Alicia Ault

WASHINGTON – The Sustainable Growth Rate is “flawed in many ways,” according to the Medicare Payment Advisory Commission, which presented several possible alternatives in its semiannual report to Congress.

Reform of the Sustainable Growth Rate formula (SGR) is essential to fixing the American health care system, MedPAC chairman Glenn M. Hackbarth said in a statement. “The Commission believes payment reform is a necessary, although not sufficient, condition for reform of the health care delivery system.”

It is not the first time that the MedPAC commissioners have expressed their concern about the SGR and its continuing threat to both physicians and patients. Under the SGR, Medicare is on track to cut physician pay by 30% in 2012.

To eliminate the cuts that have mounted over the years is an expensive proposition – about $300 billion, according to estimates by MedPAC and others.

Thus, the commission has suggested several alternatives as well as potential ways to create Medicare savings to cover the cost of replacing the SGR.

One idea that has garnered strong support from the commission is overhauling the fee-for-service system by rewarding primary care physicians and encouraging a medical home model of care. Under that scenario, payments essentially would be shifted away from specialty care and procedure-based medicine to primary care, said MedPAC executive director Mark Miller.

The report also called for possible short-term fixes to the SGR to last for at least 2 years. In 2010, updates were so short-lived that they were often applied retroactively. The lack of predictability was difficult for physician practices, according to the report, which added that “the most disturbing outcome resulting from the short-term fixes was damage to patients' and providers' confidence in Medicare.”

Mr. Miller said that the SGR proposals are just a small facet of MedPAC's goal to move Medicare away from its fee-for-service payment system. MedPAC commissioners have been discussing how to move Medicare toward a more global payment model, such as the accountable care organizations (ACOs) that are being proposed by the Centers for Medicare and Medicaid Services.

The report also made a series of recommendations to reduce the ever-rising cost of ancillary services provided by physicians, particularly imaging services. The commission is not anti-imaging, said Mr. Miller. But there has been such a spike in volume in the last decade – 6% growth per beneficiary per year for 2004-2008 and 2% per year for 2008-2009 – that commissioners felt it was imperative to suggest ways to curb the growth.

Among the suggestions: Disallow multiple payments for imaging of multiple body parts that are carried out simultaneously, and reduce fees for physicians who order a procedure and then perform it themselves.

The report also recommended that Medicare require prior authorization of magnetic resonance imaging, computed tomography, and nuclear imaging for physicians who order more of these tests than do their peers. This change would likely take an act of Congress, however.

The commission outlined a process whereby physicians who are found to order more – but within appropriate bounds – would merely be subject to a prior notification process.

The commissioners did not embrace outright the radiology benefits management (RBM) model that's used in the private sector, but Mr. Miller said that ultimately a Medicare contractor would administer the process, and that an RBM might be eligible.

The report also contained recommendations on improving how Medicare can support physicians and other health care providers interested in improving the quality of care they deliver. Among the biggest changes: Take some payments that would go to Quality Improvement Organizations, and funnel them directly to providers or communities that want to band together to create their own quality improvement programs.

The report can be viewed online at http://medpac.gov/documents/Jun11_EntireReport.pdf

WASHINGTON – The Sustainable Growth Rate is “flawed in many ways,” according to the Medicare Payment Advisory Commission, which presented several possible alternatives in its semiannual report to Congress.

Reform of the Sustainable Growth Rate formula (SGR) is essential to fixing the American health care system, MedPAC chairman Glenn M. Hackbarth said in a statement. “The Commission believes payment reform is a necessary, although not sufficient, condition for reform of the health care delivery system.”

It is not the first time that the MedPAC commissioners have expressed their concern about the SGR and its continuing threat to both physicians and patients. Under the SGR, Medicare is on track to cut physician pay by 30% in 2012.

To eliminate the cuts that have mounted over the years is an expensive proposition – about $300 billion, according to estimates by MedPAC and others.

Thus, the commission has suggested several alternatives as well as potential ways to create Medicare savings to cover the cost of replacing the SGR.

One idea that has garnered strong support from the commission is overhauling the fee-for-service system by rewarding primary care physicians and encouraging a medical home model of care. Under that scenario, payments essentially would be shifted away from specialty care and procedure-based medicine to primary care, said MedPAC executive director Mark Miller.

The report also called for possible short-term fixes to the SGR to last for at least 2 years. In 2010, updates were so short-lived that they were often applied retroactively. The lack of predictability was difficult for physician practices, according to the report, which added that “the most disturbing outcome resulting from the short-term fixes was damage to patients' and providers' confidence in Medicare.”

Mr. Miller said that the SGR proposals are just a small facet of MedPAC's goal to move Medicare away from its fee-for-service payment system. MedPAC commissioners have been discussing how to move Medicare toward a more global payment model, such as the accountable care organizations (ACOs) that are being proposed by the Centers for Medicare and Medicaid Services.

The report also made a series of recommendations to reduce the ever-rising cost of ancillary services provided by physicians, particularly imaging services. The commission is not anti-imaging, said Mr. Miller. But there has been such a spike in volume in the last decade – 6% growth per beneficiary per year for 2004-2008 and 2% per year for 2008-2009 – that commissioners felt it was imperative to suggest ways to curb the growth.

Among the suggestions: Disallow multiple payments for imaging of multiple body parts that are carried out simultaneously, and reduce fees for physicians who order a procedure and then perform it themselves.

The report also recommended that Medicare require prior authorization of magnetic resonance imaging, computed tomography, and nuclear imaging for physicians who order more of these tests than do their peers. This change would likely take an act of Congress, however.

The commission outlined a process whereby physicians who are found to order more – but within appropriate bounds – would merely be subject to a prior notification process.

The commissioners did not embrace outright the radiology benefits management (RBM) model that's used in the private sector, but Mr. Miller said that ultimately a Medicare contractor would administer the process, and that an RBM might be eligible.

The report also contained recommendations on improving how Medicare can support physicians and other health care providers interested in improving the quality of care they deliver. Among the biggest changes: Take some payments that would go to Quality Improvement Organizations, and funnel them directly to providers or communities that want to band together to create their own quality improvement programs.

The report can be viewed online at http://medpac.gov/documents/Jun11_EntireReport.pdf

WASHINGTON – The Sustainable Growth Rate is “flawed in many ways,” according to the Medicare Payment Advisory Commission, which presented several possible alternatives in its semiannual report to Congress.

Reform of the Sustainable Growth Rate formula (SGR) is essential to fixing the American health care system, MedPAC chairman Glenn M. Hackbarth said in a statement. “The Commission believes payment reform is a necessary, although not sufficient, condition for reform of the health care delivery system.”

It is not the first time that the MedPAC commissioners have expressed their concern about the SGR and its continuing threat to both physicians and patients. Under the SGR, Medicare is on track to cut physician pay by 30% in 2012.

To eliminate the cuts that have mounted over the years is an expensive proposition – about $300 billion, according to estimates by MedPAC and others.

Thus, the commission has suggested several alternatives as well as potential ways to create Medicare savings to cover the cost of replacing the SGR.

One idea that has garnered strong support from the commission is overhauling the fee-for-service system by rewarding primary care physicians and encouraging a medical home model of care. Under that scenario, payments essentially would be shifted away from specialty care and procedure-based medicine to primary care, said MedPAC executive director Mark Miller.

The report also called for possible short-term fixes to the SGR to last for at least 2 years. In 2010, updates were so short-lived that they were often applied retroactively. The lack of predictability was difficult for physician practices, according to the report, which added that “the most disturbing outcome resulting from the short-term fixes was damage to patients' and providers' confidence in Medicare.”

Mr. Miller said that the SGR proposals are just a small facet of MedPAC's goal to move Medicare away from its fee-for-service payment system. MedPAC commissioners have been discussing how to move Medicare toward a more global payment model, such as the accountable care organizations (ACOs) that are being proposed by the Centers for Medicare and Medicaid Services.

The report also made a series of recommendations to reduce the ever-rising cost of ancillary services provided by physicians, particularly imaging services. The commission is not anti-imaging, said Mr. Miller. But there has been such a spike in volume in the last decade – 6% growth per beneficiary per year for 2004-2008 and 2% per year for 2008-2009 – that commissioners felt it was imperative to suggest ways to curb the growth.

Among the suggestions: Disallow multiple payments for imaging of multiple body parts that are carried out simultaneously, and reduce fees for physicians who order a procedure and then perform it themselves.

The report also recommended that Medicare require prior authorization of magnetic resonance imaging, computed tomography, and nuclear imaging for physicians who order more of these tests than do their peers. This change would likely take an act of Congress, however.

The commission outlined a process whereby physicians who are found to order more – but within appropriate bounds – would merely be subject to a prior notification process.

The commissioners did not embrace outright the radiology benefits management (RBM) model that's used in the private sector, but Mr. Miller said that ultimately a Medicare contractor would administer the process, and that an RBM might be eligible.

