Many of the readers of Practice Notes are members of or affiliated with small physician practices — physician organizations of 10 physicians or less. As you are now undoubtedly aware, the U.S. government is making a significant investment, as a major component of the American Recovery and Reinvestment Act, to support the adoption of electronic health records.
EHR adoption is still very low in the United States, especially among smaller practices. Therefore, to facilitate the adoption and the achievement of meaningful use of these EHRs among small practices, the Office of National Coordination for Health Information Technology (ONC) has now designated some 60 Regional Extension Centers (REC).
Read more
The mission of the RECs are to help primary-care physicians, small practices, and safety-net providers such as community health centers, rural health centers, and critical-access hospitals, through the provision of consultative support and advisory services to enable successful development of EHR systems, and ultimately achievement of meaningful use.
The REC program funding will create technical extension centers throughout the U.S., and each REC will target approximately 1,000 to 2,000 physicians. They are chartered to be vendor agnostic and to provide unbiased guidance — that is to say that they will not promote any specific application over others — with a goal of helping the smallest of practices manage the work flow and business process challenges of achieving meaningful use.
In total, the federal goal is to assist 100,000 physicians nationally by the end of 2012. Each REC will have access to a newly created, federally funded health IT research center — meant to act as a knowledge management hub and disseminator of best practices to the individual RECs and its clients, the physicians. The RECS will be moving to full operating status within the next six months and a list of each REC, as well as information about the REC program, can be accessed at HHS’ Web site. I encourage all practices to reach out to their assigned REC to ascertain how it can help you on your health IT journey.
Showing posts with label CMS. Show all posts
Showing posts with label CMS. Show all posts
Friday, April 16, 2010
Monday, March 29, 2010
CMS could get new director
After more than three years without a permanent leader, CMS might have a new administrator. Obama plans to nominate to the post Donald Berwick, MD, a pediatrician, health policy scholar, and CEO of the Institute for Healthcare Improvement.
Read more
Berwick, who would need to be confirmed by the Senate, has challenged doctors and hospitals to provide better care at lower cost, and that payments should be based on the value of services, not the volume, according to the NY Times.
As the head of CMS, Berwick would certainly have his work cut out for him in the wake of the healthcare reform legislation.
MGMA applauded the news in a statement: “As healthcare organizations and professionals shape a reformed healthcare delivery system, his knowledge and proven leadership will be critical to success.”
Read more
Berwick, who would need to be confirmed by the Senate, has challenged doctors and hospitals to provide better care at lower cost, and that payments should be based on the value of services, not the volume, according to the NY Times.
As the head of CMS, Berwick would certainly have his work cut out for him in the wake of the healthcare reform legislation.
MGMA applauded the news in a statement: “As healthcare organizations and professionals shape a reformed healthcare delivery system, his knowledge and proven leadership will be critical to success.”
Friday, March 5, 2010
MGMA survey: Meaningful use criteria mean decreased productivity
Changes in practices’ operations to meet the EHR meaningful use criteria would lead to decreased productivity, according to new research by the MGMA.
Nearly 68 percent of respondents said physician productivity would decrease, and 31 percent said that it would dip by 10 percent, according to the poll. Practices were asked to estimate the change in productivity from implementing all the 25 meaningful use criteria.
“If the final rule mirrors those outlined in the current proposal, there is a significant risk that the program will fail to meet the intent of the legislation, and that a historic opportunity to transform the nation’s healthcare system will be missed.” MGMA President and CEO William F. Jessee, MD, FACMPE, said in a statement.
Read more
MGMA’s research also identified which criteria would be hard to achieve:
• The proposed requirement that 80 percent of all patient requests for an electronic copy of their health information be fulfilled within 48 hours (45.9 percent) and
• The proposed requirement that 10 percent of all patients be given electronic access to their health information within 96 hours of the information being available (53.5 percent).
In a recent podcast, Robert Tennant of the MGMA, explained to me that these criteria that require practices to deliver electronic copies of health information in a timely manner would be particularly troublesome. He said it would require many practices to acquire patient portals, which are often separate systems from their EHRs. This could be a costly proposition.
However, for those practices that said they didn’t currently use an EHR, about 42 percent said it was “very likely” that they would attempt to qualify for the EHR incentives. Another 18 percent said it was “likely.” But there is that more than 23 percent who said it was “very unlikely” or “unlikely” that they would.
Unsurprisingly, among those with an EHR, nearly 83 percent said it was “likely” or “very likely” that they would try to qualify for the incentives.
What do you think? Will these requirements have a major impact on your practice's productivity?
Nearly 68 percent of respondents said physician productivity would decrease, and 31 percent said that it would dip by 10 percent, according to the poll. Practices were asked to estimate the change in productivity from implementing all the 25 meaningful use criteria.
“If the final rule mirrors those outlined in the current proposal, there is a significant risk that the program will fail to meet the intent of the legislation, and that a historic opportunity to transform the nation’s healthcare system will be missed.” MGMA President and CEO William F. Jessee, MD, FACMPE, said in a statement.
Read more
MGMA’s research also identified which criteria would be hard to achieve:
• The proposed requirement that 80 percent of all patient requests for an electronic copy of their health information be fulfilled within 48 hours (45.9 percent) and
• The proposed requirement that 10 percent of all patients be given electronic access to their health information within 96 hours of the information being available (53.5 percent).
In a recent podcast, Robert Tennant of the MGMA, explained to me that these criteria that require practices to deliver electronic copies of health information in a timely manner would be particularly troublesome. He said it would require many practices to acquire patient portals, which are often separate systems from their EHRs. This could be a costly proposition.
However, for those practices that said they didn’t currently use an EHR, about 42 percent said it was “very likely” that they would attempt to qualify for the EHR incentives. Another 18 percent said it was “likely.” But there is that more than 23 percent who said it was “very unlikely” or “unlikely” that they would.
Unsurprisingly, among those with an EHR, nearly 83 percent said it was “likely” or “very likely” that they would try to qualify for the incentives.
What do you think? Will these requirements have a major impact on your practice's productivity?
Wednesday, March 3, 2010
More on Medicare payment shenanigans
In case you missed the latest in the Medicare payment shenanigans in Washington, the Senate voted again last night to delay the 21 percent cuts. (This after Sen. Bunning blocked the bill last week.)
Now, Congress has until April 1 to fix the flawed payment formula.
From AMA President J. James Rohack, MD: “Physicians are outraged by the Senate’s failure to act before the March 1 deadline, as their patients and practices are hurt by the continued instability in the Medicare system.”
He continues to say, “The vicious cycle of short-term delays … must come to an end.”
Now, Congress has until April 1 to fix the flawed payment formula.
From AMA President J. James Rohack, MD: “Physicians are outraged by the Senate’s failure to act before the March 1 deadline, as their patients and practices are hurt by the continued instability in the Medicare system.”
He continues to say, “The vicious cycle of short-term delays … must come to an end.”
Monday, March 1, 2010
Medicare payment cut update
Late last week, the clock was ticking for Congress to pass legislation to stave off the 21 percent Medicare payment cuts, which were to go into effect today.
But they left for the weekend before doing so, surely leaving many practitioners in a panic about the impending cuts and their own future with accepting Medicare patients.
Then, this morning the news is that CMS delayed the physician cuts themselves.
Read more
So the issue was that the Medicare payment fix was part of a larger jobs bill that would have extended unemployment benefits and federal subsidies for health premiums. But Sen. Jim Bunning, a Republican from Kentucky, blocked the bill, saying it should be paid for rather than added to the deficit. With him refusing to relent, the NY Times explains, Dems will have to move to override his objections, but that couldn’t happen until early this week.
This morning, HealthLeaders Media reports that CMS ordered contractors to hold claims for 10 days, which temporarily halts the pay cut. This gives CMS and Congress 10 days to fix it. CMS also said they don’t expect this affect provider cash flow.
But they left for the weekend before doing so, surely leaving many practitioners in a panic about the impending cuts and their own future with accepting Medicare patients.
Then, this morning the news is that CMS delayed the physician cuts themselves.
Read more
So the issue was that the Medicare payment fix was part of a larger jobs bill that would have extended unemployment benefits and federal subsidies for health premiums. But Sen. Jim Bunning, a Republican from Kentucky, blocked the bill, saying it should be paid for rather than added to the deficit. With him refusing to relent, the NY Times explains, Dems will have to move to override his objections, but that couldn’t happen until early this week.
