Alicia Ault

Physicians may find themselves under increased scrutiny as a result of provisions in the Affordable Care Act—one of the health reform laws—giving government agencies new funding and enforcement powers to go after fraud and abuse.

The Affordable Care Act will require providers and suppliers to meet new compliance criteria, said Daniel Levinson, inspector general for the Department of Health and Human Services. After the criteria are issued, his office will provide training to health care providers, he added at a May 13 briefing.

HHS Secretary Kathleen Sebelius said that the Affordable Care Act provides $600 million over the next 10 years to combat fraud and abuse. In 2009, the federal government recovered $2.5 billion in fraudulent Medicare payments, officials said at the briefing.

Potential Medicare or Medicaid providers will be categorized as at high, medium, or low risk of fraud at the time of enrollment. More face-to-face checks will be used to verify a provider's legitimacy, Ms. Sebelius said. The law increases penalties for fraud, and puts more emphasis on real-time detection of fraud and abuse, she noted, as opposed to the current “pay and chase” model.

The HHS and the Department of Justice also will be adopting strategies used by credit card companies to flag aberrant charges and stop fraud in its tracks. “As we try to bring down skyrocketing costs across our health care system, we can't afford to ignore the billions of dollars we lose to fraud and theft,” she said.

In 2009, the federal government received about $1.6 billion in settlements and judgments from hospitals, health care providers, drug and device makers, and non–health providers found to have illegally billed federal health care programs. With penalties and settlements, $2.5 billion was returned to the Medicare Trust Fund and $441 million to Medicaid, according to the Health Care Fraud and Abuse Control Program Report.

A total of 583 individuals were convicted of health care fraud in 2009. On the civil side, the Department of Justice opened 886 new investigations and had 1,155 civil fraud matters pending.

Ms. Sebelius and Attorney General Eric Holder highlighted efforts by the Health Care Fraud Prevention and Enforcement Action Team (HEAT) Medicare Fraud Strike Force, which was formed in 2007 to address durable medical equipment fraud and abuse in south Florida. The strike force has been expanded to focus on potential hot spots of potential fraud, identified by claims patterns. Los Angeles, Detroit, and Houston were added in 2009. The strike force now also operates in Brooklyn, N.Y.; Baton Rouge, La.; and Tampa, Fla.

New types of scams are emerging as criminals try to take advantage of seniors who may not understand the health reform laws. Scam artists have gone door-to-door in some states selling bogus “ObamaCare” policies, or asking Medicare beneficiaries for identifying information to issue “new Medicare cards,” Ms. Sebelius said.

Other scams are tied to the issuance of rebate checks to Medicare beneficiaries whose Medicare Part D drug expenditures push them into the so-called doughnut hole that limits coverage, she said.

The HHS is working with advocacy organizations to educate laypeople who can train their peers how to recognize illegal and inappropriate schemes, Ms. Sebelius added.

Physicians may find themselves under increased scrutiny as a result of provisions in the Affordable Care Act—one of the health reform laws—giving government agencies new funding and enforcement powers to go after fraud and abuse.

The Affordable Care Act will require providers and suppliers to meet new compliance criteria, said Daniel Levinson, inspector general for the Department of Health and Human Services. After the criteria are issued, his office will provide training to health care providers, he added at a May 13 briefing.

HHS Secretary Kathleen Sebelius said that the Affordable Care Act provides $600 million over the next 10 years to combat fraud and abuse. In 2009, the federal government recovered $2.5 billion in fraudulent Medicare payments, officials said at the briefing.

Potential Medicare or Medicaid providers will be categorized as at high, medium, or low risk of fraud at the time of enrollment. More face-to-face checks will be used to verify a provider's legitimacy, Ms. Sebelius said. The law increases penalties for fraud, and puts more emphasis on real-time detection of fraud and abuse, she noted, as opposed to the current “pay and chase” model.

The HHS and the Department of Justice also will be adopting strategies used by credit card companies to flag aberrant charges and stop fraud in its tracks. “As we try to bring down skyrocketing costs across our health care system, we can't afford to ignore the billions of dollars we lose to fraud and theft,” she said.

In 2009, the federal government received about $1.6 billion in settlements and judgments from hospitals, health care providers, drug and device makers, and non–health providers found to have illegally billed federal health care programs. With penalties and settlements, $2.5 billion was returned to the Medicare Trust Fund and $441 million to Medicaid, according to the Health Care Fraud and Abuse Control Program Report.

A total of 583 individuals were convicted of health care fraud in 2009. On the civil side, the Department of Justice opened 886 new investigations and had 1,155 civil fraud matters pending.

Ms. Sebelius and Attorney General Eric Holder highlighted efforts by the Health Care Fraud Prevention and Enforcement Action Team (HEAT) Medicare Fraud Strike Force, which was formed in 2007 to address durable medical equipment fraud and abuse in south Florida. The strike force has been expanded to focus on potential hot spots of potential fraud, identified by claims patterns. Los Angeles, Detroit, and Houston were added in 2009. The strike force now also operates in Brooklyn, N.Y.; Baton Rouge, La.; and Tampa, Fla.

New types of scams are emerging as criminals try to take advantage of seniors who may not understand the health reform laws. Scam artists have gone door-to-door in some states selling bogus “ObamaCare” policies, or asking Medicare beneficiaries for identifying information to issue “new Medicare cards,” Ms. Sebelius said.

Other scams are tied to the issuance of rebate checks to Medicare beneficiaries whose Medicare Part D drug expenditures push them into the so-called doughnut hole that limits coverage, she said.

The HHS is working with advocacy organizations to educate laypeople who can train their peers how to recognize illegal and inappropriate schemes, Ms. Sebelius added.

Physicians may find themselves under increased scrutiny as a result of provisions in the Affordable Care Act—one of the health reform laws—giving government agencies new funding and enforcement powers to go after fraud and abuse.

The Affordable Care Act will require providers and suppliers to meet new compliance criteria, said Daniel Levinson, inspector general for the Department of Health and Human Services. After the criteria are issued, his office will provide training to health care providers, he added at a May 13 briefing.

HHS Secretary Kathleen Sebelius said that the Affordable Care Act provides $600 million over the next 10 years to combat fraud and abuse. In 2009, the federal government recovered $2.5 billion in fraudulent Medicare payments, officials said at the briefing.

Potential Medicare or Medicaid providers will be categorized as at high, medium, or low risk of fraud at the time of enrollment. More face-to-face checks will be used to verify a provider's legitimacy, Ms. Sebelius said. The law increases penalties for fraud, and puts more emphasis on real-time detection of fraud and abuse, she noted, as opposed to the current “pay and chase” model.

The HHS and the Department of Justice also will be adopting strategies used by credit card companies to flag aberrant charges and stop fraud in its tracks. “As we try to bring down skyrocketing costs across our health care system, we can't afford to ignore the billions of dollars we lose to fraud and theft,” she said.

In 2009, the federal government received about $1.6 billion in settlements and judgments from hospitals, health care providers, drug and device makers, and non–health providers found to have illegally billed federal health care programs. With penalties and settlements, $2.5 billion was returned to the Medicare Trust Fund and $441 million to Medicaid, according to the Health Care Fraud and Abuse Control Program Report.

A total of 583 individuals were convicted of health care fraud in 2009. On the civil side, the Department of Justice opened 886 new investigations and had 1,155 civil fraud matters pending.

Ms. Sebelius and Attorney General Eric Holder highlighted efforts by the Health Care Fraud Prevention and Enforcement Action Team (HEAT) Medicare Fraud Strike Force, which was formed in 2007 to address durable medical equipment fraud and abuse in south Florida. The strike force has been expanded to focus on potential hot spots of potential fraud, identified by claims patterns. Los Angeles, Detroit, and Houston were added in 2009. The strike force now also operates in Brooklyn, N.Y.; Baton Rouge, La.; and Tampa, Fla.

New types of scams are emerging as criminals try to take advantage of seniors who may not understand the health reform laws. Scam artists have gone door-to-door in some states selling bogus “ObamaCare” policies, or asking Medicare beneficiaries for identifying information to issue “new Medicare cards,” Ms. Sebelius said.

Other scams are tied to the issuance of rebate checks to Medicare beneficiaries whose Medicare Part D drug expenditures push them into the so-called doughnut hole that limits coverage, she said.

The HHS is working with advocacy organizations to educate laypeople who can train their peers how to recognize illegal and inappropriate schemes, Ms. Sebelius added.

The American Medical Association on May 25 called on U.S. health insurance companies to adopt its just-issued code of conduct.

The Health Insurer Code of Conduct Principles evolved out of a resolution put forward and unanimously adopted by the AMA House of Delegates at its 2008 Interim Meeting. The New York Delegation called on the AMA to develop such a code, get insurers to sign on, and come up with a way to monitor compliance. The code has already been endorsed by nearly every state medical society as well as 19 specialty societies, according to the AMA.

The last time the insurance industry issued any kind of internal standards was 15 years ago, according to the AMA, which added in a statement that the industry has had a “questionable” record of compliance with those standards, known as the Philosophy of Care.

“The health insurance industry has a crisis of credibility,” Dr. J. James Rohack, AMA president, said in the statement. “With the enactment of federal health reform legislation, it’s time for insurers to re-commit to patients’ best interests and the fair business practices necessary to re-establish trust with the patient and physician communities.”

Americas Health Insurance Plans, the industry trade organization, did not directly address the AMA code. But AHIP spokesman Robert Zirkelbach said that many of the principles are covered under the health reform law—formally, the Affordable Care Act.

