Mary Ellen Schneider

New federal regulations mandated by the Affordable Care Act will give patients new rights to appeal claims denials made by their health plans.

The rules, which were announced on July 22, will allow consumers in new health plans to appeal decisions both through their insurer's internal process and to an outside, independent entity. While most health plans already provide for an internal appeals process, not all offer an external review of plan decisions, according to the U.S. Department of Health and Human Services. The types of appeals processes often depend on individual state laws.

HHS officials estimate that in 2011 there will be about 31 million people in new employer plans and another 10 million people in new individual market plans who will be able to take advantage of these new appeals opportunities. By 2013, that number is expected to grow to 88 million people. The rules do not apply to grandfathered health plans.

Under the new rules, health plans that begin on or after Sept. 23, 2010, must have an internal appeals process that allows consumers to appeal whenever the plan denies a claim for a covered service or rescinds coverage. The internal appeals process must also offer consumers detailed information about the grounds for their denial and information on how to file an appeal.

The new rules aim to make internal appeals more objective by ensuring that the person considering the appeal does not have a conflict of interest. For example, the health plan is not allowed to offer financial incentives to employees based on the number of claims that are denied. Health plans will also have to provide an expedited appeals process, which would allow urgent cases to be reviewed within 24 hours.

The new federal appeals regulations also standardize rules for external appeals.

New federal regulations mandated by the Affordable Care Act will give patients new rights to appeal claims denials made by their health plans.

The rules, which were announced on July 22, will allow consumers in new health plans to appeal decisions both through their insurer's internal process and to an outside, independent entity. While most health plans already provide for an internal appeals process, not all offer an external review of plan decisions, according to the U.S. Department of Health and Human Services. The types of appeals processes often depend on individual state laws.

HHS officials estimate that in 2011 there will be about 31 million people in new employer plans and another 10 million people in new individual market plans who will be able to take advantage of these new appeals opportunities. By 2013, that number is expected to grow to 88 million people. The rules do not apply to grandfathered health plans.

Under the new rules, health plans that begin on or after Sept. 23, 2010, must have an internal appeals process that allows consumers to appeal whenever the plan denies a claim for a covered service or rescinds coverage. The internal appeals process must also offer consumers detailed information about the grounds for their denial and information on how to file an appeal.

The new rules aim to make internal appeals more objective by ensuring that the person considering the appeal does not have a conflict of interest. For example, the health plan is not allowed to offer financial incentives to employees based on the number of claims that are denied. Health plans will also have to provide an expedited appeals process, which would allow urgent cases to be reviewed within 24 hours.

The new federal appeals regulations also standardize rules for external appeals.

New federal regulations mandated by the Affordable Care Act will give patients new rights to appeal claims denials made by their health plans.

The rules, which were announced on July 22, will allow consumers in new health plans to appeal decisions both through their insurer's internal process and to an outside, independent entity. While most health plans already provide for an internal appeals process, not all offer an external review of plan decisions, according to the U.S. Department of Health and Human Services. The types of appeals processes often depend on individual state laws.

HHS officials estimate that in 2011 there will be about 31 million people in new employer plans and another 10 million people in new individual market plans who will be able to take advantage of these new appeals opportunities. By 2013, that number is expected to grow to 88 million people. The rules do not apply to grandfathered health plans.

Under the new rules, health plans that begin on or after Sept. 23, 2010, must have an internal appeals process that allows consumers to appeal whenever the plan denies a claim for a covered service or rescinds coverage. The internal appeals process must also offer consumers detailed information about the grounds for their denial and information on how to file an appeal.

The new rules aim to make internal appeals more objective by ensuring that the person considering the appeal does not have a conflict of interest. For example, the health plan is not allowed to offer financial incentives to employees based on the number of claims that are denied. Health plans will also have to provide an expedited appeals process, which would allow urgent cases to be reviewed within 24 hours.

The new federal appeals regulations also standardize rules for external appeals.

With the federal government filing an injunction, a fight is looming over the future of federal funding for research using human embryonic stem cells. The fracas started with an earlier ruling by a federal judge that temporarily blocked such research funding, leaving researchers who study human embryonic stem cells calling themselves surprised, disappointed, and even angry.

The Obama administration responded by filing a stay and notice of appeal on August 31.

The contested federal ruling bars the use of federal funds for any research involving human embryonic stem cells. As a result of the temporary injunction, the National Institutes of Health has stopped accepting submissions of information on human embryonic stem cell lines for NIH review and has also suspended all review of embryonic stem cell lines.

President Obama expanded opportunities to receive federal funding for embryonic stem cell research when he issued an executive order in 2009 that eliminated many of the restrictions placed on funding during the George W. Bush administration.

The NIH followed with guidelines that allowed research to be conducted on embryonic stem cells derived from embryos created through in vitro fertilization and donated for research.

With the recent court decision, some researchers worry that the development of therapies that use embryonic stem cells will be set back and that the loss of federal funding will have a chilling effect on newly minted researchers who are considering whether to enter the field.

The halt on funding for research using embryonic stem cells has implications on all types of stem cell research, said Alan Trounson, Ph.D., president of the California Institute for Regenerative Medicine, which issues grants to researchers in California who use state funds. “The decision is a deplorable brake on all stem cell research,” he said in a statement. “Many discoveries with other cell types, notably the so-called reprogrammed [induced pluripotent stem] cells, would not happen without ongoing research in human embryonic stem cells.”

Dr. Trounson said the California institute's funding plans would not be affected by the federal court decision. Institutions that have obtained private funding for their stem cell work will also be able to continue that work. However, even those with deep pockets are concerned that private funding alone is not enough. “It's a blow to us,” said B.D. Colen, a spokesman for the Harvard Stem Cell Institute.

The institute, a collaborative of stem cell researchers from around Massachusetts, has raised about $120 million in private funds since its founding 2004, but those sources are not unlimited, Mr. Colen said. The loss of federal funding that was expected to go to the institute's researchers will be disruptive, he said, and the impact will be worse for those researchers who do not have private funding sources to fall back on.

Another source of concern for researchers has to do with the legal issues involved in the case. An earlier lawsuit challenging the Obama stem cell guidelines had been dismissed after the court ruled that the plaintiffs had no standing to challenge it. However, the recent injunction came about after the court decided that two researchers who work with adult stem cells could challenge the guidelines because funding of embryonic stem cell research was harming their chances for receiving federal funds for adult stem cells.

“This judge opens the door for every scientist who ever has a grant request rejected on the merits to sue the federal government,” the American Society for Reproductive Medicine said in a statement condemning the court decision.

In granting the temporary injunction, Judge Royce C. Lamberth, the chief judge in the U.S. District Court for the District of Columbia, said the NIH guidelines violated the intent of Congress to bar the use of federal funds for research in which human embryos are destroyed. He said the rules violated the Dickey-Wicker amendment, a rider generally attached to health spending bills each year. It prohibits the use of federal funds for the creation of a human embryo or embryos for research purposes or research in which a human embryo or embryos are destroyed or discarded. However, the Obama administration has argued that the amendment doesn't apply because federal funds are used for research on the embryonic stem cell lines, not in the destruction of the embryos.

Judge Lamberth said: “[Embryonic stem cell] research is clearly research in which an embryo is destroyed. Despite defendants' attempt to separate the derivation of [embryonic stem cells] from research on the [embryonic stem cells], the two cannot be separated.”

With the federal government filing an injunction, a fight is looming over the future of federal funding for research using human embryonic stem cells. The fracas started with an earlier ruling by a federal judge that temporarily blocked such research funding, leaving researchers who study human embryonic stem cells calling themselves surprised, disappointed, and even angry.

The Obama administration responded by filing a stay and notice of appeal on August 31.

The contested federal ruling bars the use of federal funds for any research involving human embryonic stem cells. As a result of the temporary injunction, the National Institutes of Health has stopped accepting submissions of information on human embryonic stem cell lines for NIH review and has also suspended all review of embryonic stem cell lines.

President Obama expanded opportunities to receive federal funding for embryonic stem cell research when he issued an executive order in 2009 that eliminated many of the restrictions placed on funding during the George W. Bush administration.

The NIH followed with guidelines that allowed research to be conducted on embryonic stem cells derived from embryos created through in vitro fertilization and donated for research.

With the recent court decision, some researchers worry that the development of therapies that use embryonic stem cells will be set back and that the loss of federal funding will have a chilling effect on newly minted researchers who are considering whether to enter the field.

The halt on funding for research using embryonic stem cells has implications on all types of stem cell research, said Alan Trounson, Ph.D., president of the California Institute for Regenerative Medicine, which issues grants to researchers in California who use state funds. “The decision is a deplorable brake on all stem cell research,” he said in a statement. “Many discoveries with other cell types, notably the so-called reprogrammed [induced pluripotent stem] cells, would not happen without ongoing research in human embryonic stem cells.”

Dr. Trounson said the California institute's funding plans would not be affected by the federal court decision. Institutions that have obtained private funding for their stem cell work will also be able to continue that work. However, even those with deep pockets are concerned that private funding alone is not enough. “It's a blow to us,” said B.D. Colen, a spokesman for the Harvard Stem Cell Institute.

The institute, a collaborative of stem cell researchers from around Massachusetts, has raised about $120 million in private funds since its founding 2004, but those sources are not unlimited, Mr. Colen said. The loss of federal funding that was expected to go to the institute's researchers will be disruptive, he said, and the impact will be worse for those researchers who do not have private funding sources to fall back on.

Another source of concern for researchers has to do with the legal issues involved in the case. An earlier lawsuit challenging the Obama stem cell guidelines had been dismissed after the court ruled that the plaintiffs had no standing to challenge it. However, the recent injunction came about after the court decided that two researchers who work with adult stem cells could challenge the guidelines because funding of embryonic stem cell research was harming their chances for receiving federal funds for adult stem cells.

“This judge opens the door for every scientist who ever has a grant request rejected on the merits to sue the federal government,” the American Society for Reproductive Medicine said in a statement condemning the court decision.

In granting the temporary injunction, Judge Royce C. Lamberth, the chief judge in the U.S. District Court for the District of Columbia, said the NIH guidelines violated the intent of Congress to bar the use of federal funds for research in which human embryos are destroyed. He said the rules violated the Dickey-Wicker amendment, a rider generally attached to health spending bills each year. It prohibits the use of federal funds for the creation of a human embryo or embryos for research purposes or research in which a human embryo or embryos are destroyed or discarded. However, the Obama administration has argued that the amendment doesn't apply because federal funds are used for research on the embryonic stem cell lines, not in the destruction of the embryos.

Judge Lamberth said: “[Embryonic stem cell] research is clearly research in which an embryo is destroyed. Despite defendants' attempt to separate the derivation of [embryonic stem cells] from research on the [embryonic stem cells], the two cannot be separated.”

