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Established Performance Metrics Help CMS Expand Its Value-Based Purchasing Program
—Thomas B. Valuck, MD, JD, senior vice president of strategic partnerships, National Quality Forum, former CMS adviser
No longer content to be a passive purchaser of healthcare services, the Centers for Medicare & Medicaid Services (CMS) is becoming a savvier shopper, holding providers increasingly accountable for the quality and efficiency of the care they deliver. With its value-based purchasing (VPB) program for hospitals already in place, now it’s the physicians’ turn.
CMS is marching toward a value-based payment modifier program that will adjust physician reimbursement based on the relative quality and efficiency of care that physicians provide to Medicare fee-for-service patients. The program will begin January 2015 and will extend to all physicians in 2017. Like the hospital VBP program, it will be budget-neutral—meaning that payment will increase for some physicians but decrease for others.
The coming months mark a pivotal period for physicians as CMS tweaks its accountability apparatus in ways that will determine how reimbursement will rise and fall, for whom, and for what.
Menu of Metrics
In crafting the payment modifier program, CMS can tap performance metrics from several of its existing programs, including the Physician Quality Reporting System (PQRS), the soon-to-be-expanded Physician Compare website (www.medicare.gov/find-a-doctor/provider-search.aspx), and the Physician Feedback Program.
“These agendas are part of a continuum, and of equal importance, in the evolution toward physician value-based purchasing,” says Patrick J. Torcson, MD, MMM, FACP, SFHM, chair of SHM’s Performance Measurement and Reporting Committee, and director of hospital medicine at St. Tammany Parish Hospital in Covington, La.
PQRS began as a voluntary “pay for reporting” system that gave physicians a modest financial bonus (currently 0.5% of allowable Medicare charges) for submitting quality data (left). The Affordable Care Act (ACA) has since authorized CMS to penalize physicians who do not participate—1.5% of allowable Medicare charges beginning in 2015, and 2% in 2016.
The Physician Compare website, launched at the end of 2010, currently contains such rudimentary information as education, gender, and whether a physician is enrolled in Medicare and satisfactorily reports data to the PQRS. But as of January, the site will begin reporting some PQRS data, as well as other metrics.
CMS’ Physician Feedback Program provides quality and cost information to physicians in an effort to encourage them to improve the care they provide and its efficiency. CMS recently combined the program with its value-based payment modifier program as it moves toward physician reimbursement that it says will reward “value rather than volume.” The program, currently being piloted in Iowa, Nebraska, Kansas, and Missouri, issues to physicians confidential quality and resource use reports (QRURs) that compare their performance to peer groups in similar specialties by tracking PQRS results, Healthcare Effectiveness Data and Information Set (HEDIS) measures, and per-capita cost data and preventable hospital admission rates for various medical conditions. CMS will roll out the program nationwide next year.
Metrics Lack Relevance
Developing performance measures that capture the most relevant activities of physicians across many different specialties with equal validity is notoriously difficult—something that CMS acknowledges.1
Assigning the right patient to the right physician (i.e. figuring out who contributed what care, in what proportion, to which patient) also is fraught with complications, especially in the inpatient care setting, where a patient is likely to see many different physicians during a hospitalization.
SHM president Shaun Frost, MD, SFHM, highlighted these challenges in a letter sent in May to acting CMS administrator Marilyn B. Tavenner in which he pointed to dramatic data deficiencies in the initial round of QRURs sent to Physician Feedback Program participants that included hospitalists in Iowa, Nebraska, Kansas and Missouri. Because hospitalists were categorized as general internal-medicine physicians in the reports, their per-capita cost of care was dramatically higher (73% higher, in one case study) than the average cost of all internal-medicine physicians. No allowance was made for distinguishing the outpatient-oriented practice of a general internist from the inherently more expensive inpatient-focused hospitalist practice.
In the case study reviewed by SHM, the hospitalist’s patients saw, on average, 28 different physicians over the course of a year, during which the hospitalist contributed to the care of many patients but did not direct the care of any one of them—facts that clearly highlight the difficulty of assigning responsibility and accountability for a patient’s care when comparing physician performance.
“Based on the measurement used in the QRUR, it seems likely that a hospitalist would be severely disadvantaged with the introduction of a value-based modifier based on the present QRUR methodology,” Dr. Frost wrote.
SHM is similarly critical of the PQRS measures, which Dr. Torcson says lack relevance to hospitalist practices. “We want to be defined as HM physicians with our own unique measures of quality and cost,” he says. “Our results will look very different from those of an internist with a primarily outpatient practice.”
Dr. Torcson notes that SHM is an active participant in providing feedback during CMS rule proposals and has offered to work with the CMS on further refining the measures. For example, SHM proposed adding additional measures related to care transitions, given their particular relevance to hospitalist practices.
Rule-Changing Reform
The disruptive innovation of CMS’ healthcare reform agenda might wind up being a game-changer that dramatically affects the contours of all provider performance reporting and incentive systems, redefining the issues of physician accountability and patient assignment.
“We’re going to need to figure out how to restructure our measurement systems to match our evolving healthcare delivery and payment systems,” says Thomas B. Valuck, MD, JD, senior vice president of strategic partnerships for the National Quality Forum and former CMS adviser to the VBP program. Healthcare quality reporting should focus more on measures that cut across care contexts and assess whether the care provided truly made a difference for patients—metrics such as health improvement, return to functional status, level of patient involvement in the management of their care, provider team coordination, and other patient needs and preferences, Dr. Valuck believes.
“We need to be focused more on measures that encourage joint responsibility and cooperation among providers, and are important to patients across hospital, post-acute, and ambulatory settings, rather than those that are compartmentalized to one setting or relevant only to specific diseases or subspecialties,” Dr. Valuck says.
Such measure sets, while still retaining some disease- and physician-specific metrics, ideally would be complementary with families of related measures at the community, state, and national levels, Dr. Valuck says. “Such a multidimensional framework can begin to tell a meaningful story about what’s happening to the patient, and how well our system is delivering the right care,” he adds.
Dr. Torcson says HM has a pioneering role to play in this evolution, and he notes that SHM has proposed that CMS harmonize measures that align hospital-based physician activities (e.g. hospital medicine, emergency medicine, anesthesia, radiology) with hospital-level performance agendas so that physicians practicing together in the hospital setting can report on measures that are relevant to both.
Christopher Guadagnino is a freelance medical writer in Philadelphia.
Reference
- Centers for Medicare & Medicaid Services. Physician Quality Reporting System Town Hall Meeting. Available at: http://www.usqualitymeasures.org/shared/content/C4M_PQRS_transcript.pdf. Accessed July 3, 2012.
—Thomas B. Valuck, MD, JD, senior vice president of strategic partnerships, National Quality Forum, former CMS adviser
No longer content to be a passive purchaser of healthcare services, the Centers for Medicare & Medicaid Services (CMS) is becoming a savvier shopper, holding providers increasingly accountable for the quality and efficiency of the care they deliver. With its value-based purchasing (VPB) program for hospitals already in place, now it’s the physicians’ turn.
CMS is marching toward a value-based payment modifier program that will adjust physician reimbursement based on the relative quality and efficiency of care that physicians provide to Medicare fee-for-service patients. The program will begin January 2015 and will extend to all physicians in 2017. Like the hospital VBP program, it will be budget-neutral—meaning that payment will increase for some physicians but decrease for others.
The coming months mark a pivotal period for physicians as CMS tweaks its accountability apparatus in ways that will determine how reimbursement will rise and fall, for whom, and for what.
Menu of Metrics
In crafting the payment modifier program, CMS can tap performance metrics from several of its existing programs, including the Physician Quality Reporting System (PQRS), the soon-to-be-expanded Physician Compare website (www.medicare.gov/find-a-doctor/provider-search.aspx), and the Physician Feedback Program.
“These agendas are part of a continuum, and of equal importance, in the evolution toward physician value-based purchasing,” says Patrick J. Torcson, MD, MMM, FACP, SFHM, chair of SHM’s Performance Measurement and Reporting Committee, and director of hospital medicine at St. Tammany Parish Hospital in Covington, La.
PQRS began as a voluntary “pay for reporting” system that gave physicians a modest financial bonus (currently 0.5% of allowable Medicare charges) for submitting quality data (left). The Affordable Care Act (ACA) has since authorized CMS to penalize physicians who do not participate—1.5% of allowable Medicare charges beginning in 2015, and 2% in 2016.
The Physician Compare website, launched at the end of 2010, currently contains such rudimentary information as education, gender, and whether a physician is enrolled in Medicare and satisfactorily reports data to the PQRS. But as of January, the site will begin reporting some PQRS data, as well as other metrics.
CMS’ Physician Feedback Program provides quality and cost information to physicians in an effort to encourage them to improve the care they provide and its efficiency. CMS recently combined the program with its value-based payment modifier program as it moves toward physician reimbursement that it says will reward “value rather than volume.” The program, currently being piloted in Iowa, Nebraska, Kansas, and Missouri, issues to physicians confidential quality and resource use reports (QRURs) that compare their performance to peer groups in similar specialties by tracking PQRS results, Healthcare Effectiveness Data and Information Set (HEDIS) measures, and per-capita cost data and preventable hospital admission rates for various medical conditions. CMS will roll out the program nationwide next year.
Metrics Lack Relevance
Developing performance measures that capture the most relevant activities of physicians across many different specialties with equal validity is notoriously difficult—something that CMS acknowledges.1
Assigning the right patient to the right physician (i.e. figuring out who contributed what care, in what proportion, to which patient) also is fraught with complications, especially in the inpatient care setting, where a patient is likely to see many different physicians during a hospitalization.
SHM president Shaun Frost, MD, SFHM, highlighted these challenges in a letter sent in May to acting CMS administrator Marilyn B. Tavenner in which he pointed to dramatic data deficiencies in the initial round of QRURs sent to Physician Feedback Program participants that included hospitalists in Iowa, Nebraska, Kansas and Missouri. Because hospitalists were categorized as general internal-medicine physicians in the reports, their per-capita cost of care was dramatically higher (73% higher, in one case study) than the average cost of all internal-medicine physicians. No allowance was made for distinguishing the outpatient-oriented practice of a general internist from the inherently more expensive inpatient-focused hospitalist practice.
