Mary Ellen Schneider

A new proposal from the Department of Health and Human Services aims to expand the rights of patients to choose who visits them at the hospital.

The proposed rule, which was released last month, applies to all hospitals and critical access hospitals that participate in the Medicare and Medicaid programs. The proposal comes after President Obama issued a memorandum calling for new rules that would allow patients to pick who may and may not visit them. It also instructed HHS to ensure that hospitals are respecting patients' advance directives and giving patients' representatives the chance to be informed about and participate in care planning.

In his memo, the president said that limiting hospital visitation to family members can deny patients support from the people they depend on the most, whether that is a same-sex partner or a good friend. Restrictive visiting policies can also have a clinical impact, he noted.

In the proposed rule, HHS writes that physicians and other hospital staff may miss an opportunity to gain information on medical history and allergies, especially if the patient has trouble recalling or communicating the information: “We agree that restricted or limited hospital and [critical access hospital] visitation can effectively eliminate these advocates for many patients, potentially to the detriment of the patient's health and safety.”

Under the proposal, patients will have the right to designate who can visit them and to revoke that permission at any time. For their part, hospitals must give all visitors the same visiting privileges afforded to family members. Hospitals also must inform patients on these rights and explain under what circumstances visitation rights may be restricted for medical reasons. The proposal bars hospitals from restricting visitation based on race, color, national origin, religion, sex, sexual orientation, gender identity, or disability.

HHS officials plan to publish a final regulation by late fall. In the meantime, HHS Secretary Kathleen Sebelius wrote to the leaders of major hospital associations, calling on hospitals not to wait to begin implementing these changes in their visitation policies. “Your actions could spare many patients the pain of being separated from a loved one during an admission to a hospital—often one of the most anxious times in their lives,” she wrote.

A new proposal from the Department of Health and Human Services aims to expand the rights of patients to choose who visits them at the hospital.

The proposed rule, which was released last month, applies to all hospitals and critical access hospitals that participate in the Medicare and Medicaid programs. The proposal comes after President Obama issued a memorandum calling for new rules that would allow patients to pick who may and may not visit them. It also instructed HHS to ensure that hospitals are respecting patients' advance directives and giving patients' representatives the chance to be informed about and participate in care planning.

In his memo, the president said that limiting hospital visitation to family members can deny patients support from the people they depend on the most, whether that is a same-sex partner or a good friend. Restrictive visiting policies can also have a clinical impact, he noted.

In the proposed rule, HHS writes that physicians and other hospital staff may miss an opportunity to gain information on medical history and allergies, especially if the patient has trouble recalling or communicating the information: “We agree that restricted or limited hospital and [critical access hospital] visitation can effectively eliminate these advocates for many patients, potentially to the detriment of the patient's health and safety.”

Under the proposal, patients will have the right to designate who can visit them and to revoke that permission at any time. For their part, hospitals must give all visitors the same visiting privileges afforded to family members. Hospitals also must inform patients on these rights and explain under what circumstances visitation rights may be restricted for medical reasons. The proposal bars hospitals from restricting visitation based on race, color, national origin, religion, sex, sexual orientation, gender identity, or disability.

HHS officials plan to publish a final regulation by late fall. In the meantime, HHS Secretary Kathleen Sebelius wrote to the leaders of major hospital associations, calling on hospitals not to wait to begin implementing these changes in their visitation policies. “Your actions could spare many patients the pain of being separated from a loved one during an admission to a hospital—often one of the most anxious times in their lives,” she wrote.

A new proposal from the Department of Health and Human Services aims to expand the rights of patients to choose who visits them at the hospital.

The proposed rule, which was released last month, applies to all hospitals and critical access hospitals that participate in the Medicare and Medicaid programs. The proposal comes after President Obama issued a memorandum calling for new rules that would allow patients to pick who may and may not visit them. It also instructed HHS to ensure that hospitals are respecting patients' advance directives and giving patients' representatives the chance to be informed about and participate in care planning.

In his memo, the president said that limiting hospital visitation to family members can deny patients support from the people they depend on the most, whether that is a same-sex partner or a good friend. Restrictive visiting policies can also have a clinical impact, he noted.

In the proposed rule, HHS writes that physicians and other hospital staff may miss an opportunity to gain information on medical history and allergies, especially if the patient has trouble recalling or communicating the information: “We agree that restricted or limited hospital and [critical access hospital] visitation can effectively eliminate these advocates for many patients, potentially to the detriment of the patient's health and safety.”

Under the proposal, patients will have the right to designate who can visit them and to revoke that permission at any time. For their part, hospitals must give all visitors the same visiting privileges afforded to family members. Hospitals also must inform patients on these rights and explain under what circumstances visitation rights may be restricted for medical reasons. The proposal bars hospitals from restricting visitation based on race, color, national origin, religion, sex, sexual orientation, gender identity, or disability.

HHS officials plan to publish a final regulation by late fall. In the meantime, HHS Secretary Kathleen Sebelius wrote to the leaders of major hospital associations, calling on hospitals not to wait to begin implementing these changes in their visitation policies. “Your actions could spare many patients the pain of being separated from a loved one during an admission to a hospital—often one of the most anxious times in their lives,” she wrote.

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 aren't likely to get back into the DXA business if they have already gotten out, said Dr. David Goddard, a rheumatologist 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. Goddard agreed, 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 aren't likely to get back into the DXA business if they have already gotten out, said Dr. David Goddard, a rheumatologist 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. Goddard agreed, 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 aren't likely to get back into the DXA business if they have already gotten out, said Dr. David Goddard, a rheumatologist 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. Goddard agreed, 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.

The American Board of Internal Medicine has sanctioned 139 physicians for sharing or seeking questions used on the certification exam.

Depending on the extent of the physician's involvement in the scheme, the ABIM has revoked or suspended their board certification. Those who have yet to achieve certification will not be admitted to sit for a certification exam for at least 1 year. The board has filed suit against the five physicians it considers to be the most egregious offenders.

