Government and Regulations

SAN DIEGO -- Facebook, Twitter, and other social media have their rightful place in surgeons' busy schedules, according to several surgeons who participated in a social media symposium at the annual meeting of the Society of American Gastrointestinal and Endoscopic Surgeons.

In fact, these media just might help you land your dream job, raise money, screen applicants to your fellowship program, enhance communication with your peers, or strengthen relationships with your patients.

Dr. Gretchen Purcell Jackson noted that 61% of adults in the United States look online for health information. In addition, 41% of patients have read a commentary or shared experiences about health or medical issues in an online news group, website, or blog; 24% of online patients have consulted rankings or reviews of physicians, providers, and hospitals; 60% of active online patients report that using the Web affected a medical decision; and more than 700 hospitals currently use social networking tools.

"People seek and give advice about their health care concerns, they seek and share information about medical problems, and they share stories about their health care experiences. Some people use social media to raise money for health-related causes. Patients are using social media in a wide variety of ways, and they might be talking about you," said Dr. Jackson, an ACS Fellow and assistant professor of surgery and biomedical informatics at Vanderbilt University, Nashville, Tenn.

Facebook has 845 million active users making more than 1 billion posts per day, while Twitter has more than 465 million accounts and grows by 11 accounts per second.

Facebook is used by 64% of surgeons, compared with 42% of the general population in the United States, according to Dr. Kiran K. Turaga. "As usual, we surgeons are ahead of the curve, but Facebook has unique characteristics that can affect every single aspect of our lives," said Dr. Turaga, assistant professor of surgery at the Medical College of Wisconsin, Milwaukee. "In terms of trainees, it can affect medical student and resident education, and it can affect recruitment. For patients, you can use this for fund-raising, marketing, forming support groups, increasing awareness [about an aspect of health], recruiting for clinical trials, and monitoring for diseases."

More than 95% of U.S. medical schools have a Facebook presence, Dr. Turaga said, and 71% of these have active student group accounts. In addition, 70% of medical students have active individual Facebook accounts. However, 60% of medical schools have reported incidents of students posting unprofessional content, including profanity (in 52% of cases), breach of patient confidentiality (in 13% of cases), or photos of themselves in a state of intoxication (in 39% of cases) (JAMA 2009;302:1309-15).

Through a sister organization known as Causes (www.causes.com), Facebook has 170 million users who have generated $40 million for 27,000 not-for-profit groups, including hospitals. This makes Facebook "a remarkable tool for fund-raising," Dr. Turaga said. "This could be as simple as raising $1,000 for a new east wing in your hospital."

Furthermore, he said, creating an ad on Facebook allows you to reach 19 million people with an interest in cancer, 600,000 people with an interest in surgery, and 5,000 people with an interest in laparoscopy. Facebook also offers physicians unique opportunities for peer-to-peer interaction by providing a platform for online consultations, virtual tumor boards, journals and summaries of medical news and blogs, and discussions of health care reform and other topics of interest. There are currently 757 Facebook health groups with 300,000 members, he said.

Dr. Turaga warned that posting recognizable patient information on Facebook or other social media channels can violate the Health Insurance Portability and Accountability Act, state criminal laws regarding patient health information, state licensure laws, state professional misconduct laws, and standards set by the Joint Commission.

"If you are considering posting any information that is patient specific, make sure you have exclusive consent of the patient," he said. "The other thing to consider is unnecessary patient-provider interaction, which would mean that you start engaging in a relationship with a patient in which you start giving advice. Then you become liable for that advice, so there can be medical-legal consequences."

Before you start using Facebook or another type of social media, Dr. Turaga recommends considering the acronym POST, which stands for people (whom do you want to target with your social media?), objectives (why do you want to target them?), strategy (how are you going to target them?), and technology (which social media will you use to do so?).

Twitter, a microblogging site that allows communication by posts of no more than 140 characters in length, is an open platform of communication rather than a closed platform, explained Dr. Niraj J. Gusani. "This adds a level of complexity – and possibly risk – that may make this medium less ideal for health care professional use. Anything that you post can be seen by anyone in the world at any time. There’s no filter. On the other hand, Twitter has a wide reach, and it’s easy for people to find you," said Dr. Gusani, an ACS Fellow and assistant professor of surgery, medicine, and public health sciences at Pennsylvania State University, Hershey.

A recent survey of 315 members of the American College of Surgeons found that 79% never use Twitter, while 6% use it daily and 3% use it weekly (Bull. Am. Coll. Surg. 2011;96:46-8). In Dr. Gusani’s opinion, surgeons can use Twitter to update the public about the latest news, events, and research highlights; respond to other tweets related to their field, area of research, or organization; participate in tweet chats or Q&A sessions; and tweet highlights from professional events and meetings.

While some clinicians use Twitter for patient contact and marketing, Dr. Gusani cautioned that it’s important to be wary of violating patient confidentiality. A review of 260 physician Twitter accounts revealed that 144 of 5,156 tweets (3%) were categorized as unprofessional (JAMA 2011;305:566-8). Of these, 38 (0.7%) represented potential patient privacy violations and 33 (0.6%) contained profanity.

Dr. Gusani said that he uses Twitter to "push information, studies, and observations related mainly to oncology and surgical oncology patient education. I post perspectives about medical news and occasional retweets." Twitter-based resources and chats that are recommended by Dr. Gusani include #twitJP, a journal club; #hcsm, a global health care chat that takes place at 9 p.m. ET every Sunday; #CMEchat, which takes place every Wednesday at 11 a.m. ET; and #Meded chat, which takes place every Thursday at 4 p.m. and 9 p.m. ET.

Dr. Seung S. Gwon spoke about the potential benefits of LinkedIn, a professional networking site that allows users to strengthen and expand their network of contacts. It currently has more than 15 million members in more than 200 countries and territories, including 44 million-plus members in the U. S. alone.

"The best part about LinkedIn is that it only takes a few minutes to set up your online profile, where you might list your experience, education, and accomplishments," said Dr. Gwon, an ACS Fellow with El Centro (Calif.) Regional Medical Center. The overall purpose is to connect to other users and build a network of trusted contacts, including personal e-mail contacts, professional colleagues, coworkers, and former classmates.

Dr. Gwon said that physicians have been slow to join LinkedIn because it doesn’t allow them to directly connect with their patients. "However, it does provide you with a digital footprint, so if patients want to look, they can," she said. "Also, a lot of people feel there is no value to networking if they’re already employed. If you like your job and you like where you are, there’s no reason to set up a big profile, primarily because most physicians work in a narrowly defined geography and we don’t really see the need to sell ourselves. We rely on word-of-mouth, the reputations that we create in our communities, [and] physicians who refer patients to us."

Even so, she advises physicians to consider joining LinkedIn because it improves Google search rankings, and it is a cost-effective and efficient means to share information and maintain professional relationships.

No speaker had relevant conflicts.

SAN DIEGO -- Facebook, Twitter, and other social media have their rightful place in surgeons' busy schedules, according to several surgeons who participated in a social media symposium at the annual meeting of the Society of American Gastrointestinal and Endoscopic Surgeons.

In fact, these media just might help you land your dream job, raise money, screen applicants to your fellowship program, enhance communication with your peers, or strengthen relationships with your patients.

Dr. Gretchen Purcell Jackson noted that 61% of adults in the United States look online for health information. In addition, 41% of patients have read a commentary or shared experiences about health or medical issues in an online news group, website, or blog; 24% of online patients have consulted rankings or reviews of physicians, providers, and hospitals; 60% of active online patients report that using the Web affected a medical decision; and more than 700 hospitals currently use social networking tools.

"People seek and give advice about their health care concerns, they seek and share information about medical problems, and they share stories about their health care experiences. Some people use social media to raise money for health-related causes. Patients are using social media in a wide variety of ways, and they might be talking about you," said Dr. Jackson, an ACS Fellow and assistant professor of surgery and biomedical informatics at Vanderbilt University, Nashville, Tenn.

Facebook has 845 million active users making more than 1 billion posts per day, while Twitter has more than 465 million accounts and grows by 11 accounts per second.

Facebook is used by 64% of surgeons, compared with 42% of the general population in the United States, according to Dr. Kiran K. Turaga. "As usual, we surgeons are ahead of the curve, but Facebook has unique characteristics that can affect every single aspect of our lives," said Dr. Turaga, assistant professor of surgery at the Medical College of Wisconsin, Milwaukee. "In terms of trainees, it can affect medical student and resident education, and it can affect recruitment. For patients, you can use this for fund-raising, marketing, forming support groups, increasing awareness [about an aspect of health], recruiting for clinical trials, and monitoring for diseases."

More than 95% of U.S. medical schools have a Facebook presence, Dr. Turaga said, and 71% of these have active student group accounts. In addition, 70% of medical students have active individual Facebook accounts. However, 60% of medical schools have reported incidents of students posting unprofessional content, including profanity (in 52% of cases), breach of patient confidentiality (in 13% of cases), or photos of themselves in a state of intoxication (in 39% of cases) (JAMA 2009;302:1309-15).

Through a sister organization known as Causes (www.causes.com), Facebook has 170 million users who have generated $40 million for 27,000 not-for-profit groups, including hospitals. This makes Facebook "a remarkable tool for fund-raising," Dr. Turaga said. "This could be as simple as raising $1,000 for a new east wing in your hospital."

Furthermore, he said, creating an ad on Facebook allows you to reach 19 million people with an interest in cancer, 600,000 people with an interest in surgery, and 5,000 people with an interest in laparoscopy. Facebook also offers physicians unique opportunities for peer-to-peer interaction by providing a platform for online consultations, virtual tumor boards, journals and summaries of medical news and blogs, and discussions of health care reform and other topics of interest. There are currently 757 Facebook health groups with 300,000 members, he said.