In the case study reviewed by SHM, the hospitalist’s patients saw, on average, 28 different physicians over the course of a year, during which the hospitalist contributed to the care of many patients but did not direct the care of any one of them—facts that clearly highlight the difficulty of assigning responsibility and accountability for a patient’s care when comparing physician performance.
“Based on the measurement used in the QRUR, it seems likely that a hospitalist would be severely disadvantaged with the introduction of a value-based modifier based on the present QRUR methodology,” Dr. Frost wrote.
SHM is similarly critical of the PQRS measures, which Dr. Torcson says lack relevance to hospitalist practices. “We want to be defined as HM physicians with our own unique measures of quality and cost,” he says. “Our results will look very different from those of an internist with a primarily outpatient practice.”
Dr. Torcson notes that SHM is an active participant in providing feedback during CMS rule proposals and has offered to work with the CMS on further refining the measures. For example, SHM proposed adding additional measures related to care transitions, given their particular relevance to hospitalist practices.
Rule-Changing Reform
The disruptive innovation of CMS’ healthcare reform agenda might wind up being a game-changer that dramatically affects the contours of all provider performance reporting and incentive systems, redefining the issues of physician accountability and patient assignment.
“We’re going to need to figure out how to restructure our measurement systems to match our evolving healthcare delivery and payment systems,” says Thomas B. Valuck, MD, JD, senior vice president of strategic partnerships for the National Quality Forum and former CMS adviser to the VBP program. Healthcare quality reporting should focus more on measures that cut across care contexts and assess whether the care provided truly made a difference for patients—metrics such as health improvement, return to functional status, level of patient involvement in the management of their care, provider team coordination, and other patient needs and preferences, Dr. Valuck believes.
“We need to be focused more on measures that encourage joint responsibility and cooperation among providers, and are important to patients across hospital, post-acute, and ambulatory settings, rather than those that are compartmentalized to one setting or relevant only to specific diseases or subspecialties,” Dr. Valuck says.
Such measure sets, while still retaining some disease- and physician-specific metrics, ideally would be complementary with families of related measures at the community, state, and national levels, Dr. Valuck says. “Such a multidimensional framework can begin to tell a meaningful story about what’s happening to the patient, and how well our system is delivering the right care,” he adds.
Dr. Torcson says HM has a pioneering role to play in this evolution, and he notes that SHM has proposed that CMS harmonize measures that align hospital-based physician activities (e.g. hospital medicine, emergency medicine, anesthesia, radiology) with hospital-level performance agendas so that physicians practicing together in the hospital setting can report on measures that are relevant to both.
Christopher Guadagnino is a freelance medical writer in Philadelphia.
Reference
- Centers for Medicare & Medicaid Services. Physician Quality Reporting System Town Hall Meeting. Available at: http://www.usqualitymeasures.org/shared/content/C4M_PQRS_transcript.pdf. Accessed July 3, 2012.
—Thomas B. Valuck, MD, JD, senior vice president of strategic partnerships, National Quality Forum, former CMS adviser
No longer content to be a passive purchaser of healthcare services, the Centers for Medicare & Medicaid Services (CMS) is becoming a savvier shopper, holding providers increasingly accountable for the quality and efficiency of the care they deliver. With its value-based purchasing (VPB) program for hospitals already in place, now it’s the physicians’ turn.
CMS is marching toward a value-based payment modifier program that will adjust physician reimbursement based on the relative quality and efficiency of care that physicians provide to Medicare fee-for-service patients. The program will begin January 2015 and will extend to all physicians in 2017. Like the hospital VBP program, it will be budget-neutral—meaning that payment will increase for some physicians but decrease for others.
The coming months mark a pivotal period for physicians as CMS tweaks its accountability apparatus in ways that will determine how reimbursement will rise and fall, for whom, and for what.
Menu of Metrics
In crafting the payment modifier program, CMS can tap performance metrics from several of its existing programs, including the Physician Quality Reporting System (PQRS), the soon-to-be-expanded Physician Compare website (www.medicare.gov/find-a-doctor/provider-search.aspx), and the Physician Feedback Program.
“These agendas are part of a continuum, and of equal importance, in the evolution toward physician value-based purchasing,” says Patrick J. Torcson, MD, MMM, FACP, SFHM, chair of SHM’s Performance Measurement and Reporting Committee, and director of hospital medicine at St. Tammany Parish Hospital in Covington, La.
PQRS began as a voluntary “pay for reporting” system that gave physicians a modest financial bonus (currently 0.5% of allowable Medicare charges) for submitting quality data (left). The Affordable Care Act (ACA) has since authorized CMS to penalize physicians who do not participate—1.5% of allowable Medicare charges beginning in 2015, and 2% in 2016.
The Physician Compare website, launched at the end of 2010, currently contains such rudimentary information as education, gender, and whether a physician is enrolled in Medicare and satisfactorily reports data to the PQRS. But as of January, the site will begin reporting some PQRS data, as well as other metrics.
CMS’ Physician Feedback Program provides quality and cost information to physicians in an effort to encourage them to improve the care they provide and its efficiency. CMS recently combined the program with its value-based payment modifier program as it moves toward physician reimbursement that it says will reward “value rather than volume.” The program, currently being piloted in Iowa, Nebraska, Kansas, and Missouri, issues to physicians confidential quality and resource use reports (QRURs) that compare their performance to peer groups in similar specialties by tracking PQRS results, Healthcare Effectiveness Data and Information Set (HEDIS) measures, and per-capita cost data and preventable hospital admission rates for various medical conditions. CMS will roll out the program nationwide next year.
Metrics Lack Relevance
Developing performance measures that capture the most relevant activities of physicians across many different specialties with equal validity is notoriously difficult—something that CMS acknowledges.1
Assigning the right patient to the right physician (i.e. figuring out who contributed what care, in what proportion, to which patient) also is fraught with complications, especially in the inpatient care setting, where a patient is likely to see many different physicians during a hospitalization.
SHM president Shaun Frost, MD, SFHM, highlighted these challenges in a letter sent in May to acting CMS administrator Marilyn B. Tavenner in which he pointed to dramatic data deficiencies in the initial round of QRURs sent to Physician Feedback Program participants that included hospitalists in Iowa, Nebraska, Kansas and Missouri. Because hospitalists were categorized as general internal-medicine physicians in the reports, their per-capita cost of care was dramatically higher (73% higher, in one case study) than the average cost of all internal-medicine physicians. No allowance was made for distinguishing the outpatient-oriented practice of a general internist from the inherently more expensive inpatient-focused hospitalist practice.
In the case study reviewed by SHM, the hospitalist’s patients saw, on average, 28 different physicians over the course of a year, during which the hospitalist contributed to the care of many patients but did not direct the care of any one of them—facts that clearly highlight the difficulty of assigning responsibility and accountability for a patient’s care when comparing physician performance.
“Based on the measurement used in the QRUR, it seems likely that a hospitalist would be severely disadvantaged with the introduction of a value-based modifier based on the present QRUR methodology,” Dr. Frost wrote.
SHM is similarly critical of the PQRS measures, which Dr. Torcson says lack relevance to hospitalist practices. “We want to be defined as HM physicians with our own unique measures of quality and cost,” he says. “Our results will look very different from those of an internist with a primarily outpatient practice.”
Dr. Torcson notes that SHM is an active participant in providing feedback during CMS rule proposals and has offered to work with the CMS on further refining the measures. For example, SHM proposed adding additional measures related to care transitions, given their particular relevance to hospitalist practices.
Rule-Changing Reform
The disruptive innovation of CMS’ healthcare reform agenda might wind up being a game-changer that dramatically affects the contours of all provider performance reporting and incentive systems, redefining the issues of physician accountability and patient assignment.
“We’re going to need to figure out how to restructure our measurement systems to match our evolving healthcare delivery and payment systems,” says Thomas B. Valuck, MD, JD, senior vice president of strategic partnerships for the National Quality Forum and former CMS adviser to the VBP program. Healthcare quality reporting should focus more on measures that cut across care contexts and assess whether the care provided truly made a difference for patients—metrics such as health improvement, return to functional status, level of patient involvement in the management of their care, provider team coordination, and other patient needs and preferences, Dr. Valuck believes.
“We need to be focused more on measures that encourage joint responsibility and cooperation among providers, and are important to patients across hospital, post-acute, and ambulatory settings, rather than those that are compartmentalized to one setting or relevant only to specific diseases or subspecialties,” Dr. Valuck says.
Such measure sets, while still retaining some disease- and physician-specific metrics, ideally would be complementary with families of related measures at the community, state, and national levels, Dr. Valuck says. “Such a multidimensional framework can begin to tell a meaningful story about what’s happening to the patient, and how well our system is delivering the right care,” he adds.
Dr. Torcson says HM has a pioneering role to play in this evolution, and he notes that SHM has proposed that CMS harmonize measures that align hospital-based physician activities (e.g. hospital medicine, emergency medicine, anesthesia, radiology) with hospital-level performance agendas so that physicians practicing together in the hospital setting can report on measures that are relevant to both.
Christopher Guadagnino is a freelance medical writer in Philadelphia.
Reference
- Centers for Medicare & Medicaid Services. Physician Quality Reporting System Town Hall Meeting. Available at: http://www.usqualitymeasures.org/shared/content/C4M_PQRS_transcript.pdf. Accessed July 3, 2012.
ICD-10 Update
On April 17, the U.S. Department of Health and Human Services (HHS) published a proposed rule to delay the compliance date for the International Classification of Diseases, 10th Edition, diagnosis and procedure codes (ICD-10) from Oct. 1, 2013, to Oct. 1, 2014.2
Per HHS, the ICD-10 compliance date change is part of a proposed rule that would adopt a standard for a unique health plan identifier (HPID), adopt a data element that would serve as an “other entity” identifier (OEID), and add a National Provider Identifier (NPI) requirement. The proposed rule was developed by the Office of E-Health Standards and Services (OESS) as part of its ongoing role, delegated by HHS, to establish standards for electronic healthcare transactions under the Health Insurance Portability and Accountability Act of 1996 (HIPAA).
HHS proposes that covered entities must be in compliance with ICD-10 by Oct. 1, 2014.
