meet the reporting specifications regarding gender, age, or diagnosis or procedure code for a particular measure. For instance, the PQRI does not accept reports for diabetes measures on patients over age 75, Dr. Rapp said.

He said that the CMS plans to rerun reports for providers who did not qualify for the bonus, with the idea that mistakes could have been made and some providers could be found eligible for the bonus on reanalysis. If that is the case, the CMS will issue checks retroactively, he said.

The agency also aims to make some changes that are expected to reduce the number of reports that are rejected.

The CMS said that it would continue to conduct provider education and outreach to make sure that physicians understand the specifications for reporting each measure.

The agency also is working with local Medicare carriers to ensure that when claims get split—where the quality codes are separated—they will be “reconnected and counted,” according to the agency.

Also, claims that were submitted to carriers for payment in 2008 without an NPI were automatically rejected. As a result, in the first half of 2008, less than 1% of claims that were submitted under the PQRI program were missing an NPI, according to the agency's report. The CMS expects less than 0.5% of PQRI claims to be without an NPI.

Dr. Rapp said that the agency would make it easier to get PQRI reports for 2008 and that they would be more meaningful to providers.

The feedback reports are being redesigned and will better explain what percentage of quality codes are accepted, indicate why the provider did not earn an incentive, and provide information on how well they performed on each measure.

The PPAC panel recommended that the CMS find a way to make the quality reports available to physicians on a real-time basis so that they can perform more timely adjustments of their data collection and reporting.

The agency should also work toward greater transparency with the PQRI program, including measurement development, the panelists said.

WASHINGTON — Data from the first 6 months of the Physician Quality Reporting Initiative are spurring improvements for the upcoming year, a Medicare official testified at a meeting of the Practicing Physicians Advisory Council.

In the summer of 2008, the CMS paid $36 million in bonuses to 56,000 physicians for their 2007 reporting, said Dr. Michael T. Rapp, director of the quality measurement and health assessment group at the Centers for Medicare and Medicaid Services. The average payment was $600 for 6 months' of data; for 2008 reports, the 1.5% bonus is likely to be around $800 on average, he said.

There will be a number of changes for reporting in 2009. In all, there will be 153 reportable measures. Fifty-two are new, and 18 are reportable only through registries.

There are seven measures groups: diabetes mellitus, chronic kidney disease, preventive care, coronary artery bypass graft surgery, rheumatoid arthritis, perioperative care, and back pain. Each group contains a number of measures; physicians can report these only as groups.

There will be nine different ways physicians can qualify for the 2% PQRI bonus in 2009, Dr. Rapp said. Physicians also can receive an additional 2% bonus for satisfying requirements under the separate e-prescribing incentive program.

Under last year's Medicare Improvements for Patients and Providers Act, the CMS is required to post on its Web site the names of physicians who satisfactorily report quality measures for 2009. That proposal has been controversial.

PPAC panelist Dr. Frederica Smith, an internist and rheumatologist in Albuquerque, N.M., called the idea a “terrifying concept,” given that it might appear that physicians who were not on the list did not care about quality.

And physicians had many problems complying with the CMS process for reporting measures in 2007, she noted.

Dr. Rapp agreed that the first phase of the program had been frustrating. But “the way it was for 2007 doesn't mean that's the way it will be for 2008,” he said. The agency posted a detailed report on the 2007 experience at its Web site last month (www.cms.hhs.gov/PQRI/Downloads/PQRI2007ReportExperience.pdf

Overall, there were submissions from 109,349 national provider identifier/tax identification numbers with at least one quality data code. Of those providers, about 93% (101,138) submitted at least one valid code. More than 14 million codes were reported; more than 50% of those (7.3 million) were validly submitted.

There were three major reasons for code nonvalidity: the provider did not adhere to the measure specification; the codes were not submitted with the same claim as the billing and diagnosis code submitted for the procedure; or there was no national provider number (NPI) on the claim.

Many of the submission errors were for patients who did not meet the reporting specifications regarding gender, age, or diagnosis or procedure code for a particular measure. For instance, the PQRI does not accept reports for diabetes measures on patients over age 75, Dr. Rapp said.

He said that the CMS plans to rerun reports for providers who did not qualify for the bonus, with the idea that mistakes could have been made and some providers could be found eligible for the bonus on reanalysis. If that is the case, the CMS will issue checks retroactively, he said.

The agency also aims to make some changes that are expected to reduce the number of reports that are rejected.

The CMS said that it would continue to conduct provider education and outreach to make sure that physicians understand the specifications for reporting each measure.

The agency also is working with local Medicare carriers to ensure that when claims get split—where the quality codes are separated—they will be “reconnected and counted,” according to the agency.