The report also contained recommendations on improving how Medicare can support physicians and other health care providers interested in improving the quality of care they deliver. Among the biggest changes: Take some payments that would go to Quality Improvement Organizations, and funnel them directly to providers or communities that want to band together to create their own quality improvement programs.

The report can be viewed online at http://medpac.gov/documents/Jun11_EntireReport.pdf

WASHINGTON – The Sustainable Growth Rate is “flawed in many ways,” according to the Medicare Payment Advisory Commission, which presented several possible alternatives in its semiannual report to Congress.

Reform of the Sustainable Growth Rate formula (SGR) is essential to fixing the American health care system, MedPAC chairman Glenn M. Hackbarth said in a statement. “The Commission believes payment reform is a necessary, although not sufficient, condition for reform of the health care delivery system.”

It is not the first time that the MedPAC commissioners have expressed their concern about the SGR and its continuing threat to both physicians and patients. Under the SGR, Medicare is on track to cut physician pay by 30% in 2012.

To eliminate the cuts that have mounted over the years is an expensive proposition – about $300 billion, according to estimates by MedPAC and others.

Thus, the commission has suggested several alternatives as well as potential ways to create Medicare savings to cover the cost of replacing the SGR.

One idea that has garnered strong support from the commission is overhauling the fee-for-service system by rewarding primary care physicians and encouraging a medical home model of care. Under that scenario, payments essentially would be shifted away from specialty care and procedure-based medicine to primary care, said MedPAC executive director Mark Miller.

With SGR replacement, the report advises reforming the payment structure by increasing payments for cognitive services relative to procedural services.

The report also called for possible fixes to the SGR to last for at least 2 years. In 2010, updates were so short-lived that they were often applied retroactively. The lack of predictability was difficult for physician practices, according to the report, which added that “the most disturbing outcome resulting from the short-term fixes was damage to patients' and providers' confidence in Medicare.”

Mr. Miller said that the SGR proposals are just a small facet of MedPAC's goal to move Medicare away from its fee-for-service payment system. MedPAC commissioners have been discussing how to move Medicare toward a more global payment model, such as the accountable care organizations that are being proposed by the Centers for Medicare and Medicaid Services.

The report also made a series of recommendations to reduce the ever-rising cost of ancillary services provided by physicians, particularly imaging services. The commission is not anti-imaging, said Mr. Miller. But there has been such a spike in volume in the last decade – 6% growth per beneficiary per year from 2004-2008 and 2% per year from 2008-2009 – that commissioners felt it was imperative to suggest ways to curb the growth.

Among the suggestions: Disallow multiple payments for imaging of multiple body parts that are carried out simultaneously and reduce fees for physicians who order a procedure and then perform it themselves.

The report also recommended that Medicare require prior authorization of MRI, CT, and nuclear imaging scans for physicians who order more of these tests than do their peers. This change would likely take an act of Congress, however.

The commission outlined a process whereby physicians who are found to order more – but within appropriate bounds – would merely be subject to a prior notification process.

The report also recommended taking some payments that would go to Quality Improvement Organizations and funneling them directly to providers or communities that want to create their own quality improvement programs.

The report can be viewed online at http://medpac.gov/documents/Jun11_EntireReport.pdf

WASHINGTON – The Sustainable Growth Rate is “flawed in many ways,” according to the Medicare Payment Advisory Commission, which presented several possible alternatives in its semiannual report to Congress.

Reform of the Sustainable Growth Rate formula (SGR) is essential to fixing the American health care system, MedPAC chairman Glenn M. Hackbarth said in a statement. “The Commission believes payment reform is a necessary, although not sufficient, condition for reform of the health care delivery system.”

It is not the first time that the MedPAC commissioners have expressed their concern about the SGR and its continuing threat to both physicians and patients. Under the SGR, Medicare is on track to cut physician pay by 30% in 2012.

To eliminate the cuts that have mounted over the years is an expensive proposition – about $300 billion, according to estimates by MedPAC and others.

Thus, the commission has suggested several alternatives as well as potential ways to create Medicare savings to cover the cost of replacing the SGR.

One idea that has garnered strong support from the commission is overhauling the fee-for-service system by rewarding primary care physicians and encouraging a medical home model of care. Under that scenario, payments essentially would be shifted away from specialty care and procedure-based medicine to primary care, said MedPAC executive director Mark Miller.

With SGR replacement, the report advises reforming the payment structure by increasing payments for cognitive services relative to procedural services.

The report also called for possible fixes to the SGR to last for at least 2 years. In 2010, updates were so short-lived that they were often applied retroactively. The lack of predictability was difficult for physician practices, according to the report, which added that “the most disturbing outcome resulting from the short-term fixes was damage to patients' and providers' confidence in Medicare.”

Mr. Miller said that the SGR proposals are just a small facet of MedPAC's goal to move Medicare away from its fee-for-service payment system. MedPAC commissioners have been discussing how to move Medicare toward a more global payment model, such as the accountable care organizations that are being proposed by the Centers for Medicare and Medicaid Services.

The report also made a series of recommendations to reduce the ever-rising cost of ancillary services provided by physicians, particularly imaging services. The commission is not anti-imaging, said Mr. Miller. But there has been such a spike in volume in the last decade – 6% growth per beneficiary per year from 2004-2008 and 2% per year from 2008-2009 – that commissioners felt it was imperative to suggest ways to curb the growth.

Among the suggestions: Disallow multiple payments for imaging of multiple body parts that are carried out simultaneously and reduce fees for physicians who order a procedure and then perform it themselves.

The report also recommended that Medicare require prior authorization of MRI, CT, and nuclear imaging scans for physicians who order more of these tests than do their peers. This change would likely take an act of Congress, however.

The commission outlined a process whereby physicians who are found to order more – but within appropriate bounds – would merely be subject to a prior notification process.

The report also recommended taking some payments that would go to Quality Improvement Organizations and funneling them directly to providers or communities that want to create their own quality improvement programs.

The report can be viewed online at http://medpac.gov/documents/Jun11_EntireReport.pdf

WASHINGTON – The Sustainable Growth Rate is “flawed in many ways,” according to the Medicare Payment Advisory Commission, which presented several possible alternatives in its semiannual report to Congress.

Reform of the Sustainable Growth Rate formula (SGR) is essential to fixing the American health care system, MedPAC chairman Glenn M. Hackbarth said in a statement. “The Commission believes payment reform is a necessary, although not sufficient, condition for reform of the health care delivery system.”

It is not the first time that the MedPAC commissioners have expressed their concern about the SGR and its continuing threat to both physicians and patients. Under the SGR, Medicare is on track to cut physician pay by 30% in 2012.

To eliminate the cuts that have mounted over the years is an expensive proposition – about $300 billion, according to estimates by MedPAC and others.

Thus, the commission has suggested several alternatives as well as potential ways to create Medicare savings to cover the cost of replacing the SGR.

One idea that has garnered strong support from the commission is overhauling the fee-for-service system by rewarding primary care physicians and encouraging a medical home model of care. Under that scenario, payments essentially would be shifted away from specialty care and procedure-based medicine to primary care, said MedPAC executive director Mark Miller.

With SGR replacement, the report advises reforming the payment structure by increasing payments for cognitive services relative to procedural services.

The report also called for possible fixes to the SGR to last for at least 2 years. In 2010, updates were so short-lived that they were often applied retroactively. The lack of predictability was difficult for physician practices, according to the report, which added that “the most disturbing outcome resulting from the short-term fixes was damage to patients' and providers' confidence in Medicare.”

Mr. Miller said that the SGR proposals are just a small facet of MedPAC's goal to move Medicare away from its fee-for-service payment system. MedPAC commissioners have been discussing how to move Medicare toward a more global payment model, such as the accountable care organizations that are being proposed by the Centers for Medicare and Medicaid Services.

The report also made a series of recommendations to reduce the ever-rising cost of ancillary services provided by physicians, particularly imaging services. The commission is not anti-imaging, said Mr. Miller. But there has been such a spike in volume in the last decade – 6% growth per beneficiary per year from 2004-2008 and 2% per year from 2008-2009 – that commissioners felt it was imperative to suggest ways to curb the growth.

Among the suggestions: Disallow multiple payments for imaging of multiple body parts that are carried out simultaneously and reduce fees for physicians who order a procedure and then perform it themselves.

The report also recommended that Medicare require prior authorization of MRI, CT, and nuclear imaging scans for physicians who order more of these tests than do their peers. This change would likely take an act of Congress, however.

The commission outlined a process whereby physicians who are found to order more – but within appropriate bounds – would merely be subject to a prior notification process.

The report also recommended taking some payments that would go to Quality Improvement Organizations and funneling them directly to providers or communities that want to create their own quality improvement programs.

The report can be viewed online at http://medpac.gov/documents/Jun11_EntireReport.pdf

WASHINGTON – The Sustainable Growth Rate is “flawed in many ways,” according to the Medicare Payment Advisory Commission, which presented several possible alternatives in its semiannual report to Congress.

