Mary Ellen Schneider

Arthritis Plagues Older Americans

Nearly half of people aged 65 and older reported suffering from arthritis in 2007-2008, according to a federal report. The condition was most prevalent among women (55%), compared with men (42%) and non-Hispanic blacks (52%) in this age group. The only chronic condition with a greater prevalence among older Americans was hypertension, which affected about 56% of older Americans. The figures come from the Center for Disease Control and Prevention's National Health Interview Survey. The full report on the well-being of older Americans is available at

www.agingstats.gov

State Bill Targets Step Therapy

Fibromyalgia-patient advocates in California are gaining ground in their attempt to limit the insurance industry practice of step therapy, in which patients must first fail on less expensive therapies before getting more costly prescriptions. In June, the California State Assembly passed AB 1826 to require health plans that offer outpatient drug benefits to cover pain drugs without requiring that patients first try another drug or an over-the-counter product. The bill does allow health plans to require that patients first use a generically equivalent drug. The legislation is now pending in a State senate committee. “The recent FDA-approved medications for fibromyalgia mean that patients finally have the long-awaited prescribed treatment options to help ease their suffering,” Rae Marie Gleason, executive director of the National Fibromyalgia Association, said in a statement. “We urge the passage of this legislation so that patient care will be decided by the physician who has the expertise to provide the best possible care for patients.”

FDA to Share Drug-Risk Findings

The FDA will post on its Web site summaries of postmarketing safety analyses on recently approved drugs and biologics, including brief discussions of steps that are being taken to address identified safety issues. The new summaries will cover side effects that might not become apparent until after a medicine becomes available to a large, diverse population, including previously unidentified risks and known adverse events that occur more frequently than expected. The initial reports will contain information on drugs and biologics approved since September 2007, including several drugs for infections, hypertension, and depression, the agency said.

J&J Discloses Physician Payments

Following in the footsteps of Pfizer Inc., GlaxoSmithKline, and, most recently, Medtronic Inc., Johnson & Johnson said that it is disclosing how much it pays physician to be speakers and consultants, at least for a number of its pharmaceutical subsidiaries. Unlike disclosures at other companies, however, the data cover only those J&J divisions that were subject to corporate integrity agreements with the federal government, according to a company spokesman. Those divisions are PriCara, Ortho-McNeil Pharmaceuticals, Ortho-McNeil Neurologics, Janssen, and McNeil Pediatrics. Payment disclosures are listed at those units' individual Web sites, such as

www.janssen.com/transparency.html

Men Less Likely to Get Care

Men are much less likely than women to seek routine medical care: Just over half of U.S. men see a doctor, nurse practitioner, or physician assistant for routine care, compared with nearly three-quarters of women, according to the Agency for Healthcare Research and Quality. Only about 35% of Hispanic men and 43% of black men made routine appointments, compared with 63% of white men, and uninsured people were only about half as likely as those with private insurance to make a routine care appointment, the agency said.

State Backs Coordinated Care

Health care providers in five communities across New Hampshire have agreed with the state's major insurance companies to participate in a 5-year pilot program to encourage collaboration, prevention, and disease management instead of fee-for-service medicine, said Gov. John Lynch (D). Groups of providers in each community will become “accountable care organizations” and thus take responsibility for coordinating health care and preventive services to local residents. Each organization will determine how to spend its budget to achieve quality outcomes and efficiency in its area. The program “will move New Hampshire away from the fee-for-service model,” according to a statement from the governor's office. “Our current health care system rewards providers for seeing as many patients as possible. We're going to change that. Under this pilot project, we are moving to a system where health care providers will profit from spending time with their patients and keeping them healthy,” Gov. Lynch said in the statement.

Arthritis Plagues Older Americans

Nearly half of people aged 65 and older reported suffering from arthritis in 2007-2008, according to a federal report. The condition was most prevalent among women (55%), compared with men (42%) and non-Hispanic blacks (52%) in this age group. The only chronic condition with a greater prevalence among older Americans was hypertension, which affected about 56% of older Americans. The figures come from the Center for Disease Control and Prevention's National Health Interview Survey. The full report on the well-being of older Americans is available at

www.agingstats.gov

State Bill Targets Step Therapy

Fibromyalgia-patient advocates in California are gaining ground in their attempt to limit the insurance industry practice of step therapy, in which patients must first fail on less expensive therapies before getting more costly prescriptions. In June, the California State Assembly passed AB 1826 to require health plans that offer outpatient drug benefits to cover pain drugs without requiring that patients first try another drug or an over-the-counter product. The bill does allow health plans to require that patients first use a generically equivalent drug. The legislation is now pending in a State senate committee. “The recent FDA-approved medications for fibromyalgia mean that patients finally have the long-awaited prescribed treatment options to help ease their suffering,” Rae Marie Gleason, executive director of the National Fibromyalgia Association, said in a statement. “We urge the passage of this legislation so that patient care will be decided by the physician who has the expertise to provide the best possible care for patients.”

FDA to Share Drug-Risk Findings

The FDA will post on its Web site summaries of postmarketing safety analyses on recently approved drugs and biologics, including brief discussions of steps that are being taken to address identified safety issues. The new summaries will cover side effects that might not become apparent until after a medicine becomes available to a large, diverse population, including previously unidentified risks and known adverse events that occur more frequently than expected. The initial reports will contain information on drugs and biologics approved since September 2007, including several drugs for infections, hypertension, and depression, the agency said.

J&J Discloses Physician Payments

Following in the footsteps of Pfizer Inc., GlaxoSmithKline, and, most recently, Medtronic Inc., Johnson & Johnson said that it is disclosing how much it pays physician to be speakers and consultants, at least for a number of its pharmaceutical subsidiaries. Unlike disclosures at other companies, however, the data cover only those J&J divisions that were subject to corporate integrity agreements with the federal government, according to a company spokesman. Those divisions are PriCara, Ortho-McNeil Pharmaceuticals, Ortho-McNeil Neurologics, Janssen, and McNeil Pediatrics. Payment disclosures are listed at those units' individual Web sites, such as

www.janssen.com/transparency.html

Men Less Likely to Get Care

Men are much less likely than women to seek routine medical care: Just over half of U.S. men see a doctor, nurse practitioner, or physician assistant for routine care, compared with nearly three-quarters of women, according to the Agency for Healthcare Research and Quality. Only about 35% of Hispanic men and 43% of black men made routine appointments, compared with 63% of white men, and uninsured people were only about half as likely as those with private insurance to make a routine care appointment, the agency said.