On April 17, the U.S. Department of Health and Human Services (HHS) published a proposed rule to delay the compliance date for the International Classification of Diseases, 10th Edition, diagnosis and procedure codes (ICD-10) from Oct. 1, 2013, to Oct. 1, 2014.2
Per HHS, the ICD-10 compliance date change is part of a proposed rule that would adopt a standard for a unique health plan identifier (HPID), adopt a data element that would serve as an “other entity” identifier (OEID), and add a National Provider Identifier (NPI) requirement. The proposed rule was developed by the Office of E-Health Standards and Services (OESS) as part of its ongoing role, delegated by HHS, to establish standards for electronic healthcare transactions under the Health Insurance Portability and Accountability Act of 1996 (HIPAA).
HHS proposes that covered entities must be in compliance with ICD-10 by Oct. 1, 2014.
On April 17, the U.S. Department of Health and Human Services (HHS) published a proposed rule to delay the compliance date for the International Classification of Diseases, 10th Edition, diagnosis and procedure codes (ICD-10) from Oct. 1, 2013, to Oct. 1, 2014.2
Per HHS, the ICD-10 compliance date change is part of a proposed rule that would adopt a standard for a unique health plan identifier (HPID), adopt a data element that would serve as an “other entity” identifier (OEID), and add a National Provider Identifier (NPI) requirement. The proposed rule was developed by the Office of E-Health Standards and Services (OESS) as part of its ongoing role, delegated by HHS, to establish standards for electronic healthcare transactions under the Health Insurance Portability and Accountability Act of 1996 (HIPAA).
HHS proposes that covered entities must be in compliance with ICD-10 by Oct. 1, 2014.
Study: ACA Will Up Health Spending
WASHINGTON – The major expansions in health care coverage in 2014 called for by the Affordable Care Act will cause health care spending to grow by 7.4% that year alone – a rate two percentage points higher than would have occurred without the law, according to an analysis by economists from the Centers for Medicare and Medicaid Services.
Much of that growth will be driven by increased use of physician services (projected to grow by 8.5%) and prescription drugs (projected to grow by 8.8%) as an estimated additional 30 million Americans gain health coverage under the law, Sean P. Keehan and his colleagues from the CMS Office of the Actuary said at a press briefing sponsored by the journal Health Affairs.
Their analysis was published online in the journal Health Affairs (2012 June [doi:10.1377/hlthaff.2012.0404]).
The coming growth in health spending is tempered by the current economic climate, according to the analysis. Estimated spending growth for 2011 is 3.9% – the same rate seen in 2010 and just above the historically slow growth rate of 3.8% in 2009.
"The recent recession and the modest economic recovery have played a role in our projection of near historic lows in health spending growth through 2013," Mr. Keehan said.
The economists noted, however, that once the health care system absorbs those newly insured via the state health insurance exchanges and Medicaid expansion in 2014, growth in spending is projected to stabilize.
"Once you have [the population from the coverage expansion] in, the growth rate of national health spending is projected to be fairly similar with or without the Affordable Care Act," Mr. Keehan said.
The projections also assume the approximate 30% cut in Medicare physician payment under the Sustainable Growth Rate formula will go into effect Jan. 1, 2013, and will remain in effect thereafter. This would bring the growth in Medicare spending down to 1.3%, from 5.9% in 2012. Previously Congress has generally prevented these SGR cuts.
Medicare costs are projected to grow every year, as more baby boomers qualify for benefits. Those costs will be offset partially by cost-saving provisions under the ACA, said CMS economist Gigi Cuckler.
"The growth rate in 2014 is largely influenced by the coverage expansions, but once you go into 2015 through 2021, you still have continuing effects of the coverage expansions," she said.
"However, you have a lot of Medicare cost-savings provisions also in play here that are bringing down the costs at this time."
The analysis is similar to that released last July by CMS.
The projections are based on economic and demographic assumptions that were obtained from the 2012 Medicare Trustees Report.
As everyone knows by now, in essence, the Supreme Court upheld the Accountable Care Act in its entirety on June 28th. Unless repealed by Congress, all or in part, the fiscal projections outlined in this article will become reality. I must say, I find it difficult to believe that growth in spending, as predicted in the article, will stabilize anytime soon. In balance, the law is good for patients who otherwise would go without coverage. In the short run, it may even be good for doctors (absent the 30% cut we face based on the SGR formulation). I am quite sure it will be good for many hospitals. However, over the long haul, the impending increase in healthcare spending, unless truly offset by improvements in prevention and quality, will likely be disastrous for this country, placing an insurmountable burden on our children and their children. An added fiscal note and a plea to call your legislators ...with sequestration, an additional 2% cut for physicians is scheduled to take effect on January 1, 2013.
Mark D. Morasch, M.D., is a vascular surgeon at The Heart and Vascular Center, St. Vincent's Hospital, Billings, Montana, and an associate medical editor of Vascular Specialist.
As everyone knows by now, in essence, the Supreme Court upheld the Accountable Care Act in its entirety on June 28th. Unless repealed by Congress, all or in part, the fiscal projections outlined in this article will become reality. I must say, I find it difficult to believe that growth in spending, as predicted in the article, will stabilize anytime soon. In balance, the law is good for patients who otherwise would go without coverage. In the short run, it may even be good for doctors (absent the 30% cut we face based on the SGR formulation). I am quite sure it will be good for many hospitals. However, over the long haul, the impending increase in healthcare spending, unless truly offset by improvements in prevention and quality, will likely be disastrous for this country, placing an insurmountable burden on our children and their children. An added fiscal note and a plea to call your legislators ...with sequestration, an additional 2% cut for physicians is scheduled to take effect on January 1, 2013.
Mark D. Morasch, M.D., is a vascular surgeon at The Heart and Vascular Center, St. Vincent's Hospital, Billings, Montana, and an associate medical editor of Vascular Specialist.
As everyone knows by now, in essence, the Supreme Court upheld the Accountable Care Act in its entirety on June 28th. Unless repealed by Congress, all or in part, the fiscal projections outlined in this article will become reality. I must say, I find it difficult to believe that growth in spending, as predicted in the article, will stabilize anytime soon. In balance, the law is good for patients who otherwise would go without coverage. In the short run, it may even be good for doctors (absent the 30% cut we face based on the SGR formulation). I am quite sure it will be good for many hospitals. However, over the long haul, the impending increase in healthcare spending, unless truly offset by improvements in prevention and quality, will likely be disastrous for this country, placing an insurmountable burden on our children and their children. An added fiscal note and a plea to call your legislators ...with sequestration, an additional 2% cut for physicians is scheduled to take effect on January 1, 2013.
Mark D. Morasch, M.D., is a vascular surgeon at The Heart and Vascular Center, St. Vincent's Hospital, Billings, Montana, and an associate medical editor of Vascular Specialist.
WASHINGTON – The major expansions in health care coverage in 2014 called for by the Affordable Care Act will cause health care spending to grow by 7.4% that year alone – a rate two percentage points higher than would have occurred without the law, according to an analysis by economists from the Centers for Medicare and Medicaid Services.
Much of that growth will be driven by increased use of physician services (projected to grow by 8.5%) and prescription drugs (projected to grow by 8.8%) as an estimated additional 30 million Americans gain health coverage under the law, Sean P. Keehan and his colleagues from the CMS Office of the Actuary said at a press briefing sponsored by the journal Health Affairs.
Their analysis was published online in the journal Health Affairs (2012 June [doi:10.1377/hlthaff.2012.0404]).
The coming growth in health spending is tempered by the current economic climate, according to the analysis. Estimated spending growth for 2011 is 3.9% – the same rate seen in 2010 and just above the historically slow growth rate of 3.8% in 2009.
"The recent recession and the modest economic recovery have played a role in our projection of near historic lows in health spending growth through 2013," Mr. Keehan said.
The economists noted, however, that once the health care system absorbs those newly insured via the state health insurance exchanges and Medicaid expansion in 2014, growth in spending is projected to stabilize.
"Once you have [the population from the coverage expansion] in, the growth rate of national health spending is projected to be fairly similar with or without the Affordable Care Act," Mr. Keehan said.
The projections also assume the approximate 30% cut in Medicare physician payment under the Sustainable Growth Rate formula will go into effect Jan. 1, 2013, and will remain in effect thereafter. This would bring the growth in Medicare spending down to 1.3%, from 5.9% in 2012. Previously Congress has generally prevented these SGR cuts.
Medicare costs are projected to grow every year, as more baby boomers qualify for benefits. Those costs will be offset partially by cost-saving provisions under the ACA, said CMS economist Gigi Cuckler.
"The growth rate in 2014 is largely influenced by the coverage expansions, but once you go into 2015 through 2021, you still have continuing effects of the coverage expansions," she said.
"However, you have a lot of Medicare cost-savings provisions also in play here that are bringing down the costs at this time."
The analysis is similar to that released last July by CMS.
The projections are based on economic and demographic assumptions that were obtained from the 2012 Medicare Trustees Report.
WASHINGTON – The major expansions in health care coverage in 2014 called for by the Affordable Care Act will cause health care spending to grow by 7.4% that year alone – a rate two percentage points higher than would have occurred without the law, according to an analysis by economists from the Centers for Medicare and Medicaid Services.
Much of that growth will be driven by increased use of physician services (projected to grow by 8.5%) and prescription drugs (projected to grow by 8.8%) as an estimated additional 30 million Americans gain health coverage under the law, Sean P. Keehan and his colleagues from the CMS Office of the Actuary said at a press briefing sponsored by the journal Health Affairs.
Their analysis was published online in the journal Health Affairs (2012 June [doi:10.1377/hlthaff.2012.0404]).
The coming growth in health spending is tempered by the current economic climate, according to the analysis. Estimated spending growth for 2011 is 3.9% – the same rate seen in 2010 and just above the historically slow growth rate of 3.8% in 2009.
"The recent recession and the modest economic recovery have played a role in our projection of near historic lows in health spending growth through 2013," Mr. Keehan said.
The economists noted, however, that once the health care system absorbs those newly insured via the state health insurance exchanges and Medicaid expansion in 2014, growth in spending is projected to stabilize.
"Once you have [the population from the coverage expansion] in, the growth rate of national health spending is projected to be fairly similar with or without the Affordable Care Act," Mr. Keehan said.