“Health plans have pioneered innovative programs to reward quality, promote prevention and wellness, coordinate care for patients with chronic conditions, streamline administrative processes, and provide policyholders with greater peace of mind,” Mr. Zirkelbach said. “We will continue to work with policymakers and other health care stakeholders to improve the quality, safety, and efficiency of our health care system.”

The code’s principles address topics including cancellations and recissions; medical loss ratios and calculating fair premiums; open access to care, including transparent rules on provider networks and benefit limitations; fairness in contract negotiations with physicians; medical necessity and who can define it; and a call for more administrative simplification, fewer restrictions on benefits, and better risk adjustment mechanisms for “physician profiling” systems.

Physicians should also have more opportunity to review and challenge their ratings in those systems, according to the principles.

The systems are used to select physicians for preferential networks.

The AMA said that it has written to the eight largest health insurers seeking their pledge to comply with the code.

The American Medical Association on May 25 called on U.S. health insurance companies to adopt its just-issued code of conduct.

The Health Insurer Code of Conduct Principles evolved out of a resolution put forward and unanimously adopted by the AMA House of Delegates at its 2008 Interim Meeting. The New York Delegation called on the AMA to develop such a code, get insurers to sign on, and come up with a way to monitor compliance. The code has already been endorsed by nearly every state medical society as well as 19 specialty societies, according to the AMA.

The last time the insurance industry issued any kind of internal standards was 15 years ago, according to the AMA, which added in a statement that the industry has had a “questionable” record of compliance with those standards, known as the Philosophy of Care.

“The health insurance industry has a crisis of credibility,” Dr. J. James Rohack, AMA president, said in the statement. “With the enactment of federal health reform legislation, it’s time for insurers to re-commit to patients’ best interests and the fair business practices necessary to re-establish trust with the patient and physician communities.”

Americas Health Insurance Plans, the industry trade organization, did not directly address the AMA code. But AHIP spokesman Robert Zirkelbach said that many of the principles are covered under the health reform law—formally, the Affordable Care Act.

“Health plans have pioneered innovative programs to reward quality, promote prevention and wellness, coordinate care for patients with chronic conditions, streamline administrative processes, and provide policyholders with greater peace of mind,” Mr. Zirkelbach said. “We will continue to work with policymakers and other health care stakeholders to improve the quality, safety, and efficiency of our health care system.”

The code’s principles address topics including cancellations and recissions; medical loss ratios and calculating fair premiums; open access to care, including transparent rules on provider networks and benefit limitations; fairness in contract negotiations with physicians; medical necessity and who can define it; and a call for more administrative simplification, fewer restrictions on benefits, and better risk adjustment mechanisms for “physician profiling” systems.

Physicians should also have more opportunity to review and challenge their ratings in those systems, according to the principles.

The systems are used to select physicians for preferential networks.

The AMA said that it has written to the eight largest health insurers seeking their pledge to comply with the code.

The American Medical Association on May 25 called on U.S. health insurance companies to adopt its just-issued code of conduct.

The Health Insurer Code of Conduct Principles evolved out of a resolution put forward and unanimously adopted by the AMA House of Delegates at its 2008 Interim Meeting. The New York Delegation called on the AMA to develop such a code, get insurers to sign on, and come up with a way to monitor compliance. The code has already been endorsed by nearly every state medical society as well as 19 specialty societies, according to the AMA.

The last time the insurance industry issued any kind of internal standards was 15 years ago, according to the AMA, which added in a statement that the industry has had a “questionable” record of compliance with those standards, known as the Philosophy of Care.

“The health insurance industry has a crisis of credibility,” Dr. J. James Rohack, AMA president, said in the statement. “With the enactment of federal health reform legislation, it’s time for insurers to re-commit to patients’ best interests and the fair business practices necessary to re-establish trust with the patient and physician communities.”

Americas Health Insurance Plans, the industry trade organization, did not directly address the AMA code. But AHIP spokesman Robert Zirkelbach said that many of the principles are covered under the health reform law—formally, the Affordable Care Act.

“Health plans have pioneered innovative programs to reward quality, promote prevention and wellness, coordinate care for patients with chronic conditions, streamline administrative processes, and provide policyholders with greater peace of mind,” Mr. Zirkelbach said. “We will continue to work with policymakers and other health care stakeholders to improve the quality, safety, and efficiency of our health care system.”

The code’s principles address topics including cancellations and recissions; medical loss ratios and calculating fair premiums; open access to care, including transparent rules on provider networks and benefit limitations; fairness in contract negotiations with physicians; medical necessity and who can define it; and a call for more administrative simplification, fewer restrictions on benefits, and better risk adjustment mechanisms for “physician profiling” systems.

Physicians should also have more opportunity to review and challenge their ratings in those systems, according to the principles.

The systems are used to select physicians for preferential networks.

The AMA said that it has written to the eight largest health insurers seeking their pledge to comply with the code.

The federal government recovered $2.5 billion in fraudulent Medicare payments in 2009, government officials said at a briefing May 13.

The Affordable Care Act – one of the health reform laws – gives government agencies new enforcement powers and new funding to go after fraud and abuse and physicians may find themselves under increased scrutiny as a result.

Daniel Levinson, the Health and Human Services Department Inspector General, said that the Affordable Care Act will require providers and suppliers to adopt compliance programs that meet core criteria. He added that his office will provide training to health care providers once those criteria are issued.

According to HHS Secretary Kathleen Sebelius, the Affordable Care Act provides $600 million over the next 10 years to combat fraud and abuse.

The law will make it more difficult to become enrolled as a Medicare or Medicaid provider as potential providers will be categorized as high, medium, or low risk of fraud at the time of enrollment. More face-to-face checks will be used to verify a provider’s legitimacy, she said, adding that the law increases penalties for fraud, and put more emphasis on real-time detection of fraud and abuse as opposed to the “pay and chase” model used now.

HHS and the Department of Justice also will look closely at adopting strategies used by credit card companies to immediately flag aberrant charges to stop fraud in its tracks, said Ms. Sebelius. Preventing waste, fraud, and abuse is especially important as the cost of health care continues to rise, Ms. Sebelius said.

“For years, we’ve tolerated health care fraud,” she said. “We’ve accepted that with any big enterprise there was going to be some waste and abuse, but those days are coming to an end. As we try to bring down skyrocketing costs across our health care system we can’t afford to ignore the billions of dollars we lose to fraud and theft.”

In 2009, the federal government received about $1.6 billion in settlements and judgments from hospitals, physicians and other health care providers, drug and device makers, and non-health providers that were found to have illegally billed federal health care programs. With penalties and settlements, $2.5 billion was returned to the Medicare Trust Fund and $441 million to Medicaid, according to the Health Care Fraud and Abuse Control Program Report.

A total of 583 individuals were convicted of health care fraud in 2009, by U.S. Attorneys’ Offices and federal prosecutors. On the civil side, the Department of Justice opened 886 new investigations and had 1,155 civil fraud matters pending.

Physicians were among those convicted or fined for fraud and abuse schemes, including a California physician who paid $2.2 million to settle allegations that between 2002 and 2006, he allowed his universal provider identification number to be used to bill Medicare for respiratory therapy. A Kansas cardiologist paid $1.3 million to settle allegations that his group submitted claims for services not provided.

Ms. Sebelius and Attorney General Eric Holder highlighted efforts by the Health Care Fraud Prevention and Enforcement Action Team (HEAT) Medicare Fraud Strike Force, which was begun in 2007 to address durable medical equipment fraud and abuse in south Florida.

The strike force has since been expanded to focus on potential hot spots of potential fraud, identified by claims patterns. In 2009, Los Angeles, Detroit, and Houston, were added; now the strike force also operates in Brooklyn, N.Y., Baton Rouge, La., and Tampa, Fla.

Ms. Sebelius said that new types of scams are emerging, as criminals attempt to take advantage of seniors who may not understand the health reform laws. Scam artists have gone door-to-door in some states selling bogus “ObamaCare” policies, or asking Medicare beneficiaries for identifying information to issue “new Medicare cards,” she said.

Other scams are tied to the issuance of rebate checks to Medicare beneficiaries whose Medicare Part D drug expenditures push them into the doughnut hole, Ms. Sebelius said.

The HHS is working with advocacy organizations to educate laypersons who can train their peers how to recognize illegal and inappropriate come-ons, she added.

The federal government recovered $2.5 billion in fraudulent Medicare payments in 2009, government officials said at a briefing May 13.

The Affordable Care Act – one of the health reform laws – gives government agencies new enforcement powers and new funding to go after fraud and abuse and physicians may find themselves under increased scrutiny as a result.

Daniel Levinson, the Health and Human Services Department Inspector General, said that the Affordable Care Act will require providers and suppliers to adopt compliance programs that meet core criteria. He added that his office will provide training to health care providers once those criteria are issued.

According to HHS Secretary Kathleen Sebelius, the Affordable Care Act provides $600 million over the next 10 years to combat fraud and abuse.

The law will make it more difficult to become enrolled as a Medicare or Medicaid provider as potential providers will be categorized as high, medium, or low risk of fraud at the time of enrollment. More face-to-face checks will be used to verify a provider’s legitimacy, she said, adding that the law increases penalties for fraud, and put more emphasis on real-time detection of fraud and abuse as opposed to the “pay and chase” model used now.

