Mary Ellen Schneider

Looking to buy or implement an electronic health record in your practice? Help is on the way.

The Department of Health and Human Services has awarded more than $640 million in grants to set up regional extension centers around the country, with the goal of helping physicians and hospitals achieve “meaningful use” of electronic health record (EHR) technology. At press time, several centers were preparing to enroll physicians.

The staff at these regional extension centers will work “elbow to elbow” with physicians, Dr. David Blumenthal, national coordinator for health information technology, said during a press conference to announce the final round of regional extension center grants.

In April, HHS awarded more than $267 million in grants to 28 nonprofit organizations that will set up Health Information Technology Regional Extension Centers. This builds on more than $375 million in grants that the agency awarded for 32 regional extension centers in February. The funding is part of the 2009 American Recovery and Reinvestment Act.

The main goal of the regional extension centers is to help physicians and other health care providers to become meaningful users of EHRs, even as the standard for meaningful use is being defined through federal rule making.

Under the Health Information Technology for Economic and Clinical Health (HITECH) Act, a part of the 2009 federal stimulus law, physicians who treat Medicare patients can earn up to $44,000 over 5 years for the meaningful use of a certified health information systems. Those with patient populations of at least 30% Medicaid can earn up to $64,000 in federal incentive payments.

To help physicians become meaningful users, the regional extension centers will provide a broad range of services, Dr. Blumenthal said, from helping physicians select the most appropriate equipment for their practice through the implementation of the products. The centers also will help practices purchase technology in groups at reduced prices, he said.

“We hope that these regional extension centers will help providers improve their workflow using electronic health records, improve the quality and efficiency of the care they can provide using electronic health records, and of course thereby increase the efficiency and quality of care available to the American people,” Dr. Blumenthal said.

Farzad Mostashari, a senior adviser in the Office of the National Coordinator for Health Information Technology, encouraged physicians to enroll with their regional extension center as soon as possible, even before they make a decision about purchasing an EHR product.

Physicians can expect to get a lot of assistance from the regional extension center staff, he said. For example, the practice staff and the regional extension staff may have weekly contacts as the practice works to establish a work plan for implementation, as well as during the implementation period. Following implementation, the regional extension center staff may check in with the practice on a monthly basis to see how they are progressing with quality improvement and workflow design.

Initially, the regional extension centers will focus on aiding primary care providers in small practices. HHS estimates that the 60 regional extension centers will provide services to at least 100,000 primary care providers and hospitals within 2 years. Small, primary care practices are being targeted because this group reaches a large number of patients, Dr. Blumenthal said, but they are also the least likely to be able to afford to purchase health information technology support services in the private market.

Although the stimulus law directs the regional extension centers to give priority for direct technical assistance to primary care providers, all physicians are encouraged to participate in the outreach and educational opportunities of these centers.

Looking to buy or implement an electronic health record in your practice? Help is on the way.

The Department of Health and Human Services has awarded more than $640 million in grants to set up regional extension centers around the country, with the goal of helping physicians and hospitals achieve “meaningful use” of electronic health record (EHR) technology. At press time, several centers were preparing to enroll physicians.

The staff at these regional extension centers will work “elbow to elbow” with physicians, Dr. David Blumenthal, national coordinator for health information technology, said during a press conference to announce the final round of regional extension center grants.

In April, HHS awarded more than $267 million in grants to 28 nonprofit organizations that will set up Health Information Technology Regional Extension Centers. This builds on more than $375 million in grants that the agency awarded for 32 regional extension centers in February. The funding is part of the 2009 American Recovery and Reinvestment Act.

The main goal of the regional extension centers is to help physicians and other health care providers to become meaningful users of EHRs, even as the standard for meaningful use is being defined through federal rule making.

Under the Health Information Technology for Economic and Clinical Health (HITECH) Act, a part of the 2009 federal stimulus law, physicians who treat Medicare patients can earn up to $44,000 over 5 years for the meaningful use of a certified health information systems. Those with patient populations of at least 30% Medicaid can earn up to $64,000 in federal incentive payments.

To help physicians become meaningful users, the regional extension centers will provide a broad range of services, Dr. Blumenthal said, from helping physicians select the most appropriate equipment for their practice through the implementation of the products. The centers also will help practices purchase technology in groups at reduced prices, he said.

“We hope that these regional extension centers will help providers improve their workflow using electronic health records, improve the quality and efficiency of the care they can provide using electronic health records, and of course thereby increase the efficiency and quality of care available to the American people,” Dr. Blumenthal said.

Farzad Mostashari, a senior adviser in the Office of the National Coordinator for Health Information Technology, encouraged physicians to enroll with their regional extension center as soon as possible, even before they make a decision about purchasing an EHR product.

Physicians can expect to get a lot of assistance from the regional extension center staff, he said. For example, the practice staff and the regional extension staff may have weekly contacts as the practice works to establish a work plan for implementation, as well as during the implementation period. Following implementation, the regional extension center staff may check in with the practice on a monthly basis to see how they are progressing with quality improvement and workflow design.

Initially, the regional extension centers will focus on aiding primary care providers in small practices. HHS estimates that the 60 regional extension centers will provide services to at least 100,000 primary care providers and hospitals within 2 years. Small, primary care practices are being targeted because this group reaches a large number of patients, Dr. Blumenthal said, but they are also the least likely to be able to afford to purchase health information technology support services in the private market.

Although the stimulus law directs the regional extension centers to give priority for direct technical assistance to primary care providers, all physicians are encouraged to participate in the outreach and educational opportunities of these centers.

Looking to buy or implement an electronic health record in your practice? Help is on the way.

The Department of Health and Human Services has awarded more than $640 million in grants to set up regional extension centers around the country, with the goal of helping physicians and hospitals achieve “meaningful use” of electronic health record (EHR) technology. At press time, several centers were preparing to enroll physicians.

The staff at these regional extension centers will work “elbow to elbow” with physicians, Dr. David Blumenthal, national coordinator for health information technology, said during a press conference to announce the final round of regional extension center grants.

In April, HHS awarded more than $267 million in grants to 28 nonprofit organizations that will set up Health Information Technology Regional Extension Centers. This builds on more than $375 million in grants that the agency awarded for 32 regional extension centers in February. The funding is part of the 2009 American Recovery and Reinvestment Act.

The main goal of the regional extension centers is to help physicians and other health care providers to become meaningful users of EHRs, even as the standard for meaningful use is being defined through federal rule making.

Under the Health Information Technology for Economic and Clinical Health (HITECH) Act, a part of the 2009 federal stimulus law, physicians who treat Medicare patients can earn up to $44,000 over 5 years for the meaningful use of a certified health information systems. Those with patient populations of at least 30% Medicaid can earn up to $64,000 in federal incentive payments.

To help physicians become meaningful users, the regional extension centers will provide a broad range of services, Dr. Blumenthal said, from helping physicians select the most appropriate equipment for their practice through the implementation of the products. The centers also will help practices purchase technology in groups at reduced prices, he said.

“We hope that these regional extension centers will help providers improve their workflow using electronic health records, improve the quality and efficiency of the care they can provide using electronic health records, and of course thereby increase the efficiency and quality of care available to the American people,” Dr. Blumenthal said.

Farzad Mostashari, a senior adviser in the Office of the National Coordinator for Health Information Technology, encouraged physicians to enroll with their regional extension center as soon as possible, even before they make a decision about purchasing an EHR product.

Physicians can expect to get a lot of assistance from the regional extension center staff, he said. For example, the practice staff and the regional extension staff may have weekly contacts as the practice works to establish a work plan for implementation, as well as during the implementation period. Following implementation, the regional extension center staff may check in with the practice on a monthly basis to see how they are progressing with quality improvement and workflow design.

Initially, the regional extension centers will focus on aiding primary care providers in small practices. HHS estimates that the 60 regional extension centers will provide services to at least 100,000 primary care providers and hospitals within 2 years. Small, primary care practices are being targeted because this group reaches a large number of patients, Dr. Blumenthal said, but they are also the least likely to be able to afford to purchase health information technology support services in the private market.

Although the stimulus law directs the regional extension centers to give priority for direct technical assistance to primary care providers, all physicians are encouraged to participate in the outreach and educational opportunities of these centers.

The Agency for Healthcare Research and Quality has awarded $25 million in grants to states and health systems to test various approaches to medical liability reform.

The grant awards follow through on a 2009 promise made by President Obama. In a speech to Congress last September, the president pledged to fund demonstration projects that would look at malpractice reforms that also improve patient safety.

The focus on patient safety is critical, said Dr. Carolyn Clancy, director of AHRQ, because when physicians fear being sued, they are less likely to be open about potential errors, near misses, and avoidable harms, and that's a major hurdle to improving patient safety in any organization.

“If you're fearful and you're worried about being sued, that has a very chilling effect on people's willingness to step forward and say 'we have a problem and we need to do something about it,' ” Dr. Clancy said during a press briefing.

The awards, which were announced on June 11, include 3-year grants to states and health systems of as much as $3 million. The $25 million pool also includes 1-year planning grants of as much as $300,000, and a $2 million grant to JBA/RAND Corp. to evaluate the various projects.

Many of the demonstration grants will focus on early disclosure of errors and early offers of compensation, Dr. Clancy said. The aim with early offers is not to short-circuit the system, she added, but to give both physicians and patients relief from a process that often drags on. Another common theme among the grants is to promote better communication among providers, patients, and families.

None of the grants will examine the concept of health courts. Although health courts have been talked about for years and praised as a possible solution by President Obama, none of the grant applicants proposed studying that concept. One project, however, will look at a judge-directed negotiation program that is currently in use in New York in combination with an early disclosure and settlement model.

The Affordable Care Act authorizes an additional $50 million over 5 years to fund more studies, Dr. Clancy said.

A list of the projects is available at www.ahrq.gov/qual/liability/demogrants.htmwww.ahrq.gov/qual/liability/planninggrants.htm

The Agency for Healthcare Research and Quality has awarded $25 million in grants to states and health systems to test various approaches to medical liability reform.

The grant awards follow through on a 2009 promise made by President Obama. In a speech to Congress last September, the president pledged to fund demonstration projects that would look at malpractice reforms that also improve patient safety.

The focus on patient safety is critical, said Dr. Carolyn Clancy, director of AHRQ, because when physicians fear being sued, they are less likely to be open about potential errors, near misses, and avoidable harms, and that's a major hurdle to improving patient safety in any organization.

“If you're fearful and you're worried about being sued, that has a very chilling effect on people's willingness to step forward and say 'we have a problem and we need to do something about it,' ” Dr. Clancy said during a press briefing.

The awards, which were announced on June 11, include 3-year grants to states and health systems of as much as $3 million. The $25 million pool also includes 1-year planning grants of as much as $300,000, and a $2 million grant to JBA/RAND Corp. to evaluate the various projects.

