Medicare Reform Plan Would Freeze Physician Pay for 3 Years

June 30, 2011 — Physicians would dodge a nearly 30% Medicare pay cut next January and see their rates frozen for 3 years under an ambitious proposal from 2 US senators to slow the growth of Medicare spending and save the government healthcare program for seniors.

However, seniors would get hit squarely with fiscal pain. The reform plan issued yesterday by Sen. Tom Coburn, MD (R-OK), and Sen. Joe Lieberman (I-CT) would gradually raise the Medicare eligibility age from 65 to 67 years by 2025, require wealthier seniors to pay more for their share of the Part B medical program and the Part D drug program, and increase Part B premiums for all enrollees. These and other features of the plan that have not yet been submitted as legislation would supposedly save more than $600 billion over 10 years.

The proposal is one more chip in the high-stakes Congressional poker match over the federal deficit and debt ceiling, or the limit on how much the government can borrow. The Treasury Department warns that the government will default on its obligations, such as interest payments, if Congress fails to raise the debt ceiling from its present level of $14.3 trillion by August 2. Republicans who control the House and hold enough Senate seats to filibuster the Democratic majority there have made massive budget cuts a prerequisite for raising the debt ceiling.

In turn, Congressional Democrats have resisted Republican efforts to put Medicare and other entitlement programs on a crash diet at the expense of beneficiaries. In response to the Coburn-Lieberman proposal, House Minority Leader Nancy Pelosi (D-CA) stated, "It is unfair to ask seniors to get less in benefits and wait longer to get onto Medicare — all while Republicans back tax breaks for Big Oil and corporations that ship American jobs overseas." Pelosi said the proposal is just as unacceptable as legislation passed by the House, and defeated by the Senate, that would give seniors subsidies to buy health coverage from private insurers.

More Time for Congress to Devise Better Pay Formula

Congressional Republicans and Democrats are more united on the need to solve the Medicare reimbursement crisis, created by the program's sustainable growth rate formula for setting physician pay. That formula sets an annual target for Medicare spending on physician services based in part on changes in the gross domestic product. When spending exceeds that target in a given year, reimbursement rates the following year are supposed to decrease to make up the difference. Every year since 2003, however, Congress has postponed such cuts, all the way up to 2010, when it voted to spare physicians a 25% reduction set for January 1, 2011.

Every postponement causes the next cut to deepen. Accordingly, the sustainable growth rate formula is now mandating a nearly 30% reimbursement reduction on January 1, 2012. For years, organized medicine has warned that such a plummet in revenue would cause physicians to leave Medicare in droves.

The Coburn-Lieberman proposal would avert this catastrophe by freezing Medicare rates at their current levels for 3 years. This "bridge" period would give Congress time to develop an improved method for paying Medicare providers, according to the 2 senators. They put the cost of the 3-year "doc fix," as such measures are called on Capitol Hill, at $37.7 billion over 10 years.

Earn CME Credit with EHR Medscape Modules

Medscape Modules are Available on the CMS EHR Incentive Programs

CMS is pleased to announce that through Medscape Education, you now have the opportunity to achieve CME credits by learning more about the Electronic Health Records (EHR) Incentive Programs.

On Medscape's EHR Learning Center website, leading physician experts in medical informatics provide information, resources, and tools to help providers determine eligibility for the EHR Incentive Programs, understand the requirements for participating, take steps to participate, and recognize the immediate benefits of participation and future consequences of not participating.

By completing the module From Meaningful Use to Meaningful Care, providers can earn CME credit while gaining a better understanding about the purpose of the EHR Incentive Programs, the stages of meaningful use, a timeline of key dates, and most importantly, how patients will benefit.

Providers can also use the Medscape Learning Center to determine their comprehension of the EHR Incentive Programs by taking the Participant Self Assessment: Medicare and Medicaid EHR Incentives: What Do You Know and Do You Know Enough?  By completing the assessment, providers can help to shape the content of future CME activities to best address the educational and clinical performance gaps identified.

The site also offers interviews, where physician EHR experts explain why it's important to register for the programs and the significance of EHRs to health care overall. Expert interviews include:

• Registering for the EHR Incentive Program -- Ready, Set, Go:  An Expert Interview With Jason M. Mitchell, MD, and Richard Paula, MD


• Are You an Eligible Professional Who Hasn't Registered for the EHR Incentive Program? What Are You Waiting For? -- An Expert Interview With William F. Bria II, MD

In the next few weeks, new CME modules on meaningful use will be available. Look out for for a listserv message to announce these new learning resources.

Want more information about the EHR Incentive Programs?
Make sure to visit the EHR Incentive Programs website for the latest news and updates on the EHR Incentive Programs. 

Physicians Adopt Public Safety Policies at AMA Meeting

June 24, 2011 (Chicago, Illinois) — The American Medical Association (AMA) considered the public health implications of bisphenol A (BPA), mercury emissions, and bath salts here at the 2011 Annual Meeting. There commendations of the AMA's Reference Committee E were passed to a standing ovation in an unprecedented unanimous vote by the AMA's House of Delegates.

BPA is widely used in the production of polycarbonate plastics. The AMA's Council on Science and Public Health prepared a report reviewing human exposure to BPA and the federal regulation of BPA. In the United States, BPA is regulated by 2 agencies, the Environmental Protection Agency (EPA) and the US Food and Drug Administration (FDA). Physicians testified that these agencies do not appear to be on the same page when regulating this endocrine-disrupting chemical.