The projections also assume the approximate 30% cut in Medicare physician payment under the Sustainable Growth Rate formula will go into effect Jan. 1, 2013, and will remain in effect thereafter. This would bring the growth in Medicare spending down to 1.3%, from 5.9% in 2012. Previously Congress has generally prevented these SGR cuts.
Medicare costs are projected to grow every year, as more baby boomers qualify for benefits. Those costs will be offset partially by cost-saving provisions under the ACA, said CMS economist Gigi Cuckler.
"The growth rate in 2014 is largely influenced by the coverage expansions, but once you go into 2015 through 2021, you still have continuing effects of the coverage expansions," she said.
"However, you have a lot of Medicare cost-savings provisions also in play here that are bringing down the costs at this time."
The analysis is similar to that released last July by CMS.
The projections are based on economic and demographic assumptions that were obtained from the 2012 Medicare Trustees Report.
A PRESS BRIEFING SPONSORED BY THE JOURNAL HEALTH AFFAIRS
Societies Release Update to 2001 Cath Lab Standards
An updated standards document for cardiac catheterization laboratories lifts almost all restrictions on the types of patients eligible for diagnostic procedures in laboratories without cardiovascular surgical backup, details the role of hybrid cath labs, and emphasizes quality improvement and assurance programs.
On May 8, the Society for Cardiovascular Angiography and Interventions (SCAI) and the American College of Cardiology Foundation (ACCF) released an update to the 2001 (J. Am. Coll. Cardiol. 2001;37:2170-214) Cardiac Catheterization Laboratory Standards. (J. Am. Coll. Cardiol. 2012;59:2201-2305)
"There have been a lot of changes since 2001, some of them dramatic," Dr. Thomas M. Bashore, chair of the writing committee and clinical chief of cardiology at Duke University, Durham, N.C., said in a statement. "This document sets the stage for what’s really happening in cath labs today and updates everyone on accepted quality standards and best practices."
Over the last decade, advancements in technology have changed imaging and reporting systems, the authors wrote. Due to lower risk of invasive procedures, there are now cardiac cath labs without on-site surgical backup, a trend that highlights the importance of quality assurance and quality improvement initiatives. Meanwhile, the cath lab has become "multipurpose suite" for diagnostic and therapeutic procedures for pediatric and adult patients, the authors noted. And while hybrid cath labs are not a new phenomenon, more medical centers are looking into creating them as they consider starting transcatheter aortic valve replacement (TAVR) programs.
The consensus document details examples of procedures suitable for hybrid cath labs; staffing, location, and equipment requirements; room, floor, and ceiling design; and audio/video input and output needs. The document also addresses several issues including:
• Cardiac cath labs without on-site cardiac surgical back-up. The document proposes requirements for establishing off-site surgical back-up, but lifts many prior limitations on the types of patients eligible for diagnostic procedures. Specifically, age, heart failure status, severity of stress test abnormalities, left ventricular function, and valve disease no longer restrict patients from receiving diagnostic procedures at stand-alone cath labs. Therapeutic procedures that should still be done only in facilities with cardiovascular surgical back-up include those in adults with congenital heart disease and in children. Primary percutaneous coronary intervention in patients with acute coronary syndrome can be performed in a stand-alone cath lab, provided that the facility complies "with all current guidelines on the establishment of such a program."
• Quality assurance and improvement initiatives. The document details elements of such initiatives, such as benchmarking against peers, participation in a national clinical database, and monitoring the procedures’ quality and appropriateness.
• X-ray imaging. The document summarizes major changes in x-ray imaging that have occurred since the last statement in 2001, in addition to measurement and prevention of exposure to radiation.
• Training requirements. The document summarizes the already-established requirements for training. It also recommends "that both training and practice activity associated with structural heart disease intervention be concentrated among a limited number of laboratories and operators with a particular interest in these procedures."
"What this document does is put everything in one paper," said Dr. Bashore in an interview. "[Cardiologists] can look at their lab and how they’re running their lab, and then compare it to some national standards, and that’s really what this is meant to do, and it’s really trying to get them the tools to do it, so that they can ensure that they’re up to date."
Dr. Charles E. Chambers, who represented SCAI on the document’s writing committee, said that the document is also a resource. "Pay-for performance is what is potentially down the road, if we aren’t already there. And issues such as benchmarking and risk factor stratification are important in quality programs and tracking outcomes, and that’s what’s covered nicely in this paper," said Dr. Chambers, of the Penn State Hershey Heart and Vascular Institute, Hershey, Pa.
But will the document be embraced by practicing physicians? "This document certainly shows best practices, and I think that’s what [physicians] are interested in. We want to give best patient care, and there are enough questions out there that I think this will be embraced as a reference when questions arise," said Dr. Chambers.
The authors’ disclosures are listed at in the consensus document. Dr. Bashore and Dr. Chambers had no relevant disclosures.
Stand-alone cath labs have changed the dynamic in the never ending competition among hospitals and physicians for lucrative cardiovascular services. Downtown teaching hospitals no longer monopolize the interventional cardiology business, and, in fact, in many places have been losing market share rapidly to outlying community hospitals where these procedures can be done more cheaply and with seemingly no increase in risk to the patient in spite of the lack of cardiac surgery backup.
As these centers continue to proliferate it is important to set standards to ensure quality and safety - the intent I’m sure of the SCAI and ACCF document. However, will the benefit of high-quality, cost effective care be realized? Will the proliferation of these labs decrease costs or lead to an increase in procedures and in doing so, drive up the costs of care? Will they perform other procedures to increase revenue and will these non cardiac procedures meet the same quality standard as coronary interventions? And what effect will they have on the education of the next generation of interventional cardiologists if the downtown teaching centers lose too much volume? Time will tell, but based on past experience I would be concerned that cost will increase and maintaining quality may prove to be an elusive goal.
Frank Pomposelli, M.D., is chairman of surgery at St. Elizabeth's Medical Center, Boston. He is also an associate medical editor for Vascular Specialist.
Stand-alone cath labs have changed the dynamic in the never ending competition among hospitals and physicians for lucrative cardiovascular services. Downtown teaching hospitals no longer monopolize the interventional cardiology business, and, in fact, in many places have been losing market share rapidly to outlying community hospitals where these procedures can be done more cheaply and with seemingly no increase in risk to the patient in spite of the lack of cardiac surgery backup.
As these centers continue to proliferate it is important to set standards to ensure quality and safety - the intent I’m sure of the SCAI and ACCF document. However, will the benefit of high-quality, cost effective care be realized? Will the proliferation of these labs decrease costs or lead to an increase in procedures and in doing so, drive up the costs of care? Will they perform other procedures to increase revenue and will these non cardiac procedures meet the same quality standard as coronary interventions? And what effect will they have on the education of the next generation of interventional cardiologists if the downtown teaching centers lose too much volume? Time will tell, but based on past experience I would be concerned that cost will increase and maintaining quality may prove to be an elusive goal.
Frank Pomposelli, M.D., is chairman of surgery at St. Elizabeth's Medical Center, Boston. He is also an associate medical editor for Vascular Specialist.
Stand-alone cath labs have changed the dynamic in the never ending competition among hospitals and physicians for lucrative cardiovascular services. Downtown teaching hospitals no longer monopolize the interventional cardiology business, and, in fact, in many places have been losing market share rapidly to outlying community hospitals where these procedures can be done more cheaply and with seemingly no increase in risk to the patient in spite of the lack of cardiac surgery backup.
As these centers continue to proliferate it is important to set standards to ensure quality and safety - the intent I’m sure of the SCAI and ACCF document. However, will the benefit of high-quality, cost effective care be realized? Will the proliferation of these labs decrease costs or lead to an increase in procedures and in doing so, drive up the costs of care? Will they perform other procedures to increase revenue and will these non cardiac procedures meet the same quality standard as coronary interventions? And what effect will they have on the education of the next generation of interventional cardiologists if the downtown teaching centers lose too much volume? Time will tell, but based on past experience I would be concerned that cost will increase and maintaining quality may prove to be an elusive goal.
Frank Pomposelli, M.D., is chairman of surgery at St. Elizabeth's Medical Center, Boston. He is also an associate medical editor for Vascular Specialist.
An updated standards document for cardiac catheterization laboratories lifts almost all restrictions on the types of patients eligible for diagnostic procedures in laboratories without cardiovascular surgical backup, details the role of hybrid cath labs, and emphasizes quality improvement and assurance programs.
On May 8, the Society for Cardiovascular Angiography and Interventions (SCAI) and the American College of Cardiology Foundation (ACCF) released an update to the 2001 (J. Am. Coll. Cardiol. 2001;37:2170-214) Cardiac Catheterization Laboratory Standards. (J. Am. Coll. Cardiol. 2012;59:2201-2305)
"There have been a lot of changes since 2001, some of them dramatic," Dr. Thomas M. Bashore, chair of the writing committee and clinical chief of cardiology at Duke University, Durham, N.C., said in a statement. "This document sets the stage for what’s really happening in cath labs today and updates everyone on accepted quality standards and best practices."
Over the last decade, advancements in technology have changed imaging and reporting systems, the authors wrote. Due to lower risk of invasive procedures, there are now cardiac cath labs without on-site surgical backup, a trend that highlights the importance of quality assurance and quality improvement initiatives. Meanwhile, the cath lab has become "multipurpose suite" for diagnostic and therapeutic procedures for pediatric and adult patients, the authors noted. And while hybrid cath labs are not a new phenomenon, more medical centers are looking into creating them as they consider starting transcatheter aortic valve replacement (TAVR) programs.
The consensus document details examples of procedures suitable for hybrid cath labs; staffing, location, and equipment requirements; room, floor, and ceiling design; and audio/video input and output needs. The document also addresses several issues including:
• Cardiac cath labs without on-site cardiac surgical back-up. The document proposes requirements for establishing off-site surgical back-up, but lifts many prior limitations on the types of patients eligible for diagnostic procedures. Specifically, age, heart failure status, severity of stress test abnormalities, left ventricular function, and valve disease no longer restrict patients from receiving diagnostic procedures at stand-alone cath labs. Therapeutic procedures that should still be done only in facilities with cardiovascular surgical back-up include those in adults with congenital heart disease and in children. Primary percutaneous coronary intervention in patients with acute coronary syndrome can be performed in a stand-alone cath lab, provided that the facility complies "with all current guidelines on the establishment of such a program."