State Backs Coordinated Care

Health care providers in five communities across New Hampshire have agreed with the state's major insurance companies to participate in a 5-year pilot program to encourage collaboration, prevention, and disease management instead of fee-for-service medicine, said Gov. John Lynch (D). Groups of providers in each community will become “accountable care organizations” and thus take responsibility for coordinating health care and preventive services to local residents. Each organization will determine how to spend its budget to achieve quality outcomes and efficiency in its area. The program “will move New Hampshire away from the fee-for-service model,” according to a statement from the governor's office. “Our current health care system rewards providers for seeing as many patients as possible. We're going to change that. Under this pilot project, we are moving to a system where health care providers will profit from spending time with their patients and keeping them healthy,” Gov. Lynch said in the statement.

Arthritis Plagues Older Americans

Nearly half of people aged 65 and older reported suffering from arthritis in 2007-2008, according to a federal report. The condition was most prevalent among women (55%), compared with men (42%) and non-Hispanic blacks (52%) in this age group. The only chronic condition with a greater prevalence among older Americans was hypertension, which affected about 56% of older Americans. The figures come from the Center for Disease Control and Prevention's National Health Interview Survey. The full report on the well-being of older Americans is available at

www.agingstats.gov

State Bill Targets Step Therapy

Fibromyalgia-patient advocates in California are gaining ground in their attempt to limit the insurance industry practice of step therapy, in which patients must first fail on less expensive therapies before getting more costly prescriptions. In June, the California State Assembly passed AB 1826 to require health plans that offer outpatient drug benefits to cover pain drugs without requiring that patients first try another drug or an over-the-counter product. The bill does allow health plans to require that patients first use a generically equivalent drug. The legislation is now pending in a State senate committee. “The recent FDA-approved medications for fibromyalgia mean that patients finally have the long-awaited prescribed treatment options to help ease their suffering,” Rae Marie Gleason, executive director of the National Fibromyalgia Association, said in a statement. “We urge the passage of this legislation so that patient care will be decided by the physician who has the expertise to provide the best possible care for patients.”

FDA to Share Drug-Risk Findings

The FDA will post on its Web site summaries of postmarketing safety analyses on recently approved drugs and biologics, including brief discussions of steps that are being taken to address identified safety issues. The new summaries will cover side effects that might not become apparent until after a medicine becomes available to a large, diverse population, including previously unidentified risks and known adverse events that occur more frequently than expected. The initial reports will contain information on drugs and biologics approved since September 2007, including several drugs for infections, hypertension, and depression, the agency said.

J&J Discloses Physician Payments

Following in the footsteps of Pfizer Inc., GlaxoSmithKline, and, most recently, Medtronic Inc., Johnson & Johnson said that it is disclosing how much it pays physician to be speakers and consultants, at least for a number of its pharmaceutical subsidiaries. Unlike disclosures at other companies, however, the data cover only those J&J divisions that were subject to corporate integrity agreements with the federal government, according to a company spokesman. Those divisions are PriCara, Ortho-McNeil Pharmaceuticals, Ortho-McNeil Neurologics, Janssen, and McNeil Pediatrics. Payment disclosures are listed at those units' individual Web sites, such as

www.janssen.com/transparency.html

Men Less Likely to Get Care

Men are much less likely than women to seek routine medical care: Just over half of U.S. men see a doctor, nurse practitioner, or physician assistant for routine care, compared with nearly three-quarters of women, according to the Agency for Healthcare Research and Quality. Only about 35% of Hispanic men and 43% of black men made routine appointments, compared with 63% of white men, and uninsured people were only about half as likely as those with private insurance to make a routine care appointment, the agency said.

State Backs Coordinated Care

Health care providers in five communities across New Hampshire have agreed with the state's major insurance companies to participate in a 5-year pilot program to encourage collaboration, prevention, and disease management instead of fee-for-service medicine, said Gov. John Lynch (D). Groups of providers in each community will become “accountable care organizations” and thus take responsibility for coordinating health care and preventive services to local residents. Each organization will determine how to spend its budget to achieve quality outcomes and efficiency in its area. The program “will move New Hampshire away from the fee-for-service model,” according to a statement from the governor's office. “Our current health care system rewards providers for seeing as many patients as possible. We're going to change that. Under this pilot project, we are moving to a system where health care providers will profit from spending time with their patients and keeping them healthy,” Gov. Lynch said in the statement.

Medicare's decision to eliminate consultation codes has resulted in a loss of revenue for many physicians and forced some to cut back on appointments with Medicare beneficiaries, according to a survey commissioned by the American Medical Association and several other medical specialty societies.

“Rheumatic diseases are complex, chronic, debilitating, and oftentimes life threatening, and specialized care from a rheumatologist is essential to the livelihood of people with rheumatic diseases,” Dr. Stanley B. Cohen, president of the American College of Rheumatology, said in a statement. “By removing consultation service codes, CMS is stating that the … unique specialty care provided by rheumatologists is not valued.”

CMS argues that the billings by primary care physicians and specialists are identical except the consultant sends a report to the requesting physician.

“When we [rheumatologists and other specialists] are asked to see a patient on referral, it is because the case is complicated, and the referring physician could not figure out the diagnosis. We are sought out for our extra training to assess the problem and develop a good care plan,” said Dr. Karen S. Kolba, a rheumatologist in private practice in Santa Maria, Calif.

In an online survey of about 5,500 physicians, about 730% reported that not being able to bill for consultations had decreased their total revenues by more than 15%.

The loss of revenue has in turn impacted physicians' practices: 20% of respondents said they have already reduced the number of new Medicare patients seen in their practices, and.39% said they will hold off on purchasing new equipment or health information technology.

In addition, about 6% of responding physicians said they have stopped providing primary care physicians with written reports following consults with Medicare patients, and another 19% said they plan to do so.

Medicare's decision to eliminate consultation codes has resulted in a loss of revenue for many physicians and forced some to cut back on appointments with Medicare beneficiaries, according to a survey commissioned by the American Medical Association and several other medical specialty societies.

“Rheumatic diseases are complex, chronic, debilitating, and oftentimes life threatening, and specialized care from a rheumatologist is essential to the livelihood of people with rheumatic diseases,” Dr. Stanley B. Cohen, president of the American College of Rheumatology, said in a statement. “By removing consultation service codes, CMS is stating that the … unique specialty care provided by rheumatologists is not valued.”

CMS argues that the billings by primary care physicians and specialists are identical except the consultant sends a report to the requesting physician.