Reform of the Sustainable Growth Rate formula (SGR) is essential to fixing the American health care system, MedPAC chairman Glenn M. Hackbarth said in a statement. “The Commission believes payment reform is a necessary, although not sufficient, condition for reform of the health care delivery system.”

It is not the first time that the MedPAC commissioners have expressed their concern about the SGR and its continuing threat to both physicians and patients. Under the SGR, Medicare is on track to cut physician pay by 30% in 2012.

To eliminate the cuts that have mounted over the years is an expensive proposition – about $300 billion, according to estimates by MedPAC and others. Thus, the commission has suggested several alternatives as well as potential ways to create Medicare savings to cover the cost of replacing the SGR.

One idea that has garnered strong support from the commission is overhauling the fee-for-service system by rewarding primary care physicians and encouraging a medical home model of care. Under that scenario, payments essentially would be shifted away from specialty care and procedure-based medicine to primary care, said MedPAC executive director Mark Miller.

The report also called for possible short-term fixes to the SGR to last for at least 2 years. In 2010, updates were so short-lived that they were often applied retroactively. The lack of predictability was difficult for physician practices, according to the report, which added that “the most disturbing outcome resulting from the short-term fixes was damage to patients' and providers' confidence in Medicare.”

Mr. Miller said that the SGR proposals are just a small facet of MedPAC's goal to move Medicare away from its fee-for-service payment system. MedPAC commissioners have been discussing how to move Medicare toward a more global payment model, such as the accountable care organizations (ACOs) that are being proposed by the Centers for Medicare and Medicaid Services (CMS).

The report also made a series of recommendations to reduce the ever-rising cost of ancillary services provided by physicians, particularly imaging services. The commission is not anti-imaging, said Mr. Miller. But there has been such a spike in volume in the last decade – 6% growth per beneficiary per year for 2004–2008 and 2% per year for 2008–2009 – that commissioners felt it was imperative to suggest ways to curb the growth.

Among the suggestions: Disallow multiple payments for imaging of multiple body parts that are carried out simultaneously, and reduce fees for physicians who order a procedure and then perform it themselves. The report also recommended that Medicare require prior authorization of MRIs, CTs, and nuclear imaging for physicians who order more of these tests than do their peers. This change would likely take an act of Congress, however.

The commission outlined a process whereby physicians who are found to order more – but within appropriate bounds – would merely be subject to a prior notification process.

The commissioners did not embrace outright the radiology benefits management (RBM) model that's used in the private sector, but Mr. Miller said that ultimately a Medicare contractor would administer the process, and that an RBM might be eligible.

The report also contained recommendations on improving how Medicare can support physicians and other health care providers interested in improving the quality of care they deliver. Among the biggest changes: Take some payments that would go to Quality Improvement Organizations, and funnel them directly to providers or communities that want to band together to create their own quality improvement programs.

The report can be viewed online at http://medpac.gov/documents/Jun11_EntireReport.pdf

WASHINGTON – The Sustainable Growth Rate is “flawed in many ways,” according to the Medicare Payment Advisory Commission, which presented several possible alternatives in its semiannual report to Congress.

Reform of the Sustainable Growth Rate formula (SGR) is essential to fixing the American health care system, MedPAC chairman Glenn M. Hackbarth said in a statement. “The Commission believes payment reform is a necessary, although not sufficient, condition for reform of the health care delivery system.”

It is not the first time that the MedPAC commissioners have expressed their concern about the SGR and its continuing threat to both physicians and patients. Under the SGR, Medicare is on track to cut physician pay by 30% in 2012.

To eliminate the cuts that have mounted over the years is an expensive proposition – about $300 billion, according to estimates by MedPAC and others. Thus, the commission has suggested several alternatives as well as potential ways to create Medicare savings to cover the cost of replacing the SGR.

One idea that has garnered strong support from the commission is overhauling the fee-for-service system by rewarding primary care physicians and encouraging a medical home model of care. Under that scenario, payments essentially would be shifted away from specialty care and procedure-based medicine to primary care, said MedPAC executive director Mark Miller.

The report also called for possible short-term fixes to the SGR to last for at least 2 years. In 2010, updates were so short-lived that they were often applied retroactively. The lack of predictability was difficult for physician practices, according to the report, which added that “the most disturbing outcome resulting from the short-term fixes was damage to patients' and providers' confidence in Medicare.”

Mr. Miller said that the SGR proposals are just a small facet of MedPAC's goal to move Medicare away from its fee-for-service payment system. MedPAC commissioners have been discussing how to move Medicare toward a more global payment model, such as the accountable care organizations (ACOs) that are being proposed by the Centers for Medicare and Medicaid Services (CMS).

The report also made a series of recommendations to reduce the ever-rising cost of ancillary services provided by physicians, particularly imaging services. The commission is not anti-imaging, said Mr. Miller. But there has been such a spike in volume in the last decade – 6% growth per beneficiary per year for 2004–2008 and 2% per year for 2008–2009 – that commissioners felt it was imperative to suggest ways to curb the growth.

Among the suggestions: Disallow multiple payments for imaging of multiple body parts that are carried out simultaneously, and reduce fees for physicians who order a procedure and then perform it themselves. The report also recommended that Medicare require prior authorization of MRIs, CTs, and nuclear imaging for physicians who order more of these tests than do their peers. This change would likely take an act of Congress, however.

The commission outlined a process whereby physicians who are found to order more – but within appropriate bounds – would merely be subject to a prior notification process.

The commissioners did not embrace outright the radiology benefits management (RBM) model that's used in the private sector, but Mr. Miller said that ultimately a Medicare contractor would administer the process, and that an RBM might be eligible.

The report also contained recommendations on improving how Medicare can support physicians and other health care providers interested in improving the quality of care they deliver. Among the biggest changes: Take some payments that would go to Quality Improvement Organizations, and funnel them directly to providers or communities that want to band together to create their own quality improvement programs.

The report can be viewed online at http://medpac.gov/documents/Jun11_EntireReport.pdf

WASHINGTON – The Sustainable Growth Rate is “flawed in many ways,” according to the Medicare Payment Advisory Commission, which presented several possible alternatives in its semiannual report to Congress.

Reform of the Sustainable Growth Rate formula (SGR) is essential to fixing the American health care system, MedPAC chairman Glenn M. Hackbarth said in a statement. “The Commission believes payment reform is a necessary, although not sufficient, condition for reform of the health care delivery system.”

It is not the first time that the MedPAC commissioners have expressed their concern about the SGR and its continuing threat to both physicians and patients. Under the SGR, Medicare is on track to cut physician pay by 30% in 2012.

To eliminate the cuts that have mounted over the years is an expensive proposition – about $300 billion, according to estimates by MedPAC and others. Thus, the commission has suggested several alternatives as well as potential ways to create Medicare savings to cover the cost of replacing the SGR.

One idea that has garnered strong support from the commission is overhauling the fee-for-service system by rewarding primary care physicians and encouraging a medical home model of care. Under that scenario, payments essentially would be shifted away from specialty care and procedure-based medicine to primary care, said MedPAC executive director Mark Miller.

The report also called for possible short-term fixes to the SGR to last for at least 2 years. In 2010, updates were so short-lived that they were often applied retroactively. The lack of predictability was difficult for physician practices, according to the report, which added that “the most disturbing outcome resulting from the short-term fixes was damage to patients' and providers' confidence in Medicare.”

Mr. Miller said that the SGR proposals are just a small facet of MedPAC's goal to move Medicare away from its fee-for-service payment system. MedPAC commissioners have been discussing how to move Medicare toward a more global payment model, such as the accountable care organizations (ACOs) that are being proposed by the Centers for Medicare and Medicaid Services (CMS).

The report also made a series of recommendations to reduce the ever-rising cost of ancillary services provided by physicians, particularly imaging services. The commission is not anti-imaging, said Mr. Miller. But there has been such a spike in volume in the last decade – 6% growth per beneficiary per year for 2004–2008 and 2% per year for 2008–2009 – that commissioners felt it was imperative to suggest ways to curb the growth.

Among the suggestions: Disallow multiple payments for imaging of multiple body parts that are carried out simultaneously, and reduce fees for physicians who order a procedure and then perform it themselves. The report also recommended that Medicare require prior authorization of MRIs, CTs, and nuclear imaging for physicians who order more of these tests than do their peers. This change would likely take an act of Congress, however.

The commission outlined a process whereby physicians who are found to order more – but within appropriate bounds – would merely be subject to a prior notification process.

The commissioners did not embrace outright the radiology benefits management (RBM) model that's used in the private sector, but Mr. Miller said that ultimately a Medicare contractor would administer the process, and that an RBM might be eligible.

The report also contained recommendations on improving how Medicare can support physicians and other health care providers interested in improving the quality of care they deliver. Among the biggest changes: Take some payments that would go to Quality Improvement Organizations, and funnel them directly to providers or communities that want to band together to create their own quality improvement programs.

