CMS Puts 2012 Medicare Fee Cut at Nearly 30 Percent

Image via WikipediaBy Emily P. Walker, Washington Correspondent, MedPage Today

The Centers for Medicare and Medicaid Services (CMS) has estimated that in 2012 Medicare physician reimbursement will be cut by 29.5%.

When President Obama signed a bill in 2010 to postpone the scheduled 25% cut in Medicare reimbursement through 2011, physicians were aware that the pay cut would be greater than 25% come 2012. And, if CMS' estimate holds true, it will be.

Writing in a letter to the chairman of the Medicare Payment Advisory Commission (MedPAC), Jonathan Blum, deputy administrator of CMS' Center for Medicare, said that the "conversion factor" -- the dollar multiplier used to calculate physician payments under the current reimbursement system -- will be cut by an estimated 29.5% in 2012, from $33.98 to $23.94.

The cut is mandated by the sustainable growth rate (SGR), a formula that ties physician reimbursement to the gross domestic product; the SGR has called for cuts in pay every year since 2002. Every year since 2003, Congress has voted at the last minute to push those cuts down the road.

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When Elderly Drivers Must Stop Driving - NYTimes.com

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By JANE GROSS

In my many years of reporting about the elderly, I found little that caused doctors more angst than confronting a patient and family about driving. When is it time for someone with physical or cognitive problems to give up the car keys? Who makes that decision? And how can it safely and compassionately be enforced?

Late into the fray, but with a comprehensive and thoughtful handbook, is the American Medical Association, in collaboration with the National Highway Traffic Safety Administration. Recently updated, the “A.M.A. Physician’s Guide to Assessing and Counseling Older Drivers” is an invaluable addition to the literature on the subject, directed to its own members but accessible and informative to the layperson as well.

The guidebook has plenty of information about assessing a patient’s driving ability; medications and medical conditions that impair mobility, vision, hearing, reflexes and judgment; tips on having the conversation with patients and caregivers; advice on how to avoid isolation and dependence when driving is no longer sensible or safe; discussion of a doctor’s ethical responsibilities; and state-by-state guidelines for reporting drivers to the state department of motor vehicles, which has the ultimate say in who remains on the road.

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Inverse Benefits Due to Drug Marketing Undermine Patient Safety and Public Health, Study Finds

ScienceDaily (2011-01-13) -- Drugs that pharmaceutical companies market most aggressively to physicians and patients tend to offer less benefit and more harm to most patients -- a phenomenon described as the "inverse benefit law," according to new research.

The End Of Internal Medicine As We Know It – Health Affairs Blog

by Caroline Poplin

Physicians have doubtless been issuing jeremiads since before Jeremiah. We are overworked, underpaid, and underappreciated.

But today, general internists have a real problem. And it is our leaders who do this to us. As summarized in the Annals of Internal Medicine:

To realize the full benefits of the Affordable Care Act, physicians will need to embrace rather than resist change. The economic forces put in motion by the Act are likely to lead to vertical organization of providers and accelerate physician employment by hospitals and aggregation into larger physician groups. The most successful physicians will be those who collaborate with other providers to improve outcomes, care productivity and patient experience.

In the future envisioned by the health policy community, including the leadership of the Amercian College of Physicians and the American Medical Association, patients who want a personal physician, someone they know and trust, who understands and cares about them as individuals will have to pay extra for “concierge” care. Everyone else will migrate to team care from large “Accountable Care Oranizations” (accountable to whom, one may ask—certainly not the patients). These teams may well improve patients’ blood pressures, glucose control, lipid panels, maybe even weight, and indeed improve the outcomes of patients whose outcomes can be improved. Their care will be efficient: providers (yes, providers) who do not see enough patients, whose patients do not improve adequately, who order too many tests, do not meet the fifteen criteria for meaningful use of EHRs, or do not continuously pursue quality improvement projects, will see their incomes fall.

Perhaps the new organizations will provide better care for some patients and some conditions. Will other patients — those with poor prognoses, bad attitudes, complex or ill-defined diagnoses, multiple complications, cognitive limitations, even just morbid obesity — be lost in the shuffle.

And whether this radical overhaul of the health care delivery system will reduce health care costs overall, ostensibly the point of the exercise, is unknown. The cost of multiple layers of highly paid managers (including multi-million dollar executives) and the extensive information technology infrastructure on which these elaborate systems depend, is not trivial. Indeed, modern industry abandoned command-and-control style vertical integration decades ago in favor of flatter, more nimble institutions that pay serious attention to suggestions from production workers and those who deal directly with customers. What little evidence we have on cost savings from ACOs is largely anecdotal and equivocal.
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How to Fix Medicare’s Doc Fix Problem – Health Affairs Blog

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by Jeff Goldsmith in Health Affairs blog

Of all the ghosts that haunt the Medicare program, none has been noisier, scarier or rattled more chains than the Medicare Sustainable Growth Rate (SGR) problem. SGR has required Congress to reset physician payment policy almost every year for the last decade to avoid gutting Medicare physician compensation, a recurring reminder of how difficult Medicare cost containment really is. Uwe Reinhardt’s recent Economix post in the New York Times is an excellent primer on this problem.