The AMA adopted a policy urging that BPA-containing products be clearly labeled if there is a potential for human exposure. "Both the FDA and Canadian officials have recently expressed concern about potential harmful effects of BPA and taken interim action to protect sensitive populations, such as infants and toddlers, by banning the sale of baby bottles, food containers, and cups containing BPA," said AMA board member Edward Langston, MD, from Lafayette, Indiana. "The policy adopted today supports these measures and a shift to a more robust science-based federal regulatory framework for oversight of BPA."

The AMA also adopted a policy that supports the EPA's national mercury emissions standards for cement kilns. "Exposure to mercury can have adverse affects on human neurological development and is associated with reproductive toxicity and cardiovascular morbidity," said Dr. Langston. The new AMA policy "supports stricter monitoring of mercury emissions from cement plants to lessen or eliminate the potential for Americans to be exposed to potentially harmful levels of mercury."

The House of Delegates also voted to support national legislation banning bath salts that contain methylenedioxypyrovalerone (MDPV) and related compounds that may be toxic. "The misuse of bath salts containing MDPV, mephedrone, and related substances has led to deaths and hundreds of calls to poison centers nationwide," Dr. Langston told Medscape Medical News.

The House of Delegates voted to support the development of written consumer medical information to replace the current framework of patient package inserts. The supporting report on the subject stressed the fact that the lack of availability of useful written patient information is a factor in patient medication nonadherence.

Although the AMA did not pass a resolution on airport security scanners, the physicians did call for more independent research on the health effects of ionizing radiation.

At the meeting, Peter W. Carmel, MD, a pediatric neurosurgeon practicing in Newark, New Jersey, was inaugurated as the AMA's 166th president.

Dr. Langston has disclosed no relevant financial relationships.

CMS Has Electronic Health Record (EHR) Materials Available at the AANP 26th National Conference!

Are you attending the American Academy of Nurse Practitioners (AANP) 26th National Conference in Las Vegas? Visit CMS at booth #8110 for EHR materials that can help you to successfully participate in the Medicaid EHR Incentive Program.

CMS is also presenting informational sessions about the Medicaid EHR Incentive Program in the AANP classroom in the conference exhibit hall. The remaining sessions are taking place on:

• June 24 at 1:00 p.m. PST time


• June 25 at 1:40 p.m. PST time

Nurse practitioners are eligible for incentive payments under the Medicaid EHR Incentive Program. For more information on this program, and how to participate, go to the Path to Payment section of the CMS EHR website.

You can also visit the Office of the National Coordinator for Health Information Technology (ONC) booth #8106 that is located directly next to CMS' booth for more information on how ONC's Regional Extension Centers can assist you in adopting certified EHR technology.

Want more information about the EHR Incentive Programs?

Make sure to visit the EHR Incentive Programs website for the latest news and updates on the EHR Incentive Programs. 

CMS Has a New FAQ on Payment for the Medicare EHR Incentive Program

CMS wants to keep you updated with information on the Medicare and Medicaid Electronic Health Record (EHR) Incentive Programs. Take a minute and review CMS' new FAQ on receiving an incentive payment in the Medicare EHR Incentive Program.

Question: I am an eligible professional (EP) who has successfully attested for the Medicare EHR Incentive Program, so why haven't I received my incentive payment yet?

Answer: For EPs, incentive payments for the Medicare EHR Incentive Program will be made approximately four to eight weeks after an EP successfully attests that they have demonstrated meaningful use of certified EHR technology. However, EPs will not receive incentive payments within that time frame if they have not yet met the threshold for allowed charges for covered professional services furnished by the EP during the year.

The Medicare EHR incentive payments to EPs are based on 75% of the estimated allowed charges for covered professional services furnished by the EP during the entire payment year. Therefore, to receive the maximum incentive payment of $18,000 for the first year of participation in 2011 or 2012, the EP must accumulate $24,000 in allowed charges. If the EP has not met the $24,000 threshold in allowed charges at the time of attestation, CMS will hold the incentive payment until the EP meets the $24,000 threshold in order to maximize the amount of the EHR incentive payment the EP receives. If the EP still has not met the $24,000 threshold in allowed charges by the end of calendar year, CMS expects to issue an incentive payment for the EP in March 2012 (allowing 60 days after the end of the 2011 calendar year for all pending claims to be processed).

Payments to Medicare EPs will be made to the taxpayer identification number (TIN) selected at the time of registration, through the same channels their claims payments are made. The form of payment (electronic funds transfer or check) will be the same as claims payments.

Bonus payments for EPs who practice predominantly in a geographic Health Professional Shortage Area (HPSA) will be made as separate lump-sum payments no later than 120 days after the end of the calendar year for which the EP was eligible for the bonus payment.

Want more information about the EHR Incentive Programs?

Make sure to visit the CMS EHR Incentive Programs website for the latest news and updates on the EHR Incentive Programs. 

