Alicia Ault

The American Society for Dermatologic Surgery and the American Society of Cosmetic Dermatology and Aesthetic Surgery will hold their annual meetings jointly in Phoenix in October, the groups announced.

The decision was driven largely by the faltering economy, but also by a desire to offer a new and innovative program to the membership of both societies, according to officers of both groups.

The decision to combine forces at one annual meeting was warmly embraced by board members and the membership.

The goal of the collaboration was primarily to make it less cost-prohibitive for dermatologists to network with each other and with manufacturers and other exhibitors, said Dr. Ranella Hirsch, ASCDAS past president.

“We wanted to deliver more—more attendees, more opinion leaders,” she said, adding that “from our point of view, it was a natural partnership between the best of each society.”

Traditionally, the two meetings are held about 6 weeks apart. Combining them reduces hurdles for dermatologists, who now won't have to shut down a practice twice in a short period, or have to choose between the two meetings, said Dr. Phil Werschler, ASCDAS president.

There is a large overlap between the ASDS and ASCDAS membership, he said. But the ASDS meeting has been more surgically oriented, while the ASCDAS meeting has placed more emphasis on aesthetic procedures, he said.

The ASDS is looking forward to offering some of the more basic courses that ASCDAS offers, Dr. Robert Weiss, ASDS president, said in an interview.

ASCDAS also brings cosmeceutical expertise that ASDS usually only touches on; ASDS will offer more content on skin cancer, and topics such as chemical peels and hair transplants that might not be part of the ASCDAS agenda, Dr. Weiss said.

The idea for a joint meeting may also have been spurred by the spirit of unity embodied by the 2008 presidential election, said Dr. Weiss.

The meeting will “show other specialties our unity and it's going to help propel dermatologic surgery,” he predicted.

Representatives from the two societies said that currently there is no plan to hold a joint meeting again in 2010.

The American Society for Dermatologic Surgery and the American Society of Cosmetic Dermatology and Aesthetic Surgery will hold their annual meetings jointly in Phoenix in October, the groups announced.

The decision was driven largely by the faltering economy, but also by a desire to offer a new and innovative program to the membership of both societies, according to officers of both groups.

The decision to combine forces at one annual meeting was warmly embraced by board members and the membership.

The goal of the collaboration was primarily to make it less cost-prohibitive for dermatologists to network with each other and with manufacturers and other exhibitors, said Dr. Ranella Hirsch, ASCDAS past president.

“We wanted to deliver more—more attendees, more opinion leaders,” she said, adding that “from our point of view, it was a natural partnership between the best of each society.”

Traditionally, the two meetings are held about 6 weeks apart. Combining them reduces hurdles for dermatologists, who now won't have to shut down a practice twice in a short period, or have to choose between the two meetings, said Dr. Phil Werschler, ASCDAS president.

There is a large overlap between the ASDS and ASCDAS membership, he said. But the ASDS meeting has been more surgically oriented, while the ASCDAS meeting has placed more emphasis on aesthetic procedures, he said.

The ASDS is looking forward to offering some of the more basic courses that ASCDAS offers, Dr. Robert Weiss, ASDS president, said in an interview.

ASCDAS also brings cosmeceutical expertise that ASDS usually only touches on; ASDS will offer more content on skin cancer, and topics such as chemical peels and hair transplants that might not be part of the ASCDAS agenda, Dr. Weiss said.

The idea for a joint meeting may also have been spurred by the spirit of unity embodied by the 2008 presidential election, said Dr. Weiss.

The meeting will “show other specialties our unity and it's going to help propel dermatologic surgery,” he predicted.

Representatives from the two societies said that currently there is no plan to hold a joint meeting again in 2010.

The American Society for Dermatologic Surgery and the American Society of Cosmetic Dermatology and Aesthetic Surgery will hold their annual meetings jointly in Phoenix in October, the groups announced.

The decision was driven largely by the faltering economy, but also by a desire to offer a new and innovative program to the membership of both societies, according to officers of both groups.

The decision to combine forces at one annual meeting was warmly embraced by board members and the membership.

The goal of the collaboration was primarily to make it less cost-prohibitive for dermatologists to network with each other and with manufacturers and other exhibitors, said Dr. Ranella Hirsch, ASCDAS past president.

“We wanted to deliver more—more attendees, more opinion leaders,” she said, adding that “from our point of view, it was a natural partnership between the best of each society.”

Traditionally, the two meetings are held about 6 weeks apart. Combining them reduces hurdles for dermatologists, who now won't have to shut down a practice twice in a short period, or have to choose between the two meetings, said Dr. Phil Werschler, ASCDAS president.

There is a large overlap between the ASDS and ASCDAS membership, he said. But the ASDS meeting has been more surgically oriented, while the ASCDAS meeting has placed more emphasis on aesthetic procedures, he said.

The ASDS is looking forward to offering some of the more basic courses that ASCDAS offers, Dr. Robert Weiss, ASDS president, said in an interview.

ASCDAS also brings cosmeceutical expertise that ASDS usually only touches on; ASDS will offer more content on skin cancer, and topics such as chemical peels and hair transplants that might not be part of the ASCDAS agenda, Dr. Weiss said.

The idea for a joint meeting may also have been spurred by the spirit of unity embodied by the 2008 presidential election, said Dr. Weiss.

The meeting will “show other specialties our unity and it's going to help propel dermatologic surgery,” he predicted.

Representatives from the two societies said that currently there is no plan to hold a joint meeting again in 2010.

FDA Says Humira Ad Misleading

The Food and Drug Administration said that Abbott Laboratories downplayed the risks associated with the psoriasis therapy Humira (adalimumab) in an ad intended for dermatologists. The ad was misleading because it "suggests that Humira is useful in a broader range of conditions or patients than has been demonstrated by substantial evidence or substantial clinical experience," the FDA noted. The drug has many risks, including tuberculosis and invasive fungal infections, and its use should be carefully weighed, the agency wrote in a December letter to Abbott, which contended that the ad gave a full description of the drug's approved use only in small, "nearly illegible" text. Also, the patient pictured in the ad was not representative of approved users since the model showed only a small area of plaque psoriasis. The agency said Abbott should immediately stop the ads. A company spokeswoman said the ad was discontinued in October and that it will "work with the agency to address their concerns."

Phototherapy Copays Prompt Action

The National Psoriasis Foundation has written to insurance commissioners in six states to request that they encourage health plans to eliminate or reduce patients' copayments for phototherapy sessions. Members of a foundation task force on the issue—who are primarily dermatologists—decided to target commissioners in California, Massachusetts, Missouri, New York, Texas, and Utah. The foundation has received two responses, neither of which was very encouraging, said Sheila Rittenberg, the organization's senior director of advocacy and external affairs. The task force effort came after a failed attempt to convince 85 health insurers around the country to cut copayments, she said in an interview. Patients are paying anywhere from $5 to $50 per psoriasis-phototherapy session, and most need several a week, said Ms. Rittenberg. In some cases, she added, patients are being prescribed biologics because they can't afford phototherapy.

Colorings Must Be Declared

Many foods and cosmetics contain carmine and cochineal, but they have been hidden under the rubric of "artificial coloring" or "colors added." The FDA has ruled that manufacturers must clearly state on labels that carmine and cochineal are in those products. The final rule, published Jan. 5, is partly in response to a petition filed by the Center for Science in the Public Interest in 1998. The nonprofit advocacy group contended that because carmine and cochineal extracts—which give products red hues—come from insects, they were the most likely causes of dozens of allergic reactions. The FDA acknowledged that reactions and anaphylaxis have been associated with carmine- and cochineal-colored products, and the agency first proposed requiring disclosure of the two extracts in 2006. But the FDA has refused to ban the colorants. Manufacturers have 2 years to comply with the new labeling requirements.

2009 Predictions on Cosmetic Front

There will be an increase in horror stories about consumers having bargain cosmetic procedures, and Botox will finally get some competition this year, according to a list of predictions from the American Society for Aesthetic Plastic Surgery. The professional society said that the injectable botulinum toxin Reloxin should gain approval in 2009. The organization also said that noninvasive fat-removal techniques will gain credence as they are tested in clinical trials and that men will continue to be a growing segment of the market for cosmetic procedures. The society said its predictions are based on interviews with plastic surgeons.

FDA Says Humira Ad Misleading

The Food and Drug Administration said that Abbott Laboratories downplayed the risks associated with the psoriasis therapy Humira (adalimumab) in an ad intended for dermatologists. The ad was misleading because it "suggests that Humira is useful in a broader range of conditions or patients than has been demonstrated by substantial evidence or substantial clinical experience," the FDA noted. The drug has many risks, including tuberculosis and invasive fungal infections, and its use should be carefully weighed, the agency wrote in a December letter to Abbott, which contended that the ad gave a full description of the drug's approved use only in small, "nearly illegible" text. Also, the patient pictured in the ad was not representative of approved users since the model showed only a small area of plaque psoriasis. The agency said Abbott should immediately stop the ads. A company spokeswoman said the ad was discontinued in October and that it will "work with the agency to address their concerns."

Phototherapy Copays Prompt Action

The National Psoriasis Foundation has written to insurance commissioners in six states to request that they encourage health plans to eliminate or reduce patients' copayments for phototherapy sessions. Members of a foundation task force on the issue—who are primarily dermatologists—decided to target commissioners in California, Massachusetts, Missouri, New York, Texas, and Utah. The foundation has received two responses, neither of which was very encouraging, said Sheila Rittenberg, the organization's senior director of advocacy and external affairs. The task force effort came after a failed attempt to convince 85 health insurers around the country to cut copayments, she said in an interview. Patients are paying anywhere from $5 to $50 per psoriasis-phototherapy session, and most need several a week, said Ms. Rittenberg. In some cases, she added, patients are being prescribed biologics because they can't afford phototherapy.

Colorings Must Be Declared

Many foods and cosmetics contain carmine and cochineal, but they have been hidden under the rubric of "artificial coloring" or "colors added." The FDA has ruled that manufacturers must clearly state on labels that carmine and cochineal are in those products. The final rule, published Jan. 5, is partly in response to a petition filed by the Center for Science in the Public Interest in 1998. The nonprofit advocacy group contended that because carmine and cochineal extracts—which give products red hues—come from insects, they were the most likely causes of dozens of allergic reactions. The FDA acknowledged that reactions and anaphylaxis have been associated with carmine- and cochineal-colored products, and the agency first proposed requiring disclosure of the two extracts in 2006. But the FDA has refused to ban the colorants. Manufacturers have 2 years to comply with the new labeling requirements.

2009 Predictions on Cosmetic Front

There will be an increase in horror stories about consumers having bargain cosmetic procedures, and Botox will finally get some competition this year, according to a list of predictions from the American Society for Aesthetic Plastic Surgery. The professional society said that the injectable botulinum toxin Reloxin should gain approval in 2009. The organization also said that noninvasive fat-removal techniques will gain credence as they are tested in clinical trials and that men will continue to be a growing segment of the market for cosmetic procedures. The society said its predictions are based on interviews with plastic surgeons.

FDA Says Humira Ad Misleading

The Food and Drug Administration said that Abbott Laboratories downplayed the risks associated with the psoriasis therapy Humira (adalimumab) in an ad intended for dermatologists. The ad was misleading because it "suggests that Humira is useful in a broader range of conditions or patients than has been demonstrated by substantial evidence or substantial clinical experience," the FDA noted. The drug has many risks, including tuberculosis and invasive fungal infections, and its use should be carefully weighed, the agency wrote in a December letter to Abbott, which contended that the ad gave a full description of the drug's approved use only in small, "nearly illegible" text. Also, the patient pictured in the ad was not representative of approved users since the model showed only a small area of plaque psoriasis. The agency said Abbott should immediately stop the ads. A company spokeswoman said the ad was discontinued in October and that it will "work with the agency to address their concerns."

Phototherapy Copays Prompt Action

The National Psoriasis Foundation has written to insurance commissioners in six states to request that they encourage health plans to eliminate or reduce patients' copayments for phototherapy sessions. Members of a foundation task force on the issue—who are primarily dermatologists—decided to target commissioners in California, Massachusetts, Missouri, New York, Texas, and Utah. The foundation has received two responses, neither of which was very encouraging, said Sheila Rittenberg, the organization's senior director of advocacy and external affairs. The task force effort came after a failed attempt to convince 85 health insurers around the country to cut copayments, she said in an interview. Patients are paying anywhere from $5 to $50 per psoriasis-phototherapy session, and most need several a week, said Ms. Rittenberg. In some cases, she added, patients are being prescribed biologics because they can't afford phototherapy.

