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Medicare Finalizes 1.1% pay raise bonus criteria AZ choosen for pilot personal heathcare record by CMS Medicares E-prescribing incentives President-elect Barack Obama today announced that Sen. Tom Daschle (D) will head Health and Human Services and serve as the White House healthcare "czar" in his administration. Medicare finalizes 1.1% pay raise bonus criteria But physician organizations worry that new doctor enrollment restrictions starting in January 2009 will cause more payment problems. By David Glendinning AMNews staff. Nov. 24 2008. Washington -- The final Medicare physician fee schedule for 2009 shows just how large a bullet doctors dodged when they successfully lobbied Congress this year for a payment patch. It also spells out how some of them can move past that close call and secure a relatively healthy raise for next year's work. Legislation enacted in July reversed a 10.6% cut that took effect at the beginning of that month. Starting in January 2009 a 1.1% across-the-board increase will replace an additional roughly 5% cut that would have gone into effect if lawmakers had not acted, the Centers for Medicare & Medicaid Services said in the final pay rule issued Oct. 30. Because the rule applies payment changes related to the most recent five-year adjustment in Medicare relative values for certain services, some physician specialties might see updates slightly larger than or smaller than 1.1%. "Medicare's new rule confirms that physicians caring for seniors would have faced a harsh payment cut of 15.1% next year if Congress had not stepped in," said American Medical Association President-elect J. James Rohack, MD. The upcoming 1.1% boost will fall short of the CMS-projected 1.6% increase in the cost to physicians of providing care next year. Payment freezes and increases in recent years also have come in under the rise in costs. But the agency stressed that two bonus opportunities exist to more than quadruple the raise that doctors will get for the year. Physicians who successfully participate in the Physician Quality Reporting Initiative will receive a 2% bonus on all of their Medicare payments for the year. Also, the program for the first time will award a separate 2% bonus to physicians who successfully prescribe medications electronically for their Medicare patients. Although the sums will not be paid out until sometime in 2010, after Medicare has processed all of next year's claims, this means the maximum effective raise for 2009 will be 5.1%. The rule gives more detail on how a doctor can secure an e-prescribing bonus. For example, he or she would need to have a qualified system that can adequately communicate with the patient's pharmacy, identify appropriate drugs and lower-cost alternatives, provide formulary information, and generate adverse event alerts. A physician must report one of three special e-prescribing codes at least half of the times they are applicable. Claims containing the codes must represent at least 10% of all the services for which the physician bills Medicare for the year. CMS envisions that the e-prescribing bonus will provide the "tipping point" for the health care industry as a whole to move to widespread adoption of the technology, the agency said in the final rule. The effects would go well beyond physician pay. "E-prescribing can greatly reduce the number of medication errors that jeopardize the health and safety of Medicare patients and waste precious health care dollars treating conditions that never should have happened," said CMS Acting Administrator Kerry Weems. More enrollment headaches ahead? Despite the prospect of more money on the table, physicians worry that more restrictive policies in other areas of the rule could increase the number of doctors who see their payments -- or their ability to see Medicare patients -- stop altogether. "We are reviewing the 1,500-page rule now to determine how it addresses AMA concerns with proposals that would exacerbate already significant administrative hassles that take physicians away from patient care," Dr. Rohack said Nov. 10. Earlier this year, for example, the AMA and others strongly opposed a provision in the proposed 2009 fee schedule rule to clamp down on retroactive Medicare billing. Doctors cannot bill until they are officially enrolled in Medicare, but afterward they can bill for services provided as far back as 27 months from when their enrollment takes effect. CMS proposed limiting that retroactive billing to only 30 days before the date the enrollment application was successfully filed or the date a doctor started providing services at a new practice location, whichever comes later. The organizations argued that the process of enrolling or re-enrolling in Medicare has turned into a complex process that often takes much longer than a month to complete. Backlogs on the part of Medicare contractors often make the process even longer, and the prospect that this could lead to a denial of retroactive payments means that a doctor waiting to enroll or re-enroll might be unable to see Medicare patients until the contractors resolve the problems, they said. "Simply adding another 'gotcha' regulation to the mix will only make matters worse," AMA Executive Vice President and CEO Michael D. Maves, MD, MBA, wrote in a comment letter on the proposed rule. But CMS rejected the comments and adopted the new retroactive billing restrictions in the final rule. Agency officials insisted that they cannot know whether a newly enrolled physician met Medicare requirements prior to the date that the enrollment actually takes effect. CMS in this case appears to be fixed on a solution in search