Dr. Turaga warned that posting recognizable patient information on Facebook or other social media channels can violate the Health Insurance Portability and Accountability Act, state criminal laws regarding patient health information, state licensure laws, state professional misconduct laws, and standards set by the Joint Commission.

"If you are considering posting any information that is patient specific, make sure you have exclusive consent of the patient," he said. "The other thing to consider is unnecessary patient-provider interaction, which would mean that you start engaging in a relationship with a patient in which you start giving advice. Then you become liable for that advice, so there can be medical-legal consequences."

Before you start using Facebook or another type of social media, Dr. Turaga recommends considering the acronym POST, which stands for people (whom do you want to target with your social media?), objectives (why do you want to target them?), strategy (how are you going to target them?), and technology (which social media will you use to do so?).

Twitter, a microblogging site that allows communication by posts of no more than 140 characters in length, is an open platform of communication rather than a closed platform, explained Dr. Niraj J. Gusani. "This adds a level of complexity – and possibly risk – that may make this medium less ideal for health care professional use. Anything that you post can be seen by anyone in the world at any time. There’s no filter. On the other hand, Twitter has a wide reach, and it’s easy for people to find you," said Dr. Gusani, an ACS Fellow and assistant professor of surgery, medicine, and public health sciences at Pennsylvania State University, Hershey.

A recent survey of 315 members of the American College of Surgeons found that 79% never use Twitter, while 6% use it daily and 3% use it weekly (Bull. Am. Coll. Surg. 2011;96:46-8). In Dr. Gusani’s opinion, surgeons can use Twitter to update the public about the latest news, events, and research highlights; respond to other tweets related to their field, area of research, or organization; participate in tweet chats or Q&A sessions; and tweet highlights from professional events and meetings.

While some clinicians use Twitter for patient contact and marketing, Dr. Gusani cautioned that it’s important to be wary of violating patient confidentiality. A review of 260 physician Twitter accounts revealed that 144 of 5,156 tweets (3%) were categorized as unprofessional (JAMA 2011;305:566-8). Of these, 38 (0.7%) represented potential patient privacy violations and 33 (0.6%) contained profanity.

Dr. Gusani said that he uses Twitter to "push information, studies, and observations related mainly to oncology and surgical oncology patient education. I post perspectives about medical news and occasional retweets." Twitter-based resources and chats that are recommended by Dr. Gusani include #twitJP, a journal club; #hcsm, a global health care chat that takes place at 9 p.m. ET every Sunday; #CMEchat, which takes place every Wednesday at 11 a.m. ET; and #Meded chat, which takes place every Thursday at 4 p.m. and 9 p.m. ET.

Dr. Seung S. Gwon spoke about the potential benefits of LinkedIn, a professional networking site that allows users to strengthen and expand their network of contacts. It currently has more than 15 million members in more than 200 countries and territories, including 44 million-plus members in the U. S. alone.

"The best part about LinkedIn is that it only takes a few minutes to set up your online profile, where you might list your experience, education, and accomplishments," said Dr. Gwon, an ACS Fellow with El Centro (Calif.) Regional Medical Center. The overall purpose is to connect to other users and build a network of trusted contacts, including personal e-mail contacts, professional colleagues, coworkers, and former classmates.

Dr. Gwon said that physicians have been slow to join LinkedIn because it doesn’t allow them to directly connect with their patients. "However, it does provide you with a digital footprint, so if patients want to look, they can," she said. "Also, a lot of people feel there is no value to networking if they’re already employed. If you like your job and you like where you are, there’s no reason to set up a big profile, primarily because most physicians work in a narrowly defined geography and we don’t really see the need to sell ourselves. We rely on word-of-mouth, the reputations that we create in our communities, [and] physicians who refer patients to us."

Even so, she advises physicians to consider joining LinkedIn because it improves Google search rankings, and it is a cost-effective and efficient means to share information and maintain professional relationships.

No speaker had relevant conflicts.

SAN DIEGO -- Facebook, Twitter, and other social media have their rightful place in surgeons' busy schedules, according to several surgeons who participated in a social media symposium at the annual meeting of the Society of American Gastrointestinal and Endoscopic Surgeons.

In fact, these media just might help you land your dream job, raise money, screen applicants to your fellowship program, enhance communication with your peers, or strengthen relationships with your patients.

Dr. Gretchen Purcell Jackson noted that 61% of adults in the United States look online for health information. In addition, 41% of patients have read a commentary or shared experiences about health or medical issues in an online news group, website, or blog; 24% of online patients have consulted rankings or reviews of physicians, providers, and hospitals; 60% of active online patients report that using the Web affected a medical decision; and more than 700 hospitals currently use social networking tools.

"People seek and give advice about their health care concerns, they seek and share information about medical problems, and they share stories about their health care experiences. Some people use social media to raise money for health-related causes. Patients are using social media in a wide variety of ways, and they might be talking about you," said Dr. Jackson, an ACS Fellow and assistant professor of surgery and biomedical informatics at Vanderbilt University, Nashville, Tenn.

Facebook has 845 million active users making more than 1 billion posts per day, while Twitter has more than 465 million accounts and grows by 11 accounts per second.

Facebook is used by 64% of surgeons, compared with 42% of the general population in the United States, according to Dr. Kiran K. Turaga. "As usual, we surgeons are ahead of the curve, but Facebook has unique characteristics that can affect every single aspect of our lives," said Dr. Turaga, assistant professor of surgery at the Medical College of Wisconsin, Milwaukee. "In terms of trainees, it can affect medical student and resident education, and it can affect recruitment. For patients, you can use this for fund-raising, marketing, forming support groups, increasing awareness [about an aspect of health], recruiting for clinical trials, and monitoring for diseases."

More than 95% of U.S. medical schools have a Facebook presence, Dr. Turaga said, and 71% of these have active student group accounts. In addition, 70% of medical students have active individual Facebook accounts. However, 60% of medical schools have reported incidents of students posting unprofessional content, including profanity (in 52% of cases), breach of patient confidentiality (in 13% of cases), or photos of themselves in a state of intoxication (in 39% of cases) (JAMA 2009;302:1309-15).

Through a sister organization known as Causes (www.causes.com), Facebook has 170 million users who have generated $40 million for 27,000 not-for-profit groups, including hospitals. This makes Facebook "a remarkable tool for fund-raising," Dr. Turaga said. "This could be as simple as raising $1,000 for a new east wing in your hospital."

Furthermore, he said, creating an ad on Facebook allows you to reach 19 million people with an interest in cancer, 600,000 people with an interest in surgery, and 5,000 people with an interest in laparoscopy. Facebook also offers physicians unique opportunities for peer-to-peer interaction by providing a platform for online consultations, virtual tumor boards, journals and summaries of medical news and blogs, and discussions of health care reform and other topics of interest. There are currently 757 Facebook health groups with 300,000 members, he said.

Dr. Turaga warned that posting recognizable patient information on Facebook or other social media channels can violate the Health Insurance Portability and Accountability Act, state criminal laws regarding patient health information, state licensure laws, state professional misconduct laws, and standards set by the Joint Commission.

"If you are considering posting any information that is patient specific, make sure you have exclusive consent of the patient," he said. "The other thing to consider is unnecessary patient-provider interaction, which would mean that you start engaging in a relationship with a patient in which you start giving advice. Then you become liable for that advice, so there can be medical-legal consequences."

Before you start using Facebook or another type of social media, Dr. Turaga recommends considering the acronym POST, which stands for people (whom do you want to target with your social media?), objectives (why do you want to target them?), strategy (how are you going to target them?), and technology (which social media will you use to do so?).

Twitter, a microblogging site that allows communication by posts of no more than 140 characters in length, is an open platform of communication rather than a closed platform, explained Dr. Niraj J. Gusani. "This adds a level of complexity – and possibly risk – that may make this medium less ideal for health care professional use. Anything that you post can be seen by anyone in the world at any time. There’s no filter. On the other hand, Twitter has a wide reach, and it’s easy for people to find you," said Dr. Gusani, an ACS Fellow and assistant professor of surgery, medicine, and public health sciences at Pennsylvania State University, Hershey.

A recent survey of 315 members of the American College of Surgeons found that 79% never use Twitter, while 6% use it daily and 3% use it weekly (Bull. Am. Coll. Surg. 2011;96:46-8). In Dr. Gusani’s opinion, surgeons can use Twitter to update the public about the latest news, events, and research highlights; respond to other tweets related to their field, area of research, or organization; participate in tweet chats or Q&A sessions; and tweet highlights from professional events and meetings.

While some clinicians use Twitter for patient contact and marketing, Dr. Gusani cautioned that it’s important to be wary of violating patient confidentiality. A review of 260 physician Twitter accounts revealed that 144 of 5,156 tweets (3%) were categorized as unprofessional (JAMA 2011;305:566-8). Of these, 38 (0.7%) represented potential patient privacy violations and 33 (0.6%) contained profanity.

Dr. Gusani said that he uses Twitter to "push information, studies, and observations related mainly to oncology and surgical oncology patient education. I post perspectives about medical news and occasional retweets." Twitter-based resources and chats that are recommended by Dr. Gusani include #twitJP, a journal club; #hcsm, a global health care chat that takes place at 9 p.m. ET every Sunday; #CMEchat, which takes place every Wednesday at 11 a.m. ET; and #Meded chat, which takes place every Thursday at 4 p.m. and 9 p.m. ET.

Dr. Seung S. Gwon spoke about the potential benefits of LinkedIn, a professional networking site that allows users to strengthen and expand their network of contacts. It currently has more than 15 million members in more than 200 countries and territories, including 44 million-plus members in the U. S. alone.

"The best part about LinkedIn is that it only takes a few minutes to set up your online profile, where you might list your experience, education, and accomplishments," said Dr. Gwon, an ACS Fellow with El Centro (Calif.) Regional Medical Center. The overall purpose is to connect to other users and build a network of trusted contacts, including personal e-mail contacts, professional colleagues, coworkers, and former classmates.

