We've Posted New FAQs to the EHR Website!

Take a Look at the New Medicare and Medicaid EHR Incentive Programs FAQs    

We want to keep you updated with the latest information about the Medicare and Medicaid Electronic Health Record (EHR) Incentive Programs. These new FAQs include information about clinical quality measures (CQMs), meaningful use, attestation, and other Medicare and Medicaid EHR Incentive Programs topics.

1. Does a provider have to record all clinical data in their certified EHR technology in order to accurately report complete CQM data for the Medicare and Medicaid EHR Incentive Programs? Read the answer.


2. Do providers have to contribute a minimum dollar amount toward their certified EHR technology for the Medicare and Medicaid EHR Incentive Programs? Read the answer.


3. Where can I find a list of public health agencies and immunization registries to submit my data as required by the public health objectives for the EHR Incentive Programs? Read the answer.


4. Can two separate practices with two different TINs purchase a single certified EHR system and share it in order to participate in the Medicare and Medicaid EHR Incentive Programs? Read the answer.


5. For the Medicare and Medicaid EHR Incentive Programs, how should an eligible professional (EP), eligible hospital, or critical access hospital (CAH) that sees patients in multiple practice locations equipped with certified EHR technology calculate numerators and denominators for the meaningful use objectives and measures? Read the answer.


6. For the EHR Incentive Programs, how should an eligible hospital or CAH with multiple certified EHR systems report their CQMs? Read the answer.


7. Does the person who completes the registration for the EHR Incentive Programs need to be the same person who completes the attestation? Read the answer.


8. For the meaningful use objective “Capability to submit electronic syndromic surveillance data to public health agencies,” what is the definition of "syndromic surveillance"? Read the answer.
   

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.

Big Medicare Pay Cut Would Shut Physician Doors to Patients

October 27, 2011 — In yet another warning to lawmakers, a new survey of group practices shows that 51% will reduce the number of available appointment slots for new Medicare patients if Congress does not avert a 29.5% Medicare pay cut set for January 1.

Another 30.9% of group practices would stop seeing new Medicare patients altogether, according to the survey conducted by the Medical Group Management Association (MGMA). And 34.8% would reduce access to existing Medicare patients.

The MGMA says it intends to impress these findings on the Congressional Joint Select Committee on Deficit Reduction, the "super committee" tasked with recommending $1.5 trillion in savings that Congress must enact by December 23. Organized medicine is strenuously lobbying the super committee to repeal the sustainable growth rate (SGR) formula for physician reimbursement, which is triggering the scheduled reduction in 2012.

Physicians have faced SGR-mandated pay cuts each year since 2002. Except for a 4.8% reduction that went through in 2002, Congress has always postponed them, but postponement has caused them to accumulate to the point of catastrophe. Last year Congress voted no fewer than 5 times to stave off a reduction topping 20%.

Life on the edge of the SGR cliff has taken its toll on physicians. Sixty-five percent of respondents to the MGMA survey, released Monday, reported that they have delayed buying new clinical equipment and facilities because of the uncertainty over Medicare reimbursement. Roughly half said they have had to reduce charity care, the size of their administrative staff, and staff salaries and benefits.

"Our data reflects a dire Medicare environment for physician practices," said Susan Turney, MD, president and chief executive officer of the MGMA, in a press release. "The 5 short-term congressional patches last year substantially diminished practices' faith in Congress and the stability of the Medicare program. This time, practices are not waiting to implement tough business decisions. The SGR is a runaway train that threatens the future of Medicare."

A repeal of the SGR would not necessarily end the Medicare reimbursement crisis. Earlier this month, the Medicare Payment Advisory Commission (MedPac) recommended a "doc fix" for the SGR problem that would freeze reimbursement rates for primary care physicians for 10 years while cutting rates for specialists by 5.9% for 3 straight years, followed by zero growth over the next 7 years. Organized medicine has warned that these draconian measures, if approved by Congress, also would drive physicians out of Medicare and make it harder for seniors to get the care they need.

Find CMS at the AOA OMED Conference in Orlando, FL from Oct. 30 - Nov. 1

CMS will be Presenting in the Exhibit Theater next to our Booth #322 To Help You Learn about the EHR Incentive Programs   

Are you attending the American Osteopathic Association's Osteopathic Medical Conference and Exhibition beginning this Sunday, October 30th? CMS will be at Booth #322, next to the Office of the National Coordinator for Health Information Technology (ONC) exhibit. CMS and ONC are partnering to present information on the Medicare and Medicaid EHR Incentive Programs and other HIT initiatives.

 

Representatives from CMS will be on-site to discuss your questions and listen to your EHR and HIT program experiences. You can even sign up for a chance to share your EHR story by participating in a recorded discussion with CMS on Monday, October 31st.

