Government and Regulations

Starting in October 2012, about 1% of the payments that hospitals receive from Medicare will be calculated based on performance on clinical quality measures and patient satisfaction scores.

Details of the new initiative, known as the Hospital Inpatient Value-Based Purchasing program, were unveiled in a final rule released by the Centers for Medicare and Medicaid Services (CMS) this Spring.

The initiative was mandated by Congress under the Affordable Care Act.

Under the program, CMS will take 1% of the payments that would otherwise go to hospitals under Medicare’s Inpatient Prospective Payment System and put them in a fund to pay for care based on quality. In the first year, CMS estimates that about $850 million will be available through the fund. Medicare officials will score hospitals based on their performance on each of the measures compared with other hospitals and to how their performance has improved over time.

The new program is the first step in shifting payments toward quality and away from volume, aacording to Dr. Donald Berwick, a CMS administrator, who spoke during a press conference.

"This is one of those areas where improvement of quality and reduction in cost go hand-in-hand," Dr. Berwick said. "My feeling continues to be that the best way for us to arrive at sustainable costs for the health care system is precisely through the improvement of quality of care."

Under the program, payments will be based on performance on 12 clinical process-of-care measures and a survey of patient satisfaction. Process-of-care indicators include measures such as the percentage of patients with myocardial infarction who are given fibrinolytic medication within 30 minutes of arrival at the hospital.

To evaluate patient satisfaction, a random sample of discharged patients will be surveyed about their perceptions, including physician and nurse communication, hospital staff responsiveness, pain management, discharge instructions, and hospital cleanliness.

A complete list of the measures is available online at www.healthcare.gov/news/factsheets/valuebasedpurchasing04292011b.html.

The measures have been endorsed by such national panels as the National Quality Forum, and hospitals have already been reporting their performance on them through Medicare’s Hospital Compare website.

The measures are weighted so that 70% of the payment is based on the quality measures and 30% is based on patient evaluations.

Over time, CMS officials plan to add measures focused on patient outcomes, including prevention of hospital-acquired conditions. And measures will be phased out over time if hospitals achieve consistently high compliance scores, Dr. Berwick said.

The new value-based purchasing initiative is only one way that hospital payments will be tied to quality of care. Starting in 2013, Medicare will reduce payments to hospitals if they have excess 30-day readmissions for patients who suffer heart attacks, heart failure, and pneumonia.

And in 2015, hospitals could see their payments cut if they have high rates of certain hospital-acquired conditions.

The final rule on hospital value-based purchasing was published in the Federal Register in May and becomes final in July.

Starting in October 2012, about 1% of the payments that hospitals receive from Medicare will be calculated based on performance on clinical quality measures and patient satisfaction scores.

Details of the new initiative, known as the Hospital Inpatient Value-Based Purchasing program, were unveiled in a final rule released by the Centers for Medicare and Medicaid Services (CMS) this Spring.

The initiative was mandated by Congress under the Affordable Care Act.

Under the program, CMS will take 1% of the payments that would otherwise go to hospitals under Medicare’s Inpatient Prospective Payment System and put them in a fund to pay for care based on quality. In the first year, CMS estimates that about $850 million will be available through the fund. Medicare officials will score hospitals based on their performance on each of the measures compared with other hospitals and to how their performance has improved over time.

The new program is the first step in shifting payments toward quality and away from volume, aacording to Dr. Donald Berwick, a CMS administrator, who spoke during a press conference.

"This is one of those areas where improvement of quality and reduction in cost go hand-in-hand," Dr. Berwick said. "My feeling continues to be that the best way for us to arrive at sustainable costs for the health care system is precisely through the improvement of quality of care."

Under the program, payments will be based on performance on 12 clinical process-of-care measures and a survey of patient satisfaction. Process-of-care indicators include measures such as the percentage of patients with myocardial infarction who are given fibrinolytic medication within 30 minutes of arrival at the hospital.

To evaluate patient satisfaction, a random sample of discharged patients will be surveyed about their perceptions, including physician and nurse communication, hospital staff responsiveness, pain management, discharge instructions, and hospital cleanliness.

A complete list of the measures is available online at www.healthcare.gov/news/factsheets/valuebasedpurchasing04292011b.html.

The measures have been endorsed by such national panels as the National Quality Forum, and hospitals have already been reporting their performance on them through Medicare’s Hospital Compare website.

The measures are weighted so that 70% of the payment is based on the quality measures and 30% is based on patient evaluations.

Over time, CMS officials plan to add measures focused on patient outcomes, including prevention of hospital-acquired conditions. And measures will be phased out over time if hospitals achieve consistently high compliance scores, Dr. Berwick said.