of a problem, said Lisa Goldstein, government affairs representative with the Medical Group Management Assn. A practice taking on a new physician who needs to be enrolled in Medicare, for instance, would never risk the liability of having that doctor see Medicare patients if he or she were not in compliance with program rules, she said. Goldstein said even more physicians could experience enrollment-related payment problems once the new restrictions take effect Jan. 1, 2009. Doctors are already citing widespread enrollment delays and payment stoppages related to this year's Medicare contracting reforms and the move to the National Provider Identifier. Some of the physician comments on the proposed rule did have a positive impact. CMS had planned to ban the use of computer-generated faxes to order Medicare drug prescriptions starting next year, but a strong response from the AMA and others caused the agency to push off that effective date until 2012. Many doctors who have electronic medical records systems rely on computer-generated faxes for drug orders. A Medicare ban in 2009 likely would have driven a large number of them to revert to paper prescriptions rather than having the intended effect of moving them toward true e-prescribing, said Steven E. Waldren, MD, the director of the American Academy of Family Physicians' Center for Health Information Technology. ADDITIONAL INFORMATION: Some physicians might see a larger raise in their Medicare pay for next year, although some of those additional dollars would be deferred. Here's how physicians might receive the maximum for 2009: 1.1% Legislation passed by Congress in July mandated a raise in physician pay to reverse an estimated 5% cut that would have occurred starting Jan. 1, 2009. 2.0% Physicians who report a sufficient number of quality measures through the Medicare Physician Quality Reporting Initiative are eligible for a lump-sum bonus that will be paid sometime in the middle of 2010. 2.0% Physicians who demonstrate they use electronic prescribing for enough of their Medicare patients are eligible for a lump-sum bonus that will be paid sometime in the middle of 2010.Source: Centers for Medicare & Medicaid Services
In addition to finalizing a 1.1% Medicare raise and a chance for another 4% in bonuses, the final pay rule has many terms affecting doctors. The rule: · Finalizes 153 quality measures and seven measures groups for the 2009 Physician Quality Reporting Initiative. · Preserves the 1.0 floor on the geographic adjustment to the physician work component through Dec. 31, 2009. Establishes a 1.5 floor on the geographic adjustment for physician work in Alaska starting Jan. 1, 2009. · Extends the exceptions process for caps on physical, speech and occupational therapy through Dec. 31, 2009. · Allows telehealth services to originate at skilled nursing facilities, community mental health centers and hospital-based dialysis centers. · Clarifies when anti-markup prohibitions apply to the purchase of technical or professional components of diagnostic tests from outside suppliers. · Defers requiring practices that provide imaging services to register as independent diagnostic testing facilities. · Delays a plan to crack down on unnecessary use and self-referral of imaging services. · Postpones a plan to create a self-referral exception to incentive or shared savings plans between hospitals and physicians. Source: Centers for Medicare & Medicaid Services
Salynn Boyles
November 5 2008 — Tuesday's election of Democrat Barack Obama ushers in a new administration that is all but certain to include some level of health care reform. Less clear is how extensive that reform will be and when it will come. The Illinois senator has proposed sweeping changes in the health care system designed to provide health coverage to millions of uninsured Americans. But experts tell WebMD that the current financial crisis makes sweeping change unlikely any time soon. "I have no inside track but I would bet that in this economic climate it is far more likely that changes will be phased in over time" says Karen Davis president of the health policy and research group Commonwealth Fund. University of Michigan health economist Thomas Buckmueller PhD agrees that the economic climate is likely to slow reform. "I am not extremely optimistic that major reform will happen, but this seems to be the best chance we have had in a long time." Obama spoke often during the campaign about his mother's battle with ovarian cancer to illustrate his commitment to changing the health care system. He told of her final days, spent battling insurance company bureaucrats who did not want to pay for her cancer treatments. "I know what it's like to see a loved one suffer, not just because they are sick, but because of a broken health care system," he said at a rally last week and at countless campaign stops before that. His plan would extend health coverage by expanding existing private and public programs with the help of federal subsidies and mandates. He has repeatedly claimed the reforms will lower the average family's health insurance premiums by about $2,500 a year. These reforms include:
According to the Tax Policy Center, a nonpartisan tax analysis group, the president-elect's plan, if fully implemented, would reduce the number of uninsured Americans from a projected 67 million to 33 million over the next decade at a cost of $1.6 trillion. Obama has said he would pay for his plan by rolling back President Bush's tax cuts on people making more than $250,000 a year and keeping the estate tax at 2009 levels, but he has not been more specific. He has not provided a timetable for seeking his proposed reforms and has not said if he would present a comprehensive health care reform package or try for incremental change. Expansion Likely for State Children's Health Insurance Program Experts interviewed by WebMD agreed that expansion of the children's insurance program SCHIP is likely to be the first of the proposed reforms to be considered. Last December, Democrats in Congress lost a yearlong fight to boost federal spending that would have expanded the program after two separate vetoes by Bush. The program will be up for congressional review next March, and experts say it will probably be the Obama administration's first chance to make good on a health care promise. "SCHIP is one of the big success stories in health policy over the last 20 years," Buckmueller says. "It has succeeded in getting kids the preventive care they need to keep them out of the ERs." Medicare Reform More Problematic Many of Obama's other proposals -- from the expansion of Medicare to his National Health Insurance Exchange -- will be much harder to win support for, even with a largely friendly Congress behind him. Buckmueller believes the best chance for major reform lies in seeking bipartisan support for his proposals. He says a key reason for the failure of President Clinton's 1993 health care reform effort is that his administration did not reach across the aisle. "Assuming that Obama has learned from the Clinton debacle, I think he would be wise to say, 'Here are the basic principles of my plan. You work out the details, get bipartisan support, and I'll sign it.'" Health Spending 'Not Sustainable' While sweeping reform may not come soon, experts contacted by WebMD agreed that the nation's broken health care system must be addressed and that this must happen sooner rather than later. The statistics bear this out:
Total spending on health care represented around 16% of the gross domestic product in 2007, and the Congressional Budget Office says spending will rise to a quarter of gross domestic product by 2025. "We are not going to reduce health care spending," says former Congressional Budget Office Director Alice Rivlin, PhD, who is now a scholar with the Brookings Institution. "The best we can do is reduce the rate of health care spending growth. That should be the No. 1 priority of any health care reform." If jobs are the next thing to go in the current economic crisis, as many economists are predicting, the number of Americans without health insurance will quickly increase beyond projections. "Something has to happen over the next few years, because the cost of doing nothing is too great," Rivlin says. Davis echoes the thought. "We can't afford to stay on the path we are on with regard to total health spending," she says. "Employers can't afford it, the government can't afford it, and individuals can't afford it. It is just not sustainable." SOURCES: Karen Davis, president, Commonwealth Fund. Thomas Buckmueller, PhD, professor of business economics and public policy, Ross School of Business, University of Michigan, Ann Arbor. Alice Rivlin, director, Greater Washington Research project, Brookings Institution. Tax Policy Center: "Presidential Candidates Tax Plans," Sept. 12, 2008. Congressional Budget Office, health care spending, 2007.
Ariz. picked for Google health-file experiment 23 commentsby Ken Alltucker - Nov. 13, 2008 12:00 AM Arizona seniors will be pioneers in a Medicare program that encourages patients to store their medical histories on Google or other commercial Web sites as part of a government effort to streamline and improve health care. The federal agency that oversees Medicare selected Arizona and Utah for a pilot program that invites patients to store their health records on the Internet with Google or one of three other vendors. The program allows patients to easily share their medical histories, which now often must be provided separately to doctors, hospitals, labs or pharmacies. That could help patients if they switch doctors, pick up prescriptions or get care at an emergency room Medicare's program is one part of the health-care industry's push to modernize medical record-keeping using information technology. Advocates say electronic records can help reduce medical errors that occur when a doctor doesn't know a patient's history. But some have raised privacy concerns because there is no federal law that restricts how third-party vendors such as Google can use health records. "An electronic record can easily follow a patient to a new city or a specialist across town," said Kerry Weems, acting administrator for the Centers for Medicare and Medicaid Services. "The purpose is not to save money but to improve quality of health." Health-care officials estimate 80 percent or more of doctors offices do not have digital records. Medicare, the federal government's insurance program for those 65 or older, tapped Arizona and Utah because the states have a diverse mix of seniors and a split of rural and urban areas. Also, Arizona has made advanced health-information technology a priority. The state's Health-e Connection has established a goal that all doctors, hospitals and other health-care providers convert all medical records to digital form by 2010. Medicare officials do not know how many Arizonans will enroll, but they expect it will be a popular health tool, particularly as Baby Boomers become eligible for Medicare. About 816,000 Arizonans are enrolled in Medicare, according to 2007 U.S. Census figures. Doctors say that personal-health records can give physicians a complete snapshot of a patient's health history. "This is an attempt to empower patients who are increasingly interested in their own health," said Edward "Ted" Shortliffe, a physician