Blue Cross of GA Uses Google Maps to Encourage Use of Urgent Care

You may have heard of a few enlightened payors who have sent letters to encourage their members to use urgent care instead of the emergency department. That makes perfect sense given the savings of 50-70% with urgent care. However, Blue Cross Blue Shield of Georgia has taken this a step further by utilizing technology to launch a program aimed at educating their members on their health care options in order to prevent unnecessary ER visits. BCBS hopes to accomplish this through the launch of the website http://www.bcbsga.com/eralt that includes a Google Maps application – which will eventually include an iPhone app – that allows their members to find clinics in their area; online tutorials on whether to visit an ER or urgent care; and information on how to access their 24-hour nurse line for recommendations on where to go and directions to clinics. Read More

 

AMA Reaffirms Support of Health Insurance Mandate

June 21, 2011 (Chicago, Illinois) — The American Medical Association (AMA) voted to continue its support of the individual health insurance mandate last night at its annual meeting of its House of Delegates, which includes physicians representing all state and medical specialty societies.

AMA president Cecil B. Wilson, MD, spoke at a press briefing after the contentious vote: "We celebrate the democracy of our house and we celebrate that our house came to this conclusion."

Dr. Wilson noted that the AMA has a strong policy in support of covering the uninsured. He added that this vote renews the AMA's commitment to achieve this through individual responsibility for health insurance, and with avenues of assistance for those who need it. The policy advocates a requirement that those earning more than 500% of the federal poverty level obtain a minimum level of catastrophic and preventive coverage.

The AMA believes that the individual mandate is the best option available today to improve access and ensure coverage for the uninsured. The AMA also notes that there is a difference between the positions of the AMA policy that supports individual responsibility and the individual requirement provisions of the Affordable Care Act.

Prior to the vote, the AMA reviewed and evaluated alternatives to the individual mandate and described its findings in a Report of the Council on Medical Services, entitled Covering the Uninsured and Individual Responsibility. The report reviewed AMA policy and advocacy efforts on the subject and summarized the history of requiring individual responsibility. The report was hotly debated in the reference committee meeting on Sunday, and the reference committee made 3 recommendations to the House of Delegates:

• The AMA reaffirms that it is committed to health system reforms that include health insurance coverage for all Americans, and to insurance market reforms that expand choice of affordable coverage, which are consistent with AMA policies concerning pluralism, freedom of choice, freedom of practice, and universal access for patients.


• The AMA reaffirms its policy of advocating that state governments be given the freedom to develop and test different models for covering the uninsured.


• That the report be filed and adopted in lieu of resolutions 102, 109, and 114.

The first 2 recommendations passed easily through the House of Delegates. The last recommendation initiated a 40-minute debate on the House floor related to the nature of the 3 resolutions that were being rejected.

Resolution 102 asked that the AMA continue to support policies that include personal responsibility to participate in private insurance risk-pooling arrangements, such as financial disincentives (penalties) on people who choose to forgo coverage until they are sick.

Resolution 109 asked that the AMA support the use of tax incentives and other noncompulsory measures to encourage the purchase of health insurance, rather than a federal mandate, and rescind the AMA's Individual Responsibility to Obtain Health Insurance Policy.

Resolution 114 asked that the AMA reaffirm policies that provide for an individual insurance mandate, combined with sufficiently financed advanceable and refundable tax credits, as a fundamental part of market-based comprehensive health system reform.

The reference committee heard extensive testimony on all of these resolutions during Sunday's well-attended committee meeting. The debate continued on the floor of the House of Delegates on Monday. Supporters of the individual mandate noted that, in addition to improving healthcare access for the uninsured, the individual mandate would create a private-market approach to expanding coverage and choice, and thereby would promote the growth of the private health insurance market.

Speakers who wanted to modify the AMA's policy on the individual mandate expressed concerns that the AMA's Covering the Uninsured and Individual Responsibility report conflicts with AMA policy that supports freedom of choice, pluralism, free-market economic principles, and preserving the physician–patient relationship. Some physicians also expressed concern that the individual mandate equates with support for increased government intervention and interference in healthcare. Another concern that was raised was the fear that an individual mandate would lead to an increase in the number of individuals who depend on a government subsidy for their health insurance coverage.

The discussion included references to the Affordable Care Act and the Massachusetts health reform effort, both as reasons to support and to reject the individual mandate.

The debate concluded with the testimony of Leah S. McCormack, MD, the delegate from New York, who stated: "I would still give care to patients whether they had insurance or not. . . . There are some things that are more important than healthcare [insurance]. . . . That is the liberty to make my own decisions and not have the government tell me what to buy."

Throughout the debate, many of the physician speakers reflected Dr. McCormack's acute sensitivity to the health consequences of being uninsured and the effect of an individual mandate on personal liberty. In the end, the vote seemed to come down to how to balance these 2 needs.

AMA physicians voted 326 to 165 (66.4% to 33.6%) to reaffirm the AMA's position on the individual mandate. It also voted to reaffirm support for the AMA policy supporting health insurance tax credits and health insurance market regulation, health savings accounts, and direct subsidies for coverage of high-risk patients.

American Medical Association (AMA) 2011 Annual Meeting. Press briefing, June 20, 2011.

FDA Plans to Extend Its Global Regulatory Reach

June 20, 2011 — The US Food and Drug Administration (FDA) plans to take a more global approach to ensure the safety and quality of regulated drugs and medical devices, the agency's commissioner announced during a media briefing today.

One prong of the new 4-pronged approach will involve partnering with counterparts worldwide and creating global coalitions of regulators intent on ensuring and improving global product safety and quality, said FDA Commissioner Margaret Hamburg, MD.