The new value-based purchasing initiative is only one way that hospital payments will be tied to quality of care. Starting in 2013, Medicare will reduce payments to hospitals if they have excess 30-day readmissions for patients who suffer heart attacks, heart failure, and pneumonia.

And in 2015, hospitals could see their payments cut if they have high rates of certain hospital-acquired conditions.

The final rule on hospital value-based purchasing was published in the Federal Register in May and becomes final in July.

Starting in October 2012, about 1% of the payments that hospitals receive from Medicare will be calculated based on performance on clinical quality measures and patient satisfaction scores.

Details of the new initiative, known as the Hospital Inpatient Value-Based Purchasing program, were unveiled in a final rule released by the Centers for Medicare and Medicaid Services (CMS) this Spring.

The initiative was mandated by Congress under the Affordable Care Act.

Under the program, CMS will take 1% of the payments that would otherwise go to hospitals under Medicare’s Inpatient Prospective Payment System and put them in a fund to pay for care based on quality. In the first year, CMS estimates that about $850 million will be available through the fund. Medicare officials will score hospitals based on their performance on each of the measures compared with other hospitals and to how their performance has improved over time.

The new program is the first step in shifting payments toward quality and away from volume, aacording to Dr. Donald Berwick, a CMS administrator, who spoke during a press conference.

"This is one of those areas where improvement of quality and reduction in cost go hand-in-hand," Dr. Berwick said. "My feeling continues to be that the best way for us to arrive at sustainable costs for the health care system is precisely through the improvement of quality of care."

Under the program, payments will be based on performance on 12 clinical process-of-care measures and a survey of patient satisfaction. Process-of-care indicators include measures such as the percentage of patients with myocardial infarction who are given fibrinolytic medication within 30 minutes of arrival at the hospital.

To evaluate patient satisfaction, a random sample of discharged patients will be surveyed about their perceptions, including physician and nurse communication, hospital staff responsiveness, pain management, discharge instructions, and hospital cleanliness.

A complete list of the measures is available online at www.healthcare.gov/news/factsheets/valuebasedpurchasing04292011b.html.

The measures have been endorsed by such national panels as the National Quality Forum, and hospitals have already been reporting their performance on them through Medicare’s Hospital Compare website.

The measures are weighted so that 70% of the payment is based on the quality measures and 30% is based on patient evaluations.

Over time, CMS officials plan to add measures focused on patient outcomes, including prevention of hospital-acquired conditions. And measures will be phased out over time if hospitals achieve consistently high compliance scores, Dr. Berwick said.

The new value-based purchasing initiative is only one way that hospital payments will be tied to quality of care. Starting in 2013, Medicare will reduce payments to hospitals if they have excess 30-day readmissions for patients who suffer heart attacks, heart failure, and pneumonia.

And in 2015, hospitals could see their payments cut if they have high rates of certain hospital-acquired conditions.

The final rule on hospital value-based purchasing was published in the Federal Register in May and becomes final in July.

A 40% premium cut and simpler enrollment procedures are two changes the federal government is employing to increase enrollment in the Pre-Existing Condition Insurance Plan, Health and Human Services Secretary Kathleen Sebelius announced during a press briefing.

Launched in July 2010 under the Affordable Care Act (ACA), the Pre-Existing Condition Insurance Plan (PCIP) provides an insurance option for people with preexisting conditions who have been denied coverage and have been without insurance for 6 months or more.

To increase awareness for the program, HHS will offer payment for insurance brokers and agents for successfully connecting eligible enrollees with the PCIP program, said Richard Popper, deputy director of insurance programs in the Office of Consumer Information and Insurance Oversight.

Those seeking coverage under the PCIP will no longer have to wait to receive a denial letter from their insurance company in order to enroll. Instead, they can provide attestation of their condition from their physician, nurse practitioner, or physician assistant. Patients with preexisting conditions still will be required to be without insurance for 6 months before they are eligible for coverage under the plan, said Mr. Popper. He added that HHS does not have the authority to waive the 6-month waiting period under the current health law.

Ms. Sebelius emphasized HHS’s priority to increase enrollment in the program. "It’s encouraging to see more people who need health insurance the most getting it, but we know that’s not enough," Ms. Sebelius said.

The measures comply with the ACA provision requiring the PCIP to align premiums and benefits with the private insurance market, Mr. Popper said. However, he said there’s still plenty of room for new enrollees.

"We’ve been enrolling people at an increasing rate, but we know we have the capacity to cover even more people," Mr. Popper said.