Dr. Gwon said that physicians have been slow to join LinkedIn because it doesn’t allow them to directly connect with their patients. "However, it does provide you with a digital footprint, so if patients want to look, they can," she said. "Also, a lot of people feel there is no value to networking if they’re already employed. If you like your job and you like where you are, there’s no reason to set up a big profile, primarily because most physicians work in a narrowly defined geography and we don’t really see the need to sell ourselves. We rely on word-of-mouth, the reputations that we create in our communities, [and] physicians who refer patients to us."

Even so, she advises physicians to consider joining LinkedIn because it improves Google search rankings, and it is a cost-effective and efficient means to share information and maintain professional relationships.

No speaker had relevant conflicts.

WASHINGTON – By implementing a series of payment reforms now – and adopting MedPAC’s recommendations on replacing the SGR – Congress can fix the Medicare physician pay problem and come closer to paying for it, too.

That’s the bottom line of the March 2012 Report to Congress from the Medicare Payment Advisory Commission (MedPAC), released March 15.

While the recommended cuts may cause some physicians to wince, according to Mark Miller, the blow would be much harder if Congress allows the nearly 30% physician pay cut called for by the Medicare SGR Growth Rate formula to go through, Mr. Miller, MedPAC executive director, said at a press conference.

Key among those recommendations was freezing most Medicare payments to primary care physicians for 10 years and cutting specialists’ payments by 17% over 3 years, followed by a freeze for 7 years more.

"That’s hard medicine," Mr. Miller said. "But one of the things that it does is it reduces the cost of the fix."

MedPAC estimates their recommendations will bring the price tag of repealing the SGR to approximately $200 billion. To pick up another $60 billion to $65 billion in savings, the MedPAC March report lists 29 recommended program and policy changes.

Key among the changes:

• Freeze payments to skilled nursing facilities in 2013, then cut them by 4% in 2014.
• Equalize payments for office-based and hospital outpatient services.
• Modify Medicare Part D low-income subsidies to favor more generic drugs.

"The biggest reason that Congress doesn’t move forward on this issue is that it costs $300 billion. ... It’s a big cost."

WASHINGTON – By implementing a series of payment reforms now – and adopting MedPAC’s recommendations on replacing the SGR – Congress can fix the Medicare physician pay problem and come closer to paying for it, too.

That’s the bottom line of the March 2012 Report to Congress from the Medicare Payment Advisory Commission (MedPAC), released March 15.

While the recommended cuts may cause some physicians to wince, according to Mark Miller, the blow would be much harder if Congress allows the nearly 30% physician pay cut called for by the Medicare SGR Growth Rate formula to go through, Mr. Miller, MedPAC executive director, said at a press conference.

Key among those recommendations was freezing most Medicare payments to primary care physicians for 10 years and cutting specialists’ payments by 17% over 3 years, followed by a freeze for 7 years more.

"That’s hard medicine," Mr. Miller said. "But one of the things that it does is it reduces the cost of the fix."

MedPAC estimates their recommendations will bring the price tag of repealing the SGR to approximately $200 billion. To pick up another $60 billion to $65 billion in savings, the MedPAC March report lists 29 recommended program and policy changes.

Key among the changes:

• Freeze payments to skilled nursing facilities in 2013, then cut them by 4% in 2014.
• Equalize payments for office-based and hospital outpatient services.
• Modify Medicare Part D low-income subsidies to favor more generic drugs.

"The biggest reason that Congress doesn’t move forward on this issue is that it costs $300 billion. ... It’s a big cost."

WASHINGTON – By implementing a series of payment reforms now – and adopting MedPAC’s recommendations on replacing the SGR – Congress can fix the Medicare physician pay problem and come closer to paying for it, too.

That’s the bottom line of the March 2012 Report to Congress from the Medicare Payment Advisory Commission (MedPAC), released March 15.

While the recommended cuts may cause some physicians to wince, according to Mark Miller, the blow would be much harder if Congress allows the nearly 30% physician pay cut called for by the Medicare SGR Growth Rate formula to go through, Mr. Miller, MedPAC executive director, said at a press conference.

Key among those recommendations was freezing most Medicare payments to primary care physicians for 10 years and cutting specialists’ payments by 17% over 3 years, followed by a freeze for 7 years more.

"That’s hard medicine," Mr. Miller said. "But one of the things that it does is it reduces the cost of the fix."

MedPAC estimates their recommendations will bring the price tag of repealing the SGR to approximately $200 billion. To pick up another $60 billion to $65 billion in savings, the MedPAC March report lists 29 recommended program and policy changes.

Key among the changes:

• Freeze payments to skilled nursing facilities in 2013, then cut them by 4% in 2014.
• Equalize payments for office-based and hospital outpatient services.
• Modify Medicare Part D low-income subsidies to favor more generic drugs.

"The biggest reason that Congress doesn’t move forward on this issue is that it costs $300 billion. ... It’s a big cost."

Physicians who opt out of participating in social media risk losing control of their reputations to a certain extent, according to Dr. Danielle S. Walsh.

"People are creating accounts and information about you whether you do it or not. Google your name and I promise you will find something there. You can either contribute to this and police what’s said about you and add to that information, or you can let everyone else do it for you," Dr. Walsh said at the annual meeting of the Society of American Gastrointestinal and Endoscopic Surgeons.

If you choose to become a social media player, one of the best ways to protect yourself from a legal standpoint is to establish a social media policy, said Dr. Walsh, an ACS Fellow in the division of pediatric surgery at the Brody School of Medicine at East Carolina University, Greenville, N.C. "You want to ensure that you can place accurate information on there and correct any inaccuracies that are posted to your site. You also want to give guidance to employees who already use or want to use social media appropriately," she explained.

Templates of social media policies can be found at www.SocialMediaGovernance.com, and the American Medical Association’s guidelines for professionalism in the use of social media can be viewed at www.ama-assn.org/ama/pubmeeting/professionalism-social-media.html.

As you devise a policy, identify all of the involved parties, including your information technology department if you have one, the risk management team of your employer or your hospital, and the legal department and administrative leaders of your institution. "Make sure they all have an opportunity to review what you’re about to do, why you’re doing it; and get their feedback," she advised. Next, decide who will have ultimate ownership and oversight of the social media sites you plan to launch. She offered five "Ws" to include in the policy:

• Who it applies to and who manages the content.

• What types of information/statements are covered by the policy, including legal issues.

• Where it applies, that is, whether it applies to computers used at home, in the workplace, or both.

• When to bring information to top-level managers (e.g., in cases of threats of harm to office staff or patients, complaints about the practice, or privacy violations).

• Why the policy is important: Your guidelines should be designed to keep you out of legal trouble.

Dr. Walsh emphasized the importance of protecting patient privacy online and noted that physicians’ identities can be traced through posts referring to patients, even if physicians omit their names.

"If they know where you work and you describe a patient scenario, or if you post a photograph, and a story about that person eventually hits the media, they can go back and put the pieces together and identify you," she said.

If a patient posts a complaint about you or your practice, a carefully worded response can offset negativity, Dr. Walsh said, by showing that you care and that you are responding in a proactive way.

Dr. Walsh said that she had no relevant financial disclosures.

Physicians who opt out of participating in social media risk losing control of their reputations to a certain extent, according to Dr. Danielle S. Walsh.

"People are creating accounts and information about you whether you do it or not. Google your name and I promise you will find something there. You can either contribute to this and police what’s said about you and add to that information, or you can let everyone else do it for you," Dr. Walsh said at the annual meeting of the Society of American Gastrointestinal and Endoscopic Surgeons.

If you choose to become a social media player, one of the best ways to protect yourself from a legal standpoint is to establish a social media policy, said Dr. Walsh, an ACS Fellow in the division of pediatric surgery at the Brody School of Medicine at East Carolina University, Greenville, N.C. "You want to ensure that you can place accurate information on there and correct any inaccuracies that are posted to your site. You also want to give guidance to employees who already use or want to use social media appropriately," she explained.

Templates of social media policies can be found at www.SocialMediaGovernance.com, and the American Medical Association’s guidelines for professionalism in the use of social media can be viewed at www.ama-assn.org/ama/pubmeeting/professionalism-social-media.html.

As you devise a policy, identify all of the involved parties, including your information technology department if you have one, the risk management team of your employer or your hospital, and the legal department and administrative leaders of your institution. "Make sure they all have an opportunity to review what you’re about to do, why you’re doing it; and get their feedback," she advised. Next, decide who will have ultimate ownership and oversight of the social media sites you plan to launch. She offered five "Ws" to include in the policy:

• Who it applies to and who manages the content.

• What types of information/statements are covered by the policy, including legal issues.

• Where it applies, that is, whether it applies to computers used at home, in the workplace, or both.

• When to bring information to top-level managers (e.g., in cases of threats of harm to office staff or patients, complaints about the practice, or privacy violations).

• Why the policy is important: Your guidelines should be designed to keep you out of legal trouble.

Dr. Walsh emphasized the importance of protecting patient privacy online and noted that physicians’ identities can be traced through posts referring to patients, even if physicians omit their names.

"If they know where you work and you describe a patient scenario, or if you post a photograph, and a story about that person eventually hits the media, they can go back and put the pieces together and identify you," she said.

If a patient posts a complaint about you or your practice, a carefully worded response can offset negativity, Dr. Walsh said, by showing that you care and that you are responding in a proactive way.

Dr. Walsh said that she had no relevant financial disclosures.

Physicians who opt out of participating in social media risk losing control of their reputations to a certain extent, according to Dr. Danielle S. Walsh.

"People are creating accounts and information about you whether you do it or not. Google your name and I promise you will find something there. You can either contribute to this and police what’s said about you and add to that information, or you can let everyone else do it for you," Dr. Walsh said at the annual meeting of the Society of American Gastrointestinal and Endoscopic Surgeons.