Many of the demonstration grants will focus on early disclosure of errors and early offers of compensation, Dr. Clancy said. The aim with early offers is not to short-circuit the system, she added, but to give both physicians and patients relief from a process that often drags on. Another common theme among the grants is to promote better communication among providers, patients, and families.

None of the grants will examine the concept of health courts. Although health courts have been talked about for years and praised as a possible solution by President Obama, none of the grant applicants proposed studying that concept. One project, however, will look at a judge-directed negotiation program that is currently in use in New York in combination with an early disclosure and settlement model.

The Affordable Care Act authorizes an additional $50 million over 5 years to fund more studies, Dr. Clancy said.

A list of the projects is available at www.ahrq.gov/qual/liability/demogrants.htmwww.ahrq.gov/qual/liability/planninggrants.htm

The Agency for Healthcare Research and Quality has awarded $25 million in grants to states and health systems to test various approaches to medical liability reform.

The grant awards follow through on a 2009 promise made by President Obama. In a speech to Congress last September, the president pledged to fund demonstration projects that would look at malpractice reforms that also improve patient safety.

The focus on patient safety is critical, said Dr. Carolyn Clancy, director of AHRQ, because when physicians fear being sued, they are less likely to be open about potential errors, near misses, and avoidable harms, and that's a major hurdle to improving patient safety in any organization.

“If you're fearful and you're worried about being sued, that has a very chilling effect on people's willingness to step forward and say 'we have a problem and we need to do something about it,' ” Dr. Clancy said during a press briefing.

The awards, which were announced on June 11, include 3-year grants to states and health systems of as much as $3 million. The $25 million pool also includes 1-year planning grants of as much as $300,000, and a $2 million grant to JBA/RAND Corp. to evaluate the various projects.

Many of the demonstration grants will focus on early disclosure of errors and early offers of compensation, Dr. Clancy said. The aim with early offers is not to short-circuit the system, she added, but to give both physicians and patients relief from a process that often drags on. Another common theme among the grants is to promote better communication among providers, patients, and families.

None of the grants will examine the concept of health courts. Although health courts have been talked about for years and praised as a possible solution by President Obama, none of the grant applicants proposed studying that concept. One project, however, will look at a judge-directed negotiation program that is currently in use in New York in combination with an early disclosure and settlement model.

The Affordable Care Act authorizes an additional $50 million over 5 years to fund more studies, Dr. Clancy said.

A list of the projects is available at www.ahrq.gov/qual/liability/demogrants.htmwww.ahrq.gov/qual/liability/planninggrants.htm

TORONTO — For electronic health records to have real value, physicians must use them to improve quality, not just to ease documentation and coding.

That's the message the American College of Physicians is sending to doctors, policy makers, and the health information technology industry with the release of a position paper on EHR-based quality measurement and reporting. The paper outlines several objectives to maximize the use of EHRs for reporting quality measures, such as using only those measures that are clinically relevant and help improve outcomes.

The ACP advised that any EHR-based measurement should be based on information routinely collected during a visit. This will likely require EHR systems to include new functionalities that are not part of today's standard systems, such as practice-based registries that allow reporting on a population of patients, as well as connections to patient portals.

The collection of information must not create another administrative burden for physicians, said Dr. Michael S. Barr, ACP's vice president for practice advocacy and improvement. “If we layer additional processes onto the daily workload of doctors, especially without taking away other responsibilities, we won't get the potential of EHRs because physicians will not implement them,” he said.

The paper also emphasizes the need for EHRs to provide real-time clinical decision support systems that are linked to quality reporting. This would allow physicians to get patient-specific recommendations after entering routine clinical information into the system.

This kind of real-time feedback has been lacking in current quality reporting programs such as Medicare's Physician Quality Reporting Initiative (PQRI), said Dr. Joseph W. Stubbs, ACP president. He said there is often a long lag time between when physicians report on measures and when they receive reports on their performance under PQRI. For example, he submitted his final 2008 quality measures in December 2008 and did not receive any feedback until October 2009. “That kind of feedback … is not a very helpful thing,” Dr. Stubbs said.

Most current EHR systems can't provide the level of functionality described in the ACP's policy paper. But technology is not the major obstacle, Dr. Barr said. A bigger barrier is the cultural change required of each member of the clinical team in rethinking the office workflow as part of EHR implementation, he said.

Another hurdle is the physician payment system. The current volume-based system doesn't allow physicians to be paid for actually improving quality, Dr. Stubbs said. “Without the business model for practicing better quality of care, it's an extraordinarily expensive prospect for physicians, particularly in small groups, to think about putting in an electronic health record,” he said.

Despite these obstacles, the ACP is encouraging its members to adopt EHRs, and is launching new resources for evaluating the technology. At the annual meeting, the ACP demonstrated its new AmericanEHR Partners program (www.americanehr.com

The focus on using EHRs for quality comes as the federal government is finalizing regulations on what constitutes “meaningful use” of EHRs, the standard for qualifying for Medicare and Medicaid incentive payments under the HITECH (Health Information Technology for Economic and Clinical Health) Act. Physicians who demonstrate meaningful use of certified EHR technology can earn up to $44,000 in bonus payments under Medicare starting in 2011. A similar program under Medicaid allows eligible physicians to earn nearly $64,000 in incentive payments.

Dr. Stubbs said the federal incentives could be a big boost for physicians looking to purchase EHR systems. But the success of the program depends on whether the meaningful use criteria can actually be achieved. The worst thing would be for physicians to invest money up front to purchase EHRs, but find out later that they fell short of meaningful use by one measure and thus won't get any incentive dollars. “That would do more to destroy the effort than anything,” Dr. Stubbs said.

As written, the proposed rule on meaningful use is not achievable, said Dr. Peter Basch of MedStar Health in the Baltimore-Washington area.

The overall goals of meaningful use are reasonable, he said, but the details in the proposed rule raise concerns. Some of the metrics and thresholds in the rule contain “unintended trip wires” that even advanced users of EHRs probably can't overcome, he added. But Dr. Basch, who also is a member of the ACP's Medical Informatics Subcommittee, said he is hopeful that the Centers for Medicare and Medicaid Services will modify the requirements in the final rule that is expected later this year, so that the average physician can achieve meaningful use in 2011 or 2012.

“These are dollars they do want to pay out,” he said. “They do want to make this reasonable for doctors to do.”

The ACP position paper is available online at www.acponline.org/advocacy/where_we_stand/health_information_technology/ehrs.pdf

Small Practices Have Smaller Return on Investment From EHRs

The return on investment that physicians can expect to see after implementing an electronic health record is likely to differ greatly based on the size of their practice, according to one health information technology expert.

In large practices, physicians can anticipate significant cost reductions from elimination of chart pulls and improved intra-office communication. And such practices are likely to achieve savings from improvements in process throughput, coding, elimination of transcription, reductions in physician-to-staff ratios, and increased productivity, Dr. Basch said.

But the return on investment equation is quite different for small practices, Dr. Basch said. For example, small practices can't bank on saving much by reducing or eliminating chart pulls, because they typically keep charts right in the office and don't pay $8-$15 per chart pull the way large practices do. Small practices have the potential to reduce some staff following EHR adoption, but that won't happen immediately. Also, if the practice is already fairly lean there may not be much trimming of staff costs, he said.

The greatest potential for savings comes from better coding and the elimination of transcription. “Most of us tend to undercode, and EHRs can help us with coding,” Dr. Basch said.

Small practices have additional obstacles when implementing an EHR, he noted. They generally don't have sufficient capital to invest in an expensive system, so they have to borrow money or take a reduction in income during the initial start-up period. Practices that aren't interested in taking out loans or reducing their income can consider an application service provider model, which essentially allows them to lease an EHR system. This isn't a good fit for every practice, Dr. Basch said, but it is attractive because it doesn't involve a large cash outlay upfront.

For practices considering the leasing approach, the monthly cost will be important. Those costs have typically ranged from $500 to $1,000 per month, but they appear to be coming down, Dr. Basch said. “As those monthly figures begin to move down because of market pressure, this could certainly make an EHR investment a lot more affordable for many, many people,” he said.

—Mary Ellen Schneider

TORONTO — For electronic health records to have real value, physicians must use them to improve quality, not just to ease documentation and coding.

That's the message the American College of Physicians is sending to doctors, policy makers, and the health information technology industry with the release of a position paper on EHR-based quality measurement and reporting. The paper outlines several objectives to maximize the use of EHRs for reporting quality measures, such as using only those measures that are clinically relevant and help improve outcomes.

The ACP advised that any EHR-based measurement should be based on information routinely collected during a visit. This will likely require EHR systems to include new functionalities that are not part of today's standard systems, such as practice-based registries that allow reporting on a population of patients, as well as connections to patient portals.

The collection of information must not create another administrative burden for physicians, said Dr. Michael S. Barr, ACP's vice president for practice advocacy and improvement. “If we layer additional processes onto the daily workload of doctors, especially without taking away other responsibilities, we won't get the potential of EHRs because physicians will not implement them,” he said.

The paper also emphasizes the need for EHRs to provide real-time clinical decision support systems that are linked to quality reporting. This would allow physicians to get patient-specific recommendations after entering routine clinical information into the system.

This kind of real-time feedback has been lacking in current quality reporting programs such as Medicare's Physician Quality Reporting Initiative (PQRI), said Dr. Joseph W. Stubbs, ACP president. He said there is often a long lag time between when physicians report on measures and when they receive reports on their performance under PQRI. For example, he submitted his final 2008 quality measures in December 2008 and did not receive any feedback until October 2009. “That kind of feedback … is not a very helpful thing,” Dr. Stubbs said.

Most current EHR systems can't provide the level of functionality described in the ACP's policy paper. But technology is not the major obstacle, Dr. Barr said. A bigger barrier is the cultural change required of each member of the clinical team in rethinking the office workflow as part of EHR implementation, he said.

Another hurdle is the physician payment system. The current volume-based system doesn't allow physicians to be paid for actually improving quality, Dr. Stubbs said. “Without the business model for practicing better quality of care, it's an extraordinarily expensive prospect for physicians, particularly in small groups, to think about putting in an electronic health record,” he said.

Despite these obstacles, the ACP is encouraging its members to adopt EHRs, and is launching new resources for evaluating the technology. At the annual meeting, the ACP demonstrated its new AmericanEHR Partners program (www.americanehr.com

The focus on using EHRs for quality comes as the federal government is finalizing regulations on what constitutes “meaningful use” of EHRs, the standard for qualifying for Medicare and Medicaid incentive payments under the HITECH (Health Information Technology for Economic and Clinical Health) Act. Physicians who demonstrate meaningful use of certified EHR technology can earn up to $44,000 in bonus payments under Medicare starting in 2011. A similar program under Medicaid allows eligible physicians to earn nearly $64,000 in incentive payments.