This morning, HealthLeaders Media reports that CMS ordered contractors to hold claims for 10 days, which temporarily halts the pay cut. This gives CMS and Congress 10 days to fix it. CMS also said they don’t expect this affect provider cash flow.
Friday, February 26, 2010
How do you feel about accepting Medicare?
Will you stop accepting Medicare because of the looming rate cut?
Time is running out for Congress to step in and block a 21 percent Medicare reimbursement rate cut set for Monday. Some docs are saying they will stop taking Medicare patients, Kaiser Health News reports.
The AMA continues their intense lobbying effort to have Congress repeal the cuts and the faulty SGR payment formula on which the rates are based. But in the meantime, they are also providing information to their members, including how to remove themselves from the Medicare program and help their patients find other doctors, AMA according to CNN.
If you’re losing money every time you see a Medicare patient, why keep seeing them? Primary-care physician and blogger Kevin Pho (KevinMD) put it this way: Duty and conscience. He references fellow doc and blogger Dr. Robert Lambert’s post on the topic. Dr. Lamberts writes:
Read more
“So why in the world do I accept M/M still? Why would I continue to make my life so difficult? Two words: duty and calling. I view my seeing M/M patients as a social responsibility (especially Medicare). These people need to be seen and they deserve good care, and despite the hassle and drain on income they cause, I make a reasonable income. So far.”
Dr. Lamberts says his conscience and tolerance of pain keep him accepting Medicare, but that he is sympathetic to docs who drop insurance and Medicare. For some, the conscience isn’t enough to stay in business.
Congress has consistently stepped in in the past to stave off the payment cuts, most recently just a few months ago to extend the deadline to March 1. But what if they fail to act this time? What will you do? How do you feel about accepting Medicare patients?
Time is running out for Congress to step in and block a 21 percent Medicare reimbursement rate cut set for Monday. Some docs are saying they will stop taking Medicare patients, Kaiser Health News reports.
The AMA continues their intense lobbying effort to have Congress repeal the cuts and the faulty SGR payment formula on which the rates are based. But in the meantime, they are also providing information to their members, including how to remove themselves from the Medicare program and help their patients find other doctors, AMA according to CNN.
If you’re losing money every time you see a Medicare patient, why keep seeing them? Primary-care physician and blogger Kevin Pho (KevinMD) put it this way: Duty and conscience. He references fellow doc and blogger Dr. Robert Lambert’s post on the topic. Dr. Lamberts writes:
Read more
“So why in the world do I accept M/M still? Why would I continue to make my life so difficult? Two words: duty and calling. I view my seeing M/M patients as a social responsibility (especially Medicare). These people need to be seen and they deserve good care, and despite the hassle and drain on income they cause, I make a reasonable income. So far.”
Dr. Lamberts says his conscience and tolerance of pain keep him accepting Medicare, but that he is sympathetic to docs who drop insurance and Medicare. For some, the conscience isn’t enough to stay in business.
Congress has consistently stepped in in the past to stave off the payment cuts, most recently just a few months ago to extend the deadline to March 1. But what if they fail to act this time? What will you do? How do you feel about accepting Medicare patients?
Wednesday, February 24, 2010
Trendspotter: RACs Are Now Encouraged to Search For Fraud
While the January 1 launch of the permanent, nationwide RAC program was a wake-up call for providers, there hasn’t been much concern that the RACs would actively seek out fraud. They are supposed to forward fraud cases to CMS, but they have no financial motivation to ferret it out, says Jessica Gustafson, a Southfield, Mich.-based attorney who specializes in Medicare audits. “The financial incentive is for them to do the audit,” she points out, because that’s how they make money.
Read more
But something in that equation changed recently. CMS has decided to provide formal training to the RACs on how to identify fraud and where to refer fraud cases. It is also developing a database to track fraud referrals. Needless to say, this will give the contractors’ personnel an extra incentive—although not yet a financial one—to look for fraud wherever it may lurk.
CMS chose this course after the Office of the Inspector General (OIG) in the Department of Health and Human Services examined what the RACs were doing about fraud—which was not much. During the three-year pilot that preceded the current program, an OIG report says, the RACs turned over evidence of fraud to CMS in only two cases. CMS wasn’t aware of these cases, according to the report, but has now forwarded them to OIG for further development.
OIG’s interest reflects the Obama Administration’s crackdown on fraud and abuse in the Medicare and Medicaid programs. “The government thinks they can whack close to 10 percent of their healthcare spending by nailing people for fraud,” says David Glaser, a healthcare attorney in Minneapolis who defends physicians against Medicare audits. “So concern is warranted, because they’re coming after you and it’s a way of reducing healthcare costs that doesn’t offend anyone except physicians.”
When does a pattern of improper coding become fraud? “The majority of audits involve a pattern of medically unnecessary services,” says attorney Abby Pendleton, one of Gustafson’s colleagues. “That’s a common reason for denial of claims. When does it rise to the level of fraud and abuse? It’s got to be pretty extreme.”
The government’s definition of fraud is vague, says Glaser. If a single claim error is viewed as an honest mistake, but a series of errors is regarded as fraud, he notes, that definition ignores the likelihood that someone who makes one mistake is likely to repeat it. “Say a lab had one code wrong a couple hundred times. Should the false claims law apply?” He has also seen an overpayment of $150,000 to one doctor regarded as evidence of fraud, while another physician who got a $3 million overpayment merely had to refund it.
In any case, the RACs are still less likely to turn up fraud than a Medicare auditor would be. The OIG report notes, “We recognize that RACs are not responsible for identifying potential fraud; however, we believe that there may be a disincentive for RACs to refer cases of potential fraud because they do not receive their contingency fees for cases determined to be fraud.” Let’s hope that it remains that way: the RACs should not have a financial incentive to find fraud and turn in physicians who may have made honest mistakes.
Meanwhile, the government needs to develop a better definition of fraud and a more reliable method of identifying it. Certainly, some providers are cheating the government, and they should be caught and punished. But especially when private contractors are enlisted in this effort, there is a danger that physicians may be wrongly accused unless CMS carefully supervises the anti-fraud effort.
Friday, January 15, 2010
Don McDaniel: Health reform death spiral
I gave a speech in early January 2010 to a group of bankers and accountants to discuss the impact of proposed health reform on business. Everyone is nervous about what’s coming down the pike, and the average business owner (or even the average business advisor) doesn’t have the time or the proclivity to dig into reform legislation to understand how it might affect them — it seems our legislative process is geared to obfuscation.
As I thought about health reform and how it might affect business, I started to focus on the impact on one of my favorite small businesses: the physician practice. It seems that even without reform in the offing, the physician-entrepreneur is moving toward extinction — how many businesses can, or want, to operate in an environment where revenue is largely fixed, heavily regulated — sort of like a utility — and highly dependent mostly upon factors outside the control of the entrepreneur, and operating and capital expenses are rising every year.
Read more
So, cash flow is being squeezed from every conceivable angle, the government is mandating purchase of expensive information technology (which mostly benefits others that aren’t contributing to the purchase), and practicing physicians in many states deliver services every day under the specter of being sued.
What else could happen to make things even peachier? How about health reform, which is really insurance reform, which is really focused on expanding coverage for the uninsured?
Here’s one scenario from a particularly contrarian observer (me) that nonetheless has legs. As health reform will be paid for largely on the back of reductions in the Medicare program — almost $700 billion in cuts over the next 10 years — it seems an inevitability that the Medicare program will continue devolving into one of the poorest payers for physicians and hospitals, second only to the Medicaid program.
And, oh by the way, a lot of the proposed coverage expansion in the Senate bill will manifest as new Medicaid enrollees — yes, that’s right, the program that is busting the budgets in states all across the country, will be expanded. So, we’ll have growing public sector programs, at the expense of commercial insurance enrollment, which is today subsidizing the underpayments from Medicare and Medicaid.
Anyway as FFS reimbursement for Medicare (and Medicaid) continues to degrade, physicians, especially primary care physicians, will vote with their pocket books and decide to, in the short run, drop out of public sector programs, and in the longer term, those historically groomed to practice medicine are going to start deciding to choose another career path — one without frivolous malpractice risk, crazy student loans, ever-growing expenses and fixed revenue.
