Alicia Ault

WASHINGTON — More than $260 million in Medicaid funds set aside to pay physicians to conduct brief screening and interventions for substance abuse are practically untouched, according to federal experts in the White House Office of National Drug Control Policy.

In January, the Centers for Medicare and Medicaid Services designated the matching funds for states that adopt Medicaid codes for substance abuse Screening and Brief Intervention (SBI). But so far, only nine states (Iowa, Indiana, Maine, Maryland, Minnesota, Montana, Oklahoma, Oregon, and Virginia) have begun using the codes, Bertha Madras, Ph.D., deputy director for demand reduction at the White House Office of National Drug Control Policy (ONDCP), said at a meeting to discuss the program. Wisconsin and Washington are reimbursing for SBI in limited circumstances.

The CMS established G codes for SBI in 2006 and followed with H codes. Last year, the American Medical Association established current procedural terminology codes for SBI; they were published for the first time in the 2008 CPT manual.

For CPT 99408, which involves screening and a brief intervention of 15–30 minutes, the reimbursement is $33.41. For SBI longer than 30 minutes (CPT 99409), the rate is $65.51. (See box.) Dr. Madras did not say how much money has been reimbursed by Medicaid and Medicare, but indicated that the codes are vastly underused.

The ONDCP has been seeking ways to encourage more physicians to conduct SBIs. At the meeting, Dr. Madras cited recently released figures from the Substance Abuse and Mental Health Services Administration showing that 19.9 million people abuse drugs in the United States, but that 93% of those who are addicted are not aware that they have a problem and do not seek treatment.

Dr. Madras said that so far, about 700,000 people have been screened. Almost a quarter were positive for alcohol or drug use; 70% needed a brief intervention and about 16% were referred to treatment, she said. According to self-reports 6 months later, at least a third of those who received treatment said their health status improved.

Citing several recent developments, she said that screening is gaining currency.

At the beginning of 2008, the Federal Employees Health Benefits Plan, which covers 8 million employees and dependents, notified its carriers that the CPT codes for screening and intervention were added and available for use.

In June, the Department of Veterans Affairs directed all VA medical centers to routinely screen for alcohol use and provide brief interventions.

Screening for alcohol intoxication is required at level I and II trauma centers; patients with positive screens should be offered interventions, according to criteria adopted by the American College of Surgeons' Committee on Trauma. The committee decided to institute SBI because alcohol use is the single most important risk factor associated with serious injury, said Dr. John Fildes, who represented the ACS committee at the meeting.

Health insurer Aetna Inc. is aiming to have more of its participating physicians offer screening and brief interventions, said Dr. Hyong Un, national medical director for behavioral health at the company. Dr. Un said Aetna has the systems in place to pay claims with the SBI codes and that its behavioral health specialists will work with physicians. Aetna will offer training to physicians and office managers, with a goal of starting more widespread screening.

Physicians can also find more information about screening and brief intervention at www.sbirt.samhsa.gov

ELSEVIER GLOBAL MEDICAL NEWS

WASHINGTON — More than $260 million in Medicaid funds set aside to pay physicians to conduct brief screening and interventions for substance abuse are practically untouched, according to federal experts in the White House Office of National Drug Control Policy.

In January, the Centers for Medicare and Medicaid Services designated the matching funds for states that adopt Medicaid codes for substance abuse Screening and Brief Intervention (SBI). But so far, only nine states (Iowa, Indiana, Maine, Maryland, Minnesota, Montana, Oklahoma, Oregon, and Virginia) have begun using the codes, Bertha Madras, Ph.D., deputy director for demand reduction at the White House Office of National Drug Control Policy (ONDCP), said at a meeting to discuss the program. Wisconsin and Washington are reimbursing for SBI in limited circumstances.

The CMS established G codes for SBI in 2006 and followed with H codes. Last year, the American Medical Association established current procedural terminology codes for SBI; they were published for the first time in the 2008 CPT manual.

For CPT 99408, which involves screening and a brief intervention of 15–30 minutes, the reimbursement is $33.41. For SBI longer than 30 minutes (CPT 99409), the rate is $65.51. (See box.) Dr. Madras did not say how much money has been reimbursed by Medicaid and Medicare, but indicated that the codes are vastly underused.

The ONDCP has been seeking ways to encourage more physicians to conduct SBIs. At the meeting, Dr. Madras cited recently released figures from the Substance Abuse and Mental Health Services Administration showing that 19.9 million people abuse drugs in the United States, but that 93% of those who are addicted are not aware that they have a problem and do not seek treatment.

Dr. Madras said that so far, about 700,000 people have been screened. Almost a quarter were positive for alcohol or drug use; 70% needed a brief intervention and about 16% were referred to treatment, she said. According to self-reports 6 months later, at least a third of those who received treatment said their health status improved.

Citing several recent developments, she said that screening is gaining currency.

At the beginning of 2008, the Federal Employees Health Benefits Plan, which covers 8 million employees and dependents, notified its carriers that the CPT codes for screening and intervention were added and available for use.

In June, the Department of Veterans Affairs directed all VA medical centers to routinely screen for alcohol use and provide brief interventions.

Screening for alcohol intoxication is required at level I and II trauma centers; patients with positive screens should be offered interventions, according to criteria adopted by the American College of Surgeons' Committee on Trauma. The committee decided to institute SBI because alcohol use is the single most important risk factor associated with serious injury, said Dr. John Fildes, who represented the ACS committee at the meeting.

Health insurer Aetna Inc. is aiming to have more of its participating physicians offer screening and brief interventions, said Dr. Hyong Un, national medical director for behavioral health at the company. Dr. Un said Aetna has the systems in place to pay claims with the SBI codes and that its behavioral health specialists will work with physicians. Aetna will offer training to physicians and office managers, with a goal of starting more widespread screening.

Physicians can also find more information about screening and brief intervention at www.sbirt.samhsa.gov

ELSEVIER GLOBAL MEDICAL NEWS

WASHINGTON — More than $260 million in Medicaid funds set aside to pay physicians to conduct brief screening and interventions for substance abuse are practically untouched, according to federal experts in the White House Office of National Drug Control Policy.

In January, the Centers for Medicare and Medicaid Services designated the matching funds for states that adopt Medicaid codes for substance abuse Screening and Brief Intervention (SBI). But so far, only nine states (Iowa, Indiana, Maine, Maryland, Minnesota, Montana, Oklahoma, Oregon, and Virginia) have begun using the codes, Bertha Madras, Ph.D., deputy director for demand reduction at the White House Office of National Drug Control Policy (ONDCP), said at a meeting to discuss the program. Wisconsin and Washington are reimbursing for SBI in limited circumstances.

The CMS established G codes for SBI in 2006 and followed with H codes. Last year, the American Medical Association established current procedural terminology codes for SBI; they were published for the first time in the 2008 CPT manual.

For CPT 99408, which involves screening and a brief intervention of 15–30 minutes, the reimbursement is $33.41. For SBI longer than 30 minutes (CPT 99409), the rate is $65.51. (See box.) Dr. Madras did not say how much money has been reimbursed by Medicaid and Medicare, but indicated that the codes are vastly underused.

The ONDCP has been seeking ways to encourage more physicians to conduct SBIs. At the meeting, Dr. Madras cited recently released figures from the Substance Abuse and Mental Health Services Administration showing that 19.9 million people abuse drugs in the United States, but that 93% of those who are addicted are not aware that they have a problem and do not seek treatment.

Dr. Madras said that so far, about 700,000 people have been screened. Almost a quarter were positive for alcohol or drug use; 70% needed a brief intervention and about 16% were referred to treatment, she said. According to self-reports 6 months later, at least a third of those who received treatment said their health status improved.

Citing several recent developments, she said that screening is gaining currency.

At the beginning of 2008, the Federal Employees Health Benefits Plan, which covers 8 million employees and dependents, notified its carriers that the CPT codes for screening and intervention were added and available for use.

In June, the Department of Veterans Affairs directed all VA medical centers to routinely screen for alcohol use and provide brief interventions.

Screening for alcohol intoxication is required at level I and II trauma centers; patients with positive screens should be offered interventions, according to criteria adopted by the American College of Surgeons' Committee on Trauma. The committee decided to institute SBI because alcohol use is the single most important risk factor associated with serious injury, said Dr. John Fildes, who represented the ACS committee at the meeting.

Health insurer Aetna Inc. is aiming to have more of its participating physicians offer screening and brief interventions, said Dr. Hyong Un, national medical director for behavioral health at the company. Dr. Un said Aetna has the systems in place to pay claims with the SBI codes and that its behavioral health specialists will work with physicians. Aetna will offer training to physicians and office managers, with a goal of starting more widespread screening.

Physicians can also find more information about screening and brief intervention at www.sbirt.samhsa.gov

ELSEVIER GLOBAL MEDICAL NEWS

No Such Thing as a Safe Tan

Three papers published in the October issue of Pigment Cell and Melanoma Research contend that there's no evidence supporting the safety of tanning—especially indoor tanning—and they call on the tanning bed industry to cease promoting its services. Dr. David Fisher, president of the Society of Melanoma Research, and colleagues from Massachusetts General Hospital's dermatology department write that while genetic and other factors play a role in skin cancer risk, "the role of UV is incontrovertible, and efforts to confuse the public, particularly for purposes of economic gain by the indoor tanning industry, should be vigorously combated for the public health." Dr. Marianne Berwick of the University of New Mexico, Albuquerque, writes, "Epidemiologic data—incomplete and unsatisfactory—suggests that tanning beds are not safer than solar ultraviolet radiation and that they may have independent effects from solar exposure that increase risk for melanoma." Finally, Dr. Dorothy Bennett of the University of London argues that recreational exposure to ultraviolet light should be discouraged because UV is a known mutagen.

Industry Groups Protest IVIG Cuts

The Biotechnology Industry Organization, the American Society of Clinical Oncology, the Association of Community Cancer Centers, and the Alliance for Plasma Therapies are urging the Centers for Medicare and Medicaid Services to preserve the preadministration fee currently paid for administering intravenous immune globulin (IVIG) therapy in hospital outpatient settings. The CMS proposed to eliminate the payment as part of its hospital outpatient prospective payment system rule for next year. The preadministration payment began in 2006 at a time when IVIG supplies were tight, driving up the price. The CMS says it's not clear that supply is still an issue, but manufacturers and patient organizations say there are still difficulties. "BIO does not believe that there is stability in the IVIG marketplace when over 40% of the providers cannot purchase IVIG at or below the Medicare payment rate," said the group in its comments. The CMS also said that it wants to cut the add-on fee because IVIG use has gone up markedly. BIO argued that increased use shows that the preadministration payment has helped providers acquire and administer the drug.

CMS Alters Overpayment Policy

CMS officials are changing the procedures for recovering certain overpayments made to physicians. The CMS will no longer seek payment from a physician for an overpayment while the physician is seeking a reconsideration of the overpayment determination by a qualified independent contractor. Under the new policy, which was mandated by the 2003 Medicare Modernization Act, the CMS can only seek to recoup the payment after a decision has been made on the reconsideration. The changes, which went into effect Sept. 29, will apply to all Part A and Part B claims for which a demand letter has been issued. However, a number of claims have been excluded, including Part A cost reports, hospice caps calculations, provider initiated adjustments, home health agency requests for anticipated payment, accelerated/advanced payments, and certain other claims adjustments. The changes do not affect the appeal process or the normal debt collection and referral process, according to the CMS.

HHS Privacy Efforts Lacking

The Health and Human Services department has taken some steps to safeguard patient privacy, but efforts in several areas are still lacking, according to a report from the Government Accountability Office. The report notes that although the HHS has made progress in developing a confidentiality, security, and privacy framework for health records, it has looked at some areas only in a narrow view. For example, the agency's efforts at harmonizing certification and standards mostly address technical issues such as data encryption and password protections, while the recommendations submitted by the HHS's advisory committees are primarily aimed at policy and legal issues. In response, the report noted that the "HHS agreed that more work remains to be done in the department's efforts to protect the privacy of electronic personal health information and stated that it is actively pursuing a two-phased process for assessing and prioritizing privacy-related initiatives intended to build public trust and confidence in health IT, particularly in electronic health information exchange."

Immigrants Must Get HPV Vaccine

Young women seeking to immigrate to the United States currently are required to be vaccinated against the human papillomavirus, under an amendment to the Immigration and Nationality Act. Under the 1996 amendment, individuals seeking immigrant visas must provide proof of vaccination for all vaccines recommended by the U.S. Advisory Committee for Immunization Practices. This list, which is updated periodically, now includes HPV vaccination for females aged 11–12 years, with catch-up vaccination among those aged 13–26 years. The addition of the HPV vaccine to the list of required vaccines for immigrants was automatic and required by statute, according to Centers for Disease Control and Prevention spokesman Curtis Allen, and was not part of ACIP deliberations when the committee originally recommended use of the HPV vaccine. According to a spokeswoman for Merck & Co., the HPV vaccine Gardasil costs approximately $290-$375 for the three-dose series. The company was not aware of the immigration policy and did not lobby for that provision, she added.