With the federal government filing an injunction, a fight is looming over the future of federal funding for research using human embryonic stem cells. The fracas started with an earlier ruling by a federal judge that temporarily blocked such research funding, leaving researchers who study human embryonic stem cells calling themselves surprised, disappointed, and even angry.

The Obama administration responded by filing a stay and notice of appeal on August 31.

The contested federal ruling bars the use of federal funds for any research involving human embryonic stem cells. As a result of the temporary injunction, the National Institutes of Health has stopped accepting submissions of information on human embryonic stem cell lines for NIH review and has also suspended all review of embryonic stem cell lines.

President Obama expanded opportunities to receive federal funding for embryonic stem cell research when he issued an executive order in 2009 that eliminated many of the restrictions placed on funding during the George W. Bush administration.

The NIH followed with guidelines that allowed research to be conducted on embryonic stem cells derived from embryos created through in vitro fertilization and donated for research.

With the recent court decision, some researchers worry that the development of therapies that use embryonic stem cells will be set back and that the loss of federal funding will have a chilling effect on newly minted researchers who are considering whether to enter the field.

The halt on funding for research using embryonic stem cells has implications on all types of stem cell research, said Alan Trounson, Ph.D., president of the California Institute for Regenerative Medicine, which issues grants to researchers in California who use state funds. “The decision is a deplorable brake on all stem cell research,” he said in a statement. “Many discoveries with other cell types, notably the so-called reprogrammed [induced pluripotent stem] cells, would not happen without ongoing research in human embryonic stem cells.”

Dr. Trounson said the California institute's funding plans would not be affected by the federal court decision. Institutions that have obtained private funding for their stem cell work will also be able to continue that work. However, even those with deep pockets are concerned that private funding alone is not enough. “It's a blow to us,” said B.D. Colen, a spokesman for the Harvard Stem Cell Institute.

The institute, a collaborative of stem cell researchers from around Massachusetts, has raised about $120 million in private funds since its founding 2004, but those sources are not unlimited, Mr. Colen said. The loss of federal funding that was expected to go to the institute's researchers will be disruptive, he said, and the impact will be worse for those researchers who do not have private funding sources to fall back on.

Another source of concern for researchers has to do with the legal issues involved in the case. An earlier lawsuit challenging the Obama stem cell guidelines had been dismissed after the court ruled that the plaintiffs had no standing to challenge it. However, the recent injunction came about after the court decided that two researchers who work with adult stem cells could challenge the guidelines because funding of embryonic stem cell research was harming their chances for receiving federal funds for adult stem cells.

“This judge opens the door for every scientist who ever has a grant request rejected on the merits to sue the federal government,” the American Society for Reproductive Medicine said in a statement condemning the court decision.

In granting the temporary injunction, Judge Royce C. Lamberth, the chief judge in the U.S. District Court for the District of Columbia, said the NIH guidelines violated the intent of Congress to bar the use of federal funds for research in which human embryos are destroyed. He said the rules violated the Dickey-Wicker amendment, a rider generally attached to health spending bills each year. It prohibits the use of federal funds for the creation of a human embryo or embryos for research purposes or research in which a human embryo or embryos are destroyed or discarded. However, the Obama administration has argued that the amendment doesn't apply because federal funds are used for research on the embryonic stem cell lines, not in the destruction of the embryos.

Judge Lamberth said: “[Embryonic stem cell] research is clearly research in which an embryo is destroyed. Despite defendants' attempt to separate the derivation of [embryonic stem cells] from research on the [embryonic stem cells], the two cannot be separated.”

In less than 6 months, doctors can begin to qualify for tens of thousands of dollars in incentive payments from the federal government for using electronic health record technology. Many physicians are asking: How do I get ready?

The first step, experts agree, is to prepare your practice. Implementing an electronic health record (EHR) effectively is only partially about the technology, said Mary Griskewicz, senior director for ambulatory information systems at Healthcare Information and Management Systems Society (HIMSS), a nonprofit organization.

Most of the work is about re-engineering the practice, assessing and changing processes and workflows. “This is not a small task, in particular for small practices,” she said.

And before practices jump into an implementation, Dr. Steven Waldren, director of the Center for Health IT at the American Academy of Family Physicians, suggests that they examine their motivation for using an EHR. He cautioned physicians not to do it just to take advantage of the new federal incentives.

Physicians who qualify as “meaningful users” of EHR technology through the Medicare program can receive up to $44,000 over 5 years, and those who qualify through the Medicaid program can earn about $64,000. But that may not cover the costs of a new system, Dr. Waldren said, so physicians should have other reasons for making the switch.

“They shouldn't be doing this for the $44,000,” Dr. Waldren said. “They should be doing it because they believe it's the right thing to do for them, their practice, and their patients. Without that, you don't have the commitment to make it actually happen.”

Once a practice has decided to purchase an EHR and laid the groundwork with the staff, there are still a number of challenges. For example, under the HITECH Act, which established the EHR incentive program, physicians can qualify only if they are meaningful users of certified EHR technology. While the government has released regulations defining meaningful use requirements, as well as requirements for certification, there are currently no certified products on the market. The first products are expected to gain certification sometime this fall, according to the Office of the National Coordinator for Health Information Technology, which is shepherding this effort.

But the current lack of certified products shouldn't keep physicians from shopping for a system now, experts said. One way to deal with it is to build a guarantee of certification into the contract with the vendor. Physicians just need to be sure to get any assurances in writing, said Dr. Waldren. And they need to be clear on the terms of the guarantee. For example, will the guarantee allow you to get your money back if the vendor fails to become certified or does it allow you to withhold payments until the vendor becomes certified?

Physicians also should look to include service level agreements in their contacts with vendors, Dr. Waldren said. This ensures that the practice will get specific levels of support within certain time frames. If the company fails to deliver on the promised level of service, the practice may be able to make reduced payments or hold payments until that service level is met. These agreements could become important, Dr. Waldren said, since vendors are likely to be very busy as more practices adopt EHRs over the next few years.

When choosing an EHR product, there are several factors to consider, Ms. Griskewicz said, such as whether the software will fit in with the workflow of the practice and whether it is usable by everyone in the office.

One way to answer some of those questions is to talk to clinicians at other practices who have already implemented the product. It's best to try to find practices that are similar to your own, Ms. Griskewicz said. And ask about integration issues such as how the system will work with existing billing software or how it can help the practice to handle future regulatory changes such as the switch from ICD-9 to ICD-10, she said.

Physicians should consider future meaningful use requirements when choosing a product, Dr. Waldren advised. Right now, physicians have to meet stage 1 criteria for meaningful use, but the requirements will get more difficult in stages 2 and 3 and require different functionality from the EHR technology, he said.

For now, physicians may be able to meet many of the early requirements through the implementation of e-prescribing and registry programs. Since the law does not require that physicians implement a full EHR system to qualify for incentive payments, physicians who are buying an EHR product for the first time may want to consider purchasing individual EHR modules, Dr. Waldren said.

The modules are significantly less expensive than traditional full systems. However, physicians who are considering a modular approach need to find out how the vendor would support stages 2 and 3 of meaningful use. And they would need a plan for how to move their data if they decided to switch to a different system later, he said.

For those practices that have already implemented an EHR system, the work is not over. They now have to ensure that they can meet the meaningful use requirements and that their system will be certified under the new federal rules. Many vendors will be offering upgrades to meet the certification requirements at varying costs.

If you're satisfied with your current system, it makes sense to stay with that vendor even if certification requirements can't be met right away, Dr. Waldren said. Although physicians can begin to qualify for meaningful use on Jan. 1, 2011, they can start submitting information to the government as late as October 2012 and still be eligible for the full incentive payments under Medicare.

Physicians who are not satisfied with their current system and who want to switch to a new product should consider that it may take some time to migrate the data from one product to another, Dr. Waldren added. Since vendors will be focused on trying to add as many new users as possible, getting the support and service for data migration may be challenging, he said.

As physicians consider their options, the key is to get educated, Ms. Griskewicz said. She recommends that physicians seek out trusted sources such as the Centers for Medicare and Medicaid Services and their medical professional societies, many of which are offering free Webinars and other online information. “The big thing right now is that they educate themselves,” she said.

Talk with physicians in other practices to learn from their experience with a particular EHR software product.

Source MS. GRISKEWICZ

Physicians should have a better motivation for adopting EHRs than getting the federal incentive payment.

Source DR. WALDREN

Don't Wait, but Don't Rush

Dr. David Blumenthal, the national coordinator for health information technology, has been making the rounds, getting the word out to physicians about the new meaningful use requirements and how to qualify for incentive payments for using EHRs.

During recent Webinars offered by professional medical societies, Dr. Blumenthal told physicians that they should get started on EHR implementation, but that they don't have to rush to be using the system by Jan. 1, when the new incentive program begins.

At that point, physicians can begin to apply to the Centers for Medicare and Medicaid Services to become meaningful users.

Those who qualify could begin receiving incentive payments as early as May 2011, according to Dr. Blumenthal. However, under the Medicare program, physicians can take advantage of the full amount of incentive payments, just at a later date, as long as they can become meaningful users by Oct. 1, 2012.

“You have time to learn to be a meaningful user,” Dr. Blumenthal said during a Webinar sponsored by the Medical Group Management Association.

For physicians who need assistance selecting or implementing EHR technology, Dr. Blumenthal recommended that they contact their local regional extension centers. The Office of the National Coordinator for Health Information Technology has awarded grant money to set up 60 of these centers around the country. The centers are focused on assisting primary care physicians in small practices and in underserved areas, but no practices will be turned away, Dr. Blumenthal said.

For more information about the regional extension program, go to

http://healthit.hhs.gov/extension-program

In less than 6 months, doctors can begin to qualify for tens of thousands of dollars in incentive payments from the federal government for using electronic health record technology. Many physicians are asking: How do I get ready?

The first step, experts agree, is to prepare your practice. Implementing an electronic health record (EHR) effectively is only partially about the technology, said Mary Griskewicz, senior director for ambulatory information systems at Healthcare Information and Management Systems Society (HIMSS), a nonprofit organization.

Most of the work is about re-engineering the practice, assessing and changing processes and workflows. “This is not a small task, in particular for small practices,” she said.

And before practices jump into an implementation, Dr. Steven Waldren, director of the Center for Health IT at the American Academy of Family Physicians, suggests that they examine their motivation for using an EHR. He cautioned physicians not to do it just to take advantage of the new federal incentives.

Physicians who qualify as “meaningful users” of EHR technology through the Medicare program can receive up to $44,000 over 5 years, and those who qualify through the Medicaid program can earn about $64,000. But that may not cover the costs of a new system, Dr. Waldren said, so physicians should have other reasons for making the switch.

“They shouldn't be doing this for the $44,000,” Dr. Waldren said. “They should be doing it because they believe it's the right thing to do for them, their practice, and their patients. Without that, you don't have the commitment to make it actually happen.”