If you choose to become a social media player, one of the best ways to protect yourself from a legal standpoint is to establish a social media policy, said Dr. Walsh, an ACS Fellow in the division of pediatric surgery at the Brody School of Medicine at East Carolina University, Greenville, N.C. "You want to ensure that you can place accurate information on there and correct any inaccuracies that are posted to your site. You also want to give guidance to employees who already use or want to use social media appropriately," she explained.

Templates of social media policies can be found at www.SocialMediaGovernance.com, and the American Medical Association’s guidelines for professionalism in the use of social media can be viewed at www.ama-assn.org/ama/pubmeeting/professionalism-social-media.html.

As you devise a policy, identify all of the involved parties, including your information technology department if you have one, the risk management team of your employer or your hospital, and the legal department and administrative leaders of your institution. "Make sure they all have an opportunity to review what you’re about to do, why you’re doing it; and get their feedback," she advised. Next, decide who will have ultimate ownership and oversight of the social media sites you plan to launch. She offered five "Ws" to include in the policy:

• Who it applies to and who manages the content.

• What types of information/statements are covered by the policy, including legal issues.

• Where it applies, that is, whether it applies to computers used at home, in the workplace, or both.

• When to bring information to top-level managers (e.g., in cases of threats of harm to office staff or patients, complaints about the practice, or privacy violations).

• Why the policy is important: Your guidelines should be designed to keep you out of legal trouble.

Dr. Walsh emphasized the importance of protecting patient privacy online and noted that physicians’ identities can be traced through posts referring to patients, even if physicians omit their names.

"If they know where you work and you describe a patient scenario, or if you post a photograph, and a story about that person eventually hits the media, they can go back and put the pieces together and identify you," she said.

If a patient posts a complaint about you or your practice, a carefully worded response can offset negativity, Dr. Walsh said, by showing that you care and that you are responding in a proactive way.

Dr. Walsh said that she had no relevant financial disclosures.

Medicare officials have released a coverage proposal for transcatheter aortic valve replacement 3 months after the procedure was approved in the United States.

The Centers for Medicare and Medicaid Services’ proposal restricts the procedure’s coverage to situations in which all of the following five criteria are met:

• The procedure meets Food and Drug Administration–approved criteria, and an FDA-approved device is used.

• Two cardiac surgeons evaluate the patient’s suitability for open valve replacement surgery.

• The procedure is performed in a facility that meets a certain level of experience. The document breaks down the criteria by centers with or without previous transcatheter aortic valve replacement (TAVR) clinical trial experience. All centers are required to participate in a prospective national TAVR stud, and be committed to the Heart Team concept.

• The cardiac surgeon and interventionalist meet certain qualifications and levels of experience.

• The patient is enrolled in the prospective national registry for TAVR. The treating physician team also needs to be participating in the national registry.

The memo arrived ahead of its March 28 due date, just days after four cardiovascular societies issued a document providing detailed guidance on TAVR implementation in centers across the United States. Heart teams, a national registry, and careful selection of patients are also among the societies’ consensus document highlights.

In the United States, the first valve to be used for TAVR (the Edwards Lifesciences Sapien valve) was approved in November 2011. The valve is currently approved for use in inoperable patients with severe aortic stenosis. Other use of the Sapien valve is limited to clinical trials. Medtronic’s CoreValve is also in being studied in large U.S. trials.

In a joint statement, the Society of Thoracic Surgeons and the American College of Cardiology said they were pleased with CMS’s comprehensive approach to the coverage of TAVR, balancing the patients’ needs with measures that would ensure quality of care.

"This coverage analysis achieves these goals through the use of specialized centers with multidisciplinary heart teams and registry enrollment," said STS President Dr. Jeffrey B. Rich, in a statement. "We are especially pleased that CMS has proposed to provide a smooth path to Medicare coverage as the technology continues to evolve and improve," said ACC President Dr. David R. Holmes, in a statement.

CMS opened the national coverage analysis in September, before Sapien was even approved, in response to a request from the ACC and STS to establish the criteria for national Medicare coverage of the minimally invasive valve procedure. The CMS proposal is a step in the national coverage analysis process, in which the agency decides whether an item or service is covered by Medicare.

The agency is expected to have made a final decision by May of this year.

Medicare officials have released a coverage proposal for transcatheter aortic valve replacement 3 months after the procedure was approved in the United States.

The Centers for Medicare and Medicaid Services’ proposal restricts the procedure’s coverage to situations in which all of the following five criteria are met:

• The procedure meets Food and Drug Administration–approved criteria, and an FDA-approved device is used.

• Two cardiac surgeons evaluate the patient’s suitability for open valve replacement surgery.

• The procedure is performed in a facility that meets a certain level of experience. The document breaks down the criteria by centers with or without previous transcatheter aortic valve replacement (TAVR) clinical trial experience. All centers are required to participate in a prospective national TAVR stud, and be committed to the Heart Team concept.

• The cardiac surgeon and interventionalist meet certain qualifications and levels of experience.

• The patient is enrolled in the prospective national registry for TAVR. The treating physician team also needs to be participating in the national registry.

The memo arrived ahead of its March 28 due date, just days after four cardiovascular societies issued a document providing detailed guidance on TAVR implementation in centers across the United States. Heart teams, a national registry, and careful selection of patients are also among the societies’ consensus document highlights.

In the United States, the first valve to be used for TAVR (the Edwards Lifesciences Sapien valve) was approved in November 2011. The valve is currently approved for use in inoperable patients with severe aortic stenosis. Other use of the Sapien valve is limited to clinical trials. Medtronic’s CoreValve is also in being studied in large U.S. trials.

In a joint statement, the Society of Thoracic Surgeons and the American College of Cardiology said they were pleased with CMS’s comprehensive approach to the coverage of TAVR, balancing the patients’ needs with measures that would ensure quality of care.

"This coverage analysis achieves these goals through the use of specialized centers with multidisciplinary heart teams and registry enrollment," said STS President Dr. Jeffrey B. Rich, in a statement. "We are especially pleased that CMS has proposed to provide a smooth path to Medicare coverage as the technology continues to evolve and improve," said ACC President Dr. David R. Holmes, in a statement.

CMS opened the national coverage analysis in September, before Sapien was even approved, in response to a request from the ACC and STS to establish the criteria for national Medicare coverage of the minimally invasive valve procedure. The CMS proposal is a step in the national coverage analysis process, in which the agency decides whether an item or service is covered by Medicare.

The agency is expected to have made a final decision by May of this year.

Medicare officials have released a coverage proposal for transcatheter aortic valve replacement 3 months after the procedure was approved in the United States.

The Centers for Medicare and Medicaid Services’ proposal restricts the procedure’s coverage to situations in which all of the following five criteria are met:

• The procedure meets Food and Drug Administration–approved criteria, and an FDA-approved device is used.

• Two cardiac surgeons evaluate the patient’s suitability for open valve replacement surgery.

• The procedure is performed in a facility that meets a certain level of experience. The document breaks down the criteria by centers with or without previous transcatheter aortic valve replacement (TAVR) clinical trial experience. All centers are required to participate in a prospective national TAVR stud, and be committed to the Heart Team concept.

• The cardiac surgeon and interventionalist meet certain qualifications and levels of experience.

• The patient is enrolled in the prospective national registry for TAVR. The treating physician team also needs to be participating in the national registry.

The memo arrived ahead of its March 28 due date, just days after four cardiovascular societies issued a document providing detailed guidance on TAVR implementation in centers across the United States. Heart teams, a national registry, and careful selection of patients are also among the societies’ consensus document highlights.

In the United States, the first valve to be used for TAVR (the Edwards Lifesciences Sapien valve) was approved in November 2011. The valve is currently approved for use in inoperable patients with severe aortic stenosis. Other use of the Sapien valve is limited to clinical trials. Medtronic’s CoreValve is also in being studied in large U.S. trials.

In a joint statement, the Society of Thoracic Surgeons and the American College of Cardiology said they were pleased with CMS’s comprehensive approach to the coverage of TAVR, balancing the patients’ needs with measures that would ensure quality of care.

"This coverage analysis achieves these goals through the use of specialized centers with multidisciplinary heart teams and registry enrollment," said STS President Dr. Jeffrey B. Rich, in a statement. "We are especially pleased that CMS has proposed to provide a smooth path to Medicare coverage as the technology continues to evolve and improve," said ACC President Dr. David R. Holmes, in a statement.

CMS opened the national coverage analysis in September, before Sapien was even approved, in response to a request from the ACC and STS to establish the criteria for national Medicare coverage of the minimally invasive valve procedure. The CMS proposal is a step in the national coverage analysis process, in which the agency decides whether an item or service is covered by Medicare.

The agency is expected to have made a final decision by May of this year.

Medicare officials have released a coverage proposal for transcatheter aortic valve replacement 3 months after the procedure was approved in the United States.

The Centers for Medicare and Medicaid Services’ proposal restricts the procedure’s coverage to situations in which all of the following five criteria are met:

• The procedure meets Food and Drug Administration–approved criteria, and an FDA-approved device is used.

• Two cardiac surgeons evaluate the patient’s suitability for open valve replacement surgery.

• The procedure is performed in a facility that meets a certain level of experience. The document breaks down the criteria by centers with or without previous transcatheter aortic valve replacement (TAVR) clinical trial experience. All centers are required to participate in a prospective national TAVR stud, and be committed to the Heart Team concept.

• The cardiac surgeon and interventionalist meet certain qualifications and levels of experience.

• The patient is enrolled in the prospective national registry for TAVR. The treating physician team also needs to be participating in the national registry.

The memo arrived ahead of its March 28 due date, just days after four cardiovascular societies issued a document providing detailed guidance on TAVR implementation in centers across the United States. Heart teams, a national registry, and careful selection of patients are also among the societies’ consensus document highlights.