No Such Thing as a Safe Tan

Three papers published in the October issue of Pigment Cell and Melanoma Research contend that there's no evidence supporting the safety of tanning—especially indoor tanning—and they call on the tanning bed industry to cease promoting its services. Dr. David Fisher, president of the Society of Melanoma Research, and colleagues from Massachusetts General Hospital's dermatology department write that while genetic and other factors play a role in skin cancer risk, "the role of UV is incontrovertible, and efforts to confuse the public, particularly for purposes of economic gain by the indoor tanning industry, should be vigorously combated for the public health." Dr. Marianne Berwick of the University of New Mexico, Albuquerque, writes, "Epidemiologic data—incomplete and unsatisfactory—suggests that tanning beds are not safer than solar ultraviolet radiation and that they may have independent effects from solar exposure that increase risk for melanoma." Finally, Dr. Dorothy Bennett of the University of London argues that recreational exposure to ultraviolet light should be discouraged because UV is a known mutagen.

Industry Groups Protest IVIG Cuts

The Biotechnology Industry Organization, the American Society of Clinical Oncology, the Association of Community Cancer Centers, and the Alliance for Plasma Therapies are urging the Centers for Medicare and Medicaid Services to preserve the preadministration fee currently paid for administering intravenous immune globulin (IVIG) therapy in hospital outpatient settings. The CMS proposed to eliminate the payment as part of its hospital outpatient prospective payment system rule for next year. The preadministration payment began in 2006 at a time when IVIG supplies were tight, driving up the price. The CMS says it's not clear that supply is still an issue, but manufacturers and patient organizations say there are still difficulties. "BIO does not believe that there is stability in the IVIG marketplace when over 40% of the providers cannot purchase IVIG at or below the Medicare payment rate," said the group in its comments. The CMS also said that it wants to cut the add-on fee because IVIG use has gone up markedly. BIO argued that increased use shows that the preadministration payment has helped providers acquire and administer the drug.

CMS Alters Overpayment Policy

CMS officials are changing the procedures for recovering certain overpayments made to physicians. The CMS will no longer seek payment from a physician for an overpayment while the physician is seeking a reconsideration of the overpayment determination by a qualified independent contractor. Under the new policy, which was mandated by the 2003 Medicare Modernization Act, the CMS can only seek to recoup the payment after a decision has been made on the reconsideration. The changes, which went into effect Sept. 29, will apply to all Part A and Part B claims for which a demand letter has been issued. However, a number of claims have been excluded, including Part A cost reports, hospice caps calculations, provider initiated adjustments, home health agency requests for anticipated payment, accelerated/advanced payments, and certain other claims adjustments. The changes do not affect the appeal process or the normal debt collection and referral process, according to the CMS.

HHS Privacy Efforts Lacking

The Health and Human Services department has taken some steps to safeguard patient privacy, but efforts in several areas are still lacking, according to a report from the Government Accountability Office. The report notes that although the HHS has made progress in developing a confidentiality, security, and privacy framework for health records, it has looked at some areas only in a narrow view. For example, the agency's efforts at harmonizing certification and standards mostly address technical issues such as data encryption and password protections, while the recommendations submitted by the HHS's advisory committees are primarily aimed at policy and legal issues. In response, the report noted that the "HHS agreed that more work remains to be done in the department's efforts to protect the privacy of electronic personal health information and stated that it is actively pursuing a two-phased process for assessing and prioritizing privacy-related initiatives intended to build public trust and confidence in health IT, particularly in electronic health information exchange."

Immigrants Must Get HPV Vaccine

Young women seeking to immigrate to the United States currently are required to be vaccinated against the human papillomavirus, under an amendment to the Immigration and Nationality Act. Under the 1996 amendment, individuals seeking immigrant visas must provide proof of vaccination for all vaccines recommended by the U.S. Advisory Committee for Immunization Practices. This list, which is updated periodically, now includes HPV vaccination for females aged 11–12 years, with catch-up vaccination among those aged 13–26 years. The addition of the HPV vaccine to the list of required vaccines for immigrants was automatic and required by statute, according to Centers for Disease Control and Prevention spokesman Curtis Allen, and was not part of ACIP deliberations when the committee originally recommended use of the HPV vaccine. According to a spokeswoman for Merck & Co., the HPV vaccine Gardasil costs approximately $290-$375 for the three-dose series. The company was not aware of the immigration policy and did not lobby for that provision, she added.

No Such Thing as a Safe Tan

Three papers published in the October issue of Pigment Cell and Melanoma Research contend that there's no evidence supporting the safety of tanning—especially indoor tanning—and they call on the tanning bed industry to cease promoting its services. Dr. David Fisher, president of the Society of Melanoma Research, and colleagues from Massachusetts General Hospital's dermatology department write that while genetic and other factors play a role in skin cancer risk, "the role of UV is incontrovertible, and efforts to confuse the public, particularly for purposes of economic gain by the indoor tanning industry, should be vigorously combated for the public health." Dr. Marianne Berwick of the University of New Mexico, Albuquerque, writes, "Epidemiologic data—incomplete and unsatisfactory—suggests that tanning beds are not safer than solar ultraviolet radiation and that they may have independent effects from solar exposure that increase risk for melanoma." Finally, Dr. Dorothy Bennett of the University of London argues that recreational exposure to ultraviolet light should be discouraged because UV is a known mutagen.

Industry Groups Protest IVIG Cuts

The Biotechnology Industry Organization, the American Society of Clinical Oncology, the Association of Community Cancer Centers, and the Alliance for Plasma Therapies are urging the Centers for Medicare and Medicaid Services to preserve the preadministration fee currently paid for administering intravenous immune globulin (IVIG) therapy in hospital outpatient settings. The CMS proposed to eliminate the payment as part of its hospital outpatient prospective payment system rule for next year. The preadministration payment began in 2006 at a time when IVIG supplies were tight, driving up the price. The CMS says it's not clear that supply is still an issue, but manufacturers and patient organizations say there are still difficulties. "BIO does not believe that there is stability in the IVIG marketplace when over 40% of the providers cannot purchase IVIG at or below the Medicare payment rate," said the group in its comments. The CMS also said that it wants to cut the add-on fee because IVIG use has gone up markedly. BIO argued that increased use shows that the preadministration payment has helped providers acquire and administer the drug.

CMS Alters Overpayment Policy

CMS officials are changing the procedures for recovering certain overpayments made to physicians. The CMS will no longer seek payment from a physician for an overpayment while the physician is seeking a reconsideration of the overpayment determination by a qualified independent contractor. Under the new policy, which was mandated by the 2003 Medicare Modernization Act, the CMS can only seek to recoup the payment after a decision has been made on the reconsideration. The changes, which went into effect Sept. 29, will apply to all Part A and Part B claims for which a demand letter has been issued. However, a number of claims have been excluded, including Part A cost reports, hospice caps calculations, provider initiated adjustments, home health agency requests for anticipated payment, accelerated/advanced payments, and certain other claims adjustments. The changes do not affect the appeal process or the normal debt collection and referral process, according to the CMS.

HHS Privacy Efforts Lacking

The Health and Human Services department has taken some steps to safeguard patient privacy, but efforts in several areas are still lacking, according to a report from the Government Accountability Office. The report notes that although the HHS has made progress in developing a confidentiality, security, and privacy framework for health records, it has looked at some areas only in a narrow view. For example, the agency's efforts at harmonizing certification and standards mostly address technical issues such as data encryption and password protections, while the recommendations submitted by the HHS's advisory committees are primarily aimed at policy and legal issues. In response, the report noted that the "HHS agreed that more work remains to be done in the department's efforts to protect the privacy of electronic personal health information and stated that it is actively pursuing a two-phased process for assessing and prioritizing privacy-related initiatives intended to build public trust and confidence in health IT, particularly in electronic health information exchange."

Immigrants Must Get HPV Vaccine

Young women seeking to immigrate to the United States currently are required to be vaccinated against the human papillomavirus, under an amendment to the Immigration and Nationality Act. Under the 1996 amendment, individuals seeking immigrant visas must provide proof of vaccination for all vaccines recommended by the U.S. Advisory Committee for Immunization Practices. This list, which is updated periodically, now includes HPV vaccination for females aged 11–12 years, with catch-up vaccination among those aged 13–26 years. The addition of the HPV vaccine to the list of required vaccines for immigrants was automatic and required by statute, according to Centers for Disease Control and Prevention spokesman Curtis Allen, and was not part of ACIP deliberations when the committee originally recommended use of the HPV vaccine. According to a spokeswoman for Merck & Co., the HPV vaccine Gardasil costs approximately $290-$375 for the three-dose series. The company was not aware of the immigration policy and did not lobby for that provision, she added.

WASHINGTON — More than $260 million in Medicaid funds set aside to pay physicians to conduct brief screening and interventions for substance abuse are practically untouched, according to federal experts in the White House Office of National Drug Control Policy.

In January, the Centers for Medicare and Medicaid Services designated the matching funds for states that adopt Medicaid codes for substance abuse Screening and Brief Intervention (SBI). But so far, only nine states (Iowa, Indiana, Maine, Maryland, Minnesota, Montana, Oklahoma, Oregon, and Virginia) have begun using the codes, Bertha Madras, Ph.D., deputy director for demand reduction at the White House Office of National Drug Control Policy (ONDCP) said at a meeting to discuss the program. Wisconsin and Washington are reimbursing for SBI in limited circumstances.

The CMS established G codes for SBI in 2006 and followed with H codes. Last year, the American Medical Association established current procedural terminology codes for SBI; they were published for the first time in the 2008 CPT manual.

For CPT 99408, which involves screening and a brief intervention of 15-30 minutes, the reimbursement is $33.41. For SBI longer than 30 minutes (CPT 99409), the rate is $65.51. (See box below.)

Dr. Madras did not say how much money has been reimbursed by Medicaid and Medicare, but indicated that the codes are vastly underused.

The ONDCP has been seeking ways to encourage more physicians to conduct SBIs. At the meeting, Dr. Madras cited recently released figures from the Substance Abuse and Mental Health Services Administration showing that 19.9 million people abuse drugs in the United States, but that 93% of those who are addicted are not aware that they have a problem and do not seek treatment.

Dr. Madras said that so far, about 700,000 people have been screened. Almost a quarter were positive for alcohol or drug use; 70% needed a brief intervention and about 16% were referred to treatment, she said. According to self-reports 6 months later, at least a third of those who received treatment said their health status improved.

Citing several recent developments, she said that screening is gaining currency.

At the beginning of 2008, the Federal Employees Health Benefits Plan, which covers 8 million employees and dependents, notified its carriers that the CPT codes for screening and intervention were added and available for use. In June, the Department of Veterans Affairs directed all VA medical centers to routinely screen for alcohol use and provide brief interventions.

Screening for alcohol intoxication is required at level I and II trauma centers; patients with positive screens should be offered interventions, according to criteria adopted by the American College of Surgeons' Committee on Trauma. The committee decided to institute SBI because alcohol use is the single most important risk factor associated with serious injury, said Dr. John Fildes, who represented the ACS committee at the meeting.

Screening and brief intervention protocols are also incorporated into the latest edition of the Advanced Trauma Life Support manual, which was released in October, said Dr. Fildes, professor of surgery at the University of Nevada, Las Vegas.

The ACS Committee on Trauma hopes to expand SBI to all level II and III trauma centers and have drug and alcohol intoxication data included in the National Trauma Data Bank, Dr. Fildes said.

The National Institute on Drug Abuse is developing a resource guide for primary care physicians that will eventually be posted on the agency's Web site, said Dr. Wilson Compton of the NIDA. Some online training is already available at www.mdalcoholtraining.org

The curriculum is sponsored by the National Institute on Alcohol Abuse and Alcoholism and Boston University. Physicians can also find more information about screening and brief intervention at www.sbirt.samhsa.gov

ELSEVIER GLOBAL MEDICAL NEWS

WASHINGTON — More than $260 million in Medicaid funds set aside to pay physicians to conduct brief screening and interventions for substance abuse are practically untouched, according to federal experts in the White House Office of National Drug Control Policy.

In January, the Centers for Medicare and Medicaid Services designated the matching funds for states that adopt Medicaid codes for substance abuse Screening and Brief Intervention (SBI). But so far, only nine states (Iowa, Indiana, Maine, Maryland, Minnesota, Montana, Oklahoma, Oregon, and Virginia) have begun using the codes, Bertha Madras, Ph.D., deputy director for demand reduction at the White House Office of National Drug Control Policy (ONDCP) said at a meeting to discuss the program. Wisconsin and Washington are reimbursing for SBI in limited circumstances.