Dr. Stubbs said the federal incentives could be a big boost for physicians looking to purchase EHR systems. But the success of the program depends on whether the meaningful use criteria can actually be achieved. The worst thing would be for physicians to invest money up front to purchase EHRs, but find out later that they fell short of meaningful use by one measure and thus won't get any incentive dollars. “That would do more to destroy the effort than anything,” Dr. Stubbs said.

As written, the proposed rule on meaningful use is not achievable, said Dr. Peter Basch of MedStar Health in the Baltimore-Washington area.

The overall goals of meaningful use are reasonable, he said, but the details in the proposed rule raise concerns. Some of the metrics and thresholds in the rule contain “unintended trip wires” that even advanced users of EHRs probably can't overcome, he added. But Dr. Basch, who also is a member of the ACP's Medical Informatics Subcommittee, said he is hopeful that the Centers for Medicare and Medicaid Services will modify the requirements in the final rule that is expected later this year, so that the average physician can achieve meaningful use in 2011 or 2012.

“These are dollars they do want to pay out,” he said. “They do want to make this reasonable for doctors to do.”

The ACP position paper is available online at www.acponline.org/advocacy/where_we_stand/health_information_technology/ehrs.pdf

Small Practices Have Smaller Return on Investment From EHRs

The return on investment that physicians can expect to see after implementing an electronic health record is likely to differ greatly based on the size of their practice, according to one health information technology expert.

In large practices, physicians can anticipate significant cost reductions from elimination of chart pulls and improved intra-office communication. And such practices are likely to achieve savings from improvements in process throughput, coding, elimination of transcription, reductions in physician-to-staff ratios, and increased productivity, Dr. Basch said.

But the return on investment equation is quite different for small practices, Dr. Basch said. For example, small practices can't bank on saving much by reducing or eliminating chart pulls, because they typically keep charts right in the office and don't pay $8-$15 per chart pull the way large practices do. Small practices have the potential to reduce some staff following EHR adoption, but that won't happen immediately. Also, if the practice is already fairly lean there may not be much trimming of staff costs, he said.

The greatest potential for savings comes from better coding and the elimination of transcription. “Most of us tend to undercode, and EHRs can help us with coding,” Dr. Basch said.

Small practices have additional obstacles when implementing an EHR, he noted. They generally don't have sufficient capital to invest in an expensive system, so they have to borrow money or take a reduction in income during the initial start-up period. Practices that aren't interested in taking out loans or reducing their income can consider an application service provider model, which essentially allows them to lease an EHR system. This isn't a good fit for every practice, Dr. Basch said, but it is attractive because it doesn't involve a large cash outlay upfront.

For practices considering the leasing approach, the monthly cost will be important. Those costs have typically ranged from $500 to $1,000 per month, but they appear to be coming down, Dr. Basch said. “As those monthly figures begin to move down because of market pressure, this could certainly make an EHR investment a lot more affordable for many, many people,” he said.

—Mary Ellen Schneider

TORONTO — For electronic health records to have real value, physicians must use them to improve quality, not just to ease documentation and coding.

That's the message the American College of Physicians is sending to doctors, policy makers, and the health information technology industry with the release of a position paper on EHR-based quality measurement and reporting. The paper outlines several objectives to maximize the use of EHRs for reporting quality measures, such as using only those measures that are clinically relevant and help improve outcomes.

The ACP advised that any EHR-based measurement should be based on information routinely collected during a visit. This will likely require EHR systems to include new functionalities that are not part of today's standard systems, such as practice-based registries that allow reporting on a population of patients, as well as connections to patient portals.

The collection of information must not create another administrative burden for physicians, said Dr. Michael S. Barr, ACP's vice president for practice advocacy and improvement. “If we layer additional processes onto the daily workload of doctors, especially without taking away other responsibilities, we won't get the potential of EHRs because physicians will not implement them,” he said.

The paper also emphasizes the need for EHRs to provide real-time clinical decision support systems that are linked to quality reporting. This would allow physicians to get patient-specific recommendations after entering routine clinical information into the system.

This kind of real-time feedback has been lacking in current quality reporting programs such as Medicare's Physician Quality Reporting Initiative (PQRI), said Dr. Joseph W. Stubbs, ACP president. He said there is often a long lag time between when physicians report on measures and when they receive reports on their performance under PQRI. For example, he submitted his final 2008 quality measures in December 2008 and did not receive any feedback until October 2009. “That kind of feedback … is not a very helpful thing,” Dr. Stubbs said.

Most current EHR systems can't provide the level of functionality described in the ACP's policy paper. But technology is not the major obstacle, Dr. Barr said. A bigger barrier is the cultural change required of each member of the clinical team in rethinking the office workflow as part of EHR implementation, he said.

Another hurdle is the physician payment system. The current volume-based system doesn't allow physicians to be paid for actually improving quality, Dr. Stubbs said. “Without the business model for practicing better quality of care, it's an extraordinarily expensive prospect for physicians, particularly in small groups, to think about putting in an electronic health record,” he said.

Despite these obstacles, the ACP is encouraging its members to adopt EHRs, and is launching new resources for evaluating the technology. At the annual meeting, the ACP demonstrated its new AmericanEHR Partners program (www.americanehr.com

The focus on using EHRs for quality comes as the federal government is finalizing regulations on what constitutes “meaningful use” of EHRs, the standard for qualifying for Medicare and Medicaid incentive payments under the HITECH (Health Information Technology for Economic and Clinical Health) Act. Physicians who demonstrate meaningful use of certified EHR technology can earn up to $44,000 in bonus payments under Medicare starting in 2011. A similar program under Medicaid allows eligible physicians to earn nearly $64,000 in incentive payments.

Dr. Stubbs said the federal incentives could be a big boost for physicians looking to purchase EHR systems. But the success of the program depends on whether the meaningful use criteria can actually be achieved. The worst thing would be for physicians to invest money up front to purchase EHRs, but find out later that they fell short of meaningful use by one measure and thus won't get any incentive dollars. “That would do more to destroy the effort than anything,” Dr. Stubbs said.

As written, the proposed rule on meaningful use is not achievable, said Dr. Peter Basch of MedStar Health in the Baltimore-Washington area.

The overall goals of meaningful use are reasonable, he said, but the details in the proposed rule raise concerns. Some of the metrics and thresholds in the rule contain “unintended trip wires” that even advanced users of EHRs probably can't overcome, he added. But Dr. Basch, who also is a member of the ACP's Medical Informatics Subcommittee, said he is hopeful that the Centers for Medicare and Medicaid Services will modify the requirements in the final rule that is expected later this year, so that the average physician can achieve meaningful use in 2011 or 2012.

“These are dollars they do want to pay out,” he said. “They do want to make this reasonable for doctors to do.”

The ACP position paper is available online at www.acponline.org/advocacy/where_we_stand/health_information_technology/ehrs.pdf

Small Practices Have Smaller Return on Investment From EHRs

The return on investment that physicians can expect to see after implementing an electronic health record is likely to differ greatly based on the size of their practice, according to one health information technology expert.

In large practices, physicians can anticipate significant cost reductions from elimination of chart pulls and improved intra-office communication. And such practices are likely to achieve savings from improvements in process throughput, coding, elimination of transcription, reductions in physician-to-staff ratios, and increased productivity, Dr. Basch said.

But the return on investment equation is quite different for small practices, Dr. Basch said. For example, small practices can't bank on saving much by reducing or eliminating chart pulls, because they typically keep charts right in the office and don't pay $8-$15 per chart pull the way large practices do. Small practices have the potential to reduce some staff following EHR adoption, but that won't happen immediately. Also, if the practice is already fairly lean there may not be much trimming of staff costs, he said.

The greatest potential for savings comes from better coding and the elimination of transcription. “Most of us tend to undercode, and EHRs can help us with coding,” Dr. Basch said.

Small practices have additional obstacles when implementing an EHR, he noted. They generally don't have sufficient capital to invest in an expensive system, so they have to borrow money or take a reduction in income during the initial start-up period. Practices that aren't interested in taking out loans or reducing their income can consider an application service provider model, which essentially allows them to lease an EHR system. This isn't a good fit for every practice, Dr. Basch said, but it is attractive because it doesn't involve a large cash outlay upfront.

For practices considering the leasing approach, the monthly cost will be important. Those costs have typically ranged from $500 to $1,000 per month, but they appear to be coming down, Dr. Basch said. “As those monthly figures begin to move down because of market pressure, this could certainly make an EHR investment a lot more affordable for many, many people,” he said.

—Mary Ellen Schneider

Medicare officials have temporarily increased payments for performing dual-energy x-ray absorptiometry, but osteoporosis experts say the boost isn't likely to make much of a difference in the number of physicians offering the service.

Under the health reform law—formally known as the Affordable Care Act—Congress instructed officials at the Centers for Medicare and Medicaid Services to increase DXA payments to 70% of the rate paid by Medicare in 2006. For example, nonfacility fees for CPT code 77080 increased from about $45 to $98. The same service was paid at about $143 in 2006, according to estimates from the American College of Rheumatology.

While the increased payments began on June 1 and are retroactive to Jan. 1, 2010, they also expire at the end of 2011. In the meantime, Congress has called on the Institute of Medicine to study the impact of past DXA payment reductions on patient access.

The American College of Rheumatology hailed the increase as a victory for physicians.

But even with the additional reimbursement, physicians are not likely to get back into the DXA business if they have already gotten out, said Dr. David Goddard, a rheumatologist in private practice in Brooklyn, N.Y., and a member of the ACR's government affairs committee. However, it could motivate others who were on the fence to continue to offer the service.

One of the big determinants going forward is likely to be the cost of the equipment, he said. The average lifespan of a DXA scanner is about 8–10 years, depending on usage, and physicians will be faced with the question of whether the payment level makes it worthwhile to purchase a new machine.

Steep cuts to DXA services began in 2007, after Congress included bone densitometry among a group of other imaging services that were slashed as part of the Deficit Reduction Act of 2005.

Since then, physicians have been struggling to cover their costs as reimbursement steadily declined from around $140 in 2006 to about $45 in the first half of this year.

Adding to the problem is that private insurers have largely followed the lead of Medicare and have been ratcheting down their rates over the years as well, Dr. Goddard said.

Patient access to the bone densitometry services depends in large part on geography, Dr. Goddard said.

Generally, patients who live near large urban centers will have little difficulty finding bone densitometry testing in either a medical center or a specialist's office. However, patients in rural areas are likely to have a harder time accessing the same services, he said.

“The whole thing is nonsensical anyway because it's a very low cost test with a reasonably high predictive value,” Dr. Goddard said. “So in terms of identification of people at risk, it's very cost effective.”

At this point, it is physicians' concern for patients, not the payment, that motivates them to continue to offer bone densitometry services, said Dr. Steven Petak, immediate past president of the American College of Endocrinology and director of the Osteoporosis and Bone Densitometry Unit at the Texas Institute for Reproductive Medicine and Endocrinology in Houston.