HHS and the Department of Justice also will look closely at adopting strategies used by credit card companies to immediately flag aberrant charges to stop fraud in its tracks, said Ms. Sebelius. Preventing waste, fraud, and abuse is especially important as the cost of health care continues to rise, Ms. Sebelius said.

“For years, we’ve tolerated health care fraud,” she said. “We’ve accepted that with any big enterprise there was going to be some waste and abuse, but those days are coming to an end. As we try to bring down skyrocketing costs across our health care system we can’t afford to ignore the billions of dollars we lose to fraud and theft.”

In 2009, the federal government received about $1.6 billion in settlements and judgments from hospitals, physicians and other health care providers, drug and device makers, and non-health providers that were found to have illegally billed federal health care programs. With penalties and settlements, $2.5 billion was returned to the Medicare Trust Fund and $441 million to Medicaid, according to the Health Care Fraud and Abuse Control Program Report.

A total of 583 individuals were convicted of health care fraud in 2009, by U.S. Attorneys’ Offices and federal prosecutors. On the civil side, the Department of Justice opened 886 new investigations and had 1,155 civil fraud matters pending.

Physicians were among those convicted or fined for fraud and abuse schemes, including a California physician who paid $2.2 million to settle allegations that between 2002 and 2006, he allowed his universal provider identification number to be used to bill Medicare for respiratory therapy. A Kansas cardiologist paid $1.3 million to settle allegations that his group submitted claims for services not provided.

Ms. Sebelius and Attorney General Eric Holder highlighted efforts by the Health Care Fraud Prevention and Enforcement Action Team (HEAT) Medicare Fraud Strike Force, which was begun in 2007 to address durable medical equipment fraud and abuse in south Florida.

The strike force has since been expanded to focus on potential hot spots of potential fraud, identified by claims patterns. In 2009, Los Angeles, Detroit, and Houston, were added; now the strike force also operates in Brooklyn, N.Y., Baton Rouge, La., and Tampa, Fla.

Ms. Sebelius said that new types of scams are emerging, as criminals attempt to take advantage of seniors who may not understand the health reform laws. Scam artists have gone door-to-door in some states selling bogus “ObamaCare” policies, or asking Medicare beneficiaries for identifying information to issue “new Medicare cards,” she said.

Other scams are tied to the issuance of rebate checks to Medicare beneficiaries whose Medicare Part D drug expenditures push them into the doughnut hole, Ms. Sebelius said.

The HHS is working with advocacy organizations to educate laypersons who can train their peers how to recognize illegal and inappropriate come-ons, she added.

The federal government recovered $2.5 billion in fraudulent Medicare payments in 2009, government officials said at a briefing May 13.

The Affordable Care Act – one of the health reform laws – gives government agencies new enforcement powers and new funding to go after fraud and abuse and physicians may find themselves under increased scrutiny as a result.

Daniel Levinson, the Health and Human Services Department Inspector General, said that the Affordable Care Act will require providers and suppliers to adopt compliance programs that meet core criteria. He added that his office will provide training to health care providers once those criteria are issued.

According to HHS Secretary Kathleen Sebelius, the Affordable Care Act provides $600 million over the next 10 years to combat fraud and abuse.

The law will make it more difficult to become enrolled as a Medicare or Medicaid provider as potential providers will be categorized as high, medium, or low risk of fraud at the time of enrollment. More face-to-face checks will be used to verify a provider’s legitimacy, she said, adding that the law increases penalties for fraud, and put more emphasis on real-time detection of fraud and abuse as opposed to the “pay and chase” model used now.

HHS and the Department of Justice also will look closely at adopting strategies used by credit card companies to immediately flag aberrant charges to stop fraud in its tracks, said Ms. Sebelius. Preventing waste, fraud, and abuse is especially important as the cost of health care continues to rise, Ms. Sebelius said.

“For years, we’ve tolerated health care fraud,” she said. “We’ve accepted that with any big enterprise there was going to be some waste and abuse, but those days are coming to an end. As we try to bring down skyrocketing costs across our health care system we can’t afford to ignore the billions of dollars we lose to fraud and theft.”

In 2009, the federal government received about $1.6 billion in settlements and judgments from hospitals, physicians and other health care providers, drug and device makers, and non-health providers that were found to have illegally billed federal health care programs. With penalties and settlements, $2.5 billion was returned to the Medicare Trust Fund and $441 million to Medicaid, according to the Health Care Fraud and Abuse Control Program Report.

A total of 583 individuals were convicted of health care fraud in 2009, by U.S. Attorneys’ Offices and federal prosecutors. On the civil side, the Department of Justice opened 886 new investigations and had 1,155 civil fraud matters pending.

Physicians were among those convicted or fined for fraud and abuse schemes, including a California physician who paid $2.2 million to settle allegations that between 2002 and 2006, he allowed his universal provider identification number to be used to bill Medicare for respiratory therapy. A Kansas cardiologist paid $1.3 million to settle allegations that his group submitted claims for services not provided.

Ms. Sebelius and Attorney General Eric Holder highlighted efforts by the Health Care Fraud Prevention and Enforcement Action Team (HEAT) Medicare Fraud Strike Force, which was begun in 2007 to address durable medical equipment fraud and abuse in south Florida.

The strike force has since been expanded to focus on potential hot spots of potential fraud, identified by claims patterns. In 2009, Los Angeles, Detroit, and Houston, were added; now the strike force also operates in Brooklyn, N.Y., Baton Rouge, La., and Tampa, Fla.

Ms. Sebelius said that new types of scams are emerging, as criminals attempt to take advantage of seniors who may not understand the health reform laws. Scam artists have gone door-to-door in some states selling bogus “ObamaCare” policies, or asking Medicare beneficiaries for identifying information to issue “new Medicare cards,” she said.

Other scams are tied to the issuance of rebate checks to Medicare beneficiaries whose Medicare Part D drug expenditures push them into the doughnut hole, Ms. Sebelius said.

The HHS is working with advocacy organizations to educate laypersons who can train their peers how to recognize illegal and inappropriate come-ons, she added.

In a long-awaited move, the American Board of Emergency Medicine and the American Board of Internal Medicine have agreed to cosponsor a pathway to certification in Internal Medicine Critical Care Medicine.

The landmark agreement comes after decades of effort to find an appropriate mechanism for emergency physicians to receive certification in the subspecialty of critical care medicine.

Emergency physicians have been receiving advanced training through critical care fellowships since the late 1980s, but there was never a pathway to board certification, Dr. Eric Holmboe, the ABIM's chief medical officer, Quality Research and Academic Affairs, said in an interview.

Many of those critical care fellows have gone on to take an examination through the European Society of Intensive Care Medicine. In general, some hospitals accept that overseas exam certification as a surrogate due to the lack of an equivalent U.S. examination, said Dr. Lillian L. Emlet, chair of the Critical Care Medicine section of the American College of Emergency Physicians.

The impact of the new certification is unclear, but “it's a very exciting thing for all of us,” Dr. Emlet said in an interview. At a minimum, it should facilitate additional communication between the ABEM and the two other boards that currently certify in adult critical care medicine, the American Board of Surgery and the American Board of Anesthesiology, said Dr. Emlet, of the University of Pittsburgh.

But the availability of a 2-year fellowship and subsequent U.S. certification will also help produce more U.S.-trained intensivists, Dr. Emlet said.

Currently, about 20 emergency medicine residents enter a critical care fellowship each year, Dr. Emlet said, adding that there's a natural affinity between emergency medicine and critical care medicine. A recently published survey of emergency physicians in a critical care medicine fellowship found that of those who had completed their fellowship, 49% (36 of 73) were practicing both specialties (Acad. Emerg. Med. 2010;17:325–9).

The number of emergency physicians who have completed critical care fellowships has risen from 12 over the 1974-1989 time period to 43 in 2000-2007, according to the survey.

Even so, Dr. Debra G. Perina, ABEM president, said that there is a continuing shortage of critical care physicians in the United States—a problem discussed in a 2006 report by the Institute of Medicine called “The Future of Emergency Care in the United States Health System.”

The current boards are not supplying enough specialists to meet the demand in critical care medicine, Dr. Perina, an associate professor at the University of Virginia, Charlottesville, said in an interview.

A 2005 white paper—published by the ACEP, the Council of Emergency Medicine Residency Directors, the Emergency Medicine Residents' Association, the Society of Academic Emergency Medicine, and the Society of Critical Care Medicine—urged an expansion of training to allow emergency physicians to become certified in critical care medicine.

The new certification program still requires approval from the American Board of Medical Specialties. At this point, “we're not aware of any issues that would keep this from coming to fruition,” Dr. Perina said.

She and Dr. Holmboe said they expected the first certification exam to be offered in 2012.

In a long-awaited move, the American Board of Emergency Medicine and the American Board of Internal Medicine have agreed to cosponsor a pathway to certification in Internal Medicine Critical Care Medicine.

The landmark agreement comes after decades of effort to find an appropriate mechanism for emergency physicians to receive certification in the subspecialty of critical care medicine.

Emergency physicians have been receiving advanced training through critical care fellowships since the late 1980s, but there was never a pathway to board certification, Dr. Eric Holmboe, the ABIM's chief medical officer, Quality Research and Academic Affairs, said in an interview.

Many of those critical care fellows have gone on to take an examination through the European Society of Intensive Care Medicine. In general, some hospitals accept that overseas exam certification as a surrogate due to the lack of an equivalent U.S. examination, said Dr. Lillian L. Emlet, chair of the Critical Care Medicine section of the American College of Emergency Physicians.