In the United States, the first valve to be used for TAVR (the Edwards Lifesciences Sapien valve) was approved in November 2011. The valve is currently approved for use in inoperable patients with severe aortic stenosis. Other use of the Sapien valve is limited to clinical trials. Medtronic’s CoreValve is also in being studied in large U.S. trials.

In a joint statement, the Society of Thoracic Surgeons and the American College of Cardiology said they were pleased with CMS’s comprehensive approach to the coverage of TAVR, balancing the patients’ needs with measures that would ensure quality of care.

"This coverage analysis achieves these goals through the use of specialized centers with multidisciplinary heart teams and registry enrollment," said STS President Dr. Jeffrey B. Rich, in a statement. "We are especially pleased that CMS has proposed to provide a smooth path to Medicare coverage as the technology continues to evolve and improve," said ACC President Dr. David R. Holmes, in a statement.

CMS opened the national coverage analysis in September, before Sapien was even approved, in response to a request from the ACC and STS to establish the criteria for national Medicare coverage of the minimally invasive valve procedure. The CMS proposal is a step in the national coverage analysis process, in which the agency decides whether an item or service is covered by Medicare.

The agency is expected to have made a final decision by May of this year.

Medicare officials have released a coverage proposal for transcatheter aortic valve replacement 3 months after the procedure was approved in the United States.

The Centers for Medicare and Medicaid Services’ proposal restricts the procedure’s coverage to situations in which all of the following five criteria are met:

• The procedure meets Food and Drug Administration–approved criteria, and an FDA-approved device is used.

• Two cardiac surgeons evaluate the patient’s suitability for open valve replacement surgery.

• The procedure is performed in a facility that meets a certain level of experience. The document breaks down the criteria by centers with or without previous transcatheter aortic valve replacement (TAVR) clinical trial experience. All centers are required to participate in a prospective national TAVR stud, and be committed to the Heart Team concept.

• The cardiac surgeon and interventionalist meet certain qualifications and levels of experience.

• The patient is enrolled in the prospective national registry for TAVR. The treating physician team also needs to be participating in the national registry.

The memo arrived ahead of its March 28 due date, just days after four cardiovascular societies issued a document providing detailed guidance on TAVR implementation in centers across the United States. Heart teams, a national registry, and careful selection of patients are also among the societies’ consensus document highlights.

In the United States, the first valve to be used for TAVR (the Edwards Lifesciences Sapien valve) was approved in November 2011. The valve is currently approved for use in inoperable patients with severe aortic stenosis. Other use of the Sapien valve is limited to clinical trials. Medtronic’s CoreValve is also in being studied in large U.S. trials.

In a joint statement, the Society of Thoracic Surgeons and the American College of Cardiology said they were pleased with CMS’s comprehensive approach to the coverage of TAVR, balancing the patients’ needs with measures that would ensure quality of care.

"This coverage analysis achieves these goals through the use of specialized centers with multidisciplinary heart teams and registry enrollment," said STS President Dr. Jeffrey B. Rich, in a statement. "We are especially pleased that CMS has proposed to provide a smooth path to Medicare coverage as the technology continues to evolve and improve," said ACC President Dr. David R. Holmes, in a statement.

CMS opened the national coverage analysis in September, before Sapien was even approved, in response to a request from the ACC and STS to establish the criteria for national Medicare coverage of the minimally invasive valve procedure. The CMS proposal is a step in the national coverage analysis process, in which the agency decides whether an item or service is covered by Medicare.

The agency is expected to have made a final decision by May of this year.

Medicare officials have released a coverage proposal for transcatheter aortic valve replacement 3 months after the procedure was approved in the United States.

The Centers for Medicare and Medicaid Services’ proposal restricts the procedure’s coverage to situations in which all of the following five criteria are met:

• The procedure meets Food and Drug Administration–approved criteria, and an FDA-approved device is used.

• Two cardiac surgeons evaluate the patient’s suitability for open valve replacement surgery.

• The procedure is performed in a facility that meets a certain level of experience. The document breaks down the criteria by centers with or without previous transcatheter aortic valve replacement (TAVR) clinical trial experience. All centers are required to participate in a prospective national TAVR stud, and be committed to the Heart Team concept.

• The cardiac surgeon and interventionalist meet certain qualifications and levels of experience.

• The patient is enrolled in the prospective national registry for TAVR. The treating physician team also needs to be participating in the national registry.

The memo arrived ahead of its March 28 due date, just days after four cardiovascular societies issued a document providing detailed guidance on TAVR implementation in centers across the United States. Heart teams, a national registry, and careful selection of patients are also among the societies’ consensus document highlights.

In the United States, the first valve to be used for TAVR (the Edwards Lifesciences Sapien valve) was approved in November 2011. The valve is currently approved for use in inoperable patients with severe aortic stenosis. Other use of the Sapien valve is limited to clinical trials. Medtronic’s CoreValve is also in being studied in large U.S. trials.

In a joint statement, the Society of Thoracic Surgeons and the American College of Cardiology said they were pleased with CMS’s comprehensive approach to the coverage of TAVR, balancing the patients’ needs with measures that would ensure quality of care.

"This coverage analysis achieves these goals through the use of specialized centers with multidisciplinary heart teams and registry enrollment," said STS President Dr. Jeffrey B. Rich, in a statement. "We are especially pleased that CMS has proposed to provide a smooth path to Medicare coverage as the technology continues to evolve and improve," said ACC President Dr. David R. Holmes, in a statement.

CMS opened the national coverage analysis in September, before Sapien was even approved, in response to a request from the ACC and STS to establish the criteria for national Medicare coverage of the minimally invasive valve procedure. The CMS proposal is a step in the national coverage analysis process, in which the agency decides whether an item or service is covered by Medicare.

The agency is expected to have made a final decision by May of this year.

New federal regulations aim to accelerate the use of electronic payments to health care providers while reducing administrative costs and saving resources.

The interim final regulations – part of a series of regulations coming from the Department of Health and Human Services – standardize the format and content of the transmissions that health plans send to banks when paying claims via electronic funds transfer (EFT) and will require plans to use a trace number to match the EFT with the remittance advice sent to providers. Currently the EFT and the remittance documents are sent to providers separately, and matching them is difficult.

The new standards took effect on Jan. 1; full compliance will be required by Jan. 1, 2014, according to the agency.

Under the new rules, "health care professionals will spend less time filling out paperwork and more time focusing on delivering the best care for patients," HHS Secretary Kathleen Sebelius said in a statement.

Further, the rules will cost physicians, hospitals, and other providers little or nothing, since "providers are the receivers of the standardized transactions and not the senders," according to HHS.

The agency also estimated that widespread use of EFT should save physician practices and hospitals between $3 billion and $4.5 billion over the next 10 years. The most common savings from implementation of electronic fund transfers are in paper, printing, and postage, as well as staff time for processing paper payments and depositing checks.

The cost to implement the new standards across all commercial health plans is estimated at between $18 million and $28 million. Implementation in Medicaid, the Children’s Health Insurance Plan, and the Indian Health Service is estimated at $400,000-$600,000. Meanwhile, the savings for commercial health plans could be as much as $40 million over 10 years, and $31 million for Medicaid, CHIP, and IHS, according to an HHS fact sheet.

Use of EFT, while widespread in many industries – has been slow in health care, partly due to lack of standardization of transactions, HHS officials said.

The new standards are required by the Affordable Care Act, and fall under the Health Insurance Portability and Accountability Act (HIPAA). They are second in a series of regulations that aim to streamline health care administrative transactions within the next 5 years. Future efforts are slated to include a standard unique identifier for health plans and standardized claim attachments.

New federal regulations aim to accelerate the use of electronic payments to health care providers while reducing administrative costs and saving resources.

The interim final regulations – part of a series of regulations coming from the Department of Health and Human Services – standardize the format and content of the transmissions that health plans send to banks when paying claims via electronic funds transfer (EFT) and will require plans to use a trace number to match the EFT with the remittance advice sent to providers. Currently the EFT and the remittance documents are sent to providers separately, and matching them is difficult.

The new standards took effect on Jan. 1; full compliance will be required by Jan. 1, 2014, according to the agency.

Under the new rules, "health care professionals will spend less time filling out paperwork and more time focusing on delivering the best care for patients," HHS Secretary Kathleen Sebelius said in a statement.

Further, the rules will cost physicians, hospitals, and other providers little or nothing, since "providers are the receivers of the standardized transactions and not the senders," according to HHS.

The agency also estimated that widespread use of EFT should save physician practices and hospitals between $3 billion and $4.5 billion over the next 10 years. The most common savings from implementation of electronic fund transfers are in paper, printing, and postage, as well as staff time for processing paper payments and depositing checks.

The cost to implement the new standards across all commercial health plans is estimated at between $18 million and $28 million. Implementation in Medicaid, the Children’s Health Insurance Plan, and the Indian Health Service is estimated at $400,000-$600,000. Meanwhile, the savings for commercial health plans could be as much as $40 million over 10 years, and $31 million for Medicaid, CHIP, and IHS, according to an HHS fact sheet.

Use of EFT, while widespread in many industries – has been slow in health care, partly due to lack of standardization of transactions, HHS officials said.

The new standards are required by the Affordable Care Act, and fall under the Health Insurance Portability and Accountability Act (HIPAA). They are second in a series of regulations that aim to streamline health care administrative transactions within the next 5 years. Future efforts are slated to include a standard unique identifier for health plans and standardized claim attachments.

New federal regulations aim to accelerate the use of electronic payments to health care providers while reducing administrative costs and saving resources.

The interim final regulations – part of a series of regulations coming from the Department of Health and Human Services – standardize the format and content of the transmissions that health plans send to banks when paying claims via electronic funds transfer (EFT) and will require plans to use a trace number to match the EFT with the remittance advice sent to providers. Currently the EFT and the remittance documents are sent to providers separately, and matching them is difficult.