Colorings Must Be Declared

Many foods and cosmetics contain carmine and cochineal, but they have been hidden under the rubric of "artificial coloring" or "colors added." The FDA has ruled that manufacturers must clearly state on labels that carmine and cochineal are in those products. The final rule, published Jan. 5, is partly in response to a petition filed by the Center for Science in the Public Interest in 1998. The nonprofit advocacy group contended that because carmine and cochineal extracts—which give products red hues—come from insects, they were the most likely causes of dozens of allergic reactions. The FDA acknowledged that reactions and anaphylaxis have been associated with carmine- and cochineal-colored products, and the agency first proposed requiring disclosure of the two extracts in 2006. But the FDA has refused to ban the colorants. Manufacturers have 2 years to comply with the new labeling requirements.

2009 Predictions on Cosmetic Front

There will be an increase in horror stories about consumers having bargain cosmetic procedures, and Botox will finally get some competition this year, according to a list of predictions from the American Society for Aesthetic Plastic Surgery. The professional society said that the injectable botulinum toxin Reloxin should gain approval in 2009. The organization also said that noninvasive fat-removal techniques will gain credence as they are tested in clinical trials and that men will continue to be a growing segment of the market for cosmetic procedures. The society said its predictions are based on interviews with plastic surgeons.

WASHINGTON — A new study shows that Medicare beneficiaries will be paying more out of pocket for cancer therapies in 2009, and also will have more restrictions on access than they had in the past.

The American Cancer Society's Cancer Action Network (ACS CAN) and Avalere Health, a health care consulting company, studied the changing patterns in out-of-pocket payments and presented the results at a meeting sponsored by the two organizations.

Cancer therapies are covered under Part B and Part D of the Medicare program. Beneficiaries are responsible for copayments that vary. The ACS and Avalere analysis was based on claims and formulary data for about 4,500 Medicare prescription drug plans.

The researchers found that the plans have been moving brand-name oral cancer drugs to higher formulary tiers—essentially requiring much higher copayments from patients.

Tier 1 requires no or very low copays. Cost sharing rises with each succeeding tier level, with beneficiaries being asked to make a copayment for tiers 1–3 and a percentage of the drug's cost starting on tier 4. Four-tier formularies are the most common, although some plans use as many as six tiers, said the Avalere and ACS CAN researchers.

In 2009, the drugs Gleevec (imatinib mesylate), Sutent (sunitinib malate), Tarceva (erlotinib), Thalomid (thalidomide), and Tykerb (lapatinib) will all be placed on a top formulary tier, with beneficiaries having to pay 26%–35% of the drugs' cost. These therapies cost anywhere from $2,000 to $5,000 a month, depending on the drug. Sixty-two percent to 74% of plans require prior authorization for these five therapies, and a quarter to a third limit the quantity of the drug, for instance by limiting the number of pills that can be received in a month.

This reflects a growing trend, said the analysts, noting that from 2006 to 2008, a growing number of health plans have moved Gleevec to a formulary tier requiring greater cost sharing. In 2006, only 37% had the drug on tier 4; in 2007, 73% had the drug on tier 4, and by 2008, 74% listed it as a tier 4 therapy, 8% as a tier 5, and 2% as a tier 6. In 2009, 63% of plans will list Gleevec as a tier 4 drug, 13% as a tier 5, and none as a tier 6, according to Avalere and ACS.

Medicare beneficiaries are also paying a greater percentage of each drug's cost in each year since 2006. For Gleevec, Sutent, and Tarceva, beneficiaries paid an average of 27% of the cost in 2006; by 2009, that will rise to 33%.

A generic of the drug tamoxifen, however, is on the lowest formulary tier for most plans. No plans require prior authorization and 2% limit quantities. Patients generally pay nothing or $10 for a tamoxifen prescription.

The analysts also looked at the typical drug mix for breast and colon cancer and calculated how much beneficiaries would pay out of pocket in 2006 and in 2009. For breast cancer, they used an example of a woman with comorbidities, since it provides a more realistic picture of the patient's total cost-sharing burden, said the analysts. For a breast cancer patient with hyperlipidemia, type 2 diabetes, and hypertension, the Part B cost, which includes the premium and physician administration fees (and assumes that the beneficiary does not have supplemental Part B insurance), would decline from $7,196 in 2006 to $4,964 in 2009.

Drugs covered under Part B included Adriamycin (doxorubicin), Cytoxan (cyclophosphamide), Taxotere (docetaxel), Kytril (granisetron), Neulasta (pegfilgrastim), and Aloxi (palonosetron) in 2006. In 2009, Taxotere and Kytril were removed and Taxol (paclitaxel) and Benadryl were added. The Part D cost sharing would rise from a range of $1,747–$2,810 in 2006 to $2,122–$3,239 in 2009. Those therapies include Arimidex (anastrozole), dexa-methasone, prochlorperazine, Lipitor (atorvastatin), Glucophage (metformin), hydrochlorothiazide and Ativan (lorazepam). Fosamax (alendronate) was added to the calculations for 2009.

The difference is starker for colon cancer, largely because of the addition of a single therapy. In 2006, the typical regimen—Camptosar (irinotecan), leuco-vorin, fluorouracil, dolasetron, and dexamethasone—was $8,395 for Part B, and Part D cost sharing (for prochlorperazine) ranged from $29 to $825. With fluorouracil and leucovorin dropped and Erbitux (cetuximab) added to the mix in 2009, Part B costs will hit $14,780. Part D sharing will be relatively unchanged at $21–$654. It also appears that beneficiary Part D out-of-pocket costs vary depending on the state of residence. For instance, breast cancer patients living in California would spend about $3,000 in 2009 if they have coverage with the Humana Standard plan, while patients in Illinois and Florida on the same plan would pay several hundred dollars less.

Premiums, deductibles, and cost sharing for various plans vary greatly, the analysts found. At the five largest drug plans, beneficiaries paid anywhere from nothing to $7 for first-tier drugs. Second-tier therapies cost $22–$40; although one plan charged a 28% coinsurance rate and another 25%. With so much variation, it's difficult to make a blanket statement about the impact of cost sharing for beneficiaries, said Sarah Barber, an ACS CAN researcher. How much beneficiaries will shoulder depends on the type of cancer they have, where they live, the mix of drugs they receive, and what plan they have for Part D, she said.

WASHINGTON — A new study shows that Medicare beneficiaries will be paying more out of pocket for cancer therapies in 2009, and also will have more restrictions on access than they had in the past.

The American Cancer Society's Cancer Action Network (ACS CAN) and Avalere Health, a health care consulting company, studied the changing patterns in out-of-pocket payments and presented the results at a meeting sponsored by the two organizations.

Cancer therapies are covered under Part B and Part D of the Medicare program. Beneficiaries are responsible for copayments that vary. The ACS and Avalere analysis was based on claims and formulary data for about 4,500 Medicare prescription drug plans.

The researchers found that the plans have been moving brand-name oral cancer drugs to higher formulary tiers—essentially requiring much higher copayments from patients.

Tier 1 requires no or very low copays. Cost sharing rises with each succeeding tier level, with beneficiaries being asked to make a copayment for tiers 1–3 and a percentage of the drug's cost starting on tier 4. Four-tier formularies are the most common, although some plans use as many as six tiers, said the Avalere and ACS CAN researchers.

In 2009, the drugs Gleevec (imatinib mesylate), Sutent (sunitinib malate), Tarceva (erlotinib), Thalomid (thalidomide), and Tykerb (lapatinib) will all be placed on a top formulary tier, with beneficiaries having to pay 26%–35% of the drugs' cost. These therapies cost anywhere from $2,000 to $5,000 a month, depending on the drug. Sixty-two percent to 74% of plans require prior authorization for these five therapies, and a quarter to a third limit the quantity of the drug, for instance by limiting the number of pills that can be received in a month.

This reflects a growing trend, said the analysts, noting that from 2006 to 2008, a growing number of health plans have moved Gleevec to a formulary tier requiring greater cost sharing. In 2006, only 37% had the drug on tier 4; in 2007, 73% had the drug on tier 4, and by 2008, 74% listed it as a tier 4 therapy, 8% as a tier 5, and 2% as a tier 6. In 2009, 63% of plans will list Gleevec as a tier 4 drug, 13% as a tier 5, and none as a tier 6, according to Avalere and ACS.

Medicare beneficiaries are also paying a greater percentage of each drug's cost in each year since 2006. For Gleevec, Sutent, and Tarceva, beneficiaries paid an average of 27% of the cost in 2006; by 2009, that will rise to 33%.

A generic of the drug tamoxifen, however, is on the lowest formulary tier for most plans. No plans require prior authorization and 2% limit quantities. Patients generally pay nothing or $10 for a tamoxifen prescription.

The analysts also looked at the typical drug mix for breast and colon cancer and calculated how much beneficiaries would pay out of pocket in 2006 and in 2009. For breast cancer, they used an example of a woman with comorbidities, since it provides a more realistic picture of the patient's total cost-sharing burden, said the analysts. For a breast cancer patient with hyperlipidemia, type 2 diabetes, and hypertension, the Part B cost, which includes the premium and physician administration fees (and assumes that the beneficiary does not have supplemental Part B insurance), would decline from $7,196 in 2006 to $4,964 in 2009.

Drugs covered under Part B included Adriamycin (doxorubicin), Cytoxan (cyclophosphamide), Taxotere (docetaxel), Kytril (granisetron), Neulasta (pegfilgrastim), and Aloxi (palonosetron) in 2006. In 2009, Taxotere and Kytril were removed and Taxol (paclitaxel) and Benadryl were added. The Part D cost sharing would rise from a range of $1,747–$2,810 in 2006 to $2,122–$3,239 in 2009. Those therapies include Arimidex (anastrozole), dexa-methasone, prochlorperazine, Lipitor (atorvastatin), Glucophage (metformin), hydrochlorothiazide and Ativan (lorazepam). Fosamax (alendronate) was added to the calculations for 2009.

The difference is starker for colon cancer, largely because of the addition of a single therapy. In 2006, the typical regimen—Camptosar (irinotecan), leuco-vorin, fluorouracil, dolasetron, and dexamethasone—was $8,395 for Part B, and Part D cost sharing (for prochlorperazine) ranged from $29 to $825. With fluorouracil and leucovorin dropped and Erbitux (cetuximab) added to the mix in 2009, Part B costs will hit $14,780. Part D sharing will be relatively unchanged at $21–$654. It also appears that beneficiary Part D out-of-pocket costs vary depending on the state of residence. For instance, breast cancer patients living in California would spend about $3,000 in 2009 if they have coverage with the Humana Standard plan, while patients in Illinois and Florida on the same plan would pay several hundred dollars less.

Premiums, deductibles, and cost sharing for various plans vary greatly, the analysts found. At the five largest drug plans, beneficiaries paid anywhere from nothing to $7 for first-tier drugs. Second-tier therapies cost $22–$40; although one plan charged a 28% coinsurance rate and another 25%. With so much variation, it's difficult to make a blanket statement about the impact of cost sharing for beneficiaries, said Sarah Barber, an ACS CAN researcher. How much beneficiaries will shoulder depends on the type of cancer they have, where they live, the mix of drugs they receive, and what plan they have for Part D, she said.

WASHINGTON — A new study shows that Medicare beneficiaries will be paying more out of pocket for cancer therapies in 2009, and also will have more restrictions on access than they had in the past.

The American Cancer Society's Cancer Action Network (ACS CAN) and Avalere Health, a health care consulting company, studied the changing patterns in out-of-pocket payments and presented the results at a meeting sponsored by the two organizations.

Cancer therapies are covered under Part B and Part D of the Medicare program. Beneficiaries are responsible for copayments that vary. The ACS and Avalere analysis was based on claims and formulary data for about 4,500 Medicare prescription drug plans.

The researchers found that the plans have been moving brand-name oral cancer drugs to higher formulary tiers—essentially requiring much higher copayments from patients.