The impact of the new certification is unclear, but “it's a very exciting thing for all of us,” Dr. Emlet said in an interview. At a minimum, it should facilitate additional communication between the ABEM and the two other boards that currently certify in adult critical care medicine, the American Board of Surgery and the American Board of Anesthesiology, said Dr. Emlet, of the University of Pittsburgh.

But the availability of a 2-year fellowship and subsequent U.S. certification will also help produce more U.S.-trained intensivists, Dr. Emlet said.

Currently, about 20 emergency medicine residents enter a critical care fellowship each year, Dr. Emlet said, adding that there's a natural affinity between emergency medicine and critical care medicine. A recently published survey of emergency physicians in a critical care medicine fellowship found that of those who had completed their fellowship, 49% (36 of 73) were practicing both specialties (Acad. Emerg. Med. 2010;17:325–9).

The number of emergency physicians who have completed critical care fellowships has risen from 12 over the 1974-1989 time period to 43 in 2000-2007, according to the survey.

Even so, Dr. Debra G. Perina, ABEM president, said that there is a continuing shortage of critical care physicians in the United States—a problem discussed in a 2006 report by the Institute of Medicine called “The Future of Emergency Care in the United States Health System.”

The current boards are not supplying enough specialists to meet the demand in critical care medicine, Dr. Perina, an associate professor at the University of Virginia, Charlottesville, said in an interview.

A 2005 white paper—published by the ACEP, the Council of Emergency Medicine Residency Directors, the Emergency Medicine Residents' Association, the Society of Academic Emergency Medicine, and the Society of Critical Care Medicine—urged an expansion of training to allow emergency physicians to become certified in critical care medicine.

The new certification program still requires approval from the American Board of Medical Specialties. At this point, “we're not aware of any issues that would keep this from coming to fruition,” Dr. Perina said.

She and Dr. Holmboe said they expected the first certification exam to be offered in 2012.

In a long-awaited move, the American Board of Emergency Medicine and the American Board of Internal Medicine have agreed to cosponsor a pathway to certification in Internal Medicine Critical Care Medicine.

The landmark agreement comes after decades of effort to find an appropriate mechanism for emergency physicians to receive certification in the subspecialty of critical care medicine.

Emergency physicians have been receiving advanced training through critical care fellowships since the late 1980s, but there was never a pathway to board certification, Dr. Eric Holmboe, the ABIM's chief medical officer, Quality Research and Academic Affairs, said in an interview.

Many of those critical care fellows have gone on to take an examination through the European Society of Intensive Care Medicine. In general, some hospitals accept that overseas exam certification as a surrogate due to the lack of an equivalent U.S. examination, said Dr. Lillian L. Emlet, chair of the Critical Care Medicine section of the American College of Emergency Physicians.

The impact of the new certification is unclear, but “it's a very exciting thing for all of us,” Dr. Emlet said in an interview. At a minimum, it should facilitate additional communication between the ABEM and the two other boards that currently certify in adult critical care medicine, the American Board of Surgery and the American Board of Anesthesiology, said Dr. Emlet, of the University of Pittsburgh.

But the availability of a 2-year fellowship and subsequent U.S. certification will also help produce more U.S.-trained intensivists, Dr. Emlet said.

Currently, about 20 emergency medicine residents enter a critical care fellowship each year, Dr. Emlet said, adding that there's a natural affinity between emergency medicine and critical care medicine. A recently published survey of emergency physicians in a critical care medicine fellowship found that of those who had completed their fellowship, 49% (36 of 73) were practicing both specialties (Acad. Emerg. Med. 2010;17:325–9).

The number of emergency physicians who have completed critical care fellowships has risen from 12 over the 1974-1989 time period to 43 in 2000-2007, according to the survey.

Even so, Dr. Debra G. Perina, ABEM president, said that there is a continuing shortage of critical care physicians in the United States—a problem discussed in a 2006 report by the Institute of Medicine called “The Future of Emergency Care in the United States Health System.”

The current boards are not supplying enough specialists to meet the demand in critical care medicine, Dr. Perina, an associate professor at the University of Virginia, Charlottesville, said in an interview.

A 2005 white paper—published by the ACEP, the Council of Emergency Medicine Residency Directors, the Emergency Medicine Residents' Association, the Society of Academic Emergency Medicine, and the Society of Critical Care Medicine—urged an expansion of training to allow emergency physicians to become certified in critical care medicine.

The new certification program still requires approval from the American Board of Medical Specialties. At this point, “we're not aware of any issues that would keep this from coming to fruition,” Dr. Perina said.

She and Dr. Holmboe said they expected the first certification exam to be offered in 2012.

The White House announced on April 19 that it has nominated Dr. Donald M. Berwick to lead the Centers for Medicare and Medicaid Services.

The nomination of Dr. Berwick, a pediatrician who is president and chief executive officer of the Institute for Healthcare Improvement, had been rumored for weeks.

In a statement released by the White House, President Obama said, “Dr. Berwick has dedicated his career to improving outcomes for patients and providing better care at lower cost. That's one of the core missions facing our next CMS Administrator, and I'm confident that Don will be an outstanding leader for the agency and the millions of Americans it serves.”

The American Medical Association praised Dr. Berwick's “visionary leadership efforts” in quality and patient safety in a statement given by Dr. Nancy H. Nielsen, the AMA's immediate-past president. “Upon confirmation, we look forward to working with Dr. Berwick at CMS on implementation of the new health reform law and on ensuring that physicians can continue to care for seniors who rely on Medicare.”

With the recent passage of health reform and the continuing lack of a permanent solution for the fee cuts threatened by Medicare's sustainable growth rate (SGR) formula, Dr. Berwick will have a full plate if he is confirmed by the Senate.

Physicians, hospitals, insurers, consumers, and pharmaceutical and medical device manufacturers all are hoping to influence how the law is implemented.

The medical device industry lobby, AdvaMed, issued a statement praising Dr. Berwick's “compelling vision,” but reminded him also of what he will be taking on. “There is perhaps no more important job in health care,” said Stephen J. Ubl, president and CEO of AdvaMed. “The decisions made by Dr. Berwick will affect the lives of America's seniors and every health care provider, and CMS will play a pivotal role in implementing the comprehensive health reform program recently enacted by Congress.”

For his part, Dr. Berwick said in a statement that he felt “flattered and humbled” at his nomination. He added, “If confirmed by the U.S. Senate, I would welcome the opportunity to lead CMS because it offers the chance to help extend the effort to improve America's health care system—the very vision that led to the founding of the Institute for Healthcare Improvement.”

Dr. Berwick is a member of the adjunct staff in the department of medicine at Children's Hospital, Boston, and is a consultant in pediatrics at Massachusetts General Hospital. He is an elected member of the Institute of Medicine, and previously chaired the National Advisory Council for the federal Agency for Healthcare Research and Quality. He also served on President Clinton's Advisory Commission on Consumer Protection and Quality in the Healthcare Industry in 1997 and 1998.

'I would welcome the opportunity … to help extend the effort to improve America's health care system.'

Source DR. BERWICK

The White House announced on April 19 that it has nominated Dr. Donald M. Berwick to lead the Centers for Medicare and Medicaid Services.

The nomination of Dr. Berwick, a pediatrician who is president and chief executive officer of the Institute for Healthcare Improvement, had been rumored for weeks.

In a statement released by the White House, President Obama said, “Dr. Berwick has dedicated his career to improving outcomes for patients and providing better care at lower cost. That's one of the core missions facing our next CMS Administrator, and I'm confident that Don will be an outstanding leader for the agency and the millions of Americans it serves.”

The American Medical Association praised Dr. Berwick's “visionary leadership efforts” in quality and patient safety in a statement given by Dr. Nancy H. Nielsen, the AMA's immediate-past president. “Upon confirmation, we look forward to working with Dr. Berwick at CMS on implementation of the new health reform law and on ensuring that physicians can continue to care for seniors who rely on Medicare.”

With the recent passage of health reform and the continuing lack of a permanent solution for the fee cuts threatened by Medicare's sustainable growth rate (SGR) formula, Dr. Berwick will have a full plate if he is confirmed by the Senate.

Physicians, hospitals, insurers, consumers, and pharmaceutical and medical device manufacturers all are hoping to influence how the law is implemented.

The medical device industry lobby, AdvaMed, issued a statement praising Dr. Berwick's “compelling vision,” but reminded him also of what he will be taking on. “There is perhaps no more important job in health care,” said Stephen J. Ubl, president and CEO of AdvaMed. “The decisions made by Dr. Berwick will affect the lives of America's seniors and every health care provider, and CMS will play a pivotal role in implementing the comprehensive health reform program recently enacted by Congress.”

For his part, Dr. Berwick said in a statement that he felt “flattered and humbled” at his nomination. He added, “If confirmed by the U.S. Senate, I would welcome the opportunity to lead CMS because it offers the chance to help extend the effort to improve America's health care system—the very vision that led to the founding of the Institute for Healthcare Improvement.”

Dr. Berwick is a member of the adjunct staff in the department of medicine at Children's Hospital, Boston, and is a consultant in pediatrics at Massachusetts General Hospital. He is an elected member of the Institute of Medicine, and previously chaired the National Advisory Council for the federal Agency for Healthcare Research and Quality. He also served on President Clinton's Advisory Commission on Consumer Protection and Quality in the Healthcare Industry in 1997 and 1998.

'I would welcome the opportunity … to help extend the effort to improve America's health care system.'