The actions come after an ABIM investigation revealed that an independent test preparation company based in New Jersey, Arora Board Review, was allegedly promoting its review course by telling physicians that they used the actual board exam questions in their materials.

Company officials are also alleged to have asked physicians to report back on the questions used immediately after taking the certification exam. The ABIM filed suit earlier this year against Arora Board Review for copyright infringement and theft of trade secrets.

The home page of the Arora Board Review Web site states that the company has put its business on hold until a settlement can be reached with the ABIM.

The ABIM estimates that hundreds of exam questions were disclosed through this scheme. Those questions have been removed from the exam pool.

All test takers sign a “pledge of honesty” that they will not disclose, copy, or reproduce the exam material. ABIM officials are sending letters to any physicians who took the Arora course, expressing concern that they did not notify the board about the “questionable activities.”

The American Board of Internal Medicine has sanctioned 139 physicians for sharing or seeking questions used on the certification exam.

Depending on the extent of the physician's involvement in the scheme, the ABIM has revoked or suspended their board certification. Those who have yet to achieve certification will not be admitted to sit for a certification exam for at least 1 year. The board has filed suit against the five physicians it considers to be the most egregious offenders.

The actions come after an ABIM investigation revealed that an independent test preparation company based in New Jersey, Arora Board Review, was allegedly promoting its review course by telling physicians that they used the actual board exam questions in their materials.

Company officials are also alleged to have asked physicians to report back on the questions used immediately after taking the certification exam. The ABIM filed suit earlier this year against Arora Board Review for copyright infringement and theft of trade secrets.

The home page of the Arora Board Review Web site states that the company has put its business on hold until a settlement can be reached with the ABIM.

The ABIM estimates that hundreds of exam questions were disclosed through this scheme. Those questions have been removed from the exam pool.

All test takers sign a “pledge of honesty” that they will not disclose, copy, or reproduce the exam material. ABIM officials are sending letters to any physicians who took the Arora course, expressing concern that they did not notify the board about the “questionable activities.”

The American Board of Internal Medicine has sanctioned 139 physicians for sharing or seeking questions used on the certification exam.

Depending on the extent of the physician's involvement in the scheme, the ABIM has revoked or suspended their board certification. Those who have yet to achieve certification will not be admitted to sit for a certification exam for at least 1 year. The board has filed suit against the five physicians it considers to be the most egregious offenders.

The actions come after an ABIM investigation revealed that an independent test preparation company based in New Jersey, Arora Board Review, was allegedly promoting its review course by telling physicians that they used the actual board exam questions in their materials.

Company officials are also alleged to have asked physicians to report back on the questions used immediately after taking the certification exam. The ABIM filed suit earlier this year against Arora Board Review for copyright infringement and theft of trade secrets.

The home page of the Arora Board Review Web site states that the company has put its business on hold until a settlement can be reached with the ABIM.

The ABIM estimates that hundreds of exam questions were disclosed through this scheme. Those questions have been removed from the exam pool.

All test takers sign a “pledge of honesty” that they will not disclose, copy, or reproduce the exam material. ABIM officials are sending letters to any physicians who took the Arora course, expressing concern that they did not notify the board about the “questionable activities.”

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 aren't likely to get back into the DXA business if they have already gotten out, said Dr. David Goddard, a rheumatologist 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.

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 M. 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.

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 aren't likely to get back into the DXA business if they have already gotten out, said Dr. David Goddard, a rheumatologist 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.

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 M. 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.

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 aren't likely to get back into the DXA business if they have already gotten out, said Dr. David Goddard, a rheumatologist 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.

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 M. 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.

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.

Physicians are now feeling the effect of a 21% cut in their Medicare payments, and efforts to even temporarily reverse that cut are stalled on Capitol Hill.

On June 18, the Senate passed a bill (H.R. 3962) that would replace the 21% Medicare physician fee cut with a 2.2% pay raise through Nov. 30. The provision had been pulled out of a larger legislative package (H.R. 4213) that includes extensions of unemployment benefits, extra federal Medicaid funding, and several jobs provisions. Senate leaders had been unable to pass the larger package, known as the tax extenders bill, so they focused on the more popular physician-payment provision and passed it separately.

House members had been expected to vote on the measure when they returned to the Capitol on June 22, but so far House Speaker Nancy Pelosi (D.-Calif.) has not agreed to take up the physician-pay bill. Although Speaker Pelosi supports reversing the pay cut, she said the Senate's bill fell short when it came to addressing the issue: On May 28, the House passed legislation that would have replaced the 21% cut with small pay increases for physicians through 2011. Speaker Pelosi said she was also disappointed by the Senate's lack of action on the rest of the tax extenders package, especially the jobs provisions.

"I see no reason to pass this inadequate bill until we see jobs legislation coming out of the Senate," Speaker Pelosi said in a statement on June 18. "House Democrats are saying to Republicans in the Senate: show us the jobs!"

Physicians are now feeling the effect of a 21% cut in their Medicare payments, and efforts to even temporarily reverse that cut are stalled on Capitol Hill.

On June 18, the Senate passed a bill (H.R. 3962) that would replace the 21% Medicare physician fee cut with a 2.2% pay raise through Nov. 30. The provision had been pulled out of a larger legislative package (H.R. 4213) that includes extensions of unemployment benefits, extra federal Medicaid funding, and several jobs provisions. Senate leaders had been unable to pass the larger package, known as the tax extenders bill, so they focused on the more popular physician-payment provision and passed it separately.

House members had been expected to vote on the measure when they returned to the Capitol on June 22, but so far House Speaker Nancy Pelosi (D.-Calif.) has not agreed to take up the physician-pay bill. Although Speaker Pelosi supports reversing the pay cut, she said the Senate's bill fell short when it came to addressing the issue: On May 28, the House passed legislation that would have replaced the 21% cut with small pay increases for physicians through 2011. Speaker Pelosi said she was also disappointed by the Senate's lack of action on the rest of the tax extenders package, especially the jobs provisions.