That seismic workforce shift will further drive structural physician shortages, creating a lot of upward pressure on prices (i.e. outsize growth in expenditures) forcing the dreaded r-word – explicit rationing. Get ready to queue-up for that procedure!
Don McDaniel, president and CEO of Sage Growth Partners LLC, is an entrepreneur, economist, technologist, educator, speaker, and writer. He is a skeptical contrarian who writes about the power of free markets, disruption, innovation, and technology in healthcare.
As I thought about health reform and how it might affect business, I started to focus on the impact on one of my favorite small businesses: the physician practice. It seems that even without reform in the offing, the physician-entrepreneur is moving toward extinction — how many businesses can, or want, to operate in an environment where revenue is largely fixed, heavily regulated — sort of like a utility — and highly dependent mostly upon factors outside the control of the entrepreneur, and operating and capital expenses are rising every year.
Read more
So, cash flow is being squeezed from every conceivable angle, the government is mandating purchase of expensive information technology (which mostly benefits others that aren’t contributing to the purchase), and practicing physicians in many states deliver services every day under the specter of being sued.
What else could happen to make things even peachier? How about health reform, which is really insurance reform, which is really focused on expanding coverage for the uninsured?
Here’s one scenario from a particularly contrarian observer (me) that nonetheless has legs. As health reform will be paid for largely on the back of reductions in the Medicare program — almost $700 billion in cuts over the next 10 years — it seems an inevitability that the Medicare program will continue devolving into one of the poorest payers for physicians and hospitals, second only to the Medicaid program.
And, oh by the way, a lot of the proposed coverage expansion in the Senate bill will manifest as new Medicaid enrollees — yes, that’s right, the program that is busting the budgets in states all across the country, will be expanded. So, we’ll have growing public sector programs, at the expense of commercial insurance enrollment, which is today subsidizing the underpayments from Medicare and Medicaid.
Anyway as FFS reimbursement for Medicare (and Medicaid) continues to degrade, physicians, especially primary care physicians, will vote with their pocket books and decide to, in the short run, drop out of public sector programs, and in the longer term, those historically groomed to practice medicine are going to start deciding to choose another career path — one without frivolous malpractice risk, crazy student loans, ever-growing expenses and fixed revenue.
That seismic workforce shift will further drive structural physician shortages, creating a lot of upward pressure on prices (i.e. outsize growth in expenditures) forcing the dreaded r-word – explicit rationing. Get ready to queue-up for that procedure!
Don McDaniel, president and CEO of Sage Growth Partners LLC, is an entrepreneur, economist, technologist, educator, speaker, and writer. He is a skeptical contrarian who writes about the power of free markets, disruption, innovation, and technology in healthcare.
Wednesday, January 13, 2010
Trendspotter: What health reform will mean for you
By Ken Terry
While congressional leaders dicker over the details of healthcare reform legislation, this is a good time for physicians to take stock of how reform will affect them and what they can do to help repair the system.
On the issue of Medicare reimbursement, don’t expect the Senate to follow the House’s example and restore projected Medicare cuts to physicians for the next 10 years. The Senate earlier rejected this permanent fix, and it is unlikely to reverse its position. Instead, the final reform package will probably eliminate the planned cuts this year and perhaps next year, according to consultant Julius Hobson, former lobbying chief for the AMA. After that, the issue will again come up for debate.
However, I do not believe that we will see Congress continue to do its annual dance with the AMA over these cuts, giving back the money at the last minute without solving anything. The direction of Medicare reimbursement will be increasingly tied to approaches like the value-based purchasing and payment bundling proposals in the Senate bill, as well as to the accountable care organizations (ACOs) that the measure encourages providers to form. These aggregations of hospitals and physicians, similar to the Mayo Clinic or the Cleveland Clinic, but perhaps more loosely organized, will deliver care within some kind of budget and will be able to keep a portion of any savings they achieve. If Medicare starts doing this, look for private payers to follow suit.
Read more
So how will all of this affect you if you don’t belong to an ACO and are not involved in a CMS demonstration project? It won’t affect you immediately, but eventually the tsunami of change will reach your practice. When it does, you may find that what worries you now is no longer relevant. In fact, the issue that medical societies have emphasized during this reform season — how much the government will pay doctors for each unit of service — will eventually become moot, because fee for service is on its way out. In five or 10 years, you’ll be paid on an entirely different basis.
This is going to happen because fee for service is one of the key drivers of healthcare inflation in the U.S. Don’t be fooled by the recent announcement that health cost growth in 2008 dropped to its lowest level in decades: That was largely due to the recession, and the growth in spending was still far higher than general inflation or the rise in GDP. Costs are still out of control; the number of uninsured is rising; and more and more employers will drop coverage of their workers unless something is done. If you think that won’t affect your business, you’re living under a rock.
The current reform legislation is a step in the right direction: by expanding coverage and making it easier to afford insurance, it should result in more timely and comprehensive care that will keep many out of the ER and the hospital. But the measure will also create a couple of problems for physicians and patients. First, it is going to produce a tremendous demand for services from the previously uninsured without increasing the number of doctors. (This has already become a problem in Massachusetts, which enacted similar reforms.) And second, it does too little to restructure healthcare financing and delivery. So in essence, the reform is going to pile more volume on a system that is outmoded, wasteful, and inefficient.
What can you do about it? To begin with, recognize the simple fact that, despite your belief that payers control the game, physicians actually have the power to effect meaningful change. After all, your medical decisions determine how about 80 percent of the money in the system is spent. So if you start changing how you practice, you can have a surprisingly large impact. Of course, that might reduce your income, because the system is not yet set up to reward quality or nonvisit care.
The medical home movement is trying to show physicians how to do this without losing money, but it’s still a daunting challenge, especially for small practices. So another thing to consider is how you and your colleagues can start to change the equation in your own community, perhaps through your IPA, your PHO, or your hospital.
While I don’t have the space to discuss this in detail, I’d heartily recommend an article in The New England Journal of Medicine by Elliott Fisher, MD, a Dartmouth professor who has done important research on regional variations in Medicare costs; Donald Berwick, MD, president and CEO of the Institute for Healthcare Improvement; and Karen Davis, president of the Commonwealth Fund, a New York think tank. Entitled “Achieving Healthcare Reform — How Physicians Can Help,” the essay argues that physicians should join integrated delivery systems, which could be “virtual,” to achieve the aims of the Institute of Medicine report “Crossing The Quality Chasm.”
ACOs are already being formed across the country on a de facto basis, as more and more physicians go to work for hospitals. Already, more than a third of all doctors are employed by healthcare systems. But you don’t necessarily have to give up private practice to get involved in some kind of physician organization. The important thing to recognize is that the small, unaffiliated practice is a dinosaur. Only by connecting with your colleagues can you hope to have a voice in the changes that are going to remake medicine in the coming years.
Ken Terry is a New Jersey-based freelance writer and the author of the book "Rx for Health Care Reform." In his weekly Trendspotter column, Ken is looking out for trends and changes that may affect your practice.
While congressional leaders dicker over the details of healthcare reform legislation, this is a good time for physicians to take stock of how reform will affect them and what they can do to help repair the system.
On the issue of Medicare reimbursement, don’t expect the Senate to follow the House’s example and restore projected Medicare cuts to physicians for the next 10 years. The Senate earlier rejected this permanent fix, and it is unlikely to reverse its position. Instead, the final reform package will probably eliminate the planned cuts this year and perhaps next year, according to consultant Julius Hobson, former lobbying chief for the AMA. After that, the issue will again come up for debate.
However, I do not believe that we will see Congress continue to do its annual dance with the AMA over these cuts, giving back the money at the last minute without solving anything. The direction of Medicare reimbursement will be increasingly tied to approaches like the value-based purchasing and payment bundling proposals in the Senate bill, as well as to the accountable care organizations (ACOs) that the measure encourages providers to form. These aggregations of hospitals and physicians, similar to the Mayo Clinic or the Cleveland Clinic, but perhaps more loosely organized, will deliver care within some kind of budget and will be able to keep a portion of any savings they achieve. If Medicare starts doing this, look for private payers to follow suit.
Read more
So how will all of this affect you if you don’t belong to an ACO and are not involved in a CMS demonstration project? It won’t affect you immediately, but eventually the tsunami of change will reach your practice. When it does, you may find that what worries you now is no longer relevant. In fact, the issue that medical societies have emphasized during this reform season — how much the government will pay doctors for each unit of service — will eventually become moot, because fee for service is on its way out. In five or 10 years, you’ll be paid on an entirely different basis.