“When we [rheumatologists and other specialists] are asked to see a patient on referral, it is because the case is complicated, and the referring physician could not figure out the diagnosis. We are sought out for our extra training to assess the problem and develop a good care plan,” said Dr. Karen S. Kolba, a rheumatologist in private practice in Santa Maria, Calif.

In an online survey of about 5,500 physicians, about 730% reported that not being able to bill for consultations had decreased their total revenues by more than 15%.

The loss of revenue has in turn impacted physicians' practices: 20% of respondents said they have already reduced the number of new Medicare patients seen in their practices, and.39% said they will hold off on purchasing new equipment or health information technology.

In addition, about 6% of responding physicians said they have stopped providing primary care physicians with written reports following consults with Medicare patients, and another 19% said they plan to do so.

Medicare's decision to eliminate consultation codes has resulted in a loss of revenue for many physicians and forced some to cut back on appointments with Medicare beneficiaries, according to a survey commissioned by the American Medical Association and several other medical specialty societies.

“Rheumatic diseases are complex, chronic, debilitating, and oftentimes life threatening, and specialized care from a rheumatologist is essential to the livelihood of people with rheumatic diseases,” Dr. Stanley B. Cohen, president of the American College of Rheumatology, said in a statement. “By removing consultation service codes, CMS is stating that the … unique specialty care provided by rheumatologists is not valued.”

CMS argues that the billings by primary care physicians and specialists are identical except the consultant sends a report to the requesting physician.

“When we [rheumatologists and other specialists] are asked to see a patient on referral, it is because the case is complicated, and the referring physician could not figure out the diagnosis. We are sought out for our extra training to assess the problem and develop a good care plan,” said Dr. Karen S. Kolba, a rheumatologist in private practice in Santa Maria, Calif.

In an online survey of about 5,500 physicians, about 730% reported that not being able to bill for consultations had decreased their total revenues by more than 15%.

The loss of revenue has in turn impacted physicians' practices: 20% of respondents said they have already reduced the number of new Medicare patients seen in their practices, and.39% said they will hold off on purchasing new equipment or health information technology.

In addition, about 6% of responding physicians said they have stopped providing primary care physicians with written reports following consults with Medicare patients, and another 19% said they plan to do so.

Patients could gain greater access to their health information and have more power to limit disclosures of certain personal information to health plans under a new proposal from the Health and Human Services department.

The new requirements, announced July 8, are aimed at beefing up privacy and security, as the Obama administration pushes to get more physicians using electronic health records over the next few years.

“The benefits of health IT can only be fully realized if patients and providers are confident that electronic health information is kept private and secure at all times,” Georgina Verdugo, director of the HHS Office for Civil Rights, said in a statement. “This proposed rule strengthens the privacy and security of health information, and is an integral piece of the administration's efforts to broaden the use of health information technology in health care today.”

The proposal alters the Health Insurance Portability and Accountability Act (HIPAA) rules by setting new limits on the use of disclosure of protected health information for marketing and fundraising and by requiring business associates of HIPAA-covered entities to follow most of the same rules that covered entities follow. The proposal would also bar the sale of protected health information without explicit authorization from the patient.

The proposal also implements elements of the 2009 Health Information Technology for Economic and Clinical Health (HITECH) Act, which requires physicians and other covered entities to grant patient requests to restrict certain information from their health plans.

Individuals can provide comments on the rule for 60 days, beginning on July 14.

HHS has also launched a new Web site that provides consumers with information on their privacy rights under existing regulations (www.hhs.gov/healthprivacy/index.html

Patients could gain greater access to their health information and have more power to limit disclosures of certain personal information to health plans under a new proposal from the Health and Human Services department.

The new requirements, announced July 8, are aimed at beefing up privacy and security, as the Obama administration pushes to get more physicians using electronic health records over the next few years.

“The benefits of health IT can only be fully realized if patients and providers are confident that electronic health information is kept private and secure at all times,” Georgina Verdugo, director of the HHS Office for Civil Rights, said in a statement. “This proposed rule strengthens the privacy and security of health information, and is an integral piece of the administration's efforts to broaden the use of health information technology in health care today.”

The proposal alters the Health Insurance Portability and Accountability Act (HIPAA) rules by setting new limits on the use of disclosure of protected health information for marketing and fundraising and by requiring business associates of HIPAA-covered entities to follow most of the same rules that covered entities follow. The proposal would also bar the sale of protected health information without explicit authorization from the patient.

The proposal also implements elements of the 2009 Health Information Technology for Economic and Clinical Health (HITECH) Act, which requires physicians and other covered entities to grant patient requests to restrict certain information from their health plans.

Individuals can provide comments on the rule for 60 days, beginning on July 14.

HHS has also launched a new Web site that provides consumers with information on their privacy rights under existing regulations (www.hhs.gov/healthprivacy/index.html

Patients could gain greater access to their health information and have more power to limit disclosures of certain personal information to health plans under a new proposal from the Health and Human Services department.

The new requirements, announced July 8, are aimed at beefing up privacy and security, as the Obama administration pushes to get more physicians using electronic health records over the next few years.

“The benefits of health IT can only be fully realized if patients and providers are confident that electronic health information is kept private and secure at all times,” Georgina Verdugo, director of the HHS Office for Civil Rights, said in a statement. “This proposed rule strengthens the privacy and security of health information, and is an integral piece of the administration's efforts to broaden the use of health information technology in health care today.”

The proposal alters the Health Insurance Portability and Accountability Act (HIPAA) rules by setting new limits on the use of disclosure of protected health information for marketing and fundraising and by requiring business associates of HIPAA-covered entities to follow most of the same rules that covered entities follow. The proposal would also bar the sale of protected health information without explicit authorization from the patient.

The proposal also implements elements of the 2009 Health Information Technology for Economic and Clinical Health (HITECH) Act, which requires physicians and other covered entities to grant patient requests to restrict certain information from their health plans.

Individuals can provide comments on the rule for 60 days, beginning on July 14.

HHS has also launched a new Web site that provides consumers with information on their privacy rights under existing regulations (www.hhs.gov/healthprivacy/index.html

The federal government on July 13 released the much-anticipated requirements for how physicians and hospitals can qualify for tens of thousands of dollars in incentive payments to adopt and use electronic health records.

The final rule on the meaningful use of electronic health records (EHRs) eases many of the requirements that officials in the Health and Human Services department had outlined in a proposal published in January. Physician organizations had objected to the initial proposal, saying that it asked doctors, especially those in small practices, to do too much too quickly. Physicians were also critical of the all or nothing framework of the proposal, which required them to meet all 25 objectives for meaningful use or lose out on incentive payments.