"I see no reason to pass this inadequate bill until we see jobs legislation coming out of the Senate," Speaker Pelosi said in a statement on June 18. "House Democrats are saying to Republicans in the Senate: show us the jobs!"

Physicians are now feeling the effect of a 21% cut in their Medicare payments, and efforts to even temporarily reverse that cut are stalled on Capitol Hill.

On June 18, the Senate passed a bill (H.R. 3962) that would replace the 21% Medicare physician fee cut with a 2.2% pay raise through Nov. 30. The provision had been pulled out of a larger legislative package (H.R. 4213) that includes extensions of unemployment benefits, extra federal Medicaid funding, and several jobs provisions. Senate leaders had been unable to pass the larger package, known as the tax extenders bill, so they focused on the more popular physician-payment provision and passed it separately.

House members had been expected to vote on the measure when they returned to the Capitol on June 22, but so far House Speaker Nancy Pelosi (D.-Calif.) has not agreed to take up the physician-pay bill. Although Speaker Pelosi supports reversing the pay cut, she said the Senate's bill fell short when it came to addressing the issue: On May 28, the House passed legislation that would have replaced the 21% cut with small pay increases for physicians through 2011. Speaker Pelosi said she was also disappointed by the Senate's lack of action on the rest of the tax extenders package, especially the jobs provisions.

"I see no reason to pass this inadequate bill until we see jobs legislation coming out of the Senate," Speaker Pelosi said in a statement on June 18. "House Democrats are saying to Republicans in the Senate: show us the jobs!"

Next year, patient cost sharing for brand-name drugs will be cut in half, and the doughnut hole will be closed completely by 2020.

Marilyn Tavenner, acting administrator at the Centers for Medicare and Medicaid Services, answered questions about how the new benefit will be implemented.

Skin & Allergy News: How many Medicare beneficiaries will fall into the doughnut hole this year? Will they all get checks this summer?

Tavenner: About 8 million Medicare beneficiaries are expected to reach the prescription drug coverage gap that we call the doughnut hole this year. Of those, 4 million will be eligible to get a tax-free, one-time rebate check. The remaining beneficiaries already receive assistance through Medicare Extra Help

Beneficiaries who hit this coverage gap do not need to fill out any form, or make any phone call, to receive this benefit under the Affordable Care Act. The one-time $250 rebate checks will be mailed automatically to seniors’ homes from Medicare when they enter the doughnut hole. The first rebate checks were sent in June, and checks will sent each month throughout this year as more beneficiaries enter the doughnut hole.

Skin & Allergy News: Will the $250 rebate have a significant impact on patients’ out-of-pocket drug costs this year?

Tavenner: The $250 rebate is immediate relief that marks the first step in completely eliminating the doughnut hole. This year’s rebate will help put money back in the pockets of seniors who are too often forced to choose between paying for their groceries or for their medications.

Next year, seniors who reach the coverage gap will get a 50% discount on brand-name drugs that will help reduce their costs. In addition, under the new law, actual coverage gap will get smaller and smaller every year, until it completely disappears in 2020.

Skin & Allergy News: Physicians in all specialties spend a lot of time helping patients find affordable medications. How will these changes decrease the burden on doctors?

Tavenner: Physicians are on the front lines in helping seniors obtain medications that are not only successful in treating the patient, but are also affordable. By closing the coverage gap and making care more affordable, Medicare beneficiaries will be able to get the care they need and deserve. And starting next year, patients with Medicare can get free preventive care services like colorectal cancer screening and mammograms. Medicare also will cover an annual physical, where they can work with their physician to develop a personal prevention plan based on current health needs.

Skin & Allergy News: How can physicians help their patients to take advantage of this new benefit?

Tavenner: Doctors can continue to help their patients by educating them about the Affordable Care Act so they can take full advantage of its new benefits. If patients have questions on their rebate checks, they can call 1-800-Medicare or visit www.medicare.gov. And to receive updates on the health reform law as it is implemented, they can visit www.healthreform.gov.

One important note: Along with the additional benefits provided by the Affordable Care Act come increased threats of fraud. That’s precisely why we’re working with the Department of Justice to crack down on scam artists who are trying to procure personal information from Medicare beneficiaries by promising them rebate checks and other benefits under the law. Patients should never give their Medicare ID number to anyone promising benefits or discounts under the new law. For fraud-fighting tips, please visit www.stopmedicarefraud.gov.

Marilyn Tavenner is acting administrator for the Centers for Medicare and Medicaid Services, which administers the Part D Medicare benefit and will be responsible for implementing many elements of the new health reform law. She previously served as secretary of health and human resources for Virginia.

Next year, patient cost sharing for brand-name drugs will be cut in half, and the doughnut hole will be closed completely by 2020.

Marilyn Tavenner, acting administrator at the Centers for Medicare and Medicaid Services, answered questions about how the new benefit will be implemented.

Skin & Allergy News: How many Medicare beneficiaries will fall into the doughnut hole this year? Will they all get checks this summer?

Tavenner: About 8 million Medicare beneficiaries are expected to reach the prescription drug coverage gap that we call the doughnut hole this year. Of those, 4 million will be eligible to get a tax-free, one-time rebate check. The remaining beneficiaries already receive assistance through Medicare Extra Help

Beneficiaries who hit this coverage gap do not need to fill out any form, or make any phone call, to receive this benefit under the Affordable Care Act. The one-time $250 rebate checks will be mailed automatically to seniors’ homes from Medicare when they enter the doughnut hole. The first rebate checks were sent in June, and checks will sent each month throughout this year as more beneficiaries enter the doughnut hole.

Skin & Allergy News: Will the $250 rebate have a significant impact on patients’ out-of-pocket drug costs this year?