 

There will be computers and CMS staff available on-site to help guide providers through the EHR program registration and attestation processes. Educational information and resources will be available at our booth to help you successfully participate in the EHR Incentive Programs.

 

CMS will also be holding two learning sessions on the EHR Incentive Programs at the Exhibit Hall Theater near the CMS booth:

• Sunday, October 30 at 2:45 p.m. - CMS: EHR Medicaid Presentation  by John Allison


• Monday, October 31 at 2:45 p.m. - CMS: EHR Medicare and ICD-10 Presentation  by Michael Pierson and Ethan Moore

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. 

Sign up for CMS' CQM Webinar For Small-Practice Providers

CMS is Holding a Second Webinar on the CQMs and the EHR Incentive Programs for Small-Practice Providers

Overview

What:Webinar- The CMS EHR Incentive Programs: Small-Practice Providers and Clinical Quality Measures (CQMs)

When: October 25 from 1:00 – 2:30 p.m. EDT Why: To help small-practice providers successfully report CQMs How: Register online  

The Centers for Medicare & Medicaid Services (CMS) is holding a second webinar on CQMs and their importance in attesting to meaningful use for the EHR Incentive Programs. CMS hopes to help small-practice and rural providers become more knowledgeable in the topics below:

• An overview of the CQMs


• How to report CQMs during attestation


• Why CQMs are included in the EHR Incentive Programs


• Answers to many FAQs on the CQMs and the EHR Incentive Programs

Although, small-practice providers are the intended audience of this webinar, anyone is welcome to join.

 

The webinar presentation, a document with over 300 questions and answersfrom the webinar held on August 30, and an informational CQM fact sheet will be provided to participants before the webinar as downloadable handouts.

 

Additionally, registrants will be given an opportunity to submit questions through the registration site before the webinar that will be answered by CMS subject matter experts and posted to the CMS EHR website a few weeks after the webinar has been completed.

Registration

Individuals can register online for the webinar. After successfully registering, they will be sent a confirmation message with a link to the webinar site. Space is limited, so interested participants should register now to secure their place. 

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.

Medicare Mailing eRx Pay-Cut Letters to Physicians

October 18, 2011 — Physicians participating in Medicare should read their mail carefully over the next few weeks. There could be a letter warning them about a possible 1% pay cut next year because of their failure to meet the program’s e-prescribing requirements, the Centers for Medicare and Medicaid Services (CMS) announced today.

Anyone who opens such a letter may have enough time to beat a November 1 deadline to apply for a hardship exemption from the penalty, dubbed a "payment adjustment" by CMS.

Companies who process and pay Medicare claims on behalf of CMS began mailing out the letters Monday, said Michael Rapp, MD, JD, director of the Quality Measurement and Health Assessment Group in the CMS Office of Clinical Standards and Quality, during a conference call with providers today. The agency had intended to inform physicians about the e-prescribing penalty through a so-called Payment Adjustment Feedback Report that they could access at the CMS Web site, but the reports will not be ready to post until late November or early December. So CMS resorted to snail mail to get the word out, said Dr. Rapp.

The mailing should be completed by October 25, just days before the November 1 deadline to apply for an exemption from the penalty.

In addition, in the coming weeks Medicare help-desk personnel will telephone physicians who unsuccessfully attempted to comply with the eRx requirements to give them a head’s up about the penalty.

CMS will inform physicians only about the possibility of a penalty because the warning is based on a preliminary as opposed to a final analysis of claims data, said Molly MacHarris, a policy analyst in Dr. Rapp’s department at CMS, during the conference call.

Penalties Increase Over Time

In 2009, Medicare began paying bonuses to physicians and other clinicians who qualified as "successful" e-prescribers — that is, they reported electronically transmitting a certain number of prescriptions from their computer to a pharmacy computer. In 2011 and 2012, the bonus equals 1% of a clinician’s fee-for-service (FFS) charges. It drops to 0.5% in 2013, the last year of the incentive program.

Meanwhile, physicians who have not satisfied the complicated rules for e-prescribing this year face a 1% reduction in their FFS charges in 2012. The penalty increases to 1.5% in 2013 and 2% in 2014.

Not every physician is subject to the eRx penalty next year. Someone who was not licensed as of June 30, 2011, for example, need not do anything. Physicians who are subject to the penalty can apply for 1 of 6 exemptions, which cover situations such as practicing in a rural area that lacks high-speed Internet access. They can submit their exemption application at a CMS Web site called the Quality Reporting Communication Support Page. Medical groups participating in Medicare's Physician Quality Reporting System under the Group Practice Reporting Option must apply for a hardship exemption in writing. Either way, the deadline is November 1.