Dr. Petak said a reasonable number of physicians will continue to perform DXA studies, but that number is likely to drop dramatically if Congress allows payment cuts again in 2012.

The problem that the medical community has had in advocating for higher payments for DXA studies is that the government isn't considering the full potential for savings from prevention of fractures, Dr. Petak said. For example, when estimating the cost of DXA payments in legislation, the Congressional Budget Office will consider the cost of utilization of DXA in Medicare Part B, but won't count potential savings to Medicare's Part A, which includes hospitalization costs.

“You can't look at the cost outlay in isolation. You have to look at how it's going to impact the preventive health care of the population,” Dr. Petak said. “That's something that the government has failed to do.”

The outlook for gaining a permanent payment increase for DXA services is pretty bleak, at least for now.

It's difficult to convince Congress to spend money on anything in the current political environment, Dr. Petak said, even if it will result in savings down the line.

“I think [Congress will] play politics with it and any kind of cost outlay will be met with resistance,” Dr. Petak said.

Dr. Goddard agreed with that assessment, citing the failure of Congress to come to consensus on how to address the impact of the Sustainable Growth Rate (SGR) formula on Medicare physician payments.

“If we can't get something fundamental like [the SGR] fixed, osteoporosis and bone densitometry is sort of, for them, a little blip on the radar,” Dr. Goddard said.

Medicare officials have temporarily increased payments for performing dual-energy x-ray absorptiometry, but osteoporosis experts say the boost isn't likely to make much of a difference in the number of physicians offering the service.

Under the health reform law—formally known as the Affordable Care Act—Congress instructed officials at the Centers for Medicare and Medicaid Services to increase DXA payments to 70% of the rate paid by Medicare in 2006. For example, nonfacility fees for CPT code 77080 increased from about $45 to $98. The same service was paid at about $143 in 2006, according to estimates from the American College of Rheumatology.

While the increased payments began on June 1 and are retroactive to Jan. 1, 2010, they also expire at the end of 2011. In the meantime, Congress has called on the Institute of Medicine to study the impact of past DXA payment reductions on patient access.

The American College of Rheumatology hailed the increase as a victory for physicians.

But even with the additional reimbursement, physicians are not likely to get back into the DXA business if they have already gotten out, said Dr. David Goddard, a rheumatologist in private practice in Brooklyn, N.Y., and a member of the ACR's government affairs committee. However, it could motivate others who were on the fence to continue to offer the service.

One of the big determinants going forward is likely to be the cost of the equipment, he said. The average lifespan of a DXA scanner is about 8–10 years, depending on usage, and physicians will be faced with the question of whether the payment level makes it worthwhile to purchase a new machine.

Steep cuts to DXA services began in 2007, after Congress included bone densitometry among a group of other imaging services that were slashed as part of the Deficit Reduction Act of 2005.

Since then, physicians have been struggling to cover their costs as reimbursement steadily declined from around $140 in 2006 to about $45 in the first half of this year.

Adding to the problem is that private insurers have largely followed the lead of Medicare and have been ratcheting down their rates over the years as well, Dr. Goddard said.

Patient access to the bone densitometry services depends in large part on geography, Dr. Goddard said.

Generally, patients who live near large urban centers will have little difficulty finding bone densitometry testing in either a medical center or a specialist's office. However, patients in rural areas are likely to have a harder time accessing the same services, he said.

“The whole thing is nonsensical anyway because it's a very low cost test with a reasonably high predictive value,” Dr. Goddard said. “So in terms of identification of people at risk, it's very cost effective.”

At this point, it is physicians' concern for patients, not the payment, that motivates them to continue to offer bone densitometry services, said Dr. Steven Petak, immediate past president of the American College of Endocrinology and director of the Osteoporosis and Bone Densitometry Unit at the Texas Institute for Reproductive Medicine and Endocrinology in Houston.

Dr. Petak said a reasonable number of physicians will continue to perform DXA studies, but that number is likely to drop dramatically if Congress allows payment cuts again in 2012.

The problem that the medical community has had in advocating for higher payments for DXA studies is that the government isn't considering the full potential for savings from prevention of fractures, Dr. Petak said. For example, when estimating the cost of DXA payments in legislation, the Congressional Budget Office will consider the cost of utilization of DXA in Medicare Part B, but won't count potential savings to Medicare's Part A, which includes hospitalization costs.

“You can't look at the cost outlay in isolation. You have to look at how it's going to impact the preventive health care of the population,” Dr. Petak said. “That's something that the government has failed to do.”

The outlook for gaining a permanent payment increase for DXA services is pretty bleak, at least for now.

It's difficult to convince Congress to spend money on anything in the current political environment, Dr. Petak said, even if it will result in savings down the line.

“I think [Congress will] play politics with it and any kind of cost outlay will be met with resistance,” Dr. Petak said.

Dr. Goddard agreed with that assessment, citing the failure of Congress to come to consensus on how to address the impact of the Sustainable Growth Rate (SGR) formula on Medicare physician payments.

“If we can't get something fundamental like [the SGR] fixed, osteoporosis and bone densitometry is sort of, for them, a little blip on the radar,” Dr. Goddard said.

Medicare officials have temporarily increased payments for performing dual-energy x-ray absorptiometry, but osteoporosis experts say the boost isn't likely to make much of a difference in the number of physicians offering the service.

Under the health reform law—formally known as the Affordable Care Act—Congress instructed officials at the Centers for Medicare and Medicaid Services to increase DXA payments to 70% of the rate paid by Medicare in 2006. For example, nonfacility fees for CPT code 77080 increased from about $45 to $98. The same service was paid at about $143 in 2006, according to estimates from the American College of Rheumatology.

While the increased payments began on June 1 and are retroactive to Jan. 1, 2010, they also expire at the end of 2011. In the meantime, Congress has called on the Institute of Medicine to study the impact of past DXA payment reductions on patient access.

The American College of Rheumatology hailed the increase as a victory for physicians.

But even with the additional reimbursement, physicians are not likely to get back into the DXA business if they have already gotten out, said Dr. David Goddard, a rheumatologist in private practice in Brooklyn, N.Y., and a member of the ACR's government affairs committee. However, it could motivate others who were on the fence to continue to offer the service.

One of the big determinants going forward is likely to be the cost of the equipment, he said. The average lifespan of a DXA scanner is about 8–10 years, depending on usage, and physicians will be faced with the question of whether the payment level makes it worthwhile to purchase a new machine.

Steep cuts to DXA services began in 2007, after Congress included bone densitometry among a group of other imaging services that were slashed as part of the Deficit Reduction Act of 2005.

Since then, physicians have been struggling to cover their costs as reimbursement steadily declined from around $140 in 2006 to about $45 in the first half of this year.

Adding to the problem is that private insurers have largely followed the lead of Medicare and have been ratcheting down their rates over the years as well, Dr. Goddard said.

Patient access to the bone densitometry services depends in large part on geography, Dr. Goddard said.

Generally, patients who live near large urban centers will have little difficulty finding bone densitometry testing in either a medical center or a specialist's office. However, patients in rural areas are likely to have a harder time accessing the same services, he said.

“The whole thing is nonsensical anyway because it's a very low cost test with a reasonably high predictive value,” Dr. Goddard said. “So in terms of identification of people at risk, it's very cost effective.”

At this point, it is physicians' concern for patients, not the payment, that motivates them to continue to offer bone densitometry services, said Dr. Steven Petak, immediate past president of the American College of Endocrinology and director of the Osteoporosis and Bone Densitometry Unit at the Texas Institute for Reproductive Medicine and Endocrinology in Houston.

Dr. Petak said a reasonable number of physicians will continue to perform DXA studies, but that number is likely to drop dramatically if Congress allows payment cuts again in 2012.

The problem that the medical community has had in advocating for higher payments for DXA studies is that the government isn't considering the full potential for savings from prevention of fractures, Dr. Petak said. For example, when estimating the cost of DXA payments in legislation, the Congressional Budget Office will consider the cost of utilization of DXA in Medicare Part B, but won't count potential savings to Medicare's Part A, which includes hospitalization costs.

“You can't look at the cost outlay in isolation. You have to look at how it's going to impact the preventive health care of the population,” Dr. Petak said. “That's something that the government has failed to do.”

The outlook for gaining a permanent payment increase for DXA services is pretty bleak, at least for now.

It's difficult to convince Congress to spend money on anything in the current political environment, Dr. Petak said, even if it will result in savings down the line.

“I think [Congress will] play politics with it and any kind of cost outlay will be met with resistance,” Dr. Petak said.

Dr. Goddard agreed with that assessment, citing the failure of Congress to come to consensus on how to address the impact of the Sustainable Growth Rate (SGR) formula on Medicare physician payments.

“If we can't get something fundamental like [the SGR] fixed, osteoporosis and bone densitometry is sort of, for them, a little blip on the radar,” Dr. Goddard said.

President Obama on June 25 signed into law a bill that replaces the 21% Medicare physician payment cut with a 2.2% pay raise for 6 months.

The legislation (H.R. 3962) provides physicians with a 2.2% increase in their Medicare payments through Nov. 30 of this year. The change is retroactive to June 1, the date that the 21% cut officially went into effect.

Officials at the Centers for Medicare and Medicaid Services held claims from June 1 to June 18 to give Congress time to reverse the cuts, but has been paying physicians at the lower rate since then.

Now that the pay cuts have been reversed, CMS has directed its contractors to stop processing claims at the lower rates and temporarily hold all claims for services provided on or after June 1. This delay will give contractors time to adjust their claims processing systems.

CMS said processing claims at the increased pay rate will begin no later than July 1.

Medicare will also begin reprocessing any June claims that were paid under the 21% cut.

Physicians should not resubmit those claims, but may need to contact their local Medicare contractor to request an adjustment, according to CMS.

Under the law, Medicare must pay physicians the lower of either their submitted charge or the Medicare Physician Fee Schedule amount.

Claims with submitted charges at or above the new 2.2% increased rate will be automatically reprocessed. But if physicians submitted claims in June with charges below the new increased rate, they must request an adjustment, according to CMS.

While physicians welcomed the temporary reprieve, they remain dissatisfied with the lack of congressional action on a permanent solution to the recurring Medicare payment cuts. The American Medical Association noted that without further action from Congress, physicians will face a 23% cut in December that will increase to nearly 30% in January 2011.

“Congress is playing a dangerous game of Russian roulette with seniors' health care. Sick patients can't wait. Congress must replace the broken payment system before the damage is done and cannot be reversed,” Dr. Cecil B. Wilson, AMA president, said in a statement. “The baby boomers begin entering Medicare in 6 months, and if the physician payment problem isn't fixed, these new Medicare patients won't be able to find a doctor to treat them.”