Federal officials aimed to address those concerns in the final rule by requiring physicians to first meet a core set of 15 requirements and then meet any 5 of 10 additional requirements. The core set includes requirements such as recording patient demographics and vital signs in the EHR, maintaining an up-to-date problem list and an active list of medications and allergies, and transmitting permissible prescriptions electronically.

HHS officials also relaxed some of the thresholds related to the requirements. For example, under the proposed rule, physicians would have had to generate and transmit 75% of their permissible prescriptions electronically to meet the e-prescribing requirement. Under the final rule, the threshold has been lowered to more than 40% of permissible prescriptions, Dr. David Blumenthal, National Coordinator for Health Information Technology at HHS, said during a press briefing to announce the final rule.

The final rule also creates an easier path for physicians to meet meaningful use requirements on electronic reporting of quality data. Under the final rule, physicians will need to report data on blood pressure, tobacco status, and adult weight screening, and follow-up in 2011 and 2012, in order to qualify. Alternatives are available if those measures do not apply to their practices. Physicians will also have to choose three other quality measures to report on through their EHRs.

The final rule outlines the steps physicians must take in 2011 and 2012 to quality for the maximum incentive payments through the Medicare and Medicaid programs. The incentives were mandated by the Health Information Technology for Economic and Clinical Health Act (HITECH).

Starting in 2011, physicians who demonstrate meaningful use of certified EHRs can receive payments of up to $18,000 from Medicare. Those bonuses continue for 5 years, with physicians eligible to earn up to $44,000 in total incentives. Physicians can still receive bonuses if they begin their meaningful use of the technology later, but they must start before 2013 to get all the available incentives. A similar program is in place under the Medicaid program, with physicians eligible to receive up to $64,000 over 6 years for the adoption and use of certified EHRs.

Vitals

Source Elsevier Global Medical News

The federal government on July 13 released the much-anticipated requirements for how physicians and hospitals can qualify for tens of thousands of dollars in incentive payments to adopt and use electronic health records.

The final rule on the meaningful use of electronic health records (EHRs) eases many of the requirements that officials in the Health and Human Services department had outlined in a proposal published in January. Physician organizations had objected to the initial proposal, saying that it asked doctors, especially those in small practices, to do too much too quickly. Physicians were also critical of the all or nothing framework of the proposal, which required them to meet all 25 objectives for meaningful use or lose out on incentive payments.

Federal officials aimed to address those concerns in the final rule by requiring physicians to first meet a core set of 15 requirements and then meet any 5 of 10 additional requirements. The core set includes requirements such as recording patient demographics and vital signs in the EHR, maintaining an up-to-date problem list and an active list of medications and allergies, and transmitting permissible prescriptions electronically.

HHS officials also relaxed some of the thresholds related to the requirements. For example, under the proposed rule, physicians would have had to generate and transmit 75% of their permissible prescriptions electronically to meet the e-prescribing requirement. Under the final rule, the threshold has been lowered to more than 40% of permissible prescriptions, Dr. David Blumenthal, National Coordinator for Health Information Technology at HHS, said during a press briefing to announce the final rule.

The final rule also creates an easier path for physicians to meet meaningful use requirements on electronic reporting of quality data. Under the final rule, physicians will need to report data on blood pressure, tobacco status, and adult weight screening, and follow-up in 2011 and 2012, in order to qualify. Alternatives are available if those measures do not apply to their practices. Physicians will also have to choose three other quality measures to report on through their EHRs.

The final rule outlines the steps physicians must take in 2011 and 2012 to quality for the maximum incentive payments through the Medicare and Medicaid programs. The incentives were mandated by the Health Information Technology for Economic and Clinical Health Act (HITECH).

Starting in 2011, physicians who demonstrate meaningful use of certified EHRs can receive payments of up to $18,000 from Medicare. Those bonuses continue for 5 years, with physicians eligible to earn up to $44,000 in total incentives. Physicians can still receive bonuses if they begin their meaningful use of the technology later, but they must start before 2013 to get all the available incentives. A similar program is in place under the Medicaid program, with physicians eligible to receive up to $64,000 over 6 years for the adoption and use of certified EHRs.

Vitals

Source Elsevier Global Medical News

The federal government on July 13 released the much-anticipated requirements for how physicians and hospitals can qualify for tens of thousands of dollars in incentive payments to adopt and use electronic health records.

The final rule on the meaningful use of electronic health records (EHRs) eases many of the requirements that officials in the Health and Human Services department had outlined in a proposal published in January. Physician organizations had objected to the initial proposal, saying that it asked doctors, especially those in small practices, to do too much too quickly. Physicians were also critical of the all or nothing framework of the proposal, which required them to meet all 25 objectives for meaningful use or lose out on incentive payments.

Federal officials aimed to address those concerns in the final rule by requiring physicians to first meet a core set of 15 requirements and then meet any 5 of 10 additional requirements. The core set includes requirements such as recording patient demographics and vital signs in the EHR, maintaining an up-to-date problem list and an active list of medications and allergies, and transmitting permissible prescriptions electronically.

HHS officials also relaxed some of the thresholds related to the requirements. For example, under the proposed rule, physicians would have had to generate and transmit 75% of their permissible prescriptions electronically to meet the e-prescribing requirement. Under the final rule, the threshold has been lowered to more than 40% of permissible prescriptions, Dr. David Blumenthal, National Coordinator for Health Information Technology at HHS, said during a press briefing to announce the final rule.

The final rule also creates an easier path for physicians to meet meaningful use requirements on electronic reporting of quality data. Under the final rule, physicians will need to report data on blood pressure, tobacco status, and adult weight screening, and follow-up in 2011 and 2012, in order to qualify. Alternatives are available if those measures do not apply to their practices. Physicians will also have to choose three other quality measures to report on through their EHRs.

The final rule outlines the steps physicians must take in 2011 and 2012 to quality for the maximum incentive payments through the Medicare and Medicaid programs. The incentives were mandated by the Health Information Technology for Economic and Clinical Health Act (HITECH).

Starting in 2011, physicians who demonstrate meaningful use of certified EHRs can receive payments of up to $18,000 from Medicare. Those bonuses continue for 5 years, with physicians eligible to earn up to $44,000 in total incentives. Physicians can still receive bonuses if they begin their meaningful use of the technology later, but they must start before 2013 to get all the available incentives. A similar program is in place under the Medicaid program, with physicians eligible to receive up to $64,000 over 6 years for the adoption and use of certified EHRs.

Vitals

Source Elsevier Global Medical News

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 wasn't 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 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 age 21 years. These guidelines were developed jointly by the Health Resources and Services Administration and the American Academy of Pediatrics.