He added that funding for the measures will fall under the original $5 billion set aside for the program through the health reform law, as well as existing member premiums.

Despite original HHS estimates that several hundred thousand people would benefit from the PCIP, 18,313 people were enrolled as of early May.

The PCIP is run by the federal government in 23 states and the District of Columbia; remaining states operate their own programs using funding from the ACA. HHS sent letters to those 27 state programs, encouraging them to consider similar reforms to their programs.

A 40% premium cut and simpler enrollment procedures are two changes the federal government is employing to increase enrollment in the Pre-Existing Condition Insurance Plan, Health and Human Services Secretary Kathleen Sebelius announced during a press briefing.

Launched in July 2010 under the Affordable Care Act (ACA), the Pre-Existing Condition Insurance Plan (PCIP) provides an insurance option for people with preexisting conditions who have been denied coverage and have been without insurance for 6 months or more.

To increase awareness for the program, HHS will offer payment for insurance brokers and agents for successfully connecting eligible enrollees with the PCIP program, said Richard Popper, deputy director of insurance programs in the Office of Consumer Information and Insurance Oversight.

Those seeking coverage under the PCIP will no longer have to wait to receive a denial letter from their insurance company in order to enroll. Instead, they can provide attestation of their condition from their physician, nurse practitioner, or physician assistant. Patients with preexisting conditions still will be required to be without insurance for 6 months before they are eligible for coverage under the plan, said Mr. Popper. He added that HHS does not have the authority to waive the 6-month waiting period under the current health law.

Ms. Sebelius emphasized HHS’s priority to increase enrollment in the program. "It’s encouraging to see more people who need health insurance the most getting it, but we know that’s not enough," Ms. Sebelius said.

The measures comply with the ACA provision requiring the PCIP to align premiums and benefits with the private insurance market, Mr. Popper said. However, he said there’s still plenty of room for new enrollees.

"We’ve been enrolling people at an increasing rate, but we know we have the capacity to cover even more people," Mr. Popper said.

He added that funding for the measures will fall under the original $5 billion set aside for the program through the health reform law, as well as existing member premiums.

Despite original HHS estimates that several hundred thousand people would benefit from the PCIP, 18,313 people were enrolled as of early May.

The PCIP is run by the federal government in 23 states and the District of Columbia; remaining states operate their own programs using funding from the ACA. HHS sent letters to those 27 state programs, encouraging them to consider similar reforms to their programs.

A 40% premium cut and simpler enrollment procedures are two changes the federal government is employing to increase enrollment in the Pre-Existing Condition Insurance Plan, Health and Human Services Secretary Kathleen Sebelius announced during a press briefing.

Launched in July 2010 under the Affordable Care Act (ACA), the Pre-Existing Condition Insurance Plan (PCIP) provides an insurance option for people with preexisting conditions who have been denied coverage and have been without insurance for 6 months or more.

To increase awareness for the program, HHS will offer payment for insurance brokers and agents for successfully connecting eligible enrollees with the PCIP program, said Richard Popper, deputy director of insurance programs in the Office of Consumer Information and Insurance Oversight.

Those seeking coverage under the PCIP will no longer have to wait to receive a denial letter from their insurance company in order to enroll. Instead, they can provide attestation of their condition from their physician, nurse practitioner, or physician assistant. Patients with preexisting conditions still will be required to be without insurance for 6 months before they are eligible for coverage under the plan, said Mr. Popper. He added that HHS does not have the authority to waive the 6-month waiting period under the current health law.

Ms. Sebelius emphasized HHS’s priority to increase enrollment in the program. "It’s encouraging to see more people who need health insurance the most getting it, but we know that’s not enough," Ms. Sebelius said.

The measures comply with the ACA provision requiring the PCIP to align premiums and benefits with the private insurance market, Mr. Popper said. However, he said there’s still plenty of room for new enrollees.

"We’ve been enrolling people at an increasing rate, but we know we have the capacity to cover even more people," Mr. Popper said.

He added that funding for the measures will fall under the original $5 billion set aside for the program through the health reform law, as well as existing member premiums.

Despite original HHS estimates that several hundred thousand people would benefit from the PCIP, 18,313 people were enrolled as of early May.

The PCIP is run by the federal government in 23 states and the District of Columbia; remaining states operate their own programs using funding from the ACA. HHS sent letters to those 27 state programs, encouraging them to consider similar reforms to their programs.

As of July 1, Medicaid will no longer pay heath care providers for preventable, health care–acquired injuries or illnesses. The final rule, which implements a part of the Affordable Care Act, takes another step forward in reducing unnecessary health care costs, Dr. Donald M. Berwick, administrator for the Center for Medicare and Medicaid Services, said during a press briefing.