The CMS established G codes for SBI in 2006 and followed with H codes. Last year, the American Medical Association established current procedural terminology codes for SBI; they were published for the first time in the 2008 CPT manual.

For CPT 99408, which involves screening and a brief intervention of 15-30 minutes, the reimbursement is $33.41. For SBI longer than 30 minutes (CPT 99409), the rate is $65.51. (See box below.)

Dr. Madras did not say how much money has been reimbursed by Medicaid and Medicare, but indicated that the codes are vastly underused.

The ONDCP has been seeking ways to encourage more physicians to conduct SBIs. At the meeting, Dr. Madras cited recently released figures from the Substance Abuse and Mental Health Services Administration showing that 19.9 million people abuse drugs in the United States, but that 93% of those who are addicted are not aware that they have a problem and do not seek treatment.

Dr. Madras said that so far, about 700,000 people have been screened. Almost a quarter were positive for alcohol or drug use; 70% needed a brief intervention and about 16% were referred to treatment, she said. According to self-reports 6 months later, at least a third of those who received treatment said their health status improved.

Citing several recent developments, she said that screening is gaining currency.

At the beginning of 2008, the Federal Employees Health Benefits Plan, which covers 8 million employees and dependents, notified its carriers that the CPT codes for screening and intervention were added and available for use. In June, the Department of Veterans Affairs directed all VA medical centers to routinely screen for alcohol use and provide brief interventions.

Screening for alcohol intoxication is required at level I and II trauma centers; patients with positive screens should be offered interventions, according to criteria adopted by the American College of Surgeons' Committee on Trauma. The committee decided to institute SBI because alcohol use is the single most important risk factor associated with serious injury, said Dr. John Fildes, who represented the ACS committee at the meeting.

Screening and brief intervention protocols are also incorporated into the latest edition of the Advanced Trauma Life Support manual, which was released in October, said Dr. Fildes, professor of surgery at the University of Nevada, Las Vegas.

The ACS Committee on Trauma hopes to expand SBI to all level II and III trauma centers and have drug and alcohol intoxication data included in the National Trauma Data Bank, Dr. Fildes said.

The National Institute on Drug Abuse is developing a resource guide for primary care physicians that will eventually be posted on the agency's Web site, said Dr. Wilson Compton of the NIDA. Some online training is already available at www.mdalcoholtraining.org

The curriculum is sponsored by the National Institute on Alcohol Abuse and Alcoholism and Boston University. Physicians can also find more information about screening and brief intervention at www.sbirt.samhsa.gov

ELSEVIER GLOBAL MEDICAL NEWS

WASHINGTON — More than $260 million in Medicaid funds set aside to pay physicians to conduct brief screening and interventions for substance abuse are practically untouched, according to federal experts in the White House Office of National Drug Control Policy.

In January, the Centers for Medicare and Medicaid Services designated the matching funds for states that adopt Medicaid codes for substance abuse Screening and Brief Intervention (SBI). But so far, only nine states (Iowa, Indiana, Maine, Maryland, Minnesota, Montana, Oklahoma, Oregon, and Virginia) have begun using the codes, Bertha Madras, Ph.D., deputy director for demand reduction at the White House Office of National Drug Control Policy (ONDCP) said at a meeting to discuss the program. Wisconsin and Washington are reimbursing for SBI in limited circumstances.

The CMS established G codes for SBI in 2006 and followed with H codes. Last year, the American Medical Association established current procedural terminology codes for SBI; they were published for the first time in the 2008 CPT manual.

For CPT 99408, which involves screening and a brief intervention of 15-30 minutes, the reimbursement is $33.41. For SBI longer than 30 minutes (CPT 99409), the rate is $65.51. (See box below.)

Dr. Madras did not say how much money has been reimbursed by Medicaid and Medicare, but indicated that the codes are vastly underused.

The ONDCP has been seeking ways to encourage more physicians to conduct SBIs. At the meeting, Dr. Madras cited recently released figures from the Substance Abuse and Mental Health Services Administration showing that 19.9 million people abuse drugs in the United States, but that 93% of those who are addicted are not aware that they have a problem and do not seek treatment.

Dr. Madras said that so far, about 700,000 people have been screened. Almost a quarter were positive for alcohol or drug use; 70% needed a brief intervention and about 16% were referred to treatment, she said. According to self-reports 6 months later, at least a third of those who received treatment said their health status improved.

Citing several recent developments, she said that screening is gaining currency.

At the beginning of 2008, the Federal Employees Health Benefits Plan, which covers 8 million employees and dependents, notified its carriers that the CPT codes for screening and intervention were added and available for use. In June, the Department of Veterans Affairs directed all VA medical centers to routinely screen for alcohol use and provide brief interventions.

Screening for alcohol intoxication is required at level I and II trauma centers; patients with positive screens should be offered interventions, according to criteria adopted by the American College of Surgeons' Committee on Trauma. The committee decided to institute SBI because alcohol use is the single most important risk factor associated with serious injury, said Dr. John Fildes, who represented the ACS committee at the meeting.

Screening and brief intervention protocols are also incorporated into the latest edition of the Advanced Trauma Life Support manual, which was released in October, said Dr. Fildes, professor of surgery at the University of Nevada, Las Vegas.

The ACS Committee on Trauma hopes to expand SBI to all level II and III trauma centers and have drug and alcohol intoxication data included in the National Trauma Data Bank, Dr. Fildes said.

The National Institute on Drug Abuse is developing a resource guide for primary care physicians that will eventually be posted on the agency's Web site, said Dr. Wilson Compton of the NIDA. Some online training is already available at www.mdalcoholtraining.org

The curriculum is sponsored by the National Institute on Alcohol Abuse and Alcoholism and Boston University. Physicians can also find more information about screening and brief intervention at www.sbirt.samhsa.gov

ELSEVIER GLOBAL MEDICAL NEWS

WASHINGTON – Hispanics may place significant stress on the health care system in the future, as they are projected to be the largest segment of the population by 2050 but are less likely to have a usual source of care and have less knowledge about chronic disease, according to new data from the Pew Hispanic Center and the U.S. Census Bureau.

The Hispanic population will triple from 2008 to 2050, rising from 47 million today to 133 million in 4 decades. By 2050, Hispanics will make up 30% (131 million) of the nation's total population of an estimated 439 million, according to the Census Bureau.

And, as the nation ages overall, the number of Hispanics who are aged 65 years and older also will rise. By 2050, 88 million people will be older than 65 years old, according to the Census Bureau.

Currently, there are some 45 million Hispanics in the United States, 30 million of whom are adults, according a new report by the Pew Hispanic Center, “Hispanics and Health Care in the United States: Access, Information and Knowledge.” The Pew Hispanic Center, in conjunction with the Robert Wood Johnson Foundation, conducted a national telephone survey in mid to late 2007. Overall, about 4,000 Hispanic individuals completed the survey.

Survey data showed that Hispanics generally tend to be young and healthy, but have a high prevalence of obesity and a predisposition to diabetes, indicating a potential future crisis, said Susan Minushkin, deputy director of the Pew Hispanic Center, in a briefing with reporters. The Centers for Disease Control and Prevention has estimated that 10% of Hispanics have diabetes, 20% have hypertension, 40% are overweight, and 27% are obese, she said.

Therefore, it is worrisome that 27% of Hispanics–about 8 million adults–lacked a usual health care provider, Ms. Minushkin said. Only 62% of Hispanics without a usual provider had a blood pressure check in the last 2 years, compared with 86% of those who have a provider, the Pew Center found. Only 67% of those lacking a usual provider had a blood sugar test in the last 2 years, compared with 90% of those with a provider.

Diabetes knowledge was inconsistent, even among those diagnosed with the disease, the Pew Center found. Of diagnosed diabetics, 27% answered at least three of eight questions about the disease incorrectly, for instance. Overall, Hispanic women were more likely to give correct answers, as were middle-aged Hispanics of both sexes. Immigrants had the least amount of knowledge.

Those who did not have a usual health care provider were more likely to be young (aged 18–29 years), to lack a high school diploma, and to be uninsured. They also were more likely to be predominantly Spanish-speaking and to be foreign-born but not yet legal permanent residents. However, 45% of those who did not have a usual provider had health insurance.

The primary reason–given by 41% of respondents–for not having a usual health care provider was that they were seldom or never sick. Another 13% said they treat themselves or don't use a physician, 11% said the cost of care was prohibitive, 2% said they didn't know where to go for care, and 1% said they couldn't find a provider who spoke their language.

Though 78% rated the quality of their care as good or excellent, some 25% said the care they received was poor, which they blamed on their ethnicity or their English-speaking skills or accent.

More than two-thirds of respondents (71%) said they received information about health from a physician or other medical professional, but 83% said they received it from the media. “I can't comment on whether the information they are getting is good or bad,” said Ms. Minushkin, adding that the Pew Center did not ask what types of media were being cited.

But, she added, “those who do get information from the media make changes in their behavior.” About 40%–64% said the information affected decisions on how to treat an illness, led them to ask a physician a new question, or changed the way they thought about diet or exercise.

The National Hispanic Medical Association has joined the call for the establishment of medical homes that would provide patient-centered, coordinated care, Dr. Elena Rios, president and CEO of the NHMA, said at the briefing.

WASHINGTON – Hispanics may place significant stress on the health care system in the future, as they are projected to be the largest segment of the population by 2050 but are less likely to have a usual source of care and have less knowledge about chronic disease, according to new data from the Pew Hispanic Center and the U.S. Census Bureau.

The Hispanic population will triple from 2008 to 2050, rising from 47 million today to 133 million in 4 decades. By 2050, Hispanics will make up 30% (131 million) of the nation's total population of an estimated 439 million, according to the Census Bureau.

And, as the nation ages overall, the number of Hispanics who are aged 65 years and older also will rise. By 2050, 88 million people will be older than 65 years old, according to the Census Bureau.

Currently, there are some 45 million Hispanics in the United States, 30 million of whom are adults, according a new report by the Pew Hispanic Center, “Hispanics and Health Care in the United States: Access, Information and Knowledge.” The Pew Hispanic Center, in conjunction with the Robert Wood Johnson Foundation, conducted a national telephone survey in mid to late 2007. Overall, about 4,000 Hispanic individuals completed the survey.

Survey data showed that Hispanics generally tend to be young and healthy, but have a high prevalence of obesity and a predisposition to diabetes, indicating a potential future crisis, said Susan Minushkin, deputy director of the Pew Hispanic Center, in a briefing with reporters. The Centers for Disease Control and Prevention has estimated that 10% of Hispanics have diabetes, 20% have hypertension, 40% are overweight, and 27% are obese, she said.

Therefore, it is worrisome that 27% of Hispanics–about 8 million adults–lacked a usual health care provider, Ms. Minushkin said. Only 62% of Hispanics without a usual provider had a blood pressure check in the last 2 years, compared with 86% of those who have a provider, the Pew Center found. Only 67% of those lacking a usual provider had a blood sugar test in the last 2 years, compared with 90% of those with a provider.

Diabetes knowledge was inconsistent, even among those diagnosed with the disease, the Pew Center found. Of diagnosed diabetics, 27% answered at least three of eight questions about the disease incorrectly, for instance. Overall, Hispanic women were more likely to give correct answers, as were middle-aged Hispanics of both sexes. Immigrants had the least amount of knowledge.

Those who did not have a usual health care provider were more likely to be young (aged 18–29 years), to lack a high school diploma, and to be uninsured. They also were more likely to be predominantly Spanish-speaking and to be foreign-born but not yet legal permanent residents. However, 45% of those who did not have a usual provider had health insurance.

The primary reason–given by 41% of respondents–for not having a usual health care provider was that they were seldom or never sick. Another 13% said they treat themselves or don't use a physician, 11% said the cost of care was prohibitive, 2% said they didn't know where to go for care, and 1% said they couldn't find a provider who spoke their language.

Though 78% rated the quality of their care as good or excellent, some 25% said the care they received was poor, which they blamed on their ethnicity or their English-speaking skills or accent.

More than two-thirds of respondents (71%) said they received information about health from a physician or other medical professional, but 83% said they received it from the media. “I can't comment on whether the information they are getting is good or bad,” said Ms. Minushkin, adding that the Pew Center did not ask what types of media were being cited.

But, she added, “those who do get information from the media make changes in their behavior.” About 40%–64% said the information affected decisions on how to treat an illness, led them to ask a physician a new question, or changed the way they thought about diet or exercise.