More information on the e-prescribing incentive program, and how to obtain an exemption, is available on the CMS Web site.

UPDATED: Are you Aware of the Registration Deadlines for the EHR Incentive Programs?

Updated Message on Important Information on Registration for the EHR Incentive Programs

This message is an updated version of the registration listserv message that was sent by CMS on October 4. This version of the message provides updated language to help providers understand the difference in registration and attestation dates for the Medicare and Medicaid Electronic Health Record (EHR) Incentive Programs.

 

CMS wants to remind eligible professionals (EPs), eligible hospitals, and critical access hospitals (CAHs) of the key registration and attestation dates for the EHR Incentive Programs, and provide information to help them successfully register and start their path to payment for 2011.

 

Important Registration Details for Medicare and Medicaid

• Medicare - November 30, 2011, is the last day for Medicare eligible hospitals and CAHs to register and attest to receive an incentive payment for Federal fiscal year 2011.


• Medicare - February 29, 2012, is the last day for Medicare EPs to register and attest to receive an incentive payment for calendar year 2011.


• Medicaid - Each state may have different attestation deadlines. Please check with your State Medicaid agency to find out the last day you can attest.

When Should Providers Register?

CMS encourages providers to register for the Medicare and/or Medicaid EHR Incentive Program(s) as soon as possible to avoid payment delays. Please note that not all states have launched a Medicaid EHR Incentive Program yet. EPs will not be able to complete their registration for the Medicaid EHR Incentive Program until their state's program has launched and that state's site has opened. Eligible professionals should check their state's status.

Note: Providers can register before they have a certified EHR and can also register if they do not have an enrollment record in PECOS.

Registration Resources CMS has a number of resources to help providers successfully register for the EHR Incentive Programs:

• Step-by-step registration guides, available on CMS' Registration page.


• A number of FAQs  about registration on the EHR Incentive Programs website.


• Webinars on YouTube to help guide providers through the registration .process– one for EPs, and one for hospitals. 
  
  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.

Meaningful Use: Attesting to the Data

What Does Attestation for the EHR Incentive Programs Entail?

Over 114,000 eligible professionals and hospitals have registered for the Medicare and Medicaid Electronic Health Record (EHR) Incentive Programs. As more hospitals move towards meeting meaningful use and attesting, the Centers for Medicare & Medicaid Services (CMS) wants to make sure everyone understands what attestation entails.

 

In order to attest, successfully demonstrate meaningful use, and receive an incentive payment under the Medicare EHR Incentive Program, eligible hospitals must indicate that they agree with several attestation statements.

 

Eligible hospitals must agree that the information submitted:

• is accurate to the knowledge and belief of the hospital or the person submitting on behalf of the hospital.


• is accurate and complete for numerators, denominators, exclusions, and measures applicable to the hospital.


• includes information on all patients to whom the measure applies.


• for clinical quality measures (CQMs), was generated as output from an identified certified EHR technology.

By agreeing to the above statements, the hospital is attesting to providing all of the information necessary from certified EHR technology, uncertified EHR technology, and/or paper-based records in order to render complete and accurate information for all meaningful use core and menu set measures except CQMs.

 

Attesting to CQM Data's Validity

CMS considers information to be accurate and complete for CQMs to the extent that it is identical to the output that was generated from certified EHR technology. In other words, the hospital is only attesting that what was put in the attestation module is identical to the output generated by its certified EHR technology. Therefore, the numerator, denominator, and exclusion information for CQMs must be reported directly from information generated by certified EHR technology.

 

CMS, through meaningful use, does not require any data validation. Eligible hospitals are not required to provide any additional information beyond what is generated from certified EHR technology in order to satisfy the requirement for submitting CQM information, even if the reported values include zeros. If a hospital has concerns about the accuracy of its output, the hospital can still attest but should work with its vendor and/or the Office of the National Coordinator for Health Information Technology to improve the accuracy of the individual product and/or the level of accuracy guaranteed by certification.

 

CMS recommends that hospitals print out or save an electronic copy of the CQM report used at attestation from their certified EHR. The eligible hospital should retain this copy for its records so that the hospital can show its numbers in the event of an audit. Upon audit, this documentation will be used to validate that the hospital accurately attested and submitted CQMs.

 

For more information about the Medicare and Medicaid EHR Incentive Programs, please visit the CMS EHR website, and see the Frequently Asked Questions page for answers on various topic areas of the programs.

AMA to Medicare: Begin Paying for Care Coordination in 2012

October 12, 2011 — An influential committee of the American Medical Association (AMA) has issued a challenge to Medicare: If you are serious about the patient-centered medical home, show us the money in 2012.