Tavenner: The $250 rebate is immediate relief that marks the first step in completely eliminating the doughnut hole. This year’s rebate will help put money back in the pockets of seniors who are too often forced to choose between paying for their groceries or for their medications.

Next year, seniors who reach the coverage gap will get a 50% discount on brand-name drugs that will help reduce their costs. In addition, under the new law, actual coverage gap will get smaller and smaller every year, until it completely disappears in 2020.

Skin & Allergy News: Physicians in all specialties spend a lot of time helping patients find affordable medications. How will these changes decrease the burden on doctors?

Tavenner: Physicians are on the front lines in helping seniors obtain medications that are not only successful in treating the patient, but are also affordable. By closing the coverage gap and making care more affordable, Medicare beneficiaries will be able to get the care they need and deserve. And starting next year, patients with Medicare can get free preventive care services like colorectal cancer screening and mammograms. Medicare also will cover an annual physical, where they can work with their physician to develop a personal prevention plan based on current health needs.

Skin & Allergy News: How can physicians help their patients to take advantage of this new benefit?

Tavenner: Doctors can continue to help their patients by educating them about the Affordable Care Act so they can take full advantage of its new benefits. If patients have questions on their rebate checks, they can call 1-800-Medicare or visit www.medicare.gov. And to receive updates on the health reform law as it is implemented, they can visit www.healthreform.gov.

One important note: Along with the additional benefits provided by the Affordable Care Act come increased threats of fraud. That’s precisely why we’re working with the Department of Justice to crack down on scam artists who are trying to procure personal information from Medicare beneficiaries by promising them rebate checks and other benefits under the law. Patients should never give their Medicare ID number to anyone promising benefits or discounts under the new law. For fraud-fighting tips, please visit www.stopmedicarefraud.gov.

Marilyn Tavenner is acting administrator for the Centers for Medicare and Medicaid Services, which administers the Part D Medicare benefit and will be responsible for implementing many elements of the new health reform law. She previously served as secretary of health and human resources for Virginia.

Next year, patient cost sharing for brand-name drugs will be cut in half, and the doughnut hole will be closed completely by 2020.

Marilyn Tavenner, acting administrator at the Centers for Medicare and Medicaid Services, answered questions about how the new benefit will be implemented.

Skin & Allergy News: How many Medicare beneficiaries will fall into the doughnut hole this year? Will they all get checks this summer?

Tavenner: About 8 million Medicare beneficiaries are expected to reach the prescription drug coverage gap that we call the doughnut hole this year. Of those, 4 million will be eligible to get a tax-free, one-time rebate check. The remaining beneficiaries already receive assistance through Medicare Extra Help

Beneficiaries who hit this coverage gap do not need to fill out any form, or make any phone call, to receive this benefit under the Affordable Care Act. The one-time $250 rebate checks will be mailed automatically to seniors’ homes from Medicare when they enter the doughnut hole. The first rebate checks were sent in June, and checks will sent each month throughout this year as more beneficiaries enter the doughnut hole.

Skin & Allergy News: Will the $250 rebate have a significant impact on patients’ out-of-pocket drug costs this year?

Tavenner: The $250 rebate is immediate relief that marks the first step in completely eliminating the doughnut hole. This year’s rebate will help put money back in the pockets of seniors who are too often forced to choose between paying for their groceries or for their medications.

Next year, seniors who reach the coverage gap will get a 50% discount on brand-name drugs that will help reduce their costs. In addition, under the new law, actual coverage gap will get smaller and smaller every year, until it completely disappears in 2020.

Skin & Allergy News: Physicians in all specialties spend a lot of time helping patients find affordable medications. How will these changes decrease the burden on doctors?

Tavenner: Physicians are on the front lines in helping seniors obtain medications that are not only successful in treating the patient, but are also affordable. By closing the coverage gap and making care more affordable, Medicare beneficiaries will be able to get the care they need and deserve. And starting next year, patients with Medicare can get free preventive care services like colorectal cancer screening and mammograms. Medicare also will cover an annual physical, where they can work with their physician to develop a personal prevention plan based on current health needs.

Skin & Allergy News: How can physicians help their patients to take advantage of this new benefit?

Tavenner: Doctors can continue to help their patients by educating them about the Affordable Care Act so they can take full advantage of its new benefits. If patients have questions on their rebate checks, they can call 1-800-Medicare or visit www.medicare.gov. And to receive updates on the health reform law as it is implemented, they can visit www.healthreform.gov.

One important note: Along with the additional benefits provided by the Affordable Care Act come increased threats of fraud. That’s precisely why we’re working with the Department of Justice to crack down on scam artists who are trying to procure personal information from Medicare beneficiaries by promising them rebate checks and other benefits under the law. Patients should never give their Medicare ID number to anyone promising benefits or discounts under the new law. For fraud-fighting tips, please visit www.stopmedicarefraud.gov.

Marilyn Tavenner is acting administrator for the Centers for Medicare and Medicaid Services, which administers the Part D Medicare benefit and will be responsible for implementing many elements of the new health reform law. She previously served as secretary of health and human resources for Virginia.

Senators voted by unanimous consent on June 18 to increase Medicare physician fees by 2.2% through Nov. 30 and retroactive to June 1.

Because the vote came after the House adjourned for the weekend, the Centers for Medicare and Medicaid Services (CMS) began processing claims at the 21% reduction called for by the Sustainable Growth Rate formula.

Despite the Senate’s action, leaders at the American Medical Association were still frustrated with Congress and said that the constant temporary actions are likely to lead to patient access issues.

“This is no way to run a major health coverage program—already the instability caused by repeated short-term delays is taking its toll,” Dr. Cecil B. Wilson, AMA president, said in a statement. “About one in five physicians say they have already been forced to limit the number of Medicare patients in their practice. Nearly one-third of primary care physicians have already been forced to take that action. The top two reasons physicians gave for these actions were the ongoing threat of future cuts and the fact that Medicare payment rates were already too low.”