The rule 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 the 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 non-grandfathered 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 wasn't 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 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 age 21 years. These guidelines were developed jointly by the Health Resources and Services Administration and the American Academy of Pediatrics.

The rule 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 the 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 non-grandfathered 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 wasn't 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 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 age 21 years. These guidelines were developed jointly by the Health Resources and Services Administration and the American Academy of Pediatrics.

The rule 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 the 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 non-grandfathered 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

Medicare's decision to eliminate consultation codes has resulted in a loss of revenue for many physicians and forced some to cut back on appointments with Medicare beneficiaries, according to a survey commissioned by the American Medical Association and several other medical specialty societies.

In January, officials at the Centers for Medicare and Medicaid Services discontinued the use of inpatient and outpatient consultation codes when billing Medicare, except for telehealth codes.

Physicians instead were asked to use new or established office visit codes, initial hospital care codes, or initial nursing facility care codes. At the time of the policy change, CMS officials said they could no longer justify paying physicians more for a consultation when they had reduced so much of the documentation required to bill for a consultation. The agency also said that eliminating consultation codes would reduce the confusion around the differing definitions of consultations, transfers, and referrals.

But according to many specialists, the approach is flawed and is hurting both their bottom line and patient access to care.

In an online survey of 5,500 physicians, 72% said that not being able to bill for consultations had decreased their total revenues by more than 5%, with 30% reporting their revenues had fallen more than 15%. (The survey is available at www.ama-assn.org/ama1/pub/upload/mm/399/consultation-codes-survey.pdf

The loss of revenue has in turn impacted physicians' practices. For example, 20% of respondents said they have already reduced the number of new Medicare patients seen in their practices. Additionally, 39% said they will hold off on purchasing new equipment or health information technology.

The policy change may also undermine efforts to improve care coordination. About 6% of responding physicians said they have stopped providing primary care physicians with written reports following consults with Medicare patients, and another 19% said they plan to do so.

“Patient health is best managed when physicians can work together across specialties to coordinate care,” Dr. J. James Rohack, AMA immediate past president, said in a statement.

“Twenty percent of patients over age 65 live with five or more chronic illnesses, and managing their care frequently requires primary care physicians to consult with a physician who specializes in the medical or surgical care of their conditions. The new policy of eliminating Medicare consultation codes fails to adequately recognize the additional time and effort involved in these consultations.”

In a letter to the CMS, officials from more than 30 medical societies urged the agency to revise the policy when they issue a final regulation on the 2011 Medicare Physician Fee Schedule this fall.

They suggested that the CMS consider paying consulting physicians for providing the referring physician with a comprehensive report.

They also said the agency could ease the financial pressure on physicians by revising its guidelines for prolonged visits to allow for reimbursement for services provided outside of the face-to-face visit, such as reviewing charts and communicating with families and other health care providers.

Source Elsevier Global Medical News

Medicare's decision to eliminate consultation codes has resulted in a loss of revenue for many physicians and forced some to cut back on appointments with Medicare beneficiaries, according to a survey commissioned by the American Medical Association and several other medical specialty societies.

In January, officials at the Centers for Medicare and Medicaid Services discontinued the use of inpatient and outpatient consultation codes when billing Medicare, except for telehealth codes.

Physicians instead were asked to use new or established office visit codes, initial hospital care codes, or initial nursing facility care codes. At the time of the policy change, CMS officials said they could no longer justify paying physicians more for a consultation when they had reduced so much of the documentation required to bill for a consultation. The agency also said that eliminating consultation codes would reduce the confusion around the differing definitions of consultations, transfers, and referrals.

But according to many specialists, the approach is flawed and is hurting both their bottom line and patient access to care.

In an online survey of 5,500 physicians, 72% said that not being able to bill for consultations had decreased their total revenues by more than 5%, with 30% reporting their revenues had fallen more than 15%. (The survey is available at www.ama-assn.org/ama1/pub/upload/mm/399/consultation-codes-survey.pdf

The loss of revenue has in turn impacted physicians' practices. For example, 20% of respondents said they have already reduced the number of new Medicare patients seen in their practices. Additionally, 39% said they will hold off on purchasing new equipment or health information technology.

The policy change may also undermine efforts to improve care coordination. About 6% of responding physicians said they have stopped providing primary care physicians with written reports following consults with Medicare patients, and another 19% said they plan to do so.

“Patient health is best managed when physicians can work together across specialties to coordinate care,” Dr. J. James Rohack, AMA immediate past president, said in a statement.

“Twenty percent of patients over age 65 live with five or more chronic illnesses, and managing their care frequently requires primary care physicians to consult with a physician who specializes in the medical or surgical care of their conditions. The new policy of eliminating Medicare consultation codes fails to adequately recognize the additional time and effort involved in these consultations.”

In a letter to the CMS, officials from more than 30 medical societies urged the agency to revise the policy when they issue a final regulation on the 2011 Medicare Physician Fee Schedule this fall.

They suggested that the CMS consider paying consulting physicians for providing the referring physician with a comprehensive report.

They also said the agency could ease the financial pressure on physicians by revising its guidelines for prolonged visits to allow for reimbursement for services provided outside of the face-to-face visit, such as reviewing charts and communicating with families and other health care providers.

Source Elsevier Global Medical News

Medicare's decision to eliminate consultation codes has resulted in a loss of revenue for many physicians and forced some to cut back on appointments with Medicare beneficiaries, according to a survey commissioned by the American Medical Association and several other medical specialty societies.

In January, officials at the Centers for Medicare and Medicaid Services discontinued the use of inpatient and outpatient consultation codes when billing Medicare, except for telehealth codes.

Physicians instead were asked to use new or established office visit codes, initial hospital care codes, or initial nursing facility care codes. At the time of the policy change, CMS officials said they could no longer justify paying physicians more for a consultation when they had reduced so much of the documentation required to bill for a consultation. The agency also said that eliminating consultation codes would reduce the confusion around the differing definitions of consultations, transfers, and referrals.

But according to many specialists, the approach is flawed and is hurting both their bottom line and patient access to care.

In an online survey of 5,500 physicians, 72% said that not being able to bill for consultations had decreased their total revenues by more than 5%, with 30% reporting their revenues had fallen more than 15%. (The survey is available at www.ama-assn.org/ama1/pub/upload/mm/399/consultation-codes-survey.pdf

The loss of revenue has in turn impacted physicians' practices. For example, 20% of respondents said they have already reduced the number of new Medicare patients seen in their practices. Additionally, 39% said they will hold off on purchasing new equipment or health information technology.