The report can be viewed online at http://medpac.gov/documents/Jun11_EntireReport.pdf

Stroke Care Disparities

The burden of strokes continues to weigh more heavily on blacks and Hispanics than whites, according to a joint scientific statement from the American Heart Association and the American Stroke Association. “We see disparities in every aspect of stroke care, from lack of awareness of stroke risk factors and symptoms to delayed arrival to the emergency room and increased waiting time,” Dr. Salvador Cruz-Flores, neurology professor at the Souers Stroke Institute at St. Louis University, said in a press statement. He led a panel of biostatisticians, epidemiologists, nurses, cardiologists, and vascular neurologists that found a higher prevalence and incidence of stroke in blacks and Hispanics than in whites. The panel noted that the percentage of racial and ethnic minorities in the U.S. population could double by 2050, so it is urgent to address disparities in stroke and stroke care. The statement added that researchers have a poor understanding of socioeconomic factors that may contribute to the disparities.

Clot Buster Underused

Although the use of tissue plasminogen activator has increased, still only a fraction of eligible Americans are receiving the clot-busting therapy, researchers at the University of Cincinnati found. Dr. Opeolu Adeoye and his colleagues used 2005-2009 Medicare and pharmacy records showing whether TPA was administered to people suffering acute ischemic strokes. In 2005, 1%-1.4% of those patients were given the Food and Drug Administration–approved clot buster. Four years later, 3%-3.4% were recorded as having received the drug. When the authors adjusted for potential billing errors, they concluded that as many as 5% of eligible patients were getting TPA in 2009. That still means that between 23,800 and 36,000 of the 700,000 Americans who had an ischemic stroke got TPA that year. The study was published in the journal Stroke.

Group Backs Stent Fight

The Society for Cardiovascular Angiography and Interventions said it backs hospitals in Texas and Oklahoma fighting Medicare denials of payment for admission of patients getting coronary stents (MS-DRG 247 claims). The American Hospital Association and its state affiliates wrote Medicare administrators objecting to denials of medically necessary admissions made by Trailblazer Health Enterprises, a Medicare contractor. The hospital groups said that Trailblazer's coverage decisions appeared based on stay lengths rather than patients' clinical characteristics, a violation of Medicare policy. The groups asked the Centers for Medicare and Medicaid Services to suspend Trailblazer's audits of MS-DRG 247 claims until the issue is resolved.

Multispecialty Groups Pay Better

Specialists working in multispecialty practices had higher starting salaries last year than did those working in single-specialty groups, according to new data from the Medical Group Management Association. Multispecialty groups paid a median $258,677 in guaranteed compensation, whereas single-specialty practices paid $240,598 to specialists. But the opposite was true in primary care: The median first-year guaranteed salary was $172,400 in single-specialty group practices, while multispecialty groups paid $165,000. The median annual compensation for rheumatologists during their first year after residency, including physicians in fellowships, was $190,000. “First-year” compensation for rheumatologists, excluding those just out of residency or in fellowships, was $205,000. The figures come from the association's Physician Placement Starting Salary Survey.

Older Americans Doing Just Fine

Older Americans beat out all other age groups on various measures of well-being, with higher scores on healthy behaviors, work satisfaction, and access to necessities, according to a Gallup poll. Americans aged older than 65 years scored 69 out of 100 on a well-being index, which measures physical, mental, social, and emotional health. Adults aged 18-29 years scored 68, those aged 30-44 scored 67, and people aged 45-64 trailed with a score of 65. The survey report indicated that seniors tend to be less sad and depressed than any other age group, although they fall slightly behind others in physical health.

No, It's Never Healthy

The Food and Drug Administration has warned online retailers to stop marketing tobacco products with misleading or unsubstantiated claims that the products can reduce the risk of tobacco-related diseases. In 11 warning letters, the agency cited the online retailers for a variety of illegal claims, including use of terms such as “light,” “mild,” “low,” “less toxic,” and “safer.” Companies can't make these claims unless the FDA has okayed them, and the FDA hasn't okayed any such claim for any tobacco product. The agency also cited some Internet retailers for selling flavored cigarettes. “There is no known safe tobacco product,” said Dr. Lawrence Deyton, director of the FDA's Center for Tobacco Products, in a statement. “It is illegal for tobacco companies or retailers, including Internet sellers, to make unsubstantiated claims or statements that imply tobacco products reduce health risks.”

Stroke Care Disparities

The burden of strokes continues to weigh more heavily on blacks and Hispanics than whites, according to a joint scientific statement from the American Heart Association and the American Stroke Association. “We see disparities in every aspect of stroke care, from lack of awareness of stroke risk factors and symptoms to delayed arrival to the emergency room and increased waiting time,” Dr. Salvador Cruz-Flores, neurology professor at the Souers Stroke Institute at St. Louis University, said in a press statement. He led a panel of biostatisticians, epidemiologists, nurses, cardiologists, and vascular neurologists that found a higher prevalence and incidence of stroke in blacks and Hispanics than in whites. The panel noted that the percentage of racial and ethnic minorities in the U.S. population could double by 2050, so it is urgent to address disparities in stroke and stroke care. The statement added that researchers have a poor understanding of socioeconomic factors that may contribute to the disparities.

Clot Buster Underused

Although the use of tissue plasminogen activator has increased, still only a fraction of eligible Americans are receiving the clot-busting therapy, researchers at the University of Cincinnati found. Dr. Opeolu Adeoye and his colleagues used 2005-2009 Medicare and pharmacy records showing whether TPA was administered to people suffering acute ischemic strokes. In 2005, 1%-1.4% of those patients were given the Food and Drug Administration–approved clot buster. Four years later, 3%-3.4% were recorded as having received the drug. When the authors adjusted for potential billing errors, they concluded that as many as 5% of eligible patients were getting TPA in 2009. That still means that between 23,800 and 36,000 of the 700,000 Americans who had an ischemic stroke got TPA that year. The study was published in the journal Stroke.

Group Backs Stent Fight

The Society for Cardiovascular Angiography and Interventions said it backs hospitals in Texas and Oklahoma fighting Medicare denials of payment for admission of patients getting coronary stents (MS-DRG 247 claims). The American Hospital Association and its state affiliates wrote Medicare administrators objecting to denials of medically necessary admissions made by Trailblazer Health Enterprises, a Medicare contractor. The hospital groups said that Trailblazer's coverage decisions appeared based on stay lengths rather than patients' clinical characteristics, a violation of Medicare policy. The groups asked the Centers for Medicare and Medicaid Services to suspend Trailblazer's audits of MS-DRG 247 claims until the issue is resolved.

Multispecialty Groups Pay Better

Specialists working in multispecialty practices had higher starting salaries last year than did those working in single-specialty groups, according to new data from the Medical Group Management Association. Multispecialty groups paid a median $258,677 in guaranteed compensation, whereas single-specialty practices paid $240,598 to specialists. But the opposite was true in primary care: The median first-year guaranteed salary was $172,400 in single-specialty group practices, while multispecialty groups paid $165,000. The median annual compensation for rheumatologists during their first year after residency, including physicians in fellowships, was $190,000. “First-year” compensation for rheumatologists, excluding those just out of residency or in fellowships, was $205,000. The figures come from the association's Physician Placement Starting Salary Survey.

Older Americans Doing Just Fine

Older Americans beat out all other age groups on various measures of well-being, with higher scores on healthy behaviors, work satisfaction, and access to necessities, according to a Gallup poll. Americans aged older than 65 years scored 69 out of 100 on a well-being index, which measures physical, mental, social, and emotional health. Adults aged 18-29 years scored 68, those aged 30-44 scored 67, and people aged 45-64 trailed with a score of 65. The survey report indicated that seniors tend to be less sad and depressed than any other age group, although they fall slightly behind others in physical health.

No, It's Never Healthy

The Food and Drug Administration has warned online retailers to stop marketing tobacco products with misleading or unsubstantiated claims that the products can reduce the risk of tobacco-related diseases. In 11 warning letters, the agency cited the online retailers for a variety of illegal claims, including use of terms such as “light,” “mild,” “low,” “less toxic,” and “safer.” Companies can't make these claims unless the FDA has okayed them, and the FDA hasn't okayed any such claim for any tobacco product. The agency also cited some Internet retailers for selling flavored cigarettes. “There is no known safe tobacco product,” said Dr. Lawrence Deyton, director of the FDA's Center for Tobacco Products, in a statement. “It is illegal for tobacco companies or retailers, including Internet sellers, to make unsubstantiated claims or statements that imply tobacco products reduce health risks.”