Also, claims that were submitted to carriers for payment in 2008 without an NPI were automatically rejected. As a result, in the first half of 2008, less than 1% of claims that were submitted under the PQRI program were missing an NPI, according to the agency's report. The CMS expects less than 0.5% of PQRI claims to be without an NPI.

Dr. Rapp said that the agency would make it easier to get PQRI reports for 2008 and that they would be more meaningful to providers.

The feedback reports are being redesigned and will better explain what percentage of quality codes are accepted, indicate why the provider did not earn an incentive, and provide information on how well they performed on each measure.

The PPAC panel recommended that the CMS find a way to make the quality reports available to physicians on a real-time basis so that they can perform more timely adjustments of their data collection and reporting.

The agency should also work toward greater transparency with the PQRI program, including measurement development, the panelists said.

WASHINGTON — Data from the first 6 months of the Physician Quality Reporting Initiative are spurring improvements for the upcoming year, a Medicare official testified at a meeting of the Practicing Physicians Advisory Council.

In the summer of 2008, the CMS paid $36 million in bonuses to 56,000 physicians for their 2007 reporting, said Dr. Michael T. Rapp, director of the quality measurement and health assessment group at the Centers for Medicare and Medicaid Services. The average payment was $600 for 6 months' of data; for 2008 reports, the 1.5% bonus is likely to be around $800 on average, he said.

There will be a number of changes for reporting in 2009. In all, there will be 153 reportable measures. Fifty-two are new, and 18 are reportable only through registries.

There are seven measures groups: diabetes mellitus, chronic kidney disease, preventive care, coronary artery bypass graft surgery, rheumatoid arthritis, perioperative care, and back pain. Each group contains a number of measures; physicians can report these only as groups.

There will be nine different ways physicians can qualify for the 2% PQRI bonus in 2009, Dr. Rapp said. Physicians also can receive an additional 2% bonus for satisfying requirements under the separate e-prescribing incentive program.

Under last year's Medicare Improvements for Patients and Providers Act, the CMS is required to post on its Web site the names of physicians who satisfactorily report quality measures for 2009. That proposal has been controversial.

PPAC panelist Dr. Frederica Smith, an internist and rheumatologist in Albuquerque, N.M., called the idea a “terrifying concept,” given that it might appear that physicians who were not on the list did not care about quality.

And physicians had many problems complying with the CMS process for reporting measures in 2007, she noted.

Dr. Rapp agreed that the first phase of the program had been frustrating. But “the way it was for 2007 doesn't mean that's the way it will be for 2008,” he said. The agency posted a detailed report on the 2007 experience at its Web site last month (www.cms.hhs.gov/PQRI/Downloads/PQRI2007ReportExperience.pdf

Overall, there were submissions from 109,349 national provider identifier/tax identification numbers with at least one quality data code. Of those providers, about 93% (101,138) submitted at least one valid code. More than 14 million codes were reported; more than 50% of those (7.3 million) were validly submitted.

There were three major reasons for code nonvalidity: the provider did not adhere to the measure specification; the codes were not submitted with the same claim as the billing and diagnosis code submitted for the procedure; or there was no national provider number (NPI) on the claim.

Many of the submission errors were for patients who did not meet the reporting specifications regarding gender, age, or diagnosis or procedure code for a particular measure. For instance, the PQRI does not accept reports for diabetes measures on patients over age 75, Dr. Rapp said.

He said that the CMS plans to rerun reports for providers who did not qualify for the bonus, with the idea that mistakes could have been made and some providers could be found eligible for the bonus on reanalysis. If that is the case, the CMS will issue checks retroactively, he said.

The agency also aims to make some changes that are expected to reduce the number of reports that are rejected.

The CMS said that it would continue to conduct provider education and outreach to make sure that physicians understand the specifications for reporting each measure.

The agency also is working with local Medicare carriers to ensure that when claims get split—where the quality codes are separated—they will be “reconnected and counted,” according to the agency.

Also, claims that were submitted to carriers for payment in 2008 without an NPI were automatically rejected. As a result, in the first half of 2008, less than 1% of claims that were submitted under the PQRI program were missing an NPI, according to the agency's report. The CMS expects less than 0.5% of PQRI claims to be without an NPI.

Dr. Rapp said that the agency would make it easier to get PQRI reports for 2008 and that they would be more meaningful to providers.

The feedback reports are being redesigned and will better explain what percentage of quality codes are accepted, indicate why the provider did not earn an incentive, and provide information on how well they performed on each measure.

The PPAC panel recommended that the CMS find a way to make the quality reports available to physicians on a real-time basis so that they can perform more timely adjustments of their data collection and reporting.

The agency should also work toward greater transparency with the PQRI program, including measurement development, the panelists said.