"This is a long-term strategy," Dr. Hamburg said. "It cannot be accomplished immediately and will probably take many years to implement, depending upon resources."

One part of the new approach will mean regulators no longer regard borders the same way. "The border can no longer be the nation's primary line of defense against unsafe imported products," she said. "Instead, the border must serve as a final checkpoint on preventive controls throughout the supply chain."

An FDA report, Pathway to Global Product Safety and Quality, describes the new strategy. Most notably, it calls for the agency to change how it conducts business and to take a more global approach to promote and protect the health of US consumers. Highlights of the report include 3 other prongs of the 4-pronged approach:

• The coalitions of regulators will develop international data information systems and networks and increase the regular and proactive sharing of data and regulatory resources across world markets.


• The FDA will build in more information gathering and analysis, with an increased focus on risk analytics and information technology.


• The FDA increasingly will leverage the efforts of public and private third parties and industry and allocate FDA resources based on risk.

Such coalition-type models do not exist in the world of FDA-regulated products, said John Taylor, JD, acting principal deputy commissioner of the FDA, and the FDA does not already have a coalition in place. However, many peer regulators have expressed interest in working more closely together to ensure the safety and integrity of products moving through the global supply chain.

Current Regulatory Authority Outdated

When asked whether the FDA would need new authority from Congress to proceed with the project, Taylor said the agency would move ahead with the strategy regardless of whether it needs new authority to do so. He also noted that the agency's authority relating to medical products is outdated. In 1938, the authority given to the FDA largely grew out of a world where manufacturers of regulated products were based in the United States.

"We've been a domestic agency that works in an international world," he said. "What we need to do is transform ourselves into a global agency that is able to work all around the world and address product issues that arise all over the world."

Taking a more global approach will enable the FDA to better monitor companies in far-flung areas that might otherwise escape regulatory scrutiny as more FDA-regulated products are produced overseas.

Global production of FDA-regulated goods has exploded over the past 10 years, according to Dr. Hamburg. Manufacturers increasingly use imported materials and ingredients in their US production facilities, "making the distinction between domestic and imported products outdated, to say the least," she said.

Products regulated by FDA, Dr. Hamburg said, reflect the globalization of today's economy:

• 10% of all imports into the United States consist of products FDA regulates,


• 80% of active pharmaceutical ingredients in the drugs Americans use come from overseas,


• 40% of drugs themselves are imports, and


• about half of all medical devices used in this country are imported.

Yet the FDA does not have the resources to keep pace with demands created by globalization, according to the report issued today that describes the FDA's new plan. In 2008, the Government Accountability Office recommended that the FDA increase inspections of foreign drug companies, but at current rates, it would take 9 years for the agency to inspect every high-priority pharmaceutical facility just once.

The new strategy would build on changes already made by the FDA. Between 2007 and 2009, the FDA increased the number of foreign drug manufacturing inspections by 27% and opened international offices in several key locations around the world.

The FDA has also collaborated with counterparts in the European Union and Australia on drug inspections, and it has joined an organization of drug manufacturing inspectorates from 39 countries. The FDA and other global leaders are also creating an expanded global regulators forum for medical devices.

More information on the new strategy is available on the FDA Web site.

AMA: Eliminating claims errors would save $17 billion annually

Claims-processing errors among commercial insurers add an estimated $17 billion in unnecessary administrative costs to the healthcare system annually, according to the AMA, which released its fourth annual National Health Insurer Report Card in conjunction with the group's annual delegates meeting in Chicago.

The 2011 report card is based on a random sampling of about 2.4 million electronic claims for approximately 4 million medical services submitted in February and March 2011 to Aetna, Anthem Blue Cross Blue Shield, Cigna, Health Care Service Corp., Humana, the Regence Group, UnitedHealthcare and, for comparison, Medicare, according to the AMA. The claims were gathered from more than 400 physician practice groups in 80 medical specialties in 42 states.The average claims-processing error rate for the six commercial insurers that were analyzed both in 2010 and in 2011 was 19.3% this year—an increase of 2% over last year, according to an AMA news release. That increase is expected to add $1.5 billion in administrative costs over the course of this year, according to the AMA.

Robert Zirkelbach, spokesman for America's Health Insurance Plans, said in an e-mailed response that insurers and providers share the responsibility of improving claims payment accuracy and efficiency. "Health plans are doing their part by collaborating with providers and investing in new technologies to improve the process for submitting claims electronically and receiving payments quickly," he said. "At the same time, more work needs to be done to reduce the number of claims submitted to health plans that are duplicative, inaccurate or delayed."

The AMA also found "dramatic reductions" in denial rates for several of the insurers studied. Lack of patient eligibility for medical services remains the most frequent reason for denials, the association noted in the release.

Primary Care Physicians Boost Income in 2010, Survey Finds

June 15, 2011 — Primary care physicians saw modest increases in their 2010 compensation, while some of their better-paid specialist colleagues lost ground, according to a new survey of almost 60,000 physicians around the United States from the Medical Group Management Association (MGMA).

In the Physician Compensation and Production Survey: 2011 Report Based on 2010 Data, internists were found to have earned a median of $205,379, which is an increase of 4.21% since 2009. Family physicians (without obstetrics) saw their median incomes rise by 2.94% to $189,402, and pediatricians had a compensation increase of 0.39% to $192,148, which did not keep up with the low inflation rate.