That group, the AMA/Specialty Society Relative Value Scale Update Committee (RUC), is asking the Centers for Medicare and Medicaid Services (CMS) to start paying separately for certain care coordination services for the chronically ill:

• telephone consults with patients;


• education and training for patient self-management performed by nonphysicians;


• medical team conferences, regardless of whether the patient is present; and


• anticoagulation management.

Right now, such services are generally considered rolled into, and reimbursed under, evaluation and management (E&M) services, epitomized by office visits with established patients. In addition, such services all involve care that does not hinge on a face-to-face encounter between physicians and patients. Organized medicine has long complained that although Medicare pays for the work that occurs in the exam room, it does not adequately compensate physicians for what they do once the patient walks out the door.

The new healthcare reform law aims to solve this payment problem through the medical home, which consists of clinician teams, usually lead by physicians, that will receive a monthly fee for care coordination on top of fee-for-service reimbursement. CMS is testing the medical home concept through pilot projects.

RUC, however, wants quicker, broader action. In a letter to CMS last week, RUC Chair Barbara Levy, MD, asked the agency to begin reimbursing care coordination services for the chronically ill next year on a short-term, piecemeal basis until a more comprehensive approach, such as the medical home, is in place. By doing so, Dr. Levy says, CMS would demonstrate that it "is prepared to incentivize care coordination and foster delivery reform."

While boosting Medicare spending up front, separately reimbursed care coordination services will pay for themselves by eliminating unnecessary office visits, trips to the emergency department, hospitalizations, and prescriptions, she added.

CMS can ignore RUC's recommendations. However, the agency is in the habit of listening to them. It relies heavily on the AMA committee for input when, every 5 years, it updates the relative value units that make up the resource-based relative value scale, which is used by CMS to price physician services.

Codes Already Exist, but Go Unreimbursed

RUC's proposal to CMS is couched in the words and numbers of Current Procedural Terminology (CPT) codes, which are developed and maintained by the AMA for reporting services and procedures performed by physicians. CMS has officially adopted this code set as the means to bill Medicare and Medicaid for physician services.

However, just because the AMA creates a CPT code for a particular service does not guarantee that Medicare and Medicaid will necessarily reimburse it. Case in point are CPT codes 99363 and 99364 for anticoagulation management. The AMA's CPT editorial panel created them in 2007, using 99363 for the first 90 days of such therapy and 99364 for each subsequent 90-day period. In her letter to CMS, Dr. Levy noted that the agency had calculated the reimbursement for the 2 codes ($41 per month for 99363, and $14 per month for 99364), but never authorized paying for them, reasoning that managing someone's warfarin regimen was bundled into E&M reimbursement. RUC is asking CMS to begin paying for these codes on their own.

Other care coordination services listed in the RUC letter also come with codes already on the books:

• Education and training for patient self-management, CPT codes 98960 to 98962: These apply to sessions conducted by nonphysicians such as a registered nurse on a physician's staff.


• Telephone services, CPT codes 99441 to 99443 and 98966 to 98968: These codes are designed for telephone conversations initiated by an established patient that do not originate from a related E&M service within the previous 7 days or lead to an E&M service or procedure within the next 24 hours, or at the soonest available appointment. The first set of codes is for telephone conversations between patients and physicians. When another kind of clinician takes the call, the second set of codes applies.


• Medical team conferences, CPT codes 99366 to 99368: The 99366 code pertains to nonphysicians who confer together with the patient or family members; 99368 is for such nonphysician conferences when patient and family are absent. The 99367 code describes team meetings that include a physician, but not a patient or family members.

Someday, "One Big Code" for Care Coordination

The RUC recommendation to pay for care coordination on a piecemeal basis until the medical home model is in place drew nods of approval from domains of organized medicine beyond the AMA.

"These are short-term fixes, but they recognize the value of work done outside the face-to-face visit, which has not been properly paid for," Lori Heim, MD, who chairs the primary care payment valuation task force of the American Academy of Family Physicians, said in an interview with Medscape Medical News. "[The RUC proposal] could be a real game-changer."

Likewise, Shawn Martin, director of government relations for the American Osteopathic Association, called the RUC recommendations an interim step toward a "comprehensive payment model."

"We're pretty pleased," Martin told Medscape Medical News. "Compensation for services outside the face-to-face visit is a core element of the medical home. Ultimately, you will have one big code for an undefined set of services."

Six New State Medicaid EHR Incentive Programs Launched

California, Maine, Maryland, Massachusetts, Utah, and Vermont Launched Their Medicaid EHR Programs This Month

On October 3rd, the Medicaid Electronic Health Record (EHR) Incentive Program launched in California, Maine, Maryland, Massachusetts, Utah, and Vermont. This means that eligible professionals (EPs) and eligible hospitals in these six states 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 California, Maine, Maryland, Massachusetts, Utah, or Vermont, 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. Click on a State below to access its website.