The night before the surprise vote, Senate leaders had fallen short in bringing a pay fix bill to a vote.

The Democratic leadership in the Senate had vowed to continue to try to pass the legislation (H.R. 4213), which includes an array of other spending such as an extension of unemployment benefits and increased funding for Medicaid.

They faced a hard road since every Senate Republican and even some Democrats said they wouldn’t vote for the bill without additional budget offsets. Sen. Ben Nelson (D-Neb.), who voted against the cloture motion on June 17, said that he is concerned that this type of deficit spending will harm the nation’s economic recovery.

“Washington needs to put a plug in deficit spending,” he said in a June 16 statement. “Taxpayers are demanding fiscal responsibility, and we need to listen to them.”

The bill containing the 2.2% pay increase is expected to be passed by the House and signed by the President next week.

According to CMS, the agency will send physicians additional payments for any claims processed between June 18 and when the pay increase bill is signed.

Senators voted by unanimous consent on June 18 to increase Medicare physician fees by 2.2% through Nov. 30 and retroactive to June 1.

Because the vote came after the House adjourned for the weekend, the Centers for Medicare and Medicaid Services (CMS) began processing claims at the 21% reduction called for by the Sustainable Growth Rate formula.

Despite the Senate’s action, leaders at the American Medical Association were still frustrated with Congress and said that the constant temporary actions are likely to lead to patient access issues.

“This is no way to run a major health coverage program—already the instability caused by repeated short-term delays is taking its toll,” Dr. Cecil B. Wilson, AMA president, said in a statement. “About one in five physicians say they have already been forced to limit the number of Medicare patients in their practice. Nearly one-third of primary care physicians have already been forced to take that action. The top two reasons physicians gave for these actions were the ongoing threat of future cuts and the fact that Medicare payment rates were already too low.”

The night before the surprise vote, Senate leaders had fallen short in bringing a pay fix bill to a vote.

The Democratic leadership in the Senate had vowed to continue to try to pass the legislation (H.R. 4213), which includes an array of other spending such as an extension of unemployment benefits and increased funding for Medicaid.

They faced a hard road since every Senate Republican and even some Democrats said they wouldn’t vote for the bill without additional budget offsets. Sen. Ben Nelson (D-Neb.), who voted against the cloture motion on June 17, said that he is concerned that this type of deficit spending will harm the nation’s economic recovery.

“Washington needs to put a plug in deficit spending,” he said in a June 16 statement. “Taxpayers are demanding fiscal responsibility, and we need to listen to them.”

The bill containing the 2.2% pay increase is expected to be passed by the House and signed by the President next week.

According to CMS, the agency will send physicians additional payments for any claims processed between June 18 and when the pay increase bill is signed.

Senators voted by unanimous consent on June 18 to increase Medicare physician fees by 2.2% through Nov. 30 and retroactive to June 1.

Because the vote came after the House adjourned for the weekend, the Centers for Medicare and Medicaid Services (CMS) began processing claims at the 21% reduction called for by the Sustainable Growth Rate formula.

Despite the Senate’s action, leaders at the American Medical Association were still frustrated with Congress and said that the constant temporary actions are likely to lead to patient access issues.

“This is no way to run a major health coverage program—already the instability caused by repeated short-term delays is taking its toll,” Dr. Cecil B. Wilson, AMA president, said in a statement. “About one in five physicians say they have already been forced to limit the number of Medicare patients in their practice. Nearly one-third of primary care physicians have already been forced to take that action. The top two reasons physicians gave for these actions were the ongoing threat of future cuts and the fact that Medicare payment rates were already too low.”

The night before the surprise vote, Senate leaders had fallen short in bringing a pay fix bill to a vote.

The Democratic leadership in the Senate had vowed to continue to try to pass the legislation (H.R. 4213), which includes an array of other spending such as an extension of unemployment benefits and increased funding for Medicaid.

They faced a hard road since every Senate Republican and even some Democrats said they wouldn’t vote for the bill without additional budget offsets. Sen. Ben Nelson (D-Neb.), who voted against the cloture motion on June 17, said that he is concerned that this type of deficit spending will harm the nation’s economic recovery.

“Washington needs to put a plug in deficit spending,” he said in a June 16 statement. “Taxpayers are demanding fiscal responsibility, and we need to listen to them.”

The bill containing the 2.2% pay increase is expected to be passed by the House and signed by the President next week.

According to CMS, the agency will send physicians additional payments for any claims processed between June 18 and when the pay increase bill is signed.

As implementation of health reform gains momentum, subspecialist physicians are concerned about their lack of a role in care coordination and the patient-centered medical home model.

“We're a little bit frustrated about where we fit in,” said Dr. Karen Kolba, a rheumatologist in solo practice in Santa Maria, Calif., and chair of the American College of Rheumatology's Committee on Rheumatologic Care.

The ACR is one of a handful of medical specialty societies that has not signed on to the concept of the patient-centered medical home. It's not that the college doesn't support increased access for patients or coordinated care; rather, she said, they feel they have been excluded from the model.

In 2007, the American Academy of Family Physicians, the American Academy of Pediatrics, the American College of Physicians, and the American Osteopathic Association issued a paper outlining the principles of the patient-centered medical home, which seeks to provide comprehensive primary care to children and adults.

Under the model, each patient has a personal physician who directs a practice-based care team and is responsible for providing all of the patient's health care needs or coordinating that care with another provider. The model also emphasizes evidence-based medicine and clinical decision support, enhanced access for patients, and additional payment for the personal physician for providing care coordination and improving quality.

A voluntary recognition program created by the National Committee for Quality Assurance (NCQA) aims to operationalize the model; physicians who meet the program's standards can qualify for additional payment from certain health plans. The standards measure a practice on access and communication, patient tracking and registry functions, care management, referral tracking, and electronic prescribing, among others.