Once a practice has decided to purchase an EHR and laid the groundwork with the staff, there are still a number of challenges. For example, under the HITECH Act, which established the EHR incentive program, physicians can qualify only if they are meaningful users of certified EHR technology. While the government has released regulations defining meaningful use requirements, as well as requirements for certification, there are currently no certified products on the market. The first products are expected to gain certification sometime this fall, according to the Office of the National Coordinator for Health Information Technology, which is shepherding this effort.

But the current lack of certified products shouldn't keep physicians from shopping for a system now, experts said. One way to deal with it is to build a guarantee of certification into the contract with the vendor. Physicians just need to be sure to get any assurances in writing, said Dr. Waldren. And they need to be clear on the terms of the guarantee. For example, will the guarantee allow you to get your money back if the vendor fails to become certified or does it allow you to withhold payments until the vendor becomes certified?

Physicians also should look to include service level agreements in their contacts with vendors, Dr. Waldren said. This ensures that the practice will get specific levels of support within certain time frames. If the company fails to deliver on the promised level of service, the practice may be able to make reduced payments or hold payments until that service level is met. These agreements could become important, Dr. Waldren said, since vendors are likely to be very busy as more practices adopt EHRs over the next few years.

When choosing an EHR product, there are several factors to consider, Ms. Griskewicz said, such as whether the software will fit in with the workflow of the practice and whether it is usable by everyone in the office.

One way to answer some of those questions is to talk to clinicians at other practices who have already implemented the product. It's best to try to find practices that are similar to your own, Ms. Griskewicz said. And ask about integration issues such as how the system will work with existing billing software or how it can help the practice to handle future regulatory changes such as the switch from ICD-9 to ICD-10, she said.

Physicians should consider future meaningful use requirements when choosing a product, Dr. Waldren advised. Right now, physicians have to meet stage 1 criteria for meaningful use, but the requirements will get more difficult in stages 2 and 3 and require different functionality from the EHR technology, he said.

For now, physicians may be able to meet many of the early requirements through the implementation of e-prescribing and registry programs. Since the law does not require that physicians implement a full EHR system to qualify for incentive payments, physicians who are buying an EHR product for the first time may want to consider purchasing individual EHR modules, Dr. Waldren said.

The modules are significantly less expensive than traditional full systems. However, physicians who are considering a modular approach need to find out how the vendor would support stages 2 and 3 of meaningful use. And they would need a plan for how to move their data if they decided to switch to a different system later, he said.

For those practices that have already implemented an EHR system, the work is not over. They now have to ensure that they can meet the meaningful use requirements and that their system will be certified under the new federal rules. Many vendors will be offering upgrades to meet the certification requirements at varying costs.

If you're satisfied with your current system, it makes sense to stay with that vendor even if certification requirements can't be met right away, Dr. Waldren said. Although physicians can begin to qualify for meaningful use on Jan. 1, 2011, they can start submitting information to the government as late as October 2012 and still be eligible for the full incentive payments under Medicare.

Physicians who are not satisfied with their current system and who want to switch to a new product should consider that it may take some time to migrate the data from one product to another, Dr. Waldren added. Since vendors will be focused on trying to add as many new users as possible, getting the support and service for data migration may be challenging, he said.

As physicians consider their options, the key is to get educated, Ms. Griskewicz said. She recommends that physicians seek out trusted sources such as the Centers for Medicare and Medicaid Services and their medical professional societies, many of which are offering free Webinars and other online information. “The big thing right now is that they educate themselves,” she said.

Talk with physicians in other practices to learn from their experience with a particular EHR software product.

Source MS. GRISKEWICZ

Physicians should have a better motivation for adopting EHRs than getting the federal incentive payment.

Source DR. WALDREN

Don't Wait, but Don't Rush

Dr. David Blumenthal, the national coordinator for health information technology, has been making the rounds, getting the word out to physicians about the new meaningful use requirements and how to qualify for incentive payments for using EHRs.

During recent Webinars offered by professional medical societies, Dr. Blumenthal told physicians that they should get started on EHR implementation, but that they don't have to rush to be using the system by Jan. 1, when the new incentive program begins.

At that point, physicians can begin to apply to the Centers for Medicare and Medicaid Services to become meaningful users.

Those who qualify could begin receiving incentive payments as early as May 2011, according to Dr. Blumenthal. However, under the Medicare program, physicians can take advantage of the full amount of incentive payments, just at a later date, as long as they can become meaningful users by Oct. 1, 2012.

“You have time to learn to be a meaningful user,” Dr. Blumenthal said during a Webinar sponsored by the Medical Group Management Association.

For physicians who need assistance selecting or implementing EHR technology, Dr. Blumenthal recommended that they contact their local regional extension centers. The Office of the National Coordinator for Health Information Technology has awarded grant money to set up 60 of these centers around the country. The centers are focused on assisting primary care physicians in small practices and in underserved areas, but no practices will be turned away, Dr. Blumenthal said.

For more information about the regional extension program, go to

http://healthit.hhs.gov/extension-program

In less than 6 months, doctors can begin to qualify for tens of thousands of dollars in incentive payments from the federal government for using electronic health record technology. Many physicians are asking: How do I get ready?

The first step, experts agree, is to prepare your practice. Implementing an electronic health record (EHR) effectively is only partially about the technology, said Mary Griskewicz, senior director for ambulatory information systems at Healthcare Information and Management Systems Society (HIMSS), a nonprofit organization.

Most of the work is about re-engineering the practice, assessing and changing processes and workflows. “This is not a small task, in particular for small practices,” she said.

And before practices jump into an implementation, Dr. Steven Waldren, director of the Center for Health IT at the American Academy of Family Physicians, suggests that they examine their motivation for using an EHR. He cautioned physicians not to do it just to take advantage of the new federal incentives.

Physicians who qualify as “meaningful users” of EHR technology through the Medicare program can receive up to $44,000 over 5 years, and those who qualify through the Medicaid program can earn about $64,000. But that may not cover the costs of a new system, Dr. Waldren said, so physicians should have other reasons for making the switch.

“They shouldn't be doing this for the $44,000,” Dr. Waldren said. “They should be doing it because they believe it's the right thing to do for them, their practice, and their patients. Without that, you don't have the commitment to make it actually happen.”

Once a practice has decided to purchase an EHR and laid the groundwork with the staff, there are still a number of challenges. For example, under the HITECH Act, which established the EHR incentive program, physicians can qualify only if they are meaningful users of certified EHR technology. While the government has released regulations defining meaningful use requirements, as well as requirements for certification, there are currently no certified products on the market. The first products are expected to gain certification sometime this fall, according to the Office of the National Coordinator for Health Information Technology, which is shepherding this effort.

But the current lack of certified products shouldn't keep physicians from shopping for a system now, experts said. One way to deal with it is to build a guarantee of certification into the contract with the vendor. Physicians just need to be sure to get any assurances in writing, said Dr. Waldren. And they need to be clear on the terms of the guarantee. For example, will the guarantee allow you to get your money back if the vendor fails to become certified or does it allow you to withhold payments until the vendor becomes certified?

Physicians also should look to include service level agreements in their contacts with vendors, Dr. Waldren said. This ensures that the practice will get specific levels of support within certain time frames. If the company fails to deliver on the promised level of service, the practice may be able to make reduced payments or hold payments until that service level is met. These agreements could become important, Dr. Waldren said, since vendors are likely to be very busy as more practices adopt EHRs over the next few years.

When choosing an EHR product, there are several factors to consider, Ms. Griskewicz said, such as whether the software will fit in with the workflow of the practice and whether it is usable by everyone in the office.

One way to answer some of those questions is to talk to clinicians at other practices who have already implemented the product. It's best to try to find practices that are similar to your own, Ms. Griskewicz said. And ask about integration issues such as how the system will work with existing billing software or how it can help the practice to handle future regulatory changes such as the switch from ICD-9 to ICD-10, she said.

Physicians should consider future meaningful use requirements when choosing a product, Dr. Waldren advised. Right now, physicians have to meet stage 1 criteria for meaningful use, but the requirements will get more difficult in stages 2 and 3 and require different functionality from the EHR technology, he said.

For now, physicians may be able to meet many of the early requirements through the implementation of e-prescribing and registry programs. Since the law does not require that physicians implement a full EHR system to qualify for incentive payments, physicians who are buying an EHR product for the first time may want to consider purchasing individual EHR modules, Dr. Waldren said.

The modules are significantly less expensive than traditional full systems. However, physicians who are considering a modular approach need to find out how the vendor would support stages 2 and 3 of meaningful use. And they would need a plan for how to move their data if they decided to switch to a different system later, he said.

For those practices that have already implemented an EHR system, the work is not over. They now have to ensure that they can meet the meaningful use requirements and that their system will be certified under the new federal rules. Many vendors will be offering upgrades to meet the certification requirements at varying costs.

If you're satisfied with your current system, it makes sense to stay with that vendor even if certification requirements can't be met right away, Dr. Waldren said. Although physicians can begin to qualify for meaningful use on Jan. 1, 2011, they can start submitting information to the government as late as October 2012 and still be eligible for the full incentive payments under Medicare.

Physicians who are not satisfied with their current system and who want to switch to a new product should consider that it may take some time to migrate the data from one product to another, Dr. Waldren added. Since vendors will be focused on trying to add as many new users as possible, getting the support and service for data migration may be challenging, he said.

As physicians consider their options, the key is to get educated, Ms. Griskewicz said. She recommends that physicians seek out trusted sources such as the Centers for Medicare and Medicaid Services and their medical professional societies, many of which are offering free Webinars and other online information. “The big thing right now is that they educate themselves,” she said.

Talk with physicians in other practices to learn from their experience with a particular EHR software product.

Source MS. GRISKEWICZ

Physicians should have a better motivation for adopting EHRs than getting the federal incentive payment.

Source DR. WALDREN

Don't Wait, but Don't Rush

Dr. David Blumenthal, the national coordinator for health information technology, has been making the rounds, getting the word out to physicians about the new meaningful use requirements and how to qualify for incentive payments for using EHRs.

During recent Webinars offered by professional medical societies, Dr. Blumenthal told physicians that they should get started on EHR implementation, but that they don't have to rush to be using the system by Jan. 1, when the new incentive program begins.

At that point, physicians can begin to apply to the Centers for Medicare and Medicaid Services to become meaningful users.

Those who qualify could begin receiving incentive payments as early as May 2011, according to Dr. Blumenthal. However, under the Medicare program, physicians can take advantage of the full amount of incentive payments, just at a later date, as long as they can become meaningful users by Oct. 1, 2012.

“You have time to learn to be a meaningful user,” Dr. Blumenthal said during a Webinar sponsored by the Medical Group Management Association.