• California


• Maine


• Maryland


• Massachusetts


• Utah


• Vermont

As of October 3rd, 33 states have launched Medicaid EHR Incentive Programs and through September, 22 states have issued incentive payments to Medicaid EPs 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.

A new FAQ has been posted on Medicaid patient volume Q: For the Medicaid EHR Incentive Program, can a non-hospital based eligible professional (EP) include their in-patient encounters for purposes of calculating Medicaid patient volume even if the patient is included in the eligible hospital's patient volume for the same 90-day period?

A: Read the answer.

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.

Seniors aren't familiar with and don't use Medicare Star ratings for plan selection

Few seniors are familiar with the Medicare Star Quality Ratings for Medicare plans from the Centers for Medicare & Medicaid Services and even those who do know about them rarely use the information to help select their Medicare plan.

These are the findings of a recent Harris Interactive survey conducted for Kaiser Permanente aimed at finding how familiar Medicare beneficiaries are with the CMS rating system.

"Evaluating a Medicare plan can be challenging,” said Jed Weissberg, MD, senior vice president, Hospitals, Quality and Care Delivery Excellence, Kaiser Permanente. “There are many things to consider, but quality should be at the top of any consumer's list. Educating consumers about and encouraging them to use the Medicare Star Quality Ratings helps to ensure that Medicare beneficiaries are receiving only the best available care."

But the survey showed the annual ratings are not used regularly by seniors to help them make their MA plan selections. Only 18 percent of Medicare-eligible seniors said that they are familiar with the rating system and, of that group, less than one-third have used the system to select their health plan. Even more significantly, only 2 percent of respondents were aware of how their current plans rates.

"As health services providers, it is our responsibility to maintain the highest levels of quality," said Weissberg, in a press release detailing the survey results. "We urge seniors to hold their Medicare providers accountable by taking advantage of the Medicare Star Quality Ratings and selecting plans that meet and exceed quality standards."

One roadblock to seniors becoming more familiar of the star ratings is that most don’t know where to turn to find ratings information. Among the 483 Medicare-aged people questioned for the survey, less than 30 percent knew where to find the information.

Medicare Payment Advisory (MedPac) searching for alternative benefit models for Medicare beneficiaries

The Medicare Payment Advisory Commission (MedPAC) is exploring alternative benefit models for Medicare beneficiaries as policymakers seek to rein in spending, but the models so far that the panel is considering rely primarily on various approaches to cost-sharing.

Some commission members urged at its Oct. 7 meeting that researchers develop models to incorporate benefit designs that would encourage changes in unhealthy beneficiary behavior, such as controlling weight or diabetes.

MedPAC wants to reform Medicare’s current fee-for-service benefit design because it has no limit on responsibility for sharing costs, different categories of care setting require various levels of cost-sharing, and premiums for supplemental coverage are often expensive and mask overall healthcare costs.

For the alternative benefit designs, all three would have a cap of $5,000 on out-of-pocket expenses. One model would have a $500 deductible and co-insurance package; another would have a $750 deductible with prices set for medical services; and the third would have a $500 deductible with the same medical service expenses, said Scott Harrison, a MedPAC principal policy analyst. The three would require co-payments.

Only the model with coinsurance would have higher average cost-sharing at $1,550 than what currently exists. Another model would have cost sharing that is similar to current and the other would have somewhat lower average cost-sharing of $1,150. Researchers used 2009 Medicare data to develop the models.

Glenn Hackbarth, MedPAC chairman and an independent consultant, said that supplemental coverage that beneficiaries purchase and how that interacts with their benefits is a critical element. Many seniors on a fixed income purchase Medigap insurance plans to help them cover deductibles and other expenses not covered by Medicare’s fee-for-service benefits. But the protection of the supplemental coverage also enables seniors to use more services.

“If we were able to have a potential source of savings that could offset some of the costs of the expansion of the benefit package and limit to the extent to which people supplement it, then they would not incur such cost sharing,” he said.

Scott Armstrong, MedPAC member and president and CEO of Group Health Cooperative, said the panel should consider how to create more value with Medicare benefits. For example, generic statins could require no co-pay compared with brand names.

“We can look at different models of benefit designs that do more than rejigger the out-of-pocket costs with a cap but actually invest in higher value services that change utilization patterns over time,” he said. Some employers offer such designs, and many employees in the boomer generation are familiar with them.

If the panel is unable to develop a value-based benefit design, Michael Chernew, commission member and healthcare policy professor at Harvard Medical School, said that co-pay design would be important.” It can incent beneficiaries if the most expensive treatment doesn’t add any extra value,” he said.

In November, the commission staff will add more demographic data and supplemental coverage information to its models to determine how the design changes would affect beneficiaries.