Provider-preventable conditions that will no longer be reimbursed include catheter-associated vascular infections, pressure ulcers, blood incompatibilities, air embolisms, surgical site infections, wrong surgery, wrong-patient surgery, and wrong surgical site, Dr. Berwick said.

The rule is based on similar measures already implemented under Medicare and independently by many states, Dr. Berwick said. Currently, 27 states prohibit payment for health care–acquired conditions and 17 do not pay for preventable conditions, according to Cindy Mann, director of CMS’s Center for Medicaid, CHIP, and Survey and Certification.

The Washington State Medicaid program is considering ways to increase accountability-based payment systems, according to its chief medical officer, Dr. Jeffery Thompson, who spoke during the briefing. Dr. Thompson said the state has determined it could save as much as $100 million, one-sixth of its budget, by eliminating 30-day hospital readmissions.

Under the provision, states will have the flexibility to expand the list of conditions to not be reimbursed, pending CMS approval. States also will have the option to implement the provisions between July 1, 2011, and July 1, 2012.

As of July 1, Medicaid will no longer pay heath care providers for preventable, health care–acquired injuries or illnesses. The final rule, which implements a part of the Affordable Care Act, takes another step forward in reducing unnecessary health care costs, Dr. Donald M. Berwick, administrator for the Center for Medicare and Medicaid Services, said during a press briefing.

Provider-preventable conditions that will no longer be reimbursed include catheter-associated vascular infections, pressure ulcers, blood incompatibilities, air embolisms, surgical site infections, wrong surgery, wrong-patient surgery, and wrong surgical site, Dr. Berwick said.

The rule is based on similar measures already implemented under Medicare and independently by many states, Dr. Berwick said. Currently, 27 states prohibit payment for health care–acquired conditions and 17 do not pay for preventable conditions, according to Cindy Mann, director of CMS’s Center for Medicaid, CHIP, and Survey and Certification.

The Washington State Medicaid program is considering ways to increase accountability-based payment systems, according to its chief medical officer, Dr. Jeffery Thompson, who spoke during the briefing. Dr. Thompson said the state has determined it could save as much as $100 million, one-sixth of its budget, by eliminating 30-day hospital readmissions.

Under the provision, states will have the flexibility to expand the list of conditions to not be reimbursed, pending CMS approval. States also will have the option to implement the provisions between July 1, 2011, and July 1, 2012.

As of July 1, Medicaid will no longer pay heath care providers for preventable, health care–acquired injuries or illnesses. The final rule, which implements a part of the Affordable Care Act, takes another step forward in reducing unnecessary health care costs, Dr. Donald M. Berwick, administrator for the Center for Medicare and Medicaid Services, said during a press briefing.

Provider-preventable conditions that will no longer be reimbursed include catheter-associated vascular infections, pressure ulcers, blood incompatibilities, air embolisms, surgical site infections, wrong surgery, wrong-patient surgery, and wrong surgical site, Dr. Berwick said.

The rule is based on similar measures already implemented under Medicare and independently by many states, Dr. Berwick said. Currently, 27 states prohibit payment for health care–acquired conditions and 17 do not pay for preventable conditions, according to Cindy Mann, director of CMS’s Center for Medicaid, CHIP, and Survey and Certification.

The Washington State Medicaid program is considering ways to increase accountability-based payment systems, according to its chief medical officer, Dr. Jeffery Thompson, who spoke during the briefing. Dr. Thompson said the state has determined it could save as much as $100 million, one-sixth of its budget, by eliminating 30-day hospital readmissions.

Under the provision, states will have the flexibility to expand the list of conditions to not be reimbursed, pending CMS approval. States also will have the option to implement the provisions between July 1, 2011, and July 1, 2012.

WASHINGTON – At a recent hearing on public reporting of hospital performance data, panelists agreed on the importance of measuring for quality, but not on which measurement standards to use.

Current data used to evaluate performance are limited to too small a number of determining factors, asserted Nancy Foster, vice president for quality and patient safety at the American Hospital Association. Ms. Foster served on the five-person panel at a forum titled "Public Reporting of Quality Outcomes: What’s the Best Path Forward?"

It was sponsored by the Alliance for Health Reform and The Commonwealth Fund.

On March 31, the Centers for Medicare and Medicaid Services published data on hospitals’ incidence of eight conditions: foreign object remaining after surgery, air embolisms, blood incompatibility, late-stage pressure ulcers, falls and trauma, vascular catheter–associated infections, catheter-associated urinary tract infections, and manifestations of poor glycemic control.