For physicians who need assistance selecting or implementing EHR technology, Dr. Blumenthal recommended that they contact their local regional extension centers. The Office of the National Coordinator for Health Information Technology has awarded grant money to set up 60 of these centers around the country. The centers are focused on assisting primary care physicians in small practices and in underserved areas, but no practices will be turned away, Dr. Blumenthal said.

For more information about the regional extension program, go to

http://healthit.hhs.gov/extension-program

New health plans will soon be required to offer a range of recommended preventive health services to patients free of charge under the Affordable Care Act.

The requirements will affect new private health plans in the individual and group markets starting with plan years that begin on or after Sept. 23. The Health and Human Services department estimates that in 2011, the rules will impact about 30 million people in group health plans and another 10 million in individual market plans. The rules do not apply to grandfathered plans.

The administration released an interim final regulation detailing the new requirements on July 14.

Under the final rule, health plans may not collect copayments, coinsurance, or deductibles for a number of recommended preventive services. However, they may collect fees for the associated office visit if the preventive service was not the primary purpose of the visit. Patients may also incur cost sharing if they go out of network for the recommended screenings.

The covered services include those given an evidence rating of “A” or “B” from the U.S. Preventive Services Task Force. Those services include breast and colon cancer screenings, diabetes screenings, blood pressure and cholesterol testing, and screening for vitamin deficiencies during pregnancy. Tobacco cessation counseling is also given a high evidence rating by the USPSTF and would be covered under the new rule.

Health plans will have some extra time to begin covering newly recommended services. For recommendations that have been in effect for less than a year, plans will have 1 year to comply after the effective date, according to the interim final rule.

Health plans will also be required to cover the list of adult and childhood vaccines recommended by the Advisory Committee on Immunization Practices. For children, the rule also requires health plans to cover all preventive care recommended under the Bright Futures guidelines.

The guidelines include screenings, developmental assessments, immunizations, and regular well-child visits from birth to age 21 years. These guidelines were developed jointly by the Health Resources and Services Administration and the American Academy of Pediatrics.

The rule also calls for coverage of additional preventive services for women, which will be developed by an independent group of experts.

The recommendations from that group are expected by Aug. 1, 2011. There was no word from HHS on whether those recommendations are likely to include coverage for contraceptives, something many reproductive health advocates have been lobbying for in recent months.

HHS officials expect that the move to expand coverage and eliminate out-of-pocket costs for these services will decrease costs for many Americans, especially those at high risk for certain health conditions. At the same time, the change is expected to increase premiums for enrollees in nongrandfathered plans. The federal government estimates that premiums in the affected plans could increase about 1.5% on average.

A list of the recommended preventive services is available online at www.healthcare.gov/center/regulations/prevention/recommendations.html

New health plans will soon be required to offer a range of recommended preventive health services to patients free of charge under the Affordable Care Act.

The requirements will affect new private health plans in the individual and group markets starting with plan years that begin on or after Sept. 23. The Health and Human Services department estimates that in 2011, the rules will impact about 30 million people in group health plans and another 10 million in individual market plans. The rules do not apply to grandfathered plans.

The administration released an interim final regulation detailing the new requirements on July 14.

Under the final rule, health plans may not collect copayments, coinsurance, or deductibles for a number of recommended preventive services. However, they may collect fees for the associated office visit if the preventive service was not the primary purpose of the visit. Patients may also incur cost sharing if they go out of network for the recommended screenings.

The covered services include those given an evidence rating of “A” or “B” from the U.S. Preventive Services Task Force. Those services include breast and colon cancer screenings, diabetes screenings, blood pressure and cholesterol testing, and screening for vitamin deficiencies during pregnancy. Tobacco cessation counseling is also given a high evidence rating by the USPSTF and would be covered under the new rule.

Health plans will have some extra time to begin covering newly recommended services. For recommendations that have been in effect for less than a year, plans will have 1 year to comply after the effective date, according to the interim final rule.

Health plans will also be required to cover the list of adult and childhood vaccines recommended by the Advisory Committee on Immunization Practices. For children, the rule also requires health plans to cover all preventive care recommended under the Bright Futures guidelines.

The guidelines include screenings, developmental assessments, immunizations, and regular well-child visits from birth to age 21 years. These guidelines were developed jointly by the Health Resources and Services Administration and the American Academy of Pediatrics.

The rule also calls for coverage of additional preventive services for women, which will be developed by an independent group of experts.

The recommendations from that group are expected by Aug. 1, 2011. There was no word from HHS on whether those recommendations are likely to include coverage for contraceptives, something many reproductive health advocates have been lobbying for in recent months.

HHS officials expect that the move to expand coverage and eliminate out-of-pocket costs for these services will decrease costs for many Americans, especially those at high risk for certain health conditions. At the same time, the change is expected to increase premiums for enrollees in nongrandfathered plans. The federal government estimates that premiums in the affected plans could increase about 1.5% on average.

A list of the recommended preventive services is available online at www.healthcare.gov/center/regulations/prevention/recommendations.html

New health plans will soon be required to offer a range of recommended preventive health services to patients free of charge under the Affordable Care Act.

The requirements will affect new private health plans in the individual and group markets starting with plan years that begin on or after Sept. 23. The Health and Human Services department estimates that in 2011, the rules will impact about 30 million people in group health plans and another 10 million in individual market plans. The rules do not apply to grandfathered plans.

The administration released an interim final regulation detailing the new requirements on July 14.

Under the final rule, health plans may not collect copayments, coinsurance, or deductibles for a number of recommended preventive services. However, they may collect fees for the associated office visit if the preventive service was not the primary purpose of the visit. Patients may also incur cost sharing if they go out of network for the recommended screenings.

The covered services include those given an evidence rating of “A” or “B” from the U.S. Preventive Services Task Force. Those services include breast and colon cancer screenings, diabetes screenings, blood pressure and cholesterol testing, and screening for vitamin deficiencies during pregnancy. Tobacco cessation counseling is also given a high evidence rating by the USPSTF and would be covered under the new rule.

Health plans will have some extra time to begin covering newly recommended services. For recommendations that have been in effect for less than a year, plans will have 1 year to comply after the effective date, according to the interim final rule.

Health plans will also be required to cover the list of adult and childhood vaccines recommended by the Advisory Committee on Immunization Practices. For children, the rule also requires health plans to cover all preventive care recommended under the Bright Futures guidelines.

The guidelines include screenings, developmental assessments, immunizations, and regular well-child visits from birth to age 21 years. These guidelines were developed jointly by the Health Resources and Services Administration and the American Academy of Pediatrics.

The rule also calls for coverage of additional preventive services for women, which will be developed by an independent group of experts.

The recommendations from that group are expected by Aug. 1, 2011. There was no word from HHS on whether those recommendations are likely to include coverage for contraceptives, something many reproductive health advocates have been lobbying for in recent months.

HHS officials expect that the move to expand coverage and eliminate out-of-pocket costs for these services will decrease costs for many Americans, especially those at high risk for certain health conditions. At the same time, the change is expected to increase premiums for enrollees in nongrandfathered plans. The federal government estimates that premiums in the affected plans could increase about 1.5% on average.

A list of the recommended preventive services is available online at www.healthcare.gov/center/regulations/prevention/recommendations.html

New health plans will soon be required to offer a range of recommended preventive health services to patients free of charge under the Affordable Care Act.

The requirements will affect new private health plans in the individual and group markets starting with plan years that begin on or after Sept. 23. The Health and Human Services department estimates that in 2011, the rules will impact about 30 million people in group health plans and another 10 million in individual market plans. The new rules do not apply to grandfathered plans.

The administration released an interim final regulation detailing the new requirements in July.

Under the final rule, health plans may not collect copayments, coinsurance, or deductibles for a number of recommended preventive services. However, insurers may collect a fee for the associated office visit if the preventive health service was not the primary purpose of the visit.

Patients may also incur cost sharing if they go out of network for the recommended screenings.

The services that are covered include those given an evidence rating of “A” or “B” from the U.S. Preventive Services Task Force.

Those services include breast and colon cancer screenings, diabetes screenings, blood pressure and cholesterol testing, and screening for vitamin deficiencies during pregnancy. Tobacco cessation counseling is also given a high evidence rating by the U.S. Preventive Services Task Force and would be covered under the new rule.

Health plans will have some extra time to begin covering newly recommended services. For recommendations that have been in effect for less than a year, plans will have 1 year to comply after the effective date, according to the interim final rule.

Health plans will also be required to cover the list of adult and childhood vaccines recommended by the Advisory Committee on Immunization Practices. For children, the rule also requires health plans to cover all preventive care recommended under the Bright Futures guidelines.

The guidelines include screenings, developmental assessments, immunizations, and regular well-child visits from birth to the age of 21 years. These guidelines were developed jointly by the Health Resources and Services Administration and the American Academy of Pediatrics.

The rule also calls for coverage of additional preventive services for women, which will be developed by an independent group of experts. The recommendations from that group are expected by Aug. 1, 2011.

There was no word from HHS on whether those recommendations are likely to include coverage for contraceptives, something many reproductive health advocates have been lobbying for in recent months.

HHS officials expect that the move to expand coverage and eliminate out-of-pocket costs for these services will decrease costs for many Americans, especially those at high risk for certain health conditions.

At the same time, the change is expected to increase premiums for those who are enrolled in nongrandfathered plans. The federal government has estimated that premiums in the affected plans could increase by about 1.5% on average.

A list of the recommended preventive services is available online at www.healthcare.gov/center/regulations/prevention/recommendations.html

New health plans will soon be required to offer a range of recommended preventive health services to patients free of charge under the Affordable Care Act.

The requirements will affect new private health plans in the individual and group markets starting with plan years that begin on or after Sept. 23. The Health and Human Services department estimates that in 2011, the rules will impact about 30 million people in group health plans and another 10 million in individual market plans. The new rules do not apply to grandfathered plans.

The administration released an interim final regulation detailing the new requirements in July.

Under the final rule, health plans may not collect copayments, coinsurance, or deductibles for a number of recommended preventive services. However, insurers may collect a fee for the associated office visit if the preventive health service was not the primary purpose of the visit.

Patients may also incur cost sharing if they go out of network for the recommended screenings.

The services that are covered include those given an evidence rating of “A” or “B” from the U.S. Preventive Services Task Force.

Those services include breast and colon cancer screenings, diabetes screenings, blood pressure and cholesterol testing, and screening for vitamin deficiencies during pregnancy. Tobacco cessation counseling is also given a high evidence rating by the U.S. Preventive Services Task Force and would be covered under the new rule.

Health plans will have some extra time to begin covering newly recommended services. For recommendations that have been in effect for less than a year, plans will have 1 year to comply after the effective date, according to the interim final rule.

Health plans will also be required to cover the list of adult and childhood vaccines recommended by the Advisory Committee on Immunization Practices. For children, the rule also requires health plans to cover all preventive care recommended under the Bright Futures guidelines.