What follows is a proposed permanent solution: writing off the SGR “debt” to the federal budget as “uncollectable” and demanding both sacrifice and reform from the physician community in exchange.
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Physician EMR Use Passes 50% as Incentives Outweigh Resistance

By Bob Cook, amednews staff

25% of office-based physicians have a basic EMR system and 10% have a fully functional system.

The transition has happened for a number of reasons, technology analysts say. One is simple demographics: As more older physicians retire and more freshly minted doctors join the work force, the resistance to EMRs lessens. (A previous 2010 CDC report said the younger the doctor, the more likely he or she was to embrace EMRs.) But the resistance has lessened even among older physicians, who have grown more comfortable with EMRs as they have become more common in offices and hospitals. "The fear factor is dissipating," said Mary Shacklett, CEO of Transworld Data, a technology research and consulting firm in Olympia, Wash.

Another major factor: financial assistance and incentives to get physicians to adopt.

In 2006, the Dept. of Health and Human Services granted Stark law exceptions and anti-kickback safe harbors to hospitals through Dec. 31, 2013, so they could help affiliated practices finance EMRs and other technology. A July 2010 study from consulting firm CSC said one-third of hospitals have offered financial assistance to physicians for EMRs, and more than 60% of hospitals offer physicians access to the hospital's EMR and a hosted EMR for physicians delivering ambulatory care.

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H.R. 92: To amend title XVIII of the Social Security Act to provide payments under the Medicare Program to... (GovTrack.us)

To amend title XVIII of the Social Security Act to provide payments under the Medicare Program to licensed health care practitioners for unscheduled telephone consultation services in the case that such payments are determined to be cost and quality effective.

Sponsor:	Rep. Judy Biggert [R-IL13](no cosponsors) Cosponsors:
Text:	The text of this legislation is not yet available on GovTrack. It may not have been made available by the Government Printing Office yet.
Status:	Introduced Jan 5, 2011 Referred to Committee View Committee Assignments Reported by Committee ... House Vote ... Senate Vote ... Signed by President ... This bill is in the first step in the legislative process. Introduced bills and resolutions first go to committees that deliberate, investigate, and revise them before they go to general debate. The majority of bills and resolutions never make it out of committee. [Last Updated: Jan 6, 2011 11:20AM]
Last Action:	Jan 5, 2011: Referred to House Ways and Means

Current Status

Congress Passes Legislation to Avert Medicare Physician Cuts and Extend Programs

Congress has passed legislation that prevents a 25 percent reduction in payments to Medicare physicians from taking effect on January 1. The bill, known as the Medicare and Medicaid Extenders Act of 2010, also prevents further cuts to physician payments effectuated under the Sustainable Growth Rate formula enacted by Congress in 1997, and maintains current Medicare physician payment rates through December 31, 2011.

The Medicare and Medicaid Extenders Act also extends a number of other programs that were set to expire on December 31, including the Qualified Individual (QI) Program and the Medicare therapy caps exception process. The legislation extends QI, a Medicare Savings Program (MSP) that helps pay Part B premiums for individuals with incomes between 120 and 135 percent of the federal poverty level, until December 31, 2011. The legislation also extends for an additional year the Medicare therapy caps exception process, which allows consumers to apply for exceptions to the $1,860 coverage limit for combined speech and physical therapy services and the $1,860 coverage limit for occupational therapy services if such services are medically necessary.

Read the House Majority Leader’s press release.

Read Joe Baker’s statement on the passage of the Medicare and Medicaid Extenders Package of 2010.

Primary care physician training expanded with $167 million HHS grant... American Medical News

Image via WikipediaBy Chris Silva, amednews staff
More than 80 accredited primary care residency programs will be able to increase the number of doctors they help train, thanks to a $167.3 million grant from the Dept. of Health and Human Services.

By 2015, the money will help create 889 primary care residencies in general pediatrics, general internal medicine and family medicine.

The grant is part of $320 million in awards that HHS announced on Sept. 27. The funding, which will strengthen the primary care work force, was made available through the health system reform law.