Source DR. BERWICK

The White House announced on April 19 that it has nominated Dr. Donald M. Berwick to lead the Centers for Medicare and Medicaid Services.

The nomination of Dr. Berwick, a pediatrician who is president and chief executive officer of the Institute for Healthcare Improvement, had been rumored for weeks.

In a statement released by the White House, President Obama said, “Dr. Berwick has dedicated his career to improving outcomes for patients and providing better care at lower cost. That's one of the core missions facing our next CMS Administrator, and I'm confident that Don will be an outstanding leader for the agency and the millions of Americans it serves.”

The American Medical Association praised Dr. Berwick's “visionary leadership efforts” in quality and patient safety in a statement given by Dr. Nancy H. Nielsen, the AMA's immediate-past president. “Upon confirmation, we look forward to working with Dr. Berwick at CMS on implementation of the new health reform law and on ensuring that physicians can continue to care for seniors who rely on Medicare.”

With the recent passage of health reform and the continuing lack of a permanent solution for the fee cuts threatened by Medicare's sustainable growth rate (SGR) formula, Dr. Berwick will have a full plate if he is confirmed by the Senate.

Physicians, hospitals, insurers, consumers, and pharmaceutical and medical device manufacturers all are hoping to influence how the law is implemented.

The medical device industry lobby, AdvaMed, issued a statement praising Dr. Berwick's “compelling vision,” but reminded him also of what he will be taking on. “There is perhaps no more important job in health care,” said Stephen J. Ubl, president and CEO of AdvaMed. “The decisions made by Dr. Berwick will affect the lives of America's seniors and every health care provider, and CMS will play a pivotal role in implementing the comprehensive health reform program recently enacted by Congress.”

For his part, Dr. Berwick said in a statement that he felt “flattered and humbled” at his nomination. He added, “If confirmed by the U.S. Senate, I would welcome the opportunity to lead CMS because it offers the chance to help extend the effort to improve America's health care system—the very vision that led to the founding of the Institute for Healthcare Improvement.”

Dr. Berwick is a member of the adjunct staff in the department of medicine at Children's Hospital, Boston, and is a consultant in pediatrics at Massachusetts General Hospital. He is an elected member of the Institute of Medicine, and previously chaired the National Advisory Council for the federal Agency for Healthcare Research and Quality. He also served on President Clinton's Advisory Commission on Consumer Protection and Quality in the Healthcare Industry in 1997 and 1998.

'I would welcome the opportunity … to help extend the effort to improve America's health care system.'

Source DR. BERWICK

Fourteen medical specialty societies have signed a voluntary pledge to be more transparent in dealings with pharmaceutical and medical device manufacturers and other for-profit companies in the health care field.

The pledge, issued by the Council of Medical Specialty Societies (CMSS), was the result of at least a year of negotiations, said Dr. Allen S. Lichter, who is chair of the CMSS Task Force on Professionalism and Conflict of Interest and the chief executive officer of the American Society of Clinical Oncology (ASCO).

“CMSS is committed to encouraging and supporting a culture of integrity, voluntary self-regulation, and transparency,” said Dr. James H. Scully Jr., CMSS president and chief executive officer of the American Psychiatric Association. “This code provides a clear benchmark for maintaining integrity and independence.”

The 14 societies adopting the CMSS Code for Interactions with Companies agree to establish and publish conflict of interest policies as well as policies and procedures to ensure separation of program development from sponsor influence. They also must disclose corporate contributions and board members' financial relationships with companies, and prohibit financial relationships for key association leaders.

The initial signers included the American College of Physicians (ACP), American Academy of Family Physicians (AAFP), American Academy of Neurology (AAN), American College of Cardiology (ACC), Accreditation Council for Continuing Medical Education (ACCME), American College of Emergency Physicians (ACEP), American College of Obstetricians and Gynecologists (ACOG), American College of Radiology (ACR), American Society for Radiation Oncology (ASTRO), and ASCO.

Dr. Daniel J. Ostergaard, the AAFP's vice president for professional activities, said that the CMSS code gives his organization a chance to see where it might improve its current policies on disclosure and ethical conflicts. He said that the AAFP has a long history of seeking to conduct itself ethically. “I feel very confident that my academy has always been addressing the issues pretty directly and with transparency,” Dr. Ostergaard said in an interview.

The AAFP's board members and counsel will spend the next few months determining how to bring its policies into compliance with the CMSS code, he added.

Adoption of the code will not impact the controversial alliance the AAFP struck with Coca-Cola in the fall of 2009 to conduct a consumer awareness campaign about beverages and sweeteners. Dr. Ostergaard said that the code related specifically to health-related companies and that Coca-Cola did not purport to be health related.

Dr. Lichter called the code a “very important milestone” because it will create consistency where there has been none. Many previous efforts to reduce conflicts have been done in private, but this effort is very much a public undertaking, designed to reassure the public and regulators that professional societies are acting ethically, Dr. Lichter said.

It is also, however, just a first step, he said. The code is not meant to be the last word; it represents a minimum set of guidelines. Some organizations may choose to be more restrictive, Dr. Lichter said.

According to the CMSS, the code was developed by a 30-member task force. More of the 32 CMSS members plan to adopt the code in the next few months.

The 25-page code is available on the CMSS Web site at www.cmss.org/codeforinteractions.aspx

Fourteen medical specialty societies have signed a voluntary pledge to be more transparent in dealings with pharmaceutical and medical device manufacturers and other for-profit companies in the health care field.

The pledge, issued by the Council of Medical Specialty Societies (CMSS), was the result of at least a year of negotiations, said Dr. Allen S. Lichter, who is chair of the CMSS Task Force on Professionalism and Conflict of Interest and the chief executive officer of the American Society of Clinical Oncology (ASCO).

“CMSS is committed to encouraging and supporting a culture of integrity, voluntary self-regulation, and transparency,” said Dr. James H. Scully Jr., CMSS president and chief executive officer of the American Psychiatric Association. “This code provides a clear benchmark for maintaining integrity and independence.”

The 14 societies adopting the CMSS Code for Interactions with Companies agree to establish and publish conflict of interest policies as well as policies and procedures to ensure separation of program development from sponsor influence. They also must disclose corporate contributions and board members' financial relationships with companies, and prohibit financial relationships for key association leaders.

The initial signers included the American College of Physicians (ACP), American Academy of Family Physicians (AAFP), American Academy of Neurology (AAN), American College of Cardiology (ACC), Accreditation Council for Continuing Medical Education (ACCME), American College of Emergency Physicians (ACEP), American College of Obstetricians and Gynecologists (ACOG), American College of Radiology (ACR), American Society for Radiation Oncology (ASTRO), and ASCO.

Dr. Daniel J. Ostergaard, the AAFP's vice president for professional activities, said that the CMSS code gives his organization a chance to see where it might improve its current policies on disclosure and ethical conflicts. He said that the AAFP has a long history of seeking to conduct itself ethically. “I feel very confident that my academy has always been addressing the issues pretty directly and with transparency,” Dr. Ostergaard said in an interview.

The AAFP's board members and counsel will spend the next few months determining how to bring its policies into compliance with the CMSS code, he added.

Adoption of the code will not impact the controversial alliance the AAFP struck with Coca-Cola in the fall of 2009 to conduct a consumer awareness campaign about beverages and sweeteners. Dr. Ostergaard said that the code related specifically to health-related companies and that Coca-Cola did not purport to be health related.

Dr. Lichter called the code a “very important milestone” because it will create consistency where there has been none. Many previous efforts to reduce conflicts have been done in private, but this effort is very much a public undertaking, designed to reassure the public and regulators that professional societies are acting ethically, Dr. Lichter said.

It is also, however, just a first step, he said. The code is not meant to be the last word; it represents a minimum set of guidelines. Some organizations may choose to be more restrictive, Dr. Lichter said.

According to the CMSS, the code was developed by a 30-member task force. More of the 32 CMSS members plan to adopt the code in the next few months.

The 25-page code is available on the CMSS Web site at www.cmss.org/codeforinteractions.aspx

Fourteen medical specialty societies have signed a voluntary pledge to be more transparent in dealings with pharmaceutical and medical device manufacturers and other for-profit companies in the health care field.

The pledge, issued by the Council of Medical Specialty Societies (CMSS), was the result of at least a year of negotiations, said Dr. Allen S. Lichter, who is chair of the CMSS Task Force on Professionalism and Conflict of Interest and the chief executive officer of the American Society of Clinical Oncology (ASCO).

“CMSS is committed to encouraging and supporting a culture of integrity, voluntary self-regulation, and transparency,” said Dr. James H. Scully Jr., CMSS president and chief executive officer of the American Psychiatric Association. “This code provides a clear benchmark for maintaining integrity and independence.”

The 14 societies adopting the CMSS Code for Interactions with Companies agree to establish and publish conflict of interest policies as well as policies and procedures to ensure separation of program development from sponsor influence. They also must disclose corporate contributions and board members' financial relationships with companies, and prohibit financial relationships for key association leaders.

The initial signers included the American College of Physicians (ACP), American Academy of Family Physicians (AAFP), American Academy of Neurology (AAN), American College of Cardiology (ACC), Accreditation Council for Continuing Medical Education (ACCME), American College of Emergency Physicians (ACEP), American College of Obstetricians and Gynecologists (ACOG), American College of Radiology (ACR), American Society for Radiation Oncology (ASTRO), and ASCO.