The guidelines include screenings, developmental assessments, immunizations, and regular well-child visits from birth to the age of 21 years. These guidelines were developed jointly by the Health Resources and Services Administration and the American Academy of Pediatrics.

The rule also calls for coverage of additional preventive services for women, which will be developed by an independent group of experts. The recommendations from that group are expected by Aug. 1, 2011.

There was no word from HHS on whether those recommendations are likely to include coverage for contraceptives, something many reproductive health advocates have been lobbying for in recent months.

HHS officials expect that the move to expand coverage and eliminate out-of-pocket costs for these services will decrease costs for many Americans, especially those at high risk for certain health conditions.

At the same time, the change is expected to increase premiums for those who are enrolled in nongrandfathered plans. The federal government has estimated that premiums in the affected plans could increase by about 1.5% on average.

A list of the recommended preventive services is available online at www.healthcare.gov/center/regulations/prevention/recommendations.html

New health plans will soon be required to offer a range of recommended preventive health services to patients free of charge under the Affordable Care Act.

The requirements will affect new private health plans in the individual and group markets starting with plan years that begin on or after Sept. 23. The Health and Human Services department estimates that in 2011, the rules will impact about 30 million people in group health plans and another 10 million in individual market plans. The new rules do not apply to grandfathered plans.

The administration released an interim final regulation detailing the new requirements in July.

Under the final rule, health plans may not collect copayments, coinsurance, or deductibles for a number of recommended preventive services. However, insurers may collect a fee for the associated office visit if the preventive health service was not the primary purpose of the visit.

Patients may also incur cost sharing if they go out of network for the recommended screenings.

The services that are covered include those given an evidence rating of “A” or “B” from the U.S. Preventive Services Task Force.

Those services include breast and colon cancer screenings, diabetes screenings, blood pressure and cholesterol testing, and screening for vitamin deficiencies during pregnancy. Tobacco cessation counseling is also given a high evidence rating by the U.S. Preventive Services Task Force and would be covered under the new rule.

Health plans will have some extra time to begin covering newly recommended services. For recommendations that have been in effect for less than a year, plans will have 1 year to comply after the effective date, according to the interim final rule.

Health plans will also be required to cover the list of adult and childhood vaccines recommended by the Advisory Committee on Immunization Practices. For children, the rule also requires health plans to cover all preventive care recommended under the Bright Futures guidelines.

The guidelines include screenings, developmental assessments, immunizations, and regular well-child visits from birth to the age of 21 years. These guidelines were developed jointly by the Health Resources and Services Administration and the American Academy of Pediatrics.

The rule also calls for coverage of additional preventive services for women, which will be developed by an independent group of experts. The recommendations from that group are expected by Aug. 1, 2011.

There was no word from HHS on whether those recommendations are likely to include coverage for contraceptives, something many reproductive health advocates have been lobbying for in recent months.

HHS officials expect that the move to expand coverage and eliminate out-of-pocket costs for these services will decrease costs for many Americans, especially those at high risk for certain health conditions.

At the same time, the change is expected to increase premiums for those who are enrolled in nongrandfathered plans. The federal government has estimated that premiums in the affected plans could increase by about 1.5% on average.

A list of the recommended preventive services is available online at www.healthcare.gov/center/regulations/prevention/recommendations.html

New federal regulations mandated by the Affordable Care Act will give patients rights to appeal claims denials made by their health plans.

The rules will allow consumers in new health plans to appeal decisions both through their insurer's internal process and to an outside, independent entity. Most health plans already provide for an internal appeals process, but not all offer an external review of plan decisions, said the U.S. Department of Health and Human Services. The types of appeals processes often depend on state laws.

HHS officials estimate that in 2011 there will be about 31 million people in new employer plans and another 10 million in new individual market plans who will be able to take advantage of these new appeals opportunities. The rules do not apply to grandfathered health plans.

Health plans that begin on or after Sept. 23, 2010, must have an internal appeals process for consumers to appeal whenever the plan denies a claim for a covered service or rescinds coverage. The appeals process must offer consumers detailed information about the grounds for their denial and information on filing an appeal.

The rules aim to make internal appeals more objective by ensuring that the person considering the appeal does not have a conflict of interest. Health plans will also have to provide an expedited appeals process, which would allow urgent cases to be reviewed within 24 hours.

The appeals regulations also standardize rules for external appeals. Health plans must provide clear information about external appeals and expedited access to the process. The decisions made through external appeals will be binding.

New federal regulations mandated by the Affordable Care Act will give patients rights to appeal claims denials made by their health plans.

The rules will allow consumers in new health plans to appeal decisions both through their insurer's internal process and to an outside, independent entity. Most health plans already provide for an internal appeals process, but not all offer an external review of plan decisions, said the U.S. Department of Health and Human Services. The types of appeals processes often depend on state laws.

HHS officials estimate that in 2011 there will be about 31 million people in new employer plans and another 10 million in new individual market plans who will be able to take advantage of these new appeals opportunities. The rules do not apply to grandfathered health plans.

Health plans that begin on or after Sept. 23, 2010, must have an internal appeals process for consumers to appeal whenever the plan denies a claim for a covered service or rescinds coverage. The appeals process must offer consumers detailed information about the grounds for their denial and information on filing an appeal.

The rules aim to make internal appeals more objective by ensuring that the person considering the appeal does not have a conflict of interest. Health plans will also have to provide an expedited appeals process, which would allow urgent cases to be reviewed within 24 hours.

The appeals regulations also standardize rules for external appeals. Health plans must provide clear information about external appeals and expedited access to the process. The decisions made through external appeals will be binding.

New federal regulations mandated by the Affordable Care Act will give patients rights to appeal claims denials made by their health plans.

The rules will allow consumers in new health plans to appeal decisions both through their insurer's internal process and to an outside, independent entity. Most health plans already provide for an internal appeals process, but not all offer an external review of plan decisions, said the U.S. Department of Health and Human Services. The types of appeals processes often depend on state laws.

HHS officials estimate that in 2011 there will be about 31 million people in new employer plans and another 10 million in new individual market plans who will be able to take advantage of these new appeals opportunities. The rules do not apply to grandfathered health plans.

Health plans that begin on or after Sept. 23, 2010, must have an internal appeals process for consumers to appeal whenever the plan denies a claim for a covered service or rescinds coverage. The appeals process must offer consumers detailed information about the grounds for their denial and information on filing an appeal.

The rules aim to make internal appeals more objective by ensuring that the person considering the appeal does not have a conflict of interest. Health plans will also have to provide an expedited appeals process, which would allow urgent cases to be reviewed within 24 hours.

The appeals regulations also standardize rules for external appeals. Health plans must provide clear information about external appeals and expedited access to the process. The decisions made through external appeals will be binding.

Provisions of the new Affordable Care Act, coupled with other payment changes, will save Medicare nearly $8 billion over 2 years and extend the solvency of the Medicare Trust Funds by 12 years.

The immediate savings come from cuts to Medicare Advantage payments, competitive bidding for durable medical equipment, changes to how Medicare pays for advanced imaging services, productivity improvements in the hospital, and efforts to reduce waste, fraud, and abuse, says a report from the Centers for Medicare and Medicaid Services. The changes are expected to save $7.8 billion for the Medicare program by the end of next year.

Health and Human Services Secretary Kathleen Sebelius said at a press conference that the new law will protect Medicare beneficiaries by maintaining current benefits and adding new ones such as free preventive care and the eventually closing the Medicare Part D prescription drug doughnut hole.

CMS officials estimate that Medicare savings will exceed $418 billion by 2019. Some of those savings will come from reducing hospital readmissions and hospital-acquired infections, bundling payments for end-stage renal disease care, promoting Accountable Care Organizations, and improving quality reporting by physicians. CMS also expects the establishment of the Independent Payment Advisory Board, which will recommend payment changes aimed at slowing growth in Medicare spending.

Ms. Sebelius said she expects private insurers to implement some of these payment changes as they prove effective in the Medicare program.

Provisions of the new Affordable Care Act, coupled with other payment changes, will save Medicare nearly $8 billion over 2 years and extend the solvency of the Medicare Trust Funds by 12 years.

The immediate savings come from cuts to Medicare Advantage payments, competitive bidding for durable medical equipment, changes to how Medicare pays for advanced imaging services, productivity improvements in the hospital, and efforts to reduce waste, fraud, and abuse, says a report from the Centers for Medicare and Medicaid Services. The changes are expected to save $7.8 billion for the Medicare program by the end of next year.

Health and Human Services Secretary Kathleen Sebelius said at a press conference that the new law will protect Medicare beneficiaries by maintaining current benefits and adding new ones such as free preventive care and the eventually closing the Medicare Part D prescription drug doughnut hole.

CMS officials estimate that Medicare savings will exceed $418 billion by 2019. Some of those savings will come from reducing hospital readmissions and hospital-acquired infections, bundling payments for end-stage renal disease care, promoting Accountable Care Organizations, and improving quality reporting by physicians. CMS also expects the establishment of the Independent Payment Advisory Board, which will recommend payment changes aimed at slowing growth in Medicare spending.

Ms. Sebelius said she expects private insurers to implement some of these payment changes as they prove effective in the Medicare program.

Provisions of the new Affordable Care Act, coupled with other payment changes, will save Medicare nearly $8 billion over 2 years and extend the solvency of the Medicare Trust Funds by 12 years.

The immediate savings come from cuts to Medicare Advantage payments, competitive bidding for durable medical equipment, changes to how Medicare pays for advanced imaging services, productivity improvements in the hospital, and efforts to reduce waste, fraud, and abuse, says a report from the Centers for Medicare and Medicaid Services. The changes are expected to save $7.8 billion for the Medicare program by the end of next year.

Health and Human Services Secretary Kathleen Sebelius said at a press conference that the new law will protect Medicare beneficiaries by maintaining current benefits and adding new ones such as free preventive care and the eventually closing the Medicare Part D prescription drug doughnut hole.

CMS officials estimate that Medicare savings will exceed $418 billion by 2019. Some of those savings will come from reducing hospital readmissions and hospital-acquired infections, bundling payments for end-stage renal disease care, promoting Accountable Care Organizations, and improving quality reporting by physicians. CMS also expects the establishment of the Independent Payment Advisory Board, which will recommend payment changes aimed at slowing growth in Medicare spending.

Ms. Sebelius said she expects private insurers to implement some of these payment changes as they prove effective in the Medicare program.

In less than 6 months, doctors can begin to qualify for tens of thousands of dollars in incentive payments from the federal government for using electronic health record technology. Many physicians are asking: How do I get ready?

The first step, experts agree, is to prepare your practice. Implementing an electronic health record (EHR) effectively is only partially about the technology, said Mary Griskewicz, senior director for ambulatory information systems at Healthcare Information and Management Systems Society (HIMSS), a nonprofit organization.