Tier 1 requires no or very low copays. Cost sharing rises with each succeeding tier level, with beneficiaries being asked to make a copayment for tiers 1–3 and a percentage of the drug's cost starting on tier 4. Four-tier formularies are the most common, although some plans use as many as six tiers, said the Avalere and ACS CAN researchers.

In 2009, the drugs Gleevec (imatinib mesylate), Sutent (sunitinib malate), Tarceva (erlotinib), Thalomid (thalidomide), and Tykerb (lapatinib) will all be placed on a top formulary tier, with beneficiaries having to pay 26%–35% of the drugs' cost. These therapies cost anywhere from $2,000 to $5,000 a month, depending on the drug. Sixty-two percent to 74% of plans require prior authorization for these five therapies, and a quarter to a third limit the quantity of the drug, for instance by limiting the number of pills that can be received in a month.

This reflects a growing trend, said the analysts, noting that from 2006 to 2008, a growing number of health plans have moved Gleevec to a formulary tier requiring greater cost sharing. In 2006, only 37% had the drug on tier 4; in 2007, 73% had the drug on tier 4, and by 2008, 74% listed it as a tier 4 therapy, 8% as a tier 5, and 2% as a tier 6. In 2009, 63% of plans will list Gleevec as a tier 4 drug, 13% as a tier 5, and none as a tier 6, according to Avalere and ACS.

Medicare beneficiaries are also paying a greater percentage of each drug's cost in each year since 2006. For Gleevec, Sutent, and Tarceva, beneficiaries paid an average of 27% of the cost in 2006; by 2009, that will rise to 33%.

A generic of the drug tamoxifen, however, is on the lowest formulary tier for most plans. No plans require prior authorization and 2% limit quantities. Patients generally pay nothing or $10 for a tamoxifen prescription.

The analysts also looked at the typical drug mix for breast and colon cancer and calculated how much beneficiaries would pay out of pocket in 2006 and in 2009. For breast cancer, they used an example of a woman with comorbidities, since it provides a more realistic picture of the patient's total cost-sharing burden, said the analysts. For a breast cancer patient with hyperlipidemia, type 2 diabetes, and hypertension, the Part B cost, which includes the premium and physician administration fees (and assumes that the beneficiary does not have supplemental Part B insurance), would decline from $7,196 in 2006 to $4,964 in 2009.

Drugs covered under Part B included Adriamycin (doxorubicin), Cytoxan (cyclophosphamide), Taxotere (docetaxel), Kytril (granisetron), Neulasta (pegfilgrastim), and Aloxi (palonosetron) in 2006. In 2009, Taxotere and Kytril were removed and Taxol (paclitaxel) and Benadryl were added. The Part D cost sharing would rise from a range of $1,747–$2,810 in 2006 to $2,122–$3,239 in 2009. Those therapies include Arimidex (anastrozole), dexa-methasone, prochlorperazine, Lipitor (atorvastatin), Glucophage (metformin), hydrochlorothiazide and Ativan (lorazepam). Fosamax (alendronate) was added to the calculations for 2009.

The difference is starker for colon cancer, largely because of the addition of a single therapy. In 2006, the typical regimen—Camptosar (irinotecan), leuco-vorin, fluorouracil, dolasetron, and dexamethasone—was $8,395 for Part B, and Part D cost sharing (for prochlorperazine) ranged from $29 to $825. With fluorouracil and leucovorin dropped and Erbitux (cetuximab) added to the mix in 2009, Part B costs will hit $14,780. Part D sharing will be relatively unchanged at $21–$654. It also appears that beneficiary Part D out-of-pocket costs vary depending on the state of residence. For instance, breast cancer patients living in California would spend about $3,000 in 2009 if they have coverage with the Humana Standard plan, while patients in Illinois and Florida on the same plan would pay several hundred dollars less.

Premiums, deductibles, and cost sharing for various plans vary greatly, the analysts found. At the five largest drug plans, beneficiaries paid anywhere from nothing to $7 for first-tier drugs. Second-tier therapies cost $22–$40; although one plan charged a 28% coinsurance rate and another 25%. With so much variation, it's difficult to make a blanket statement about the impact of cost sharing for beneficiaries, said Sarah Barber, an ACS CAN researcher. How much beneficiaries will shoulder depends on the type of cancer they have, where they live, the mix of drugs they receive, and what plan they have for Part D, she said.

BALTIMORE — After a daylong discussion, a panel of Medicare advisers tentatively said they support use of computed tomographic colonography to screen for colorectal cancer in average-risk Medicare beneficiaries.

The Medicare Evidence Development and Coverage Advisory Committee (MEDCAC) was given an overview of existing evidence on sensitivity, specificity, and cost-effectiveness of the technology, and then was asked to vote on a series of questions gauging panelists' level of confidence in computed tomographic colonography (CTC) as a screening tool, when compared with optical colonoscopy.

The Centers for Medicare and Medicaid Services is considering whether to offer coverage of CTC. The agency already pays for colorectal cancer screening for average-risk individuals aged 50 and older using fecal occult blood testing, sigmoidoscopy, colonoscopy, and barium enema. In March, the American Cancer Society, the U.S. Multi-Society Task Force on Co-lorectal Cancer, and the American College of Radiology issued new cancer screening guidelines, which included the statement that CTC was an acceptable option.

A majority of the MEDCAC panelists were moderately to highly confident that there is sufficient evidence to determine sensitivity and specificity of CTC in screening for polyps that measure 6 mm to less than 10 mm, and for polyps larger than 10 mm. They were less confident that the evidence could determine specificity and sensitivity for polyps smaller than 6 mm.

Most panelists said that CTC would provide a net health benefit for average-risk Medicare beneficiaries—that is, a decrease in morbidity and mortality from identification and removal of polyps, when balanced against the risks of the procedure and the identification of extracolonic abnormalities.

But many committee members said they were quite concerned about those extracolonic findings, and said that they could skew both the health benefits of the procedure and its potential cost-effectiveness.

Dr. Mary Barton, scientific director of the U.S. Preventive Services Task Force, told the panel that the task force's systematic review of CTC found that it was comparable to optical colonoscopy in sensitivity and specificity for lesions larger than 10 mm, but not quite similar for lesions larger than 6 mm.

Colonoscopy has the potential for serious harm in 28 per 10,000 patients, partly because of the risk of perforation, Dr. Barton said. While CTC has no significant harms per 18,000 patients, there is uncertainty regarding the radiation exposure, extracolonic findings, and false positives, she said.

Dr. Ned Calonge, chairman of Preventive Services Task Force and chief medical officer of the Colorado Department of Public Health and Environment, said that the unknowns about these potential harms led the group to give CTC a grade of “I,” for insufficient evidence. “This is really a call for further research,” Dr. Calonge told the Medicare advisers.

Dr. Jason Dominitz of the University of Washington, Seattle, who spoke on behalf of the American Society for Gastrointestinal Endoscopy, agreed that the jury was still out on CTC. “It's our overall belief that it's premature to endorse CTC for average-risk Medicare beneficiaries at this time,” Dr. Dominitz told the committee.

The screening should be offered to people with incomplete colonoscopies or to those who refuse to undergo that test, but otherwise, there are too many questions, including questions about its sensitivity for small and flat polyps, how to manage extracolonic findings, the radiation risk, and the appropriate intervals for CTC screening, he said.

BALTIMORE — After a daylong discussion, a panel of Medicare advisers tentatively said they support use of computed tomographic colonography to screen for colorectal cancer in average-risk Medicare beneficiaries.

The Medicare Evidence Development and Coverage Advisory Committee (MEDCAC) was given an overview of existing evidence on sensitivity, specificity, and cost-effectiveness of the technology, and then was asked to vote on a series of questions gauging panelists' level of confidence in computed tomographic colonography (CTC) as a screening tool, when compared with optical colonoscopy.

The Centers for Medicare and Medicaid Services is considering whether to offer coverage of CTC. The agency already pays for colorectal cancer screening for average-risk individuals aged 50 and older using fecal occult blood testing, sigmoidoscopy, colonoscopy, and barium enema. In March, the American Cancer Society, the U.S. Multi-Society Task Force on Co-lorectal Cancer, and the American College of Radiology issued new cancer screening guidelines, which included the statement that CTC was an acceptable option.

A majority of the MEDCAC panelists were moderately to highly confident that there is sufficient evidence to determine sensitivity and specificity of CTC in screening for polyps that measure 6 mm to less than 10 mm, and for polyps larger than 10 mm. They were less confident that the evidence could determine specificity and sensitivity for polyps smaller than 6 mm.

Most panelists said that CTC would provide a net health benefit for average-risk Medicare beneficiaries—that is, a decrease in morbidity and mortality from identification and removal of polyps, when balanced against the risks of the procedure and the identification of extracolonic abnormalities.

But many committee members said they were quite concerned about those extracolonic findings, and said that they could skew both the health benefits of the procedure and its potential cost-effectiveness.

Dr. Mary Barton, scientific director of the U.S. Preventive Services Task Force, told the panel that the task force's systematic review of CTC found that it was comparable to optical colonoscopy in sensitivity and specificity for lesions larger than 10 mm, but not quite similar for lesions larger than 6 mm.

Colonoscopy has the potential for serious harm in 28 per 10,000 patients, partly because of the risk of perforation, Dr. Barton said. While CTC has no significant harms per 18,000 patients, there is uncertainty regarding the radiation exposure, extracolonic findings, and false positives, she said.

Dr. Ned Calonge, chairman of Preventive Services Task Force and chief medical officer of the Colorado Department of Public Health and Environment, said that the unknowns about these potential harms led the group to give CTC a grade of “I,” for insufficient evidence. “This is really a call for further research,” Dr. Calonge told the Medicare advisers.

Dr. Jason Dominitz of the University of Washington, Seattle, who spoke on behalf of the American Society for Gastrointestinal Endoscopy, agreed that the jury was still out on CTC. “It's our overall belief that it's premature to endorse CTC for average-risk Medicare beneficiaries at this time,” Dr. Dominitz told the committee.

The screening should be offered to people with incomplete colonoscopies or to those who refuse to undergo that test, but otherwise, there are too many questions, including questions about its sensitivity for small and flat polyps, how to manage extracolonic findings, the radiation risk, and the appropriate intervals for CTC screening, he said.

BALTIMORE — After a daylong discussion, a panel of Medicare advisers tentatively said they support use of computed tomographic colonography to screen for colorectal cancer in average-risk Medicare beneficiaries.

The Medicare Evidence Development and Coverage Advisory Committee (MEDCAC) was given an overview of existing evidence on sensitivity, specificity, and cost-effectiveness of the technology, and then was asked to vote on a series of questions gauging panelists' level of confidence in computed tomographic colonography (CTC) as a screening tool, when compared with optical colonoscopy.

The Centers for Medicare and Medicaid Services is considering whether to offer coverage of CTC. The agency already pays for colorectal cancer screening for average-risk individuals aged 50 and older using fecal occult blood testing, sigmoidoscopy, colonoscopy, and barium enema. In March, the American Cancer Society, the U.S. Multi-Society Task Force on Co-lorectal Cancer, and the American College of Radiology issued new cancer screening guidelines, which included the statement that CTC was an acceptable option.

A majority of the MEDCAC panelists were moderately to highly confident that there is sufficient evidence to determine sensitivity and specificity of CTC in screening for polyps that measure 6 mm to less than 10 mm, and for polyps larger than 10 mm. They were less confident that the evidence could determine specificity and sensitivity for polyps smaller than 6 mm.

Most panelists said that CTC would provide a net health benefit for average-risk Medicare beneficiaries—that is, a decrease in morbidity and mortality from identification and removal of polyps, when balanced against the risks of the procedure and the identification of extracolonic abnormalities.

But many committee members said they were quite concerned about those extracolonic findings, and said that they could skew both the health benefits of the procedure and its potential cost-effectiveness.

Dr. Mary Barton, scientific director of the U.S. Preventive Services Task Force, told the panel that the task force's systematic review of CTC found that it was comparable to optical colonoscopy in sensitivity and specificity for lesions larger than 10 mm, but not quite similar for lesions larger than 6 mm.

Colonoscopy has the potential for serious harm in 28 per 10,000 patients, partly because of the risk of perforation, Dr. Barton said. While CTC has no significant harms per 18,000 patients, there is uncertainty regarding the radiation exposure, extracolonic findings, and false positives, she said.