Although the medical home model doesn't specify that only a primary care physician can qualify, the criteria make it nearly impossible for specialists to act as a medical home, Dr. Kolba said. For example, rheumatologists frequently are the main point of medical contact for patients with chronic rheumatologic diseases and they provide a significant amount of coordination of care, she said. However, few perform or coordinate nonrheumatologic care such as a patient's regular mammogram. And that's a sticking point in being able to qualify as a personal physician under the medical home, she said.

Dr. Kolba said she supports increasing payment for primary care, but not at the expense of other physicians. And she said primary care physicians ought to be entitled to additional pay for the work they do, without creating a new system to justify the increases.

AAFP leaders defend the medical home model and specialists' role in it. The patient-centered medical home was very purposefully defined to include a “personal physician”—not a primary care physician, said Dr. Terry McGeeney, the president and CEO of TransforMED, a subsidiary of the AAFP that helps primary care practices transition to the medical home model.

Although most practices using the medical home model will be led by primary care physicians, not all will be. The personal physician could be an infectious disease specialist, a neurologist, or an oncologist, he said.

But the key, Dr. McGeeney said, is that the physician must provide a medical home for the whole patient, and not focus on a certain disease or organ system. That means that a neurologist, for example, must keep track not only of the neurologic care, but also the patient's cholesterol levels and mammogram results. They don't have to perform these services themselves, but they have to coordinate and track them, he said. In the medical home, the personal physician is the “quarterback” for the patient's care and there's no “free pass” on those responsibilities for specialists, he said.

Specialists who do want to provide a medical home may even have an advantage, according to Dr. McGeeney, who pointed out that specialty practices tend to have more resources to invest in practice transformation. That said, specialists often have not been trained to provide the types and level of care required of medical homes.

Where specialists may fit in more easily, Dr. McGeeney said, is in the “medical home neighborhood,” which includes all the physicians caring for a patient, as well as the emergency department, the hospital, and the pharmacy.

TransforMED is encouraging medical home practices to have letters of agreement with specialists regarding care coordination. As part of the agreement, the primary care physician promises to send all the patient's information to the specialist and to communicate with them about tests and results. These agreements aren't legally binding on either party, but they force everyone to have a conversation about coordination of care, he said.

Some specialists remain skeptical about their role in the medical home and the medical home neighborhood. Dr. Alfred Bove, past president of the American College of Cardiology and emeritus professor of medicine at Temple University, Philadelphia, said cardiologists frequently act as a medical home for heart failure and transplantation patients, for example, and don't want to be left out. For years, many cardiologists have worked in multidisciplinary care teams, used electronic health records, and provided immunizations and screening, he said.

“We have all the ingredients needed to be a patient-centered medical home in an area of chronic disease that probably is better done by cardiologists that have a lot of experience in managing very sick heart failure patients than in a primary care practice where there's a broad spectrum of different kinds of patients,” Dr. Bove said.

The ACC has been advocating for specialty-based patient-centered medical homes in specific areas where the cardiologist's expertise is unique and they would be willing to assume responsibility for preventive care.

But another issue is what to do about specialty practices that act as a medical home for only a portion of their patients. In a recent article in the New England Journal of Medicine, researchers looked at single-specialty practices in cardiology, endocrinology, and pulmonology to find out to what extent those specialty practices function as medical homes.

They found that a large percentage of the practices provided both primary care and specialty care, but generally for a subset of patients. For example, 81% of the 373 practices surveyed said they served as primary care physicians for 10% or fewer of their patients. Only 2.7% of the practices said they act as primary care physicians for more than 50% of their patients (N. Engl. J. Med. 2010;362:1555–8).

As implementation of health reform gains momentum, subspecialist physicians are concerned about their lack of a role in care coordination and the patient-centered medical home model.

“We're a little bit frustrated about where we fit in,” said Dr. Karen Kolba, a rheumatologist in solo practice in Santa Maria, Calif., and chair of the American College of Rheumatology's Committee on Rheumatologic Care.

The ACR is one of a handful of medical specialty societies that has not signed on to the concept of the patient-centered medical home. It's not that the college doesn't support increased access for patients or coordinated care; rather, she said, they feel they have been excluded from the model.

In 2007, the American Academy of Family Physicians, the American Academy of Pediatrics, the American College of Physicians, and the American Osteopathic Association issued a paper outlining the principles of the patient-centered medical home, which seeks to provide comprehensive primary care to children and adults.

Under the model, each patient has a personal physician who directs a practice-based care team and is responsible for providing all of the patient's health care needs or coordinating that care with another provider. The model also emphasizes evidence-based medicine and clinical decision support, enhanced access for patients, and additional payment for the personal physician for providing care coordination and improving quality.

A voluntary recognition program created by the National Committee for Quality Assurance (NCQA) aims to operationalize the model; physicians who meet the program's standards can qualify for additional payment from certain health plans. The standards measure a practice on access and communication, patient tracking and registry functions, care management, referral tracking, and electronic prescribing, among others.

Although the medical home model doesn't specify that only a primary care physician can qualify, the criteria make it nearly impossible for specialists to act as a medical home, Dr. Kolba said. For example, rheumatologists frequently are the main point of medical contact for patients with chronic rheumatologic diseases and they provide a significant amount of coordination of care, she said. However, few perform or coordinate nonrheumatologic care such as a patient's regular mammogram. And that's a sticking point in being able to qualify as a personal physician under the medical home, she said.

Dr. Kolba said she supports increasing payment for primary care, but not at the expense of other physicians. And she said primary care physicians ought to be entitled to additional pay for the work they do, without creating a new system to justify the increases.

AAFP leaders defend the medical home model and specialists' role in it. The patient-centered medical home was very purposefully defined to include a “personal physician”—not a primary care physician, said Dr. Terry McGeeney, the president and CEO of TransforMED, a subsidiary of the AAFP that helps primary care practices transition to the medical home model.

Although most practices using the medical home model will be led by primary care physicians, not all will be. The personal physician could be an infectious disease specialist, a neurologist, or an oncologist, he said.