The new standards took effect on Jan. 1; full compliance will be required by Jan. 1, 2014, according to the agency.

Under the new rules, "health care professionals will spend less time filling out paperwork and more time focusing on delivering the best care for patients," HHS Secretary Kathleen Sebelius said in a statement.

Further, the rules will cost physicians, hospitals, and other providers little or nothing, since "providers are the receivers of the standardized transactions and not the senders," according to HHS.

The agency also estimated that widespread use of EFT should save physician practices and hospitals between $3 billion and $4.5 billion over the next 10 years. The most common savings from implementation of electronic fund transfers are in paper, printing, and postage, as well as staff time for processing paper payments and depositing checks.

The cost to implement the new standards across all commercial health plans is estimated at between $18 million and $28 million. Implementation in Medicaid, the Children’s Health Insurance Plan, and the Indian Health Service is estimated at $400,000-$600,000. Meanwhile, the savings for commercial health plans could be as much as $40 million over 10 years, and $31 million for Medicaid, CHIP, and IHS, according to an HHS fact sheet.

Use of EFT, while widespread in many industries – has been slow in health care, partly due to lack of standardization of transactions, HHS officials said.

The new standards are required by the Affordable Care Act, and fall under the Health Insurance Portability and Accountability Act (HIPAA). They are second in a series of regulations that aim to streamline health care administrative transactions within the next 5 years. Future efforts are slated to include a standard unique identifier for health plans and standardized claim attachments.

A push to better publicize prices paid by hospitals for implantable devices could gain more steam in response to a recent report from the Government Accountability Office, but device makers contend they should retain the right to keep secret the prices they negotiate with hospitals.

"Lack of price transparency may hamper hospitals’ ability to be prudent purchasers of implantable medical devices," GAO concluded in the report issued earlier this month. It identified substantial variation in prices that hospitals paid for the same type of device based on a survey of dozens of U.S. hospitals, group purchasing organizations (GPOs) and government health care systems. This might indicate Medicare is paying more than it should for certain device-heavy procedures such as cardiac stenting and joint replacements, some policymakers suggest.

In response to the report, Sen. Max Baucus, D-Mont., Senate Finance Committee Chairman who requested the report in 2010, floated the prospect of requiring hospitals that treat Medicare beneficiaries to report to CMS the prices they pay for implantable devices.

Device makers vehemently oppose such an approach, according to David Nexon, senior executive vice president of AdvaMed. Such laws would "disrupt a very well-functioning competitive market and would be bad for the public," he said in an interview.

But hospitals and group purchasing organizations say that the current secrecy puts them at a disadvantage in negotiations with manufacturers, leading to prices that are higher than they would be in a more transparent market. The GAO report offers more support for a statutory change to right the situation, they say.

Jeffrey Lerner, CEO of ECRI Institute, a nonprofit research and services firm for hospitals, is calling for legislation that would simply remove pricing confidentiality clauses from manufacturers’ purchase contracts with hospitals and GPOs.

"In my view, the legislation should be quite simple," Mr. Lerner said in an interview. "It should say, ‘If you want to do business with Medicare, you cannot restrict the sharing and comparing of prices paid.’"

Group purchasing organizations also want to work with Sen. Baucus and other lawmakers to help shape legislation that would prohibit the use of confidentiality clauses in device manufacturers’ purchase contracts. "The medical device companies have essentially made price a proprietary piece of information, which we completely disagree with," said Curtis Rooney, president of the Healthcare Supply Chain Association, the trade group for GPOs.

The American Hospital Association would likely support outlawing gag clauses, said Don May, VP of policy for AHA. But AHA would also be happy to see new rules at least making it easier for hospitals to share more pricing information with the clinical teams that practice at their facilities, Mr. May said.

According to GAO, a manufacturer’s purchase contract often limits a hospital from discussing prices even with its own physicians, which makes it more difficult for surgeons to consider cost when selecting among devices.

Particularly with the evolution toward value-based reimbursement programs and accountable care organizations, hospitals are stepping up efforts to coordinate with physicians to reduce costs. But the lack of price transparency makes those efforts more difficult, hospitals suggest.

Parties on both sides of the price transparency debate admit that any legislation striking down confidentiality clauses would not altogether eliminate variation in device prices charged to hospitals.

"There’s a whole set of reasons prices between hospitals will vary," Mr. Nexon said. This is one reason he argued that it is difficult to come to any policy conclusions based on the data in the GAO report.

Mr. Nexon, citing the work of some economists, also floats the possibility that device prices could actually go up rather than down if full pricing transparency were imposed on manufacturers. Companies may be less willing to give discounts, he explained, "because if you’re going to give a discount to somebody, then how do you justify not giving it to somebody else."

Whether the GAO report actually ends up driving momentum toward legislation in this area remains to be seen. GAO issued a number of caveats in the report, noting, for example, that "the data we obtained on cardiac and orthopedic [device] prices are not generalizable" and "differences in how hospitals purchase the parts or components needed for certain procedures may limit the comparability" of pricing information. Further, the investigators acknowledged that they cannot specify how much implantable device pricing impacts government spending because Medicare reimburses for procedures that incorporate the devices, not the implantables themselves.n

This article was edited from "The Gray Sheet," which is also an Elsevier publication.

A push to better publicize prices paid by hospitals for implantable devices could gain more steam in response to a recent report from the Government Accountability Office, but device makers contend they should retain the right to keep secret the prices they negotiate with hospitals.

"Lack of price transparency may hamper hospitals’ ability to be prudent purchasers of implantable medical devices," GAO concluded in the report issued earlier this month. It identified substantial variation in prices that hospitals paid for the same type of device based on a survey of dozens of U.S. hospitals, group purchasing organizations (GPOs) and government health care systems. This might indicate Medicare is paying more than it should for certain device-heavy procedures such as cardiac stenting and joint replacements, some policymakers suggest.

In response to the report, Sen. Max Baucus, D-Mont., Senate Finance Committee Chairman who requested the report in 2010, floated the prospect of requiring hospitals that treat Medicare beneficiaries to report to CMS the prices they pay for implantable devices.

Device makers vehemently oppose such an approach, according to David Nexon, senior executive vice president of AdvaMed. Such laws would "disrupt a very well-functioning competitive market and would be bad for the public," he said in an interview.

But hospitals and group purchasing organizations say that the current secrecy puts them at a disadvantage in negotiations with manufacturers, leading to prices that are higher than they would be in a more transparent market. The GAO report offers more support for a statutory change to right the situation, they say.

Jeffrey Lerner, CEO of ECRI Institute, a nonprofit research and services firm for hospitals, is calling for legislation that would simply remove pricing confidentiality clauses from manufacturers’ purchase contracts with hospitals and GPOs.

"In my view, the legislation should be quite simple," Mr. Lerner said in an interview. "It should say, ‘If you want to do business with Medicare, you cannot restrict the sharing and comparing of prices paid.’"

Group purchasing organizations also want to work with Sen. Baucus and other lawmakers to help shape legislation that would prohibit the use of confidentiality clauses in device manufacturers’ purchase contracts. "The medical device companies have essentially made price a proprietary piece of information, which we completely disagree with," said Curtis Rooney, president of the Healthcare Supply Chain Association, the trade group for GPOs.

The American Hospital Association would likely support outlawing gag clauses, said Don May, VP of policy for AHA. But AHA would also be happy to see new rules at least making it easier for hospitals to share more pricing information with the clinical teams that practice at their facilities, Mr. May said.

According to GAO, a manufacturer’s purchase contract often limits a hospital from discussing prices even with its own physicians, which makes it more difficult for surgeons to consider cost when selecting among devices.

Particularly with the evolution toward value-based reimbursement programs and accountable care organizations, hospitals are stepping up efforts to coordinate with physicians to reduce costs. But the lack of price transparency makes those efforts more difficult, hospitals suggest.

Parties on both sides of the price transparency debate admit that any legislation striking down confidentiality clauses would not altogether eliminate variation in device prices charged to hospitals.

"There’s a whole set of reasons prices between hospitals will vary," Mr. Nexon said. This is one reason he argued that it is difficult to come to any policy conclusions based on the data in the GAO report.

Mr. Nexon, citing the work of some economists, also floats the possibility that device prices could actually go up rather than down if full pricing transparency were imposed on manufacturers. Companies may be less willing to give discounts, he explained, "because if you’re going to give a discount to somebody, then how do you justify not giving it to somebody else."

Whether the GAO report actually ends up driving momentum toward legislation in this area remains to be seen. GAO issued a number of caveats in the report, noting, for example, that "the data we obtained on cardiac and orthopedic [device] prices are not generalizable" and "differences in how hospitals purchase the parts or components needed for certain procedures may limit the comparability" of pricing information. Further, the investigators acknowledged that they cannot specify how much implantable device pricing impacts government spending because Medicare reimburses for procedures that incorporate the devices, not the implantables themselves.n

This article was edited from "The Gray Sheet," which is also an Elsevier publication.

A push to better publicize prices paid by hospitals for implantable devices could gain more steam in response to a recent report from the Government Accountability Office, but device makers contend they should retain the right to keep secret the prices they negotiate with hospitals.

"Lack of price transparency may hamper hospitals’ ability to be prudent purchasers of implantable medical devices," GAO concluded in the report issued earlier this month. It identified substantial variation in prices that hospitals paid for the same type of device based on a survey of dozens of U.S. hospitals, group purchasing organizations (GPOs) and government health care systems. This might indicate Medicare is paying more than it should for certain device-heavy procedures such as cardiac stenting and joint replacements, some policymakers suggest.

In response to the report, Sen. Max Baucus, D-Mont., Senate Finance Committee Chairman who requested the report in 2010, floated the prospect of requiring hospitals that treat Medicare beneficiaries to report to CMS the prices they pay for implantable devices.