The National Hispanic Medical Association has joined the call for the establishment of medical homes that would provide patient-centered, coordinated care, Dr. Elena Rios, president and CEO of the NHMA, said at the briefing.

WASHINGTON – Hispanics may place significant stress on the health care system in the future, as they are projected to be the largest segment of the population by 2050 but are less likely to have a usual source of care and have less knowledge about chronic disease, according to new data from the Pew Hispanic Center and the U.S. Census Bureau.

The Hispanic population will triple from 2008 to 2050, rising from 47 million today to 133 million in 4 decades. By 2050, Hispanics will make up 30% (131 million) of the nation's total population of an estimated 439 million, according to the Census Bureau.

And, as the nation ages overall, the number of Hispanics who are aged 65 years and older also will rise. By 2050, 88 million people will be older than 65 years old, according to the Census Bureau.

Currently, there are some 45 million Hispanics in the United States, 30 million of whom are adults, according a new report by the Pew Hispanic Center, “Hispanics and Health Care in the United States: Access, Information and Knowledge.” The Pew Hispanic Center, in conjunction with the Robert Wood Johnson Foundation, conducted a national telephone survey in mid to late 2007. Overall, about 4,000 Hispanic individuals completed the survey.

Survey data showed that Hispanics generally tend to be young and healthy, but have a high prevalence of obesity and a predisposition to diabetes, indicating a potential future crisis, said Susan Minushkin, deputy director of the Pew Hispanic Center, in a briefing with reporters. The Centers for Disease Control and Prevention has estimated that 10% of Hispanics have diabetes, 20% have hypertension, 40% are overweight, and 27% are obese, she said.

Therefore, it is worrisome that 27% of Hispanics–about 8 million adults–lacked a usual health care provider, Ms. Minushkin said. Only 62% of Hispanics without a usual provider had a blood pressure check in the last 2 years, compared with 86% of those who have a provider, the Pew Center found. Only 67% of those lacking a usual provider had a blood sugar test in the last 2 years, compared with 90% of those with a provider.

Diabetes knowledge was inconsistent, even among those diagnosed with the disease, the Pew Center found. Of diagnosed diabetics, 27% answered at least three of eight questions about the disease incorrectly, for instance. Overall, Hispanic women were more likely to give correct answers, as were middle-aged Hispanics of both sexes. Immigrants had the least amount of knowledge.

Those who did not have a usual health care provider were more likely to be young (aged 18–29 years), to lack a high school diploma, and to be uninsured. They also were more likely to be predominantly Spanish-speaking and to be foreign-born but not yet legal permanent residents. However, 45% of those who did not have a usual provider had health insurance.

The primary reason–given by 41% of respondents–for not having a usual health care provider was that they were seldom or never sick. Another 13% said they treat themselves or don't use a physician, 11% said the cost of care was prohibitive, 2% said they didn't know where to go for care, and 1% said they couldn't find a provider who spoke their language.

Though 78% rated the quality of their care as good or excellent, some 25% said the care they received was poor, which they blamed on their ethnicity or their English-speaking skills or accent.

More than two-thirds of respondents (71%) said they received information about health from a physician or other medical professional, but 83% said they received it from the media. “I can't comment on whether the information they are getting is good or bad,” said Ms. Minushkin, adding that the Pew Center did not ask what types of media were being cited.

But, she added, “those who do get information from the media make changes in their behavior.” About 40%–64% said the information affected decisions on how to treat an illness, led them to ask a physician a new question, or changed the way they thought about diet or exercise.

The National Hispanic Medical Association has joined the call for the establishment of medical homes that would provide patient-centered, coordinated care, Dr. Elena Rios, president and CEO of the NHMA, said at the briefing.

The Centers for Medicare and Medicaid Services has proposed an overall 3% increase in payments for outpatient hospital care in 2009, almost a full percentage point below the update for 2008. As expected, reporting on quality of care is being tied to the amount of increase hospitals and other outpatient providers will receive.

For the first time, hospitals and other recipients of payments under the outpatient system that do not report data on seven quality measures of emergency and perioperative care will see only a 1% increase.

The proposed rule also outlines changes for ambulatory surgery centers (ASCs) that are part of a 4-year transition to a new payment system that began this year. In 2009, as was the case this year, ASCs would be paid 65% of the rate paid for the same service in an outpatient hospital department.

The agency estimates it will spend $29 billion in 2009 on payments to acute care hospitals, inpatient rehabilitation facilities, inpatient psychiatric facilities, long-term acute-care hospitals, community mental health centers, children's hospitals, and cancer hospitals. That's a $2 billion increase from the estimated $27 billion CMS will spend on outpatient services this year, said the agency. Payments to ambulatory surgery centers will increase from an estimated $3.5 billion in 2008 to $3.9 billion in 2009, according to CMS.

CMS is proposing to more aggressively penalize hospitals and other outpatient providers that do not report quality data. Providers must report on 7 measures in 2008 and on 11 in 2009, including 4 imaging efficiency measures. In addition, the agency is seeking to reduce copayments for beneficiaries who are treated at hospitals that do not report quality data.

By law, Medicare is gradually changing the payment system so that beneficiaries will be liable for only 20% of a covered service. The coinsurance rate has varied widely over the last 8–10 years. In 2009, about 25% of services will be subject to the 20% coinsurance, from 23% in 2008, said CMS.

For imaging—a huge and growing portion of Medicare expenditures—CMS would make a single payment for multiple imaging procedures performed in a single hospital session, including ultrasound, computed tomography, and magnetic resonance imaging.

CMS also proposes reducing pay for some device-oriented procedures: a 48% reduction for the placing of left ventricular pacing add-on leads; a 3% decrease for replacing pacemakers, electrodes, or pulse generators; 4% for stent placement; and 1% for drug-eluting stents.

A small increase is proposed for most neurology devices and drug infusion devices, but placement of neurostimulator electrodes would be slashed by 52%.

For ASCs, reimbursement would decrease for 92 procedures, but increase for 2,475, according to the Ambulatory Surgery Center Association. Nervous system procedures and pain management would be reduced by 3%, according to Washington Analysis, a firm that advises investors on health policy developments.

CMS proposes adding nine surgical procedures to the list of services covered at an ASC. Three have new Current Procedural Terminology (CPT) codes, and six—nasal/sinus endoscopy surgery; removal of vein clot; blood exchange/transfuse, non-nb; laparoscopic insertion of a permanent intraperitoneal catheter; laparoscopic revision of a permanent intraperitoneal catheter; and laparoscopy with omentopexy add-on—were previously excluded from coverage. Five procedures will be added to the list of office-based procedures, paid at either the ASC rate or the office practice expense payment rate, whichever is lower.

Finally, the agency is proposing to create four new ambulatory payment classifications for type B emergency departments (EDs that are not open 24 hours a day, 7 days a week). According to data collected by CMS, most type B visits are more expensive than a clinic visit, but less expensive than a visit to a traditional ED. The goal is to make payment for the type B centers more reflective of actual costs. The four payment groups will be based on claims data from the type B providers.

CMS will issue the final rule Nov. 1.

The Centers for Medicare and Medicaid Services has proposed an overall 3% increase in payments for outpatient hospital care in 2009, almost a full percentage point below the update for 2008. As expected, reporting on quality of care is being tied to the amount of increase hospitals and other outpatient providers will receive.

For the first time, hospitals and other recipients of payments under the outpatient system that do not report data on seven quality measures of emergency and perioperative care will see only a 1% increase.

The proposed rule also outlines changes for ambulatory surgery centers (ASCs) that are part of a 4-year transition to a new payment system that began this year. In 2009, as was the case this year, ASCs would be paid 65% of the rate paid for the same service in an outpatient hospital department.

The agency estimates it will spend $29 billion in 2009 on payments to acute care hospitals, inpatient rehabilitation facilities, inpatient psychiatric facilities, long-term acute-care hospitals, community mental health centers, children's hospitals, and cancer hospitals. That's a $2 billion increase from the estimated $27 billion CMS will spend on outpatient services this year, said the agency. Payments to ambulatory surgery centers will increase from an estimated $3.5 billion in 2008 to $3.9 billion in 2009, according to CMS.

CMS is proposing to more aggressively penalize hospitals and other outpatient providers that do not report quality data. Providers must report on 7 measures in 2008 and on 11 in 2009, including 4 imaging efficiency measures. In addition, the agency is seeking to reduce copayments for beneficiaries who are treated at hospitals that do not report quality data.

By law, Medicare is gradually changing the payment system so that beneficiaries will be liable for only 20% of a covered service. The coinsurance rate has varied widely over the last 8–10 years. In 2009, about 25% of services will be subject to the 20% coinsurance, from 23% in 2008, said CMS.

For imaging—a huge and growing portion of Medicare expenditures—CMS would make a single payment for multiple imaging procedures performed in a single hospital session, including ultrasound, computed tomography, and magnetic resonance imaging.

CMS also proposes reducing pay for some device-oriented procedures: a 48% reduction for the placing of left ventricular pacing add-on leads; a 3% decrease for replacing pacemakers, electrodes, or pulse generators; 4% for stent placement; and 1% for drug-eluting stents.

A small increase is proposed for most neurology devices and drug infusion devices, but placement of neurostimulator electrodes would be slashed by 52%.

For ASCs, reimbursement would decrease for 92 procedures, but increase for 2,475, according to the Ambulatory Surgery Center Association. Nervous system procedures and pain management would be reduced by 3%, according to Washington Analysis, a firm that advises investors on health policy developments.

CMS proposes adding nine surgical procedures to the list of services covered at an ASC. Three have new Current Procedural Terminology (CPT) codes, and six—nasal/sinus endoscopy surgery; removal of vein clot; blood exchange/transfuse, non-nb; laparoscopic insertion of a permanent intraperitoneal catheter; laparoscopic revision of a permanent intraperitoneal catheter; and laparoscopy with omentopexy add-on—were previously excluded from coverage. Five procedures will be added to the list of office-based procedures, paid at either the ASC rate or the office practice expense payment rate, whichever is lower.

Finally, the agency is proposing to create four new ambulatory payment classifications for type B emergency departments (EDs that are not open 24 hours a day, 7 days a week). According to data collected by CMS, most type B visits are more expensive than a clinic visit, but less expensive than a visit to a traditional ED. The goal is to make payment for the type B centers more reflective of actual costs. The four payment groups will be based on claims data from the type B providers.

CMS will issue the final rule Nov. 1.

The Centers for Medicare and Medicaid Services has proposed an overall 3% increase in payments for outpatient hospital care in 2009, almost a full percentage point below the update for 2008. As expected, reporting on quality of care is being tied to the amount of increase hospitals and other outpatient providers will receive.

For the first time, hospitals and other recipients of payments under the outpatient system that do not report data on seven quality measures of emergency and perioperative care will see only a 1% increase.

The proposed rule also outlines changes for ambulatory surgery centers (ASCs) that are part of a 4-year transition to a new payment system that began this year. In 2009, as was the case this year, ASCs would be paid 65% of the rate paid for the same service in an outpatient hospital department.

The agency estimates it will spend $29 billion in 2009 on payments to acute care hospitals, inpatient rehabilitation facilities, inpatient psychiatric facilities, long-term acute-care hospitals, community mental health centers, children's hospitals, and cancer hospitals. That's a $2 billion increase from the estimated $27 billion CMS will spend on outpatient services this year, said the agency. Payments to ambulatory surgery centers will increase from an estimated $3.5 billion in 2008 to $3.9 billion in 2009, according to CMS.

CMS is proposing to more aggressively penalize hospitals and other outpatient providers that do not report quality data. Providers must report on 7 measures in 2008 and on 11 in 2009, including 4 imaging efficiency measures. In addition, the agency is seeking to reduce copayments for beneficiaries who are treated at hospitals that do not report quality data.

By law, Medicare is gradually changing the payment system so that beneficiaries will be liable for only 20% of a covered service. The coinsurance rate has varied widely over the last 8–10 years. In 2009, about 25% of services will be subject to the 20% coinsurance, from 23% in 2008, said CMS.

For imaging—a huge and growing portion of Medicare expenditures—CMS would make a single payment for multiple imaging procedures performed in a single hospital session, including ultrasound, computed tomography, and magnetic resonance imaging.

CMS also proposes reducing pay for some device-oriented procedures: a 48% reduction for the placing of left ventricular pacing add-on leads; a 3% decrease for replacing pacemakers, electrodes, or pulse generators; 4% for stent placement; and 1% for drug-eluting stents.

A small increase is proposed for most neurology devices and drug infusion devices, but placement of neurostimulator electrodes would be slashed by 52%.

For ASCs, reimbursement would decrease for 92 procedures, but increase for 2,475, according to the Ambulatory Surgery Center Association. Nervous system procedures and pain management would be reduced by 3%, according to Washington Analysis, a firm that advises investors on health policy developments.