Stroke Care Disparities

The burden of strokes continues to weigh more heavily on blacks and Hispanics than whites, according to a joint scientific statement from the American Heart Association and the American Stroke Association. “We see disparities in every aspect of stroke care, from lack of awareness of stroke risk factors and symptoms to delayed arrival to the emergency room and increased waiting time,” Dr. Salvador Cruz-Flores, neurology professor at the Souers Stroke Institute at St. Louis University, said in a press statement. He led a panel of biostatisticians, epidemiologists, nurses, cardiologists, and vascular neurologists that found a higher prevalence and incidence of stroke in blacks and Hispanics than in whites. The panel noted that the percentage of racial and ethnic minorities in the U.S. population could double by 2050, so it is urgent to address disparities in stroke and stroke care. The statement added that researchers have a poor understanding of socioeconomic factors that may contribute to the disparities.

Clot Buster Underused

Although the use of tissue plasminogen activator has increased, still only a fraction of eligible Americans are receiving the clot-busting therapy, researchers at the University of Cincinnati found. Dr. Opeolu Adeoye and his colleagues used 2005-2009 Medicare and pharmacy records showing whether TPA was administered to people suffering acute ischemic strokes. In 2005, 1%-1.4% of those patients were given the Food and Drug Administration–approved clot buster. Four years later, 3%-3.4% were recorded as having received the drug. When the authors adjusted for potential billing errors, they concluded that as many as 5% of eligible patients were getting TPA in 2009. That still means that between 23,800 and 36,000 of the 700,000 Americans who had an ischemic stroke got TPA that year. The study was published in the journal Stroke.

Group Backs Stent Fight

The Society for Cardiovascular Angiography and Interventions said it backs hospitals in Texas and Oklahoma fighting Medicare denials of payment for admission of patients getting coronary stents (MS-DRG 247 claims). The American Hospital Association and its state affiliates wrote Medicare administrators objecting to denials of medically necessary admissions made by Trailblazer Health Enterprises, a Medicare contractor. The hospital groups said that Trailblazer's coverage decisions appeared based on stay lengths rather than patients' clinical characteristics, a violation of Medicare policy. The groups asked the Centers for Medicare and Medicaid Services to suspend Trailblazer's audits of MS-DRG 247 claims until the issue is resolved.

Multispecialty Groups Pay Better

Specialists working in multispecialty practices had higher starting salaries last year than did those working in single-specialty groups, according to new data from the Medical Group Management Association. Multispecialty groups paid a median $258,677 in guaranteed compensation, whereas single-specialty practices paid $240,598 to specialists. But the opposite was true in primary care: The median first-year guaranteed salary was $172,400 in single-specialty group practices, while multispecialty groups paid $165,000. The median annual compensation for rheumatologists during their first year after residency, including physicians in fellowships, was $190,000. “First-year” compensation for rheumatologists, excluding those just out of residency or in fellowships, was $205,000. The figures come from the association's Physician Placement Starting Salary Survey.

Older Americans Doing Just Fine

Older Americans beat out all other age groups on various measures of well-being, with higher scores on healthy behaviors, work satisfaction, and access to necessities, according to a Gallup poll. Americans aged older than 65 years scored 69 out of 100 on a well-being index, which measures physical, mental, social, and emotional health. Adults aged 18-29 years scored 68, those aged 30-44 scored 67, and people aged 45-64 trailed with a score of 65. The survey report indicated that seniors tend to be less sad and depressed than any other age group, although they fall slightly behind others in physical health.

No, It's Never Healthy

The Food and Drug Administration has warned online retailers to stop marketing tobacco products with misleading or unsubstantiated claims that the products can reduce the risk of tobacco-related diseases. In 11 warning letters, the agency cited the online retailers for a variety of illegal claims, including use of terms such as “light,” “mild,” “low,” “less toxic,” and “safer.” Companies can't make these claims unless the FDA has okayed them, and the FDA hasn't okayed any such claim for any tobacco product. The agency also cited some Internet retailers for selling flavored cigarettes. “There is no known safe tobacco product,” said Dr. Lawrence Deyton, director of the FDA's Center for Tobacco Products, in a statement. “It is illegal for tobacco companies or retailers, including Internet sellers, to make unsubstantiated claims or statements that imply tobacco products reduce health risks.”

The Centers for Medicare and Medicaid Services has proposed modifying the rules for e-prescribing so more physicians could claim exemptions from the criteria and therefore avoid being penalized in 2012.

In a conference call with reporters, agency officials said the change-up in the e-prescribing program was in response to indications from providers and professional societies that many prescribers might not be able to meet the requirements of the current incentive program.

“Today's rule demonstrates that CMS is willing to work cooperatively with the medical professional community to encourage participation in electronic prescribing,” Dr. Patrick Conway, chief medical officer at CMS and director of the agency's Office of Clinical Standards and Quality, said in a statement.

“These proposed changes will continue to encourage adoption of electronic prescribing while acknowledging circumstances that may keep health professionals from realizing the full potential of these systems right away,” he said.

Under the current incentive program, which was established in the Medicare Improvements for Patients and Providers Act of 2008, eligible prescribers were due to get a 1% bonus payment for 2011 and 2012 and a 0.5% bonus in 2013. For prescribers who did not meet the criteria, there would be a penalty imposed in 2012. The penalty would escalate in 2013 and 2014.

The final Medicare Physician Fee Schedule for 2011 contains exceptions to the criteria, along with two hardship exemptions. Eligible professional practices are exempt if they are in a rural area without high-speed internet access or an area without enough available pharmacies for electronic prescribing.

The proposed rule would modify the criteria. For instance, prescribers who use certified electronic health records can now claim this as a “qualified” e-prescribing system. This move was designed to more closely align the e-prescribing program with the program that offers incentives for meaningful use of electronic health records.

In addition, the proposed rule would create four additional hardship exemption categories. Eligible professionals would have to demonstrate that they have:

▸ registered to participate in the Medicare or Medicaid EHR incentive program and have adopted certified EHR technology.

▸ an inability to electronically prescribe due to local, state, or federal law (this primarily applies to prescribing of narcotics).

▸ very limited prescribing activity.

▸ and insufficient opportunities to report the electronic prescribing measure due to limitations on the measure's denominator.

Prescribers also would be granted an extension of the deadline, until Oct. 1, 2011, to apply for the hardship exemption.

CMS officials said that this proposal is not the final word. “This is the proposed rule, so we're looking for additional comments from stakeholders,” Dr. Conway said during the briefing.

The comment period closes July 26. According to Dr. Michael Rapp, director of quality measurement at CMS, who also spoke to reporters, it will probably take until at least August to have a final rule published.

The Centers for Medicare and Medicaid Services has proposed modifying the rules for e-prescribing so more physicians could claim exemptions from the criteria and therefore avoid being penalized in 2012.

In a conference call with reporters, agency officials said the change-up in the e-prescribing program was in response to indications from providers and professional societies that many prescribers might not be able to meet the requirements of the current incentive program.

“Today's rule demonstrates that CMS is willing to work cooperatively with the medical professional community to encourage participation in electronic prescribing,” Dr. Patrick Conway, chief medical officer at CMS and director of the agency's Office of Clinical Standards and Quality, said in a statement.

“These proposed changes will continue to encourage adoption of electronic prescribing while acknowledging circumstances that may keep health professionals from realizing the full potential of these systems right away,” he said.

Under the current incentive program, which was established in the Medicare Improvements for Patients and Providers Act of 2008, eligible prescribers were due to get a 1% bonus payment for 2011 and 2012 and a 0.5% bonus in 2013. For prescribers who did not meet the criteria, there would be a penalty imposed in 2012. The penalty would escalate in 2013 and 2014.

The final Medicare Physician Fee Schedule for 2011 contains exceptions to the criteria, along with two hardship exemptions. Eligible professional practices are exempt if they are in a rural area without high-speed internet access or an area without enough available pharmacies for electronic prescribing.

The proposed rule would modify the criteria. For instance, prescribers who use certified electronic health records can now claim this as a “qualified” e-prescribing system. This move was designed to more closely align the e-prescribing program with the program that offers incentives for meaningful use of electronic health records.

In addition, the proposed rule would create four additional hardship exemption categories. Eligible professionals would have to demonstrate that they have:

▸ registered to participate in the Medicare or Medicaid EHR incentive program and have adopted certified EHR technology.

▸ an inability to electronically prescribe due to local, state, or federal law (this primarily applies to prescribing of narcotics).

▸ very limited prescribing activity.

▸ and insufficient opportunities to report the electronic prescribing measure due to limitations on the measure's denominator.

Prescribers also would be granted an extension of the deadline, until Oct. 1, 2011, to apply for the hardship exemption.

CMS officials said that this proposal is not the final word. “This is the proposed rule, so we're looking for additional comments from stakeholders,” Dr. Conway said during the briefing.

The comment period closes July 26. According to Dr. Michael Rapp, director of quality measurement at CMS, who also spoke to reporters, it will probably take until at least August to have a final rule published.

The Centers for Medicare and Medicaid Services has proposed modifying the rules for e-prescribing so more physicians could claim exemptions from the criteria and therefore avoid being penalized in 2012.

In a conference call with reporters, agency officials said the change-up in the e-prescribing program was in response to indications from providers and professional societies that many prescribers might not be able to meet the requirements of the current incentive program.