The data presents each condition per 1,000 discharges and includes national rates of hospital-association conditions. The data were based on claims information submitted by Medicare patients from October 2008 through June 2010.

Ms. Foster maintains that the CMS data are not clinically sound. One example she gave was of hospitals with high reimbursement rates, so-called safety net hospitals that provide care to all individuals regardless of their ability to pay. These facilities, she emphasized, are generally located in communities that lack sufficient health care resources for the populations they serve.

"It shouldn’t be a surprise to us that if they can’t get their medications following discharge from the hospital, that if they can’t get into the right physician office or rehab treatment or whatever else they need, those patients are going to come back to us in larger numbers than in communities where they have adequate access to all those kinds of resources," Ms. Foster said.

Physicians will sometimes avoid treating patients who are sicker or on Medicaid because they are high risk and could make the hospital’s public reports look bad, said Dr. David Share, vice president of Value Partnerships at Blue Cross Blue Shield of Michigan.

"Sometimes the way we measure [quality] actually forces providers to focus on cohorts of patients who aren’t going to get the most benefit, but they’ll focus there because they’re concerned that they won’t look good if they don’t," Dr. Share said. He added that lower-quality outcomes could also be based on a poor hospital system, not necessarily individual physician performance, which he said should be measured separately.

Gerald Shea, assistant to the president of governmental affairs for the AFL-CIO, Washington, argued that improvement is also a question of cost, which he said amounts to nearly $250,000 to test and institute a quality measure.

"We’ve been severely hampered in this enterprise by basically only being able to develop those measures when somebody came forward and said ‘we’ll pay to develop them.’ "

While he admitted that there may be flaws in the current data from public reporting, Mr. Shea said reports have increased awareness for quality care and encouraged significant changes within hospitals. Since 2000, hospitals have increased their attention on factors including readmission rates, the importance of collegial cooperation, and hospital-association conditions, he said.

The Affordable Care Act will require health exchange plans to publicly report on quality of care based on 65 measures.

"There’s a lot of pressure now and a lot of opportunity to use public reporting and transparency as a true level to foster high performance in the country," said Dr. Anne-Marie Audet, vice president for health systems quality and efficiency at The Commonwealth Fund. Dr. Audet said systems continue to focus on ways to create better care and better health at a lower cost.

Thomas Scully, senior counsel at the law office of Alston & Bird in Washington, also served on the panel.

WASHINGTON – At a recent hearing on public reporting of hospital performance data, panelists agreed on the importance of measuring for quality, but not on which measurement standards to use.

Current data used to evaluate performance are limited to too small a number of determining factors, asserted Nancy Foster, vice president for quality and patient safety at the American Hospital Association. Ms. Foster served on the five-person panel at a forum titled "Public Reporting of Quality Outcomes: What’s the Best Path Forward?"

It was sponsored by the Alliance for Health Reform and The Commonwealth Fund.

On March 31, the Centers for Medicare and Medicaid Services published data on hospitals’ incidence of eight conditions: foreign object remaining after surgery, air embolisms, blood incompatibility, late-stage pressure ulcers, falls and trauma, vascular catheter–associated infections, catheter-associated urinary tract infections, and manifestations of poor glycemic control.

The data presents each condition per 1,000 discharges and includes national rates of hospital-association conditions. The data were based on claims information submitted by Medicare patients from October 2008 through June 2010.

Ms. Foster maintains that the CMS data are not clinically sound. One example she gave was of hospitals with high reimbursement rates, so-called safety net hospitals that provide care to all individuals regardless of their ability to pay. These facilities, she emphasized, are generally located in communities that lack sufficient health care resources for the populations they serve.

"It shouldn’t be a surprise to us that if they can’t get their medications following discharge from the hospital, that if they can’t get into the right physician office or rehab treatment or whatever else they need, those patients are going to come back to us in larger numbers than in communities where they have adequate access to all those kinds of resources," Ms. Foster said.

Physicians will sometimes avoid treating patients who are sicker or on Medicaid because they are high risk and could make the hospital’s public reports look bad, said Dr. David Share, vice president of Value Partnerships at Blue Cross Blue Shield of Michigan.

"Sometimes the way we measure [quality] actually forces providers to focus on cohorts of patients who aren’t going to get the most benefit, but they’ll focus there because they’re concerned that they won’t look good if they don’t," Dr. Share said. He added that lower-quality outcomes could also be based on a poor hospital system, not necessarily individual physician performance, which he said should be measured separately.