The instability of the current payment system doesn't just affect Medicare, but will have a significant impact on the future success of health reform, according to the American Academy of Family Physicians. The Affordable Care Act calls on physicians to change their practices through the adoption of health information technology and new practice models, both of which require time and money to implement. “Physicians cannot invest in change if they cannot count on payment for their services,” Dr. Lori Heim, AAFP president, said in a statement

Even the President is urging Congress to come up with a permanent replacement for the Medicare physician payment formula. Before signing the bill, he released a statement saying that the practice of temporary payment patches was “untenable” and must end.

On June 24, the House of Representatives passed H.R. 3962 by a vote of 417-1. The Senate approved the measure on June 18.

President Obama on June 25 signed into law a bill that replaces the 21% Medicare physician payment cut with a 2.2% pay raise for 6 months.

The legislation (H.R. 3962) provides physicians with a 2.2% increase in their Medicare payments through Nov. 30 of this year. The change is retroactive to June 1, the date that the 21% cut officially went into effect.

Officials at the Centers for Medicare and Medicaid Services held claims from June 1 to June 18 to give Congress time to reverse the cuts, but has been paying physicians at the lower rate since then.

Now that the pay cuts have been reversed, CMS has directed its contractors to stop processing claims at the lower rates and temporarily hold all claims for services provided on or after June 1. This delay will give contractors time to adjust their claims processing systems.

CMS said processing claims at the increased pay rate will begin no later than July 1.

Medicare will also begin reprocessing any June claims that were paid under the 21% cut.

Physicians should not resubmit those claims, but may need to contact their local Medicare contractor to request an adjustment, according to CMS.

Under the law, Medicare must pay physicians the lower of either their submitted charge or the Medicare Physician Fee Schedule amount.

Claims with submitted charges at or above the new 2.2% increased rate will be automatically reprocessed. But if physicians submitted claims in June with charges below the new increased rate, they must request an adjustment, according to CMS.

While physicians welcomed the temporary reprieve, they remain dissatisfied with the lack of congressional action on a permanent solution to the recurring Medicare payment cuts. The American Medical Association noted that without further action from Congress, physicians will face a 23% cut in December that will increase to nearly 30% in January 2011.

“Congress is playing a dangerous game of Russian roulette with seniors' health care. Sick patients can't wait. Congress must replace the broken payment system before the damage is done and cannot be reversed,” Dr. Cecil B. Wilson, AMA president, said in a statement. “The baby boomers begin entering Medicare in 6 months, and if the physician payment problem isn't fixed, these new Medicare patients won't be able to find a doctor to treat them.”

The instability of the current payment system doesn't just affect Medicare, but will have a significant impact on the future success of health reform, according to the American Academy of Family Physicians. The Affordable Care Act calls on physicians to change their practices through the adoption of health information technology and new practice models, both of which require time and money to implement. “Physicians cannot invest in change if they cannot count on payment for their services,” Dr. Lori Heim, AAFP president, said in a statement

Even the President is urging Congress to come up with a permanent replacement for the Medicare physician payment formula. Before signing the bill, he released a statement saying that the practice of temporary payment patches was “untenable” and must end.

On June 24, the House of Representatives passed H.R. 3962 by a vote of 417-1. The Senate approved the measure on June 18.

President Obama on June 25 signed into law a bill that replaces the 21% Medicare physician payment cut with a 2.2% pay raise for 6 months.

The legislation (H.R. 3962) provides physicians with a 2.2% increase in their Medicare payments through Nov. 30 of this year. The change is retroactive to June 1, the date that the 21% cut officially went into effect.

Officials at the Centers for Medicare and Medicaid Services held claims from June 1 to June 18 to give Congress time to reverse the cuts, but has been paying physicians at the lower rate since then.

Now that the pay cuts have been reversed, CMS has directed its contractors to stop processing claims at the lower rates and temporarily hold all claims for services provided on or after June 1. This delay will give contractors time to adjust their claims processing systems.

CMS said processing claims at the increased pay rate will begin no later than July 1.

Medicare will also begin reprocessing any June claims that were paid under the 21% cut.

Physicians should not resubmit those claims, but may need to contact their local Medicare contractor to request an adjustment, according to CMS.

Under the law, Medicare must pay physicians the lower of either their submitted charge or the Medicare Physician Fee Schedule amount.

Claims with submitted charges at or above the new 2.2% increased rate will be automatically reprocessed. But if physicians submitted claims in June with charges below the new increased rate, they must request an adjustment, according to CMS.

While physicians welcomed the temporary reprieve, they remain dissatisfied with the lack of congressional action on a permanent solution to the recurring Medicare payment cuts. The American Medical Association noted that without further action from Congress, physicians will face a 23% cut in December that will increase to nearly 30% in January 2011.

“Congress is playing a dangerous game of Russian roulette with seniors' health care. Sick patients can't wait. Congress must replace the broken payment system before the damage is done and cannot be reversed,” Dr. Cecil B. Wilson, AMA president, said in a statement. “The baby boomers begin entering Medicare in 6 months, and if the physician payment problem isn't fixed, these new Medicare patients won't be able to find a doctor to treat them.”

The instability of the current payment system doesn't just affect Medicare, but will have a significant impact on the future success of health reform, according to the American Academy of Family Physicians. The Affordable Care Act calls on physicians to change their practices through the adoption of health information technology and new practice models, both of which require time and money to implement. “Physicians cannot invest in change if they cannot count on payment for their services,” Dr. Lori Heim, AAFP president, said in a statement

Even the President is urging Congress to come up with a permanent replacement for the Medicare physician payment formula. Before signing the bill, he released a statement saying that the practice of temporary payment patches was “untenable” and must end.

On June 24, the House of Representatives passed H.R. 3962 by a vote of 417-1. The Senate approved the measure on June 18.

Want more health reform news? Subscribe to our podcast – search 'Policy & Practice' in the iTunes store

Boniva Gets Dubious Distinction

The osteoporosis therapy ibandronate (Boniva) ranked in the top 10 drugs most cited as possibly contributing to patient deaths in 2009, according to a report from the Institute for Safe Medication Practices. But those figures don't indicate a safety problem with the drug, the same report said. The large volume of patient deaths was actually attributable to marketing by the manufacturer, Roche. The company used postcards to remind patients, most of whom were elderly, to take their medication each month. If the postcard was returned to the manufacturer with the note “addressee decreased,” Roche reported an adverse event associated with ibandronate. Nearly 90% of the 250 ibandronate-associated deaths in the United States last year were reported through this program, according to Roche.

Gout Patients Report Pain, Stress

More than a third of gout patients polled in a recent survey said they would give up winning the lottery if it meant they would never have to have another gout flare. The telephone survey of 1,000 people found that they experienced significant pain and stress from the condition, even though 91% said they feel that their condition is under control. The survey revealed that 22% feared their next gout attack, and 28% have had to take time off from work because of flares. The survey was conducted by Braun Research Inc. and supported by Takeda Pharmaceuticals North America Inc., which markets the gout drug febuxostat (Uloric).

PsA Coverage Is Limited

About a third of patients with psoriatic arthritis (PsA) and psoriasis go without treatment because of insurance barriers, according to a survey by the National Psoriasis Foundation. About 12% of those surveyed reported having no insurance. However, even people with insurance had limited access to treatment. About 11% of patients said that the treatment they needed was not covered so they went without it. Another 11% said that high copayments prevented them from obtaining treatment. Access to care appeared to be worst among people with the most severe psoriatic conditions. For example, 10% of all survey respondents said that they had no prescription drug coverage vs. 21% of those with a severe psoriatic condition. The results are based on phone and online interviews with 422 individuals. About 54% of respondents had psoriasis alone, 2% had PsA alone, and 44% had both.

FDA Drafts Transparency Rules

The Food and Drug Administration's Transparency Task Force has issued 21 draft proposals concerning public disclosure of FDA operations without compromising patents or companies' trade secrets. Part of the FDA's transparency initiative that was launched last summer, the proposals are aimed at helping consumers, stakeholders, and others understand how the agency makes and enforces decisions. The FDA said that one of the draft proposals would support research into rare diseases by freeing the agency to discuss that a company has abandoned its application for an orphan drug. Once made public, this information could enable another drug manufacturer to pick up where the first one left off toward a potentially new therapy for a rare disease, the agency said.

House Probes OTC Genetic Testing

Three key House lawmakers have launched an investigation into over-the-counter (OTC) genetic-testing kits. The investigation, spearheaded by House Energy and Commerce Committee Chairman Henry A. Waxman (D-Calif.) and supported by Rep. Joe Barton (R-Tex.), Rep. Bart Stupak (D-Mich.), and Rep. Michael C. Burgess (R-Tex.), has targeted the companies 23andMe Inc., Navigenics Inc., and Pathway Genomics Corp. The companies already offer their tests to consumers by phone or online, and San Diego–based Pathway announced in May that it is seeking to sell testing kits in retail locations, despite concerns from the scientific community about the accuracy of test results. In letters to the companies, the lawmakers said they want information on how the companies analyze test results and identify potential genetic risks. The three lawmakers also want to know how the companies collect, store, and process individual genetic samples collected from consumers.

Survey: Telehealth Improves Care

Eight of 10 health care and information technology professionals believe that telehealth technology will improve quality of care, especially for the aging population, according to a survey conducted for the technology company Intel Corp. It surveyed top medical and IT executives at hospitals, clinics, home health organizations, disease management companies, and private payers. Challenges to the adoption of telehealth technology reside mainly in financial issues, such as reimbursement for services provided via telehealth, the survey respondents said. More than two-thirds said that health care providers probably will implement telehealth technology if financial issues are resolved. Intel is a developer of telehealth devices.

Want more health reform news? Subscribe to our podcast – search 'Policy & Practice' in the iTunes store

Boniva Gets Dubious Distinction

The osteoporosis therapy ibandronate (Boniva) ranked in the top 10 drugs most cited as possibly contributing to patient deaths in 2009, according to a report from the Institute for Safe Medication Practices. But those figures don't indicate a safety problem with the drug, the same report said. The large volume of patient deaths was actually attributable to marketing by the manufacturer, Roche. The company used postcards to remind patients, most of whom were elderly, to take their medication each month. If the postcard was returned to the manufacturer with the note “addressee decreased,” Roche reported an adverse event associated with ibandronate. Nearly 90% of the 250 ibandronate-associated deaths in the United States last year were reported through this program, according to Roche.

Gout Patients Report Pain, Stress

More than a third of gout patients polled in a recent survey said they would give up winning the lottery if it meant they would never have to have another gout flare. The telephone survey of 1,000 people found that they experienced significant pain and stress from the condition, even though 91% said they feel that their condition is under control. The survey revealed that 22% feared their next gout attack, and 28% have had to take time off from work because of flares. The survey was conducted by Braun Research Inc. and supported by Takeda Pharmaceuticals North America Inc., which markets the gout drug febuxostat (Uloric).