Device makers vehemently oppose such an approach, according to David Nexon, senior executive vice president of AdvaMed. Such laws would "disrupt a very well-functioning competitive market and would be bad for the public," he said in an interview.

But hospitals and group purchasing organizations say that the current secrecy puts them at a disadvantage in negotiations with manufacturers, leading to prices that are higher than they would be in a more transparent market. The GAO report offers more support for a statutory change to right the situation, they say.

Jeffrey Lerner, CEO of ECRI Institute, a nonprofit research and services firm for hospitals, is calling for legislation that would simply remove pricing confidentiality clauses from manufacturers’ purchase contracts with hospitals and GPOs.

"In my view, the legislation should be quite simple," Mr. Lerner said in an interview. "It should say, ‘If you want to do business with Medicare, you cannot restrict the sharing and comparing of prices paid.’"

Group purchasing organizations also want to work with Sen. Baucus and other lawmakers to help shape legislation that would prohibit the use of confidentiality clauses in device manufacturers’ purchase contracts. "The medical device companies have essentially made price a proprietary piece of information, which we completely disagree with," said Curtis Rooney, president of the Healthcare Supply Chain Association, the trade group for GPOs.

The American Hospital Association would likely support outlawing gag clauses, said Don May, VP of policy for AHA. But AHA would also be happy to see new rules at least making it easier for hospitals to share more pricing information with the clinical teams that practice at their facilities, Mr. May said.

According to GAO, a manufacturer’s purchase contract often limits a hospital from discussing prices even with its own physicians, which makes it more difficult for surgeons to consider cost when selecting among devices.

Particularly with the evolution toward value-based reimbursement programs and accountable care organizations, hospitals are stepping up efforts to coordinate with physicians to reduce costs. But the lack of price transparency makes those efforts more difficult, hospitals suggest.

Parties on both sides of the price transparency debate admit that any legislation striking down confidentiality clauses would not altogether eliminate variation in device prices charged to hospitals.

"There’s a whole set of reasons prices between hospitals will vary," Mr. Nexon said. This is one reason he argued that it is difficult to come to any policy conclusions based on the data in the GAO report.

Mr. Nexon, citing the work of some economists, also floats the possibility that device prices could actually go up rather than down if full pricing transparency were imposed on manufacturers. Companies may be less willing to give discounts, he explained, "because if you’re going to give a discount to somebody, then how do you justify not giving it to somebody else."

Whether the GAO report actually ends up driving momentum toward legislation in this area remains to be seen. GAO issued a number of caveats in the report, noting, for example, that "the data we obtained on cardiac and orthopedic [device] prices are not generalizable" and "differences in how hospitals purchase the parts or components needed for certain procedures may limit the comparability" of pricing information. Further, the investigators acknowledged that they cannot specify how much implantable device pricing impacts government spending because Medicare reimburses for procedures that incorporate the devices, not the implantables themselves.n

This article was edited from "The Gray Sheet," which is also an Elsevier publication.

WASHINGTON – The historically low growth in health spending in 2009 continued through 2010, driven largely by the recession, Centers for Medicare and Medicaid officials haveannounced.

U.S. health spending grew 3.9% in 2010, to a total of $2.6 trillion or $8,402 per person. That was a 0.1% rise from 2009, which was already at an all-time low growth rate.

As the nation’s economy slumped throughout 2009 and 2010, consumers cut back on elective surgical procedures, emergency room visits, physician office visits, and prescription drug use, according to the officials.

"Even though the recession officially ended in 2009, its impact on the health sector appears to have continued into 2010," said Anne Martin, an economist with the CMS.

Employers shifted the costs of insurance and care to employees, which drove up out-of-pocket spending in 2010. But consumers overall spent only 1.8% more out-of-pocket in 2010 than they had in 2009, which was a slow rate of growth when compared with historical patterns, Ms. Martin said.

Consumers reacted to cost-shifting by choosing health insurance plans with lower premiums and higher deductibles, and by reducing, where they could, use of personal health care services. Medical prices and the U.S. population remained relatively stable before, during, and after the recession, and yet, personal health spending fell, indicating a willful pullback.

"The slower growth in personal health care spending was mainly driven by the slowdown in the use and intensity of health care goods and services," Ms. Martin said.

The agency documented a shrinkage in the use of hospital care and physician services as compared with historical levels.

Hospital spending grew only 5% to $814 billion in 2010, compared to 6% in 2009. There was a decline in median inpatient admissions, and slower growth in emergency department visits, outpatient visits, and outpatient surgeries.

Overall spending on physicians and clinical services – totaling $515 billion in 2010 – accounted for 20% of total health spending. As consumers went to the doctor less frequently, fewer prescriptions were written. And, many of those dispensed were for less expensive generic drugs. These and other factors led to the slowest rate of growth in prescription drug spending ever recorded – a 1% increase from 2009 to $259 billion. The data were published in the journal Health Affairs (Health Aff. 2012 [doi: 10.1377/hlthaff.2011.1135]).

Growth in spending on physician and clinical services also was historically low, growing 2.5% in 2010 as compared with 3.3% in 2009, said Ms. Martin.

Meanwhile, as employers and private insurers reduced the amount they spent on health care, the federal government’s share of health spending rose – to 29% or a total of $742 billion in 2010.

The rise in federal spending also was attributed to federal subsidies to state Medicaid programs. Medicaid was about 15% of the nation’s health bill in 2010, at $401 billion.

In 2009, the federal government spent 22% more than in 2008; in 2010, spending rose by almost 9%. That compares to a 10% decrease in spending by states and localities in 2008, and a 4% increase in 2010.

Medicare saw an increase in enrollment, both in Medicare Advantage managed care program and traditional fee-for-service Medicare. The increase in traditional enrollment reversed a several-year pattern of decline. Overall, Medicare spending increased 5% in 2010 to $524 billion, but per-enrollee spending did not rise as quickly as it had in 2009.

This is because there was a big reduction in payments for certain types of home health services, but also because of low use of physician services. Small increases in physician fees in 2009 and 2010 also kept a lid on Medicare spending. Those increases were instituted by Congress in response to cuts that would otherwise have been required by Medicare’s Sustainable Growth Rate formula.

The Affordable Care Act had a negligible impact on overall spending, perhaps accounting for less than 0.1% of the slowdown, according to the CMS economists. This small impact is because few of its provisions were in effect in 2010, and some, such as coverage for patients with preexisting conditions, did not enroll as many people as had been expected.

WASHINGTON – The historically low growth in health spending in 2009 continued through 2010, driven largely by the recession, Centers for Medicare and Medicaid officials haveannounced.

U.S. health spending grew 3.9% in 2010, to a total of $2.6 trillion or $8,402 per person. That was a 0.1% rise from 2009, which was already at an all-time low growth rate.

As the nation’s economy slumped throughout 2009 and 2010, consumers cut back on elective surgical procedures, emergency room visits, physician office visits, and prescription drug use, according to the officials.

"Even though the recession officially ended in 2009, its impact on the health sector appears to have continued into 2010," said Anne Martin, an economist with the CMS.

Employers shifted the costs of insurance and care to employees, which drove up out-of-pocket spending in 2010. But consumers overall spent only 1.8% more out-of-pocket in 2010 than they had in 2009, which was a slow rate of growth when compared with historical patterns, Ms. Martin said.

Consumers reacted to cost-shifting by choosing health insurance plans with lower premiums and higher deductibles, and by reducing, where they could, use of personal health care services. Medical prices and the U.S. population remained relatively stable before, during, and after the recession, and yet, personal health spending fell, indicating a willful pullback.

"The slower growth in personal health care spending was mainly driven by the slowdown in the use and intensity of health care goods and services," Ms. Martin said.

The agency documented a shrinkage in the use of hospital care and physician services as compared with historical levels.

Hospital spending grew only 5% to $814 billion in 2010, compared to 6% in 2009. There was a decline in median inpatient admissions, and slower growth in emergency department visits, outpatient visits, and outpatient surgeries.

Overall spending on physicians and clinical services – totaling $515 billion in 2010 – accounted for 20% of total health spending. As consumers went to the doctor less frequently, fewer prescriptions were written. And, many of those dispensed were for less expensive generic drugs. These and other factors led to the slowest rate of growth in prescription drug spending ever recorded – a 1% increase from 2009 to $259 billion. The data were published in the journal Health Affairs (Health Aff. 2012 [doi: 10.1377/hlthaff.2011.1135]).

Growth in spending on physician and clinical services also was historically low, growing 2.5% in 2010 as compared with 3.3% in 2009, said Ms. Martin.

Meanwhile, as employers and private insurers reduced the amount they spent on health care, the federal government’s share of health spending rose – to 29% or a total of $742 billion in 2010.

The rise in federal spending also was attributed to federal subsidies to state Medicaid programs. Medicaid was about 15% of the nation’s health bill in 2010, at $401 billion.

In 2009, the federal government spent 22% more than in 2008; in 2010, spending rose by almost 9%. That compares to a 10% decrease in spending by states and localities in 2008, and a 4% increase in 2010.

Medicare saw an increase in enrollment, both in Medicare Advantage managed care program and traditional fee-for-service Medicare. The increase in traditional enrollment reversed a several-year pattern of decline. Overall, Medicare spending increased 5% in 2010 to $524 billion, but per-enrollee spending did not rise as quickly as it had in 2009.

This is because there was a big reduction in payments for certain types of home health services, but also because of low use of physician services. Small increases in physician fees in 2009 and 2010 also kept a lid on Medicare spending. Those increases were instituted by Congress in response to cuts that would otherwise have been required by Medicare’s Sustainable Growth Rate formula.

The Affordable Care Act had a negligible impact on overall spending, perhaps accounting for less than 0.1% of the slowdown, according to the CMS economists. This small impact is because few of its provisions were in effect in 2010, and some, such as coverage for patients with preexisting conditions, did not enroll as many people as had been expected.