• Quality assurance and improvement initiatives. The document details elements of such initiatives, such as benchmarking against peers, participation in a national clinical database, and monitoring the procedures’ quality and appropriateness.
• X-ray imaging. The document summarizes major changes in x-ray imaging that have occurred since the last statement in 2001, in addition to measurement and prevention of exposure to radiation.
• Training requirements. The document summarizes the already-established requirements for training. It also recommends "that both training and practice activity associated with structural heart disease intervention be concentrated among a limited number of laboratories and operators with a particular interest in these procedures."
"What this document does is put everything in one paper," said Dr. Bashore in an interview. "[Cardiologists] can look at their lab and how they’re running their lab, and then compare it to some national standards, and that’s really what this is meant to do, and it’s really trying to get them the tools to do it, so that they can ensure that they’re up to date."
Dr. Charles E. Chambers, who represented SCAI on the document’s writing committee, said that the document is also a resource. "Pay-for performance is what is potentially down the road, if we aren’t already there. And issues such as benchmarking and risk factor stratification are important in quality programs and tracking outcomes, and that’s what’s covered nicely in this paper," said Dr. Chambers, of the Penn State Hershey Heart and Vascular Institute, Hershey, Pa.
But will the document be embraced by practicing physicians? "This document certainly shows best practices, and I think that’s what [physicians] are interested in. We want to give best patient care, and there are enough questions out there that I think this will be embraced as a reference when questions arise," said Dr. Chambers.
The authors’ disclosures are listed at in the consensus document. Dr. Bashore and Dr. Chambers had no relevant disclosures.
An updated standards document for cardiac catheterization laboratories lifts almost all restrictions on the types of patients eligible for diagnostic procedures in laboratories without cardiovascular surgical backup, details the role of hybrid cath labs, and emphasizes quality improvement and assurance programs.
On May 8, the Society for Cardiovascular Angiography and Interventions (SCAI) and the American College of Cardiology Foundation (ACCF) released an update to the 2001 (J. Am. Coll. Cardiol. 2001;37:2170-214) Cardiac Catheterization Laboratory Standards. (J. Am. Coll. Cardiol. 2012;59:2201-2305)
"There have been a lot of changes since 2001, some of them dramatic," Dr. Thomas M. Bashore, chair of the writing committee and clinical chief of cardiology at Duke University, Durham, N.C., said in a statement. "This document sets the stage for what’s really happening in cath labs today and updates everyone on accepted quality standards and best practices."
Over the last decade, advancements in technology have changed imaging and reporting systems, the authors wrote. Due to lower risk of invasive procedures, there are now cardiac cath labs without on-site surgical backup, a trend that highlights the importance of quality assurance and quality improvement initiatives. Meanwhile, the cath lab has become "multipurpose suite" for diagnostic and therapeutic procedures for pediatric and adult patients, the authors noted. And while hybrid cath labs are not a new phenomenon, more medical centers are looking into creating them as they consider starting transcatheter aortic valve replacement (TAVR) programs.
The consensus document details examples of procedures suitable for hybrid cath labs; staffing, location, and equipment requirements; room, floor, and ceiling design; and audio/video input and output needs. The document also addresses several issues including:
• Cardiac cath labs without on-site cardiac surgical back-up. The document proposes requirements for establishing off-site surgical back-up, but lifts many prior limitations on the types of patients eligible for diagnostic procedures. Specifically, age, heart failure status, severity of stress test abnormalities, left ventricular function, and valve disease no longer restrict patients from receiving diagnostic procedures at stand-alone cath labs. Therapeutic procedures that should still be done only in facilities with cardiovascular surgical back-up include those in adults with congenital heart disease and in children. Primary percutaneous coronary intervention in patients with acute coronary syndrome can be performed in a stand-alone cath lab, provided that the facility complies "with all current guidelines on the establishment of such a program."
• Quality assurance and improvement initiatives. The document details elements of such initiatives, such as benchmarking against peers, participation in a national clinical database, and monitoring the procedures’ quality and appropriateness.
• X-ray imaging. The document summarizes major changes in x-ray imaging that have occurred since the last statement in 2001, in addition to measurement and prevention of exposure to radiation.
• Training requirements. The document summarizes the already-established requirements for training. It also recommends "that both training and practice activity associated with structural heart disease intervention be concentrated among a limited number of laboratories and operators with a particular interest in these procedures."
"What this document does is put everything in one paper," said Dr. Bashore in an interview. "[Cardiologists] can look at their lab and how they’re running their lab, and then compare it to some national standards, and that’s really what this is meant to do, and it’s really trying to get them the tools to do it, so that they can ensure that they’re up to date."
Dr. Charles E. Chambers, who represented SCAI on the document’s writing committee, said that the document is also a resource. "Pay-for performance is what is potentially down the road, if we aren’t already there. And issues such as benchmarking and risk factor stratification are important in quality programs and tracking outcomes, and that’s what’s covered nicely in this paper," said Dr. Chambers, of the Penn State Hershey Heart and Vascular Institute, Hershey, Pa.
But will the document be embraced by practicing physicians? "This document certainly shows best practices, and I think that’s what [physicians] are interested in. We want to give best patient care, and there are enough questions out there that I think this will be embraced as a reference when questions arise," said Dr. Chambers.
The authors’ disclosures are listed at in the consensus document. Dr. Bashore and Dr. Chambers had no relevant disclosures.
MedPAC Suggests EHR Incentives May Not Cover True Costs
WASHINGTON – Members of the Medicare Payment Advisory Commission expressed concern about the burden placed on smaller practices by the requirements of the Health Information Technology for Economic and Clinical Health (HITECH) Act.
Physicians who meet requirements for the meaningful use of an electronic health record (EHR) can earn incentive payments of up to $44,000 under HITECH. Starting in 2015, physicians who do not participate will be penalized.
One thing the incentive pay does not cover, said Commissioner Peter Butler, is the time needed to manage all the additional data requirements."What [incentives] do not do is provide dollars for decision support, for data repositories, data warehouses, which are really the heart of managing in an [accountable care organization] capitated world. It kind of ignores some of the real tools that ultimately you need to kind of make a difference," said Mr. Butler, Rush University Medical Center, Chicago.
As data requirements increase, the commission should consider how to address that concern in terms of patient satisfaction, noted Dr. Borman, a surgeon at Abington (Pa.) Memorial Hospital.
Despite the flaws in the EHR incentive program, commissioners agreed that, if it’s done right, EHRs would benefit both physicians and patients.
MedPAC Commissioner Dr. William Hall of the University of Rochester (N.Y.), noted that EHR systems support a higher level of coding, which would mean higher payments to physicians than even incentive payments could offer.
Joanna Kim, senior associate director of the American Hospital Association, Washington, testified to the commission that EHR requirements are too challenging, even for hospitals.
"[Incentive payments] are slow to come because the stage one requirements were set entirely too high," Ms. Kim said. She added that certain elements, like the patient portal are too expensive, cause major security concerns, and carry uncertain benefits.
CMS penalties for failing to meet meaningful use requirements will begin in 2015, but they’ll be based on 2013 performances. As well as examining the EHR incentive program, the commission unanimously recommended changes to Medicare fee-for-service benefit design, including:
• Establishing a limit for out-of-pocket expenses to protect beneficiaries who reach catastrophic levels of Medicare costs. The commission recognized that a small group of beneficiaries would reach the out-of-pocket cap in any given year, they said many more would benefit from the cap.
PIReplacing coinsurance (where the beneficiary pays a percentage of the fee) with copayments (where the beneficiary pays a proscribed fee per service) that vary according to the type of service and provider. MedPAC staffers stated copayments are more predictable, easier to budget for, and easier to understand than is coinsurance.
• Placing an additional charge on private supplemental insurance, or Medigap, that pays for services not covered under Medicare. The commission said the charge would help recoup some of the added costs of Medicare.
• Allow the HHS secretary to determine cost sharing based on evidence of service value.
• Maintaining a deductible for Part A and Part B services.
The recommendations were included in the commission’s June report.☐
WASHINGTON – Members of the Medicare Payment Advisory Commission expressed concern about the burden placed on smaller practices by the requirements of the Health Information Technology for Economic and Clinical Health (HITECH) Act.
Physicians who meet requirements for the meaningful use of an electronic health record (EHR) can earn incentive payments of up to $44,000 under HITECH. Starting in 2015, physicians who do not participate will be penalized.
One thing the incentive pay does not cover, said Commissioner Peter Butler, is the time needed to manage all the additional data requirements."What [incentives] do not do is provide dollars for decision support, for data repositories, data warehouses, which are really the heart of managing in an [accountable care organization] capitated world. It kind of ignores some of the real tools that ultimately you need to kind of make a difference," said Mr. Butler, Rush University Medical Center, Chicago.
As data requirements increase, the commission should consider how to address that concern in terms of patient satisfaction, noted Dr. Borman, a surgeon at Abington (Pa.) Memorial Hospital.
Despite the flaws in the EHR incentive program, commissioners agreed that, if it’s done right, EHRs would benefit both physicians and patients.
MedPAC Commissioner Dr. William Hall of the University of Rochester (N.Y.), noted that EHR systems support a higher level of coding, which would mean higher payments to physicians than even incentive payments could offer.
Joanna Kim, senior associate director of the American Hospital Association, Washington, testified to the commission that EHR requirements are too challenging, even for hospitals.
"[Incentive payments] are slow to come because the stage one requirements were set entirely too high," Ms. Kim said. She added that certain elements, like the patient portal are too expensive, cause major security concerns, and carry uncertain benefits.
CMS penalties for failing to meet meaningful use requirements will begin in 2015, but they’ll be based on 2013 performances. As well as examining the EHR incentive program, the commission unanimously recommended changes to Medicare fee-for-service benefit design, including:
• Establishing a limit for out-of-pocket expenses to protect beneficiaries who reach catastrophic levels of Medicare costs. The commission recognized that a small group of beneficiaries would reach the out-of-pocket cap in any given year, they said many more would benefit from the cap.