PsA Coverage Is Limited

About a third of patients with psoriatic arthritis (PsA) and psoriasis go without treatment because of insurance barriers, according to a survey by the National Psoriasis Foundation. About 12% of those surveyed reported having no insurance. However, even people with insurance had limited access to treatment. About 11% of patients said that the treatment they needed was not covered so they went without it. Another 11% said that high copayments prevented them from obtaining treatment. Access to care appeared to be worst among people with the most severe psoriatic conditions. For example, 10% of all survey respondents said that they had no prescription drug coverage vs. 21% of those with a severe psoriatic condition. The results are based on phone and online interviews with 422 individuals. About 54% of respondents had psoriasis alone, 2% had PsA alone, and 44% had both.

FDA Drafts Transparency Rules

The Food and Drug Administration's Transparency Task Force has issued 21 draft proposals concerning public disclosure of FDA operations without compromising patents or companies' trade secrets. Part of the FDA's transparency initiative that was launched last summer, the proposals are aimed at helping consumers, stakeholders, and others understand how the agency makes and enforces decisions. The FDA said that one of the draft proposals would support research into rare diseases by freeing the agency to discuss that a company has abandoned its application for an orphan drug. Once made public, this information could enable another drug manufacturer to pick up where the first one left off toward a potentially new therapy for a rare disease, the agency said.

House Probes OTC Genetic Testing

Three key House lawmakers have launched an investigation into over-the-counter (OTC) genetic-testing kits. The investigation, spearheaded by House Energy and Commerce Committee Chairman Henry A. Waxman (D-Calif.) and supported by Rep. Joe Barton (R-Tex.), Rep. Bart Stupak (D-Mich.), and Rep. Michael C. Burgess (R-Tex.), has targeted the companies 23andMe Inc., Navigenics Inc., and Pathway Genomics Corp. The companies already offer their tests to consumers by phone or online, and San Diego–based Pathway announced in May that it is seeking to sell testing kits in retail locations, despite concerns from the scientific community about the accuracy of test results. In letters to the companies, the lawmakers said they want information on how the companies analyze test results and identify potential genetic risks. The three lawmakers also want to know how the companies collect, store, and process individual genetic samples collected from consumers.

Survey: Telehealth Improves Care

Eight of 10 health care and information technology professionals believe that telehealth technology will improve quality of care, especially for the aging population, according to a survey conducted for the technology company Intel Corp. It surveyed top medical and IT executives at hospitals, clinics, home health organizations, disease management companies, and private payers. Challenges to the adoption of telehealth technology reside mainly in financial issues, such as reimbursement for services provided via telehealth, the survey respondents said. More than two-thirds said that health care providers probably will implement telehealth technology if financial issues are resolved. Intel is a developer of telehealth devices.

Want more health reform news? Subscribe to our podcast – search 'Policy & Practice' in the iTunes store

Boniva Gets Dubious Distinction

The osteoporosis therapy ibandronate (Boniva) ranked in the top 10 drugs most cited as possibly contributing to patient deaths in 2009, according to a report from the Institute for Safe Medication Practices. But those figures don't indicate a safety problem with the drug, the same report said. The large volume of patient deaths was actually attributable to marketing by the manufacturer, Roche. The company used postcards to remind patients, most of whom were elderly, to take their medication each month. If the postcard was returned to the manufacturer with the note “addressee decreased,” Roche reported an adverse event associated with ibandronate. Nearly 90% of the 250 ibandronate-associated deaths in the United States last year were reported through this program, according to Roche.

Gout Patients Report Pain, Stress

More than a third of gout patients polled in a recent survey said they would give up winning the lottery if it meant they would never have to have another gout flare. The telephone survey of 1,000 people found that they experienced significant pain and stress from the condition, even though 91% said they feel that their condition is under control. The survey revealed that 22% feared their next gout attack, and 28% have had to take time off from work because of flares. The survey was conducted by Braun Research Inc. and supported by Takeda Pharmaceuticals North America Inc., which markets the gout drug febuxostat (Uloric).

PsA Coverage Is Limited

About a third of patients with psoriatic arthritis (PsA) and psoriasis go without treatment because of insurance barriers, according to a survey by the National Psoriasis Foundation. About 12% of those surveyed reported having no insurance. However, even people with insurance had limited access to treatment. About 11% of patients said that the treatment they needed was not covered so they went without it. Another 11% said that high copayments prevented them from obtaining treatment. Access to care appeared to be worst among people with the most severe psoriatic conditions. For example, 10% of all survey respondents said that they had no prescription drug coverage vs. 21% of those with a severe psoriatic condition. The results are based on phone and online interviews with 422 individuals. About 54% of respondents had psoriasis alone, 2% had PsA alone, and 44% had both.

FDA Drafts Transparency Rules

The Food and Drug Administration's Transparency Task Force has issued 21 draft proposals concerning public disclosure of FDA operations without compromising patents or companies' trade secrets. Part of the FDA's transparency initiative that was launched last summer, the proposals are aimed at helping consumers, stakeholders, and others understand how the agency makes and enforces decisions. The FDA said that one of the draft proposals would support research into rare diseases by freeing the agency to discuss that a company has abandoned its application for an orphan drug. Once made public, this information could enable another drug manufacturer to pick up where the first one left off toward a potentially new therapy for a rare disease, the agency said.

House Probes OTC Genetic Testing

Three key House lawmakers have launched an investigation into over-the-counter (OTC) genetic-testing kits. The investigation, spearheaded by House Energy and Commerce Committee Chairman Henry A. Waxman (D-Calif.) and supported by Rep. Joe Barton (R-Tex.), Rep. Bart Stupak (D-Mich.), and Rep. Michael C. Burgess (R-Tex.), has targeted the companies 23andMe Inc., Navigenics Inc., and Pathway Genomics Corp. The companies already offer their tests to consumers by phone or online, and San Diego–based Pathway announced in May that it is seeking to sell testing kits in retail locations, despite concerns from the scientific community about the accuracy of test results. In letters to the companies, the lawmakers said they want information on how the companies analyze test results and identify potential genetic risks. The three lawmakers also want to know how the companies collect, store, and process individual genetic samples collected from consumers.

Survey: Telehealth Improves Care

Eight of 10 health care and information technology professionals believe that telehealth technology will improve quality of care, especially for the aging population, according to a survey conducted for the technology company Intel Corp. It surveyed top medical and IT executives at hospitals, clinics, home health organizations, disease management companies, and private payers. Challenges to the adoption of telehealth technology reside mainly in financial issues, such as reimbursement for services provided via telehealth, the survey respondents said. More than two-thirds said that health care providers probably will implement telehealth technology if financial issues are resolved. Intel is a developer of telehealth devices.

Looking to buy or implement an electronic health record in your practice? Help is on the way.

The Department of Health and Human Services has awarded more than $640 million in grants to set up regional extension centers around the country, with the goal of helping physicians and hospitals achieve “meaningful use” of electronic health record (EHR) technology. At press time, several centers were preparing to enroll physicians.

The staff at these regional extension centers will work “elbow to elbow” with physicians, Dr. David Blumenthal, national coordinator for health information technology, said during a press conference to announce the final round of regional extension center grants.

In April, HHS awarded more than $267 million in grants to 28 nonprofit organizations that will set up Health Information Technology Regional Extension Centers. This builds on more than $375 million in grants that the agency awarded for 32 regional extension centers in February. The funding is part of the 2009 American Recovery and Reinvestment Act.

The main goal of the regional extension centers is to help physicians and other health care providers become meaningful users of EHRs, even as the standard for meaningful use is being defined through federal rule making.

Under the Health Information Technology for Economic and Clinical Health (HITECH) Act, a part of the 2009 federal stimulus law, physicians who treat Medicare patients can earn up to $44,000 over a period of 5 years for the meaningful use of a certified health information system. Those with patient populations of at least 30% Medicaid can earn up to $64,000 in federal incentive payments.

To help physicians become meaningful users, the regional extension centers will provide a broad range of services, Dr. Blumenthal said, from helping physicians select the most appropriate equipment for their practice through the implementation of the products.

The centers also will help practices purchase technology in groups at reduced prices, he said.

“We hope that these regional extension centers will help providers improve their workflow using electronic health records, improve the quality and efficiency of the care they can provide using electronic health records, and of course thereby increase the efficiency and quality of care available to the American people,” Dr. Blumenthal said.

Farzad Mostashari, a senior adviser in the Office of the National Coordinator for Health Information Technology, encouraged physicians to enroll with their regional extension center as soon as possible, even before they make a decision about purchasing an EHR product.

Physicians can expect to get a lot of assistance from the regional extension center staff, he said. For example, the practice staff and the regional extension staff may have weekly contacts as the practice works to establish a work plan for implementation, as well as during the implementation period. Following implementation, the regional extension center staff may check in with the practice on a monthly basis to see how they are progressing with quality improvement and workflow design.

Initially, the regional extension centers will focus on aiding primary care providers in small practices. HHS estimates that the 60 regional extension centers will provide services to at least 100,000 primary care providers and hospitals within 2 years.

Small, primary care practices are being targeted because this group reaches a large number of patients, Dr. Blumenthal said, but they are also the least likely to be able to afford to purchase health information technology support services in the private market.

Although the stimulus law directs the regional extension centers to give priority for direct technical assistance to primary care providers, all physicians are encouraged to participate in the outreach and educational opportunities of these centers, according to HHS. The agency defines primary care as family medicine, internal medicine, pediatrics, or obstetrics and gynecology.

In addition to small practices, HHS is also reaching out to small hospitals. HHS plans to award another $25 million to regional extension centers that work with critical access and rural hospitals with 50 beds or less. Small hospitals have an especially difficult time finding the resources and expertise to successfully adopt health information technology, Dr. Blumenthal said.

Looking to buy or implement an electronic health record in your practice? Help is on the way.

The Department of Health and Human Services has awarded more than $640 million in grants to set up regional extension centers around the country, with the goal of helping physicians and hospitals achieve “meaningful use” of electronic health record (EHR) technology. At press time, several centers were preparing to enroll physicians.

The staff at these regional extension centers will work “elbow to elbow” with physicians, Dr. David Blumenthal, national coordinator for health information technology, said during a press conference to announce the final round of regional extension center grants.

In April, HHS awarded more than $267 million in grants to 28 nonprofit organizations that will set up Health Information Technology Regional Extension Centers. This builds on more than $375 million in grants that the agency awarded for 32 regional extension centers in February. The funding is part of the 2009 American Recovery and Reinvestment Act.

The main goal of the regional extension centers is to help physicians and other health care providers become meaningful users of EHRs, even as the standard for meaningful use is being defined through federal rule making.

Under the Health Information Technology for Economic and Clinical Health (HITECH) Act, a part of the 2009 federal stimulus law, physicians who treat Medicare patients can earn up to $44,000 over a period of 5 years for the meaningful use of a certified health information system. Those with patient populations of at least 30% Medicaid can earn up to $64,000 in federal incentive payments.

To help physicians become meaningful users, the regional extension centers will provide a broad range of services, Dr. Blumenthal said, from helping physicians select the most appropriate equipment for their practice through the implementation of the products.