Dr. Ned Calonge, chairman of Preventive Services Task Force and chief medical officer of the Colorado Department of Public Health and Environment, said that the unknowns about these potential harms led the group to give CTC a grade of “I,” for insufficient evidence. “This is really a call for further research,” Dr. Calonge told the Medicare advisers.

Dr. Jason Dominitz of the University of Washington, Seattle, who spoke on behalf of the American Society for Gastrointestinal Endoscopy, agreed that the jury was still out on CTC. “It's our overall belief that it's premature to endorse CTC for average-risk Medicare beneficiaries at this time,” Dr. Dominitz told the committee.

The screening should be offered to people with incomplete colonoscopies or to those who refuse to undergo that test, but otherwise, there are too many questions, including questions about its sensitivity for small and flat polyps, how to manage extracolonic findings, the radiation risk, and the appropriate intervals for CTC screening, he said.

WASHINGTON — Medicare advisors unanimously voted to recommend increasing physician fees by 1.1% next year, while expressing dismay that their June 2008 recommendation to boost primary care pay has not yet been acted upon.

The Medicare Payment Advisory Commission—better known as MedPAC—is charged with advising Congress on setting payment rates for physicians, hospitals, and other health care providers. Its recommendations are included in twice-yearly reports issued in March and June.

Under current law, Medicare physician fees are due to be reduced by 21% in 2010. MedPAC initially considered recommending that physician fees be updated by the projected change in input prices, minus an overall productivity goal that was established by the U.S. Bureau of Labor Statistics. The formula translated into a 1.1% increase, but many MedPAC commissioners were uncomfortable with the language and the possibility that it could be used to reduce fees.

Some even suggested that the panel should be considering a larger increase than 1.1%, but Chairman Glenn Hackbarth said he would not vote to approve a higher number, partly because Medicare has a statutory obligation to keep beneficiaries' Part B premiums for physician services in check. As fees rise, so do Part B premiums. And even small increases in physician fees can translate into billions more in Medicare spending, at a time when Congress is struggling to revive the faltering U.S. economy.

There seems to be no indication that Medicare reimbursement policy is leading to access problems for beneficiaries, according to reports from MedPAC staff members. A survey conducted in the early fall of 2008 found that 76% of beneficiaries said they “never” had a delay in getting an appointment for routine care, and 84% never had a delay when seeking an illness-related appointment. This is better than what has been reported by privately insured patients, said MedPAC staff member Cristina Boccuti.

Medicare fees are about 80% of private pay fees, she said.

Commissioner Nancy Kane, an associate dean of education at the Harvard School of Public Health in Boston, said that the 1.1% increase in fees would not be enough for primary care. “Primary care is in a huge state of crisis,” said Ms. Kane. She asked about the progress of the federal medical home demonstration project, and expressed concern that it could be 7–10 years before Medicare rewarded physicians for participation in medical homes. “That may not be fast enough,” she said, adding that the demonstration is a “drop in the pond. We need to move a whole ocean.”

Mr. Hackbarth pointed out that MedPAC had recommended the pilot project to help move the process along, but acknowledged that “we're talking about a significant amount of time, still.” He said he expected that interim data might support quicker action.

The panel also voted unanimously to again include its June 2008 recommendation that Congress establish a budget-neutral payment adjustment for primary care services.

Primary care could get another boost if Congress follows MedPAC's recommendation to change the equipment use rate for imaging machines that cost more than $1 million. Currently, CMS pays physicians based on an estimate that magnetic resonance imaging, computed tomography, and positron emission tomography are used an average 25 hours per week, but data suggest that 45 hours per week is a more accurate and better target, said MedPAC staff member Ariel Winter. The goal is to push physicians to be more efficient with use of the devices. Adopting the new rate would reduce the practice expense relative value unit by almost 8%.

That change would provide a savings of about $900 million annually, said Mr. Winter. The money could be reallocated to primary care pay and other physician services, if the recommendation is adopted.

MedPAC commissioners also voted to increase hospital payments by the projected increase in the market basket, and to reward high-quality, high-performing facilities with a larger, unspecified increase.

They agreed to reduce the indirect medical education (IME) payment by 1%, which would put it at 4.5% per 10% increment in the resident:bed ratio. MedPAC staff said that the IME payment was a roughly $3 billion subsidy with little required accountability in return. The staff also said that the current rate was set at more than twice the impact of teaching on hospital costs, allowing academic centers to reap higher profits.

The American Hospital Association said it was happy with the vote to increase payments overall. But the IME reduction would “negatively affect the education, clinical care and research missions of teaching hospitals, including their ability to train high-quality physicians,” said AHA Vice President for Policy Don May in a statement.

MedPAC recommended that ambulatory surgery center payments increase by 0.6% in 2010, but also that the facilities be required to report on cost and quality data so that the CMS can better evaluate the adequacy of payments.

WASHINGTON — Medicare advisors unanimously voted to recommend increasing physician fees by 1.1% next year, while expressing dismay that their June 2008 recommendation to boost primary care pay has not yet been acted upon.

The Medicare Payment Advisory Commission—better known as MedPAC—is charged with advising Congress on setting payment rates for physicians, hospitals, and other health care providers. Its recommendations are included in twice-yearly reports issued in March and June.

Under current law, Medicare physician fees are due to be reduced by 21% in 2010. MedPAC initially considered recommending that physician fees be updated by the projected change in input prices, minus an overall productivity goal that was established by the U.S. Bureau of Labor Statistics. The formula translated into a 1.1% increase, but many MedPAC commissioners were uncomfortable with the language and the possibility that it could be used to reduce fees.

Some even suggested that the panel should be considering a larger increase than 1.1%, but Chairman Glenn Hackbarth said he would not vote to approve a higher number, partly because Medicare has a statutory obligation to keep beneficiaries' Part B premiums for physician services in check. As fees rise, so do Part B premiums. And even small increases in physician fees can translate into billions more in Medicare spending, at a time when Congress is struggling to revive the faltering U.S. economy.

There seems to be no indication that Medicare reimbursement policy is leading to access problems for beneficiaries, according to reports from MedPAC staff members. A survey conducted in the early fall of 2008 found that 76% of beneficiaries said they “never” had a delay in getting an appointment for routine care, and 84% never had a delay when seeking an illness-related appointment. This is better than what has been reported by privately insured patients, said MedPAC staff member Cristina Boccuti.

Medicare fees are about 80% of private pay fees, she said.

Commissioner Nancy Kane, an associate dean of education at the Harvard School of Public Health in Boston, said that the 1.1% increase in fees would not be enough for primary care. “Primary care is in a huge state of crisis,” said Ms. Kane. She asked about the progress of the federal medical home demonstration project, and expressed concern that it could be 7–10 years before Medicare rewarded physicians for participation in medical homes. “That may not be fast enough,” she said, adding that the demonstration is a “drop in the pond. We need to move a whole ocean.”

Mr. Hackbarth pointed out that MedPAC had recommended the pilot project to help move the process along, but acknowledged that “we're talking about a significant amount of time, still.” He said he expected that interim data might support quicker action.

The panel also voted unanimously to again include its June 2008 recommendation that Congress establish a budget-neutral payment adjustment for primary care services.

Primary care could get another boost if Congress follows MedPAC's recommendation to change the equipment use rate for imaging machines that cost more than $1 million. Currently, CMS pays physicians based on an estimate that magnetic resonance imaging, computed tomography, and positron emission tomography are used an average 25 hours per week, but data suggest that 45 hours per week is a more accurate and better target, said MedPAC staff member Ariel Winter. The goal is to push physicians to be more efficient with use of the devices. Adopting the new rate would reduce the practice expense relative value unit by almost 8%.

That change would provide a savings of about $900 million annually, said Mr. Winter. The money could be reallocated to primary care pay and other physician services, if the recommendation is adopted.

MedPAC commissioners also voted to increase hospital payments by the projected increase in the market basket, and to reward high-quality, high-performing facilities with a larger, unspecified increase.

They agreed to reduce the indirect medical education (IME) payment by 1%, which would put it at 4.5% per 10% increment in the resident:bed ratio. MedPAC staff said that the IME payment was a roughly $3 billion subsidy with little required accountability in return. The staff also said that the current rate was set at more than twice the impact of teaching on hospital costs, allowing academic centers to reap higher profits.

The American Hospital Association said it was happy with the vote to increase payments overall. But the IME reduction would “negatively affect the education, clinical care and research missions of teaching hospitals, including their ability to train high-quality physicians,” said AHA Vice President for Policy Don May in a statement.

MedPAC recommended that ambulatory surgery center payments increase by 0.6% in 2010, but also that the facilities be required to report on cost and quality data so that the CMS can better evaluate the adequacy of payments.

WASHINGTON — Medicare advisors unanimously voted to recommend increasing physician fees by 1.1% next year, while expressing dismay that their June 2008 recommendation to boost primary care pay has not yet been acted upon.

The Medicare Payment Advisory Commission—better known as MedPAC—is charged with advising Congress on setting payment rates for physicians, hospitals, and other health care providers. Its recommendations are included in twice-yearly reports issued in March and June.

Under current law, Medicare physician fees are due to be reduced by 21% in 2010. MedPAC initially considered recommending that physician fees be updated by the projected change in input prices, minus an overall productivity goal that was established by the U.S. Bureau of Labor Statistics. The formula translated into a 1.1% increase, but many MedPAC commissioners were uncomfortable with the language and the possibility that it could be used to reduce fees.

Some even suggested that the panel should be considering a larger increase than 1.1%, but Chairman Glenn Hackbarth said he would not vote to approve a higher number, partly because Medicare has a statutory obligation to keep beneficiaries' Part B premiums for physician services in check. As fees rise, so do Part B premiums. And even small increases in physician fees can translate into billions more in Medicare spending, at a time when Congress is struggling to revive the faltering U.S. economy.

There seems to be no indication that Medicare reimbursement policy is leading to access problems for beneficiaries, according to reports from MedPAC staff members. A survey conducted in the early fall of 2008 found that 76% of beneficiaries said they “never” had a delay in getting an appointment for routine care, and 84% never had a delay when seeking an illness-related appointment. This is better than what has been reported by privately insured patients, said MedPAC staff member Cristina Boccuti.

Medicare fees are about 80% of private pay fees, she said.

Commissioner Nancy Kane, an associate dean of education at the Harvard School of Public Health in Boston, said that the 1.1% increase in fees would not be enough for primary care. “Primary care is in a huge state of crisis,” said Ms. Kane. She asked about the progress of the federal medical home demonstration project, and expressed concern that it could be 7–10 years before Medicare rewarded physicians for participation in medical homes. “That may not be fast enough,” she said, adding that the demonstration is a “drop in the pond. We need to move a whole ocean.”

Mr. Hackbarth pointed out that MedPAC had recommended the pilot project to help move the process along, but acknowledged that “we're talking about a significant amount of time, still.” He said he expected that interim data might support quicker action.

The panel also voted unanimously to again include its June 2008 recommendation that Congress establish a budget-neutral payment adjustment for primary care services.

Primary care could get another boost if Congress follows MedPAC's recommendation to change the equipment use rate for imaging machines that cost more than $1 million. Currently, CMS pays physicians based on an estimate that magnetic resonance imaging, computed tomography, and positron emission tomography are used an average 25 hours per week, but data suggest that 45 hours per week is a more accurate and better target, said MedPAC staff member Ariel Winter. The goal is to push physicians to be more efficient with use of the devices. Adopting the new rate would reduce the practice expense relative value unit by almost 8%.

That change would provide a savings of about $900 million annually, said Mr. Winter. The money could be reallocated to primary care pay and other physician services, if the recommendation is adopted.

MedPAC commissioners also voted to increase hospital payments by the projected increase in the market basket, and to reward high-quality, high-performing facilities with a larger, unspecified increase.

They agreed to reduce the indirect medical education (IME) payment by 1%, which would put it at 4.5% per 10% increment in the resident:bed ratio. MedPAC staff said that the IME payment was a roughly $3 billion subsidy with little required accountability in return. The staff also said that the current rate was set at more than twice the impact of teaching on hospital costs, allowing academic centers to reap higher profits.

The American Hospital Association said it was happy with the vote to increase payments overall. But the IME reduction would “negatively affect the education, clinical care and research missions of teaching hospitals, including their ability to train high-quality physicians,” said AHA Vice President for Policy Don May in a statement.