Dr. Daniel J. Ostergaard, the AAFP's vice president for professional activities, said that the CMSS code gives his organization a chance to see where it might improve its current policies on disclosure and ethical conflicts. He said that the AAFP has a long history of seeking to conduct itself ethically. “I feel very confident that my academy has always been addressing the issues pretty directly and with transparency,” Dr. Ostergaard said in an interview.

The AAFP's board members and counsel will spend the next few months determining how to bring its policies into compliance with the CMSS code, he added.

Adoption of the code will not impact the controversial alliance the AAFP struck with Coca-Cola in the fall of 2009 to conduct a consumer awareness campaign about beverages and sweeteners. Dr. Ostergaard said that the code related specifically to health-related companies and that Coca-Cola did not purport to be health related.

Dr. Lichter called the code a “very important milestone” because it will create consistency where there has been none. Many previous efforts to reduce conflicts have been done in private, but this effort is very much a public undertaking, designed to reassure the public and regulators that professional societies are acting ethically, Dr. Lichter said.

It is also, however, just a first step, he said. The code is not meant to be the last word; it represents a minimum set of guidelines. Some organizations may choose to be more restrictive, Dr. Lichter said.

According to the CMSS, the code was developed by a 30-member task force. More of the 32 CMSS members plan to adopt the code in the next few months.

The 25-page code is available on the CMSS Web site at www.cmss.org/codeforinteractions.aspx

A little-noticed provision of the new health reform law will let physicians use data collected and reported as part of the maintenance of certification process as an alternative to the Medicare Physician Quality Reporting Initiative.

The details have yet to be worked out, but it would mean that physicians likely would have at least one fewer process to report quality data, said Dr. Christine Cassel, president and CEO of the American Board of Internal Medicine.

The advantage of the maintenance of certification (MOC) process is that physicians are familiar with it, as more than 80% of all physicians participate, Dr. Cassel said in an interview.

Physicians have been eligible to receive bonuses for participation in the Medicare PQRI, but they have complained about it as a redundant, burdensome, and confusing process, and have bemoaned botched or missing payments. Even the Centers for Medicare and Medicaid Services has acknowledged problems with the program.

In a statement, Dr. Kevin B. Weiss, president and CEO of the American Board of Medical Specialties, said that “MOC reporting will give patients, health plans, and others the information they need to choose physicians based on performance and other key qualifications, including diagnostic acumen, clinical reasoning, and medical knowledge. This [law] is a significant step forward in recognizing the value of MOC in advancing health care quality for the benefit of patients.”

Under the Patient Protection and Affordable Care Act of 2010—one of the two major health reform laws—the Health and Human Services secretary will decide how MOC will fit into the PQRI process. The hope is that this will be clarified within the year, ABIM's Dr. Cassel said.

ABIM and other medical specialty boards seek to meet with CMS officials to help write the regulations for implementing the process, she said. “Our concept is that it would be kind of an alternative pathway, … that it would include all the same conditions and measures as PQRI, but be even more comprehensive,” said Dr. Cassel.

Family physicians already have some experience with using MOC as an alternative to PQRI. The American Board of Family Medicine received approval from Medicare to use its MOC registry for the PQRI process, according to Dr. Michael Hagen, ABFM's senior vice president. Instead of using Medicare “G” codes, physicians report actual patient data.

In 2008 (the first year of the registry), 260 family physicians participated. Participants could report on 15 patients over a 6-month period to receive half of the bonus, or 30 patients over a year to receive the full bonus, Dr. Hagen said in an interview. Last year, about 720 family physicians participated.

Source Elsevier Global Medical News

A little-noticed provision of the new health reform law will let physicians use data collected and reported as part of the maintenance of certification process as an alternative to the Medicare Physician Quality Reporting Initiative.

The details have yet to be worked out, but it would mean that physicians likely would have at least one fewer process to report quality data, said Dr. Christine Cassel, president and CEO of the American Board of Internal Medicine.

The advantage of the maintenance of certification (MOC) process is that physicians are familiar with it, as more than 80% of all physicians participate, Dr. Cassel said in an interview.

Physicians have been eligible to receive bonuses for participation in the Medicare PQRI, but they have complained about it as a redundant, burdensome, and confusing process, and have bemoaned botched or missing payments. Even the Centers for Medicare and Medicaid Services has acknowledged problems with the program.

In a statement, Dr. Kevin B. Weiss, president and CEO of the American Board of Medical Specialties, said that “MOC reporting will give patients, health plans, and others the information they need to choose physicians based on performance and other key qualifications, including diagnostic acumen, clinical reasoning, and medical knowledge. This [law] is a significant step forward in recognizing the value of MOC in advancing health care quality for the benefit of patients.”

Under the Patient Protection and Affordable Care Act of 2010—one of the two major health reform laws—the Health and Human Services secretary will decide how MOC will fit into the PQRI process. The hope is that this will be clarified within the year, ABIM's Dr. Cassel said.

ABIM and other medical specialty boards seek to meet with CMS officials to help write the regulations for implementing the process, she said. “Our concept is that it would be kind of an alternative pathway, … that it would include all the same conditions and measures as PQRI, but be even more comprehensive,” said Dr. Cassel.

Family physicians already have some experience with using MOC as an alternative to PQRI. The American Board of Family Medicine received approval from Medicare to use its MOC registry for the PQRI process, according to Dr. Michael Hagen, ABFM's senior vice president. Instead of using Medicare “G” codes, physicians report actual patient data.

In 2008 (the first year of the registry), 260 family physicians participated. Participants could report on 15 patients over a 6-month period to receive half of the bonus, or 30 patients over a year to receive the full bonus, Dr. Hagen said in an interview. Last year, about 720 family physicians participated.

Source Elsevier Global Medical News

A little-noticed provision of the new health reform law will let physicians use data collected and reported as part of the maintenance of certification process as an alternative to the Medicare Physician Quality Reporting Initiative.

The details have yet to be worked out, but it would mean that physicians likely would have at least one fewer process to report quality data, said Dr. Christine Cassel, president and CEO of the American Board of Internal Medicine.

The advantage of the maintenance of certification (MOC) process is that physicians are familiar with it, as more than 80% of all physicians participate, Dr. Cassel said in an interview.

Physicians have been eligible to receive bonuses for participation in the Medicare PQRI, but they have complained about it as a redundant, burdensome, and confusing process, and have bemoaned botched or missing payments. Even the Centers for Medicare and Medicaid Services has acknowledged problems with the program.

In a statement, Dr. Kevin B. Weiss, president and CEO of the American Board of Medical Specialties, said that “MOC reporting will give patients, health plans, and others the information they need to choose physicians based on performance and other key qualifications, including diagnostic acumen, clinical reasoning, and medical knowledge. This [law] is a significant step forward in recognizing the value of MOC in advancing health care quality for the benefit of patients.”

Under the Patient Protection and Affordable Care Act of 2010—one of the two major health reform laws—the Health and Human Services secretary will decide how MOC will fit into the PQRI process. The hope is that this will be clarified within the year, ABIM's Dr. Cassel said.

ABIM and other medical specialty boards seek to meet with CMS officials to help write the regulations for implementing the process, she said. “Our concept is that it would be kind of an alternative pathway, … that it would include all the same conditions and measures as PQRI, but be even more comprehensive,” said Dr. Cassel.

Family physicians already have some experience with using MOC as an alternative to PQRI. The American Board of Family Medicine received approval from Medicare to use its MOC registry for the PQRI process, according to Dr. Michael Hagen, ABFM's senior vice president. Instead of using Medicare “G” codes, physicians report actual patient data.

In 2008 (the first year of the registry), 260 family physicians participated. Participants could report on 15 patients over a 6-month period to receive half of the bonus, or 30 patients over a year to receive the full bonus, Dr. Hagen said in an interview. Last year, about 720 family physicians participated.

Source Elsevier Global Medical News

A little-noticed provision of the health reform law will let physicians use data collected and reported as part of the maintenance of certification process as an alternative to the Medicare Physician Quality Reporting Initiative.

The details have yet to be worked out, but it would mean that physicians likely would have at least one fewer process to report quality data, said Dr. Christine Cassel, president and CEO of the American Board of Internal Medicine.

The advantage of the maintenance of certification (MOC) process is that physicians are familiar with it, as more than 80% of all physicians participate, Dr. Cassel said in an interview.

Physicians have been eligible to receive bonuses for participation in the Medicare PQRI, but they have complained about it as a redundant, burdensome, and confusing process, and have bemoaned botched or missing payments. Even the Centers for Medicare and Medicaid Services has acknowledged problems with the program.

In a statement, Dr. Kevin B. Weiss, president and CEO of the American Board of Medical Specialties, said that “MOC reporting will give patients, health plans, and others the information they need to choose physicians based on performance and other key qualifications, including diagnostic acumen, clinical reasoning, and medical knowledge. This [law] is a significant step forward in recognizing the value of MOC in advancing health care quality for the benefit of patients.”

Under the Patient Protection and Affordable Care Act of 2010—one of the two major health reform laws—the Health and Human Services secretary will decide how MOC will fit into the PQRI process. The hope is that this will be clarified within the year, ABIM's Dr. Cassel said.

ABIM and other medical specialty boards seek to meet with CMS officials to help write the regulations for implementing the process, she said. “Our concept is that it would be kind of an alternative pathway … that it would include all the same conditions and measures as PQRI, but be even more comprehensive,” said Dr. Cassel.