The centers also will help practices purchase technology in groups at reduced prices, he said.

“We hope that these regional extension centers will help providers improve their workflow using electronic health records, improve the quality and efficiency of the care they can provide using electronic health records, and of course thereby increase the efficiency and quality of care available to the American people,” Dr. Blumenthal said.

Farzad Mostashari, a senior adviser in the Office of the National Coordinator for Health Information Technology, encouraged physicians to enroll with their regional extension center as soon as possible, even before they make a decision about purchasing an EHR product.

Physicians can expect to get a lot of assistance from the regional extension center staff, he said. For example, the practice staff and the regional extension staff may have weekly contacts as the practice works to establish a work plan for implementation, as well as during the implementation period. Following implementation, the regional extension center staff may check in with the practice on a monthly basis to see how they are progressing with quality improvement and workflow design.

Initially, the regional extension centers will focus on aiding primary care providers in small practices. HHS estimates that the 60 regional extension centers will provide services to at least 100,000 primary care providers and hospitals within 2 years.

Small, primary care practices are being targeted because this group reaches a large number of patients, Dr. Blumenthal said, but they are also the least likely to be able to afford to purchase health information technology support services in the private market.

Although the stimulus law directs the regional extension centers to give priority for direct technical assistance to primary care providers, all physicians are encouraged to participate in the outreach and educational opportunities of these centers, according to HHS. The agency defines primary care as family medicine, internal medicine, pediatrics, or obstetrics and gynecology.

In addition to small practices, HHS is also reaching out to small hospitals. HHS plans to award another $25 million to regional extension centers that work with critical access and rural hospitals with 50 beds or less. Small hospitals have an especially difficult time finding the resources and expertise to successfully adopt health information technology, Dr. Blumenthal said.

Looking to buy or implement an electronic health record in your practice? Help is on the way.

The Department of Health and Human Services has awarded more than $640 million in grants to set up regional extension centers around the country, with the goal of helping physicians and hospitals achieve “meaningful use” of electronic health record (EHR) technology. At press time, several centers were preparing to enroll physicians.

The staff at these regional extension centers will work “elbow to elbow” with physicians, Dr. David Blumenthal, national coordinator for health information technology, said during a press conference to announce the final round of regional extension center grants.

In April, HHS awarded more than $267 million in grants to 28 nonprofit organizations that will set up Health Information Technology Regional Extension Centers. This builds on more than $375 million in grants that the agency awarded for 32 regional extension centers in February. The funding is part of the 2009 American Recovery and Reinvestment Act.

The main goal of the regional extension centers is to help physicians and other health care providers become meaningful users of EHRs, even as the standard for meaningful use is being defined through federal rule making.

Under the Health Information Technology for Economic and Clinical Health (HITECH) Act, a part of the 2009 federal stimulus law, physicians who treat Medicare patients can earn up to $44,000 over a period of 5 years for the meaningful use of a certified health information system. Those with patient populations of at least 30% Medicaid can earn up to $64,000 in federal incentive payments.

To help physicians become meaningful users, the regional extension centers will provide a broad range of services, Dr. Blumenthal said, from helping physicians select the most appropriate equipment for their practice through the implementation of the products.

The centers also will help practices purchase technology in groups at reduced prices, he said.

“We hope that these regional extension centers will help providers improve their workflow using electronic health records, improve the quality and efficiency of the care they can provide using electronic health records, and of course thereby increase the efficiency and quality of care available to the American people,” Dr. Blumenthal said.

Farzad Mostashari, a senior adviser in the Office of the National Coordinator for Health Information Technology, encouraged physicians to enroll with their regional extension center as soon as possible, even before they make a decision about purchasing an EHR product.

Physicians can expect to get a lot of assistance from the regional extension center staff, he said. For example, the practice staff and the regional extension staff may have weekly contacts as the practice works to establish a work plan for implementation, as well as during the implementation period. Following implementation, the regional extension center staff may check in with the practice on a monthly basis to see how they are progressing with quality improvement and workflow design.

Initially, the regional extension centers will focus on aiding primary care providers in small practices. HHS estimates that the 60 regional extension centers will provide services to at least 100,000 primary care providers and hospitals within 2 years.

Small, primary care practices are being targeted because this group reaches a large number of patients, Dr. Blumenthal said, but they are also the least likely to be able to afford to purchase health information technology support services in the private market.

Although the stimulus law directs the regional extension centers to give priority for direct technical assistance to primary care providers, all physicians are encouraged to participate in the outreach and educational opportunities of these centers, according to HHS. The agency defines primary care as family medicine, internal medicine, pediatrics, or obstetrics and gynecology.

In addition to small practices, HHS is also reaching out to small hospitals. HHS plans to award another $25 million to regional extension centers that work with critical access and rural hospitals with 50 beds or less. Small hospitals have an especially difficult time finding the resources and expertise to successfully adopt health information technology, Dr. Blumenthal said.

The Federal Trade Commission has again postponed enforcement of the “Red Flags” rule, giving physicians until the end of 2010 before they must implement identity-theft prevention programs in their practices.

Enforcement of the rule had been scheduled to begin on June 1. In a statement issued on May 28, the FTC said it was delaying enforcement to give Congress time to consider pending legislation that would exclude some small physician practices and small businesses from the rule. Last year, the House passed a bill (H.R. 3763) that would have exempted physician practices with 20 or fewer employees from having to comply with the Red Flags rule, but that legislation has failed to gain traction in the Senate.

FTC officials urged lawmakers to act quickly to clarify what groups should be covered by the regulation. “As an agency we're charged with enforcing the law, and endless extensions delay enforcement,” FTC chairman Jon Leibowitz said in a statement.

The Red Flags rule was written to implement provisions of the Fair and Accurate Credit Transactions Act, which calls on creditors and financial institutions to address the risk of identity theft. The rule requires creditors to develop formal identity-theft prevention programs that would allow an organization to identify, detect, and respond to any suspicious practices, or “red flags,” that could indicate identity theft. The rule became effective on Jan. 1, 2008, with an original enforcement deadline of Nov. 1, 2008. However, the FTC has delayed enforcement of the rule several times, first to give organizations more time to get familiar with the requirements and later at the request of members of Congress.

The rule has been controversial in the medical community because many physicians believe their practices don't fit into the definition of a “creditor.” However, the FTC has continued to insist that physicians are in fact “creditors” because they allow their patients to defer payments over time.

The agency also has tried to assure physicians that the requirements should not be a burden and that small practices can come into compliance by implementing simple steps. For example, in low-risk settings, practice staff can ask patients for photo identification when they come in for an appointment.

The American Medical Association and other physician groups have been lobbying to get physicians excluded completely from the requirements. On May 21, the AMA joined the American Osteopathic Association and the Medical Society of the District Columbia in a federal lawsuit that seeks to prevent the FTC from applying the Red Flags rule to physicians.

The Federal Trade Commission has again postponed enforcement of the “Red Flags” rule, giving physicians until the end of 2010 before they must implement identity-theft prevention programs in their practices.

Enforcement of the rule had been scheduled to begin on June 1. In a statement issued on May 28, the FTC said it was delaying enforcement to give Congress time to consider pending legislation that would exclude some small physician practices and small businesses from the rule. Last year, the House passed a bill (H.R. 3763) that would have exempted physician practices with 20 or fewer employees from having to comply with the Red Flags rule, but that legislation has failed to gain traction in the Senate.

FTC officials urged lawmakers to act quickly to clarify what groups should be covered by the regulation. “As an agency we're charged with enforcing the law, and endless extensions delay enforcement,” FTC chairman Jon Leibowitz said in a statement.

The Red Flags rule was written to implement provisions of the Fair and Accurate Credit Transactions Act, which calls on creditors and financial institutions to address the risk of identity theft. The rule requires creditors to develop formal identity-theft prevention programs that would allow an organization to identify, detect, and respond to any suspicious practices, or “red flags,” that could indicate identity theft. The rule became effective on Jan. 1, 2008, with an original enforcement deadline of Nov. 1, 2008. However, the FTC has delayed enforcement of the rule several times, first to give organizations more time to get familiar with the requirements and later at the request of members of Congress.

The rule has been controversial in the medical community because many physicians believe their practices don't fit into the definition of a “creditor.” However, the FTC has continued to insist that physicians are in fact “creditors” because they allow their patients to defer payments over time.

The agency also has tried to assure physicians that the requirements should not be a burden and that small practices can come into compliance by implementing simple steps. For example, in low-risk settings, practice staff can ask patients for photo identification when they come in for an appointment.

The American Medical Association and other physician groups have been lobbying to get physicians excluded completely from the requirements. On May 21, the AMA joined the American Osteopathic Association and the Medical Society of the District Columbia in a federal lawsuit that seeks to prevent the FTC from applying the Red Flags rule to physicians.

The Federal Trade Commission has again postponed enforcement of the “Red Flags” rule, giving physicians until the end of 2010 before they must implement identity-theft prevention programs in their practices.

Enforcement of the rule had been scheduled to begin on June 1. In a statement issued on May 28, the FTC said it was delaying enforcement to give Congress time to consider pending legislation that would exclude some small physician practices and small businesses from the rule. Last year, the House passed a bill (H.R. 3763) that would have exempted physician practices with 20 or fewer employees from having to comply with the Red Flags rule, but that legislation has failed to gain traction in the Senate.

FTC officials urged lawmakers to act quickly to clarify what groups should be covered by the regulation. “As an agency we're charged with enforcing the law, and endless extensions delay enforcement,” FTC chairman Jon Leibowitz said in a statement.

The Red Flags rule was written to implement provisions of the Fair and Accurate Credit Transactions Act, which calls on creditors and financial institutions to address the risk of identity theft. The rule requires creditors to develop formal identity-theft prevention programs that would allow an organization to identify, detect, and respond to any suspicious practices, or “red flags,” that could indicate identity theft. The rule became effective on Jan. 1, 2008, with an original enforcement deadline of Nov. 1, 2008. However, the FTC has delayed enforcement of the rule several times, first to give organizations more time to get familiar with the requirements and later at the request of members of Congress.

The rule has been controversial in the medical community because many physicians believe their practices don't fit into the definition of a “creditor.” However, the FTC has continued to insist that physicians are in fact “creditors” because they allow their patients to defer payments over time.

The agency also has tried to assure physicians that the requirements should not be a burden and that small practices can come into compliance by implementing simple steps. For example, in low-risk settings, practice staff can ask patients for photo identification when they come in for an appointment.

The American Medical Association and other physician groups have been lobbying to get physicians excluded completely from the requirements. On May 21, the AMA joined the American Osteopathic Association and the Medical Society of the District Columbia in a federal lawsuit that seeks to prevent the FTC from applying the Red Flags rule to physicians.

President Obama on June 25 signed into law a bill that replaces the 21% Medicare physician payment cut with a 2.2% pay raise for 6 months.