MedPAC recommended that ambulatory surgery center payments increase by 0.6% in 2010, but also that the facilities be required to report on cost and quality data so that the CMS can better evaluate the adequacy of payments.

WASHINGTON — Data from the first 6 months of the Physician Quality Reporting Initiative are spurring improvements for the upcoming year, a Medicare official testified at a meeting of the Practicing Physicians Advisory Council.

In the summer of 2008, the Centers for Medicare and Medicaid Services paid $36 million in bonuses to 56,000 physicians for their 2007 reporting, said Dr. Michael T. Rapp, director of the quality measurement and health assessment group at the CMS. The average payment was $600 for 6 months' of data; for 2008 reports, the 1.5% bonus is likely to be around $800 on average, he said.

There will be a number of changes for reporting in 2009. In all, there will be 153 reportable measures, of which 52 are new, and 18 are reportable only through registries. There are seven measures groups: diabetes mellitus, chronic kidney disease, preventive care, coronary artery bypass graft surgery, rheumatoid arthritis, perioperative care, and back pain. Each group contains a number of measures; physicians can report these only as groups.

There will be nine ways for physicians to qualify for the 2% PQRI bonus in 2009, and they also can receive 2% bonus for satisfying requirements under the separate e-prescribing incentive program.

Under last year's Medicare Improvements for Patients and Providers Act, the CMS is required to eventually post on its Web site the names of physicians who satisfactorily report quality measures for 2009. That proposal has been controversial.

PPAC panelist Dr. Frederica Smith, an internist and rheumatologist in Albuquerque, N.M., called the idea a “terrifying concept,” given that it might appear that physicians who were not on the list did not care about quality.

And physicians had many problems complying with the CMS process for reporting measures in 2007, she noted.

Dr. Rapp agreed that the first phase of the program had been frustrating. But “the way it was for 2007 doesn't mean that's the way it will be for 2008,” he said. The agency posted a detailed report on the 2007 experience at its Web site last month (www.cms.hhs.gov/PQRI/Downloads/PQRI2007ReportExperience.pdf

Overall, there were submissions from 109,349 national provider identifier/tax identification numbers with at least one quality data code. Of those, about 93% (101,138) submitted at least one valid code. More than 14 million codes were reported; more than 50% of those (7.3 million) were validly submitted.

There were three major reasons for code nonvalidity: the provider did not adhere to the measure specification; the codes were not submitted with the same claim as the billing and diagnosis code submitted for the procedure; or there was no national provider number (NPI) on the claim.

Many of the submission errors were for patients who did not meet the reporting specifications regarding gender, age, or diagnosis or procedure code for a particular measure. For instance, the PQRI does not accept reports for diabetes measures on patients over age 75, said Dr. Rapp.

CMS plans to rerun reports for providers who did not qualify for the bonus, with the idea that mistakes could have been made and some providers could be found eligible for the bonus on reanalysis. If that is the case, the CMS will issue checks retroactively, he said.

The agency also aims to make some changes to reduce the number of rejected reports. It said it would continue conducting provider education and outreach to ensure physicians understand the specifications for reporting each measure.

The agency also is working with local Medicare carriers to ensure that when claims are split—where the quality codes are separated—they will be “reconnected and counted,” said the agency.

Claims that were submitted to carriers for payment in 2008 without an NPI were automatically rejected. As a result, in the first half of 2008, less than 1% of claims submitted were missing an NPI, said the report. The CMS expects less than 0.5% of PQRI claims to be without an NPI.

Physicians can qualify for the 2% PQRI bonus in 2009 in nine different ways, with an extra 2% for e-prescribing. DR. RAPP

WASHINGTON — Data from the first 6 months of the Physician Quality Reporting Initiative are spurring improvements for the upcoming year, a Medicare official testified at a meeting of the Practicing Physicians Advisory Council.

In the summer of 2008, the Centers for Medicare and Medicaid Services paid $36 million in bonuses to 56,000 physicians for their 2007 reporting, said Dr. Michael T. Rapp, director of the quality measurement and health assessment group at the CMS. The average payment was $600 for 6 months' of data; for 2008 reports, the 1.5% bonus is likely to be around $800 on average, he said.

There will be a number of changes for reporting in 2009. In all, there will be 153 reportable measures, of which 52 are new, and 18 are reportable only through registries. There are seven measures groups: diabetes mellitus, chronic kidney disease, preventive care, coronary artery bypass graft surgery, rheumatoid arthritis, perioperative care, and back pain. Each group contains a number of measures; physicians can report these only as groups.

There will be nine ways for physicians to qualify for the 2% PQRI bonus in 2009, and they also can receive 2% bonus for satisfying requirements under the separate e-prescribing incentive program.

Under last year's Medicare Improvements for Patients and Providers Act, the CMS is required to eventually post on its Web site the names of physicians who satisfactorily report quality measures for 2009. That proposal has been controversial.

PPAC panelist Dr. Frederica Smith, an internist and rheumatologist in Albuquerque, N.M., called the idea a “terrifying concept,” given that it might appear that physicians who were not on the list did not care about quality.

And physicians had many problems complying with the CMS process for reporting measures in 2007, she noted.

Dr. Rapp agreed that the first phase of the program had been frustrating. But “the way it was for 2007 doesn't mean that's the way it will be for 2008,” he said. The agency posted a detailed report on the 2007 experience at its Web site last month (www.cms.hhs.gov/PQRI/Downloads/PQRI2007ReportExperience.pdf

Overall, there were submissions from 109,349 national provider identifier/tax identification numbers with at least one quality data code. Of those, about 93% (101,138) submitted at least one valid code. More than 14 million codes were reported; more than 50% of those (7.3 million) were validly submitted.

There were three major reasons for code nonvalidity: the provider did not adhere to the measure specification; the codes were not submitted with the same claim as the billing and diagnosis code submitted for the procedure; or there was no national provider number (NPI) on the claim.

Many of the submission errors were for patients who did not meet the reporting specifications regarding gender, age, or diagnosis or procedure code for a particular measure. For instance, the PQRI does not accept reports for diabetes measures on patients over age 75, said Dr. Rapp.

CMS plans to rerun reports for providers who did not qualify for the bonus, with the idea that mistakes could have been made and some providers could be found eligible for the bonus on reanalysis. If that is the case, the CMS will issue checks retroactively, he said.

The agency also aims to make some changes to reduce the number of rejected reports. It said it would continue conducting provider education and outreach to ensure physicians understand the specifications for reporting each measure.

The agency also is working with local Medicare carriers to ensure that when claims are split—where the quality codes are separated—they will be “reconnected and counted,” said the agency.

Claims that were submitted to carriers for payment in 2008 without an NPI were automatically rejected. As a result, in the first half of 2008, less than 1% of claims submitted were missing an NPI, said the report. The CMS expects less than 0.5% of PQRI claims to be without an NPI.

Physicians can qualify for the 2% PQRI bonus in 2009 in nine different ways, with an extra 2% for e-prescribing. DR. RAPP

WASHINGTON — Data from the first 6 months of the Physician Quality Reporting Initiative are spurring improvements for the upcoming year, a Medicare official testified at a meeting of the Practicing Physicians Advisory Council.

In the summer of 2008, the Centers for Medicare and Medicaid Services paid $36 million in bonuses to 56,000 physicians for their 2007 reporting, said Dr. Michael T. Rapp, director of the quality measurement and health assessment group at the CMS. The average payment was $600 for 6 months' of data; for 2008 reports, the 1.5% bonus is likely to be around $800 on average, he said.

There will be a number of changes for reporting in 2009. In all, there will be 153 reportable measures, of which 52 are new, and 18 are reportable only through registries. There are seven measures groups: diabetes mellitus, chronic kidney disease, preventive care, coronary artery bypass graft surgery, rheumatoid arthritis, perioperative care, and back pain. Each group contains a number of measures; physicians can report these only as groups.

There will be nine ways for physicians to qualify for the 2% PQRI bonus in 2009, and they also can receive 2% bonus for satisfying requirements under the separate e-prescribing incentive program.

Under last year's Medicare Improvements for Patients and Providers Act, the CMS is required to eventually post on its Web site the names of physicians who satisfactorily report quality measures for 2009. That proposal has been controversial.

PPAC panelist Dr. Frederica Smith, an internist and rheumatologist in Albuquerque, N.M., called the idea a “terrifying concept,” given that it might appear that physicians who were not on the list did not care about quality.

And physicians had many problems complying with the CMS process for reporting measures in 2007, she noted.

Dr. Rapp agreed that the first phase of the program had been frustrating. But “the way it was for 2007 doesn't mean that's the way it will be for 2008,” he said. The agency posted a detailed report on the 2007 experience at its Web site last month (www.cms.hhs.gov/PQRI/Downloads/PQRI2007ReportExperience.pdf

Overall, there were submissions from 109,349 national provider identifier/tax identification numbers with at least one quality data code. Of those, about 93% (101,138) submitted at least one valid code. More than 14 million codes were reported; more than 50% of those (7.3 million) were validly submitted.

There were three major reasons for code nonvalidity: the provider did not adhere to the measure specification; the codes were not submitted with the same claim as the billing and diagnosis code submitted for the procedure; or there was no national provider number (NPI) on the claim.

Many of the submission errors were for patients who did not meet the reporting specifications regarding gender, age, or diagnosis or procedure code for a particular measure. For instance, the PQRI does not accept reports for diabetes measures on patients over age 75, said Dr. Rapp.

CMS plans to rerun reports for providers who did not qualify for the bonus, with the idea that mistakes could have been made and some providers could be found eligible for the bonus on reanalysis. If that is the case, the CMS will issue checks retroactively, he said.

The agency also aims to make some changes to reduce the number of rejected reports. It said it would continue conducting provider education and outreach to ensure physicians understand the specifications for reporting each measure.

The agency also is working with local Medicare carriers to ensure that when claims are split—where the quality codes are separated—they will be “reconnected and counted,” said the agency.

Claims that were submitted to carriers for payment in 2008 without an NPI were automatically rejected. As a result, in the first half of 2008, less than 1% of claims submitted were missing an NPI, said the report. The CMS expects less than 0.5% of PQRI claims to be without an NPI.

Physicians can qualify for the 2% PQRI bonus in 2009 in nine different ways, with an extra 2% for e-prescribing. DR. RAPP

It's Tough Being a Woman

The number of female cardiologists and fellows has doubled since 1996, but women are still vastly underrepresented and likely to report discrimination and difficulties because of family responsibilities, according to a survey commissioned by the American College of Cardiology's Women in Cardiology Council. Despite equal numbers of male and female medical school graduates, women account for fewer than 20% of cardiologists. The survey was initially conducted online in 1996 and repeated in 2006. In the latest version, 1,595 women and 1,950 age-matched male colleagues responded. Women were less likely to describe themselves as interventional cardiologists (11%, compared with 29% of male colleagues), and were more likely to practice in an academic setting. Marriage and family life seemed to be problematic for female cardiologists: They were less likely to be married (73% vs. 91% of men) and more likely to say that family responsibilities had a negative effect on ability to work (40% vs. 22% of men). In all, 69% of women said that they had faced discrimination, compared with only 22% of men. These figures were relatively unchanged since 1996. The new results were published in the Journal of the American College of Cardiology (2008;52:2215–26).

$60 Billion for CV Hospitalizations

The cost of treating patients with cardiovascular disease in hospitals was close to $60 billion in 2006, which was an almost 40% increase from the previous major study of the costs in 1997, according to the Agency for Healthcare Research and Quality. Most of the increase occurred between 1997 and 2003, as there has been a slight decline in cases and slower increase in cost per case since 2003, said the federal agency. The largest annual cost increase—10% a year—was for treating chest pain, which hit $3.9 billion in 2006. Cardiovascular disease treatments accounted for 18% of what hospitals spent on patient care in 2005, said the AHRQ.

Xience YouTube Ads Attacked

The Prescription Project has petitioned the Food and Drug Administration to require medical device makers, including Abbott Laboratories, to remove ads promoting their products on YouTube. The ads violate the FDA's direct-to-consumer rules because they do not include brief statements about the products' use, side effects, and contraindications, said the Boston-based health-industry watchdog. Abbott has posted four videos promoting its Xience V drug-coated stent. The petition also asks the agency to review online ads and videos, and to clarify how FDA rules apply to Internet advertising. Abbott said in a statement that it had provided links to the pertinent information, and that going forward, it would embed the side effect and use data in the videos.