Most of the work is about reengineering the practice, assessing and changing processes and workflows. “This is not a small task, in particular for small practices,” she said.

And before practices jump into an implementation, Dr. Steven Waldren, director of the Center for Health IT at the American Academy of Family Physicians, suggests that they examine their motivation for using an EHR. He cautioned physicians not to do it just to take advantage of the new federal incentives.

Physicians who qualify as “meaningful users” of EHR technology through the Medicare program can receive up to $44,000 over 5 years, and those who qualify through the Medicaid program can earn about $64,000. But that may not cover the costs of a new system, Dr. Waldren said, so physicians should have other reasons for making the switch.

“They shouldn't be doing this for the $44,000,” Dr. Waldren said. “They should be doing it because they believe it's the right thing to do for them, their practice, and their patients. Without that, you don't have the commitment to make it actually happen.”

Once a practice has decided to purchase an EHR and laid the groundwork with the staff, there are still a number of challenges. For example, under the HITECH Act, which established the EHR incentive program, physicians can qualify only if they are meaningful users of certified EHR technology.

While the government has released regulations defining meaningful use requirements, as well as requirements for certification, there are currently no certified products on the market. The first products are expected to gain certification sometime this fall, according to the Office of the National Coordinator for Health Information Technology, which is shepherding this effort.

But the current lack of certified products shouldn't keep physicians from shopping for a system now, experts said. One way to deal with it is to build a guarantee of certification into the contract with the vendor. Physicians just need to be sure to get any assurances in writing, said Dr. Waldren. And they need to be clear on the terms of the guarantee. For example, will the guarantee allow you to get your money back if the vendor fails to become certified or does it allow you to withhold payments until the vendor becomes certified?

Physicians also should look to include service level agreements in their contacts with vendors, Dr. Waldren said. This ensures that the practice will get specific levels of support within certain time frames. If the company fails to deliver on the promised level of service, the practice may be able to make reduced payments or hold payments until that service level is met. These agreements could become important, Dr. Waldren said, because vendors are likely to be increasingly busy as more practices adopt EHRs over the next several years.

When choosing an EHR product, there are several factors to consider, Ms. Griskewicz said, such as whether the software will fit in with the workflow of the practice and whether it is usable by everyone in the office.

One way to answer some of those questions is to speak with clinicians at other practices who have already implemented the product. It's best to try to find practices that are similar to your own, Ms. Griskewicz said. And ask about integration issues such as how the system will work with existing billing software or how it can help the practice to handle future regulatory changes such as the switch from ICD-9 to ICD-10, she said.

Doctors should consider future meaningful use requirements when choosing a product, Dr. Waldren advised. Right now, physicians have to meet stage 1 criteria for meaningful use, but the requirements will get more difficult in stages 2 and 3 and require different functionality from electronic health record technology, he said.

For now, physicians may be able to meet many of the early requirements through the implementation of e-prescribing and registry programs. Since the law does not require that physicians implement a full EHR system to qualify for incentive payments, physicians who are buying an EHR product for the first time may want to consider purchasing individual EHR modules, Dr. Waldren said.

The modules are significantly less expensive than traditional full systems. However, physicians who are considering a modular approach need to find out how the vendor would support stages 2 and 3 of meaningful use. And they would need a plan for how to move their data if they decided to switch to a different system later, he said.

For those practices that have already implemented an EHR system, the work is not over. They now have to ensure that they can meet the meaningful use requirements and that their system will be eligible for certification under the new federal rules. Many vendors will be offering upgrades to meet the certification requirements at varying costs.

If your practice is satisfied with its current EHR system, it makes sense to stay with that vendor even if certification requirements cannot be met right away, Dr. Waldren said.

Although physicians can begin to qualify for meaningful use on Jan. 1, 2011, they can start submitting information to the government as late as October 2012 and still be eligible for the full incentive payments under Medicare.

Physicians who are not satisfied with their current system and who want to switch to a new product should consider that it may take some time to migrate the data from one product to another, Dr. Waldren added.

Since vendors will be focused on trying to add as many new users as possible, getting the support and service for data migration may be challenging, he said.

As physicians consider their options, the key is to get educated, Ms. Griskewicz said. She recommends that physicians seek out trusted sources such as the Centers for Medicare and Medicaid Services and their medical professional societies, many of which are offering free Webinars and other online information.

“The big thing right now is that they educate themselves as to what are the requirements” and what they need to do and what is the best fit for their practice, she said.

Implementing an electronic health record effectively is only partially about the technology.

Source MS. GRISKEWICZ

The law does not require that physicians implement a full EHR system to qualify for incentives.

Source DR. WALDREN

Don't Wait, but Don't Rush

Dr. David Blumenthal, the national coordinator for health information technology, has been making the rounds, getting the word out to physicians about the new meaningful use requirements and how to qualify for incentive payments for using EHRs.

During recent Webinars offered by professional medical societies, Dr. Blumenthal told physicians that they should get started on EHR implementation, but that they don't have to rush to be using the system by Jan. 1, when the new incentive program begins. At that point, physicians can begin to apply to the Centers for Medicare and Medicaid Services to become meaningful users. Those who qualify could begin receiving incentive payments as early as May 2011, according to Dr. Blumenthal. However, under the Medicare program, physicians can take advantage of the full amount of incentive payments, just at a later date, as long as they can become meaningful users by Oct. 1, 2012.

“You have time to learn to be a meaningful user,” Dr. Blumenthal said during a Webinar sponsored by the Medical Group Management Association.

For physicians who need assistance selecting or implementing EHR technology, Dr. Blumenthal recommended that they contact their local regional extension centers. The Office of the National Coordinator for Health Information Technology has awarded grant money to set up 60 of these centers around the country. The centers are focused on assisting primary care physicians in small practices and in underserved areas, but no practices will be turned away, Dr. Blumenthal said. For more information about the regional extension program, go to

http://healthit.hhs.gov/extensionprogram

In less than 6 months, doctors can begin to qualify for tens of thousands of dollars in incentive payments from the federal government for using electronic health record technology. Many physicians are asking: How do I get ready?

The first step, experts agree, is to prepare your practice. Implementing an electronic health record (EHR) effectively is only partially about the technology, said Mary Griskewicz, senior director for ambulatory information systems at Healthcare Information and Management Systems Society (HIMSS), a nonprofit organization.

Most of the work is about reengineering the practice, assessing and changing processes and workflows. “This is not a small task, in particular for small practices,” she said.

And before practices jump into an implementation, Dr. Steven Waldren, director of the Center for Health IT at the American Academy of Family Physicians, suggests that they examine their motivation for using an EHR. He cautioned physicians not to do it just to take advantage of the new federal incentives.

Physicians who qualify as “meaningful users” of EHR technology through the Medicare program can receive up to $44,000 over 5 years, and those who qualify through the Medicaid program can earn about $64,000. But that may not cover the costs of a new system, Dr. Waldren said, so physicians should have other reasons for making the switch.

“They shouldn't be doing this for the $44,000,” Dr. Waldren said. “They should be doing it because they believe it's the right thing to do for them, their practice, and their patients. Without that, you don't have the commitment to make it actually happen.”

Once a practice has decided to purchase an EHR and laid the groundwork with the staff, there are still a number of challenges. For example, under the HITECH Act, which established the EHR incentive program, physicians can qualify only if they are meaningful users of certified EHR technology.

While the government has released regulations defining meaningful use requirements, as well as requirements for certification, there are currently no certified products on the market. The first products are expected to gain certification sometime this fall, according to the Office of the National Coordinator for Health Information Technology, which is shepherding this effort.

But the current lack of certified products shouldn't keep physicians from shopping for a system now, experts said. One way to deal with it is to build a guarantee of certification into the contract with the vendor. Physicians just need to be sure to get any assurances in writing, said Dr. Waldren. And they need to be clear on the terms of the guarantee. For example, will the guarantee allow you to get your money back if the vendor fails to become certified or does it allow you to withhold payments until the vendor becomes certified?

Physicians also should look to include service level agreements in their contacts with vendors, Dr. Waldren said. This ensures that the practice will get specific levels of support within certain time frames. If the company fails to deliver on the promised level of service, the practice may be able to make reduced payments or hold payments until that service level is met. These agreements could become important, Dr. Waldren said, because vendors are likely to be increasingly busy as more practices adopt EHRs over the next several years.

When choosing an EHR product, there are several factors to consider, Ms. Griskewicz said, such as whether the software will fit in with the workflow of the practice and whether it is usable by everyone in the office.

One way to answer some of those questions is to speak with clinicians at other practices who have already implemented the product. It's best to try to find practices that are similar to your own, Ms. Griskewicz said. And ask about integration issues such as how the system will work with existing billing software or how it can help the practice to handle future regulatory changes such as the switch from ICD-9 to ICD-10, she said.

Doctors should consider future meaningful use requirements when choosing a product, Dr. Waldren advised. Right now, physicians have to meet stage 1 criteria for meaningful use, but the requirements will get more difficult in stages 2 and 3 and require different functionality from electronic health record technology, he said.

For now, physicians may be able to meet many of the early requirements through the implementation of e-prescribing and registry programs. Since the law does not require that physicians implement a full EHR system to qualify for incentive payments, physicians who are buying an EHR product for the first time may want to consider purchasing individual EHR modules, Dr. Waldren said.

The modules are significantly less expensive than traditional full systems. However, physicians who are considering a modular approach need to find out how the vendor would support stages 2 and 3 of meaningful use. And they would need a plan for how to move their data if they decided to switch to a different system later, he said.

For those practices that have already implemented an EHR system, the work is not over. They now have to ensure that they can meet the meaningful use requirements and that their system will be eligible for certification under the new federal rules. Many vendors will be offering upgrades to meet the certification requirements at varying costs.

If your practice is satisfied with its current EHR system, it makes sense to stay with that vendor even if certification requirements cannot be met right away, Dr. Waldren said.

Although physicians can begin to qualify for meaningful use on Jan. 1, 2011, they can start submitting information to the government as late as October 2012 and still be eligible for the full incentive payments under Medicare.

Physicians who are not satisfied with their current system and who want to switch to a new product should consider that it may take some time to migrate the data from one product to another, Dr. Waldren added.

Since vendors will be focused on trying to add as many new users as possible, getting the support and service for data migration may be challenging, he said.

As physicians consider their options, the key is to get educated, Ms. Griskewicz said. She recommends that physicians seek out trusted sources such as the Centers for Medicare and Medicaid Services and their medical professional societies, many of which are offering free Webinars and other online information.

“The big thing right now is that they educate themselves as to what are the requirements” and what they need to do and what is the best fit for their practice, she said.

Implementing an electronic health record effectively is only partially about the technology.

Source MS. GRISKEWICZ

The law does not require that physicians implement a full EHR system to qualify for incentives.