This is going to happen because fee for service is one of the key drivers of healthcare inflation in the U.S. Don’t be fooled by the recent announcement that health cost growth in 2008 dropped to its lowest level in decades: That was largely due to the recession, and the growth in spending was still far higher than general inflation or the rise in GDP. Costs are still out of control; the number of uninsured is rising; and more and more employers will drop coverage of their workers unless something is done. If you think that won’t affect your business, you’re living under a rock.
The current reform legislation is a step in the right direction: by expanding coverage and making it easier to afford insurance, it should result in more timely and comprehensive care that will keep many out of the ER and the hospital. But the measure will also create a couple of problems for physicians and patients. First, it is going to produce a tremendous demand for services from the previously uninsured without increasing the number of doctors. (This has already become a problem in Massachusetts, which enacted similar reforms.) And second, it does too little to restructure healthcare financing and delivery. So in essence, the reform is going to pile more volume on a system that is outmoded, wasteful, and inefficient.
What can you do about it? To begin with, recognize the simple fact that, despite your belief that payers control the game, physicians actually have the power to effect meaningful change. After all, your medical decisions determine how about 80 percent of the money in the system is spent. So if you start changing how you practice, you can have a surprisingly large impact. Of course, that might reduce your income, because the system is not yet set up to reward quality or nonvisit care.
The medical home movement is trying to show physicians how to do this without losing money, but it’s still a daunting challenge, especially for small practices. So another thing to consider is how you and your colleagues can start to change the equation in your own community, perhaps through your IPA, your PHO, or your hospital.
While I don’t have the space to discuss this in detail, I’d heartily recommend an article in The New England Journal of Medicine by Elliott Fisher, MD, a Dartmouth professor who has done important research on regional variations in Medicare costs; Donald Berwick, MD, president and CEO of the Institute for Healthcare Improvement; and Karen Davis, president of the Commonwealth Fund, a New York think tank. Entitled “Achieving Healthcare Reform — How Physicians Can Help,” the essay argues that physicians should join integrated delivery systems, which could be “virtual,” to achieve the aims of the Institute of Medicine report “Crossing The Quality Chasm.”
ACOs are already being formed across the country on a de facto basis, as more and more physicians go to work for hospitals. Already, more than a third of all doctors are employed by healthcare systems. But you don’t necessarily have to give up private practice to get involved in some kind of physician organization. The important thing to recognize is that the small, unaffiliated practice is a dinosaur. Only by connecting with your colleagues can you hope to have a voice in the changes that are going to remake medicine in the coming years.
Ken Terry is a New Jersey-based freelance writer and the author of the book "Rx for Health Care Reform." In his weekly Trendspotter column, Ken is looking out for trends and changes that may affect your practice.
Wednesday, January 6, 2010
Trendspotter: Meaningful use criteria may not suffice for care coordination
By Ken Terry 
The Department of Health and Human Services (HHS) has released draft regulations on the “meaningful use” of electronic health records that will be required to qualify for government incentives in 2011. The good news is that physicians will not have to enter visit notes electronically to show meaningful use. But you will have to use some other EHR features out of the box, including electronic prescribing and decision support tools such as drug interaction alerts.
Patient demographics, vital signs, and smoking status must be recorded in the EHR, and at least 50 percent of lab results will have to go into the EHR as structured data. That means you will need interfaces with your major labs. In addition, you will have to give patients access to key data from their medical records, and you will have to transfer clinical summaries as part of referrals. In addition, you must either submit quality data based on PQRI measures and other metrics endorsed by the National Quality Forum, or attest that you can do so. In 2012, you will have to send in the data electronically.
All of this, of course, is designed to prove that physicians who apply for up to $44,000 in Medicare incentives ($64,000 for Medicaid) are using their EHRs in a way that will improve the quality, safety, and efficiency of patient care. A key part of that quality improvement is enhanced coordination of care — a major goal not only of the HITECH Act, but also of the public and private medical home pilots that are underway.
Read more
But a new study from the Center for Studying Health System Change casts doubt on whether current EHRs, even if they meet meaningful use criteria, are up to the task of improving care coordination in today’s environment.
Based on their interviews with users of EHRs (which they call EMRs) in 12 markets, the CSHSC researchers conclude:
“There is a gap between policy-makers’ expectation of current EMRs’ role in the coordination of care and clinicians’ real-world experience with them. We found that commercial ambulatory care EMRs facilitate care coordination within a practice by making data available at the point of care, but they are less helpful for exchanging information between practices and settings. EMRs may also have unintended consequences for coordination, such as creating an information overload that complicates providers’ efforts to discern key clinical information.”
There are some non-technological reasons for these shortfalls, including physician culture and a lack of reimbursement for care coordination. But the researchers also delineate some deficiencies that affect some or all EHRs. Among them are these:
• A lack of interoperability between systems used by various physician practices, hospitals, diagnostic testing facilities, and other providers. This results in practices scanning paper documents into the EHR as non-searchable PDF files.
• Problems with problem lists. Few EHRs link specific problems to portions of past notes that address them. Also, the lists often include redundant diagnoses generated by test results.
• Inability to capture the planning component of medical-decision making. EHRs typically do not remind physicians of things that need to be done for patients until the doctor opens that patient’s chart for the next visit.
• Lack of registries or other mechanisms that would facilitate population health management, ensuring that patients with particular conditions receive the preventive and chronic care they need when they need it.
• Inability to track referrals within the EHR.
• Tendency to generate too much information in referral notes, making it difficult for physicians to find the important points about a patient’s care.
The CSHSC researchers suggest that HHS use its meaningful use and EHR certification regulations to prompt vendors to correct these and other deficiencies in their products. The 2011 meaningful use criteria indirectly address some of these issues, such as interoperability, referrals, and population health management. But they are not specific about the technology tools that are needed. Neither are the accompanying standards and EHR certification criteria, which are designed to support the meaningful use requirements.
One reason why the rules are not more specific is that HHS and its advisory committees wanted to avoid requiring certain types of functionality, fearing that that would limit innovation and favor established vendors. In addition, it is clear that the government does not want to require EHRs that might prove too complex for the majority of physicians. In fact, doctors are even allowed to combine several components from different vendors if those enable them to show meaningful use.
This might be an acceptable starting point if the only goal were to persuade the bulk of physicians to adopt some kind of EHR. However, the implementation of any kind of EHR — other than a basic electronic chart — requires a big investment in time and money. If physicians are going to go to all this trouble, the least that the vendors can do is provide them with the tools they need to meet the government’s goals.
Ken Terry is a New Jersey-based freelance writer and the author of the book "Rx for Health Care Reform." In his weekly Trendspotter column, Ken is looking out for trends and changes that may affect your practice.
The Department of Health and Human Services (HHS) has released draft regulations on the “meaningful use” of electronic health records that will be required to qualify for government incentives in 2011. The good news is that physicians will not have to enter visit notes electronically to show meaningful use. But you will have to use some other EHR features out of the box, including electronic prescribing and decision support tools such as drug interaction alerts.
Patient demographics, vital signs, and smoking status must be recorded in the EHR, and at least 50 percent of lab results will have to go into the EHR as structured data. That means you will need interfaces with your major labs. In addition, you will have to give patients access to key data from their medical records, and you will have to transfer clinical summaries as part of referrals. In addition, you must either submit quality data based on PQRI measures and other metrics endorsed by the National Quality Forum, or attest that you can do so. In 2012, you will have to send in the data electronically.
All of this, of course, is designed to prove that physicians who apply for up to $44,000 in Medicare incentives ($64,000 for Medicaid) are using their EHRs in a way that will improve the quality, safety, and efficiency of patient care. A key part of that quality improvement is enhanced coordination of care — a major goal not only of the HITECH Act, but also of the public and private medical home pilots that are underway.
Read more
But a new study from the Center for Studying Health System Change casts doubt on whether current EHRs, even if they meet meaningful use criteria, are up to the task of improving care coordination in today’s environment.