Incentive Exception May Reappear

Under current Medicare and Medicaid rules governing patient referrals, physicians can't share incentive payments for quality improvement. But a proposal to make an exception may reappear, a Centers for Medicare and Medicaid Services official told the Practicing Physicians Advisory Council (PPAC) in December. The CMS proposed an exception under rules governing physician payment for 2009, but opposition—mainly from medical device manufacturers—killed it, said Lisa Ohrin, acting director of the division of technical payment policy at the CMS's Center for Medicare Management. She said, however, that allowing incentive payments is a priority for the CMS, so the agency will again propose allowing physicians to share the payments.

RAC Program Heavily Criticized

Medicare's effort to recover overpayments made to physicians and hospitals and to make good on underpayments—dubbed the Recovery Audit Contractor program—was lambasted by members of the PPAC. The program is currently on hold while the Government Accountability Office studies whether CMS has properly implemented it. During a demonstration project, however, RAC auditors found $1 billion in improper payments among $317 billion worth of claims, a CMS official reported to PPAC. As of July 2008, about 7% of those determinations were overturned on appeal. Once the program is restarted—expected by February—there will be limits on the number of years of claims an auditor can examine and how many records can be requested from practices of various sizes. Even with those plans, PPAC panelists recommended further limits.

Much Psoriasis Goes Undiagnosed

Current estimates are that 5 million adults have been diagnosed with psoriasis. But an analysis of the National Health and Nutrition Examination Survey for 2003–2004 published online Nov. 18 in the Journal of the American Academy of Dermatology indicates that between 600,000 and 3.6 million more have active disease that hasn't been diagnosed or treated. In a separate report, a panel of cardiologists and dermatologists said that because psoriasis is a risk factor for cardiovascular disease, patients with moderate to severe psoriasis should be told they are at risk and screened. The panel's consensus statement, published online in the American Journal of Cardiology, made 13 major recommendations on evaluating and treating the psoriasis-cardiovascular disease connection.

It's Tough Being a Woman

The number of female cardiologists and fellows has doubled since 1996, but women are still vastly underrepresented and likely to report discrimination and difficulties because of family responsibilities, according to a survey commissioned by the American College of Cardiology's Women in Cardiology Council. Despite equal numbers of male and female medical school graduates, women account for fewer than 20% of cardiologists. The survey was initially conducted online in 1996 and repeated in 2006. In the latest version, 1,595 women and 1,950 age-matched male colleagues responded. Women were less likely to describe themselves as interventional cardiologists (11%, compared with 29% of male colleagues), and were more likely to practice in an academic setting. Marriage and family life seemed to be problematic for female cardiologists: They were less likely to be married (73% vs. 91% of men) and more likely to say that family responsibilities had a negative effect on ability to work (40% vs. 22% of men). In all, 69% of women said that they had faced discrimination, compared with only 22% of men. These figures were relatively unchanged since 1996. The new results were published in the Journal of the American College of Cardiology (2008;52:2215–26).

$60 Billion for CV Hospitalizations

The cost of treating patients with cardiovascular disease in hospitals was close to $60 billion in 2006, which was an almost 40% increase from the previous major study of the costs in 1997, according to the Agency for Healthcare Research and Quality. Most of the increase occurred between 1997 and 2003, as there has been a slight decline in cases and slower increase in cost per case since 2003, said the federal agency. The largest annual cost increase—10% a year—was for treating chest pain, which hit $3.9 billion in 2006. Cardiovascular disease treatments accounted for 18% of what hospitals spent on patient care in 2005, said the AHRQ.

Xience YouTube Ads Attacked

The Prescription Project has petitioned the Food and Drug Administration to require medical device makers, including Abbott Laboratories, to remove ads promoting their products on YouTube. The ads violate the FDA's direct-to-consumer rules because they do not include brief statements about the products' use, side effects, and contraindications, said the Boston-based health-industry watchdog. Abbott has posted four videos promoting its Xience V drug-coated stent. The petition also asks the agency to review online ads and videos, and to clarify how FDA rules apply to Internet advertising. Abbott said in a statement that it had provided links to the pertinent information, and that going forward, it would embed the side effect and use data in the videos.

Incentive Exception May Reappear

Under current Medicare and Medicaid rules governing patient referrals, physicians can't share incentive payments for quality improvement. But a proposal to make an exception may reappear, a Centers for Medicare and Medicaid Services official told the Practicing Physicians Advisory Council (PPAC) in December. The CMS proposed an exception under rules governing physician payment for 2009, but opposition—mainly from medical device manufacturers—killed it, said Lisa Ohrin, acting director of the division of technical payment policy at the CMS's Center for Medicare Management. She said, however, that allowing incentive payments is a priority for the CMS, so the agency will again propose allowing physicians to share the payments.

RAC Program Heavily Criticized

Medicare's effort to recover overpayments made to physicians and hospitals and to make good on underpayments—dubbed the Recovery Audit Contractor program—was lambasted by members of the PPAC. The program is currently on hold while the Government Accountability Office studies whether CMS has properly implemented it. During a demonstration project, however, RAC auditors found $1 billion in improper payments among $317 billion worth of claims, a CMS official reported to PPAC. As of July 2008, about 7% of those determinations were overturned on appeal. Once the program is restarted—expected by February—there will be limits on the number of years of claims an auditor can examine and how many records can be requested from practices of various sizes. Even with those plans, PPAC panelists recommended further limits.

Much Psoriasis Goes Undiagnosed

Current estimates are that 5 million adults have been diagnosed with psoriasis. But an analysis of the National Health and Nutrition Examination Survey for 2003–2004 published online Nov. 18 in the Journal of the American Academy of Dermatology indicates that between 600,000 and 3.6 million more have active disease that hasn't been diagnosed or treated. In a separate report, a panel of cardiologists and dermatologists said that because psoriasis is a risk factor for cardiovascular disease, patients with moderate to severe psoriasis should be told they are at risk and screened. The panel's consensus statement, published online in the American Journal of Cardiology, made 13 major recommendations on evaluating and treating the psoriasis-cardiovascular disease connection.

It's Tough Being a Woman

The number of female cardiologists and fellows has doubled since 1996, but women are still vastly underrepresented and likely to report discrimination and difficulties because of family responsibilities, according to a survey commissioned by the American College of Cardiology's Women in Cardiology Council. Despite equal numbers of male and female medical school graduates, women account for fewer than 20% of cardiologists. The survey was initially conducted online in 1996 and repeated in 2006. In the latest version, 1,595 women and 1,950 age-matched male colleagues responded. Women were less likely to describe themselves as interventional cardiologists (11%, compared with 29% of male colleagues), and were more likely to practice in an academic setting. Marriage and family life seemed to be problematic for female cardiologists: They were less likely to be married (73% vs. 91% of men) and more likely to say that family responsibilities had a negative effect on ability to work (40% vs. 22% of men). In all, 69% of women said that they had faced discrimination, compared with only 22% of men. These figures were relatively unchanged since 1996. The new results were published in the Journal of the American College of Cardiology (2008;52:2215–26).

$60 Billion for CV Hospitalizations

The cost of treating patients with cardiovascular disease in hospitals was close to $60 billion in 2006, which was an almost 40% increase from the previous major study of the costs in 1997, according to the Agency for Healthcare Research and Quality. Most of the increase occurred between 1997 and 2003, as there has been a slight decline in cases and slower increase in cost per case since 2003, said the federal agency. The largest annual cost increase—10% a year—was for treating chest pain, which hit $3.9 billion in 2006. Cardiovascular disease treatments accounted for 18% of what hospitals spent on patient care in 2005, said the AHRQ.

Xience YouTube Ads Attacked

The Prescription Project has petitioned the Food and Drug Administration to require medical device makers, including Abbott Laboratories, to remove ads promoting their products on YouTube. The ads violate the FDA's direct-to-consumer rules because they do not include brief statements about the products' use, side effects, and contraindications, said the Boston-based health-industry watchdog. Abbott has posted four videos promoting its Xience V drug-coated stent. The petition also asks the agency to review online ads and videos, and to clarify how FDA rules apply to Internet advertising. Abbott said in a statement that it had provided links to the pertinent information, and that going forward, it would embed the side effect and use data in the videos.

Incentive Exception May Reappear

Under current Medicare and Medicaid rules governing patient referrals, physicians can't share incentive payments for quality improvement. But a proposal to make an exception may reappear, a Centers for Medicare and Medicaid Services official told the Practicing Physicians Advisory Council (PPAC) in December. The CMS proposed an exception under rules governing physician payment for 2009, but opposition—mainly from medical device manufacturers—killed it, said Lisa Ohrin, acting director of the division of technical payment policy at the CMS's Center for Medicare Management. She said, however, that allowing incentive payments is a priority for the CMS, so the agency will again propose allowing physicians to share the payments.

RAC Program Heavily Criticized

Medicare's effort to recover overpayments made to physicians and hospitals and to make good on underpayments—dubbed the Recovery Audit Contractor program—was lambasted by members of the PPAC. The program is currently on hold while the Government Accountability Office studies whether CMS has properly implemented it. During a demonstration project, however, RAC auditors found $1 billion in improper payments among $317 billion worth of claims, a CMS official reported to PPAC. As of July 2008, about 7% of those determinations were overturned on appeal. Once the program is restarted—expected by February—there will be limits on the number of years of claims an auditor can examine and how many records can be requested from practices of various sizes. Even with those plans, PPAC panelists recommended further limits.

Much Psoriasis Goes Undiagnosed

Current estimates are that 5 million adults have been diagnosed with psoriasis. But an analysis of the National Health and Nutrition Examination Survey for 2003–2004 published online Nov. 18 in the Journal of the American Academy of Dermatology indicates that between 600,000 and 3.6 million more have active disease that hasn't been diagnosed or treated. In a separate report, a panel of cardiologists and dermatologists said that because psoriasis is a risk factor for cardiovascular disease, patients with moderate to severe psoriasis should be told they are at risk and screened. The panel's consensus statement, published online in the American Journal of Cardiology, made 13 major recommendations on evaluating and treating the psoriasis-cardiovascular disease connection.

WASHINGTON — Data from the first 6 months of the Physician Quality Reporting Initiative (PQRI) are spurring improvements for the upcoming year, a Medicare official testified at a meeting of the Practicing Physicians Advisory Council.

In the summer of 2008, the CMS paid $36 million in bonuses to 56,000 physicians for their 2007 reporting, said Dr. Michael T. Rapp, director of the quality measurement and health assessment group at the Centers for Medicare and Medicaid Services. The average payment was $600 for 6 months' of data; for 2008 reports, the 1.5% bonus is likely to be around $800 on average, he said.

There will be a number of changes for reporting in 2009. In all, there will be 153 reportable measures. Fifty-two are new, and 18 are reportable only through registries. There are seven measures groups: diabetes mellitus, chronic kidney disease, preventive care, coronary artery bypass graft surgery, rheumatoid arthritis, perioperative care, and back pain. Each group contains a number of measures; physicians can report these only as groups.

There will be nine different ways physicians can qualify for the 2% PQRI bonus in 2009, said Dr. Rapp. Physicians also can receive an additional 2% bonus for satisfying requirements under the separate e-prescribing incentive program.

Under last year's Medicare Improvements for Patients and Providers Act, the CMS is required to eventually post on its Web site the names of physicians who satisfactorily report quality measures for 2009. That proposal has been controversial.

PPAC panelist Dr. Frederica Smith, an internist and rheumatologist in Albuquerque, N.M., called the idea a “terrifying concept,” given that it might appear that physicians who were not on the list did not care about quality.

And physicians had many problems complying with the CMS process for reporting measures in 2007, she noted.

Dr. Rapp agreed that the first phase of the program had been frustrating. But “the way it was for 2007 doesn't mean that's the way it will be for 2008,” he said. The agency has posted a detailed report on the 2007 experience at its Web site (www.cms.hhs.gov/PQRI/Downloads/PQRI2007ReportExperience.pdf

Overall, there were submissions from 109,349 national provider identifier/tax identification numbers with at least one quality data code. Of those, about 93% (101,138) submitted at least one valid code. More than 14 million codes were reported; more than 50% of those (7.3 million) were validly submitted.