CMS proposes adding nine surgical procedures to the list of services covered at an ASC. Three have new Current Procedural Terminology (CPT) codes, and six—nasal/sinus endoscopy surgery; removal of vein clot; blood exchange/transfuse, non-nb; laparoscopic insertion of a permanent intraperitoneal catheter; laparoscopic revision of a permanent intraperitoneal catheter; and laparoscopy with omentopexy add-on—were previously excluded from coverage. Five procedures will be added to the list of office-based procedures, paid at either the ASC rate or the office practice expense payment rate, whichever is lower.

Finally, the agency is proposing to create four new ambulatory payment classifications for type B emergency departments (EDs that are not open 24 hours a day, 7 days a week). According to data collected by CMS, most type B visits are more expensive than a clinic visit, but less expensive than a visit to a traditional ED. The goal is to make payment for the type B centers more reflective of actual costs. The four payment groups will be based on claims data from the type B providers.

CMS will issue the final rule Nov. 1.

The Government Accountability Office is urging Congress to require Medicare to adopt prior authorization procedures for outpatient imaging services, saying that the federal health program's current approach has allowed costs to balloon.

According to the GAO, from 2000 to 2006, Medicare Part B spending on imaging services more than doubled to $14 billion. In particular, spending on more technically demanding imaging studies, such as CT, MRI, and nuclear medicine, rose 17% a year, compared with 9% annual growth for less complex studies such as x-rays. Imaging studies have increasingly shifted to the outpatient sector and the proportion of physician income from imaging is steadily rising, said the GAO in its report, “Medicare Part B Imaging Services.”

Shortly after the report was issued, Sen. Charles Grassley (R-Iowa), introduced legislation (S. 3343) that would require physicians making referrals for MRIs, CTs, positron-emission tomography scans, and potentially other modalities, to disclose to patients in writing if they have ownership in the imaging facility.

The proposal was initially included in the bill that canceled Medicare physician fee cuts but was dropped in the final package.

The GAO analyzed Medicare claims data and also interviewed health plans and radiology benefit management companies to compile its report, which was requested by Sen. Jay Rockefeller (D-W.Va.).

Because of the rapid growth in imaging, the GAO said, “we recommend that [the Centers for Medicare and Medicaid Services] examine the feasibility of expanding its payment safeguard mechanisms by adding more front-end approaches to managing imaging services, such as using privileging and prior authorization.”

The proportion of Medicare Part B spending on imaging conducted in a physician office setting, which was 58% in 2000, rose to 64% in 2006, according to the GAO, which noted that physician-directed imaging has grown. (See Policy & Practice, p. 19.)

“The rise in testing and therefore in cost for outpatient imaging is a symptom of our broken health care system,” said Dr. Elaine Jones, a neurologist in private practice in Bristol, R.I, and a member of the legislative affairs committee of the American Association of Neurology.

“Instituting prior authorization is just a cost-shifting measure. It shifts cost to patients and risks to physicians. Most of these measures do not include reward systems, only regulations. Insurance companies, including Medicare, are looking for ways to save money,” she said.

The American College of Cardiology also criticized the GAO study, noting that the agency did not use data showing a decline in imaging growth in 2007. (See also p. 19.)

“We are disappointed that the GAO chose to ignore the work that physicians and specialty societies are doing to ensure the most appropriate use of these technologies,” the college's CEO, Dr. Jack Lewin, said in a statement. “Prior authorization is a Band-Aid to the utilization issue and not a viable solution. Medicare should look to accreditation, appropriate use criteria, and improved communication to lower utilization and improve quality.”

Dr. Jones said that, as always, “the response is 'if costs are increasing, we need to stop paying.' If a patient comes to me with pain, I don't just give them a pain pill. I try to find the cause of the pain and address that. In the same way, we need to look at why costs are rising, and not just refuse to pay.”

The Medical Imaging Technology Alliance (MITA) issued a similar critique, and noted that the GAO report did not take into account appropriateness and accreditation criteria that were part of the recently passed Medicare bill that eliminated a scheduled reduction in physician fees. The law will require imaging facilities to be accredited starting in 2012.

Appropriateness and accreditation will “ensure that an image is taken at the right time by the right person and in an appropriate manner,” MITA vice president Andrew Whitman said in an interview. MITA is the medical technology trade association of the National Electrical Manufacturers Association.

He also criticized the GAO's support of radiology benefit management companies (RBMs), which the private sector has used to implement prior authorization and other tools to rein in costs. RBMs do not readily share guidelines and appropriateness criteria and are not well regulated, he said.

In response to the GAO report, the Health and Human Services Department said it also had concerns about the “administrative burden” of using RBMs, and it pointed out that there were no independent data showing that RBMs could successfully manage imaging costs. It added that proprietary guidelines in use by RBMs might conflict with those being promoted by federal health authorities, meaning that the RBM recommendations could present a conflict for Medicare in the consideration of payment.

One RBM, MedSolutions, praised the GAO study and refuted assertions that the companies added a layer of cost or bureaucratic burden. The Nashville, Tenn.-based company also said that its clients have found its approach to be successful.

“Our administrative costs are typically a small fraction of documented savings, and it is standard practice for us to operate with complete transparency with physicians and patients,” MedSolutions CEO Curt Thorne said in a statement.

Accreditation and appropriate use criteria would be more effective in reducing imaging, say some physicians. ©Stockbyte/Getty Images

The Government Accountability Office is urging Congress to require Medicare to adopt prior authorization procedures for outpatient imaging services, saying that the federal health program's current approach has allowed costs to balloon.

According to the GAO, from 2000 to 2006, Medicare Part B spending on imaging services more than doubled to $14 billion. In particular, spending on more technically demanding imaging studies, such as CT, MRI, and nuclear medicine, rose 17% a year, compared with 9% annual growth for less complex studies such as x-rays. Imaging studies have increasingly shifted to the outpatient sector and the proportion of physician income from imaging is steadily rising, said the GAO in its report, “Medicare Part B Imaging Services.”

Shortly after the report was issued, Sen. Charles Grassley (R-Iowa), introduced legislation (S. 3343) that would require physicians making referrals for MRIs, CTs, positron-emission tomography scans, and potentially other modalities, to disclose to patients in writing if they have ownership in the imaging facility.

The proposal was initially included in the bill that canceled Medicare physician fee cuts but was dropped in the final package.

The GAO analyzed Medicare claims data and also interviewed health plans and radiology benefit management companies to compile its report, which was requested by Sen. Jay Rockefeller (D-W.Va.).

Because of the rapid growth in imaging, the GAO said, “we recommend that [the Centers for Medicare and Medicaid Services] examine the feasibility of expanding its payment safeguard mechanisms by adding more front-end approaches to managing imaging services, such as using privileging and prior authorization.”

The proportion of Medicare Part B spending on imaging conducted in a physician office setting, which was 58% in 2000, rose to 64% in 2006, according to the GAO, which noted that physician-directed imaging has grown. (See Policy & Practice, p. 19.)

“The rise in testing and therefore in cost for outpatient imaging is a symptom of our broken health care system,” said Dr. Elaine Jones, a neurologist in private practice in Bristol, R.I, and a member of the legislative affairs committee of the American Association of Neurology.

“Instituting prior authorization is just a cost-shifting measure. It shifts cost to patients and risks to physicians. Most of these measures do not include reward systems, only regulations. Insurance companies, including Medicare, are looking for ways to save money,” she said.

The American College of Cardiology also criticized the GAO study, noting that the agency did not use data showing a decline in imaging growth in 2007. (See also p. 19.)

“We are disappointed that the GAO chose to ignore the work that physicians and specialty societies are doing to ensure the most appropriate use of these technologies,” the college's CEO, Dr. Jack Lewin, said in a statement. “Prior authorization is a Band-Aid to the utilization issue and not a viable solution. Medicare should look to accreditation, appropriate use criteria, and improved communication to lower utilization and improve quality.”

Dr. Jones said that, as always, “the response is 'if costs are increasing, we need to stop paying.' If a patient comes to me with pain, I don't just give them a pain pill. I try to find the cause of the pain and address that. In the same way, we need to look at why costs are rising, and not just refuse to pay.”

The Medical Imaging Technology Alliance (MITA) issued a similar critique, and noted that the GAO report did not take into account appropriateness and accreditation criteria that were part of the recently passed Medicare bill that eliminated a scheduled reduction in physician fees. The law will require imaging facilities to be accredited starting in 2012.

Appropriateness and accreditation will “ensure that an image is taken at the right time by the right person and in an appropriate manner,” MITA vice president Andrew Whitman said in an interview. MITA is the medical technology trade association of the National Electrical Manufacturers Association.

He also criticized the GAO's support of radiology benefit management companies (RBMs), which the private sector has used to implement prior authorization and other tools to rein in costs. RBMs do not readily share guidelines and appropriateness criteria and are not well regulated, he said.

In response to the GAO report, the Health and Human Services Department said it also had concerns about the “administrative burden” of using RBMs, and it pointed out that there were no independent data showing that RBMs could successfully manage imaging costs. It added that proprietary guidelines in use by RBMs might conflict with those being promoted by federal health authorities, meaning that the RBM recommendations could present a conflict for Medicare in the consideration of payment.

One RBM, MedSolutions, praised the GAO study and refuted assertions that the companies added a layer of cost or bureaucratic burden. The Nashville, Tenn.-based company also said that its clients have found its approach to be successful.

“Our administrative costs are typically a small fraction of documented savings, and it is standard practice for us to operate with complete transparency with physicians and patients,” MedSolutions CEO Curt Thorne said in a statement.

Accreditation and appropriate use criteria would be more effective in reducing imaging, say some physicians. ©Stockbyte/Getty Images

The Government Accountability Office is urging Congress to require Medicare to adopt prior authorization procedures for outpatient imaging services, saying that the federal health program's current approach has allowed costs to balloon.

According to the GAO, from 2000 to 2006, Medicare Part B spending on imaging services more than doubled to $14 billion. In particular, spending on more technically demanding imaging studies, such as CT, MRI, and nuclear medicine, rose 17% a year, compared with 9% annual growth for less complex studies such as x-rays. Imaging studies have increasingly shifted to the outpatient sector and the proportion of physician income from imaging is steadily rising, said the GAO in its report, “Medicare Part B Imaging Services.”

Shortly after the report was issued, Sen. Charles Grassley (R-Iowa), introduced legislation (S. 3343) that would require physicians making referrals for MRIs, CTs, positron-emission tomography scans, and potentially other modalities, to disclose to patients in writing if they have ownership in the imaging facility.

The proposal was initially included in the bill that canceled Medicare physician fee cuts but was dropped in the final package.

The GAO analyzed Medicare claims data and also interviewed health plans and radiology benefit management companies to compile its report, which was requested by Sen. Jay Rockefeller (D-W.Va.).

Because of the rapid growth in imaging, the GAO said, “we recommend that [the Centers for Medicare and Medicaid Services] examine the feasibility of expanding its payment safeguard mechanisms by adding more front-end approaches to managing imaging services, such as using privileging and prior authorization.”

The proportion of Medicare Part B spending on imaging conducted in a physician office setting, which was 58% in 2000, rose to 64% in 2006, according to the GAO, which noted that physician-directed imaging has grown. (See Policy & Practice, p. 19.)

“The rise in testing and therefore in cost for outpatient imaging is a symptom of our broken health care system,” said Dr. Elaine Jones, a neurologist in private practice in Bristol, R.I, and a member of the legislative affairs committee of the American Association of Neurology.

“Instituting prior authorization is just a cost-shifting measure. It shifts cost to patients and risks to physicians. Most of these measures do not include reward systems, only regulations. Insurance companies, including Medicare, are looking for ways to save money,” she said.

The American College of Cardiology also criticized the GAO study, noting that the agency did not use data showing a decline in imaging growth in 2007. (See also p. 19.)

“We are disappointed that the GAO chose to ignore the work that physicians and specialty societies are doing to ensure the most appropriate use of these technologies,” the college's CEO, Dr. Jack Lewin, said in a statement. “Prior authorization is a Band-Aid to the utilization issue and not a viable solution. Medicare should look to accreditation, appropriate use criteria, and improved communication to lower utilization and improve quality.”

Dr. Jones said that, as always, “the response is 'if costs are increasing, we need to stop paying.' If a patient comes to me with pain, I don't just give them a pain pill. I try to find the cause of the pain and address that. In the same way, we need to look at why costs are rising, and not just refuse to pay.”

The Medical Imaging Technology Alliance (MITA) issued a similar critique, and noted that the GAO report did not take into account appropriateness and accreditation criteria that were part of the recently passed Medicare bill that eliminated a scheduled reduction in physician fees. The law will require imaging facilities to be accredited starting in 2012.