But the key, Dr. McGeeney said, is that the physician must provide a medical home for the whole patient, and not focus on a certain disease or organ system. That means that a neurologist, for example, must keep track not only of the neurologic care, but also the patient's cholesterol levels and mammogram results. They don't have to perform these services themselves, but they have to coordinate and track them, he said. In the medical home, the personal physician is the “quarterback” for the patient's care and there's no “free pass” on those responsibilities for specialists, he said.

Specialists who do want to provide a medical home may even have an advantage, according to Dr. McGeeney, who pointed out that specialty practices tend to have more resources to invest in practice transformation. That said, specialists often have not been trained to provide the types and level of care required of medical homes.

Where specialists may fit in more easily, Dr. McGeeney said, is in the “medical home neighborhood,” which includes all the physicians caring for a patient, as well as the emergency department, the hospital, and the pharmacy.

TransforMED is encouraging medical home practices to have letters of agreement with specialists regarding care coordination. As part of the agreement, the primary care physician promises to send all the patient's information to the specialist and to communicate with them about tests and results. These agreements aren't legally binding on either party, but they force everyone to have a conversation about coordination of care, he said.

Some specialists remain skeptical about their role in the medical home and the medical home neighborhood. Dr. Alfred Bove, past president of the American College of Cardiology and emeritus professor of medicine at Temple University, Philadelphia, said cardiologists frequently act as a medical home for heart failure and transplantation patients, for example, and don't want to be left out. For years, many cardiologists have worked in multidisciplinary care teams, used electronic health records, and provided immunizations and screening, he said.

“We have all the ingredients needed to be a patient-centered medical home in an area of chronic disease that probably is better done by cardiologists that have a lot of experience in managing very sick heart failure patients than in a primary care practice where there's a broad spectrum of different kinds of patients,” Dr. Bove said.

The ACC has been advocating for specialty-based patient-centered medical homes in specific areas where the cardiologist's expertise is unique and they would be willing to assume responsibility for preventive care.

But another issue is what to do about specialty practices that act as a medical home for only a portion of their patients. In a recent article in the New England Journal of Medicine, researchers looked at single-specialty practices in cardiology, endocrinology, and pulmonology to find out to what extent those specialty practices function as medical homes.

They found that a large percentage of the practices provided both primary care and specialty care, but generally for a subset of patients. For example, 81% of the 373 practices surveyed said they served as primary care physicians for 10% or fewer of their patients. Only 2.7% of the practices said they act as primary care physicians for more than 50% of their patients (N. Engl. J. Med. 2010;362:1555–8).

As implementation of health reform gains momentum, subspecialist physicians are concerned about their lack of a role in care coordination and the patient-centered medical home model.

“We're a little bit frustrated about where we fit in,” said Dr. Karen Kolba, a rheumatologist in solo practice in Santa Maria, Calif., and chair of the American College of Rheumatology's Committee on Rheumatologic Care.

The ACR is one of a handful of medical specialty societies that has not signed on to the concept of the patient-centered medical home. It's not that the college doesn't support increased access for patients or coordinated care; rather, she said, they feel they have been excluded from the model.

In 2007, the American Academy of Family Physicians, the American Academy of Pediatrics, the American College of Physicians, and the American Osteopathic Association issued a paper outlining the principles of the patient-centered medical home, which seeks to provide comprehensive primary care to children and adults.

Under the model, each patient has a personal physician who directs a practice-based care team and is responsible for providing all of the patient's health care needs or coordinating that care with another provider. The model also emphasizes evidence-based medicine and clinical decision support, enhanced access for patients, and additional payment for the personal physician for providing care coordination and improving quality.

A voluntary recognition program created by the National Committee for Quality Assurance (NCQA) aims to operationalize the model; physicians who meet the program's standards can qualify for additional payment from certain health plans. The standards measure a practice on access and communication, patient tracking and registry functions, care management, referral tracking, and electronic prescribing, among others.

Although the medical home model doesn't specify that only a primary care physician can qualify, the criteria make it nearly impossible for specialists to act as a medical home, Dr. Kolba said. For example, rheumatologists frequently are the main point of medical contact for patients with chronic rheumatologic diseases and they provide a significant amount of coordination of care, she said. However, few perform or coordinate nonrheumatologic care such as a patient's regular mammogram. And that's a sticking point in being able to qualify as a personal physician under the medical home, she said.

Dr. Kolba said she supports increasing payment for primary care, but not at the expense of other physicians. And she said primary care physicians ought to be entitled to additional pay for the work they do, without creating a new system to justify the increases.

AAFP leaders defend the medical home model and specialists' role in it. The patient-centered medical home was very purposefully defined to include a “personal physician”—not a primary care physician, said Dr. Terry McGeeney, the president and CEO of TransforMED, a subsidiary of the AAFP that helps primary care practices transition to the medical home model.

Although most practices using the medical home model will be led by primary care physicians, not all will be. The personal physician could be an infectious disease specialist, a neurologist, or an oncologist, he said.

But the key, Dr. McGeeney said, is that the physician must provide a medical home for the whole patient, and not focus on a certain disease or organ system. That means that a neurologist, for example, must keep track not only of the neurologic care, but also the patient's cholesterol levels and mammogram results. They don't have to perform these services themselves, but they have to coordinate and track them, he said. In the medical home, the personal physician is the “quarterback” for the patient's care and there's no “free pass” on those responsibilities for specialists, he said.

Specialists who do want to provide a medical home may even have an advantage, according to Dr. McGeeney, who pointed out that specialty practices tend to have more resources to invest in practice transformation. That said, specialists often have not been trained to provide the types and level of care required of medical homes.

Where specialists may fit in more easily, Dr. McGeeney said, is in the “medical home neighborhood,” which includes all the physicians caring for a patient, as well as the emergency department, the hospital, and the pharmacy.