Based on their interviews with users of EHRs (which they call EMRs) in 12 markets, the CSHSC researchers conclude:
“There is a gap between policy-makers’ expectation of current EMRs’ role in the coordination of care and clinicians’ real-world experience with them. We found that commercial ambulatory care EMRs facilitate care coordination within a practice by making data available at the point of care, but they are less helpful for exchanging information between practices and settings. EMRs may also have unintended consequences for coordination, such as creating an information overload that complicates providers’ efforts to discern key clinical information.”
There are some non-technological reasons for these shortfalls, including physician culture and a lack of reimbursement for care coordination. But the researchers also delineate some deficiencies that affect some or all EHRs. Among them are these:
• A lack of interoperability between systems used by various physician practices, hospitals, diagnostic testing facilities, and other providers. This results in practices scanning paper documents into the EHR as non-searchable PDF files.
• Problems with problem lists. Few EHRs link specific problems to portions of past notes that address them. Also, the lists often include redundant diagnoses generated by test results.
• Inability to capture the planning component of medical-decision making. EHRs typically do not remind physicians of things that need to be done for patients until the doctor opens that patient’s chart for the next visit.
• Lack of registries or other mechanisms that would facilitate population health management, ensuring that patients with particular conditions receive the preventive and chronic care they need when they need it.
• Inability to track referrals within the EHR.
• Tendency to generate too much information in referral notes, making it difficult for physicians to find the important points about a patient’s care.
The CSHSC researchers suggest that HHS use its meaningful use and EHR certification regulations to prompt vendors to correct these and other deficiencies in their products. The 2011 meaningful use criteria indirectly address some of these issues, such as interoperability, referrals, and population health management. But they are not specific about the technology tools that are needed. Neither are the accompanying standards and EHR certification criteria, which are designed to support the meaningful use requirements.
One reason why the rules are not more specific is that HHS and its advisory committees wanted to avoid requiring certain types of functionality, fearing that that would limit innovation and favor established vendors. In addition, it is clear that the government does not want to require EHRs that might prove too complex for the majority of physicians. In fact, doctors are even allowed to combine several components from different vendors if those enable them to show meaningful use.
This might be an acceptable starting point if the only goal were to persuade the bulk of physicians to adopt some kind of EHR. However, the implementation of any kind of EHR — other than a basic electronic chart — requires a big investment in time and money. If physicians are going to go to all this trouble, the least that the vendors can do is provide them with the tools they need to meet the government’s goals.
Ken Terry is a New Jersey-based freelance writer and the author of the book "Rx for Health Care Reform." In his weekly Trendspotter column, Ken is looking out for trends and changes that may affect your practice.
Monday, December 21, 2009
Health reform on the horizon
Is it really possible? Will the Senate actually pass a healthcare bill this week?
It looks like they will pass the legislation on Christmas Eve, the WSJ reports. The Senate’s bill would extend health insurance coverage to some 30 million Americans, create a national insurance exchange, and include subsidies for low- and middle-income to comply with an insurance mandate.
Read more
It also is tough on insurers, barring them from denying coverage to children with pre-existing conditions (and adults with pre-existing conditions starting in 2014).
But it also includes cuts of $480 billion over a decade in payments to Medicare providers.
Meanwhile, new, last minute provisions hiked the cost of the bill up by $23 billion to $871 billion over ten years. Reasons for the increase include expanding the small business tax credit and deleting provisions for increase payment rates under Medicare.
Senators scrapped a one-year fix to the Medicare payment rates because doctors don’t just want a temporary fix, Reid told MedPage Today. This leaves the door open for Congress to permanently repeal the flawed SGR-based payment formula. Last week, the House and the Senate passed two-month fixes, delaying the cuts until March 2010 or until a more permanent solution can be passed.
The Senate’s healthcare bill does raise some revenue by increasing the payroll tax on higher income individuals and families (from 0.5 percent to 0.9 percent for individuals making $200,000 and families making $250,000), according to HealthLeaders Media.
And unsurprisingly, the bill includes funding benefiting specific constituencies, inserted to clench certain lawmakers’ support, the NY Times reports, such as “victims of environmental hazards,” i.e. people exposed to asbestos from a mine in Montana – home state of Finance Committee chairman Sen. Max Baucus.
It looks like they will pass the legislation on Christmas Eve, the WSJ reports. The Senate’s bill would extend health insurance coverage to some 30 million Americans, create a national insurance exchange, and include subsidies for low- and middle-income to comply with an insurance mandate.
Read more
It also is tough on insurers, barring them from denying coverage to children with pre-existing conditions (and adults with pre-existing conditions starting in 2014).
But it also includes cuts of $480 billion over a decade in payments to Medicare providers.
Meanwhile, new, last minute provisions hiked the cost of the bill up by $23 billion to $871 billion over ten years. Reasons for the increase include expanding the small business tax credit and deleting provisions for increase payment rates under Medicare.
Senators scrapped a one-year fix to the Medicare payment rates because doctors don’t just want a temporary fix, Reid told MedPage Today. This leaves the door open for Congress to permanently repeal the flawed SGR-based payment formula. Last week, the House and the Senate passed two-month fixes, delaying the cuts until March 2010 or until a more permanent solution can be passed.
The Senate’s healthcare bill does raise some revenue by increasing the payroll tax on higher income individuals and families (from 0.5 percent to 0.9 percent for individuals making $200,000 and families making $250,000), according to HealthLeaders Media.
And unsurprisingly, the bill includes funding benefiting specific constituencies, inserted to clench certain lawmakers’ support, the NY Times reports, such as “victims of environmental hazards,” i.e. people exposed to asbestos from a mine in Montana – home state of Finance Committee chairman Sen. Max Baucus.
Wednesday, December 16, 2009
Trendspotter: Obama campaign against Medicare fraud emboldens RACs
By Ken Terry
Since last March, the domain of Medicare’s new Recovery Audit Contractors (RACs) has expanded from four states to nearly the whole country.
During the three-year pilot that preceded this expansion, the RACs focused mostly on hospitals, and 85 percent of the $900 million-plus in overpayments that were returned to the Medicare trust fund from 2005 to 2008 came from hospitals. Nevertheless, some experts warn that the RACs will eventually pay more attention to physician practices. And, with the Obama administration ramping up its rhetoric against Medicare “fraud and abuse,” the RACs are getting plenty of encouragement.
Read more
President Obama announced the new direction in his healthcare address to Congress in September. “The only thing this [reform] plan would eliminate [from Medicare] is the hundreds of billions of dollars in waste and fraud, as well as unwarranted subsidies in Medicare that go to insurance companies,” he said.
Then, in November, the White House announced that the Centers for Medicare and Medicaid Services (CMS) had made $54.1 billion in improper payments in fiscal 2009, and that the number of erroneous payments by the fee for service Medicare program had roughly doubled to $24.1 billion from the previous year’s level. As a percentage of total Medicare fee for service payments, that represented 7.8 percent, compared with 3.6 percent in 2008. The implication was that if these improper payments could be eliminated, the galloping rise in Medicare costs could be curtailed.
However, as White House Budget Director Peter Orszag quickly acknowledged, the apparent increase in Medicare overpayments was largely due to a change in accounting methods. For example, he said, payments on claims supported by poor documentation or illegible signatures were now being regarded as errors; before, they had generally been disregarded. And this is where the RACs may see an opening to harass physicians who have submitted Medicare claims in good faith for services they actually performed.
According to David Glaser, a Minneapolis attorney who specializes in defending physicians against Medicare audits, the RACs “are nailing people on things like unsigned notes that don’t necessarily take a lot of work. It’s clearly unfair to the doctors, because you’re fighting over that stuff even though there’s no doubt the service was provided. And recently, the RACs have been hinting that if your signature is illegible, that’s a basis for a denial.”
Then there’s the small matter of the RACs’ contingency fees for recovering government money. Those range from 9 percent to 12.5 percent of the funds they collect, depending on the region. This bounty hunting, which Glaser calls a “legitimate concern” for doctors, reflects another new approach of the Obama Administration. For example, the Office of Civil Rights in the Health and Human Services Administration is now empowered to support its investigation of HIPAA privacy violations with a portion of the fines it imposes on physicians and hospitals.
The RACs’ bounty hunting may have one positive aspect, Glaser notes. If the RACs go after physicians for minor rule violations and most of the doctors win on appeal, the RACs won’t get any money in those cases. “So that holds out some hope that they’ll be more rational than the past Medicare audits have been,” he says.