Appropriateness and accreditation will “ensure that an image is taken at the right time by the right person and in an appropriate manner,” MITA vice president Andrew Whitman said in an interview. MITA is the medical technology trade association of the National Electrical Manufacturers Association.

He also criticized the GAO's support of radiology benefit management companies (RBMs), which the private sector has used to implement prior authorization and other tools to rein in costs. RBMs do not readily share guidelines and appropriateness criteria and are not well regulated, he said.

In response to the GAO report, the Health and Human Services Department said it also had concerns about the “administrative burden” of using RBMs, and it pointed out that there were no independent data showing that RBMs could successfully manage imaging costs. It added that proprietary guidelines in use by RBMs might conflict with those being promoted by federal health authorities, meaning that the RBM recommendations could present a conflict for Medicare in the consideration of payment.

One RBM, MedSolutions, praised the GAO study and refuted assertions that the companies added a layer of cost or bureaucratic burden. The Nashville, Tenn.-based company also said that its clients have found its approach to be successful.

“Our administrative costs are typically a small fraction of documented savings, and it is standard practice for us to operate with complete transparency with physicians and patients,” MedSolutions CEO Curt Thorne said in a statement.

Accreditation and appropriate use criteria would be more effective in reducing imaging, say some physicians. ©Stockbyte/Getty Images

WASHINGTON — Without pharmaceutical funding, continuing medical education could falter, judging from comments at a forum of CME providers and physicians. The forum was sponsored by the Center for Medicine in the Public Interest, a New York-based nonprofit organization, and the Coalition for Healthcare Communication, an umbrella group for advertising agencies and medical journal publishers.

The meeting was called in response to numerous efforts from legislators and accrediting organizations for greater accountability for CME funding. In July, a task force of the Association of American Medical Colleges said that academic medical centers should discourage faculty participation in industry-sponsored speakers bureaus. A month earlier, the Accreditation Council for CME proposed tightening restrictions on commercial support of CME, and possibly banning industry funding.

“CME in the U.S. is a great success story,” said Dr. George Lundberg, a former editor of JAMA and current editor-in-chief at Medscape. CME changes knowledge, skills, and patient outcomes, he said, adding that surveys have shown that physicians are in favor of industry support.

Dr. Michael Weber, a professor of medicine at the State University of New York, Brooklyn, said that he views pharmaceutical funding of CME as a mandate, “not a luxury.” Manufacturers must educate clinicians on how to use their products, he said.

Dr. Jack Lewin, CEO of the American College of Cardiology, said that without industry funding, it would cost the ACC $2,000–$3,000 more per attendee at its annual meeting. The ACC already removes conflicts of interest from its professional and educational programs, and discloses industry funding on its Web site.

About a third of that organization's $97 million annual budget comes from outside sources ($35 million), and 21% of that is from charitable contributions, he said.

Public Citizen's Health Research Group, in comments sent to the ACCME on its proposal to limit or ban industry support of CME, said, “Despite a quadrupling of commercial support for CME over the past 10 years, in 2007, the percentage of CME income provided by commercial interests actually decreased to 2002 levels.”

Public Citizen advocates an end to commercially funded CME. “Shifting the burden of funding toward physicians (not exactly a group occupying the lower rungs of the earning ladder) would attenuate the effect of lost revenue.”

Drugmakers to Disclose Doctor Payments

Two pharmaceutical companies will begin publicly disclosing how much each pays physicians.

Eli Lilly & Co. was the first company to step forward, followed a day later by Merck & Co.

Lilly is starting a registry that will compile payments to physicians who have served as speakers or advisers for the company. It will be available to the public on the company's Web site as early as the second half of 2009, Lilly officials said in a statement. The registry will be updated each year to reflect the previous year's payments.

Lilly said that by 2011, it aims to report whatever is required under the proposed Physician Payments Sunshine Act. That bill (S. 2029) was introduced by Sen. Chuck Grassley (R-Iowa) and Sen. Herb Kohl (D-Wis.) in November 2007. As currently written, it would require manufacturers of pharmaceuticals, medical devices, and biologics to disclose the amount of money they give to doctors through payments, gifts, honoraria, and travel. Product samples for patients would be excluded.

The bill was endorsed by several major drug companies, including Lilly and Merck; the Pharmaceutical Research and Manufacturers of America; the Advanced Medical Technology Association; and the Association of American Medical Colleges, among others. But it has not had any movement since its introduction.

In a statement, Sen. Kohl congratulated Lilly, saying the company was “fulfilling the obligations of the Physician Payments Sunshine Act before it has been enacted.”

Merck said that it will start disclosing the grants to patient organizations, professional societies, and others for “independent professional education initiatives,” which would include continuing medical education. Next year, it will include other grants made by the Merck Company Foundation and the Merck Office of Corporate Contributions. The information will be posted on its Web site.

In 2009, Merck will also start disclosing payments to physicians on its speakers bureau.

WASHINGTON — Without pharmaceutical funding, continuing medical education could falter, judging from comments at a forum of CME providers and physicians. The forum was sponsored by the Center for Medicine in the Public Interest, a New York-based nonprofit organization, and the Coalition for Healthcare Communication, an umbrella group for advertising agencies and medical journal publishers.

The meeting was called in response to numerous efforts from legislators and accrediting organizations for greater accountability for CME funding. In July, a task force of the Association of American Medical Colleges said that academic medical centers should discourage faculty participation in industry-sponsored speakers bureaus. A month earlier, the Accreditation Council for CME proposed tightening restrictions on commercial support of CME, and possibly banning industry funding.

“CME in the U.S. is a great success story,” said Dr. George Lundberg, a former editor of JAMA and current editor-in-chief at Medscape. CME changes knowledge, skills, and patient outcomes, he said, adding that surveys have shown that physicians are in favor of industry support.

Dr. Michael Weber, a professor of medicine at the State University of New York, Brooklyn, said that he views pharmaceutical funding of CME as a mandate, “not a luxury.” Manufacturers must educate clinicians on how to use their products, he said.

Dr. Jack Lewin, CEO of the American College of Cardiology, said that without industry funding, it would cost the ACC $2,000–$3,000 more per attendee at its annual meeting. The ACC already removes conflicts of interest from its professional and educational programs, and discloses industry funding on its Web site.

About a third of that organization's $97 million annual budget comes from outside sources ($35 million), and 21% of that is from charitable contributions, he said.

Public Citizen's Health Research Group, in comments sent to the ACCME on its proposal to limit or ban industry support of CME, said, “Despite a quadrupling of commercial support for CME over the past 10 years, in 2007, the percentage of CME income provided by commercial interests actually decreased to 2002 levels.”

Public Citizen advocates an end to commercially funded CME. “Shifting the burden of funding toward physicians (not exactly a group occupying the lower rungs of the earning ladder) would attenuate the effect of lost revenue.”

Drugmakers to Disclose Doctor Payments

Two pharmaceutical companies will begin publicly disclosing how much each pays physicians.

Eli Lilly & Co. was the first company to step forward, followed a day later by Merck & Co.

Lilly is starting a registry that will compile payments to physicians who have served as speakers or advisers for the company. It will be available to the public on the company's Web site as early as the second half of 2009, Lilly officials said in a statement. The registry will be updated each year to reflect the previous year's payments.

Lilly said that by 2011, it aims to report whatever is required under the proposed Physician Payments Sunshine Act. That bill (S. 2029) was introduced by Sen. Chuck Grassley (R-Iowa) and Sen. Herb Kohl (D-Wis.) in November 2007. As currently written, it would require manufacturers of pharmaceuticals, medical devices, and biologics to disclose the amount of money they give to doctors through payments, gifts, honoraria, and travel. Product samples for patients would be excluded.

The bill was endorsed by several major drug companies, including Lilly and Merck; the Pharmaceutical Research and Manufacturers of America; the Advanced Medical Technology Association; and the Association of American Medical Colleges, among others. But it has not had any movement since its introduction.

In a statement, Sen. Kohl congratulated Lilly, saying the company was “fulfilling the obligations of the Physician Payments Sunshine Act before it has been enacted.”

Merck said that it will start disclosing the grants to patient organizations, professional societies, and others for “independent professional education initiatives,” which would include continuing medical education. Next year, it will include other grants made by the Merck Company Foundation and the Merck Office of Corporate Contributions. The information will be posted on its Web site.

In 2009, Merck will also start disclosing payments to physicians on its speakers bureau.

WASHINGTON — Without pharmaceutical funding, continuing medical education could falter, judging from comments at a forum of CME providers and physicians. The forum was sponsored by the Center for Medicine in the Public Interest, a New York-based nonprofit organization, and the Coalition for Healthcare Communication, an umbrella group for advertising agencies and medical journal publishers.

The meeting was called in response to numerous efforts from legislators and accrediting organizations for greater accountability for CME funding. In July, a task force of the Association of American Medical Colleges said that academic medical centers should discourage faculty participation in industry-sponsored speakers bureaus. A month earlier, the Accreditation Council for CME proposed tightening restrictions on commercial support of CME, and possibly banning industry funding.

“CME in the U.S. is a great success story,” said Dr. George Lundberg, a former editor of JAMA and current editor-in-chief at Medscape. CME changes knowledge, skills, and patient outcomes, he said, adding that surveys have shown that physicians are in favor of industry support.

Dr. Michael Weber, a professor of medicine at the State University of New York, Brooklyn, said that he views pharmaceutical funding of CME as a mandate, “not a luxury.” Manufacturers must educate clinicians on how to use their products, he said.

Dr. Jack Lewin, CEO of the American College of Cardiology, said that without industry funding, it would cost the ACC $2,000–$3,000 more per attendee at its annual meeting. The ACC already removes conflicts of interest from its professional and educational programs, and discloses industry funding on its Web site.

About a third of that organization's $97 million annual budget comes from outside sources ($35 million), and 21% of that is from charitable contributions, he said.

Public Citizen's Health Research Group, in comments sent to the ACCME on its proposal to limit or ban industry support of CME, said, “Despite a quadrupling of commercial support for CME over the past 10 years, in 2007, the percentage of CME income provided by commercial interests actually decreased to 2002 levels.”

Public Citizen advocates an end to commercially funded CME. “Shifting the burden of funding toward physicians (not exactly a group occupying the lower rungs of the earning ladder) would attenuate the effect of lost revenue.”

Drugmakers to Disclose Doctor Payments

Two pharmaceutical companies will begin publicly disclosing how much each pays physicians.

Eli Lilly & Co. was the first company to step forward, followed a day later by Merck & Co.

Lilly is starting a registry that will compile payments to physicians who have served as speakers or advisers for the company. It will be available to the public on the company's Web site as early as the second half of 2009, Lilly officials said in a statement. The registry will be updated each year to reflect the previous year's payments.

Lilly said that by 2011, it aims to report whatever is required under the proposed Physician Payments Sunshine Act. That bill (S. 2029) was introduced by Sen. Chuck Grassley (R-Iowa) and Sen. Herb Kohl (D-Wis.) in November 2007. As currently written, it would require manufacturers of pharmaceuticals, medical devices, and biologics to disclose the amount of money they give to doctors through payments, gifts, honoraria, and travel. Product samples for patients would be excluded.

The bill was endorsed by several major drug companies, including Lilly and Merck; the Pharmaceutical Research and Manufacturers of America; the Advanced Medical Technology Association; and the Association of American Medical Colleges, among others. But it has not had any movement since its introduction.

In a statement, Sen. Kohl congratulated Lilly, saying the company was “fulfilling the obligations of the Physician Payments Sunshine Act before it has been enacted.”

Merck said that it will start disclosing the grants to patient organizations, professional societies, and others for “independent professional education initiatives,” which would include continuing medical education. Next year, it will include other grants made by the Merck Company Foundation and the Merck Office of Corporate Contributions. The information will be posted on its Web site.

In 2009, Merck will also start disclosing payments to physicians on its speakers bureau.

The Food and Drug Administration said last month it would not allow generic drugs made by Ranbaxy Laboratories Ltd. at two of its Indian manufacturing plants to cross U.S. borders, citing an extensive history of manufacturing violations at those facilities.

According to the FDA the “import alert” covers 30 drugs made at Ranbaxy's Dewas and Paonta Sahib manufacturing plants, including simvastatin, fenofibrate, gabapentin, metformin HCl, ranitidine, and acyclovir.

Such a wide-ranging shutdown is not common for violations of “good manufacturing practices.” But in a teleconference with reporters, Deborah M. Autor, director at the FDA's Center for Drug Evaluation and Research Office of Compliance, said the alert and two warnings letters were issued because of the seriousness of the manufacturing violations and the company's lack of quick and appropriate actions.

Consumers were advised not to discontinue any generic medication, even if it was manufactured by Ranbaxy, because of the agency's testing and the lack of adverse event reports relating to the products, said Douglas Throckmorton, deputy director of the CDER, in the teleconference.