Source DR. WALDREN

Don't Wait, but Don't Rush

Dr. David Blumenthal, the national coordinator for health information technology, has been making the rounds, getting the word out to physicians about the new meaningful use requirements and how to qualify for incentive payments for using EHRs.

During recent Webinars offered by professional medical societies, Dr. Blumenthal told physicians that they should get started on EHR implementation, but that they don't have to rush to be using the system by Jan. 1, when the new incentive program begins. At that point, physicians can begin to apply to the Centers for Medicare and Medicaid Services to become meaningful users. Those who qualify could begin receiving incentive payments as early as May 2011, according to Dr. Blumenthal. However, under the Medicare program, physicians can take advantage of the full amount of incentive payments, just at a later date, as long as they can become meaningful users by Oct. 1, 2012.

“You have time to learn to be a meaningful user,” Dr. Blumenthal said during a Webinar sponsored by the Medical Group Management Association.

For physicians who need assistance selecting or implementing EHR technology, Dr. Blumenthal recommended that they contact their local regional extension centers. The Office of the National Coordinator for Health Information Technology has awarded grant money to set up 60 of these centers around the country. The centers are focused on assisting primary care physicians in small practices and in underserved areas, but no practices will be turned away, Dr. Blumenthal said. For more information about the regional extension program, go to

http://healthit.hhs.gov/extensionprogram

In less than 6 months, doctors can begin to qualify for tens of thousands of dollars in incentive payments from the federal government for using electronic health record technology. Many physicians are asking: How do I get ready?

The first step, experts agree, is to prepare your practice. Implementing an electronic health record (EHR) effectively is only partially about the technology, said Mary Griskewicz, senior director for ambulatory information systems at Healthcare Information and Management Systems Society (HIMSS), a nonprofit organization.

Most of the work is about reengineering the practice, assessing and changing processes and workflows. “This is not a small task, in particular for small practices,” she said.

And before practices jump into an implementation, Dr. Steven Waldren, director of the Center for Health IT at the American Academy of Family Physicians, suggests that they examine their motivation for using an EHR. He cautioned physicians not to do it just to take advantage of the new federal incentives.

Physicians who qualify as “meaningful users” of EHR technology through the Medicare program can receive up to $44,000 over 5 years, and those who qualify through the Medicaid program can earn about $64,000. But that may not cover the costs of a new system, Dr. Waldren said, so physicians should have other reasons for making the switch.

“They shouldn't be doing this for the $44,000,” Dr. Waldren said. “They should be doing it because they believe it's the right thing to do for them, their practice, and their patients. Without that, you don't have the commitment to make it actually happen.”

Once a practice has decided to purchase an EHR and laid the groundwork with the staff, there are still a number of challenges. For example, under the HITECH Act, which established the EHR incentive program, physicians can qualify only if they are meaningful users of certified EHR technology.

While the government has released regulations defining meaningful use requirements, as well as requirements for certification, there are currently no certified products on the market. The first products are expected to gain certification sometime this fall, according to the Office of the National Coordinator for Health Information Technology, which is shepherding this effort.

But the current lack of certified products shouldn't keep physicians from shopping for a system now, experts said. One way to deal with it is to build a guarantee of certification into the contract with the vendor. Physicians just need to be sure to get any assurances in writing, said Dr. Waldren. And they need to be clear on the terms of the guarantee. For example, will the guarantee allow you to get your money back if the vendor fails to become certified or does it allow you to withhold payments until the vendor becomes certified?

Physicians also should look to include service level agreements in their contacts with vendors, Dr. Waldren said. This ensures that the practice will get specific levels of support within certain time frames. If the company fails to deliver on the promised level of service, the practice may be able to make reduced payments or hold payments until that service level is met. These agreements could become important, Dr. Waldren said, because vendors are likely to be increasingly busy as more practices adopt EHRs over the next several years.

When choosing an EHR product, there are several factors to consider, Ms. Griskewicz said, such as whether the software will fit in with the workflow of the practice and whether it is usable by everyone in the office.

One way to answer some of those questions is to speak with clinicians at other practices who have already implemented the product. It's best to try to find practices that are similar to your own, Ms. Griskewicz said. And ask about integration issues such as how the system will work with existing billing software or how it can help the practice to handle future regulatory changes such as the switch from ICD-9 to ICD-10, she said.

Doctors should consider future meaningful use requirements when choosing a product, Dr. Waldren advised. Right now, physicians have to meet stage 1 criteria for meaningful use, but the requirements will get more difficult in stages 2 and 3 and require different functionality from electronic health record technology, he said.

For now, physicians may be able to meet many of the early requirements through the implementation of e-prescribing and registry programs. Since the law does not require that physicians implement a full EHR system to qualify for incentive payments, physicians who are buying an EHR product for the first time may want to consider purchasing individual EHR modules, Dr. Waldren said.

The modules are significantly less expensive than traditional full systems. However, physicians who are considering a modular approach need to find out how the vendor would support stages 2 and 3 of meaningful use. And they would need a plan for how to move their data if they decided to switch to a different system later, he said.

For those practices that have already implemented an EHR system, the work is not over. They now have to ensure that they can meet the meaningful use requirements and that their system will be eligible for certification under the new federal rules. Many vendors will be offering upgrades to meet the certification requirements at varying costs.

If your practice is satisfied with its current EHR system, it makes sense to stay with that vendor even if certification requirements cannot be met right away, Dr. Waldren said.

Although physicians can begin to qualify for meaningful use on Jan. 1, 2011, they can start submitting information to the government as late as October 2012 and still be eligible for the full incentive payments under Medicare.

Physicians who are not satisfied with their current system and who want to switch to a new product should consider that it may take some time to migrate the data from one product to another, Dr. Waldren added.

Since vendors will be focused on trying to add as many new users as possible, getting the support and service for data migration may be challenging, he said.

As physicians consider their options, the key is to get educated, Ms. Griskewicz said. She recommends that physicians seek out trusted sources such as the Centers for Medicare and Medicaid Services and their medical professional societies, many of which are offering free Webinars and other online information.

“The big thing right now is that they educate themselves as to what are the requirements” and what they need to do and what is the best fit for their practice, she said.

Implementing an electronic health record effectively is only partially about the technology.

Source MS. GRISKEWICZ

The law does not require that physicians implement a full EHR system to qualify for incentives.

Source DR. WALDREN

Don't Wait, but Don't Rush

Dr. David Blumenthal, the national coordinator for health information technology, has been making the rounds, getting the word out to physicians about the new meaningful use requirements and how to qualify for incentive payments for using EHRs.

During recent Webinars offered by professional medical societies, Dr. Blumenthal told physicians that they should get started on EHR implementation, but that they don't have to rush to be using the system by Jan. 1, when the new incentive program begins. At that point, physicians can begin to apply to the Centers for Medicare and Medicaid Services to become meaningful users. Those who qualify could begin receiving incentive payments as early as May 2011, according to Dr. Blumenthal. However, under the Medicare program, physicians can take advantage of the full amount of incentive payments, just at a later date, as long as they can become meaningful users by Oct. 1, 2012.

“You have time to learn to be a meaningful user,” Dr. Blumenthal said during a Webinar sponsored by the Medical Group Management Association.

For physicians who need assistance selecting or implementing EHR technology, Dr. Blumenthal recommended that they contact their local regional extension centers. The Office of the National Coordinator for Health Information Technology has awarded grant money to set up 60 of these centers around the country. The centers are focused on assisting primary care physicians in small practices and in underserved areas, but no practices will be turned away, Dr. Blumenthal said. For more information about the regional extension program, go to

http://healthit.hhs.gov/extensionprogram

Delays in the time from first contact with the health care system to treatment with primary percutaneous coronary intervention are linked to mortality for patients with ST-segment elevation myocardial infarction.

Researchers found that a delay of up to 60 minutes between the time of first contact with emergency medical services to the time when patients received guiding catheter insertion during PCI resulted in a long-term mortality rate of 15.4%.

When the delay increased to 61-120 minutes, the mortality rate rose to 23.3%. A delay of 121-180 minutes resulted in a long-term mortality rate of 28.1%, and a delay of 181-360 minutes had a rate of 30.8%.

After adjustment for other predictors of mortality, the system delay was still independently associated with mortality, with an adjusted hazard ratio of 1.10 per 1-hour delay, reported researchers led by Dr. Christian Juhl Terkelsen of the department of cardiology at Åarhus (Denmark) University Hospital (JAMA 2010;304:763-71).

The researchers analyzed records from 6,209 patients with STEMI or bundle-branch block MI who were admitted for primary PCI, the recommended treatment for STEMI in Denmark since 2003, during 2002-2008, at three Danish high-volume PCI centers. The median follow-up time was 3.4 years.

The Helga and Peter Komings Foundation in Denmark and the Health Research Fund of Central Denmark Region supported the study. The researchers reported no financial disclosures related to the study.

Delays in the time from first contact with the health care system to treatment with primary percutaneous coronary intervention are linked to mortality for patients with ST-segment elevation myocardial infarction.

Researchers found that a delay of up to 60 minutes between the time of first contact with emergency medical services to the time when patients received guiding catheter insertion during PCI resulted in a long-term mortality rate of 15.4%.

When the delay increased to 61-120 minutes, the mortality rate rose to 23.3%. A delay of 121-180 minutes resulted in a long-term mortality rate of 28.1%, and a delay of 181-360 minutes had a rate of 30.8%.

After adjustment for other predictors of mortality, the system delay was still independently associated with mortality, with an adjusted hazard ratio of 1.10 per 1-hour delay, reported researchers led by Dr. Christian Juhl Terkelsen of the department of cardiology at Åarhus (Denmark) University Hospital (JAMA 2010;304:763-71).

The researchers analyzed records from 6,209 patients with STEMI or bundle-branch block MI who were admitted for primary PCI, the recommended treatment for STEMI in Denmark since 2003, during 2002-2008, at three Danish high-volume PCI centers. The median follow-up time was 3.4 years.

The Helga and Peter Komings Foundation in Denmark and the Health Research Fund of Central Denmark Region supported the study. The researchers reported no financial disclosures related to the study.

Delays in the time from first contact with the health care system to treatment with primary percutaneous coronary intervention are linked to mortality for patients with ST-segment elevation myocardial infarction.

Researchers found that a delay of up to 60 minutes between the time of first contact with emergency medical services to the time when patients received guiding catheter insertion during PCI resulted in a long-term mortality rate of 15.4%.

When the delay increased to 61-120 minutes, the mortality rate rose to 23.3%. A delay of 121-180 minutes resulted in a long-term mortality rate of 28.1%, and a delay of 181-360 minutes had a rate of 30.8%.

After adjustment for other predictors of mortality, the system delay was still independently associated with mortality, with an adjusted hazard ratio of 1.10 per 1-hour delay, reported researchers led by Dr. Christian Juhl Terkelsen of the department of cardiology at Åarhus (Denmark) University Hospital (JAMA 2010;304:763-71).