and faculty member of the University of Arizona-Phoenix College of Medicine. Medicare officials stressed the personal-health-record program puts patients in charge. They decide whether a caregiver, doctor or other medical professional can access their health records over the Internet. Medicare will provide patients with up to two years of downloadable Medicare-claims data. Such information would be the foundation for a patient's records. A Medicare spokesman estimated the one-year pilot program, which starts in January, will cost the federal agency about $2.5 million in administrative costs. The program will be adjusted and potentially expanded after the first year. More than 40 vendors expressed interest in the pilot program, Weems said, but the federal agency selected Google Health, HealthTrio, NoMoreClipboard.com and PassportMD. The vendors, who will not be paid by Medicare, offer products ranging from free services to fee-driven "concierge" programs. Each vendor will be responsible for marketing its program to consumers, and each has adopted its own privacy protections. Google is a relative newcomer to electronic medical records, having launched its Google Health initiative in May. Missy Krasner, Google Health's product-marketing manager, said the search engine's widespread availability makes it easy for consumers who are interested in storing their personal-health records for free. Some watchdog groups are worried that there is little regulation over personal-health records. Google Health, for example, tells consumers that it does not sell, rent or use a consumer's health information without consent. The search-engine occasionally uses aggregate data to publish trend statistics, but such trend data cannot identify an individual, according to Google Health's privacy policy. "We are all excited about the prospects for these personal-health records, but we are dealing with some uncertainty with respect to privacy," said Deven McGraw, director of the health-privacy project for Washington, D.C.-based Center for Democracy & Technology. Hospitals and health-care providers face restrictions on the type of medical information they can share under the Health Insurance Portability and Accountability Act passed in 1996. That federal legislation does not cover private vendors that offer personal-health records. For now, consumers must decide whether they are comfortable with a vendor's privacy policy. McGraw expects there may be more pressure for the federal government to pass privacy laws as more Americans use personal-health records.
Medicare Outlines e-Rx Incentive October 31 2008 The Medicare program in 2009 will provide physicians with a financial incentive to use electronic prescribing in hopes of boosting the efficiency and safety of care. Physicians and other clinicians who adopt and use qualified electronic prescribing systems to transmit prescriptionstopharmacies may earn an incentive payment of 2% of their total Medicare allowed charges during 2009. This incentive is in addition to a 2% incentive payment to those who successfully report measures under the Physician Quality Reporting Initiative. In addition the Centers for Medicare & Medicaid Services will implement a 1.1% Medicare fee schedule hike in 2009 as required by the Medicare Improvements for Patients and Providers Act of 2008. Under the Medicare Improvements for Patients and Provider Act of 2008, Medicare’s e-prescribing incentive payments will be 2% in 2009 and 2010; 1% in 2011 and 2012 and 0.5% in 2013. Beginning in 2012, Medicare payments to physicians not electronically prescribing would be reduced by 1%, then 1.5% in 2013 and 2% in subsequent years. To participate in the e-prescribing incentive program, physicians must: * use a system that can communicate with the patient’s pharmacy; * help them identify appropriate drugs and provide information on lower cost alternatives; * provide information on formulary and tiered formulary medications; and * generate alerts about possible adverse events, such as improper dosing, drug-to-drug interactions or allergy concerns. To earn the incentive payment, physicians must report one of three codes when submitting claims for specified types of medical visits. The codes indicate: * that they did not prescribe any medications; * that they used e-prescribing for any medications prescribed; or * that they did not use e-prescribing because the law prohibits e-prescribing for the specific type of drug, such as a controlled substance. The final rule on the e-prescribing incentive program will appear Nov. 19 in the Federal Register. Comments on the rule are due by Dec. 29. CMS also announced that it’s reinstating the original computer-generated facsimile exemption that was adopted in the November 7, 2005 e-prescribing final rule, effective January 1, 2009. This means providers can continue faxing prescriptions, for an undetermined time period, if their e-prescribing system does not actually send an electronic prescription or refill request to a pharmacy, but generates a computerized fax. CMS' earlier effort to prohibit computer-generated faxes was designed to push vendors to build--and physicians to use--"true" electronic prescribing systems. But industry comments convinced federal officials that some in the industry are not yet ready to transition from computerized faxes to true electronic transmissionstopharmacies. More information is available at http://www.cms.hhs.gov/">cms.hhs.gov.
Articles: Posted October 2005 President Bush's June 2005 Address to Congress about our Healthcare system HHS Accelerates Use of E-prescribing and Electronic Health Records: visit this link |
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