WASHINGTON – The historically low growth in health spending in 2009 continued through 2010, driven largely by the recession, Centers for Medicare and Medicaid officials haveannounced.

U.S. health spending grew 3.9% in 2010, to a total of $2.6 trillion or $8,402 per person. That was a 0.1% rise from 2009, which was already at an all-time low growth rate.

As the nation’s economy slumped throughout 2009 and 2010, consumers cut back on elective surgical procedures, emergency room visits, physician office visits, and prescription drug use, according to the officials.

"Even though the recession officially ended in 2009, its impact on the health sector appears to have continued into 2010," said Anne Martin, an economist with the CMS.

Employers shifted the costs of insurance and care to employees, which drove up out-of-pocket spending in 2010. But consumers overall spent only 1.8% more out-of-pocket in 2010 than they had in 2009, which was a slow rate of growth when compared with historical patterns, Ms. Martin said.

Consumers reacted to cost-shifting by choosing health insurance plans with lower premiums and higher deductibles, and by reducing, where they could, use of personal health care services. Medical prices and the U.S. population remained relatively stable before, during, and after the recession, and yet, personal health spending fell, indicating a willful pullback.

"The slower growth in personal health care spending was mainly driven by the slowdown in the use and intensity of health care goods and services," Ms. Martin said.

The agency documented a shrinkage in the use of hospital care and physician services as compared with historical levels.

Hospital spending grew only 5% to $814 billion in 2010, compared to 6% in 2009. There was a decline in median inpatient admissions, and slower growth in emergency department visits, outpatient visits, and outpatient surgeries.

Overall spending on physicians and clinical services – totaling $515 billion in 2010 – accounted for 20% of total health spending. As consumers went to the doctor less frequently, fewer prescriptions were written. And, many of those dispensed were for less expensive generic drugs. These and other factors led to the slowest rate of growth in prescription drug spending ever recorded – a 1% increase from 2009 to $259 billion. The data were published in the journal Health Affairs (Health Aff. 2012 [doi: 10.1377/hlthaff.2011.1135]).

Growth in spending on physician and clinical services also was historically low, growing 2.5% in 2010 as compared with 3.3% in 2009, said Ms. Martin.

Meanwhile, as employers and private insurers reduced the amount they spent on health care, the federal government’s share of health spending rose – to 29% or a total of $742 billion in 2010.

The rise in federal spending also was attributed to federal subsidies to state Medicaid programs. Medicaid was about 15% of the nation’s health bill in 2010, at $401 billion.

In 2009, the federal government spent 22% more than in 2008; in 2010, spending rose by almost 9%. That compares to a 10% decrease in spending by states and localities in 2008, and a 4% increase in 2010.

Medicare saw an increase in enrollment, both in Medicare Advantage managed care program and traditional fee-for-service Medicare. The increase in traditional enrollment reversed a several-year pattern of decline. Overall, Medicare spending increased 5% in 2010 to $524 billion, but per-enrollee spending did not rise as quickly as it had in 2009.

This is because there was a big reduction in payments for certain types of home health services, but also because of low use of physician services. Small increases in physician fees in 2009 and 2010 also kept a lid on Medicare spending. Those increases were instituted by Congress in response to cuts that would otherwise have been required by Medicare’s Sustainable Growth Rate formula.

The Affordable Care Act had a negligible impact on overall spending, perhaps accounting for less than 0.1% of the slowdown, according to the CMS economists. This small impact is because few of its provisions were in effect in 2010, and some, such as coverage for patients with preexisting conditions, did not enroll as many people as had been expected.

Over the last 2 decades, policymakers have proposed a number of ways to change how health care is delivered by Medicare. But a new analysis from the nonpartisan Congressional Budget Office analyzed 10 major Medicare demonstrations involving disease management and care coordination or some type of value-based payments and found that most of the projects didn’t save money.

The analysis has clear implications for health policy going forward. Under the Affordable Care Act, Congress required the Centers for Medicare and Medicaid Services to pursue new payment and care delivery models including accountable care organizations (ACOs) and bundled payments. Congress also created a new Innovation Center within CMS to test other models of care. The idea behind the newly formed Innovation Center is that Medicare officials will be able to expand successful projects without returning for Congress approval.

Dr. Glen R. Stream, president of the American Academy of Family Physicians, said he expects that the leadership within Medicare will use the CBO analysis to improve future pilot projects. He said he’s hopeful that the work that the Innovation Center is undertaking will yield better results because its projects focus on broader care delivery concepts, such as the patient-centered medical home, rather than targeting only certain chronic conditions, as was done in several past demonstrations.

Looking at the six disease management and care coordination projects that Medicare had already undertaken, CBO analysts found that on average there was little to no effect on hospital admissions or regular Medicare spending. The demonstrations were more likely to reduce costs if they used care managers who had significant, direct contact with physicians and patients. However, those programs generally didn’t save enough money to cover the cost of the extra services provided.

For example, in programs with significant in-person or telephone interaction between care management and patients there was an average 7% drop in hospital admissions and a 3% reduction in regular Medicare spending. However, in order to offset the cost of care management fees, the programs would have had to reduce Medicare expenditures by 13%.

In the four demonstrations that focused on changing the financial incentives for providers, only one produced significant savings. A project that offered bundled payments to physicians and hospitals for heart bypass surgery reduced Medicare expenditures related to heart bypass by about 10% without adverse impact on patient outcomes.

Medicare was able to achieve those savings in large part because officials negotiated bundled payments that were lower than the traditional fee-for-service payments, according to CBO. The other projects, which offered bonuses for meeting quality standards or reducing spending, did not achieve significant savings for the Medicare program, CBO wrote. ☐

Over the last 2 decades, policymakers have proposed a number of ways to change how health care is delivered by Medicare. But a new analysis from the nonpartisan Congressional Budget Office analyzed 10 major Medicare demonstrations involving disease management and care coordination or some type of value-based payments and found that most of the projects didn’t save money.

The analysis has clear implications for health policy going forward. Under the Affordable Care Act, Congress required the Centers for Medicare and Medicaid Services to pursue new payment and care delivery models including accountable care organizations (ACOs) and bundled payments. Congress also created a new Innovation Center within CMS to test other models of care. The idea behind the newly formed Innovation Center is that Medicare officials will be able to expand successful projects without returning for Congress approval.

Dr. Glen R. Stream, president of the American Academy of Family Physicians, said he expects that the leadership within Medicare will use the CBO analysis to improve future pilot projects. He said he’s hopeful that the work that the Innovation Center is undertaking will yield better results because its projects focus on broader care delivery concepts, such as the patient-centered medical home, rather than targeting only certain chronic conditions, as was done in several past demonstrations.

Looking at the six disease management and care coordination projects that Medicare had already undertaken, CBO analysts found that on average there was little to no effect on hospital admissions or regular Medicare spending. The demonstrations were more likely to reduce costs if they used care managers who had significant, direct contact with physicians and patients. However, those programs generally didn’t save enough money to cover the cost of the extra services provided.

For example, in programs with significant in-person or telephone interaction between care management and patients there was an average 7% drop in hospital admissions and a 3% reduction in regular Medicare spending. However, in order to offset the cost of care management fees, the programs would have had to reduce Medicare expenditures by 13%.

In the four demonstrations that focused on changing the financial incentives for providers, only one produced significant savings. A project that offered bundled payments to physicians and hospitals for heart bypass surgery reduced Medicare expenditures related to heart bypass by about 10% without adverse impact on patient outcomes.

Medicare was able to achieve those savings in large part because officials negotiated bundled payments that were lower than the traditional fee-for-service payments, according to CBO. The other projects, which offered bonuses for meeting quality standards or reducing spending, did not achieve significant savings for the Medicare program, CBO wrote. ☐

Over the last 2 decades, policymakers have proposed a number of ways to change how health care is delivered by Medicare. But a new analysis from the nonpartisan Congressional Budget Office analyzed 10 major Medicare demonstrations involving disease management and care coordination or some type of value-based payments and found that most of the projects didn’t save money.

The analysis has clear implications for health policy going forward. Under the Affordable Care Act, Congress required the Centers for Medicare and Medicaid Services to pursue new payment and care delivery models including accountable care organizations (ACOs) and bundled payments. Congress also created a new Innovation Center within CMS to test other models of care. The idea behind the newly formed Innovation Center is that Medicare officials will be able to expand successful projects without returning for Congress approval.

Dr. Glen R. Stream, president of the American Academy of Family Physicians, said he expects that the leadership within Medicare will use the CBO analysis to improve future pilot projects. He said he’s hopeful that the work that the Innovation Center is undertaking will yield better results because its projects focus on broader care delivery concepts, such as the patient-centered medical home, rather than targeting only certain chronic conditions, as was done in several past demonstrations.

Looking at the six disease management and care coordination projects that Medicare had already undertaken, CBO analysts found that on average there was little to no effect on hospital admissions or regular Medicare spending. The demonstrations were more likely to reduce costs if they used care managers who had significant, direct contact with physicians and patients. However, those programs generally didn’t save enough money to cover the cost of the extra services provided.

For example, in programs with significant in-person or telephone interaction between care management and patients there was an average 7% drop in hospital admissions and a 3% reduction in regular Medicare spending. However, in order to offset the cost of care management fees, the programs would have had to reduce Medicare expenditures by 13%.

In the four demonstrations that focused on changing the financial incentives for providers, only one produced significant savings. A project that offered bundled payments to physicians and hospitals for heart bypass surgery reduced Medicare expenditures related to heart bypass by about 10% without adverse impact on patient outcomes.

Medicare was able to achieve those savings in large part because officials negotiated bundled payments that were lower than the traditional fee-for-service payments, according to CBO. The other projects, which offered bonuses for meeting quality standards or reducing spending, did not achieve significant savings for the Medicare program, CBO wrote. ☐