PIReplacing coinsurance (where the beneficiary pays a percentage of the fee) with copayments (where the beneficiary pays a proscribed fee per service) that vary according to the type of service and provider. MedPAC staffers stated copayments are more predictable, easier to budget for, and easier to understand than is coinsurance.
• Placing an additional charge on private supplemental insurance, or Medigap, that pays for services not covered under Medicare. The commission said the charge would help recoup some of the added costs of Medicare.
• Allow the HHS secretary to determine cost sharing based on evidence of service value.
• Maintaining a deductible for Part A and Part B services.
The recommendations were included in the commission’s June report.☐
WASHINGTON – Members of the Medicare Payment Advisory Commission expressed concern about the burden placed on smaller practices by the requirements of the Health Information Technology for Economic and Clinical Health (HITECH) Act.
Physicians who meet requirements for the meaningful use of an electronic health record (EHR) can earn incentive payments of up to $44,000 under HITECH. Starting in 2015, physicians who do not participate will be penalized.
One thing the incentive pay does not cover, said Commissioner Peter Butler, is the time needed to manage all the additional data requirements."What [incentives] do not do is provide dollars for decision support, for data repositories, data warehouses, which are really the heart of managing in an [accountable care organization] capitated world. It kind of ignores some of the real tools that ultimately you need to kind of make a difference," said Mr. Butler, Rush University Medical Center, Chicago.
As data requirements increase, the commission should consider how to address that concern in terms of patient satisfaction, noted Dr. Borman, a surgeon at Abington (Pa.) Memorial Hospital.
Despite the flaws in the EHR incentive program, commissioners agreed that, if it’s done right, EHRs would benefit both physicians and patients.
MedPAC Commissioner Dr. William Hall of the University of Rochester (N.Y.), noted that EHR systems support a higher level of coding, which would mean higher payments to physicians than even incentive payments could offer.
Joanna Kim, senior associate director of the American Hospital Association, Washington, testified to the commission that EHR requirements are too challenging, even for hospitals.
"[Incentive payments] are slow to come because the stage one requirements were set entirely too high," Ms. Kim said. She added that certain elements, like the patient portal are too expensive, cause major security concerns, and carry uncertain benefits.
CMS penalties for failing to meet meaningful use requirements will begin in 2015, but they’ll be based on 2013 performances. As well as examining the EHR incentive program, the commission unanimously recommended changes to Medicare fee-for-service benefit design, including:
• Establishing a limit for out-of-pocket expenses to protect beneficiaries who reach catastrophic levels of Medicare costs. The commission recognized that a small group of beneficiaries would reach the out-of-pocket cap in any given year, they said many more would benefit from the cap.
PIReplacing coinsurance (where the beneficiary pays a percentage of the fee) with copayments (where the beneficiary pays a proscribed fee per service) that vary according to the type of service and provider. MedPAC staffers stated copayments are more predictable, easier to budget for, and easier to understand than is coinsurance.
• Placing an additional charge on private supplemental insurance, or Medigap, that pays for services not covered under Medicare. The commission said the charge would help recoup some of the added costs of Medicare.
• Allow the HHS secretary to determine cost sharing based on evidence of service value.
• Maintaining a deductible for Part A and Part B services.
The recommendations were included in the commission’s June report.☐
Medicare Hospital Fund Insolvent by 2024
The Medicare Hospital Insurance Trust Fund, which covers Part A hospital benefits, will remain solvent until 2024, according to a new report that was put out by the program’s trustees.
Starting in 2024, however, the trust fund would only be sufficient to cover about 87% of expenses, with that figure falling to 67% by 2050.
These figures are similar to financial projections released in last year’s Medicare Trustees report.
The Medicare Supplemental Medical Insurance Trust Fund, which covers physician visits and prescription drugs, has adequate funding for at least the next 10 years, the trustees also reported.
But the costs for the Part B and Part D programs are rising. For example, total costs under Medicare Part B, the program which covers physician and other outpatient services, are expected to increase annually at 4.9% for the next 5 years. The Part D prescription drug program’s costs are projected to rise by 8.8% through 2021.
The projected lower spending growth for Medicare Part B is based on Congress allowing a nearly 31% cut to Medicare physician fees to occur on Jan. 1, 2013. The trustees said they doubt that lawmakers would allow that type of cut to happen.
"It’s almost certain that lawmakers will override this reduction and that Medicare Part B expenditures will therefore be higher, conceivably as much as 12% higher than is reported in these reports for 2013," according to Robert D. Reischauer, who is one of Medicare’s public trustees as well as the former president of the Urban Institute.
Health and Human Services Secretary Kathleen Sebelius, who also serves as a Medicare trustee, said the Affordable Care Act has added about 8 years of solvency to the Medicare Hospital Insurance Trust Fund in part through provisions that fight health care fraud, help prevent medical errors, and cut excessive payments in the Medicare Advantage program.
Without those changes, she said, the program would have become insolvent by 2016.
Whether the projections of extended solvency will turn out to be accurate depend on whether Congress moves forward with changes to the way Medicare pays physicians and hospitals, Mr. Reischauer said.
He added that it will also rely on the ability of physicians to become more efficient and on private payers to join with the government to demand changes in the health care delivery system. ☐
The unending progression of reports about when Medicare will go broke is beginning to leave me numb. Congress has yet to grapple meaningfully with this issue regardless of who is in the White House or which party controls the House or Senate. The Affordable Care Act, arguably the most significant and contentious piece of healthcare legislation since Medicare was enacted, has only succeeded in kicking the can down the road for 8 years.
Current efforts to control rising costs of healthcare only address half the problem by focusing almost exclusively on the healthcare providers. Until the American public lowers its expectations regarding instantaneous access to high-cost, high-tech medicine regardless of the evidence for or against its use, this problem defies long-term solution. Of course, asking voters to be accountable for their role in the problem is a political third rail and Congress won’t go near it ... at least for eight more years.
Larry W Kraiss, M.D., is professor and chief of the division of vascular surgery, University of Utah, Salt Lake City, and an associate medical editor of Vascular Specialist.
The unending progression of reports about when Medicare will go broke is beginning to leave me numb. Congress has yet to grapple meaningfully with this issue regardless of who is in the White House or which party controls the House or Senate. The Affordable Care Act, arguably the most significant and contentious piece of healthcare legislation since Medicare was enacted, has only succeeded in kicking the can down the road for 8 years.
Current efforts to control rising costs of healthcare only address half the problem by focusing almost exclusively on the healthcare providers. Until the American public lowers its expectations regarding instantaneous access to high-cost, high-tech medicine regardless of the evidence for or against its use, this problem defies long-term solution. Of course, asking voters to be accountable for their role in the problem is a political third rail and Congress won’t go near it ... at least for eight more years.
Larry W Kraiss, M.D., is professor and chief of the division of vascular surgery, University of Utah, Salt Lake City, and an associate medical editor of Vascular Specialist.
The unending progression of reports about when Medicare will go broke is beginning to leave me numb. Congress has yet to grapple meaningfully with this issue regardless of who is in the White House or which party controls the House or Senate. The Affordable Care Act, arguably the most significant and contentious piece of healthcare legislation since Medicare was enacted, has only succeeded in kicking the can down the road for 8 years.
Current efforts to control rising costs of healthcare only address half the problem by focusing almost exclusively on the healthcare providers. Until the American public lowers its expectations regarding instantaneous access to high-cost, high-tech medicine regardless of the evidence for or against its use, this problem defies long-term solution. Of course, asking voters to be accountable for their role in the problem is a political third rail and Congress won’t go near it ... at least for eight more years.
Larry W Kraiss, M.D., is professor and chief of the division of vascular surgery, University of Utah, Salt Lake City, and an associate medical editor of Vascular Specialist.
The Medicare Hospital Insurance Trust Fund, which covers Part A hospital benefits, will remain solvent until 2024, according to a new report that was put out by the program’s trustees.
Starting in 2024, however, the trust fund would only be sufficient to cover about 87% of expenses, with that figure falling to 67% by 2050.
These figures are similar to financial projections released in last year’s Medicare Trustees report.
The Medicare Supplemental Medical Insurance Trust Fund, which covers physician visits and prescription drugs, has adequate funding for at least the next 10 years, the trustees also reported.
But the costs for the Part B and Part D programs are rising. For example, total costs under Medicare Part B, the program which covers physician and other outpatient services, are expected to increase annually at 4.9% for the next 5 years. The Part D prescription drug program’s costs are projected to rise by 8.8% through 2021.
The projected lower spending growth for Medicare Part B is based on Congress allowing a nearly 31% cut to Medicare physician fees to occur on Jan. 1, 2013. The trustees said they doubt that lawmakers would allow that type of cut to happen.
"It’s almost certain that lawmakers will override this reduction and that Medicare Part B expenditures will therefore be higher, conceivably as much as 12% higher than is reported in these reports for 2013," according to Robert D. Reischauer, who is one of Medicare’s public trustees as well as the former president of the Urban Institute.
Health and Human Services Secretary Kathleen Sebelius, who also serves as a Medicare trustee, said the Affordable Care Act has added about 8 years of solvency to the Medicare Hospital Insurance Trust Fund in part through provisions that fight health care fraud, help prevent medical errors, and cut excessive payments in the Medicare Advantage program.
Without those changes, she said, the program would have become insolvent by 2016.
Whether the projections of extended solvency will turn out to be accurate depend on whether Congress moves forward with changes to the way Medicare pays physicians and hospitals, Mr. Reischauer said.
He added that it will also rely on the ability of physicians to become more efficient and on private payers to join with the government to demand changes in the health care delivery system. ☐
The Medicare Hospital Insurance Trust Fund, which covers Part A hospital benefits, will remain solvent until 2024, according to a new report that was put out by the program’s trustees.
Starting in 2024, however, the trust fund would only be sufficient to cover about 87% of expenses, with that figure falling to 67% by 2050.
These figures are similar to financial projections released in last year’s Medicare Trustees report.
The Medicare Supplemental Medical Insurance Trust Fund, which covers physician visits and prescription drugs, has adequate funding for at least the next 10 years, the trustees also reported.
But the costs for the Part B and Part D programs are rising. For example, total costs under Medicare Part B, the program which covers physician and other outpatient services, are expected to increase annually at 4.9% for the next 5 years. The Part D prescription drug program’s costs are projected to rise by 8.8% through 2021.