“Today's rule demonstrates that CMS is willing to work cooperatively with the medical professional community to encourage participation in electronic prescribing,” Dr. Patrick Conway, chief medical officer at CMS and director of the agency's Office of Clinical Standards and Quality, said in a statement.

“These proposed changes will continue to encourage adoption of electronic prescribing while acknowledging circumstances that may keep health professionals from realizing the full potential of these systems right away,” he said.

Under the current incentive program, which was established in the Medicare Improvements for Patients and Providers Act of 2008, eligible prescribers were due to get a 1% bonus payment for 2011 and 2012 and a 0.5% bonus in 2013. For prescribers who did not meet the criteria, there would be a penalty imposed in 2012. The penalty would escalate in 2013 and 2014.

The final Medicare Physician Fee Schedule for 2011 contains exceptions to the criteria, along with two hardship exemptions. Eligible professional practices are exempt if they are in a rural area without high-speed internet access or an area without enough available pharmacies for electronic prescribing.

The proposed rule would modify the criteria. For instance, prescribers who use certified electronic health records can now claim this as a “qualified” e-prescribing system. This move was designed to more closely align the e-prescribing program with the program that offers incentives for meaningful use of electronic health records.

In addition, the proposed rule would create four additional hardship exemption categories. Eligible professionals would have to demonstrate that they have:

▸ registered to participate in the Medicare or Medicaid EHR incentive program and have adopted certified EHR technology.

▸ an inability to electronically prescribe due to local, state, or federal law (this primarily applies to prescribing of narcotics).

▸ very limited prescribing activity.

▸ and insufficient opportunities to report the electronic prescribing measure due to limitations on the measure's denominator.

Prescribers also would be granted an extension of the deadline, until Oct. 1, 2011, to apply for the hardship exemption.

CMS officials said that this proposal is not the final word. “This is the proposed rule, so we're looking for additional comments from stakeholders,” Dr. Conway said during the briefing.

The comment period closes July 26. According to Dr. Michael Rapp, director of quality measurement at CMS, who also spoke to reporters, it will probably take until at least August to have a final rule published.

Physician incentives for the meaningful use of electronic health records total $75 million, the Centers for Medicare and Medicaid Services announced.

The payments were made to physicians who had registered for the incentive program in the first 2 weeks of eligibility. Starting April 18, physicians could go to a secure CMS website and “attest” that they had complied with program requirements for a continuous 90-day reporting period during the first year of participation in the Medicare EHR incentive program.

The program was created under the Health Information Technology Economic and Clinical Health Act (HITECH), which was part of the American Recovery and Reinvestment Act of 2009.

Physicians, hospitals, and other eligible providers in seven states have received an additional $83.3 million in incentive payments under Medicaid.

Each state is launching a separate program. In January, programs began in Alaska, Iowa, Kentucky, Louisiana, Michigan, Mississippi, North Carolina, Oklahoma, South Carolina, Tennessee, and Texas. In April, Alabama and Missouri began programs, and in May, Indiana and Ohio launched programs.

CMS officials said they expect incentive payments to grow, and that more professionals and hospitals will register for the Medicare and Medicaid incentives.

As of April 30, 42,600 eligible physicians and hospitals had registered for the two programs.

“I'm looking forward to continued growth and greater adoption,” CMS Administrator Dr. Donald Berwick said in a briefing with reporters.

Under Medicare, eligible providers can receive up to $44,000 over 5 years. Under the Medicaid program, eligible providers can get up to $63,750 over 6 years.

Dr. Farzad Mostashari, National Coordinator for Health Information Technology, said the meaningful use criteria under the Medicare EHR incentive program is “providing [a] model for a coordinated national transition to health information technology.”

Physician incentives for the meaningful use of electronic health records total $75 million, the Centers for Medicare and Medicaid Services announced.

The payments were made to physicians who had registered for the incentive program in the first 2 weeks of eligibility. Starting April 18, physicians could go to a secure CMS website and “attest” that they had complied with program requirements for a continuous 90-day reporting period during the first year of participation in the Medicare EHR incentive program.

The program was created under the Health Information Technology Economic and Clinical Health Act (HITECH), which was part of the American Recovery and Reinvestment Act of 2009.

Physicians, hospitals, and other eligible providers in seven states have received an additional $83.3 million in incentive payments under Medicaid.

Each state is launching a separate program. In January, programs began in Alaska, Iowa, Kentucky, Louisiana, Michigan, Mississippi, North Carolina, Oklahoma, South Carolina, Tennessee, and Texas. In April, Alabama and Missouri began programs, and in May, Indiana and Ohio launched programs.

CMS officials said they expect incentive payments to grow, and that more professionals and hospitals will register for the Medicare and Medicaid incentives.

As of April 30, 42,600 eligible physicians and hospitals had registered for the two programs.

“I'm looking forward to continued growth and greater adoption,” CMS Administrator Dr. Donald Berwick said in a briefing with reporters.

Under Medicare, eligible providers can receive up to $44,000 over 5 years. Under the Medicaid program, eligible providers can get up to $63,750 over 6 years.

Dr. Farzad Mostashari, National Coordinator for Health Information Technology, said the meaningful use criteria under the Medicare EHR incentive program is “providing [a] model for a coordinated national transition to health information technology.”

Physician incentives for the meaningful use of electronic health records total $75 million, the Centers for Medicare and Medicaid Services announced.

The payments were made to physicians who had registered for the incentive program in the first 2 weeks of eligibility. Starting April 18, physicians could go to a secure CMS website and “attest” that they had complied with program requirements for a continuous 90-day reporting period during the first year of participation in the Medicare EHR incentive program.

The program was created under the Health Information Technology Economic and Clinical Health Act (HITECH), which was part of the American Recovery and Reinvestment Act of 2009.

Physicians, hospitals, and other eligible providers in seven states have received an additional $83.3 million in incentive payments under Medicaid.

Each state is launching a separate program. In January, programs began in Alaska, Iowa, Kentucky, Louisiana, Michigan, Mississippi, North Carolina, Oklahoma, South Carolina, Tennessee, and Texas. In April, Alabama and Missouri began programs, and in May, Indiana and Ohio launched programs.

CMS officials said they expect incentive payments to grow, and that more professionals and hospitals will register for the Medicare and Medicaid incentives.

As of April 30, 42,600 eligible physicians and hospitals had registered for the two programs.

“I'm looking forward to continued growth and greater adoption,” CMS Administrator Dr. Donald Berwick said in a briefing with reporters.

Under Medicare, eligible providers can receive up to $44,000 over 5 years. Under the Medicaid program, eligible providers can get up to $63,750 over 6 years.

Dr. Farzad Mostashari, National Coordinator for Health Information Technology, said the meaningful use criteria under the Medicare EHR incentive program is “providing [a] model for a coordinated national transition to health information technology.”

CHICAGO – The diversity of opinion within organized medicine got a full airing when delegates to the American Medical Association House of Delegates were asked to consider whether to maintain support of an individual mandate for health insurance.

While the 325-165 vote was overwhelmingly in favor of reaffirming that policy, it was preceded by hours of rancorous debate.

“It was a debate in which both sides who feel passionately about this question were able to be heard,” said Dr. Cecil Wilson, AMA president. “What is important to emphasize is fully two-thirds of the House said today our policy is good.”

Many delegates used the debate over the AMA policy as a surrogate for debate on the Affordable Care Act (ACA), while others viewed it as a platform for their dissatisfaction with the AMA's support of health reform.

While concerns about the ACA still linger, majority support of the individual mandate represents a growing progressive tide within the physician community, according to Dr. Stuart Cohen, delegate with the American Academy of Pediatrics. “While the minority is very vocal and extremely articulate, I think we're seeing a change in organized medicine based on changing employment trends and the needs, aspirations, and concerns of the more progressive, younger physicians,” Dr. Cohen told

Policy Evolution

As far back as 1998, AMA promoted the idea that individuals with financial means should buy health insurance.

That idea was formalized as organizational policy at the 2010 House of Delegates meeting; however, at that time, delegations from Kansas, District of Columbia, Florida, Georgia, and the American Society of General Surgeons (ASGS) dissented and offered a resolution to withdraw support for the mandate.

The 2010 House voted to refer the question to the Board of Trustees, which tasked the Council on Medical Service (COMS) to study the issue. This year, COMS issued a report stating that not only is individual mandate the best way to ensure wider insurance coverage, but also that there is no viable alternative.

The response was a slew of resolutions addressing all sides of the issue.

One coalition offered a resolution to encourage patient responsibility via tax incentives instead of via a mandate.

The Ohio delegation offered a resolution to support “free market solutions” to achieve universal access.

Conversely, a large coalition of primary care and specialty organizations – including the AAP – as well as state delegations offered a resolution to reaffirm AMA policy and expand it somewhat.

The main debate occurred over a 3-hour period in front of Reference Committee A.