"Chronic diseases, most of which are preventable, are one of the main reasons health care costs have soared over the past several decades," HHS Secretary Kathleen Sebelius said. "Investing in our primary care work force will strengthen the role that wellness and prevention play in our health care system. With these grants, Americans from all backgrounds will have new opportunities to enter the health care work force."
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Expect doc shortages to worsen in post-reform era: AAMC - Healthcare business news from Modern Healthcare

Image by Getty Images via @daylife By Jennifer Lubell
Without increases in residency training, physician shortages post-reform will continue to worsen for both primary and specialty care, the Association of American Medical Colleges is reporting.

The AAMC estimates that there will be a shortage of 45,000 primary-care doctors and 46,000 surgeons and medical specialists over the next decade, driven in part by the healthcare reform law's new coverage expansions and the aging of the population.
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Workshop Regarding Accountable Care Organizations, and Implications Regarding Antitrust, Physician Self- Referral, Anti-Kickback, and Civil Monetary Penalty (CMP) Laws

This notice announces a public workshop hosted by the Federal Trade Commission (FTC), the Centers for Medicare & Medicaid Services (CMS), and the Office of the Inspector General (OIG) of the Department of Health and Human Services (DHHS).

This workshop will include panel discussions and a listening session on certain legal issues related to Accountable Care Organizations (ACOs). Physicians, physician associations, hospitals, health systems, consumers, and all others interested in ACOs are invited to participate, in person or by calling into the teleconference.

The meeting is open to the public, but attendance is limited to space and teleconference lines available. An agenda will be posted on the CMS Web site at http://www.cms.gov/center/ physician.asp prior to the session.

DATES: Meeting Date: The public workshop will be held on Tuesday, October 5, 2010 from 9 a.m. until 4:30 p.m. Eastern Daylight Time (E.D.T.).


Full Announcement

Consumer Reports Is Rating Heart Bypass Surgical Groups - NYTimes.com

Image via CrunchBaseby Denise Grady
Medical groups that perform heart bypass surgery are now being rated alongside cars and toaster ovens in Consumer Reports.


In most parts of the country, data-based ratings of doctors are not available to patients. Only a few states, including New York, provide them.

The magazine published ratings of 221 surgical groups from 42 states online on Tuesday and will print them in its October issue. Groups are rated, not individual doctors. The groups receive one, two or three stars, for below average, average or above average. The scores were based on complication and survival rates, whether the groups used the best surgical technique and whether patients were being sent home with certain medicines that research has shown to be beneficial after this type of surgery.

For now, the information is available only to people who subscribe to Consumer Reports online or buy the magazine. But within a few months, the ratings should be posted and freely available to the public at the Web site of the Society of Thoracic Surgeons (www.sts.org/), said Dr. Fred H. Edwards, the chairman of quality and research for the society, and medical director for cardiothoracic surgery at the University of Florida in Jacksonville. The society, which has been tracking surgeons’ performance since 1989, gave the information to Consumer Reports. More than 90 percent of the nation’s heart surgery programs participate in the society’s registry.
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Medical Jargon: A Barrier to Quality Care | Medicare Solutions Blog

Image via WikipediaBy Lucy Dylan

The Center for Disease Control and other government officials are working to improve communication between doctors and patients. The Health Literacy Action Plan, a new government initiative, hopes to improve patients’ understanding of their health by simplifying medical language. According to the program’s web site, target groups include minorities and lower income individuals, two groups likely to lack basic health literacy.

One step health insurers have taken is to use a program that essentially translates medical jargon to plain English. The program, marketed by Health Literacy Innovations, scans a doctor’s document and suggests simplifications. Meanwhile, many state Medicaid programs have opted to provide health information written for people with fourth to sixth grade reading level, ensuring that people understand the medical treatments they need.
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Older Patients' Share of Office Visits Grows from MedPage Today

By Charles Bankhead, Staff Writer, MedPage Today

Older patients account for a majority of physician office visits, which increasingly involve specialists who treat chronic conditions, according to government statistics.

Patients 45 and older made 57% of all physician office visits in 2008, compared with 49% in 1998. Medical and surgical specialists accounted for 55% of office visits among patients 65 and older and 48% of visits among patients ages 45 to 64.

U.S. demographics virtually assure that the trends in physician-service use will continue, possibly at a more rapid pace, findings from a study by the National Center for Health Statistics (NCHS) suggest.

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Accountability Measures — Using Measurement to Promote Quality Improvement | Health Care Reform Center

by Mark R. Chassin, M.D., M.P.P., M.P.H., Jerod M. Loeb, Ph.D., Stephen P. Schmaltz, Ph.D., and Robert M. Wachter, M.D.