In any case, you should remember that Medicare carriers are still actively auditing physician claims, as well. So, even if the RACs don’t aggressively pursue physicians for some time, you could still feel the sting of an auditor’s letter. And, if the government continues its aggressive campaign against Medicare fraud, those audits might occur more frequently. So mind your Ps and Qs.
Ken Terry is a New Jersey-based freelance writer and the author of the book "Rx for Health Care Reform." In his weekly Trendspotter column, Ken is looking out for trends and changes that may affect your practice.
Since last March, the domain of Medicare’s new Recovery Audit Contractors (RACs) has expanded from four states to nearly the whole country.
During the three-year pilot that preceded this expansion, the RACs focused mostly on hospitals, and 85 percent of the $900 million-plus in overpayments that were returned to the Medicare trust fund from 2005 to 2008 came from hospitals. Nevertheless, some experts warn that the RACs will eventually pay more attention to physician practices. And, with the Obama administration ramping up its rhetoric against Medicare “fraud and abuse,” the RACs are getting plenty of encouragement.
Read more
President Obama announced the new direction in his healthcare address to Congress in September. “The only thing this [reform] plan would eliminate [from Medicare] is the hundreds of billions of dollars in waste and fraud, as well as unwarranted subsidies in Medicare that go to insurance companies,” he said.
Then, in November, the White House announced that the Centers for Medicare and Medicaid Services (CMS) had made $54.1 billion in improper payments in fiscal 2009, and that the number of erroneous payments by the fee for service Medicare program had roughly doubled to $24.1 billion from the previous year’s level. As a percentage of total Medicare fee for service payments, that represented 7.8 percent, compared with 3.6 percent in 2008. The implication was that if these improper payments could be eliminated, the galloping rise in Medicare costs could be curtailed.
However, as White House Budget Director Peter Orszag quickly acknowledged, the apparent increase in Medicare overpayments was largely due to a change in accounting methods. For example, he said, payments on claims supported by poor documentation or illegible signatures were now being regarded as errors; before, they had generally been disregarded. And this is where the RACs may see an opening to harass physicians who have submitted Medicare claims in good faith for services they actually performed.
According to David Glaser, a Minneapolis attorney who specializes in defending physicians against Medicare audits, the RACs “are nailing people on things like unsigned notes that don’t necessarily take a lot of work. It’s clearly unfair to the doctors, because you’re fighting over that stuff even though there’s no doubt the service was provided. And recently, the RACs have been hinting that if your signature is illegible, that’s a basis for a denial.”
Then there’s the small matter of the RACs’ contingency fees for recovering government money. Those range from 9 percent to 12.5 percent of the funds they collect, depending on the region. This bounty hunting, which Glaser calls a “legitimate concern” for doctors, reflects another new approach of the Obama Administration. For example, the Office of Civil Rights in the Health and Human Services Administration is now empowered to support its investigation of HIPAA privacy violations with a portion of the fines it imposes on physicians and hospitals.
The RACs’ bounty hunting may have one positive aspect, Glaser notes. If the RACs go after physicians for minor rule violations and most of the doctors win on appeal, the RACs won’t get any money in those cases. “So that holds out some hope that they’ll be more rational than the past Medicare audits have been,” he says.
In any case, you should remember that Medicare carriers are still actively auditing physician claims, as well. So, even if the RACs don’t aggressively pursue physicians for some time, you could still feel the sting of an auditor’s letter. And, if the government continues its aggressive campaign against Medicare fraud, those audits might occur more frequently. So mind your Ps and Qs.
Ken Terry is a New Jersey-based freelance writer and the author of the book "Rx for Health Care Reform." In his weekly Trendspotter column, Ken is looking out for trends and changes that may affect your practice.
Wednesday, December 2, 2009
Trendspotter: New technology choices will help you with PQRI
By Ken Terry
Welcome to Trendspotter, a new weekly blog feature that bears the same name as the monthly column I’ve been penning for Physicians Practice over the past year. In this blog, I am not only going to report the news, but also will endeavor to supply some insights that you might find useful. Please post a comment if you agree or disagree with any of my entries, and also feel free to contribute your own insights and information.
That said, let’s turn to this week’s topic: CMS’ Physician Quality Reporting Initiative, or PQRI, as it’s known to most of you. This is going to become more important to practices, and not just because of the 2 percent Medicare bonus that you can now receive if you report quality data to CMS successfully.
Read more
If Congress passes healthcare reform legislation, it may well include new Medicare reimbursement methods like those in the current Senate bill. Under that measure, after tracking the utilization of every physician in the Medicare program, CMS would be empowered to reward doctors who provide high-quality, cost-efficient care, and punish those who don’t. While we don’t yet know how big the carrots and sticks will be, it’s clear that the quality piece will be based on measures like those of PQRI. So it’s time to start reporting this data, if you’re not doing it already.
According to a new CMS report, more than 85,000 physicians and other eligible professionals met PQRI requirements in 2008 and received a total of $92 million and change. (Individual payments averaged more than $1,000.) This was viewed as a smashing success, considering that only 56,700 eligible professionals received incentives in 2007, and that those payments totaled just $36 million.
But the latest figures suggest a story that is not quite as upbeat as CMS’ spin.
Let’s start with the fact that of the 153,600 providers who applied for PQRI incentives in 2008, 45 percent did not make the cut. Of course, this has nothing to do with their relative scores on these measures. Their ability to obtain the government payments depended purely on whether they met the statutory requirements for data submission. So we can assume that they or their staffs did something wrong, such as putting in the wrong G codes or selecting the wrong patients for the measures they were submitting data on.
This was also a serious problem in 2007, and not just on the physician side. CMS has just announced that, after resolving several “data issues,” it will make payments to 3,900 physicians who were erroneously excluded from the 2007 incentive pool.
One reason for the improved 2008 performance is that physicians were allowed to report their PQRI data through approved electronic registries run by third parties. About 8 percent of those who applied for the PQRI incentives availed themselves of these services, and nearly all of them received bonus payments.
The 2009 PQRI program raised the incentive from 1.5 percent to 2 percent of allowed Medicare payments. Fifty-two new measures were added, raising the total to 153 and broadening the areas in which physicians can qualify for bonuses.
In the 2010 PQRI round, the incentive will again be 2 percent , and 36 new measures have been added. For the first time, practices will be able to qualify for incentives at the group level, rather than the individual provider level. And, most important, CMS will begin accepting data from “qualified” EHRs on 10 of the measures and applying that data to meeting the requirements for PQRI incentives.
Because the ability to send quality data to CMS from your EHR is one of the criteria for “meaningful use,” you must do this if you want government subsidies for your EHR investment. Moreover, being able to use your EHR to collect and submit performance data automatically, instead of having to enter G codes in the billing system, will take a burden off of many physicians and their staffs. When more measures are added to the EHR reporting menu, it will become a no-brainer to submit data in return for a 2 percent pay bump.
Ken Terry is a New Jersey-based freelance writer and the author of the book "Rx for Health Care Reform." In his weekly Trendspotter column, Ken is looking out for trends and changes that may affect your practice.
Welcome to Trendspotter, a new weekly blog feature that bears the same name as the monthly column I’ve been penning for Physicians Practice over the past year. In this blog, I am not only going to report the news, but also will endeavor to supply some insights that you might find useful. Please post a comment if you agree or disagree with any of my entries, and also feel free to contribute your own insights and information. That said, let’s turn to this week’s topic: CMS’ Physician Quality Reporting Initiative, or PQRI, as it’s known to most of you. This is going to become more important to practices, and not just because of the 2 percent Medicare bonus that you can now receive if you report quality data to CMS successfully.
Read more
If Congress passes healthcare reform legislation, it may well include new Medicare reimbursement methods like those in the current Senate bill. Under that measure, after tracking the utilization of every physician in the Medicare program, CMS would be empowered to reward doctors who provide high-quality, cost-efficient care, and punish those who don’t. While we don’t yet know how big the carrots and sticks will be, it’s clear that the quality piece will be based on measures like those of PQRI. So it’s time to start reporting this data, if you’re not doing it already.
According to a new CMS report, more than 85,000 physicians and other eligible professionals met PQRI requirements in 2008 and received a total of $92 million and change. (Individual payments averaged more than $1,000.) This was viewed as a smashing success, considering that only 56,700 eligible professionals received incentives in 2007, and that those payments totaled just $36 million.