The legislation (H.R. 3962) provides physicians with a 2.2% increase in their Medicare payments through Nov. 30. The change is retroactive to June 1, the date that the 21% cut officially went into effect. Officials at the Centers for Medicare and Medicaid Services held claims from June 1 to June 18 to give Congress time to reverse the cuts, but has been paying physicians at the lower rate since then.

Now that the pay cuts have been reversed, CMS has directed its contractors to stop processing claims at the lower rates and temporarily hold all claims for services provided on or after June 1. This delay will give contractors time to adjust their claims processing systems. CMS said it expects to begin processing claims at the increased pay rate no later than July 1.

Medicare will also begin reprocessing any June claims that were paid under the 21% cut. Physicians should not resubmit those claims, but may need to contact their local Medicare contractor to request an adjustment, according to CMS. Under the law, Medicare must pay physicians the lower of either their submitted charge or the Medicare Physician Fee Schedule amount. Claims with submitted charges at or above the new 2.2% increased rate will be automatically reprocessed. But if physicians submitted claims in June with charges below the new increased rate, they must request an adjustment, according to CMS.

While physicians welcomed the temporary reprieve, they remain dissatisfied with the lack of congressional action on a permanent solution to the recurring Medicare payment cuts. The American Medical Association noted that without further action from Congress, physicians will face a 23% cut in December that will increase to nearly 30% in January 2011.

“Congress is playing a dangerous game of Russian roulette with seniors' health care. Sick patients can't wait. Congress must replace the broken payment system before the damage is done and cannot be reversed,” Dr. Cecil B. Wilson, AMA president, said in a statement. “The baby boomers begin entering Medicare in 6 months, and if the physician payment problem isn't fixed, these new Medicare patients won't be able to find a doctor to treat them.”

The instability of the current payment system doesn't just affect Medicare, but will have a significant impact on the future success of health reform, according to the American Academy of Family Physicians. The Affordable Care Act calls on physicians to change their practices through the adoption of health information technology and new practice models, both of which require time and money to implement. “Physicians can't invest in change if they can't count on payment for their services,” Dr. Lori Heim, AAFP president, said in a statement

Even the President is urging Congress to come up with a permanent replacement for the Medicare physician payment formula. Before signing the bill, he released a statement saying that the practice of temporary payment patches was “untenable” and must end.

On June 24, the House of Representatives passed H.R. 3962 by a vote of 417-1. The Senate approved the measure on June 18.

President Obama on June 25 signed into law a bill that replaces the 21% Medicare physician payment cut with a 2.2% pay raise for 6 months.

The legislation (H.R. 3962) provides physicians with a 2.2% increase in their Medicare payments through Nov. 30. The change is retroactive to June 1, the date that the 21% cut officially went into effect. Officials at the Centers for Medicare and Medicaid Services held claims from June 1 to June 18 to give Congress time to reverse the cuts, but has been paying physicians at the lower rate since then.

Now that the pay cuts have been reversed, CMS has directed its contractors to stop processing claims at the lower rates and temporarily hold all claims for services provided on or after June 1. This delay will give contractors time to adjust their claims processing systems. CMS said it expects to begin processing claims at the increased pay rate no later than July 1.

Medicare will also begin reprocessing any June claims that were paid under the 21% cut. Physicians should not resubmit those claims, but may need to contact their local Medicare contractor to request an adjustment, according to CMS. Under the law, Medicare must pay physicians the lower of either their submitted charge or the Medicare Physician Fee Schedule amount. Claims with submitted charges at or above the new 2.2% increased rate will be automatically reprocessed. But if physicians submitted claims in June with charges below the new increased rate, they must request an adjustment, according to CMS.

While physicians welcomed the temporary reprieve, they remain dissatisfied with the lack of congressional action on a permanent solution to the recurring Medicare payment cuts. The American Medical Association noted that without further action from Congress, physicians will face a 23% cut in December that will increase to nearly 30% in January 2011.

“Congress is playing a dangerous game of Russian roulette with seniors' health care. Sick patients can't wait. Congress must replace the broken payment system before the damage is done and cannot be reversed,” Dr. Cecil B. Wilson, AMA president, said in a statement. “The baby boomers begin entering Medicare in 6 months, and if the physician payment problem isn't fixed, these new Medicare patients won't be able to find a doctor to treat them.”

The instability of the current payment system doesn't just affect Medicare, but will have a significant impact on the future success of health reform, according to the American Academy of Family Physicians. The Affordable Care Act calls on physicians to change their practices through the adoption of health information technology and new practice models, both of which require time and money to implement. “Physicians can't invest in change if they can't count on payment for their services,” Dr. Lori Heim, AAFP president, said in a statement

Even the President is urging Congress to come up with a permanent replacement for the Medicare physician payment formula. Before signing the bill, he released a statement saying that the practice of temporary payment patches was “untenable” and must end.

On June 24, the House of Representatives passed H.R. 3962 by a vote of 417-1. The Senate approved the measure on June 18.

President Obama on June 25 signed into law a bill that replaces the 21% Medicare physician payment cut with a 2.2% pay raise for 6 months.

The legislation (H.R. 3962) provides physicians with a 2.2% increase in their Medicare payments through Nov. 30. The change is retroactive to June 1, the date that the 21% cut officially went into effect. Officials at the Centers for Medicare and Medicaid Services held claims from June 1 to June 18 to give Congress time to reverse the cuts, but has been paying physicians at the lower rate since then.

Now that the pay cuts have been reversed, CMS has directed its contractors to stop processing claims at the lower rates and temporarily hold all claims for services provided on or after June 1. This delay will give contractors time to adjust their claims processing systems. CMS said it expects to begin processing claims at the increased pay rate no later than July 1.

Medicare will also begin reprocessing any June claims that were paid under the 21% cut. Physicians should not resubmit those claims, but may need to contact their local Medicare contractor to request an adjustment, according to CMS. Under the law, Medicare must pay physicians the lower of either their submitted charge or the Medicare Physician Fee Schedule amount. Claims with submitted charges at or above the new 2.2% increased rate will be automatically reprocessed. But if physicians submitted claims in June with charges below the new increased rate, they must request an adjustment, according to CMS.

While physicians welcomed the temporary reprieve, they remain dissatisfied with the lack of congressional action on a permanent solution to the recurring Medicare payment cuts. The American Medical Association noted that without further action from Congress, physicians will face a 23% cut in December that will increase to nearly 30% in January 2011.

“Congress is playing a dangerous game of Russian roulette with seniors' health care. Sick patients can't wait. Congress must replace the broken payment system before the damage is done and cannot be reversed,” Dr. Cecil B. Wilson, AMA president, said in a statement. “The baby boomers begin entering Medicare in 6 months, and if the physician payment problem isn't fixed, these new Medicare patients won't be able to find a doctor to treat them.”

The instability of the current payment system doesn't just affect Medicare, but will have a significant impact on the future success of health reform, according to the American Academy of Family Physicians. The Affordable Care Act calls on physicians to change their practices through the adoption of health information technology and new practice models, both of which require time and money to implement. “Physicians can't invest in change if they can't count on payment for their services,” Dr. Lori Heim, AAFP president, said in a statement

Even the President is urging Congress to come up with a permanent replacement for the Medicare physician payment formula. Before signing the bill, he released a statement saying that the practice of temporary payment patches was “untenable” and must end.

On June 24, the House of Representatives passed H.R. 3962 by a vote of 417-1. The Senate approved the measure on June 18.

The Agency for Healthcare Research and Quality has awarded $25 million in grants to states and health systems to test various approaches to medical liability reform.

The grant awards follow through on a 2009 promise made by President Obama. In a speech to Congress last September, he pledged to fund demonstration projects that would look at malpractice reforms that also improve patient safety.

The focus on patient safety is critical, said Dr. Carolyn Clancy, director of AHRQ, because when physicians fear being sued, they are less likely to be open about potential errors, near misses, and avoidable harms, and that's a major hurdle to improving patient safety in any organization.

“If you're fearful and you're worried about being sued, that has a very chilling effect on people's willingness to step forward and say 'we have a problem and we need to do something about it,'” Dr. Clancy said during a press briefing.

Awards include 3-year grants to states and health systems of as much as $3 million. The $25 million pool also includes 1-year planning grants of as much as $300,000 and a $2 million grant to JBA/RAND Corp. to evaluate the projects.

Many of the demonstration grants will focus on early disclosure of errors and early offers of compensation, Dr. Clancy said. The aim with early offers is not to short-circuit the system, she added, but to give both physicians and patients relief from a process that often drags on.

Another theme among the grants is to promote better communication among providers, patients, and families.

The Agency for Healthcare Research and Quality has awarded $25 million in grants to states and health systems to test various approaches to medical liability reform.

The grant awards follow through on a 2009 promise made by President Obama. In a speech to Congress last September, he pledged to fund demonstration projects that would look at malpractice reforms that also improve patient safety.

The focus on patient safety is critical, said Dr. Carolyn Clancy, director of AHRQ, because when physicians fear being sued, they are less likely to be open about potential errors, near misses, and avoidable harms, and that's a major hurdle to improving patient safety in any organization.

“If you're fearful and you're worried about being sued, that has a very chilling effect on people's willingness to step forward and say 'we have a problem and we need to do something about it,'” Dr. Clancy said during a press briefing.

Awards include 3-year grants to states and health systems of as much as $3 million. The $25 million pool also includes 1-year planning grants of as much as $300,000 and a $2 million grant to JBA/RAND Corp. to evaluate the projects.

Many of the demonstration grants will focus on early disclosure of errors and early offers of compensation, Dr. Clancy said. The aim with early offers is not to short-circuit the system, she added, but to give both physicians and patients relief from a process that often drags on.

Another theme among the grants is to promote better communication among providers, patients, and families.

The Agency for Healthcare Research and Quality has awarded $25 million in grants to states and health systems to test various approaches to medical liability reform.

The grant awards follow through on a 2009 promise made by President Obama. In a speech to Congress last September, he pledged to fund demonstration projects that would look at malpractice reforms that also improve patient safety.

The focus on patient safety is critical, said Dr. Carolyn Clancy, director of AHRQ, because when physicians fear being sued, they are less likely to be open about potential errors, near misses, and avoidable harms, and that's a major hurdle to improving patient safety in any organization.

“If you're fearful and you're worried about being sued, that has a very chilling effect on people's willingness to step forward and say 'we have a problem and we need to do something about it,'” Dr. Clancy said during a press briefing.

Awards include 3-year grants to states and health systems of as much as $3 million. The $25 million pool also includes 1-year planning grants of as much as $300,000 and a $2 million grant to JBA/RAND Corp. to evaluate the projects.

Many of the demonstration grants will focus on early disclosure of errors and early offers of compensation, Dr. Clancy said. The aim with early offers is not to short-circuit the system, she added, but to give both physicians and patients relief from a process that often drags on.

Another theme among the grants is to promote better communication among providers, patients, and families.