The policy change may also undermine efforts to improve care coordination. About 6% of responding physicians said they have stopped providing primary care physicians with written reports following consults with Medicare patients, and another 19% said they plan to do so.

“Patient health is best managed when physicians can work together across specialties to coordinate care,” Dr. J. James Rohack, AMA immediate past president, said in a statement.

“Twenty percent of patients over age 65 live with five or more chronic illnesses, and managing their care frequently requires primary care physicians to consult with a physician who specializes in the medical or surgical care of their conditions. The new policy of eliminating Medicare consultation codes fails to adequately recognize the additional time and effort involved in these consultations.”

In a letter to the CMS, officials from more than 30 medical societies urged the agency to revise the policy when they issue a final regulation on the 2011 Medicare Physician Fee Schedule this fall.

They suggested that the CMS consider paying consulting physicians for providing the referring physician with a comprehensive report.

They also said the agency could ease the financial pressure on physicians by revising its guidelines for prolonged visits to allow for reimbursement for services provided outside of the face-to-face visit, such as reviewing charts and communicating with families and other health care providers.

Source Elsevier Global Medical News

The Obama administration has spelled out details of new insurance protections in a set of regulations it's calling the Patient's Bill of Rights.

The interim final rules implement elements of the Affordable Care Act, such as banning pre-existing condition exclusions for children under age 19, banning the practice of insurance rescissions, eliminating lifetime limits on coverage, and restricting annual dollar limits on insurance coverage. The regulations also address patients' right to seeing an ob.gyn. without a referral, and bar insurers from charging higher cost sharing for out of network emergency services.

The provisions will apply to most health plans for plan years beginning on or after Sept. 23, 2010, according to the White House.

The regulations were issued by the Departments of Health and Human Services; Labor; and Treasury in June.

In a speech at the White House, President Obama said the regulations establish the “basic rules of the road” for health insurers.

While he praised health plans for voluntarily implementing some of the new rules early, he also warned insurance executives that they should not use the new requirements as an excuse to raise rates. To that end, the administration will be requiring insurers to publicly justify rate increases and is encouraging states to use their full authority to review premium hikes.

The Obama administration has spelled out details of new insurance protections in a set of regulations it's calling the Patient's Bill of Rights.

The interim final rules implement elements of the Affordable Care Act, such as banning pre-existing condition exclusions for children under age 19, banning the practice of insurance rescissions, eliminating lifetime limits on coverage, and restricting annual dollar limits on insurance coverage. The regulations also address patients' right to seeing an ob.gyn. without a referral, and bar insurers from charging higher cost sharing for out of network emergency services.

The provisions will apply to most health plans for plan years beginning on or after Sept. 23, 2010, according to the White House.

The regulations were issued by the Departments of Health and Human Services; Labor; and Treasury in June.

In a speech at the White House, President Obama said the regulations establish the “basic rules of the road” for health insurers.

While he praised health plans for voluntarily implementing some of the new rules early, he also warned insurance executives that they should not use the new requirements as an excuse to raise rates. To that end, the administration will be requiring insurers to publicly justify rate increases and is encouraging states to use their full authority to review premium hikes.

The Obama administration has spelled out details of new insurance protections in a set of regulations it's calling the Patient's Bill of Rights.

The interim final rules implement elements of the Affordable Care Act, such as banning pre-existing condition exclusions for children under age 19, banning the practice of insurance rescissions, eliminating lifetime limits on coverage, and restricting annual dollar limits on insurance coverage. The regulations also address patients' right to seeing an ob.gyn. without a referral, and bar insurers from charging higher cost sharing for out of network emergency services.

The provisions will apply to most health plans for plan years beginning on or after Sept. 23, 2010, according to the White House.

The regulations were issued by the Departments of Health and Human Services; Labor; and Treasury in June.

In a speech at the White House, President Obama said the regulations establish the “basic rules of the road” for health insurers.

While he praised health plans for voluntarily implementing some of the new rules early, he also warned insurance executives that they should not use the new requirements as an excuse to raise rates. To that end, the administration will be requiring insurers to publicly justify rate increases and is encouraging states to use their full authority to review premium hikes.

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 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 also will 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. Currently, 44 states require health plans to have some type of external appeal but those processes vary greatly, according to HHS.

Under the federal rules, health plans must provide clear information about external appeals and expedited access to the process. The decisions made through external appeals are binding under the new federal rules.

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 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 also will 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. Currently, 44 states require health plans to have some type of external appeal but those processes vary greatly, according to HHS.

Under the federal rules, health plans must provide clear information about external appeals and expedited access to the process. The decisions made through external appeals are binding under the new federal rules.

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 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 also will 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. Currently, 44 states require health plans to have some type of external appeal but those processes vary greatly, according to HHS.

Under the federal rules, health plans must provide clear information about external appeals and expedited access to the process. The decisions made through external appeals are binding under the new federal rules.

The federal government's decision to cut some of the red tape for veterans with posttraumatic stress disorder will make it easier for them to seek benefits and treatment, mental health experts say.

The rule, which went into effect immediately after it was announced, should help veterans with PTSD to get needed treatment, said Dr. Lisa Routh, a Houston-area neuropsychiatrist.

Over the years, seeking mental health services within the VA system has been cumbersome, she said. Eliminating some of the hurdles veterans must clear should not only make services more readily available, she said, but give PTSD a higher profile within the VA.

“Many people are touched by post-traumatic stress disorder, not only the people who are victimized by war but their families as well. The relaxing of restrictions on who can seek services will improve immediate functioning of the person and their family, and their long-term performance,” Dr. Routh said.

The Department of Veterans Affairs issued a final regulation on July 13 that reduced the level of evidence that veterans must provide in order for their PTSD to be recognized as connected to their military service.

Previously, noncombat veterans had to provide extensive records proving that they experienced traumatic events during their service.

To receive benefits for non–combat service related PTSD under the newly isssued rules, a veteran now must meet the following criteria:

▸ Be diagnosed with PTSD.

▸ Provide a personal account of a stressful event or set of circumstances.

▸ Claim that the diagnosis is based on a “fear of hostile military or terrorist activity.”

▸ Show that the stressor is consistent with the place and circumstance of his or her military service.

▸ Have that stressor confirmed as adequate support of a PTSD diagnosis by a VA psychiatrist, psychologist, or contract provider.

While this is a huge step forward, Dr. Routh said it would be even more beneficial if veterans also were allowed to have their PTSD assessments conducted by physicians outside the VA system. There are many skilled physicians outside the VA community who have experience working with veterans and military personnel with PTSD. And some veterans are simply more comfortable seeking their care outside of the VA, she said. “What you ultimately want is you want people to get care,” Dr. Routh said.