Co-branded Aetna, CVS Medicare Part D plan to hit 43 states

Aetna and CVS/pharmacy announced last week a co-branded Medicare prescription drug plan available in 43 states and Washington, DC, in a deal that will leverage the retail base of more than 7,200 CVS and Long Drug stores across the country.

The announcement comes as Aetna continues to seek more ways to broaden its product lines, as well as build a strong business in the Medicare market. In June, the company acquired the Medicare supplement business of Genworth Financial, a book of business that brought 145,000 new members to the company.

“This important growth opportunity comes at a time when the Medicare population is anticipated to increase as ‘Baby Boomers’ reach age 65,” said Aetna Chairman, Presdient and CEO Mark Bertolini at the time of the Genworth deal. “Medicare supplement is expected to be a fast-growing product in the coming years as individuals seek peace of mind for out-of-pocket costs and employers look for added retiree coverages.”

The same can be said of seniors looking for Medicare Part D coverage to help them with the cost of prescription drugs. The Part D product will offer beneficiaries who fill their prescriptions at CVS with in-network savings that include $3 co-pays for generic drugs and will save $10 on copayments for non-preferred generic and preferred brand prescriptions.

“With 75 percent of the U.S. population in the markets in which CVS/pharmacy operates living within 3 miles of a CVS drugstore, Medicare beneficiaries will have convenient access to the prescription drugs they need through this plan,” said John Chomeau, head of Aetna Medicare, in a press release announcing he deal.

For CVS, the deal builds upon the relationship betwee its parent company, CVS Caremark, and Aetna. Last summer, Aetna inked a 12-year pharmacy benefits management services deal with CVS Caremark. Aetna’s PBM business is substantial, comprising more than 9.7 million customers and members who represent about $9.5 billion in drug spending each year.

The announcement of the new Part D plan comes just a couple or weeks ahead of the Medicare open enrollment period, which this years runs from Oct. 15 to Dec. 7.

Medicare Payment Advisory Commission (MedPAC) approves SGR repeal proposal

The Medicare Payment Advisory Commission (MedPAC) voted Thursday to approve the sustainable growth rate (SGR) proposal it issued last month. Medical groups are already expressing their displeasure.

MedPAC’s approved recommendation repeals the SGR for an estimated cost of $200 billion. To cover that cost MedPAC suggests a 10-year Medicare payment rate freeze for primary care physicians and cuts to payments for specialists by 5.9 percent each year for three years followed by a seven-year payment freeze. Some of the other offsets come from durable medical equipment, hospitals and Medicare benefits to seniors.

Prior to MedPAC’s Thursday vote, a slew of medical organizations, including the American Medical Association (AMA), the American College of Cardiology, the American College of Emergency Physicians, the American College of Physicians, the American College of Surgeons and the American Psychiatric Association, sent the commission a letter urging a revision of the commission’s September proposal.

“We share your concern that the SGR is undermining patient and physician confidence in the Medicare program and appreciate the Commission’s effort to present a comprehensive plan intended to improve the prospects for SGR repeal,” read the letter dated Oct. 3. “Unfortunately, however, we cannot support this plan in its present form because it retains many of the SGR’s flaws, undermines physicians’ ability to participate in payment and delivery reforms and calls for payment rates that the Commission itself has previously said could reduce Medicare beneficiaries’ access to medical care.”

As news of MedPAC’s vote in favor of its proposal got out, medical groups began announcing their displeasure.

“The recommendation voted on today by MedPAC flies in the face of their previous recommendations to stop harmful physician cuts that threaten access to care for patients,” said Peter Carmel, MD, president of the AMA in a statement. “There is already a 20 percent gap between Medicare payment updates and the cost of providing healthcare to seniors. Many physicians may also face upcoming payment penalties related to electronic prescribing, health information technology and quality reporting programs. Adding additional physician payment cuts to this mix will leave many physicians unable to care for Medicare patients or make the investments needed to participate in new models of care that can increase coordination and reduce costs.”

“The proposal is not an acceptable or sustainable solution to the SGR and does nothing to promote quality or resource stewardship,” said Jack Lewin, MD, CEO of the American College of Cardiology in a statement. “Looming primary care shortages require focused solutions, we agree. But this proposal somewhat misaligns the interests of primary and specialty doctors, rather than focusing on incentives to work together to improve quality, efficiency, coordination of care, and outcomes.”

Offering a less strident perspective, the National Coalition on Health Care (NCHC) said in a statement that while some of MedPAC’s offsets may shift more costs onto providers, businesses, health plans and beneficiaries, the proposal is essentially a good thing.