Family physicians already have some experience with using MOC as an alternative to PQRI. The American Board of Family Medicine received approval from Medicare to use its MOC registry for the PQRI process, according to Dr. Michael Hagen, ABFM's senior vice president. Instead of using Medicare “G” codes, physicians report actual patient data.

In 2008 (the first year of the registry), 260 family physicians participated. Participants could report on 15 patients over a 6-month period to receive half of the bonus, or 30 patients over a year to receive the full bonus, Dr. Hagen said in an interview. Last year, all participants were required to report on the full year; about 720 family physicians participated, he said.

Dr. Hagen said that he doesn't expect the ABFM process to change anytime soon. “Our PQRI process will continue as it is until we see the final rules and regulations” regarding implementation of the new law.

Dr. Hagen said that he envisions a future in which physicians can submit data for PQRI, for MOC, and for meaningful electronic health records in one fell swoop.

This Month's Talk Back Question

How confident are you that maintenance of certification data can be adapted to accommodate the PQRI process?

A little-noticed provision of the health reform law will let physicians use data collected and reported as part of the maintenance of certification process as an alternative to the Medicare Physician Quality Reporting Initiative.

The details have yet to be worked out, but it would mean that physicians likely would have at least one fewer process to report quality data, said Dr. Christine Cassel, president and CEO of the American Board of Internal Medicine.

The advantage of the maintenance of certification (MOC) process is that physicians are familiar with it, as more than 80% of all physicians participate, Dr. Cassel said in an interview.

Physicians have been eligible to receive bonuses for participation in the Medicare PQRI, but they have complained about it as a redundant, burdensome, and confusing process, and have bemoaned botched or missing payments. Even the Centers for Medicare and Medicaid Services has acknowledged problems with the program.

In a statement, Dr. Kevin B. Weiss, president and CEO of the American Board of Medical Specialties, said that “MOC reporting will give patients, health plans, and others the information they need to choose physicians based on performance and other key qualifications, including diagnostic acumen, clinical reasoning, and medical knowledge. This [law] is a significant step forward in recognizing the value of MOC in advancing health care quality for the benefit of patients.”

Under the Patient Protection and Affordable Care Act of 2010—one of the two major health reform laws—the Health and Human Services secretary will decide how MOC will fit into the PQRI process. The hope is that this will be clarified within the year, ABIM's Dr. Cassel said.

ABIM and other medical specialty boards seek to meet with CMS officials to help write the regulations for implementing the process, she said. “Our concept is that it would be kind of an alternative pathway … that it would include all the same conditions and measures as PQRI, but be even more comprehensive,” said Dr. Cassel.

Family physicians already have some experience with using MOC as an alternative to PQRI. The American Board of Family Medicine received approval from Medicare to use its MOC registry for the PQRI process, according to Dr. Michael Hagen, ABFM's senior vice president. Instead of using Medicare “G” codes, physicians report actual patient data.

In 2008 (the first year of the registry), 260 family physicians participated. Participants could report on 15 patients over a 6-month period to receive half of the bonus, or 30 patients over a year to receive the full bonus, Dr. Hagen said in an interview. Last year, all participants were required to report on the full year; about 720 family physicians participated, he said.

Dr. Hagen said that he doesn't expect the ABFM process to change anytime soon. “Our PQRI process will continue as it is until we see the final rules and regulations” regarding implementation of the new law.

Dr. Hagen said that he envisions a future in which physicians can submit data for PQRI, for MOC, and for meaningful electronic health records in one fell swoop.

This Month's Talk Back Question

How confident are you that maintenance of certification data can be adapted to accommodate the PQRI process?

A little-noticed provision of the health reform law will let physicians use data collected and reported as part of the maintenance of certification process as an alternative to the Medicare Physician Quality Reporting Initiative.

The details have yet to be worked out, but it would mean that physicians likely would have at least one fewer process to report quality data, said Dr. Christine Cassel, president and CEO of the American Board of Internal Medicine.

The advantage of the maintenance of certification (MOC) process is that physicians are familiar with it, as more than 80% of all physicians participate, Dr. Cassel said in an interview.

Physicians have been eligible to receive bonuses for participation in the Medicare PQRI, but they have complained about it as a redundant, burdensome, and confusing process, and have bemoaned botched or missing payments. Even the Centers for Medicare and Medicaid Services has acknowledged problems with the program.

In a statement, Dr. Kevin B. Weiss, president and CEO of the American Board of Medical Specialties, said that “MOC reporting will give patients, health plans, and others the information they need to choose physicians based on performance and other key qualifications, including diagnostic acumen, clinical reasoning, and medical knowledge. This [law] is a significant step forward in recognizing the value of MOC in advancing health care quality for the benefit of patients.”

Under the Patient Protection and Affordable Care Act of 2010—one of the two major health reform laws—the Health and Human Services secretary will decide how MOC will fit into the PQRI process. The hope is that this will be clarified within the year, ABIM's Dr. Cassel said.

ABIM and other medical specialty boards seek to meet with CMS officials to help write the regulations for implementing the process, she said. “Our concept is that it would be kind of an alternative pathway … that it would include all the same conditions and measures as PQRI, but be even more comprehensive,” said Dr. Cassel.

Family physicians already have some experience with using MOC as an alternative to PQRI. The American Board of Family Medicine received approval from Medicare to use its MOC registry for the PQRI process, according to Dr. Michael Hagen, ABFM's senior vice president. Instead of using Medicare “G” codes, physicians report actual patient data.

In 2008 (the first year of the registry), 260 family physicians participated. Participants could report on 15 patients over a 6-month period to receive half of the bonus, or 30 patients over a year to receive the full bonus, Dr. Hagen said in an interview. Last year, all participants were required to report on the full year; about 720 family physicians participated, he said.

Dr. Hagen said that he doesn't expect the ABFM process to change anytime soon. “Our PQRI process will continue as it is until we see the final rules and regulations” regarding implementation of the new law.

Dr. Hagen said that he envisions a future in which physicians can submit data for PQRI, for MOC, and for meaningful electronic health records in one fell swoop.

This Month's Talk Back Question

How confident are you that maintenance of certification data can be adapted to accommodate the PQRI process?

That physicians have received another brief reprieve from the looming 21% cut to Medicare reimbursement is not the point, according to Dr. Karen S. Kolba.

The real issue is why physicians are being asked to bear the entire burden of higher-than-expected Medicare costs, she said in an interview. “I understand there are budget implications [to rising Medicare costs], but the responsibility to provide this benefit to seniors and the disabled is the duty of all citizens, not just physicians,” said Dr. Kolba, who is chair of the American College of Rheumatology's Committee on Rheumatologic Care.

President Obama signed legislation late on April 15 giving physicians another temporary reprieve from the 21% Medicare pay cut until June 1.

Dr. Kolba expects the cuts will not go through in this election year. The question is whether Congress will have the “guts” to fix the Sustainable Growth Rate (SGR) formula, said Dr. Kolba, who practices in Santa Maria, Calif.

The fate of Medicare's physician fees was in doubt as late as the afternoon of the 15th. The Senate spent most of the week debating a bill (H.R. 4851) that would delay the cuts mandated by the SGR formula as well as extend unemployment benefits and federal subsidies for COBRA benefits.

The Senate finally approved the bill, with the House doing so in quick succession. The president signed it shortly thereafter. The Congressional Budget Office estimated the cost of this brief delay in the pay cuts at $2.1 billion, the second most costly aspect of the bill after unemployment benefits extension, at almost $12 billion.

The pay cut technically went into effect on April 1, but the Centers for Medicare and Medicaid Services held all claims submitted from that date until April 15, in anticipation that Congress would reverse the cuts retroactively. But on the afternoon of the 15th, CMS officials noted in a statement that claims with dates of service on or after April 1 would be processed at the lower rate “as soon as systems are fully tested to ensure proper claims payment.”

Physician groups were not pleased and began chiding members of Congress for their inaction. J. James Rohack, president of the American Medical Association, said in a statement, “Congress must now turn toward solving this problem once and for all through repeal of the broken payment formula that will hurt seniors, military families, and the physicians who care for them.” Dr. Rohack warned—again—that physicians are starting to limit new Medicare patients. “It is impossible for physicians to continue to care for all seniors when Medicare payments fall so far below the cost of providing care,” he said.

That physicians have received another brief reprieve from the looming 21% cut to Medicare reimbursement is not the point, according to Dr. Karen S. Kolba.

The real issue is why physicians are being asked to bear the entire burden of higher-than-expected Medicare costs, she said in an interview. “I understand there are budget implications [to rising Medicare costs], but the responsibility to provide this benefit to seniors and the disabled is the duty of all citizens, not just physicians,” said Dr. Kolba, who is chair of the American College of Rheumatology's Committee on Rheumatologic Care.

President Obama signed legislation late on April 15 giving physicians another temporary reprieve from the 21% Medicare pay cut until June 1.

Dr. Kolba expects the cuts will not go through in this election year. The question is whether Congress will have the “guts” to fix the Sustainable Growth Rate (SGR) formula, said Dr. Kolba, who practices in Santa Maria, Calif.

The fate of Medicare's physician fees was in doubt as late as the afternoon of the 15th. The Senate spent most of the week debating a bill (H.R. 4851) that would delay the cuts mandated by the SGR formula as well as extend unemployment benefits and federal subsidies for COBRA benefits.

The Senate finally approved the bill, with the House doing so in quick succession. The president signed it shortly thereafter. The Congressional Budget Office estimated the cost of this brief delay in the pay cuts at $2.1 billion, the second most costly aspect of the bill after unemployment benefits extension, at almost $12 billion.