Reducing the burden of proof on the veteran is especially important given the current military conflicts in Iraq and Afghanistan, where there isn't a clear front, said Dr. Felise S. Zollman, medical director of the brain injury medicine and rehabilitation program at Rehabilitation Institute of Chicago.

“There are a lot of people who have felt in fear for their life in the course of service who couldn't claim they were combat veterans,” she said.

Dr. Sally Satel, a psychiatrist and resident scholar at the American Enterprise Institute in Washington, said the “anticipatory fear of being in harm's way” can be crippling for some noncombat veterans. However, it's unclear just how often these symptoms persist and become a lasting disability.

If veterans get appropriate treatment early on, only in rare cases will the symptoms fail to resolve over time, Dr. Satel said.

My Take

Focused Treatments Are Essential

This development is positive, and the long view of PTSD is that it does not necessarily lead to lifetime disability. However, it is essential that mental health professionals use clear, focused treatments that work–such as guided imagery, reciprocal inhibition, and systematic desensitization. Codification of treatment strategies is needed.

ROBERT T. LONDON, M.D., is a psychiatrist with the NYU Langone Medical Center.

The federal government's decision to cut some of the red tape for veterans with posttraumatic stress disorder will make it easier for them to seek benefits and treatment, mental health experts say.

The rule, which went into effect immediately after it was announced, should help veterans with PTSD to get needed treatment, said Dr. Lisa Routh, a Houston-area neuropsychiatrist.

Over the years, seeking mental health services within the VA system has been cumbersome, she said. Eliminating some of the hurdles veterans must clear should not only make services more readily available, she said, but give PTSD a higher profile within the VA.

“Many people are touched by post-traumatic stress disorder, not only the people who are victimized by war but their families as well. The relaxing of restrictions on who can seek services will improve immediate functioning of the person and their family, and their long-term performance,” Dr. Routh said.

The Department of Veterans Affairs issued a final regulation on July 13 that reduced the level of evidence that veterans must provide in order for their PTSD to be recognized as connected to their military service.

Previously, noncombat veterans had to provide extensive records proving that they experienced traumatic events during their service.

To receive benefits for non–combat service related PTSD under the newly isssued rules, a veteran now must meet the following criteria:

▸ Be diagnosed with PTSD.

▸ Provide a personal account of a stressful event or set of circumstances.

▸ Claim that the diagnosis is based on a “fear of hostile military or terrorist activity.”

▸ Show that the stressor is consistent with the place and circumstance of his or her military service.

▸ Have that stressor confirmed as adequate support of a PTSD diagnosis by a VA psychiatrist, psychologist, or contract provider.

While this is a huge step forward, Dr. Routh said it would be even more beneficial if veterans also were allowed to have their PTSD assessments conducted by physicians outside the VA system. There are many skilled physicians outside the VA community who have experience working with veterans and military personnel with PTSD. And some veterans are simply more comfortable seeking their care outside of the VA, she said. “What you ultimately want is you want people to get care,” Dr. Routh said.

Reducing the burden of proof on the veteran is especially important given the current military conflicts in Iraq and Afghanistan, where there isn't a clear front, said Dr. Felise S. Zollman, medical director of the brain injury medicine and rehabilitation program at Rehabilitation Institute of Chicago.

“There are a lot of people who have felt in fear for their life in the course of service who couldn't claim they were combat veterans,” she said.

Dr. Sally Satel, a psychiatrist and resident scholar at the American Enterprise Institute in Washington, said the “anticipatory fear of being in harm's way” can be crippling for some noncombat veterans. However, it's unclear just how often these symptoms persist and become a lasting disability.

If veterans get appropriate treatment early on, only in rare cases will the symptoms fail to resolve over time, Dr. Satel said.

My Take

Focused Treatments Are Essential

This development is positive, and the long view of PTSD is that it does not necessarily lead to lifetime disability. However, it is essential that mental health professionals use clear, focused treatments that work–such as guided imagery, reciprocal inhibition, and systematic desensitization. Codification of treatment strategies is needed.

ROBERT T. LONDON, M.D., is a psychiatrist with the NYU Langone Medical Center.

The federal government's decision to cut some of the red tape for veterans with posttraumatic stress disorder will make it easier for them to seek benefits and treatment, mental health experts say.

The rule, which went into effect immediately after it was announced, should help veterans with PTSD to get needed treatment, said Dr. Lisa Routh, a Houston-area neuropsychiatrist.

Over the years, seeking mental health services within the VA system has been cumbersome, she said. Eliminating some of the hurdles veterans must clear should not only make services more readily available, she said, but give PTSD a higher profile within the VA.

“Many people are touched by post-traumatic stress disorder, not only the people who are victimized by war but their families as well. The relaxing of restrictions on who can seek services will improve immediate functioning of the person and their family, and their long-term performance,” Dr. Routh said.

The Department of Veterans Affairs issued a final regulation on July 13 that reduced the level of evidence that veterans must provide in order for their PTSD to be recognized as connected to their military service.

Previously, noncombat veterans had to provide extensive records proving that they experienced traumatic events during their service.

To receive benefits for non–combat service related PTSD under the newly isssued rules, a veteran now must meet the following criteria:

▸ Be diagnosed with PTSD.

▸ Provide a personal account of a stressful event or set of circumstances.

▸ Claim that the diagnosis is based on a “fear of hostile military or terrorist activity.”

▸ Show that the stressor is consistent with the place and circumstance of his or her military service.

▸ Have that stressor confirmed as adequate support of a PTSD diagnosis by a VA psychiatrist, psychologist, or contract provider.

While this is a huge step forward, Dr. Routh said it would be even more beneficial if veterans also were allowed to have their PTSD assessments conducted by physicians outside the VA system. There are many skilled physicians outside the VA community who have experience working with veterans and military personnel with PTSD. And some veterans are simply more comfortable seeking their care outside of the VA, she said. “What you ultimately want is you want people to get care,” Dr. Routh said.

Reducing the burden of proof on the veteran is especially important given the current military conflicts in Iraq and Afghanistan, where there isn't a clear front, said Dr. Felise S. Zollman, medical director of the brain injury medicine and rehabilitation program at Rehabilitation Institute of Chicago.

“There are a lot of people who have felt in fear for their life in the course of service who couldn't claim they were combat veterans,” she said.

Dr. Sally Satel, a psychiatrist and resident scholar at the American Enterprise Institute in Washington, said the “anticipatory fear of being in harm's way” can be crippling for some noncombat veterans. However, it's unclear just how often these symptoms persist and become a lasting disability.