“MedPAC has produced an honest attempt to cut the Gordian knot of federal health policy and end the SGR. Whether or not MedPAC’s shared sacrifice approach is the right one, at least MedPAC has gotten serious about addressing provider payment. It is long past time that our elected leaders do the same,” said NCHC President and CEO John Rother in his statement.

“If we’re ever going to rein in the health costs strangling our nation’s consumers, businesses and public institutions, we must redesign provider payment to encourage the highest-value care for patients. MedPAC’s proposal should spur the Congress and the Administration to get to work,” he concluded.

Free Preventive benefits for Medicare Patients

The Centers for Medicare & Medicaid Services (CMS) reported Thursday that nearly 20.5 million people with Medicare have had a free Annual Wellness Visit or received other preventive services with no deductible or cost sharing this year, thanks to funding through the Affordable Care Act. 

In addition, nearly 1.8 million people with Medicare have received discounts on brand-name drugs in the Medicare Part D coverage gap, also known as the "donut hole," between January and August of this year. The total value of discounts to people with Medicare in the donut hole is nearly $1 billion through August of this year, with an average savings of $530 per beneficiary.

“Thanks to the Affordable Care Act, more people with Medicare are getting preventive services like mammograms for free,” said HHS Secretary Kathleen Sebelius in a statement. “The new healthcare law is also making prescription drugs more affordable for millions of seniors and people with disabilities.”

Some of the free preventive services available to people with Medicare include:

• Mammograms and cervical cancer screenings

• Annual Wellness Visit

• Cholesterol and other cardiovascular screenings

• Colorectal and prostate cancer screenings

The rising number of people who are taking advantage of preventive benefits and prescription drug discounts comes as people with Medicare are beginning to review their plan options for next year. The web-based Medicare Plan Finder is now available to help beneficiaries, their families, other caregivers, and senior program advocates look at all local drug and health plan options that are available for the 2012 benefit year. The annual enrollment period begins earlier this year than last year, on Oct. 15, and runs through December 7.

Every person with a Medicare Advantage or a Part D drug plan will also see better value in those plans for the second year. Average Part D drug plan premiums will remain virtually unchanged in 2012. Those in the Part D coverage gap will continue to be able to get discounts on covered brand name drugs. People with Medicare will get deeper discounts in the years ahead until the gap is closed in 2020.

On average, Medicare Advantage premiums will be four percent lower in 2012 than in 2011, and plans project enrollment to increase by 10 percent. All beneficiaries will have access to Medicare-covered preventive services with zero cost-sharing, including the Annual Wellness Visit, bone-mass measurement, colon cancer screenings and diabetes screenings, as well as influenza and pneumococcal vaccines.

Medicare Payment Advisory Commission (MedPac) recommends New 'Doc Fix'

October 6, 2011 — The Medicare Payment Advisory Commission (MedPac) today voted 15 to 2 to recommend a "doc fix" for the Medicare reimbursement crisis that organized medicine views as the makings of another crisis.

The MedPac plan, which requires Congressional approval, would repeal the hated sustainable growth rate (SGR) formula for setting physician reimbursement and avert an SGR-triggered pay cut of 29.5% on January 1. To offset the estimated $300 billion price of this "doc fix," as it is called on Capitol Hill, MedPac recommends freezing reimbursement rates for primary care physicians for 10 years while cutting rates for specialists by 5.9% for 3 straight years, followed by zero growth during the next 7 years.

Pinching Medicare rates this way would raise roughly $100 billion toward financing the doc fix. MedPac comes up with another $235 billion in proposed cuts to Medicare Part D drug plans, post–acute care facilities, hospitals, laboratories, suppliers of durable medical equipment, Medicare Advantage plans, and other providers, along with reduced benefits for seniors.

The commission recommended this package of measures despite dire warnings from organized medicine that the proposed cut-and-freeze approach to rates would drive many of their members out of Medicare and jeopardize access to care for seniors. Medical societies have routinely predicted the same scenario if SGR-triggered pay cuts were to take effect.

In an October 3 letter to MedPac, the American Medical Association (AMA) and 42 other medical societies pointed out that since 2001, Medicare reimbursement rates have increased by 4%, but practice costs have grown 6 times as fast, at 24%. The commission's reimbursement proposal, they argued, would put physicians further in the hole as practice costs continue to rise, making it harder for them to invest in the kind of care coordination, chronic disease management, and quality improvement envisioned in healthcare reform.

Compounding the payment cuts proposed by MedPac are other Medicare policies that could reduce physician reimbursement, according to the medical societies. Some of those could take the form of penalties for not reporting quality measures to the Centers for Medicare and Medicaid Services or for not adopting electronic health record technology, both of which require physician investment.