Gerald Shea, assistant to the president of governmental affairs for the AFL-CIO, Washington, argued that improvement is also a question of cost, which he said amounts to nearly $250,000 to test and institute a quality measure.

"We’ve been severely hampered in this enterprise by basically only being able to develop those measures when somebody came forward and said ‘we’ll pay to develop them.’ "

While he admitted that there may be flaws in the current data from public reporting, Mr. Shea said reports have increased awareness for quality care and encouraged significant changes within hospitals. Since 2000, hospitals have increased their attention on factors including readmission rates, the importance of collegial cooperation, and hospital-association conditions, he said.

The Affordable Care Act will require health exchange plans to publicly report on quality of care based on 65 measures.

"There’s a lot of pressure now and a lot of opportunity to use public reporting and transparency as a true level to foster high performance in the country," said Dr. Anne-Marie Audet, vice president for health systems quality and efficiency at The Commonwealth Fund. Dr. Audet said systems continue to focus on ways to create better care and better health at a lower cost.

Thomas Scully, senior counsel at the law office of Alston & Bird in Washington, also served on the panel.

WASHINGTON – At a recent hearing on public reporting of hospital performance data, panelists agreed on the importance of measuring for quality, but not on which measurement standards to use.

Current data used to evaluate performance are limited to too small a number of determining factors, asserted Nancy Foster, vice president for quality and patient safety at the American Hospital Association. Ms. Foster served on the five-person panel at a forum titled "Public Reporting of Quality Outcomes: What’s the Best Path Forward?"

It was sponsored by the Alliance for Health Reform and The Commonwealth Fund.

On March 31, the Centers for Medicare and Medicaid Services published data on hospitals’ incidence of eight conditions: foreign object remaining after surgery, air embolisms, blood incompatibility, late-stage pressure ulcers, falls and trauma, vascular catheter–associated infections, catheter-associated urinary tract infections, and manifestations of poor glycemic control.

The data presents each condition per 1,000 discharges and includes national rates of hospital-association conditions. The data were based on claims information submitted by Medicare patients from October 2008 through June 2010.

Ms. Foster maintains that the CMS data are not clinically sound. One example she gave was of hospitals with high reimbursement rates, so-called safety net hospitals that provide care to all individuals regardless of their ability to pay. These facilities, she emphasized, are generally located in communities that lack sufficient health care resources for the populations they serve.

"It shouldn’t be a surprise to us that if they can’t get their medications following discharge from the hospital, that if they can’t get into the right physician office or rehab treatment or whatever else they need, those patients are going to come back to us in larger numbers than in communities where they have adequate access to all those kinds of resources," Ms. Foster said.

Physicians will sometimes avoid treating patients who are sicker or on Medicaid because they are high risk and could make the hospital’s public reports look bad, said Dr. David Share, vice president of Value Partnerships at Blue Cross Blue Shield of Michigan.

"Sometimes the way we measure [quality] actually forces providers to focus on cohorts of patients who aren’t going to get the most benefit, but they’ll focus there because they’re concerned that they won’t look good if they don’t," Dr. Share said. He added that lower-quality outcomes could also be based on a poor hospital system, not necessarily individual physician performance, which he said should be measured separately.

Gerald Shea, assistant to the president of governmental affairs for the AFL-CIO, Washington, argued that improvement is also a question of cost, which he said amounts to nearly $250,000 to test and institute a quality measure.

"We’ve been severely hampered in this enterprise by basically only being able to develop those measures when somebody came forward and said ‘we’ll pay to develop them.’ "

While he admitted that there may be flaws in the current data from public reporting, Mr. Shea said reports have increased awareness for quality care and encouraged significant changes within hospitals. Since 2000, hospitals have increased their attention on factors including readmission rates, the importance of collegial cooperation, and hospital-association conditions, he said.

The Affordable Care Act will require health exchange plans to publicly report on quality of care based on 65 measures.

"There’s a lot of pressure now and a lot of opportunity to use public reporting and transparency as a true level to foster high performance in the country," said Dr. Anne-Marie Audet, vice president for health systems quality and efficiency at The Commonwealth Fund. Dr. Audet said systems continue to focus on ways to create better care and better health at a lower cost.

Thomas Scully, senior counsel at the law office of Alston & Bird in Washington, also served on the panel.

As expected, the Centers for Medicare and Medicaid Services proposed that physician fees for 2012 would be reduced by 29.5%. The proposed rule was released in the Federal Register on July 1.

The reduction is required by the Sustainable Growth Rate (SGR) formula that was included as part of the Balanced Budget Act of 1997. But Dr. Donald M. Berwick, CMS administrator, said in a statement that the agency is hoping to find a way to avoid the statutory decrease.