There were three major reasons for code nonvalidity: The provider did not adhere to the measure specification; the codes were not submitted with the same claim as the billing and diagnosis code submitted for the procedure; or there was no national provider identification (NPI) number on the claim.

Many of the submission errors were for patients who did not meet the reporting specifications regarding gender, age, or diagnosis or procedure code for a particular measure. For instance, the PQRI does not accept reports for diabetes measures on patients over age 75, said Dr. Rapp.

He said that the CMS plans to rerun reports for providers who did not qualify for the bonus, with the idea that mistakes could have been made and some providers could be found eligible for the bonus on reanalysis. If that is the case, the CMS will issue checks retroactively, he said.

The agency also aims to make some changes that will hopefully reduce the number of rejected reports going forward. The CMS said that it would continue to conduct provider education and outreach to make sure that physicians understand the specifications for reporting each measure.

The agency also is working with local Medicare carriers to ensure that when claims get split—where the quality codes are separated—they will be “reconnected and counted,” according to the agency.

Also, claims that were submitted to carriers for payment in 2008 without an NPI were automatically rejected. As a result, in the first half of 2008, less than 1% of claims submitted under the PQRI program were missing an NPI, according to the agency's report. The CMS expects less than 0.5% of PQRI claims to be without an NPI.

Dr. Rapp said that the agency would make it easier to get PQRI reports for 2008 and that they would be more meaningful to providers. The feedback reports are being redesigned and will better explain what percentage of quality codes are accepted, indicate why the provider did not earn an incentive, and provide information on how well they performed on each measure.

The PPAC panel recommended that the CMS find a way to make the quality reports available to physicians on a real-time basis so that they can perform more timely adjustments of their data collection and reporting.

WASHINGTON — Data from the first 6 months of the Physician Quality Reporting Initiative (PQRI) are spurring improvements for the upcoming year, a Medicare official testified at a meeting of the Practicing Physicians Advisory Council.

In the summer of 2008, the CMS paid $36 million in bonuses to 56,000 physicians for their 2007 reporting, said Dr. Michael T. Rapp, director of the quality measurement and health assessment group at the Centers for Medicare and Medicaid Services. The average payment was $600 for 6 months' of data; for 2008 reports, the 1.5% bonus is likely to be around $800 on average, he said.

There will be a number of changes for reporting in 2009. In all, there will be 153 reportable measures. Fifty-two are new, and 18 are reportable only through registries. There are seven measures groups: diabetes mellitus, chronic kidney disease, preventive care, coronary artery bypass graft surgery, rheumatoid arthritis, perioperative care, and back pain. Each group contains a number of measures; physicians can report these only as groups.

There will be nine different ways physicians can qualify for the 2% PQRI bonus in 2009, said Dr. Rapp. Physicians also can receive an additional 2% bonus for satisfying requirements under the separate e-prescribing incentive program.

Under last year's Medicare Improvements for Patients and Providers Act, the CMS is required to eventually post on its Web site the names of physicians who satisfactorily report quality measures for 2009. That proposal has been controversial.

PPAC panelist Dr. Frederica Smith, an internist and rheumatologist in Albuquerque, N.M., called the idea a “terrifying concept,” given that it might appear that physicians who were not on the list did not care about quality.

And physicians had many problems complying with the CMS process for reporting measures in 2007, she noted.

Dr. Rapp agreed that the first phase of the program had been frustrating. But “the way it was for 2007 doesn't mean that's the way it will be for 2008,” he said. The agency has posted a detailed report on the 2007 experience at its Web site (www.cms.hhs.gov/PQRI/Downloads/PQRI2007ReportExperience.pdf

Overall, there were submissions from 109,349 national provider identifier/tax identification numbers with at least one quality data code. Of those, about 93% (101,138) submitted at least one valid code. More than 14 million codes were reported; more than 50% of those (7.3 million) were validly submitted.

There were three major reasons for code nonvalidity: The provider did not adhere to the measure specification; the codes were not submitted with the same claim as the billing and diagnosis code submitted for the procedure; or there was no national provider identification (NPI) number on the claim.

Many of the submission errors were for patients who did not meet the reporting specifications regarding gender, age, or diagnosis or procedure code for a particular measure. For instance, the PQRI does not accept reports for diabetes measures on patients over age 75, said Dr. Rapp.

He said that the CMS plans to rerun reports for providers who did not qualify for the bonus, with the idea that mistakes could have been made and some providers could be found eligible for the bonus on reanalysis. If that is the case, the CMS will issue checks retroactively, he said.

The agency also aims to make some changes that will hopefully reduce the number of rejected reports going forward. The CMS said that it would continue to conduct provider education and outreach to make sure that physicians understand the specifications for reporting each measure.

The agency also is working with local Medicare carriers to ensure that when claims get split—where the quality codes are separated—they will be “reconnected and counted,” according to the agency.

Also, claims that were submitted to carriers for payment in 2008 without an NPI were automatically rejected. As a result, in the first half of 2008, less than 1% of claims submitted under the PQRI program were missing an NPI, according to the agency's report. The CMS expects less than 0.5% of PQRI claims to be without an NPI.

Dr. Rapp said that the agency would make it easier to get PQRI reports for 2008 and that they would be more meaningful to providers. The feedback reports are being redesigned and will better explain what percentage of quality codes are accepted, indicate why the provider did not earn an incentive, and provide information on how well they performed on each measure.

The PPAC panel recommended that the CMS find a way to make the quality reports available to physicians on a real-time basis so that they can perform more timely adjustments of their data collection and reporting.

WASHINGTON — Data from the first 6 months of the Physician Quality Reporting Initiative (PQRI) are spurring improvements for the upcoming year, a Medicare official testified at a meeting of the Practicing Physicians Advisory Council.

In the summer of 2008, the CMS paid $36 million in bonuses to 56,000 physicians for their 2007 reporting, said Dr. Michael T. Rapp, director of the quality measurement and health assessment group at the Centers for Medicare and Medicaid Services. The average payment was $600 for 6 months' of data; for 2008 reports, the 1.5% bonus is likely to be around $800 on average, he said.

There will be a number of changes for reporting in 2009. In all, there will be 153 reportable measures. Fifty-two are new, and 18 are reportable only through registries. There are seven measures groups: diabetes mellitus, chronic kidney disease, preventive care, coronary artery bypass graft surgery, rheumatoid arthritis, perioperative care, and back pain. Each group contains a number of measures; physicians can report these only as groups.

There will be nine different ways physicians can qualify for the 2% PQRI bonus in 2009, said Dr. Rapp. Physicians also can receive an additional 2% bonus for satisfying requirements under the separate e-prescribing incentive program.

Under last year's Medicare Improvements for Patients and Providers Act, the CMS is required to eventually post on its Web site the names of physicians who satisfactorily report quality measures for 2009. That proposal has been controversial.

PPAC panelist Dr. Frederica Smith, an internist and rheumatologist in Albuquerque, N.M., called the idea a “terrifying concept,” given that it might appear that physicians who were not on the list did not care about quality.

And physicians had many problems complying with the CMS process for reporting measures in 2007, she noted.

Dr. Rapp agreed that the first phase of the program had been frustrating. But “the way it was for 2007 doesn't mean that's the way it will be for 2008,” he said. The agency has posted a detailed report on the 2007 experience at its Web site (www.cms.hhs.gov/PQRI/Downloads/PQRI2007ReportExperience.pdf

Overall, there were submissions from 109,349 national provider identifier/tax identification numbers with at least one quality data code. Of those, about 93% (101,138) submitted at least one valid code. More than 14 million codes were reported; more than 50% of those (7.3 million) were validly submitted.

There were three major reasons for code nonvalidity: The provider did not adhere to the measure specification; the codes were not submitted with the same claim as the billing and diagnosis code submitted for the procedure; or there was no national provider identification (NPI) number on the claim.

Many of the submission errors were for patients who did not meet the reporting specifications regarding gender, age, or diagnosis or procedure code for a particular measure. For instance, the PQRI does not accept reports for diabetes measures on patients over age 75, said Dr. Rapp.

He said that the CMS plans to rerun reports for providers who did not qualify for the bonus, with the idea that mistakes could have been made and some providers could be found eligible for the bonus on reanalysis. If that is the case, the CMS will issue checks retroactively, he said.

The agency also aims to make some changes that will hopefully reduce the number of rejected reports going forward. The CMS said that it would continue to conduct provider education and outreach to make sure that physicians understand the specifications for reporting each measure.

The agency also is working with local Medicare carriers to ensure that when claims get split—where the quality codes are separated—they will be “reconnected and counted,” according to the agency.

Also, claims that were submitted to carriers for payment in 2008 without an NPI were automatically rejected. As a result, in the first half of 2008, less than 1% of claims submitted under the PQRI program were missing an NPI, according to the agency's report. The CMS expects less than 0.5% of PQRI claims to be without an NPI.

Dr. Rapp said that the agency would make it easier to get PQRI reports for 2008 and that they would be more meaningful to providers. The feedback reports are being redesigned and will better explain what percentage of quality codes are accepted, indicate why the provider did not earn an incentive, and provide information on how well they performed on each measure.

The PPAC panel recommended that the CMS find a way to make the quality reports available to physicians on a real-time basis so that they can perform more timely adjustments of their data collection and reporting.

WASHINGTON — Data from the first 6 months of the Physician Quality Reporting Initiative (PQRI) are spurring improvements for the upcoming year, a Medicare official testified at a meeting of the Practicing Physicians Advisory Council.

In the summer of 2008, the CMS paid $36 million in bonuses to 56,000 physicians for their 2007 reporting, said Dr. Michael T. Rapp, director of the quality measurement and health assessment group at the Centers for Medicare and Medicaid Services. The average payment was $600 for 6 months' of data; for 2008 reports, the 1.5% bonus is likely to be around $800 on average, he said.

There will be a number of changes for reporting in 2009. In all, there will be 153 reportable measures. Fifty-two are new, and 18 are reportable only through registries.

There are seven measures groups: diabetes mellitus, chronic kidney disease, preventive care, coronary artery bypass graft surgery, rheumatoid arthritis, perioperative care, and back pain. Each group contains a number of measures; physicians can report these only as groups.

There will be nine different ways physicians can qualify for the 2% PQRI bonus in 2009, said Dr. Rapp. Physicians also can receive an additional 2% bonus for satisfying requirements under the separate e-prescribing incentive program.

Under last year's Medicare Improvements for Patients and Providers Act, the CMS is required to eventually post on its Web site the names of physicians who satisfactorily report quality measures for 2009. That proposal has been controversial.

PPAC panelist Dr. Frederica Smith, an internist and rheumatologist in Albuquerque, N.M., called the idea a “terrifying concept,” given that it might appear that physicians who were not on the list did not care about quality.

And physicians had many problems complying with the CMS process for reporting measures in 2007, she noted.

Dr. Rapp agreed that the first phase of the program had been frustrating. But “the way it was for 2007 doesn't mean that's the way it will be for 2008,” he said. The agency posted a report on the 2007 experience at its Web site last month (www.cms.hhs.gov/PQRI/Downloads/PQRI2007ReportExperience.pdf

Overall, there were submissions from 109,349 national provider identifier/tax identification numbers with at least one quality data code. Of those, about 93% (101,138) submitted at least one valid code. More than 14 million codes were reported; more than 50% of those (7.3 million) were validly submitted.

There were three major reasons for code nonvalidity: the provider did not adhere to the measure specification; the codes were not submitted with the same claim as the billing and diagnosis code submitted for the procedure; or there was no national provider number (NPI) on the claim.

Many of the submission errors were for patients who did not meet the reporting specifications regarding gender, age, or diagnosis or procedure code for a particular measure. For instance, the PQRI does not accept reports for diabetes measures on patients over age 75, said Dr. Rapp.

He said the CMS plans to rerun reports for providers who did not qualify for the bonus, with the idea that mistakes could have been made and some providers could be found eligible for the bonus on reanalysis. If that is the case, the CMS will issue checks retroactively.

The agency also aims to make some changes that will hopefully reduce the number of rejected reports going forward. The CMS said that it would continue to conduct provider education and outreach to make sure that physicians understand the specifications for reporting each measure.