Measuring the quality of health care and using those measurements to promote improvements in the delivery of care, to influence payment for services, and to increase transparency are now commonplace. These activities, which now involve virtually all U.S. hospitals, are migrating to ambulatory and other care settings and are increasingly evident in health care systems worldwide. Many constituencies are pressing for continued expansion of programs that rely on quality measurement and reporting.

In this article, we review the origins of contemporary standardized quality measurement, with a focus on hospitals, where such programs have reached their most highly developed state. We discuss some lessons learned from recent experience and propose a conceptual framework to guide future developments in this fast-moving field. Although many of the points we make are relevant to all kinds of quality measurement, including outcome measures, we focus our comments on process measures, both because these account for most of the measures in current use and because outcome measures have additional scientific challenges surrounding the need for case-mix adjustment. We write not as representatives of the Joint Commission articulating a specific new position of that group, but rather as individuals who have worked in the fields of quality measurement and improvement in a variety of roles and settings over many years.
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Feds Charge 94 Docs, Others With Medicare Fraud from MedPage Today

By John Gever, Senior Editor, MedPage Today

Charges have been unsealed against 94 physicians, healthcare and billing company executives, and others in five cities across the country, alleging that they submitted a total of $251 million in false Medicare claims.

U.S. Attorney General Eric Holder and Health and Human Services Secretary Kathleen Sebelius announced the indictments at a meeting on Medicare fraud in Miami, calling it "the largest federal healthcare fraud takedown since the Medicare Fraud Strike Force operations began in 2007."
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Half of county's doctors are near retirement age » Ventura County Star

By Tom Kisken

Out of a group of more than 750 doctors in Ventura County, half will turn 55 or older before the end of the year, according to a local medical association. One of three will turn 60 or older.


The doctors aren’t growing crow’s feet alone. About half of the registered nurses in Ventura, Los Angeles and Orange counties were 50 and older in 2008, according to the California Board of Registered Nursing. About 18 percent of the nurses were in their 60s, more than those who were 34 and younger.

The graying numbers don’t surprise Dr. Gary Proffett, the 62-year-old medical director of an Oxnard-based physicians network who has decided he can’t retire because of the economy. But he is alarmed at the number of healthcare professionals who could pack away their stethoscopes before hospitals and clinics are flooded by aging baby boomers with longer life expectancies and the uninsured people who will be covered by federal healthcare reform in 2014.

“Who’s going to see them?” he said. “Who’s going to see millions of people? I don’t know.”

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No Place Like Home - The New Old Age Blog - NYTimes.com

by Paula Span

Mary Wareheim suffers from a long list of health problems. She’s an amputee who uses a wheelchair. She has diabetes, heart disease, high blood pressure and an irregular heartbeat; she takes 11 prescription drugs. At 83, she leaves home infrequently, perhaps twice a year.

Yet she’s been the hospital just once in six years, probably because she’s had excellent medical care and monitoring. Though she’s essentially homebound, doctors come to her, in the Baltimore house she shares with her daughter, son-in-law and a Great Dane named Murphy, through the Johns Hopkins Elder House Call Program.

“My mother would absolutely make excuses not to go to a doctor,” said her daughter Chris Ricko, 49. “Now she doesn’t have an excuse.”

House calls aren’t a new idea, of course. Johns Hopkins has been sending attending physicians and residents out to see frail, elderly patients in their homes for 30 years. (I remember our family doctor coming to see me, black bag in hand, when I had the measles in my long-ago youth, so I wouldn’t infect everyone in his waiting room.)
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Retirements by baby-boomer doctors, nurses could strain overhaul

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By Darryl Fears Monday, Washington Post Staff Writer

Since the passage of the health-care law in March, much has been said about the coming swarm of millions of retiring baby boomers and the strain they will put on the nation's health-care system.

That's only half the problem. Overlooked in the conversation is a particular group of boomers: doctors and nurses who are itching to call it quits. Health-care economists and other experts say retirements in that group over the next 10 to 15 years will greatly weaken the health-care workforce and leave many Americans who are newly insured under the new legislation without much hope of finding a doctor or nurse.

Nearly 40 percent of doctors are 55 or older, according to the Center for Workforce Studies of the Association of American Medical Colleges. Included in that group are doctors whose specialties will be the pillars of providing care in 2014, when the overhaul kicks in; family medicine and general practitioners (37 percent); general surgeons (42 percent); pediatrics (33 percent), and internal medicine and pediatrics (35 percent).

About a third of the much larger nursing workforce is 50 or older, and about 55 percent expressed an intention to retire in the next 10 years, according to a Nursing Management Aging Workforce Survey by the Bernard Hodes Group. New registered nurses are flowing from colleges, but not enough to replace the number planning to leave the profession.

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