"This payment cut would have serious consequences and we cannot and will not allow it to happen," according to Dr. Berwick.

"We need a permanent SGR fix to solve this problem once and for all.

"That’s why the president’s budget and his fiscal framework call for averting these cuts and why we are determined to pass and implement a permanent and sustainable fix," he added.

The reductions could even be deeper for some specialties – especially for radiation oncology and diagnostic imaging – based on the impact of the Physician Practice Information Survey. The changes would reflect the third year of a 4-year transition to new practice expense relative value units.

And more payment changes may be looming. The CMS said in a statement that it is proposing to continue its efforts to identify what it calls "potentially misvalued codes."

As part of those efforts, it will be taking a look at all evaluation and management (E/M) codes to determine if they are undervalued. The agency also proposes to examine the highest non–E/M expenditure codes for each specialty to see if they are overvalued.

The agency said that the reviews will improve payment accuracy, in particular ensuring that primary care services are appropriately reimbursed. It’s the first time the agency has looked across all specialties, according to the CMS.

"We believe strong efforts are needed to evaluate Medicare’s fee schedule to ensure that it is paying accurately and ensuring that Medicare beneficiaries continue to have access to vital services, such as primary care services," Jonathan Blum, director of the Center for Medicare, said in a statement.

Diagnostic imaging has been a target for Medicare, and it is again in this proposal. The agency wants to extend the multiple procedure payment reduction (MPPR) policy to the professional component of advanced imaging services, which includes computed tomography (CT) scans, MRI, and ultrasound. The agency said the reduction would affect about 100 types of services. It is also the first time that the CMS has taken aim at the professional component of these services. That component would be reduced by 50% for subsequent procedures furnished to the same patient, on the same day, in the same session, resulting in an estimated $200 million in savings, according to the CMS.

For the first time, the agency is proposing quality and cost measures to be used in setting incentive payments for physicians who provide higher quality and more efficient care. That lays the groundwork for 2015, when the Affordable Care Act requires the CMS to begin making payment adjustments for certain physicians and physician groups.

The requirement is scheduled to go into effect for all physicians in 2017. The agency is proposing to use 2013 as the initial performance year.

In other issues addressed by the proposed rule, CMS seeks to add smoking cessation to the list of services that can be provided through telehealth. In the future, new services would be examined according to the clinical benefit they provide rather than on whether they are equivalent to a corresponding in-person service.

Finally, the CMS proposed some changes to the Physician Quality Reporting System, the ePrescribing Incentive Program, and the Electronic Health Records Incentive Program. The agency, for instance, is expanding the ways physicians can qualify for incentive payments under the meaningful use criteria.

Comments to the proposed rule can be submitted until Aug. 30 at http://www.regulations.gov; a final rule is expected to be released by Nov. 1.n

As expected, the Centers for Medicare and Medicaid Services proposed that physician fees for 2012 would be reduced by 29.5%. The proposed rule was released in the Federal Register on July 1.

The reduction is required by the Sustainable Growth Rate (SGR) formula that was included as part of the Balanced Budget Act of 1997. But Dr. Donald M. Berwick, CMS administrator, said in a statement that the agency is hoping to find a way to avoid the statutory decrease.

"This payment cut would have serious consequences and we cannot and will not allow it to happen," according to Dr. Berwick.

"We need a permanent SGR fix to solve this problem once and for all.

"That’s why the president’s budget and his fiscal framework call for averting these cuts and why we are determined to pass and implement a permanent and sustainable fix," he added.

The reductions could even be deeper for some specialties – especially for radiation oncology and diagnostic imaging – based on the impact of the Physician Practice Information Survey. The changes would reflect the third year of a 4-year transition to new practice expense relative value units.

And more payment changes may be looming. The CMS said in a statement that it is proposing to continue its efforts to identify what it calls "potentially misvalued codes."

As part of those efforts, it will be taking a look at all evaluation and management (E/M) codes to determine if they are undervalued. The agency also proposes to examine the highest non–E/M expenditure codes for each specialty to see if they are overvalued.

The agency said that the reviews will improve payment accuracy, in particular ensuring that primary care services are appropriately reimbursed. It’s the first time the agency has looked across all specialties, according to the CMS.

"We believe strong efforts are needed to evaluate Medicare’s fee schedule to ensure that it is paying accurately and ensuring that Medicare beneficiaries continue to have access to vital services, such as primary care services," Jonathan Blum, director of the Center for Medicare, said in a statement.