Dr. Wilson reminded delegates that the organization's long-standing position backing the individual mandate reaches back to before the most recent health reform efforts. “During that intervening time, there has been no additional evidence to suggest that we have another alternative,” said Dr. Wilson, an internist from Winter Park, Fla. “I would suggest that our decision in the middle of the last decade was a good decision. I think the need to stay with it is even more so now,” he said.

Reaffirmation Despite Opposition

On June 20, a day after the Reference Committee debate, that panel brought its recommendation to the floor. The committee recommended that the House vote to reaffirm current policy and reject alternative resolutions

To accommodate more debate, House Speaker Andrew Gurman, a hand surgeon from Altoona, Pa., established a precedent. Delegates who wanted to express an opinion were asked to line up at microphones marked either “pro” or “con.”

Dr. Richard Warner of the Kansas delegation, at the con mic, offered a new amendment that called on the AMA to back states' rights. “No matter what the court does, I think there is going to remain division in the country and division in the AMA about the role of the individual mandate, so probably the best solution to that is to allow a mandate to exist as policy but in control of states rather than at the federal level,” said Dr. Warner, a psychiatrist from Overland Park.

Georgia delegate Dr. Michael Greene agreed. “I believe that each state working with the population it has, and the specific problems that it has, can craft a solution that works better for that state perhaps than the one next door.” He pointed to Massachusetts as an example where the state had determined what worked for its citizens.

But Dr. Melissa Garretson, a Ft. Worth, Tex., pediatrician and AAP delegate, said that while physicians might be angry about the AMA policy, “I have 700,000 uninsured pediatric patients in Texas who are angry, too. The evidence has shown that mandating insurance coverage gives us the highest percentage of insured individuals in this country,” she said.

The Kansas amendment backing states' rights was voted down by almost 60% of the delegates. A similar amendment seeking to give states flexibility was offered by another delegation but was ruled as out of order. The delegates backed this ruling and voted down the amendment.

Frances Correa contributed to this report.

AMA president Cecil Wilson said, “What is important to emphasize is fully two-thirds of the House said today our policy is good.”

Source Alicia Ault/Elseiver Global Medical News

In other news at the AMA House of Delegates meeting:

Medicaid as Block Grants

The AAP introduced a resolution calling for the AMA to strongly oppose block granting Medicaid. Dr. Garretson spoke on the need to maintain the federal/state partnership under Medicaid so that recipients can be ensured of basic benefits no matter where in the United States they live. “Right now, what this language says is that the state gets to decide,” she said. “Well, I live in that state where they could give a you-know-what about the 1.1 million uninsured kids and they don't want to do anything with Medicaid. That's just not where they are.” Dr. Marion Burton, also an AAP delegate, agreed. “For the AMA to go on record as supporting block grants would cause millions of children to be thrown under the uninsured bus,” he said. The resolution was referred to the board of trustees for a later decision.

Membership Hit

Some state delegations complained during the debates that the AMA's support of the ACA had led to a decline in membership. Dr. Niranjan “Bonki” Rao, president of the New Jersey Medical Society, said that he had been a top recruiter for the AMA, but that it was becoming an uphill battle. “After recent events, it has become extremely difficult, if not impossible, to convince doctors to join AMA,” Dr. Rao said on the House floor. Overall membership declined by 5%, or about 12,000, from 2009 to 2010, to a total of 215,854 members. An AMA committee looking at membership issues reported that the numbers for 2011 may increase this year.

Ban on 'Bath Salts'

The House of Delegates adopted a policy to support a national ban on “bath salts,” synthetic substances that can cause severe physical and psychological effects including paranoia, hypertension, tremors, hallucinations, and violent behavior. The substance contains compounds including methylenedioxypyrovalerone and is sold at head shops nationwide in the form of crystallized or powdered bath salts that users eat, inject, or inhale. Some states have banned bath salts or are considering doing so.

Patient Counseling

Absent any further discussion or debate, the House of Delegates unanimously passed a resolution opposing any state or federal restriction on the topics physicians can discuss with their patients. The resolution was introduced in reaction to a Florida law restricting doctors inquiring about gun ownership, unless there is a related health or safety concern. The resolution states that such measures restrict the doctor's first amendment rights and restrict the privacy of the patient-physician relationship.

Body Image and Healthy Eating

The Medical Students Section introduced several resolutions aimed at addressing the affects of the obesity epidemic on youth. One resolution, passed by a voice vote, encourages fast-food restaurants to offer nutritious items such as salads at price parity with sandwiches and fries. The same resolution discourages marketing incentives such as meal toys. Opponents argued the AMA should not interfere.

–Frances Correa

CHICAGO – The diversity of opinion within organized medicine got a full airing when delegates to the American Medical Association House of Delegates were asked to consider whether to maintain support of an individual mandate for health insurance.

While the 325-165 vote was overwhelmingly in favor of reaffirming that policy, it was preceded by hours of rancorous debate.

“It was a debate in which both sides who feel passionately about this question were able to be heard,” said Dr. Cecil Wilson, AMA president. “What is important to emphasize is fully two-thirds of the House said today our policy is good.”

Many delegates used the debate over the AMA policy as a surrogate for debate on the Affordable Care Act (ACA), while others viewed it as a platform for their dissatisfaction with the AMA's support of health reform.

While concerns about the ACA still linger, majority support of the individual mandate represents a growing progressive tide within the physician community, according to Dr. Stuart Cohen, delegate with the American Academy of Pediatrics. “While the minority is very vocal and extremely articulate, I think we're seeing a change in organized medicine based on changing employment trends and the needs, aspirations, and concerns of the more progressive, younger physicians,” Dr. Cohen told

Policy Evolution

As far back as 1998, AMA promoted the idea that individuals with financial means should buy health insurance.

That idea was formalized as organizational policy at the 2010 House of Delegates meeting; however, at that time, delegations from Kansas, District of Columbia, Florida, Georgia, and the American Society of General Surgeons (ASGS) dissented and offered a resolution to withdraw support for the mandate.

The 2010 House voted to refer the question to the Board of Trustees, which tasked the Council on Medical Service (COMS) to study the issue. This year, COMS issued a report stating that not only is individual mandate the best way to ensure wider insurance coverage, but also that there is no viable alternative.

The response was a slew of resolutions addressing all sides of the issue.

One coalition offered a resolution to encourage patient responsibility via tax incentives instead of via a mandate.

The Ohio delegation offered a resolution to support “free market solutions” to achieve universal access.

Conversely, a large coalition of primary care and specialty organizations – including the AAP – as well as state delegations offered a resolution to reaffirm AMA policy and expand it somewhat.

The main debate occurred over a 3-hour period in front of Reference Committee A.

Dr. Wilson reminded delegates that the organization's long-standing position backing the individual mandate reaches back to before the most recent health reform efforts. “During that intervening time, there has been no additional evidence to suggest that we have another alternative,” said Dr. Wilson, an internist from Winter Park, Fla. “I would suggest that our decision in the middle of the last decade was a good decision. I think the need to stay with it is even more so now,” he said.

Reaffirmation Despite Opposition

On June 20, a day after the Reference Committee debate, that panel brought its recommendation to the floor. The committee recommended that the House vote to reaffirm current policy and reject alternative resolutions

To accommodate more debate, House Speaker Andrew Gurman, a hand surgeon from Altoona, Pa., established a precedent. Delegates who wanted to express an opinion were asked to line up at microphones marked either “pro” or “con.”

Dr. Richard Warner of the Kansas delegation, at the con mic, offered a new amendment that called on the AMA to back states' rights. “No matter what the court does, I think there is going to remain division in the country and division in the AMA about the role of the individual mandate, so probably the best solution to that is to allow a mandate to exist as policy but in control of states rather than at the federal level,” said Dr. Warner, a psychiatrist from Overland Park.

Georgia delegate Dr. Michael Greene agreed. “I believe that each state working with the population it has, and the specific problems that it has, can craft a solution that works better for that state perhaps than the one next door.” He pointed to Massachusetts as an example where the state had determined what worked for its citizens.

But Dr. Melissa Garretson, a Ft. Worth, Tex., pediatrician and AAP delegate, said that while physicians might be angry about the AMA policy, “I have 700,000 uninsured pediatric patients in Texas who are angry, too. The evidence has shown that mandating insurance coverage gives us the highest percentage of insured individuals in this country,” she said.

The Kansas amendment backing states' rights was voted down by almost 60% of the delegates. A similar amendment seeking to give states flexibility was offered by another delegation but was ruled as out of order. The delegates backed this ruling and voted down the amendment.

Frances Correa contributed to this report.

AMA president Cecil Wilson said, “What is important to emphasize is fully two-thirds of the House said today our policy is good.”