TransforMED is encouraging medical home practices to have letters of agreement with specialists regarding care coordination. As part of the agreement, the primary care physician promises to send all the patient's information to the specialist and to communicate with them about tests and results. These agreements aren't legally binding on either party, but they force everyone to have a conversation about coordination of care, he said.

Some specialists remain skeptical about their role in the medical home and the medical home neighborhood. Dr. Alfred Bove, past president of the American College of Cardiology and emeritus professor of medicine at Temple University, Philadelphia, said cardiologists frequently act as a medical home for heart failure and transplantation patients, for example, and don't want to be left out. For years, many cardiologists have worked in multidisciplinary care teams, used electronic health records, and provided immunizations and screening, he said.

“We have all the ingredients needed to be a patient-centered medical home in an area of chronic disease that probably is better done by cardiologists that have a lot of experience in managing very sick heart failure patients than in a primary care practice where there's a broad spectrum of different kinds of patients,” Dr. Bove said.

The ACC has been advocating for specialty-based patient-centered medical homes in specific areas where the cardiologist's expertise is unique and they would be willing to assume responsibility for preventive care.

But another issue is what to do about specialty practices that act as a medical home for only a portion of their patients. In a recent article in the New England Journal of Medicine, researchers looked at single-specialty practices in cardiology, endocrinology, and pulmonology to find out to what extent those specialty practices function as medical homes.

They found that a large percentage of the practices provided both primary care and specialty care, but generally for a subset of patients. For example, 81% of the 373 practices surveyed said they served as primary care physicians for 10% or fewer of their patients. Only 2.7% of the practices said they act as primary care physicians for more than 50% of their patients (N. Engl. J. Med. 2010;362:1555–8).

Officials at the Centers for Medicare and Medicaid Services announced June 14 that they have extended the hold on Medicare claims until June 18 in an effort to give Congress a few more days to retroactively reverse the 21% pay cut called for by the Sustainable Growth Rate formula.

The cut to physician payments technically went into effect on June 1, after the Senate failed to pass legislation to delay or repeal the scheduled cuts. The House passed a bill May 28 that would have replaced the cuts with small pay increases through 2011. The Senate is slated to resume consideration of that bill (H.R. 4213) this week.

As senators wrap up work on the bill, lawmakers may consider a longer-term pay fix for physicians. The American College of Physicians, the American Academy of Family Physicians, and the American Osteopathic Association have thrown their support behind a proposal that would provide physicians with small pay increases through 2013, as well as slightly higher payments for primary care in 2012 and 2013.

Whatever pay fix proposal garners support, the Senate is under pressure to vote on the bill quickly. In his weekly address on June 12, President Obama called on lawmakers to permanently replace the Medicare physician payment formula, which requires these steep cuts. In the meantime, he urged them to do something to stop the current cuts from going into effect now.

“I’m absolutely willing to take the difficult steps necessary to lower the cost of Medicare and put our budget on a more fiscally sustainable path,” President Obama said. “But I’m not willing to do that by punishing hard-working physicians or the millions of Americans who count on Medicare. That’s just wrong. And that’s why in the short-term, Congress must act to prevent this pay cut to doctors.”

Officials at the Centers for Medicare and Medicaid Services announced June 14 that they have extended the hold on Medicare claims until June 18 in an effort to give Congress a few more days to retroactively reverse the 21% pay cut called for by the Sustainable Growth Rate formula.

The cut to physician payments technically went into effect on June 1, after the Senate failed to pass legislation to delay or repeal the scheduled cuts. The House passed a bill May 28 that would have replaced the cuts with small pay increases through 2011. The Senate is slated to resume consideration of that bill (H.R. 4213) this week.

As senators wrap up work on the bill, lawmakers may consider a longer-term pay fix for physicians. The American College of Physicians, the American Academy of Family Physicians, and the American Osteopathic Association have thrown their support behind a proposal that would provide physicians with small pay increases through 2013, as well as slightly higher payments for primary care in 2012 and 2013.

Whatever pay fix proposal garners support, the Senate is under pressure to vote on the bill quickly. In his weekly address on June 12, President Obama called on lawmakers to permanently replace the Medicare physician payment formula, which requires these steep cuts. In the meantime, he urged them to do something to stop the current cuts from going into effect now.

“I’m absolutely willing to take the difficult steps necessary to lower the cost of Medicare and put our budget on a more fiscally sustainable path,” President Obama said. “But I’m not willing to do that by punishing hard-working physicians or the millions of Americans who count on Medicare. That’s just wrong. And that’s why in the short-term, Congress must act to prevent this pay cut to doctors.”

Officials at the Centers for Medicare and Medicaid Services announced June 14 that they have extended the hold on Medicare claims until June 18 in an effort to give Congress a few more days to retroactively reverse the 21% pay cut called for by the Sustainable Growth Rate formula.

The cut to physician payments technically went into effect on June 1, after the Senate failed to pass legislation to delay or repeal the scheduled cuts. The House passed a bill May 28 that would have replaced the cuts with small pay increases through 2011. The Senate is slated to resume consideration of that bill (H.R. 4213) this week.

As senators wrap up work on the bill, lawmakers may consider a longer-term pay fix for physicians. The American College of Physicians, the American Academy of Family Physicians, and the American Osteopathic Association have thrown their support behind a proposal that would provide physicians with small pay increases through 2013, as well as slightly higher payments for primary care in 2012 and 2013.

Whatever pay fix proposal garners support, the Senate is under pressure to vote on the bill quickly. In his weekly address on June 12, President Obama called on lawmakers to permanently replace the Medicare physician payment formula, which requires these steep cuts. In the meantime, he urged them to do something to stop the current cuts from going into effect now.

“I’m absolutely willing to take the difficult steps necessary to lower the cost of Medicare and put our budget on a more fiscally sustainable path,” President Obama said. “But I’m not willing to do that by punishing hard-working physicians or the millions of Americans who count on Medicare. That’s just wrong. And that’s why in the short-term, Congress must act to prevent this pay cut to doctors.”