The projected lower spending growth for Medicare Part B is based on Congress allowing a nearly 31% cut to Medicare physician fees to occur on Jan. 1, 2013. The trustees said they doubt that lawmakers would allow that type of cut to happen.
"It’s almost certain that lawmakers will override this reduction and that Medicare Part B expenditures will therefore be higher, conceivably as much as 12% higher than is reported in these reports for 2013," according to Robert D. Reischauer, who is one of Medicare’s public trustees as well as the former president of the Urban Institute.
Health and Human Services Secretary Kathleen Sebelius, who also serves as a Medicare trustee, said the Affordable Care Act has added about 8 years of solvency to the Medicare Hospital Insurance Trust Fund in part through provisions that fight health care fraud, help prevent medical errors, and cut excessive payments in the Medicare Advantage program.
Without those changes, she said, the program would have become insolvent by 2016.
Whether the projections of extended solvency will turn out to be accurate depend on whether Congress moves forward with changes to the way Medicare pays physicians and hospitals, Mr. Reischauer said.
He added that it will also rely on the ability of physicians to become more efficient and on private payers to join with the government to demand changes in the health care delivery system. ☐
HHS Calls for 1-Year Delay for ICD-10 Implementation
The federal government plans to delay for 1 year a requirement that doctors and other health care providers begin using the ICD-10 standard for diagnosis and procedure codes for 1 year. Physicians will now have until Oct. 1, 2014, to come into compliance with the standard.
Federal officials are also hoping to ease administrative burdens by requiring health plans to use a single, uniform identifier for all their transactions. Both changes were addressed in a proposed rule released on April 9.
Health and Human Services Secretary Kathleen Sebelius announced earlier this year that the health care community would get more time to get up to speed on ICD-10 (formally known as the International Classification of Diseases, 10th Revision), but the proposed rule firms up that commitment.
Many physician organizations, including the American Medical Association, complained to the HHS and members of Congress, arguing that the implementation of the ICD-10 codes will create a significant burden. And it would carry a hefty price tag – close to $100,000 for smaller practices and more than $2 million for large ones, according to the AMA.
Part of the problem, according to the HHS, is that medical practices are having trouble meeting the compliance deadline for a necessary prerequisite for ICD-10, the Associated Standard Committee’s X12 Version 5010 standards (Version 5010) for electronic health care transactions. Moving the compliance deadline for the so-called 5010 standard from October 2013 to October 2014 will give physicians more time to prepare and test their systems, the HHS wrote in its proposed rule.
The proposed rule also outlines a related measure: a plan to require health insurers to adopt a standard national unique health plan identifier, or HPID. Currently, health plans use multiple identifiers of differing lengths and formats. The vagaries of these identifiers can cause improper routing of transactions, difficulty in determining patient eligibility, and other claims processing errors. Health insurers must begin to use the standardized HPID by Oct. 1, 2012.
The use of a unique identifier will allow medical practices to make greater use of automation in claims processing, according to the proposed rule, in turn saving time and money. And, cleaner claims with fewer errors should compound the savings. HHS officials estimate that over 10 years, the return on investment for the entire health care industry will be between $700 million and $4.6 billion.
The adoption of the unique health plan identifier is one of a series of regulations mandated by the Affordable Care Act and aimed at simplifying health care administrative transactions. ☐
The federal government plans to delay for 1 year a requirement that doctors and other health care providers begin using the ICD-10 standard for diagnosis and procedure codes for 1 year. Physicians will now have until Oct. 1, 2014, to come into compliance with the standard.
Federal officials are also hoping to ease administrative burdens by requiring health plans to use a single, uniform identifier for all their transactions. Both changes were addressed in a proposed rule released on April 9.
Health and Human Services Secretary Kathleen Sebelius announced earlier this year that the health care community would get more time to get up to speed on ICD-10 (formally known as the International Classification of Diseases, 10th Revision), but the proposed rule firms up that commitment.
Many physician organizations, including the American Medical Association, complained to the HHS and members of Congress, arguing that the implementation of the ICD-10 codes will create a significant burden. And it would carry a hefty price tag – close to $100,000 for smaller practices and more than $2 million for large ones, according to the AMA.
Part of the problem, according to the HHS, is that medical practices are having trouble meeting the compliance deadline for a necessary prerequisite for ICD-10, the Associated Standard Committee’s X12 Version 5010 standards (Version 5010) for electronic health care transactions. Moving the compliance deadline for the so-called 5010 standard from October 2013 to October 2014 will give physicians more time to prepare and test their systems, the HHS wrote in its proposed rule.
The proposed rule also outlines a related measure: a plan to require health insurers to adopt a standard national unique health plan identifier, or HPID. Currently, health plans use multiple identifiers of differing lengths and formats. The vagaries of these identifiers can cause improper routing of transactions, difficulty in determining patient eligibility, and other claims processing errors. Health insurers must begin to use the standardized HPID by Oct. 1, 2012.
The use of a unique identifier will allow medical practices to make greater use of automation in claims processing, according to the proposed rule, in turn saving time and money. And, cleaner claims with fewer errors should compound the savings. HHS officials estimate that over 10 years, the return on investment for the entire health care industry will be between $700 million and $4.6 billion.
The adoption of the unique health plan identifier is one of a series of regulations mandated by the Affordable Care Act and aimed at simplifying health care administrative transactions. ☐
The federal government plans to delay for 1 year a requirement that doctors and other health care providers begin using the ICD-10 standard for diagnosis and procedure codes for 1 year. Physicians will now have until Oct. 1, 2014, to come into compliance with the standard.
Federal officials are also hoping to ease administrative burdens by requiring health plans to use a single, uniform identifier for all their transactions. Both changes were addressed in a proposed rule released on April 9.
Health and Human Services Secretary Kathleen Sebelius announced earlier this year that the health care community would get more time to get up to speed on ICD-10 (formally known as the International Classification of Diseases, 10th Revision), but the proposed rule firms up that commitment.
Many physician organizations, including the American Medical Association, complained to the HHS and members of Congress, arguing that the implementation of the ICD-10 codes will create a significant burden. And it would carry a hefty price tag – close to $100,000 for smaller practices and more than $2 million for large ones, according to the AMA.
Part of the problem, according to the HHS, is that medical practices are having trouble meeting the compliance deadline for a necessary prerequisite for ICD-10, the Associated Standard Committee’s X12 Version 5010 standards (Version 5010) for electronic health care transactions. Moving the compliance deadline for the so-called 5010 standard from October 2013 to October 2014 will give physicians more time to prepare and test their systems, the HHS wrote in its proposed rule.
The proposed rule also outlines a related measure: a plan to require health insurers to adopt a standard national unique health plan identifier, or HPID. Currently, health plans use multiple identifiers of differing lengths and formats. The vagaries of these identifiers can cause improper routing of transactions, difficulty in determining patient eligibility, and other claims processing errors. Health insurers must begin to use the standardized HPID by Oct. 1, 2012.
The use of a unique identifier will allow medical practices to make greater use of automation in claims processing, according to the proposed rule, in turn saving time and money. And, cleaner claims with fewer errors should compound the savings. HHS officials estimate that over 10 years, the return on investment for the entire health care industry will be between $700 million and $4.6 billion.
The adoption of the unique health plan identifier is one of a series of regulations mandated by the Affordable Care Act and aimed at simplifying health care administrative transactions. ☐
FDA Clears First Test to ID Bacteria Associated with Bloodstream Infections
Last month, the Food and Drug Administration cleared a test designed to quickly identify a dozen types of bacteria that can lead to bloodstream infections.
The Verigene GP Blood Culture Nucleic Acid Test, developed by molecular diagnostic firm Nanosphere Inc. of Northbrook, Ill., can identify Staphylococcus (including methicillin-resistant S. aureus, or MRSA), Streptococcus, Enterococcus (including vancomycin-resistant enterococci), and Listeria.
"The current standard of treatment is to provide broad-spectrum antibiotics, including some last-line therapies, such as vancomycin, in order to get coverage for everything," says Mike McGarrity, a Nanosphere executive. "With antibiotic stewardship programs in the majority of hospitals, there is an understanding of the overuse of these last-line therapies and the development of resistance."
Currently, blood cultures can take two to four days to identify certain types of bacteria and determine whether any present are resistant to certain therapies. Once a blood culture is positive, the Nanosphere test can identify bacteria and antimicrobial resistance genes in roughly two and half hours. In a pitch that McGarrity believes will resonate with HM groups, he positions the product as a cost-saver that can reduce length of stay (LOS) for hospitalized patients, as physicians don’t have to wait two days for test results. Quicker identification can also lead to lower mortality rates, he says.
McGarrity, who says Nanosphere will submit an application to the FDA this year for a similar rapid-results test for Clostridium difficile and a broad enteric panel, adds that the test is $75 per use. With LOS reduction and cost savings for targeted de-escalated therapies, he says, there is clear value in the test.
"This gets the attention of stakeholders," he says.
Last month, the Food and Drug Administration cleared a test designed to quickly identify a dozen types of bacteria that can lead to bloodstream infections.
The Verigene GP Blood Culture Nucleic Acid Test, developed by molecular diagnostic firm Nanosphere Inc. of Northbrook, Ill., can identify Staphylococcus (including methicillin-resistant S. aureus, or MRSA), Streptococcus, Enterococcus (including vancomycin-resistant enterococci), and Listeria.
"The current standard of treatment is to provide broad-spectrum antibiotics, including some last-line therapies, such as vancomycin, in order to get coverage for everything," says Mike McGarrity, a Nanosphere executive. "With antibiotic stewardship programs in the majority of hospitals, there is an understanding of the overuse of these last-line therapies and the development of resistance."
Currently, blood cultures can take two to four days to identify certain types of bacteria and determine whether any present are resistant to certain therapies. Once a blood culture is positive, the Nanosphere test can identify bacteria and antimicrobial resistance genes in roughly two and half hours. In a pitch that McGarrity believes will resonate with HM groups, he positions the product as a cost-saver that can reduce length of stay (LOS) for hospitalized patients, as physicians don’t have to wait two days for test results. Quicker identification can also lead to lower mortality rates, he says.