The pay cut technically went into effect on April 1, but the Centers for Medicare and Medicaid Services held all claims submitted from that date until April 15, in anticipation that Congress would reverse the cuts retroactively. But on the afternoon of the 15th, CMS officials noted in a statement that claims with dates of service on or after April 1 would be processed at the lower rate “as soon as systems are fully tested to ensure proper claims payment.”

Physician groups were not pleased and began chiding members of Congress for their inaction. J. James Rohack, president of the American Medical Association, said in a statement, “Congress must now turn toward solving this problem once and for all through repeal of the broken payment formula that will hurt seniors, military families, and the physicians who care for them.” Dr. Rohack warned—again—that physicians are starting to limit new Medicare patients. “It is impossible for physicians to continue to care for all seniors when Medicare payments fall so far below the cost of providing care,” he said.

That physicians have received another brief reprieve from the looming 21% cut to Medicare reimbursement is not the point, according to Dr. Karen S. Kolba.

The real issue is why physicians are being asked to bear the entire burden of higher-than-expected Medicare costs, she said in an interview. “I understand there are budget implications [to rising Medicare costs], but the responsibility to provide this benefit to seniors and the disabled is the duty of all citizens, not just physicians,” said Dr. Kolba, who is chair of the American College of Rheumatology's Committee on Rheumatologic Care.

President Obama signed legislation late on April 15 giving physicians another temporary reprieve from the 21% Medicare pay cut until June 1.

Dr. Kolba expects the cuts will not go through in this election year. The question is whether Congress will have the “guts” to fix the Sustainable Growth Rate (SGR) formula, said Dr. Kolba, who practices in Santa Maria, Calif.

The fate of Medicare's physician fees was in doubt as late as the afternoon of the 15th. The Senate spent most of the week debating a bill (H.R. 4851) that would delay the cuts mandated by the SGR formula as well as extend unemployment benefits and federal subsidies for COBRA benefits.

The Senate finally approved the bill, with the House doing so in quick succession. The president signed it shortly thereafter. The Congressional Budget Office estimated the cost of this brief delay in the pay cuts at $2.1 billion, the second most costly aspect of the bill after unemployment benefits extension, at almost $12 billion.

The pay cut technically went into effect on April 1, but the Centers for Medicare and Medicaid Services held all claims submitted from that date until April 15, in anticipation that Congress would reverse the cuts retroactively. But on the afternoon of the 15th, CMS officials noted in a statement that claims with dates of service on or after April 1 would be processed at the lower rate “as soon as systems are fully tested to ensure proper claims payment.”

Physician groups were not pleased and began chiding members of Congress for their inaction. J. James Rohack, president of the American Medical Association, said in a statement, “Congress must now turn toward solving this problem once and for all through repeal of the broken payment formula that will hurt seniors, military families, and the physicians who care for them.” Dr. Rohack warned—again—that physicians are starting to limit new Medicare patients. “It is impossible for physicians to continue to care for all seniors when Medicare payments fall so far below the cost of providing care,” he said.

The White House announced on April 19 that it has nominated Dr. Donald Berwick to lead the Centers for Medicare and Medicaid Services.

The nomination of Dr. Berwick, a pediatrician who is president and chief executive officer of the Institute for Healthcare Improvement, had been rumored for weeks.

In a statement released by the White House, President Obama said, “Dr. Berwick has dedicated his career to improving outcomes for patients and providing better care at lower cost. That's one of the core missions facing our next CMS Administrator.”

Physicians' organizations began to express enthusiasm for Dr. Berwick's nomination even before it was made official. The American Medical Association praised Dr. Berwick's “visionary leadership efforts” in quality and patient safety in a statement by Dr. Nancy H. Nielsen, the AMA's immediate -past president.

With the passage of health reform and the continuing lack of a permanent solution for the fee cuts threatened by Medicare's sustainable growth rate (SGR) formula, Dr. Berwick will have a full plate if he is confirmed by the Senate.

Physicians, hospitals, insurers, consumers, and pharmaceutical and medical device manufacturers all are hoping to influence how the law is implemented.

The medical device industry lobby, AdvaMed, issued a statement praising Dr. Berwick's “compelling vision,” but reminded him also of what he will be taking on. “There is perhaps no more important job in health care,” said Stephen J. Ubl, president and CEO of AdvaMed. “The decisions made by Dr. Berwick will affect the lives of America's seniors and every health care provider, and CMS will play a pivotal role in implementing the comprehensive health reform program recently enacted by Congress.”

For his part, Dr. Berwick said in a statement that he felt “flattered and humbled” at his nomination. He added, “If confirmed by the U.S. Senate, I would welcome the opportunity to lead CMS because it offers the chance to help extend the effort to improve America's health care system—the very vision that led to the founding of the Institute for Healthcare Improvement.”

Dr. Berwick is a affiliated with Children's Hospital Boston, and is a consultant in pediatrics at Massachusetts General Hospital. He is an elected member of the Institute of Medicine, and previously chaired the National Advisory Council for the federal Agency for Healthcare Research and Quality. He also served on President Clinton's Advisory Commission on Consumer Protection and Quality in the Healthcare Industry in 1997 and 1998.

The White House announced on April 19 that it has nominated Dr. Donald Berwick to lead the Centers for Medicare and Medicaid Services.

The nomination of Dr. Berwick, a pediatrician who is president and chief executive officer of the Institute for Healthcare Improvement, had been rumored for weeks.

In a statement released by the White House, President Obama said, “Dr. Berwick has dedicated his career to improving outcomes for patients and providing better care at lower cost. That's one of the core missions facing our next CMS Administrator.”

Physicians' organizations began to express enthusiasm for Dr. Berwick's nomination even before it was made official. The American Medical Association praised Dr. Berwick's “visionary leadership efforts” in quality and patient safety in a statement by Dr. Nancy H. Nielsen, the AMA's immediate -past president.

With the passage of health reform and the continuing lack of a permanent solution for the fee cuts threatened by Medicare's sustainable growth rate (SGR) formula, Dr. Berwick will have a full plate if he is confirmed by the Senate.

Physicians, hospitals, insurers, consumers, and pharmaceutical and medical device manufacturers all are hoping to influence how the law is implemented.

The medical device industry lobby, AdvaMed, issued a statement praising Dr. Berwick's “compelling vision,” but reminded him also of what he will be taking on. “There is perhaps no more important job in health care,” said Stephen J. Ubl, president and CEO of AdvaMed. “The decisions made by Dr. Berwick will affect the lives of America's seniors and every health care provider, and CMS will play a pivotal role in implementing the comprehensive health reform program recently enacted by Congress.”

For his part, Dr. Berwick said in a statement that he felt “flattered and humbled” at his nomination. He added, “If confirmed by the U.S. Senate, I would welcome the opportunity to lead CMS because it offers the chance to help extend the effort to improve America's health care system—the very vision that led to the founding of the Institute for Healthcare Improvement.”

Dr. Berwick is a affiliated with Children's Hospital Boston, and is a consultant in pediatrics at Massachusetts General Hospital. He is an elected member of the Institute of Medicine, and previously chaired the National Advisory Council for the federal Agency for Healthcare Research and Quality. He also served on President Clinton's Advisory Commission on Consumer Protection and Quality in the Healthcare Industry in 1997 and 1998.

The White House announced on April 19 that it has nominated Dr. Donald Berwick to lead the Centers for Medicare and Medicaid Services.

The nomination of Dr. Berwick, a pediatrician who is president and chief executive officer of the Institute for Healthcare Improvement, had been rumored for weeks.

In a statement released by the White House, President Obama said, “Dr. Berwick has dedicated his career to improving outcomes for patients and providing better care at lower cost. That's one of the core missions facing our next CMS Administrator.”

Physicians' organizations began to express enthusiasm for Dr. Berwick's nomination even before it was made official. The American Medical Association praised Dr. Berwick's “visionary leadership efforts” in quality and patient safety in a statement by Dr. Nancy H. Nielsen, the AMA's immediate -past president.

With the passage of health reform and the continuing lack of a permanent solution for the fee cuts threatened by Medicare's sustainable growth rate (SGR) formula, Dr. Berwick will have a full plate if he is confirmed by the Senate.

Physicians, hospitals, insurers, consumers, and pharmaceutical and medical device manufacturers all are hoping to influence how the law is implemented.

The medical device industry lobby, AdvaMed, issued a statement praising Dr. Berwick's “compelling vision,” but reminded him also of what he will be taking on. “There is perhaps no more important job in health care,” said Stephen J. Ubl, president and CEO of AdvaMed. “The decisions made by Dr. Berwick will affect the lives of America's seniors and every health care provider, and CMS will play a pivotal role in implementing the comprehensive health reform program recently enacted by Congress.”

For his part, Dr. Berwick said in a statement that he felt “flattered and humbled” at his nomination. He added, “If confirmed by the U.S. Senate, I would welcome the opportunity to lead CMS because it offers the chance to help extend the effort to improve America's health care system—the very vision that led to the founding of the Institute for Healthcare Improvement.”

Dr. Berwick is a affiliated with Children's Hospital Boston, and is a consultant in pediatrics at Massachusetts General Hospital. He is an elected member of the Institute of Medicine, and previously chaired the National Advisory Council for the federal Agency for Healthcare Research and Quality. He also served on President Clinton's Advisory Commission on Consumer Protection and Quality in the Healthcare Industry in 1997 and 1998.