Source Alicia Ault/Elseiver Global Medical News

In other news at the AMA House of Delegates meeting:

Medicaid as Block Grants

The AAP introduced a resolution calling for the AMA to strongly oppose block granting Medicaid. Dr. Garretson spoke on the need to maintain the federal/state partnership under Medicaid so that recipients can be ensured of basic benefits no matter where in the United States they live. “Right now, what this language says is that the state gets to decide,” she said. “Well, I live in that state where they could give a you-know-what about the 1.1 million uninsured kids and they don't want to do anything with Medicaid. That's just not where they are.” Dr. Marion Burton, also an AAP delegate, agreed. “For the AMA to go on record as supporting block grants would cause millions of children to be thrown under the uninsured bus,” he said. The resolution was referred to the board of trustees for a later decision.

Membership Hit

Some state delegations complained during the debates that the AMA's support of the ACA had led to a decline in membership. Dr. Niranjan “Bonki” Rao, president of the New Jersey Medical Society, said that he had been a top recruiter for the AMA, but that it was becoming an uphill battle. “After recent events, it has become extremely difficult, if not impossible, to convince doctors to join AMA,” Dr. Rao said on the House floor. Overall membership declined by 5%, or about 12,000, from 2009 to 2010, to a total of 215,854 members. An AMA committee looking at membership issues reported that the numbers for 2011 may increase this year.

Ban on 'Bath Salts'

The House of Delegates adopted a policy to support a national ban on “bath salts,” synthetic substances that can cause severe physical and psychological effects including paranoia, hypertension, tremors, hallucinations, and violent behavior. The substance contains compounds including methylenedioxypyrovalerone and is sold at head shops nationwide in the form of crystallized or powdered bath salts that users eat, inject, or inhale. Some states have banned bath salts or are considering doing so.

Patient Counseling

Absent any further discussion or debate, the House of Delegates unanimously passed a resolution opposing any state or federal restriction on the topics physicians can discuss with their patients. The resolution was introduced in reaction to a Florida law restricting doctors inquiring about gun ownership, unless there is a related health or safety concern. The resolution states that such measures restrict the doctor's first amendment rights and restrict the privacy of the patient-physician relationship.

Body Image and Healthy Eating

The Medical Students Section introduced several resolutions aimed at addressing the affects of the obesity epidemic on youth. One resolution, passed by a voice vote, encourages fast-food restaurants to offer nutritious items such as salads at price parity with sandwiches and fries. The same resolution discourages marketing incentives such as meal toys. Opponents argued the AMA should not interfere.

–Frances Correa

CHICAGO – The diversity of opinion within organized medicine got a full airing when delegates to the American Medical Association House of Delegates were asked to consider whether to maintain support of an individual mandate for health insurance.

While the 325-165 vote was overwhelmingly in favor of reaffirming that policy, it was preceded by hours of rancorous debate.

“It was a debate in which both sides who feel passionately about this question were able to be heard,” said Dr. Cecil Wilson, AMA president. “What is important to emphasize is fully two-thirds of the House said today our policy is good.”

Many delegates used the debate over the AMA policy as a surrogate for debate on the Affordable Care Act (ACA), while others viewed it as a platform for their dissatisfaction with the AMA's support of health reform.

While concerns about the ACA still linger, majority support of the individual mandate represents a growing progressive tide within the physician community, according to Dr. Stuart Cohen, delegate with the American Academy of Pediatrics. “While the minority is very vocal and extremely articulate, I think we're seeing a change in organized medicine based on changing employment trends and the needs, aspirations, and concerns of the more progressive, younger physicians,” Dr. Cohen told

Policy Evolution

As far back as 1998, AMA promoted the idea that individuals with financial means should buy health insurance.

That idea was formalized as organizational policy at the 2010 House of Delegates meeting; however, at that time, delegations from Kansas, District of Columbia, Florida, Georgia, and the American Society of General Surgeons (ASGS) dissented and offered a resolution to withdraw support for the mandate.

The 2010 House voted to refer the question to the Board of Trustees, which tasked the Council on Medical Service (COMS) to study the issue. This year, COMS issued a report stating that not only is individual mandate the best way to ensure wider insurance coverage, but also that there is no viable alternative.

The response was a slew of resolutions addressing all sides of the issue.

One coalition offered a resolution to encourage patient responsibility via tax incentives instead of via a mandate.

The Ohio delegation offered a resolution to support “free market solutions” to achieve universal access.

Conversely, a large coalition of primary care and specialty organizations – including the AAP – as well as state delegations offered a resolution to reaffirm AMA policy and expand it somewhat.

The main debate occurred over a 3-hour period in front of Reference Committee A.

Dr. Wilson reminded delegates that the organization's long-standing position backing the individual mandate reaches back to before the most recent health reform efforts. “During that intervening time, there has been no additional evidence to suggest that we have another alternative,” said Dr. Wilson, an internist from Winter Park, Fla. “I would suggest that our decision in the middle of the last decade was a good decision. I think the need to stay with it is even more so now,” he said.

Reaffirmation Despite Opposition

On June 20, a day after the Reference Committee debate, that panel brought its recommendation to the floor. The committee recommended that the House vote to reaffirm current policy and reject alternative resolutions

To accommodate more debate, House Speaker Andrew Gurman, a hand surgeon from Altoona, Pa., established a precedent. Delegates who wanted to express an opinion were asked to line up at microphones marked either “pro” or “con.”

Dr. Richard Warner of the Kansas delegation, at the con mic, offered a new amendment that called on the AMA to back states' rights. “No matter what the court does, I think there is going to remain division in the country and division in the AMA about the role of the individual mandate, so probably the best solution to that is to allow a mandate to exist as policy but in control of states rather than at the federal level,” said Dr. Warner, a psychiatrist from Overland Park.

Georgia delegate Dr. Michael Greene agreed. “I believe that each state working with the population it has, and the specific problems that it has, can craft a solution that works better for that state perhaps than the one next door.” He pointed to Massachusetts as an example where the state had determined what worked for its citizens.

But Dr. Melissa Garretson, a Ft. Worth, Tex., pediatrician and AAP delegate, said that while physicians might be angry about the AMA policy, “I have 700,000 uninsured pediatric patients in Texas who are angry, too. The evidence has shown that mandating insurance coverage gives us the highest percentage of insured individuals in this country,” she said.

The Kansas amendment backing states' rights was voted down by almost 60% of the delegates. A similar amendment seeking to give states flexibility was offered by another delegation but was ruled as out of order. The delegates backed this ruling and voted down the amendment.

Frances Correa contributed to this report.

AMA president Cecil Wilson said, “What is important to emphasize is fully two-thirds of the House said today our policy is good.”

Source Alicia Ault/Elseiver Global Medical News

In other news at the AMA House of Delegates meeting:

Medicaid as Block Grants

The AAP introduced a resolution calling for the AMA to strongly oppose block granting Medicaid. Dr. Garretson spoke on the need to maintain the federal/state partnership under Medicaid so that recipients can be ensured of basic benefits no matter where in the United States they live. “Right now, what this language says is that the state gets to decide,” she said. “Well, I live in that state where they could give a you-know-what about the 1.1 million uninsured kids and they don't want to do anything with Medicaid. That's just not where they are.” Dr. Marion Burton, also an AAP delegate, agreed. “For the AMA to go on record as supporting block grants would cause millions of children to be thrown under the uninsured bus,” he said. The resolution was referred to the board of trustees for a later decision.

Membership Hit

Some state delegations complained during the debates that the AMA's support of the ACA had led to a decline in membership. Dr. Niranjan “Bonki” Rao, president of the New Jersey Medical Society, said that he had been a top recruiter for the AMA, but that it was becoming an uphill battle. “After recent events, it has become extremely difficult, if not impossible, to convince doctors to join AMA,” Dr. Rao said on the House floor. Overall membership declined by 5%, or about 12,000, from 2009 to 2010, to a total of 215,854 members. An AMA committee looking at membership issues reported that the numbers for 2011 may increase this year.

Ban on 'Bath Salts'

The House of Delegates adopted a policy to support a national ban on “bath salts,” synthetic substances that can cause severe physical and psychological effects including paranoia, hypertension, tremors, hallucinations, and violent behavior. The substance contains compounds including methylenedioxypyrovalerone and is sold at head shops nationwide in the form of crystallized or powdered bath salts that users eat, inject, or inhale. Some states have banned bath salts or are considering doing so.

Patient Counseling

Absent any further discussion or debate, the House of Delegates unanimously passed a resolution opposing any state or federal restriction on the topics physicians can discuss with their patients. The resolution was introduced in reaction to a Florida law restricting doctors inquiring about gun ownership, unless there is a related health or safety concern. The resolution states that such measures restrict the doctor's first amendment rights and restrict the privacy of the patient-physician relationship.

Body Image and Healthy Eating

The Medical Students Section introduced several resolutions aimed at addressing the affects of the obesity epidemic on youth. One resolution, passed by a voice vote, encourages fast-food restaurants to offer nutritious items such as salads at price parity with sandwiches and fries. The same resolution discourages marketing incentives such as meal toys. Opponents argued the AMA should not interfere.

–Frances Correa