Diagnostic imaging has been a target for Medicare, and it is again in this proposal. The agency wants to extend the multiple procedure payment reduction (MPPR) policy to the professional component of advanced imaging services, which includes computed tomography (CT) scans, MRI, and ultrasound. The agency said the reduction would affect about 100 types of services. It is also the first time that the CMS has taken aim at the professional component of these services. That component would be reduced by 50% for subsequent procedures furnished to the same patient, on the same day, in the same session, resulting in an estimated $200 million in savings, according to the CMS.

For the first time, the agency is proposing quality and cost measures to be used in setting incentive payments for physicians who provide higher quality and more efficient care. That lays the groundwork for 2015, when the Affordable Care Act requires the CMS to begin making payment adjustments for certain physicians and physician groups.

The requirement is scheduled to go into effect for all physicians in 2017. The agency is proposing to use 2013 as the initial performance year.

In other issues addressed by the proposed rule, CMS seeks to add smoking cessation to the list of services that can be provided through telehealth. In the future, new services would be examined according to the clinical benefit they provide rather than on whether they are equivalent to a corresponding in-person service.

Finally, the CMS proposed some changes to the Physician Quality Reporting System, the ePrescribing Incentive Program, and the Electronic Health Records Incentive Program. The agency, for instance, is expanding the ways physicians can qualify for incentive payments under the meaningful use criteria.

Comments to the proposed rule can be submitted until Aug. 30 at http://www.regulations.gov; a final rule is expected to be released by Nov. 1.n

As expected, the Centers for Medicare and Medicaid Services proposed that physician fees for 2012 would be reduced by 29.5%. The proposed rule was released in the Federal Register on July 1.

The reduction is required by the Sustainable Growth Rate (SGR) formula that was included as part of the Balanced Budget Act of 1997. But Dr. Donald M. Berwick, CMS administrator, said in a statement that the agency is hoping to find a way to avoid the statutory decrease.

"This payment cut would have serious consequences and we cannot and will not allow it to happen," according to Dr. Berwick.

"We need a permanent SGR fix to solve this problem once and for all.

"That’s why the president’s budget and his fiscal framework call for averting these cuts and why we are determined to pass and implement a permanent and sustainable fix," he added.

The reductions could even be deeper for some specialties – especially for radiation oncology and diagnostic imaging – based on the impact of the Physician Practice Information Survey. The changes would reflect the third year of a 4-year transition to new practice expense relative value units.

And more payment changes may be looming. The CMS said in a statement that it is proposing to continue its efforts to identify what it calls "potentially misvalued codes."

As part of those efforts, it will be taking a look at all evaluation and management (E/M) codes to determine if they are undervalued. The agency also proposes to examine the highest non–E/M expenditure codes for each specialty to see if they are overvalued.

The agency said that the reviews will improve payment accuracy, in particular ensuring that primary care services are appropriately reimbursed. It’s the first time the agency has looked across all specialties, according to the CMS.

"We believe strong efforts are needed to evaluate Medicare’s fee schedule to ensure that it is paying accurately and ensuring that Medicare beneficiaries continue to have access to vital services, such as primary care services," Jonathan Blum, director of the Center for Medicare, said in a statement.

Diagnostic imaging has been a target for Medicare, and it is again in this proposal. The agency wants to extend the multiple procedure payment reduction (MPPR) policy to the professional component of advanced imaging services, which includes computed tomography (CT) scans, MRI, and ultrasound. The agency said the reduction would affect about 100 types of services. It is also the first time that the CMS has taken aim at the professional component of these services. That component would be reduced by 50% for subsequent procedures furnished to the same patient, on the same day, in the same session, resulting in an estimated $200 million in savings, according to the CMS.

For the first time, the agency is proposing quality and cost measures to be used in setting incentive payments for physicians who provide higher quality and more efficient care. That lays the groundwork for 2015, when the Affordable Care Act requires the CMS to begin making payment adjustments for certain physicians and physician groups.

The requirement is scheduled to go into effect for all physicians in 2017. The agency is proposing to use 2013 as the initial performance year.

In other issues addressed by the proposed rule, CMS seeks to add smoking cessation to the list of services that can be provided through telehealth. In the future, new services would be examined according to the clinical benefit they provide rather than on whether they are equivalent to a corresponding in-person service.

Finally, the CMS proposed some changes to the Physician Quality Reporting System, the ePrescribing Incentive Program, and the Electronic Health Records Incentive Program. The agency, for instance, is expanding the ways physicians can qualify for incentive payments under the meaningful use criteria.

Comments to the proposed rule can be submitted until Aug. 30 at http://www.regulations.gov; a final rule is expected to be released by Nov. 1.n