Six specialties — anesthesiologists, gastroenterologists, obstetricians/gynecologists, ophthalmologists, diagnostic radiologists, and urologists — have had modest declines in income since 2009. The largest decrease was a drop of 4.66% for urologists, who earned a median of $372,455, the survey found.

Psychiatrists, dermatologists, neurologists, general surgeons, and emergency medicine physicians were among the specialists who reported an increase in median compensation since 2009. The largest percentage increase of 5.65% was for emergency medicine physicians, who earned a median of $277,297.

Orthopaedic surgeons were the top earners in the survey, at a median compensation of $514,659 (up 3.71%), followed by invasive cardiologists ($500,993), diagnostic radiologists ($471,254), gastroenterologists ($463,995), and dermatologists ($430,874).

Physicians practicing in the South reported the highest median earnings, at $216,170 in primary care and $404,000 in specialty care. They were followed by physicians in the Midwest and West. Physicians in the East earned the least, at $194,409 in primary care and $305,575 in specialty care.

"A number of factors may attribute to regional differences in physician compensation," Jeffrey B. Milburn, MBA, CMPE, from the MGMA Health Care Consulting Group, said in a news release. "The supply and demand for primary care or specialty physicians may influence compensation. A high level of competition between groups or specific specialties may provide an opportunity for payers to reduce reimbursement. In states where payers have little competition, reimbursement and subsequent physician compensation may be lower.

"Location desirability is another factor influencing competition and compensation," Milburn noted. "Some areas have a much higher ratio of physicians to population, and one might think this would lead to increased competition and lower compensation. But the usual laws of supply and demand aren't always at work in health care."

MGMA, based in Englewood, Colorado, is an association for professional administrators and leaders of medical group practices. It serves 22,500 members who lead 13,600 organizations nationwide in which some 280,000 physicians provide more than 40% of the healthcare services delivered in the United States, the group says. MGMA notes that its surveys depend on voluntary participation and may not be representative of the industry.

How to Obtain a Medicaid Provider Number

The U.S. Department of Health and Human Services issues Medicaid provider numbers through state health and human services agencies. For instance, if you are a physician in Florida, you must apply for a Florida Medicaid provider number through the Florida Agency for Health Care Administration. Provider numbers represent unique forms of identification. You do not need a number if you will not provide health-related services to Medicaid recipients.

Instructions:

1.       Determine if you are eligible to receive a provider number. For instance, if you are a dentist licensed in New Zealand, you first must obtain authorization to provide dental care in the United States. If you recently have graduated from medical school in the U.S., you need a medical license before you can treat anyone, including Medicaid recipients.

2.      Contact the appropriate health and human services agency and obtain an official application, which usually is available for free through the agency's website. For instance, New York's Department of Health maintains a comprehensive Medicaid provider manual.

3.      Gather such relevant information as your tax identification number, usually your social security number or federal employer identifier number. You must disclose a physical address and phone number to identify your business. If you distribute medical equipment, you need to identify your company's legal name that is registered with your state's secretary of state.

4.      Complete a fingerprint card so that your criminal history can be reviewed, if requested. Some states exempt non-profit or government organizations, such as nursing homes or hospitals, from fingerprint requirements.

5.      Select a reimbursement method. You will not receive money immediately after rendering services, such as through a patient's co-pay. You can either receive payment electronically or file an exception request. To qualify for electronic fund transfers, you must provide your bank account number and routing information.

Tips & Warnings:

• Provider applications often request information about past disciplinary actions. For instance, you must disclose if you were sued for medical malpractice in another state or previously were excluded from receiving a provider number.

 

• Be wary of scam artists who charge high fees to submit provider applications. Procedures throughout the U.S. are simplified so that anyone easily can file a complete application.

Two New State Medicaid EHR Incentive Programs Launched

Pennsylvania and Washington Launched Their Medicaid EHR Programs This Month

On June 6th, the Medicaid Electronic Health Record (EHR) Incentive Program launched in Pennsylvania and Washington. This means that eligible professionals (EPs) and eligible hospitals in Pennsylvania and Washington will be able to complete their incentive program registration at the state level and receive incentive payments. More information about the Medicaid EHR Incentive Program can be found on the Medicare and Medicaid EHR Incentive Program Basics page of the CMS EHR website.

If you are a resident of Pennsylvania or Washington and are eligible to participate in the Medicaid EHR Incentive Program, visit your State Medicaid Agency website for more information on your state's participation in the Medicaid EHR Incentive Program:

• Pennsylvania


• Washington

Seventeen states have launched Medicaid EHR Incentive Programs, and 14 states have issued incentive payments to Medicaid eligible professionals and eligible hospitals who have adopted, implemented, or upgraded certified EHR technology. CMS looks forward to announcing the launches of additional states' programs in the coming months.

For a complete list of states that have already begun participation in the Medicaid EHR Incentive Program, see the Medicaid State Information page on the CMS EHR website. And watch our video of one of the first Medicaid incentive payment awards to Oklahoma EPs, Drs. Melissa and Jeffrey Gastorf, and hear their insights on how EHRs have affected their practice.

Want more information about the EHR Incentive Programs?  Make sure to visit the EHR Incentive Programs website for the latest news and updates on the EHR Incentive Programs. 

Physician Offices Nearly as Malpractice-Prone as Hospitals

June 14, 2011 — Most efforts to improve patient safety center on inpatient care, but almost as many malpractice claims paid on behalf of physicians arise from outpatient settings as they do from hospitals, according to a study published June 15 in the Journal of the American Medical Association (JAMA).