It also is working with local Medicare carriers to ensure that when claims get split—where the quality codes are separated—they will be “reconnected and counted,” said the agency.

Also, claims that were submitted to carriers for payment in 2008 without an NPI were automatically rejected. As a result, in the first half of 2008, less than 1% of claims submitted under the PQRI program were missing an NPI, according to the agency's report. The CMS expects less than 0.5% of PQRI claims to be without an NPI.

Dr. Rapp said that the agency would make it easier to get PQRI reports for 2008 and that they would be more meaningful to providers. The feedback reports are being redesigned and will better explain what percentage of quality codes are accepted, indicate why the provider did not earn an incentive, and provide information on how well they performed on each measure.

The PPAC panel recommended CMS find a way to make the quality reports available to physicians on a real-time basis so that they can perform more timely adjustments of their data collection and reporting. The CMS should also work toward greater transparency with the PQRI program, including measurement development, the panel said.

'The way it was for 2007 doesn't mean that's the way it will be for 2008.' DR. RAPP

WASHINGTON — Data from the first 6 months of the Physician Quality Reporting Initiative (PQRI) are spurring improvements for the upcoming year, a Medicare official testified at a meeting of the Practicing Physicians Advisory Council.

In the summer of 2008, the CMS paid $36 million in bonuses to 56,000 physicians for their 2007 reporting, said Dr. Michael T. Rapp, director of the quality measurement and health assessment group at the Centers for Medicare and Medicaid Services. The average payment was $600 for 6 months' of data; for 2008 reports, the 1.5% bonus is likely to be around $800 on average, he said.

There will be a number of changes for reporting in 2009. In all, there will be 153 reportable measures. Fifty-two are new, and 18 are reportable only through registries.

There are seven measures groups: diabetes mellitus, chronic kidney disease, preventive care, coronary artery bypass graft surgery, rheumatoid arthritis, perioperative care, and back pain. Each group contains a number of measures; physicians can report these only as groups.

There will be nine different ways physicians can qualify for the 2% PQRI bonus in 2009, said Dr. Rapp. Physicians also can receive an additional 2% bonus for satisfying requirements under the separate e-prescribing incentive program.

Under last year's Medicare Improvements for Patients and Providers Act, the CMS is required to eventually post on its Web site the names of physicians who satisfactorily report quality measures for 2009. That proposal has been controversial.

PPAC panelist Dr. Frederica Smith, an internist and rheumatologist in Albuquerque, N.M., called the idea a “terrifying concept,” given that it might appear that physicians who were not on the list did not care about quality.

And physicians had many problems complying with the CMS process for reporting measures in 2007, she noted.

Dr. Rapp agreed that the first phase of the program had been frustrating. But “the way it was for 2007 doesn't mean that's the way it will be for 2008,” he said. The agency posted a report on the 2007 experience at its Web site last month (www.cms.hhs.gov/PQRI/Downloads/PQRI2007ReportExperience.pdf

Overall, there were submissions from 109,349 national provider identifier/tax identification numbers with at least one quality data code. Of those, about 93% (101,138) submitted at least one valid code. More than 14 million codes were reported; more than 50% of those (7.3 million) were validly submitted.

There were three major reasons for code nonvalidity: the provider did not adhere to the measure specification; the codes were not submitted with the same claim as the billing and diagnosis code submitted for the procedure; or there was no national provider number (NPI) on the claim.

Many of the submission errors were for patients who did not meet the reporting specifications regarding gender, age, or diagnosis or procedure code for a particular measure. For instance, the PQRI does not accept reports for diabetes measures on patients over age 75, said Dr. Rapp.

He said the CMS plans to rerun reports for providers who did not qualify for the bonus, with the idea that mistakes could have been made and some providers could be found eligible for the bonus on reanalysis. If that is the case, the CMS will issue checks retroactively.

The agency also aims to make some changes that will hopefully reduce the number of rejected reports going forward. The CMS said that it would continue to conduct provider education and outreach to make sure that physicians understand the specifications for reporting each measure.

It also is working with local Medicare carriers to ensure that when claims get split—where the quality codes are separated—they will be “reconnected and counted,” said the agency.

Also, claims that were submitted to carriers for payment in 2008 without an NPI were automatically rejected. As a result, in the first half of 2008, less than 1% of claims submitted under the PQRI program were missing an NPI, according to the agency's report. The CMS expects less than 0.5% of PQRI claims to be without an NPI.

Dr. Rapp said that the agency would make it easier to get PQRI reports for 2008 and that they would be more meaningful to providers. The feedback reports are being redesigned and will better explain what percentage of quality codes are accepted, indicate why the provider did not earn an incentive, and provide information on how well they performed on each measure.

The PPAC panel recommended CMS find a way to make the quality reports available to physicians on a real-time basis so that they can perform more timely adjustments of their data collection and reporting. The CMS should also work toward greater transparency with the PQRI program, including measurement development, the panel said.

'The way it was for 2007 doesn't mean that's the way it will be for 2008.' DR. RAPP

WASHINGTON — Data from the first 6 months of the Physician Quality Reporting Initiative (PQRI) are spurring improvements for the upcoming year, a Medicare official testified at a meeting of the Practicing Physicians Advisory Council.

In the summer of 2008, the CMS paid $36 million in bonuses to 56,000 physicians for their 2007 reporting, said Dr. Michael T. Rapp, director of the quality measurement and health assessment group at the Centers for Medicare and Medicaid Services. The average payment was $600 for 6 months' of data; for 2008 reports, the 1.5% bonus is likely to be around $800 on average, he said.

There will be a number of changes for reporting in 2009. In all, there will be 153 reportable measures. Fifty-two are new, and 18 are reportable only through registries.

There are seven measures groups: diabetes mellitus, chronic kidney disease, preventive care, coronary artery bypass graft surgery, rheumatoid arthritis, perioperative care, and back pain. Each group contains a number of measures; physicians can report these only as groups.

There will be nine different ways physicians can qualify for the 2% PQRI bonus in 2009, said Dr. Rapp. Physicians also can receive an additional 2% bonus for satisfying requirements under the separate e-prescribing incentive program.

Under last year's Medicare Improvements for Patients and Providers Act, the CMS is required to eventually post on its Web site the names of physicians who satisfactorily report quality measures for 2009. That proposal has been controversial.

PPAC panelist Dr. Frederica Smith, an internist and rheumatologist in Albuquerque, N.M., called the idea a “terrifying concept,” given that it might appear that physicians who were not on the list did not care about quality.

And physicians had many problems complying with the CMS process for reporting measures in 2007, she noted.

Dr. Rapp agreed that the first phase of the program had been frustrating. But “the way it was for 2007 doesn't mean that's the way it will be for 2008,” he said. The agency posted a report on the 2007 experience at its Web site last month (www.cms.hhs.gov/PQRI/Downloads/PQRI2007ReportExperience.pdf

Overall, there were submissions from 109,349 national provider identifier/tax identification numbers with at least one quality data code. Of those, about 93% (101,138) submitted at least one valid code. More than 14 million codes were reported; more than 50% of those (7.3 million) were validly submitted.

There were three major reasons for code nonvalidity: the provider did not adhere to the measure specification; the codes were not submitted with the same claim as the billing and diagnosis code submitted for the procedure; or there was no national provider number (NPI) on the claim.

Many of the submission errors were for patients who did not meet the reporting specifications regarding gender, age, or diagnosis or procedure code for a particular measure. For instance, the PQRI does not accept reports for diabetes measures on patients over age 75, said Dr. Rapp.

He said the CMS plans to rerun reports for providers who did not qualify for the bonus, with the idea that mistakes could have been made and some providers could be found eligible for the bonus on reanalysis. If that is the case, the CMS will issue checks retroactively.

The agency also aims to make some changes that will hopefully reduce the number of rejected reports going forward. The CMS said that it would continue to conduct provider education and outreach to make sure that physicians understand the specifications for reporting each measure.

It also is working with local Medicare carriers to ensure that when claims get split—where the quality codes are separated—they will be “reconnected and counted,” said the agency.

Also, claims that were submitted to carriers for payment in 2008 without an NPI were automatically rejected. As a result, in the first half of 2008, less than 1% of claims submitted under the PQRI program were missing an NPI, according to the agency's report. The CMS expects less than 0.5% of PQRI claims to be without an NPI.

Dr. Rapp said that the agency would make it easier to get PQRI reports for 2008 and that they would be more meaningful to providers. The feedback reports are being redesigned and will better explain what percentage of quality codes are accepted, indicate why the provider did not earn an incentive, and provide information on how well they performed on each measure.

The PPAC panel recommended CMS find a way to make the quality reports available to physicians on a real-time basis so that they can perform more timely adjustments of their data collection and reporting. The CMS should also work toward greater transparency with the PQRI program, including measurement development, the panel said.

'The way it was for 2007 doesn't mean that's the way it will be for 2008.' DR. RAPP

WASHINGTON — Internet-based brief screening and self-help interventions for addictions provide an option for people who otherwise might not make it in to see a clinician in person, according to an addiction specialist who has been piloting such programs for alcohol and tobacco abuse.

Studies have shown that problem drinkers and gamblers, for instance, have ready access to the Internet and may be more likely to first seek help online rather than in a face-to-face encounter, said John A. Cunningham, Ph.D., a senior scientist at the Centre for Addiction and Mental Health, teaching hospital affiliated with the University of Toronto.

Dr. Cunningham, who spoke at the Association for Medical Education and Research in Substance Abuse, has worked as a consultant with Toronto-based V-CC Systems Inc., a company that develops and supports community-based interactive disease management programs.

One such tool can be found at www.checkyourdrinking.net

V-CC Systems has tried to evaluate whether using the screen changes behavior. The company recruited study participants through random dialing, from which 185 people were selected. They were contacted 3 and 6 months after taking the brief screen. It was determined that those who had access to the Web site had reduced the number of drinks by 6 to 7 a week. It seemed that the screen was effective for people who had a drinking problem, but not as much so for other [addictions], said Dr. Cunningham.

WASHINGTON — Internet-based brief screening and self-help interventions for addictions provide an option for people who otherwise might not make it in to see a clinician in person, according to an addiction specialist who has been piloting such programs for alcohol and tobacco abuse.

Studies have shown that problem drinkers and gamblers, for instance, have ready access to the Internet and may be more likely to first seek help online rather than in a face-to-face encounter, said John A. Cunningham, Ph.D., a senior scientist at the Centre for Addiction and Mental Health, teaching hospital affiliated with the University of Toronto.

Dr. Cunningham, who spoke at the Association for Medical Education and Research in Substance Abuse, has worked as a consultant with Toronto-based V-CC Systems Inc., a company that develops and supports community-based interactive disease management programs.

One such tool can be found at www.checkyourdrinking.net

V-CC Systems has tried to evaluate whether using the screen changes behavior. The company recruited study participants through random dialing, from which 185 people were selected. They were contacted 3 and 6 months after taking the brief screen. It was determined that those who had access to the Web site had reduced the number of drinks by 6 to 7 a week. It seemed that the screen was effective for people who had a drinking problem, but not as much so for other [addictions], said Dr. Cunningham.

WASHINGTON — Internet-based brief screening and self-help interventions for addictions provide an option for people who otherwise might not make it in to see a clinician in person, according to an addiction specialist who has been piloting such programs for alcohol and tobacco abuse.

Studies have shown that problem drinkers and gamblers, for instance, have ready access to the Internet and may be more likely to first seek help online rather than in a face-to-face encounter, said John A. Cunningham, Ph.D., a senior scientist at the Centre for Addiction and Mental Health, teaching hospital affiliated with the University of Toronto.

Dr. Cunningham, who spoke at the Association for Medical Education and Research in Substance Abuse, has worked as a consultant with Toronto-based V-CC Systems Inc., a company that develops and supports community-based interactive disease management programs.

One such tool can be found at www.checkyourdrinking.net

V-CC Systems has tried to evaluate whether using the screen changes behavior. The company recruited study participants through random dialing, from which 185 people were selected. They were contacted 3 and 6 months after taking the brief screen. It was determined that those who had access to the Web site had reduced the number of drinks by 6 to 7 a week. It seemed that the screen was effective for people who had a drinking problem, but not as much so for other [addictions], said Dr. Cunningham.