Peter Carmel, MD

The medical societies have argued that instead of asking physicians to make unreasonable sacrifices, Congress could finance a doc fix with other budget offsets already identified by the Congressional Budget Office, the Senate "Gang of Six," and the presidential deficit reduction commission.

Another Rift Between Primary Care Physicians and Specialists

Organized medicine was quick to repeat its criticism of the MedPac plan after today's decision.

"The AMA strongly opposes the Medicare physician payment recommendation voted on today by MedPAC," said AMA President Peter Carmel, MD, in a press release. "Offsetting part of the cost of [the SGR formula] repeal through drastic cuts and long-term freezes to physicians falls far short of what is needed to preserve patients' access to care. The recommendation voted on today by MedPAC flies in the face of their previous recommendations to stop harmful physician cuts that threaten access to care for patients."

Dr. Jack Lewin

Jack Lewin, MD, chief executive officer of the American College of Cardiology, said the MedPac proposal "is not an acceptable or sustainable solution to the SGR and does nothing to promote quality or resource stewardship."

"Looming primary care shortages require focused solutions, we agree," Dr. Lewin said in a press release. "But this proposal somewhat misaligns the interests of primary and specialty doctors, rather than focusing on incentives to work together to improve quality, efficiency, coordination of care, and outcomes."

Dr. Lewin's remarks reopen a traditional rift between primary care physicians and their specialist kin about who is getting a fair shake in Medicare reimbursement policy. The MedPac plan places most of the financial sacrifice on specialists, because the services subject to 3 straight years of cuts account for 92% of Medicare spending on physician services.

The MedPac proposal could become fodder for the Congressional Joint Select Committee on Deficit Reduction, the so-called super committee, which is tasked with recommending $1.5 trillion in savings that Congress must enact by December 23. Organized medicine is lobbying the super committee to repeal the SGR formula, but not pay for it MedPac-style.

Deadline Reminder for CMS eRx Program Hardship Exemption

The Deadline to Request a Hardship Exemption for the eRx Incentive Program is November 1, 2011

The Centers for Medicare & Medicaid Services (CMS) would like to remind eligible professionals and group practices that the deadline to request a hardship exemption for the 2012 Medicare Electronic Prescribing (eRx) Incentive Program adjustment is November 1, 2011.

Eligible professionals and group practices should determine if they are subject to the 2012 eRx payment adjustment by reviewing the MLN Article SE1107. If you believe that you may be subject to the 2012 eRx payment adjustment, you should determine if you meet any of the hardship exemption categories specified by CMS in the 2011 Medicare Electronic Prescribing (eRx) Incentive Program Final Rule. 

In addition, a Quick Reference Guide is available to help you understand the changes that the eRx Final Rule made to the 2011 Medicare eRx Incentive Program. As a result of changes to the program, eligible professionals and group practices have until November 1, 2011 to submit a significant hardship exemption request and rationale. 

Exemption Requirements

Please note, to be considered for an exemption under the significant hardship exemption category “Eligible professionals who register to participate in the Medicare or Medicaid Electronic Health Record (EHR) Incentive Programs and adopt Certified EHR Technology,” an eligible professional must:

1.    Have registered for either the Medicare or Medicaid EHR Incentive Program (for instructions on how to register for one of the EHR Incentive Programs, please visit the Registration and Attestation page of the EHR Incentive Programs website; and

2.    Providers have to show that they adopted certified EHR technology no later than October 1, 2011, and provide identifying information about the certified EHR technology. Please note that in order to qualify for an exemption to the 2012 eRx payment adjustment under this significant hardship exemption category, it is not necessary that an eligible professional receive an incentive payment under the Medicare or Medicaid EHR Incentive Program.

Registration Details

Eligible professionals wishing to register for the Medicaid EHR Incentive Program in states that have not yet launched their respective programs may initiate the registration process at the CMS Registration and Attestation System and obtain a registration number, even though they will not be able to successfully complete registration. If a State has not launched its Medicaid EHR Incentive Program, the State name will not appear in the drop-down menu for eligible professionals to select. However, a registration number is assigned even if registration is not successfully completed. 

In order to initiate registration for the Medicaid EHR Incentive Program, please visit the registration site and follow the instructions to begin the registration process.  Obtaining a CMS EHR Incentive Programs registration number, even if the registration is not successfully completed, suffices for the purposes of applying for a significant hardship exemption for the 2012 Medicare e-Prescribing payment adjustment.

To request an exemption, individual eligible professionals must submit their hardship exemption requests through the Quality Communications Support Page and group practices participating under the group practice reporting option (GPRO) must submit hardship exemption requests via a letter to CMS. 

Please remember that CMS will review these requests on a case-by-case basis.  All decisions on significant hardship exemption requests will be final.

For additional information and resources, please visit the eRx page on the CMS website, and see the new FAQ.

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.