The researchers analyzed records from 6,209 patients with STEMI or bundle-branch block MI who were admitted for primary PCI, the recommended treatment for STEMI in Denmark since 2003, during 2002-2008, at three Danish high-volume PCI centers. The median follow-up time was 3.4 years.

The Helga and Peter Komings Foundation in Denmark and the Health Research Fund of Central Denmark Region supported the study. The researchers reported no financial disclosures related to the study.

One of the hallmarks of the Patient Protection and Affordable Care Act is that people with preexisting medical conditions will no longer be denied coverage by insurance companies. For adults, this protection begins in 2014, but for many of those younger than age 19 years, it takes effect on Sept. 23. New regulations from the U.S. Department of Health and Human Services bar health plans from refusing to offer a policy because of a child's preexisting medical condition, and from imposing benefit limitations once the child is on a plan.

Dr. Judith S. Palfrey, president of the American Academy of Pediatrics, explains what this part of the law will mean for children.

PEDIATRIC NEWS: How important is the ban on preexisting condition exclusions in children, in terms of access to insurance and coverage for treatments?

Dr. Palfrey: This is one of the most significant provisions within the health reform law in terms of what it means for improved access and care for some of the country's most vulnerable children. Before, if a child had a chronic condition like asthma, or a debilitating disease like cancer, it was possible for insurers to deny them care, when—ironically—they were the ones who needed treatment the most.

Although this provision is an enormous step forward, there is work to be done to make sure children can benefit whether they are enrolled in a new health insurance plan or an existing one. The AAP is working with Obama administration officials to make sure that the ACA provides access to as many children with preexisting health conditions as possible.

The ACA also guarantees an array of preventive services for all children, to be offered without copay or deductible, including a yearly physical, well-child visits, and routine immunizations as well as hearing, vision, developmental, and behavioral screenings. This will help physicians detect many diseases before they cause morbidity, then treat and monitor them as needed. These essential benefits could be life saving, especially for children with preexisting and often chronic or complex conditions.

PN: How many children are likely to benefit from this provision in the near future, and what are the implications for their future health?

Dr. Palfrey: We don't have data specifically on how many children are expected to benefit from this provision, but the Congressional Budget Office estimates that about 200,000 Americans will enroll in the Preexisting Condition Insurance Plan during 2011–2013. The plan will provide an option for many sick children to gain access to coverage they don't currently have, and since a good number of these children may have forgone care or treatment because of costs or being denied insurance, the enactment of this provision should improve their future health.

PN: Will this change the way pediatricians and other physicians who treat children and adolescents are able to care for their patients?

Dr. Palfrey: This should certainly make it easier to provide care to more children, because services now will receive some level of payment. This provision also should help provide a pathway for families to get private insurance for their children, increasing access to care.

PN: Will this new requirement apply to all health plans, and what can physicians do to ensure that their patients are protected under the new law?

Dr. Palfrey: This provision applies to all new health insurance plans that begin after Sept. 23 It does not apply to plans that were already in existence when the ACA was signed into law last March, as long as those plans have not made any significant changes in coverage, like raising premiums or cutting benefits. The administration has issued additional guidance on the preexisting condition exclusions ban after some insurance companies threatened to drop child-only coverage options, citing concern about families who might enroll children only when they fall ill and drop coverage if their children are healthy.

The guidance allows insurers to limit families to specific periods of “open enrollment” when they can apply for insurance coverage for their children, rather than giving families the flexibility of applying throughout the year. The AAP is concerned that restricting families to an open-enrollment season prevents many vulnerable children from attaining health insurance when they need it. For example, if a child becomes ill outside of the open-enrollment period, parents may have to wait for months to get the child coverage. The AAP has commented publicly on this provision, and we hope to work with the administration to make sure that children can access care when they need it, regardless of their health status or the time of year.

DR. PALFREY is a professor of pediatrics at Harvard Medical School in Boston and directs the children's international pediatric center at Children's Hospital Boston.

One of the hallmarks of the Patient Protection and Affordable Care Act is that people with preexisting medical conditions will no longer be denied coverage by insurance companies. For adults, this protection begins in 2014, but for many of those younger than age 19 years, it takes effect on Sept. 23. New regulations from the U.S. Department of Health and Human Services bar health plans from refusing to offer a policy because of a child's preexisting medical condition, and from imposing benefit limitations once the child is on a plan.

Dr. Judith S. Palfrey, president of the American Academy of Pediatrics, explains what this part of the law will mean for children.

PEDIATRIC NEWS: How important is the ban on preexisting condition exclusions in children, in terms of access to insurance and coverage for treatments?

Dr. Palfrey: This is one of the most significant provisions within the health reform law in terms of what it means for improved access and care for some of the country's most vulnerable children. Before, if a child had a chronic condition like asthma, or a debilitating disease like cancer, it was possible for insurers to deny them care, when—ironically—they were the ones who needed treatment the most.

Although this provision is an enormous step forward, there is work to be done to make sure children can benefit whether they are enrolled in a new health insurance plan or an existing one. The AAP is working with Obama administration officials to make sure that the ACA provides access to as many children with preexisting health conditions as possible.

The ACA also guarantees an array of preventive services for all children, to be offered without copay or deductible, including a yearly physical, well-child visits, and routine immunizations as well as hearing, vision, developmental, and behavioral screenings. This will help physicians detect many diseases before they cause morbidity, then treat and monitor them as needed. These essential benefits could be life saving, especially for children with preexisting and often chronic or complex conditions.

PN: How many children are likely to benefit from this provision in the near future, and what are the implications for their future health?

Dr. Palfrey: We don't have data specifically on how many children are expected to benefit from this provision, but the Congressional Budget Office estimates that about 200,000 Americans will enroll in the Preexisting Condition Insurance Plan during 2011–2013. The plan will provide an option for many sick children to gain access to coverage they don't currently have, and since a good number of these children may have forgone care or treatment because of costs or being denied insurance, the enactment of this provision should improve their future health.

PN: Will this change the way pediatricians and other physicians who treat children and adolescents are able to care for their patients?

Dr. Palfrey: This should certainly make it easier to provide care to more children, because services now will receive some level of payment. This provision also should help provide a pathway for families to get private insurance for their children, increasing access to care.

PN: Will this new requirement apply to all health plans, and what can physicians do to ensure that their patients are protected under the new law?

Dr. Palfrey: This provision applies to all new health insurance plans that begin after Sept. 23 It does not apply to plans that were already in existence when the ACA was signed into law last March, as long as those plans have not made any significant changes in coverage, like raising premiums or cutting benefits. The administration has issued additional guidance on the preexisting condition exclusions ban after some insurance companies threatened to drop child-only coverage options, citing concern about families who might enroll children only when they fall ill and drop coverage if their children are healthy.

The guidance allows insurers to limit families to specific periods of “open enrollment” when they can apply for insurance coverage for their children, rather than giving families the flexibility of applying throughout the year. The AAP is concerned that restricting families to an open-enrollment season prevents many vulnerable children from attaining health insurance when they need it. For example, if a child becomes ill outside of the open-enrollment period, parents may have to wait for months to get the child coverage. The AAP has commented publicly on this provision, and we hope to work with the administration to make sure that children can access care when they need it, regardless of their health status or the time of year.

DR. PALFREY is a professor of pediatrics at Harvard Medical School in Boston and directs the children's international pediatric center at Children's Hospital Boston.

One of the hallmarks of the Patient Protection and Affordable Care Act is that people with preexisting medical conditions will no longer be denied coverage by insurance companies. For adults, this protection begins in 2014, but for many of those younger than age 19 years, it takes effect on Sept. 23. New regulations from the U.S. Department of Health and Human Services bar health plans from refusing to offer a policy because of a child's preexisting medical condition, and from imposing benefit limitations once the child is on a plan.

Dr. Judith S. Palfrey, president of the American Academy of Pediatrics, explains what this part of the law will mean for children.

PEDIATRIC NEWS: How important is the ban on preexisting condition exclusions in children, in terms of access to insurance and coverage for treatments?

Dr. Palfrey: This is one of the most significant provisions within the health reform law in terms of what it means for improved access and care for some of the country's most vulnerable children. Before, if a child had a chronic condition like asthma, or a debilitating disease like cancer, it was possible for insurers to deny them care, when—ironically—they were the ones who needed treatment the most.

Although this provision is an enormous step forward, there is work to be done to make sure children can benefit whether they are enrolled in a new health insurance plan or an existing one. The AAP is working with Obama administration officials to make sure that the ACA provides access to as many children with preexisting health conditions as possible.

The ACA also guarantees an array of preventive services for all children, to be offered without copay or deductible, including a yearly physical, well-child visits, and routine immunizations as well as hearing, vision, developmental, and behavioral screenings. This will help physicians detect many diseases before they cause morbidity, then treat and monitor them as needed. These essential benefits could be life saving, especially for children with preexisting and often chronic or complex conditions.

PN: How many children are likely to benefit from this provision in the near future, and what are the implications for their future health?

Dr. Palfrey: We don't have data specifically on how many children are expected to benefit from this provision, but the Congressional Budget Office estimates that about 200,000 Americans will enroll in the Preexisting Condition Insurance Plan during 2011–2013. The plan will provide an option for many sick children to gain access to coverage they don't currently have, and since a good number of these children may have forgone care or treatment because of costs or being denied insurance, the enactment of this provision should improve their future health.

PN: Will this change the way pediatricians and other physicians who treat children and adolescents are able to care for their patients?

Dr. Palfrey: This should certainly make it easier to provide care to more children, because services now will receive some level of payment. This provision also should help provide a pathway for families to get private insurance for their children, increasing access to care.

PN: Will this new requirement apply to all health plans, and what can physicians do to ensure that their patients are protected under the new law?

Dr. Palfrey: This provision applies to all new health insurance plans that begin after Sept. 23 It does not apply to plans that were already in existence when the ACA was signed into law last March, as long as those plans have not made any significant changes in coverage, like raising premiums or cutting benefits. The administration has issued additional guidance on the preexisting condition exclusions ban after some insurance companies threatened to drop child-only coverage options, citing concern about families who might enroll children only when they fall ill and drop coverage if their children are healthy.

The guidance allows insurers to limit families to specific periods of “open enrollment” when they can apply for insurance coverage for their children, rather than giving families the flexibility of applying throughout the year. The AAP is concerned that restricting families to an open-enrollment season prevents many vulnerable children from attaining health insurance when they need it. For example, if a child becomes ill outside of the open-enrollment period, parents may have to wait for months to get the child coverage. The AAP has commented publicly on this provision, and we hope to work with the administration to make sure that children can access care when they need it, regardless of their health status or the time of year.

DR. PALFREY is a professor of pediatrics at Harvard Medical School in Boston and directs the children's international pediatric center at Children's Hospital Boston.