"Patient safety initiatives should focus on the outpatient setting, not just on inpatient care," the researchers, with lead author Tara Bishop, MD, MPH, an assistant professor in the Department of Public Health at Weill Cornell Medical College, write.

Dr. Bishop and her coauthors view the number of malpractice cases that conclude with an award for the plaintiff — along with their dollar amounts — as a "crude indicator of the prevalence and seriousness of adverse medical events."

To compare medical malpractice in the hospital and the physician's office, the investigators dug into the National Practitioner Data Bank (NPDB). Any party paying a malpractice claim on behalf of a physician or some other clinician must report those payments to the NPDB.

From 2005 to 2009, the number of paid claims involving physicians declined 23.3%, from 14,006 to 10,739, according to Dr. Bishop, who provided Medscape Medical News claims data not published in the JAMA article. However, in both years, a small proportion of claims did not identify a location where medical malpractice allegedly occurred. For claims that identified a practice setting, the decrease from 2005 to 2009 was 21.8%.

During that period, paid claims for outpatient events decreased at a slower rate: 19.3%. The rate of decrease in hospitals was considerably higher at 24.6%. Paid claims that spanned both settings declined 18.3%.

At the same time, the proportion of paid claims involving outpatient settings rose from 41.7% to 43.1%, while the inpatient proportion declined from 49.3% to 47.6%.

Diagnostic Errors Leading Source of Outpatient Paid Claims

The near equality in paid inpatient and outpatient claims should come as no surprise, the authors suggest. After all, there are 30 times more outpatient visits than hospital discharges each year. And surgical procedures are increasingly performed in physician offices and ambulatory surgery centers "that may not have the same safety controls as hospitals."

The researchers point out that the outcomes of outpatient events that led to paid claims were not trivial. Roughly 70% involved death, a grave permanent injury such as brain damage, or a major injury, compared with 81% for inpatient outcomes. The average payment for outpatient malpractice claims — $290,000 — was nothing to sneeze at either, although it was considerably less than the $363,000 for their inpatient counterparts.

The paid-claims record in physician offices, the investigators write, is a call for patient safety advocates to pay attention to more than just hospitals. They note that over the past 5 years, the federal Agency for Healthcare Research and Quality has funded almost 10 times as many studies of inpatient safety as those of outpatient safety.

Another research area given short shrift, the authors point out, is diagnostic errors, the leading source of paid malpractice claims in physician offices (in hospitals, surgical mishaps topped the list). They note the conditions in physician offices that invite diagnostic errors: A patient's signs and symptoms "may be subtle or not adequately noted" by physicians seeing a constant stream of patients, and follow-up is harder than in the hospital.

"Communication and coordination of care are problems," Dr. Bishop told Medscape Medical News. "A doctor who orders a test or refers to a specialist won't be 100% sure that they happen until he gets back a report."

Bearing down on patient safety in this environment is especially challenging, according to the authors, because there are many more physician offices than hospitals. In addition, small medical practices may come up short in terms of well-trained staffers who can devote significant time and energy to patient safety projects. "However, the high volume of outpatient malpractice claims and the serious nature of many...suggest that the relative neglect of outpatients safety should not persist," the authors write.

They discuss several limitations to their study, including the use of NPDB data that critiques of other malpractice studies have called problematic.

The problem lies in the "corporate shield" loophole that exempts hospitals from having to report malpractice claims paid on their behalf. The loophole comes into play when someone sues both a hospital and a physician for malpractice and then reaches a settlement that drops the physician from the case. Such a paid claim never makes it to the NPDB.

This scenario — more and more common as physicians increasingly become hospital employees — results in the NPBD's underestimating total malpractice claims by roughly 20%, according to one estimate. However, Dr. Bishop and coauthors write that it is unclear how this underreporting affects the relative proportion of inpatient and outpatient malpractice claims, noting that hospitals employ physicians who work both inside and outside their walls.

Dr. Bishop is supported in part by funds provided to her as a Nanette Laitman Clinical Scholar in Public Health at Weill Cornell Medical College. Coauthor Dr. Andrew Ryan is supported by grant K01 HS018546-01 from the Agency for Healthcare Research and Quality. The authors have disclosed no relevant financial relationships.

JAMA. 2011;305:2427-2431. Abstract

Majority of New Physician Jobs Feature Hospital Employment

June 13, 2011 — Primary care physicians remain in high demand, although the majority of job openings are for hospital employees, not in private practice, according to a new survey by Irving, Texas–based national physician search firm Merritt Hawkins.

For the sixth consecutive year, family practice and general internal medicine were the top 2 most-requested physician search assignments. They were followed by hospitalists, psychiatrists, orthopaedic surgeons, emergency medicine physicians, obstetrician/gynecologists, neurologists, general surgeons, and pediatricians.

Reimbursement cuts and declines in elective procedures have reduced the volume of search assignments for radiologists, cardiologists, and anesthesiologists. Those specialists, which were among the most requested searches 4 to 5 years ago, are now ranked 17th, 18th, and 19th.

The majority of physician search assignments (56%) were for hospitals, up from 51% a year ago and 23% five years ago. Only 2% of the firm's search assignments featured openings for independent, solo practitioners, down from 17% five years ago.