But the latest figures suggest a story that is not quite as upbeat as CMS’ spin.
Let’s start with the fact that of the 153,600 providers who applied for PQRI incentives in 2008, 45 percent did not make the cut. Of course, this has nothing to do with their relative scores on these measures. Their ability to obtain the government payments depended purely on whether they met the statutory requirements for data submission. So we can assume that they or their staffs did something wrong, such as putting in the wrong G codes or selecting the wrong patients for the measures they were submitting data on.
This was also a serious problem in 2007, and not just on the physician side. CMS has just announced that, after resolving several “data issues,” it will make payments to 3,900 physicians who were erroneously excluded from the 2007 incentive pool.
One reason for the improved 2008 performance is that physicians were allowed to report their PQRI data through approved electronic registries run by third parties. About 8 percent of those who applied for the PQRI incentives availed themselves of these services, and nearly all of them received bonus payments.
The 2009 PQRI program raised the incentive from 1.5 percent to 2 percent of allowed Medicare payments. Fifty-two new measures were added, raising the total to 153 and broadening the areas in which physicians can qualify for bonuses.
In the 2010 PQRI round, the incentive will again be 2 percent , and 36 new measures have been added. For the first time, practices will be able to qualify for incentives at the group level, rather than the individual provider level. And, most important, CMS will begin accepting data from “qualified” EHRs on 10 of the measures and applying that data to meeting the requirements for PQRI incentives.
Because the ability to send quality data to CMS from your EHR is one of the criteria for “meaningful use,” you must do this if you want government subsidies for your EHR investment. Moreover, being able to use your EHR to collect and submit performance data automatically, instead of having to enter G codes in the billing system, will take a burden off of many physicians and their staffs. When more measures are added to the EHR reporting menu, it will become a no-brainer to submit data in return for a 2 percent pay bump.
Ken Terry is a New Jersey-based freelance writer and the author of the book "Rx for Health Care Reform." In his weekly Trendspotter column, Ken is looking out for trends and changes that may affect your practice.
Friday, November 6, 2009
Podcast: CMS 2010 update
Looking for more information about CMS' final physician fee schedule for 2010?
For this month's podcast, I spoke with consultant Betsy Nicoletti about changes to consultation codes, e-prescribing, and the overall 21 percent cut -- and what it all means for your practice.
For this month's podcast, I spoke with consultant Betsy Nicoletti about changes to consultation codes, e-prescribing, and the overall 21 percent cut -- and what it all means for your practice.
Monday, November 2, 2009
More on the CMS fee schedule and a payment fix
On the heels of CMS’ release of the final physician fee schedule for 2010 on Friday, AMA renewed their cries for a permanent fix to the flawed payment formula.
“Permanent repeal of the payment formula is an essential element of comprehensive reform to improve the health system for patients and physicians,” AMA’s President J. James Rohack, MD, said in a statement.
But before you decide to stop taking Medicare patients, a fix could be on its way. Read more
Congress has historically stepped in and passed legislation stopping the drastic cuts, and it looks like this year is no different. The House Ways and Means Committee introduce legislation on Thursday that would stop that 21 percent reduction in 2010 — and “replace the physician payment formula with a more stable system that ends the unrealistic cycle of threats of ever-larger fee cuts followed by short-term patches,” according to a committee statement about the bill.
The bill would replace SGR (the Sustainable Growth Index, which Medicare rates are based on), with a formula that, according to the committee:
- Removes items such as drugs and lab services not paid directly to practitioners from spending targets;
- Allows the volume of most services to grow at the rate of GDP plus 1 percentage point per year (compared to GDP without any adjustment today);
- Allows the volume of primary and preventive care services to grow at GDP plus 2% per year;
- Encourages coordinated, innovative care by allowing Accountable Care Organizations to be responsible for their own growth paths, irrespective of reductions or increases that apply elsewhere in the system.
A permanent fix has been batted around in Washington for the last couple weeks, and fizzled in the Senate, so it remains to be seen if this time it will move forward.
Still, many physicians are getting off the rollercoaster and saying no to Medicare patients.
Meanwhile, the Medicare rule also formalizes the removal of physician-administered drugs from the formula, according to AMA, and Rohack called this “a long overdue step on the road to permanent reform.” CMS says this will reduce the number of years in which physicians may see a negative update.
CMS also will stop making payment for higher-paying specialists’ consultation codes. The savings would be redistributed to increase payments for E&M services, with an eye toward increasing payments to primary-care physicians.
Among other changes, the fee schedule also includes changes to the PQRI program. For 2010, participants can earn 2 percent of total allowed charges. CMS will add 30 individual PQRI measures and add an EHR-based reporting mechanism. For more, check out their fact sheet.
There's a lot there, so I welcome your thoughts here on the changes.
“Permanent repeal of the payment formula is an essential element of comprehensive reform to improve the health system for patients and physicians,” AMA’s President J. James Rohack, MD, said in a statement.
But before you decide to stop taking Medicare patients, a fix could be on its way. Read more
Congress has historically stepped in and passed legislation stopping the drastic cuts, and it looks like this year is no different. The House Ways and Means Committee introduce legislation on Thursday that would stop that 21 percent reduction in 2010 — and “replace the physician payment formula with a more stable system that ends the unrealistic cycle of threats of ever-larger fee cuts followed by short-term patches,” according to a committee statement about the bill.
The bill would replace SGR (the Sustainable Growth Index, which Medicare rates are based on), with a formula that, according to the committee:
- Removes items such as drugs and lab services not paid directly to practitioners from spending targets;
- Allows the volume of most services to grow at the rate of GDP plus 1 percentage point per year (compared to GDP without any adjustment today);
- Allows the volume of primary and preventive care services to grow at GDP plus 2% per year;
- Encourages coordinated, innovative care by allowing Accountable Care Organizations to be responsible for their own growth paths, irrespective of reductions or increases that apply elsewhere in the system.
A permanent fix has been batted around in Washington for the last couple weeks, and fizzled in the Senate, so it remains to be seen if this time it will move forward.
Still, many physicians are getting off the rollercoaster and saying no to Medicare patients.
Meanwhile, the Medicare rule also formalizes the removal of physician-administered drugs from the formula, according to AMA, and Rohack called this “a long overdue step on the road to permanent reform.” CMS says this will reduce the number of years in which physicians may see a negative update.
CMS also will stop making payment for higher-paying specialists’ consultation codes. The savings would be redistributed to increase payments for E&M services, with an eye toward increasing payments to primary-care physicians.
Among other changes, the fee schedule also includes changes to the PQRI program. For 2010, participants can earn 2 percent of total allowed charges. CMS will add 30 individual PQRI measures and add an EHR-based reporting mechanism. For more, check out their fact sheet.
There's a lot there, so I welcome your thoughts here on the changes.
Friday, October 30, 2009
CMS finalizes physician fee schedule
CMS came out with their final physician fee schedule this afternoon, and yep, that whopping 21 percent cut is there.
From the CMS press release:
“The Administration tried to avert the pending fee schedule cut in the FY 2010 budget proposal that it submitted to Congress, and remains committed to repealing the SGR,” said Jonathan Blum, director of the CMS Center for Medicare Management. “In the meantime, CMS is finalizing its proposal to remove physician-administered drugs from the definition of ‘physicians’ services’ for purposes of computing the physician fee schedule update. While this decision will not affect payments for services during CY 2010, CMS projects it will have a positive effect on future payment updates.”
So far, Congress’ attempts to fix the SGR payment formula have fizzled and talk of a long-term solution doesn’t seem to be gaining much traction in Washington. It remains to be see what Congress will do about the 2010 cut in payments, or if a health reform bill with touch it.
We'll have more here on the final rule and the other provisions in there next week.
From the CMS press release:
“The Administration tried to avert the pending fee schedule cut in the FY 2010 budget proposal that it submitted to Congress, and remains committed to repealing the SGR,” said Jonathan Blum, director of the CMS Center for Medicare Management. “In the meantime, CMS is finalizing its proposal to remove physician-administered drugs from the definition of ‘physicians’ services’ for purposes of computing the physician fee schedule update. While this decision will not affect payments for services during CY 2010, CMS projects it will have a positive effect on future payment updates.”
So far, Congress’ attempts to fix the SGR payment formula have fizzled and talk of a long-term solution doesn’t seem to be gaining much traction in Washington. It remains to be see what Congress will do about the 2010 cut in payments, or if a health reform bill with touch it.