If veterans get appropriate treatment early on, only in rare cases will the symptoms fail to resolve over time, Dr. Satel said.

My Take

Focused Treatments Are Essential

This development is positive, and the long view of PTSD is that it does not necessarily lead to lifetime disability. However, it is essential that mental health professionals use clear, focused treatments that work–such as guided imagery, reciprocal inhibition, and systematic desensitization. Codification of treatment strategies is needed.

ROBERT T. LONDON, M.D., is a psychiatrist with the NYU Langone Medical Center.

Medicare's decision to eliminate consultation codes has resulted in a loss of revenue for many physicians and forced some to cut back on appointments with Medicare beneficiaries, according to a survey commissioned by the American Medical Association and several other medical specialty societies.

In January, officials at the Centers for Medicare and Medicaid Services discontinued the use of inpatient and outpatient consultation codes when billing Medicare, except for telehealth codes. Physicians instead were asked to use new or established office visit codes, initial hospital care codes, or initial nursing facility care codes. At the time of the policy change, CMS officials said they could no longer justify paying physicians more for a consultation when they had reduced so much of the documentation required to bill for a consultation. The agency also said that eliminating consultation codes would reduce the confusion around the differing definitions of consultations, transfers, and referrals.

But according to many specialists, the approach is flawed and is hurting their bottom line and patient access to care.

In an online survey of about 5,500 physicians, about 72% said that not being able to bill for consultations had decreased their total revenues by more than 5%, with about 30% reporting their revenues had fallen more than 15%.

The loss of revenue has in turn affected physicians' practices. For example, 20% of respondents said they have already reduced the number of new Medicare patients seen in their practices. Additionally, 39% said they would hold off on buying new equipment or health information technology.

The policy change also might undermine efforts to improve care coordination. About 6% of responding physicians said they have stopped providing primary care physicians with written reports following consults with Medicare patients, and another 19% said they plan to do so.

The elimination of consultation codes “will create a real hardship for Medicare patients, many of whom have chronic medical conditions that can be exacerbated when their psychiatric issues are not treated,” Dr. James H. Scully Jr., medical director and CEO of the American Psychiatric Association, said in a statement.

“Coordination of care between physicians is vital to maintaining the health of our Medicare population. In a letter to CMS officials, more than 30 medical specialty societies including the AMA and the APA, urged the agency to revise the policy when they issue a final regulation on the 2011 Medicare Physician Fee Schedule this fall.

The organizations suggested that CMS consider paying consulting physicians for providing the referring physician with a comprehensive report.

Medicare's decision to eliminate consultation codes has resulted in a loss of revenue for many physicians and forced some to cut back on appointments with Medicare beneficiaries, according to a survey commissioned by the American Medical Association and several other medical specialty societies.

In January, officials at the Centers for Medicare and Medicaid Services discontinued the use of inpatient and outpatient consultation codes when billing Medicare, except for telehealth codes. Physicians instead were asked to use new or established office visit codes, initial hospital care codes, or initial nursing facility care codes. At the time of the policy change, CMS officials said they could no longer justify paying physicians more for a consultation when they had reduced so much of the documentation required to bill for a consultation. The agency also said that eliminating consultation codes would reduce the confusion around the differing definitions of consultations, transfers, and referrals.

But according to many specialists, the approach is flawed and is hurting their bottom line and patient access to care.

In an online survey of about 5,500 physicians, about 72% said that not being able to bill for consultations had decreased their total revenues by more than 5%, with about 30% reporting their revenues had fallen more than 15%.

The loss of revenue has in turn affected physicians' practices. For example, 20% of respondents said they have already reduced the number of new Medicare patients seen in their practices. Additionally, 39% said they would hold off on buying new equipment or health information technology.

The policy change also might undermine efforts to improve care coordination. About 6% of responding physicians said they have stopped providing primary care physicians with written reports following consults with Medicare patients, and another 19% said they plan to do so.

The elimination of consultation codes “will create a real hardship for Medicare patients, many of whom have chronic medical conditions that can be exacerbated when their psychiatric issues are not treated,” Dr. James H. Scully Jr., medical director and CEO of the American Psychiatric Association, said in a statement.

“Coordination of care between physicians is vital to maintaining the health of our Medicare population. In a letter to CMS officials, more than 30 medical specialty societies including the AMA and the APA, urged the agency to revise the policy when they issue a final regulation on the 2011 Medicare Physician Fee Schedule this fall.

The organizations suggested that CMS consider paying consulting physicians for providing the referring physician with a comprehensive report.

Medicare's decision to eliminate consultation codes has resulted in a loss of revenue for many physicians and forced some to cut back on appointments with Medicare beneficiaries, according to a survey commissioned by the American Medical Association and several other medical specialty societies.

In January, officials at the Centers for Medicare and Medicaid Services discontinued the use of inpatient and outpatient consultation codes when billing Medicare, except for telehealth codes. Physicians instead were asked to use new or established office visit codes, initial hospital care codes, or initial nursing facility care codes. At the time of the policy change, CMS officials said they could no longer justify paying physicians more for a consultation when they had reduced so much of the documentation required to bill for a consultation. The agency also said that eliminating consultation codes would reduce the confusion around the differing definitions of consultations, transfers, and referrals.

But according to many specialists, the approach is flawed and is hurting their bottom line and patient access to care.

In an online survey of about 5,500 physicians, about 72% said that not being able to bill for consultations had decreased their total revenues by more than 5%, with about 30% reporting their revenues had fallen more than 15%.

The loss of revenue has in turn affected physicians' practices. For example, 20% of respondents said they have already reduced the number of new Medicare patients seen in their practices. Additionally, 39% said they would hold off on buying new equipment or health information technology.

The policy change also might undermine efforts to improve care coordination. About 6% of responding physicians said they have stopped providing primary care physicians with written reports following consults with Medicare patients, and another 19% said they plan to do so.

The elimination of consultation codes “will create a real hardship for Medicare patients, many of whom have chronic medical conditions that can be exacerbated when their psychiatric issues are not treated,” Dr. James H. Scully Jr., medical director and CEO of the American Psychiatric Association, said in a statement.

“Coordination of care between physicians is vital to maintaining the health of our Medicare population. In a letter to CMS officials, more than 30 medical specialty societies including the AMA and the APA, urged the agency to revise the policy when they issue a final regulation on the 2011 Medicare Physician Fee Schedule this fall.

The organizations suggested that CMS consider paying consulting physicians for providing the referring physician with a comprehensive report.