Healthcare reform, which enhances the role of primary care physicians by encouraging new delivery models such as accountable care organizations, is one factor driving the need for additional family physicians and internists, Travis Singleton, senior vice president of Merritt Hawkins, said in a news release.

"The era of the independent physician who owns and runs his or her practice is fading," said Singleton. "Doctors today are more likely to be employees working for increasingly large health systems or medical groups."

Hospital acquisitions of physician practices have "to some extent replaced traditional recruitment in the past year, as health care organizations have focused on preparing for new delivery models," the survey found. "As this trend plays out, there has been a nationwide lull in the traditional physician recruiting market, which is only now showing signs of returning to its customary vigor."

Although "pay for performance" rather than volume has become the new mantra under healthcare reform, the survey found that physicians are still compensated on volume-based formulas such as the number of patients they see, the amount of revenue they generate, or the number of work units they accrue. More than 90% of searches in the 2011 review that featured physician production bonuses reward physicians for fee-for-service style volume. Less than 7% reward physicians for meeting quality or cost objectives.

"Quality and cost rewards may be the physician compensation standards of tomorrow," Singleton notes, "but patient volume, revenue or work units remain the standards of today."

Average salaries continue to increase. Family physicians were offered an average salary of $178,000 for 2010 to 2011, up from $161,000 in 2006 to 2007. Internists averaged $205,000, up from $174,000 five years ago. Urologists saw their salaries increase to $453,000 in 2010 to 2011, up from $400,000 just a year ago. Orthopaedic surgeons, earning an average of $521,000, saw an increase of just $2000 from a year ago.

Salaries have almost entirely replaced income guarantees as a compensation model. Only 9% of physician search assignments over the past year featured income guarantees, down from 21% in 2006 to 2008, and down from 41% in 2003 to 2004.

Signing bonuses, relocation, and continuing medical education allowances remain standard in most incentive packages. Housing allowances are a new form of recruitment incentive. Because of the volatile real estate market, some physician candidates are unable to relocate without such help.

The 2011 review is based on the 2667 permanent physician and advanced allied professional search assignments that Merritt Hawkins/AMN Healthcare's physician staffing companies were engaged to conduct during the 12-month period from April 1, 2010, to March 31, 2011.

AHIMA launches HIRO fund

The American Health Information Management Association Foundation announced the establishment of the Health Information Relief Operation Fund to aid health information management professionals affected by natural or manmade disasters.

The foundation was created in 1962 to serve as a vehicle for research and education. Since 2009, though, it has broadened its goals; it now seeks to "improve health information management by supporting the people, research and resources" that advance the profession, according to its website.

Multiple natural disasters this spring—floods, fires and tornadoes—"have led to chaos, destruction and death that have literally paralyzed communities and healthcare facilities in many parts of the country," a news release (DOC) from the foundation noted. The fund, initially seeded with $10,000 from AHIMA, "will provide material relief to (health information management) professionals whose practice and personal lives have been thrust beyond the call of duty."

"There are vast numbers of health information managers still struggling to deal in aftermath, but it does not absolve our unbroken obligation to recover as much patient information as possible," AHIMA board President Bonnie Cassidy said in the release. Chicago-based AHIMA manages the foundation, which is looking for continued support for the relief fund from AHIMA members and health information management's "greater professional community."

New War on Harmful Chemical Exposure to Enlist Physicians

June 9, 2011 — Physicians in the United States would receive more training on environmental health issues such as water pollution and, using new billing codes, charge third-party payers for putting that training into practice under a government-sponsored initiative to better protect people from harmful chemicals.

The initiative, called the National Conversation on Public Health and Chemical Exposures, was launched 2 years ago by the Centers for Disease Control and Prevention (CDC) and the Agency for Toxic Substances and Disease Registry (ATSDR). Today, the project's leadership council, representing industry, state and federal public health agencies, environmental activists, and academics, released recommendations on how to create a comprehensive system for using and managing chemicals safely.

Those recommendations include fostering better science about chemical exposure, expanding systems for monitoring chemical exposures and health outcomes, overcoming "environmental injustice" by paying more attention to vulnerable communities, and replacing problematic ingredients in consumer products with safer, "greener" ones.

An entire set of recommendations focus on enabling healthcare providers and the public health workforce to address the needs of individuals exposed to toxic chemicals. It begins with teaching more environmental medicine in medical, nursing, and other healthcare professional schools, with career-long learning to follow, according to the leadership council's "action agenda." The agenda urges professional organizations, such as the American Medical Association, to develop guidelines on what budding clinicians need to know about pesticides, sick-building syndrome, and the like.

Another ambitious recommendation states that the Institute of Medicine should convene an expert committee to draft environmental health practice guidelines for physicians, nurses, and others engaged in primary care. These guidelines would address history-taking, assessment, prevention, and treatment of chemical exposure and indicators on when to refer someone to a specialist.

Experts who drafted the National Conversation document recognize the need to give clinicians incentives to follow environmental health guidelines. Accordingly, the action agenda calls on the federal government to develop a reimbursement scheme for environmental health services that would include billing codes for such things as assessing chemical exposure in a childcare center and educating patients about household chemicals stored under the kitchen sink.

"I'm Certain Cost Will Be a Barrier"

The National Conversation's numerous recommendations now await adoption by both the public and the private sectors.