We'll have more here on the final rule and the other provisions in there next week.
Tuesday, October 20, 2009
Congress considering fix to Medicare payment formula
It looks like the flawed Medicare payment system is finally getting some serious attention.
Senate Democrats are planning a vote soon on a bill that would permanently eliminate the sustainable growth rate (SGR), the formula used to determine Medicare payment rates. As you probably know all too well, that formula has and will continue to threaten payment cuts each year. Congress usually steps in at the last minute to reverse the cuts, but a 21 percent cut was looming for 2010, and there has yet to be a permanent fix.
Read more
The bill, introduced last week by Sen. Debbie Stabenow (D-Mich.) and separate from the main three health reform bills, would reset the SGR to zero for 2010 and beyond. This basically means it erases the $245 billion debt accumulated from last-minute fixes to avoid deep payment cuts, according to MedPage Today.
Among the major healthcare reform bills being worked out in Congress, the House bill scraps the SGR and later replaces it with the Medicare Economic Index, and the Senate Finance bill fixes it for just one year. That accounts for some of the cost difference between the bills.
The AMA, which supports the bill, launched a campaign last week including a television ad. “Congress can no longer put a band-aid on the problem,” AMA President J. James Rohack, MD, said in a statement.
But the cost (and the fact that the bill doesn’t really explain how to pay for the $245 billion) and the speed (it’s scheduled for a quick floor vote) has made some skeptical about this solution to the Medicare payment system.
So perhaps there are better ways to fix the SGR, but at least it's getting some real attention in Washington.
Senate Democrats are planning a vote soon on a bill that would permanently eliminate the sustainable growth rate (SGR), the formula used to determine Medicare payment rates. As you probably know all too well, that formula has and will continue to threaten payment cuts each year. Congress usually steps in at the last minute to reverse the cuts, but a 21 percent cut was looming for 2010, and there has yet to be a permanent fix.
Read more
The bill, introduced last week by Sen. Debbie Stabenow (D-Mich.) and separate from the main three health reform bills, would reset the SGR to zero for 2010 and beyond. This basically means it erases the $245 billion debt accumulated from last-minute fixes to avoid deep payment cuts, according to MedPage Today.
Among the major healthcare reform bills being worked out in Congress, the House bill scraps the SGR and later replaces it with the Medicare Economic Index, and the Senate Finance bill fixes it for just one year. That accounts for some of the cost difference between the bills.
The AMA, which supports the bill, launched a campaign last week including a television ad. “Congress can no longer put a band-aid on the problem,” AMA President J. James Rohack, MD, said in a statement.
But the cost (and the fact that the bill doesn’t really explain how to pay for the $245 billion) and the speed (it’s scheduled for a quick floor vote) has made some skeptical about this solution to the Medicare payment system.
So perhaps there are better ways to fix the SGR, but at least it's getting some real attention in Washington.
Thursday, October 1, 2009
Stricter Stark rules take effect today
Stricter self-referral rules go into effect today, prompting many physicians and hospitals to rework or cancel contracts.
The Stark law revisions restrict arrangements where hospitals contract with physician-owned entities to provide ancillary services, such as imaging services. Basically, CMS has expanded the scope of designated health services to cover the entity providing the service (the doctor’s offices), consultant Susanne Madden tells me. (Susanne is writing next week’s PEARLS column on the topic, so be sure to sign up that e-newsletter.)
So, what does this all mean?
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Under the new regulations, doctors are no longer exempt from Stark rules, so it’s as if a physician is billing for his own referral services, Madden says. It’s as if they are sending patients to themselves, where before, it wasn’t considered self-referring.
Now, doctors and hospitals are left to quickly revise those contracts. Hospitals may choose to build out their own imaging services, for example. Or it looks like the hospitals may get creative to be able to contract for these services, as physicians could lease equipment or space.
How does the change effect your practice? What do you think of the expanded Stark rules?
The Stark law revisions restrict arrangements where hospitals contract with physician-owned entities to provide ancillary services, such as imaging services. Basically, CMS has expanded the scope of designated health services to cover the entity providing the service (the doctor’s offices), consultant Susanne Madden tells me. (Susanne is writing next week’s PEARLS column on the topic, so be sure to sign up that e-newsletter.)
So, what does this all mean?
Read more
Under the new regulations, doctors are no longer exempt from Stark rules, so it’s as if a physician is billing for his own referral services, Madden says. It’s as if they are sending patients to themselves, where before, it wasn’t considered self-referring.
Now, doctors and hospitals are left to quickly revise those contracts. Hospitals may choose to build out their own imaging services, for example. Or it looks like the hospitals may get creative to be able to contract for these services, as physicians could lease equipment or space.
How does the change effect your practice? What do you think of the expanded Stark rules?
Wednesday, July 8, 2009
CMS' proposed payment shift
It looks like a boost to primary-care physicians could come at a cost to their higher-paid specialist brethren. CMS’ proposed 2010 physician fee schedule released last week would cut rates for specialists and imaging services, shifting the pay to primary care.
Organizations have been parsing through the regulation to see just how deep the cut would be for each specialty (cardiology: 11 percent, for example), while CMS says the regulation would increase payments to general practitioners, family physicians, internists, and geriatric specialists by 6 percent to 8 percent.Read more
To do this, CMS would eliminate payment for consultation codes, which are billed by specialists and paid at a higher rate than E&M codes. CMS says “resulting savings would be redistributed to increase payments for existing E&M services.” CMS would also refine practice expenses and revise malpractice premiums.
Overall, physicians’ payments would be slashed by a whopping 21.5 percent under the proposed regulation.
That is, unless Congress enacts legislation reversing the cuts, a strong possibility. The rates are updated each year based on the sustainable growth rate, which has yielded reductions for the last eight years. But, Congress has stepped in to avoid the cuts each year. (Meanwhile, specialists’ groups say they will lobby lawmakers to stop the cuts, according to the Wall Street Journal.)
Our own Pamela Moore addressed the threat of cuts last year and what docs should do if they are considering reducing their Medicare mix.
What do you think? Is this an effective way to close the pay gap between primary-care docs and specialists? Is this another sign the Obama administration is serious about primary care?
The regulations also included perhaps some good news for all. CMS proposed removing physician-administered drugs from the formula used to calculate the fee schedule, which has been long advocated for by the AMA and MGMA. (Cost hikes for outpatient drugs in recent years have outpaced other services, pushing spending levels above the target, according to AMA.) It wouldn’t prevent the 2010 reductions, but it would mean fewer years of negative updates.
All of that said, CMS is accepting comments until Aug. 31 and a final rule will be issued by Nov. 1. Congress, your move.
Organizations have been parsing through the regulation to see just how deep the cut would be for each specialty (cardiology: 11 percent, for example), while CMS says the regulation would increase payments to general practitioners, family physicians, internists, and geriatric specialists by 6 percent to 8 percent.Read more
To do this, CMS would eliminate payment for consultation codes, which are billed by specialists and paid at a higher rate than E&M codes. CMS says “resulting savings would be redistributed to increase payments for existing E&M services.” CMS would also refine practice expenses and revise malpractice premiums.
Overall, physicians’ payments would be slashed by a whopping 21.5 percent under the proposed regulation.
That is, unless Congress enacts legislation reversing the cuts, a strong possibility. The rates are updated each year based on the sustainable growth rate, which has yielded reductions for the last eight years. But, Congress has stepped in to avoid the cuts each year. (Meanwhile, specialists’ groups say they will lobby lawmakers to stop the cuts, according to the Wall Street Journal.)
Our own Pamela Moore addressed the threat of cuts last year and what docs should do if they are considering reducing their Medicare mix.
What do you think? Is this an effective way to close the pay gap between primary-care docs and specialists? Is this another sign the Obama administration is serious about primary care?
The regulations also included perhaps some good news for all. CMS proposed removing physician-administered drugs from the formula used to calculate the fee schedule, which has been long advocated for by the AMA and MGMA. (Cost hikes for outpatient drugs in recent years have outpaced other services, pushing spending levels above the target, according to AMA.) It wouldn’t prevent the 2010 reductions, but it would mean fewer years of negative updates.
All of that said, CMS is accepting comments until Aug. 31 and a final rule will be issued by Nov. 1. Congress, your move.
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