McGarrity, who says Nanosphere will submit an application to the FDA this year for a similar rapid-results test for Clostridium difficile and a broad enteric panel, adds that the test is $75 per use. With LOS reduction and cost savings for targeted de-escalated therapies, he says, there is clear value in the test.
"This gets the attention of stakeholders," he says.
Last month, the Food and Drug Administration cleared a test designed to quickly identify a dozen types of bacteria that can lead to bloodstream infections.
The Verigene GP Blood Culture Nucleic Acid Test, developed by molecular diagnostic firm Nanosphere Inc. of Northbrook, Ill., can identify Staphylococcus (including methicillin-resistant S. aureus, or MRSA), Streptococcus, Enterococcus (including vancomycin-resistant enterococci), and Listeria.
"The current standard of treatment is to provide broad-spectrum antibiotics, including some last-line therapies, such as vancomycin, in order to get coverage for everything," says Mike McGarrity, a Nanosphere executive. "With antibiotic stewardship programs in the majority of hospitals, there is an understanding of the overuse of these last-line therapies and the development of resistance."
Currently, blood cultures can take two to four days to identify certain types of bacteria and determine whether any present are resistant to certain therapies. Once a blood culture is positive, the Nanosphere test can identify bacteria and antimicrobial resistance genes in roughly two and half hours. In a pitch that McGarrity believes will resonate with HM groups, he positions the product as a cost-saver that can reduce length of stay (LOS) for hospitalized patients, as physicians don’t have to wait two days for test results. Quicker identification can also lead to lower mortality rates, he says.
McGarrity, who says Nanosphere will submit an application to the FDA this year for a similar rapid-results test for Clostridium difficile and a broad enteric panel, adds that the test is $75 per use. With LOS reduction and cost savings for targeted de-escalated therapies, he says, there is clear value in the test.
"This gets the attention of stakeholders," he says.
MedPAC Suggests EHR Incentives May Not Cover True Costs
WASHINGTON – Members of the Medicare Payment Advisory Commission expressed concern about the burden placed on smaller practices by the requirements of the Health Information Technology for Economic and Clinical Health (HITECH) Act.
Physicians who meet requirements for the meaningful use of an electronic health record (EHR) can earn incentive payments of up to $44,000 under HITECH. Starting in 2015, physicians who do not participate will be penalized.
One thing the incentive pay does not cover, according to Commissioner Peter Butler, is the time necessary to manage all the additional data requirements."What [incentives] do not do is provide dollars for decision support, for data repositories, data warehouses, which are really the heart of managing in an [accountable care organization] capitated world. It kind of ignores some of the real tools that ultimately you need to kind of make a difference," said Mr. Butler, president and chief operating officer at Rush University Medical Center, Chicago.
Dr. Karen Borman, a MedPAC commissioner, added that the additional data requirements are also forcing physicians to spend more time in front of the computer instead of interacting with the patient.
As data requirements increase, the commission should consider how to address that concern in terms of patient satisfaction, noted Dr. Borman, a surgeon at Abington (Pa.) Memorial Hospital.
Despite the flaws in the EHR incentive program, commissioners agreed that, if it’s done right, EHRs would benefit both physicians and patients.
MedPAC Commissioner Dr. William Hall of the University of Rochester (N.Y.), noted that EHR systems support a higher level of coding, which would mean higher payments to physicians than even incentive payments could offer.
Joanna Kim, senior associate director of the American Hospital Association, Washington, testified to the commission that EHR requirements are too challenging, even for hospitals.
"[Incentive payments] are slow to come because the stage one requirements were set entirely too high," Ms. Kim said. She added that certain elements, like the patient portal are too expensive to implement, cause major security concerns, and carry uncertain benefits.
CMS penalties for failing to meet meaningful use requirements will not hit until 2015, but they’ll be based on 2013 performances. As well as examining the EHR incentive program, the commission unanimously recommended changes to Medicare fee-for-service benefit design, including:
• Establishing a limit for out-of-pocket expenses to protect beneficiaries who reach catastrophic levels of Medicare costs. Although the commission recognized that a small group of beneficiaries would reach the out-of-pocket cap in any given year, they said many more would benefit from the cap.
• Replacing coinsurance (where the beneficiary pays a percentage of the fee) with copayments (where the beneficiary pays a proscribed fee per service) that vary according to the type of service and provider. According to MedPAC staffers, copayments are more predictable, easier to budget for, and easier to understand than is coinsurance.
• Placing an additional charge on private supplemental insurance, or Medigap, that pays for services not covered under Medicare. The commission said the charge would help recoup some of the added costs of Medicare.
• Allow the HHS secretary to determine cost sharing based on evidence of service value.
• Maintaining a deductible for Part A and Part B services.
The recommendations were included in the commission’s June report.
WASHINGTON – Members of the Medicare Payment Advisory Commission expressed concern about the burden placed on smaller practices by the requirements of the Health Information Technology for Economic and Clinical Health (HITECH) Act.
Physicians who meet requirements for the meaningful use of an electronic health record (EHR) can earn incentive payments of up to $44,000 under HITECH. Starting in 2015, physicians who do not participate will be penalized.
One thing the incentive pay does not cover, according to Commissioner Peter Butler, is the time necessary to manage all the additional data requirements."What [incentives] do not do is provide dollars for decision support, for data repositories, data warehouses, which are really the heart of managing in an [accountable care organization] capitated world. It kind of ignores some of the real tools that ultimately you need to kind of make a difference," said Mr. Butler, president and chief operating officer at Rush University Medical Center, Chicago.
Dr. Karen Borman, a MedPAC commissioner, added that the additional data requirements are also forcing physicians to spend more time in front of the computer instead of interacting with the patient.
As data requirements increase, the commission should consider how to address that concern in terms of patient satisfaction, noted Dr. Borman, a surgeon at Abington (Pa.) Memorial Hospital.
Despite the flaws in the EHR incentive program, commissioners agreed that, if it’s done right, EHRs would benefit both physicians and patients.
MedPAC Commissioner Dr. William Hall of the University of Rochester (N.Y.), noted that EHR systems support a higher level of coding, which would mean higher payments to physicians than even incentive payments could offer.
Joanna Kim, senior associate director of the American Hospital Association, Washington, testified to the commission that EHR requirements are too challenging, even for hospitals.
"[Incentive payments] are slow to come because the stage one requirements were set entirely too high," Ms. Kim said. She added that certain elements, like the patient portal are too expensive to implement, cause major security concerns, and carry uncertain benefits.
CMS penalties for failing to meet meaningful use requirements will not hit until 2015, but they’ll be based on 2013 performances. As well as examining the EHR incentive program, the commission unanimously recommended changes to Medicare fee-for-service benefit design, including:
• Establishing a limit for out-of-pocket expenses to protect beneficiaries who reach catastrophic levels of Medicare costs. Although the commission recognized that a small group of beneficiaries would reach the out-of-pocket cap in any given year, they said many more would benefit from the cap.
• Replacing coinsurance (where the beneficiary pays a percentage of the fee) with copayments (where the beneficiary pays a proscribed fee per service) that vary according to the type of service and provider. According to MedPAC staffers, copayments are more predictable, easier to budget for, and easier to understand than is coinsurance.
• Placing an additional charge on private supplemental insurance, or Medigap, that pays for services not covered under Medicare. The commission said the charge would help recoup some of the added costs of Medicare.
• Allow the HHS secretary to determine cost sharing based on evidence of service value.
• Maintaining a deductible for Part A and Part B services.
The recommendations were included in the commission’s June report.
WASHINGTON – Members of the Medicare Payment Advisory Commission expressed concern about the burden placed on smaller practices by the requirements of the Health Information Technology for Economic and Clinical Health (HITECH) Act.
Physicians who meet requirements for the meaningful use of an electronic health record (EHR) can earn incentive payments of up to $44,000 under HITECH. Starting in 2015, physicians who do not participate will be penalized.
One thing the incentive pay does not cover, according to Commissioner Peter Butler, is the time necessary to manage all the additional data requirements."What [incentives] do not do is provide dollars for decision support, for data repositories, data warehouses, which are really the heart of managing in an [accountable care organization] capitated world. It kind of ignores some of the real tools that ultimately you need to kind of make a difference," said Mr. Butler, president and chief operating officer at Rush University Medical Center, Chicago.
Dr. Karen Borman, a MedPAC commissioner, added that the additional data requirements are also forcing physicians to spend more time in front of the computer instead of interacting with the patient.
As data requirements increase, the commission should consider how to address that concern in terms of patient satisfaction, noted Dr. Borman, a surgeon at Abington (Pa.) Memorial Hospital.
Despite the flaws in the EHR incentive program, commissioners agreed that, if it’s done right, EHRs would benefit both physicians and patients.
MedPAC Commissioner Dr. William Hall of the University of Rochester (N.Y.), noted that EHR systems support a higher level of coding, which would mean higher payments to physicians than even incentive payments could offer.
Joanna Kim, senior associate director of the American Hospital Association, Washington, testified to the commission that EHR requirements are too challenging, even for hospitals.
"[Incentive payments] are slow to come because the stage one requirements were set entirely too high," Ms. Kim said. She added that certain elements, like the patient portal are too expensive to implement, cause major security concerns, and carry uncertain benefits.
CMS penalties for failing to meet meaningful use requirements will not hit until 2015, but they’ll be based on 2013 performances. As well as examining the EHR incentive program, the commission unanimously recommended changes to Medicare fee-for-service benefit design, including:
• Establishing a limit for out-of-pocket expenses to protect beneficiaries who reach catastrophic levels of Medicare costs. Although the commission recognized that a small group of beneficiaries would reach the out-of-pocket cap in any given year, they said many more would benefit from the cap.
• Replacing coinsurance (where the beneficiary pays a percentage of the fee) with copayments (where the beneficiary pays a proscribed fee per service) that vary according to the type of service and provider. According to MedPAC staffers, copayments are more predictable, easier to budget for, and easier to understand than is coinsurance.
• Placing an additional charge on private supplemental insurance, or Medigap, that pays for services not covered under Medicare. The commission said the charge would help recoup some of the added costs of Medicare.
• Allow the HHS secretary to determine cost sharing based on evidence of service value.
• Maintaining a deductible for Part A and Part B services.
The recommendations were included in the commission’s June report.