"There is no one owner of this document, but I would say that this document is...owned by the American public," Christopher Portier, PhD, director of the ATSDR's National Center for Environmental Health, said at press conference today. "I will take it on as my responsibility to make sure the document is widely communicated [and] shared with my federal partners. I will emphasize, when given the opportunity, where I think my federal, state, and local partners might use parts of the action agenda to improve what they're doing."

In an era of federal and state red ink, finding the money to carry out the National Conversation agenda will be hard, said Daniel Goldstein, MD, director of medical toxicology at Monsanto and a member of the National Conversation leadership council.

"I'm certain cost will be a barrier for implementing at least some of these recommendations," Dr. Goldstein said at the press conference. "Economic resources will undoubtedly get in the way." He also said industry may view the directives of the leadership council as slowing down the wheels of commerce.

However, the cost of protecting Americans from harmful chemical exposure must be weighed against "the staggering cost of environmental disease, not just in direct healthcare costs, but [also] lifelong earnings," noted Gail Shibley, an administrator in the Office of Environmental Public Health of the Oregon Health Authority.

July 3rd marks an important deadline for eligible hospitals and critical access hospitals (CAHs).

The last day that eligible hospitals and CAHs can begin their 90-day reporting period in Fiscal Year (FY) 2011 for the Medicare EHR Incentive Program is July 3, 2011. For hospitals, this means that they must begin their consecutive 90-day reporting period by July 3rd if they still want to successfully demonstrate meaningful use and receive an incentive payment for FY 2011.

Resources to Help

CMS has developed some tools to help providers attest. Eligible hospitals and CAHs who have completed their reporting period can use the CMS Eligible Hospital and CAH Attestation Worksheet to log their meaningful use measures to use as a reference when attesting for the Medicare EHR Incentive Program in the CMS system.

Additionally, the Meaningful Use Attestation Calculator allows eligible hospitals and CAHs to test whether or not they will successfully demonstrate meaningful use for the EHR Incentive Programs and the Attestation User Guide for Eligible Hospitals will walk eligible hospitals and CAHs through the attestation system, helping them to successfully attest to meeting meaningful use.

Looking Ahead

September 30, 2011 is the last day of the federal fiscal year, marking the end of the reporting year for eligible hospitals and CAHs. See what other important dates are coming in 2011 by going to our CMS Medicare and Medicaid EHR Incentive Programs Milestone Timeline, or reviewing the “Important Dates” section of the EHR Incentive Programs’ Overview page.

Want more information about the EHR Incentive Programs? 

Make sure to visit the CMS EHR Incentive Programs website for the latest news and updates on the EHR Incentive Programs. 

Pioneer ACO deadlines extended by CMS

Deadlines for provider groups looking to qualify under the recently announced CMS Pioneer Accountable Care Organization Model program were extended.

The variation on the larger and generally unpopular proposed primary ACO program aims to draw organizations already experienced with shared savings and coordinated care approaches into the Medicare program fast, while encouraging other providers to follow later.

The CMS announced June 7 that the deadline for applications was pushed back to Aug. 19 from July 18. Similarly, the deadline for applicants' nonbinding letters of intent was delayed to June 30 from June 10.

The delay stemmed from requests from provider organizations for more time to gather support within their organizations to enter the program and compile strong applications, according to a CMS official. At deadline, CMS had not responded to further questions.

About 30 Pioneer ACOs are expected, according to CMS officials, which could save Medicare about $430 million over a three-year period.

Pioneer program applicants will receive a decision on their applications well before the deadline to apply for the main ACO program, according to CMS officials. The Pioneer program is expected to launch within the last six months of 2011.

CMS Provides First Medicare Electronic Health Record (EHR) Incentive Payments Totaling $75 Million; Providers Offered Flexibility in Adopting E-Prescribing

CMS announced last Thursday that the first payments of the Medicare EHR Incentive Program were distributed on May 19. As part of the American Recovery and Reinvestment Act, the Medicare EHR Incentive Program provides payments to eligible professionals (EPs) and hospitals that demonstrate meaningful use of certified EHR technology.

CMS Administrator Donald Berwick, MD, explained in a statement that the payments are a crucial part of the nation’s future, “We can bring America’s health care system into the 21st century by adopting electronic health records and using electronic prescribing systems. Today’s announcements are steps on the right path – toward the health IT system America needs, which will save lives, save money.”

CMS noted that in addition to the $75 million given to providers participating in the Medicare program, fifteen states have initiated their Medicaid EHR Incentive Programs since January 2011, and, to date, over $83 million in incentive payments has been made to qualified Medicaid providers.

The National Coordinator for Health Information Technology, Farzad Mostashari, MD, ScM, said in a statement, “Through the EHR Incentive Programs, we are helping eligible providers invest in their technology infrastructure. But this isn’t just about technology. The goal is better and safer health care, and that means it’s about patients — about their health care and protection of their information.”

Last Thursday, CMS also announced proposals for new flexibilities to help providers phase in the use of electronic prescribing. This program provides financial incentives, including payment adjustments beginning January 1, 2012, for EPs to encourage electronic prescribing (eRx).  

The full press release can be found on the CMS website.

Detailed fact sheets on both the e-prescribing proposed rule and the EHR incentive payments can be found in the fact sheet section of the CMS website.

Want more information about the EHR Incentive Programs?
Make sure to visit the CMS EHR Incentive Programs website for the latest news and updates on the EHR Incentive Programs.