The FDA began investigating in 2005 after it received reports of manufacturing violations and allegations of potential fraudulent activity at the Dewas and Paonta Sahib plants, said Ms. Autor. The agency documented significant violations of its good manufacturing practices (GMP) rules during inspections conducted in 2006.

Inspections of both plants early this year once again found significant violations. At the Dewas plant, the FDA cited the potential for cross-contamination from the facility's ?-lactam manufacturing process, inadequate batch production and control records, inadequate failure investigations, and inadequate aseptic (sterile) processing operations.

The agency cited the Paonta Sahib plant for a lack of assurance that responsible individuals were present to determine the firm was following GMP rules, inaccurate written records of the cleaning and use of major equipment, incomplete batch production and control records, and inadequate procedures for the review and approval of production and control records.

Ranbaxy has also been under criminal investigation by the U.S. Department of Justice for alleged fraud relating to several of its FDA approvals.

The Food and Drug Administration said last month it would not allow generic drugs made by Ranbaxy Laboratories Ltd. at two of its Indian manufacturing plants to cross U.S. borders, citing an extensive history of manufacturing violations at those facilities.

According to the FDA the “import alert” covers 30 drugs made at Ranbaxy's Dewas and Paonta Sahib manufacturing plants, including simvastatin, fenofibrate, gabapentin, metformin HCl, ranitidine, and acyclovir.

Such a wide-ranging shutdown is not common for violations of “good manufacturing practices.” But in a teleconference with reporters, Deborah M. Autor, director at the FDA's Center for Drug Evaluation and Research Office of Compliance, said the alert and two warnings letters were issued because of the seriousness of the manufacturing violations and the company's lack of quick and appropriate actions.

Consumers were advised not to discontinue any generic medication, even if it was manufactured by Ranbaxy, because of the agency's testing and the lack of adverse event reports relating to the products, said Douglas Throckmorton, deputy director of the CDER, in the teleconference.

The FDA began investigating in 2005 after it received reports of manufacturing violations and allegations of potential fraudulent activity at the Dewas and Paonta Sahib plants, said Ms. Autor. The agency documented significant violations of its good manufacturing practices (GMP) rules during inspections conducted in 2006.

Inspections of both plants early this year once again found significant violations. At the Dewas plant, the FDA cited the potential for cross-contamination from the facility's ?-lactam manufacturing process, inadequate batch production and control records, inadequate failure investigations, and inadequate aseptic (sterile) processing operations.

The agency cited the Paonta Sahib plant for a lack of assurance that responsible individuals were present to determine the firm was following GMP rules, inaccurate written records of the cleaning and use of major equipment, incomplete batch production and control records, and inadequate procedures for the review and approval of production and control records.

Ranbaxy has also been under criminal investigation by the U.S. Department of Justice for alleged fraud relating to several of its FDA approvals.

The Food and Drug Administration said last month it would not allow generic drugs made by Ranbaxy Laboratories Ltd. at two of its Indian manufacturing plants to cross U.S. borders, citing an extensive history of manufacturing violations at those facilities.

According to the FDA the “import alert” covers 30 drugs made at Ranbaxy's Dewas and Paonta Sahib manufacturing plants, including simvastatin, fenofibrate, gabapentin, metformin HCl, ranitidine, and acyclovir.

Such a wide-ranging shutdown is not common for violations of “good manufacturing practices.” But in a teleconference with reporters, Deborah M. Autor, director at the FDA's Center for Drug Evaluation and Research Office of Compliance, said the alert and two warnings letters were issued because of the seriousness of the manufacturing violations and the company's lack of quick and appropriate actions.

Consumers were advised not to discontinue any generic medication, even if it was manufactured by Ranbaxy, because of the agency's testing and the lack of adverse event reports relating to the products, said Douglas Throckmorton, deputy director of the CDER, in the teleconference.

The FDA began investigating in 2005 after it received reports of manufacturing violations and allegations of potential fraudulent activity at the Dewas and Paonta Sahib plants, said Ms. Autor. The agency documented significant violations of its good manufacturing practices (GMP) rules during inspections conducted in 2006.

Inspections of both plants early this year once again found significant violations. At the Dewas plant, the FDA cited the potential for cross-contamination from the facility's ?-lactam manufacturing process, inadequate batch production and control records, inadequate failure investigations, and inadequate aseptic (sterile) processing operations.

The agency cited the Paonta Sahib plant for a lack of assurance that responsible individuals were present to determine the firm was following GMP rules, inaccurate written records of the cleaning and use of major equipment, incomplete batch production and control records, and inadequate procedures for the review and approval of production and control records.

Ranbaxy has also been under criminal investigation by the U.S. Department of Justice for alleged fraud relating to several of its FDA approvals.

ACC Says Quality Is Job #1

The American College of Cardiology has launched a preemptive strike in the likely upcoming battle for health reform. The organization and 300 member-cardiologists spent a day last month lobbying Capitol Hill, armed with ACC's new QualityFirst campaign and evidence that cardiologists are already collecting quality data and crunching numbers to improve care. The QualityFirst campaign, which will be focused inside the Beltway, backs cost-effective, quality care; payment incentives; increased transparency; and coordination across care sites. “The current system and its focus on quantity, not quality, is unsustainable,” said Dr. W. Douglas Weaver, ACC president, at a press briefing. The ACC also shared results of a poll of 1,003 likely voters conducted for the organization. Eighty-six percent of respondents said they'd trust physicians or medical or patient advocacy groups to set quality standards. In addition, 83% agreed that ACC's QualityFirst objectives were extremely or very important, and 64% said the organization's top priority should be setting new standards for health reform.

CMS Proposes Denial of CAS

The Centers for Medicare and Medicaid Services has proposed to keep the status quo—no coverage—of percutaneous transluminal angioplasty (PTA) of the carotid artery concurrent with stenting. The ACC, the Society for Vascular Medicine, and the Society of Vascular Interventional Neurology had asked the agency to reconsider and add coverage for patients who are at high risk for carotid endarterectomy because of defined anatomic factors, and who have symptomatic carotid artery stenosis of 50%-90% or greater or asymptomatic carotid artery stenosis of at least 80%. In comments on the proposed decision, the organizations again argued for coverage, citing “compelling scientific evidence” that revascularization prevents stroke, compared with medical therapy. “CMS should not require that CAS be superior to [carotid endarterectomy] to consider it a valid treatment option,” according to the groups.

CMS Alters Overpayment Policy

CMS will no longer seek payment from a physician for an overpayment while the physician is seeking a reconsideration of the overpayment determination by a qualified independent contractor. Under the new policy, which was mandated by the 2003 Medicare Modernization Act, the agency can only seek to recoup the payment after a decision has been made on the reconsideration. The changes, which went into effect Sept. 29, apply to most Part A and Part B claims for which a demand letter has been issued. The changes do not affect the appeal process or the normal debt collection and referral process, according to the CMS.

PQRI Frustrating, But Not Costly

A total of 90% of physicians answering a Medical Group Management Association survey said that they had trouble accessing their confidential 2007 Physician Quality Reporting Initiative (PQRI) reports from the Centers for Medicare and Medicaid's secure Web site. Overall, 70% sought CMS help in getting the reports; of those, 11% rated the help as not satisfactory. The PQRI reports received average marks for clarity and slightly lower ratings for providing guidance on improving outcomes. Even so, 90% of the practices said they would participate in the 2008 PQRI program. Survey responses were taken from 295 practices who said they had reported on PQRI measures from July to December 2007. When asked why they participated, the largest weight was given to preparing for the future, when quality reporting is anticipated to play a bigger role in Medicare reimbursement. Overall, 61% of practices earned a bonus from 2007. Most practices said that participation had not led to the need for more staff or higher expenses.

ACC Says Quality Is Job #1

The American College of Cardiology has launched a preemptive strike in the likely upcoming battle for health reform. The organization and 300 member-cardiologists spent a day last month lobbying Capitol Hill, armed with ACC's new QualityFirst campaign and evidence that cardiologists are already collecting quality data and crunching numbers to improve care. The QualityFirst campaign, which will be focused inside the Beltway, backs cost-effective, quality care; payment incentives; increased transparency; and coordination across care sites. “The current system and its focus on quantity, not quality, is unsustainable,” said Dr. W. Douglas Weaver, ACC president, at a press briefing. The ACC also shared results of a poll of 1,003 likely voters conducted for the organization. Eighty-six percent of respondents said they'd trust physicians or medical or patient advocacy groups to set quality standards. In addition, 83% agreed that ACC's QualityFirst objectives were extremely or very important, and 64% said the organization's top priority should be setting new standards for health reform.

CMS Proposes Denial of CAS

The Centers for Medicare and Medicaid Services has proposed to keep the status quo—no coverage—of percutaneous transluminal angioplasty (PTA) of the carotid artery concurrent with stenting. The ACC, the Society for Vascular Medicine, and the Society of Vascular Interventional Neurology had asked the agency to reconsider and add coverage for patients who are at high risk for carotid endarterectomy because of defined anatomic factors, and who have symptomatic carotid artery stenosis of 50%-90% or greater or asymptomatic carotid artery stenosis of at least 80%. In comments on the proposed decision, the organizations again argued for coverage, citing “compelling scientific evidence” that revascularization prevents stroke, compared with medical therapy. “CMS should not require that CAS be superior to [carotid endarterectomy] to consider it a valid treatment option,” according to the groups.

CMS Alters Overpayment Policy

CMS will no longer seek payment from a physician for an overpayment while the physician is seeking a reconsideration of the overpayment determination by a qualified independent contractor. Under the new policy, which was mandated by the 2003 Medicare Modernization Act, the agency can only seek to recoup the payment after a decision has been made on the reconsideration. The changes, which went into effect Sept. 29, apply to most Part A and Part B claims for which a demand letter has been issued. The changes do not affect the appeal process or the normal debt collection and referral process, according to the CMS.

PQRI Frustrating, But Not Costly

A total of 90% of physicians answering a Medical Group Management Association survey said that they had trouble accessing their confidential 2007 Physician Quality Reporting Initiative (PQRI) reports from the Centers for Medicare and Medicaid's secure Web site. Overall, 70% sought CMS help in getting the reports; of those, 11% rated the help as not satisfactory. The PQRI reports received average marks for clarity and slightly lower ratings for providing guidance on improving outcomes. Even so, 90% of the practices said they would participate in the 2008 PQRI program. Survey responses were taken from 295 practices who said they had reported on PQRI measures from July to December 2007. When asked why they participated, the largest weight was given to preparing for the future, when quality reporting is anticipated to play a bigger role in Medicare reimbursement. Overall, 61% of practices earned a bonus from 2007. Most practices said that participation had not led to the need for more staff or higher expenses.

ACC Says Quality Is Job #1

The American College of Cardiology has launched a preemptive strike in the likely upcoming battle for health reform. The organization and 300 member-cardiologists spent a day last month lobbying Capitol Hill, armed with ACC's new QualityFirst campaign and evidence that cardiologists are already collecting quality data and crunching numbers to improve care. The QualityFirst campaign, which will be focused inside the Beltway, backs cost-effective, quality care; payment incentives; increased transparency; and coordination across care sites. “The current system and its focus on quantity, not quality, is unsustainable,” said Dr. W. Douglas Weaver, ACC president, at a press briefing. The ACC also shared results of a poll of 1,003 likely voters conducted for the organization. Eighty-six percent of respondents said they'd trust physicians or medical or patient advocacy groups to set quality standards. In addition, 83% agreed that ACC's QualityFirst objectives were extremely or very important, and 64% said the organization's top priority should be setting new standards for health reform.

CMS Proposes Denial of CAS

The Centers for Medicare and Medicaid Services has proposed to keep the status quo—no coverage—of percutaneous transluminal angioplasty (PTA) of the carotid artery concurrent with stenting. The ACC, the Society for Vascular Medicine, and the Society of Vascular Interventional Neurology had asked the agency to reconsider and add coverage for patients who are at high risk for carotid endarterectomy because of defined anatomic factors, and who have symptomatic carotid artery stenosis of 50%-90% or greater or asymptomatic carotid artery stenosis of at least 80%. In comments on the proposed decision, the organizations again argued for coverage, citing “compelling scientific evidence” that revascularization prevents stroke, compared with medical therapy. “CMS should not require that CAS be superior to [carotid endarterectomy] to consider it a valid treatment option,” according to the groups.

CMS Alters Overpayment Policy

CMS will no longer seek payment from a physician for an overpayment while the physician is seeking a reconsideration of the overpayment determination by a qualified independent contractor. Under the new policy, which was mandated by the 2003 Medicare Modernization Act, the agency can only seek to recoup the payment after a decision has been made on the reconsideration. The changes, which went into effect Sept. 29, apply to most Part A and Part B claims for which a demand letter has been issued. The changes do not affect the appeal process or the normal debt collection and referral process, according to the CMS.

PQRI Frustrating, But Not Costly

A total of 90% of physicians answering a Medical Group Management Association survey said that they had trouble accessing their confidential 2007 Physician Quality Reporting Initiative (PQRI) reports from the Centers for Medicare and Medicaid's secure Web site. Overall, 70% sought CMS help in getting the reports; of those, 11% rated the help as not satisfactory. The PQRI reports received average marks for clarity and slightly lower ratings for providing guidance on improving outcomes. Even so, 90% of the practices said they would participate in the 2008 PQRI program. Survey responses were taken from 295 practices who said they had reported on PQRI measures from July to December 2007. When asked why they participated, the largest weight was given to preparing for the future, when quality reporting is anticipated to play a bigger role in Medicare reimbursement. Overall, 61% of practices earned a bonus from 2007. Most practices said that participation had not led to the need for more staff or higher expenses.

The Government Accountability Office is urging Congress to require Medicare to adopt prior authorization procedures for outpatient imaging services, saying that the federal health program's current approach has allowed costs to balloon.

According to the GAO, from 2000 to 2006, Medicare Part B spending on imaging services more than doubled to $14 billion. In particular, spending on more technically demanding imaging studies, such as computed tomography, magnetic resonance imaging, and nuclear medicine, rose 17% a year, compared with 9% annual growth for less complex studies such as x-rays. Imaging studies have increasingly shifted to the outpatient sector and the proportion of physician income from imaging is steadily rising, said the GAO in its report, “Medicare Part B Imaging Services.”

Shortly after the report was issued, Sen. Charles Grassley (R-Iowa), introduced legislation (S. 3343) that would require physicians making referrals for MRIs, CTs, PET scans, and potentially other modalities, to disclose to patients in writing if they have ownership in the imaging facility. The proposal was initially included in the bill that canceled Medicare physician fee cuts but was dropped in the final package.

The GAO analyzed Medicare claims data and also interviewed health plans and radiology benefit management companies to compile its report, which was requested by Sen. Jay Rockefeller (D-W.Va.).

Because of the rapid growth in imaging, the GAO said, “we recommend that [the Centers for Medicare and Medicaid Services] examine the feasibility of expanding its payment safeguard mechanisms by adding more front-end approaches to managing imaging services, such as using privileging and prior authorization.”

The proportion of Medicare Part B spending on imaging conducted in a physician office setting, which was 58% in 2000, rose to 64% in 2006, according to the GAO. Physician-directed imaging has grown especially in cardiology, according to the GAO report. “In 2006, cardiologists obtained 36% of their total Medicare revenue from in-office imaging, compared with 23% in 2000.”

By comparison, the proportion of income coming from use of imaging by vascular surgeons—who had the second-highest growth rate—increased from 10% in 2000 to 19% in 2006.

The American College of Cardiology criticized the GAO study, noting that “the agency did not take into account physician input, nor did it use data from 2007 showing a decline in imaging growth.”

“While the American College of Cardiology does not dispute the rapid growth in medical imaging, we are disappointed that the GAO chose to ignore the work that physicians and specialty societies are doing to ensure the most appropriate use of these technologies,” the college's CEO, Dr. Jack Lewin, said in a statement. “Prior authorization is a Band-Aid to the utilization issue and not a viable solution. Medicare should look to accreditation, appropriate use criteria, and improved communication to lower utilization and improve quality.”

The Medical Imaging Technology Alliance (MITA) issued a similar critique, and noted that the GAO report did not take into account appropriateness and accreditation criteria that were part of the just-passed Medicare bill that eliminated a scheduled reduction in physician fees. The law will require imaging facilities to be accredited starting in 2012.

Appropriateness and accreditation will “ensure that an image is taken at the right time by the right person and in an appropriate manner,” MITA vice president Andrew Whitman said in an interview. MITA is the medical technology trade association of the National Electrical Manufacturers Association.

Mr. Whitman also criticized the GAO's support of radiology benefit management companies (RBMs), which the private sector has used to implement prior authorization and other tools to rein in costs. RBMs do not readily share guidelines and appropriateness criteria and are not well regulated, Mr. Whitman said.

In response to the GAO report, the Health and Human Services department said it, too, had concerns about the “administrative burden” of using RBMs, “as well as the advisability of prior authorization for the Medicare program,” according to the report. HHS pointed out that there were no independent data showing that RBMs could successfully manage imaging costs. The agency also said that proprietary guidelines in use by RBMs might conflict with those being promoted by federal health authorities. Thus the RBM recommendations could present a conflict for Medicare when considering payment, said HHS.

“We do not dispute HHS's reservations about prior authorization, and agree that these concerns will require careful examination within the context of Medicare statutes and regulations,” said the GAO report.

The GAO ignored the work of physicians' groups in developing appropriate use criteria, said the ACC. ©Stockbyte/Getty Images

The Government Accountability Office is urging Congress to require Medicare to adopt prior authorization procedures for outpatient imaging services, saying that the federal health program's current approach has allowed costs to balloon.

According to the GAO, from 2000 to 2006, Medicare Part B spending on imaging services more than doubled to $14 billion. In particular, spending on more technically demanding imaging studies, such as computed tomography, magnetic resonance imaging, and nuclear medicine, rose 17% a year, compared with 9% annual growth for less complex studies such as x-rays. Imaging studies have increasingly shifted to the outpatient sector and the proportion of physician income from imaging is steadily rising, said the GAO in its report, “Medicare Part B Imaging Services.”

Shortly after the report was issued, Sen. Charles Grassley (R-Iowa), introduced legislation (S. 3343) that would require physicians making referrals for MRIs, CTs, PET scans, and potentially other modalities, to disclose to patients in writing if they have ownership in the imaging facility. The proposal was initially included in the bill that canceled Medicare physician fee cuts but was dropped in the final package.

The GAO analyzed Medicare claims data and also interviewed health plans and radiology benefit management companies to compile its report, which was requested by Sen. Jay Rockefeller (D-W.Va.).

Because of the rapid growth in imaging, the GAO said, “we recommend that [the Centers for Medicare and Medicaid Services] examine the feasibility of expanding its payment safeguard mechanisms by adding more front-end approaches to managing imaging services, such as using privileging and prior authorization.”

The proportion of Medicare Part B spending on imaging conducted in a physician office setting, which was 58% in 2000, rose to 64% in 2006, according to the GAO. Physician-directed imaging has grown especially in cardiology, according to the GAO report. “In 2006, cardiologists obtained 36% of their total Medicare revenue from in-office imaging, compared with 23% in 2000.”

By comparison, the proportion of income coming from use of imaging by vascular surgeons—who had the second-highest growth rate—increased from 10% in 2000 to 19% in 2006.

The American College of Cardiology criticized the GAO study, noting that “the agency did not take into account physician input, nor did it use data from 2007 showing a decline in imaging growth.”

“While the American College of Cardiology does not dispute the rapid growth in medical imaging, we are disappointed that the GAO chose to ignore the work that physicians and specialty societies are doing to ensure the most appropriate use of these technologies,” the college's CEO, Dr. Jack Lewin, said in a statement. “Prior authorization is a Band-Aid to the utilization issue and not a viable solution. Medicare should look to accreditation, appropriate use criteria, and improved communication to lower utilization and improve quality.”

The Medical Imaging Technology Alliance (MITA) issued a similar critique, and noted that the GAO report did not take into account appropriateness and accreditation criteria that were part of the just-passed Medicare bill that eliminated a scheduled reduction in physician fees. The law will require imaging facilities to be accredited starting in 2012.

Appropriateness and accreditation will “ensure that an image is taken at the right time by the right person and in an appropriate manner,” MITA vice president Andrew Whitman said in an interview. MITA is the medical technology trade association of the National Electrical Manufacturers Association.

Mr. Whitman also criticized the GAO's support of radiology benefit management companies (RBMs), which the private sector has used to implement prior authorization and other tools to rein in costs. RBMs do not readily share guidelines and appropriateness criteria and are not well regulated, Mr. Whitman said.

In response to the GAO report, the Health and Human Services department said it, too, had concerns about the “administrative burden” of using RBMs, “as well as the advisability of prior authorization for the Medicare program,” according to the report. HHS pointed out that there were no independent data showing that RBMs could successfully manage imaging costs. The agency also said that proprietary guidelines in use by RBMs might conflict with those being promoted by federal health authorities. Thus the RBM recommendations could present a conflict for Medicare when considering payment, said HHS.

“We do not dispute HHS's reservations about prior authorization, and agree that these concerns will require careful examination within the context of Medicare statutes and regulations,” said the GAO report.

The GAO ignored the work of physicians' groups in developing appropriate use criteria, said the ACC. ©Stockbyte/Getty Images

The Government Accountability Office is urging Congress to require Medicare to adopt prior authorization procedures for outpatient imaging services, saying that the federal health program's current approach has allowed costs to balloon.

According to the GAO, from 2000 to 2006, Medicare Part B spending on imaging services more than doubled to $14 billion. In particular, spending on more technically demanding imaging studies, such as computed tomography, magnetic resonance imaging, and nuclear medicine, rose 17% a year, compared with 9% annual growth for less complex studies such as x-rays. Imaging studies have increasingly shifted to the outpatient sector and the proportion of physician income from imaging is steadily rising, said the GAO in its report, “Medicare Part B Imaging Services.”

Shortly after the report was issued, Sen. Charles Grassley (R-Iowa), introduced legislation (S. 3343) that would require physicians making referrals for MRIs, CTs, PET scans, and potentially other modalities, to disclose to patients in writing if they have ownership in the imaging facility. The proposal was initially included in the bill that canceled Medicare physician fee cuts but was dropped in the final package.

The GAO analyzed Medicare claims data and also interviewed health plans and radiology benefit management companies to compile its report, which was requested by Sen. Jay Rockefeller (D-W.Va.).

Because of the rapid growth in imaging, the GAO said, “we recommend that [the Centers for Medicare and Medicaid Services] examine the feasibility of expanding its payment safeguard mechanisms by adding more front-end approaches to managing imaging services, such as using privileging and prior authorization.”

The proportion of Medicare Part B spending on imaging conducted in a physician office setting, which was 58% in 2000, rose to 64% in 2006, according to the GAO. Physician-directed imaging has grown especially in cardiology, according to the GAO report. “In 2006, cardiologists obtained 36% of their total Medicare revenue from in-office imaging, compared with 23% in 2000.”

By comparison, the proportion of income coming from use of imaging by vascular surgeons—who had the second-highest growth rate—increased from 10% in 2000 to 19% in 2006.

The American College of Cardiology criticized the GAO study, noting that “the agency did not take into account physician input, nor did it use data from 2007 showing a decline in imaging growth.”

“While the American College of Cardiology does not dispute the rapid growth in medical imaging, we are disappointed that the GAO chose to ignore the work that physicians and specialty societies are doing to ensure the most appropriate use of these technologies,” the college's CEO, Dr. Jack Lewin, said in a statement. “Prior authorization is a Band-Aid to the utilization issue and not a viable solution. Medicare should look to accreditation, appropriate use criteria, and improved communication to lower utilization and improve quality.”

The Medical Imaging Technology Alliance (MITA) issued a similar critique, and noted that the GAO report did not take into account appropriateness and accreditation criteria that were part of the just-passed Medicare bill that eliminated a scheduled reduction in physician fees. The law will require imaging facilities to be accredited starting in 2012.

Appropriateness and accreditation will “ensure that an image is taken at the right time by the right person and in an appropriate manner,” MITA vice president Andrew Whitman said in an interview. MITA is the medical technology trade association of the National Electrical Manufacturers Association.

Mr. Whitman also criticized the GAO's support of radiology benefit management companies (RBMs), which the private sector has used to implement prior authorization and other tools to rein in costs. RBMs do not readily share guidelines and appropriateness criteria and are not well regulated, Mr. Whitman said.

In response to the GAO report, the Health and Human Services department said it, too, had concerns about the “administrative burden” of using RBMs, “as well as the advisability of prior authorization for the Medicare program,” according to the report. HHS pointed out that there were no independent data showing that RBMs could successfully manage imaging costs. The agency also said that proprietary guidelines in use by RBMs might conflict with those being promoted by federal health authorities. Thus the RBM recommendations could present a conflict for Medicare when considering payment, said HHS.

“We do not dispute HHS's reservations about prior authorization, and agree that these concerns will require careful examination within the context of Medicare statutes and regulations,” said the GAO report.

The GAO ignored the work of physicians' groups in developing appropriate use criteria, said the ACC. ©Stockbyte/Getty Images