Nellie Bristol

WASHINGTON — Private bounty hunters are one way to fight fraud in the Medicaid program, according to Stan Dorn, J.D., who is senior analyst at the Economic and Social Research Institute.

Successfully used by Medicare, the bounty hunter approach allows whistle-blowers to share in funds recovered through prosecutions under the False Claims Act. According to recommendations developed by Andy Schneider, J.D., Medicaid policy expert for Taxpayers Against Fraud, Congress could bolster Medicaid whistle-blower opportunities by increasing federal payments to states that enact their own False Claims Act and by offering whistle-blowers a minimum of 20% of the federal share of any recovered funds.

At a policy forum sponsored by the American Public Health Association, Mr. Dorn included enhanced fraud reduction efforts among nine budget cutting options that would trim the cost of the program without capping spending or enrollment. Congress is expected to propose Medicaid program changes this year that will result in $10 billon in reduced federal spending over 5 years.

Mr. Dorn offered other cost savings alternatives, such as improving case management for the chronically ill and implementing community-based obesity prevention strategies. The Bush administration in its fiscal year 2006 budget proposed reducing Medicaid funding by reforming the program's drug purchasing system and limiting asset transfers that qualify seniors for long-term care.

Although limits on spending and benefits are not part of any current federal budget plans, lawmakers are looking broadly at Medicaid reform proposals this year; caps could be considered as part of those, Mr. Dorn pointed out at the forum, which was cosponsored by the Joint Center for Political and Economic Studies.

Not only would caps affect Medicaid recipients, but they also could prove detrimental to the economy, Mr. Dorn said.

Since Medicaid must provide benefits to all of those eligible, the bulk of the program is economically “countercyclical,” he said, meaning it expands as the economy contracts.

Not only does this ensure health benefits are available to low income individuals, but it also contributes to the flow of funds to health care providers and, in turn, other sectors of the economy.

To capitalize on Medicaid's stabilizing effects, Mr. Dorn suggested that federal matching rates could automatically rise when the economy slows. Using national and state unemployment rates as triggers, automatic adjustment would not require waiting for new federal legislation each time a recession begins and the increase would end promptly when economic conditions improved.

“It would be better timed and come into effect immediately,” Mr. Dorn noted.

Congress passed a 2.95% increase in the federal matching rate for the 15 months ending on June 30, 2004. Studies show the boost allowed states to continue Medicaid benefits even though state revenues shrank.

WASHINGTON — Private bounty hunters are one way to fight fraud in the Medicaid program, according to Stan Dorn, J.D., who is senior analyst at the Economic and Social Research Institute.

Successfully used by Medicare, the bounty hunter approach allows whistle-blowers to share in funds recovered through prosecutions under the False Claims Act. According to recommendations developed by Andy Schneider, J.D., Medicaid policy expert for Taxpayers Against Fraud, Congress could bolster Medicaid whistle-blower opportunities by increasing federal payments to states that enact their own False Claims Act and by offering whistle-blowers a minimum of 20% of the federal share of any recovered funds.

At a policy forum sponsored by the American Public Health Association, Mr. Dorn included enhanced fraud reduction efforts among nine budget cutting options that would trim the cost of the program without capping spending or enrollment. Congress is expected to propose Medicaid program changes this year that will result in $10 billon in reduced federal spending over 5 years.

Mr. Dorn offered other cost savings alternatives, such as improving case management for the chronically ill and implementing community-based obesity prevention strategies. The Bush administration in its fiscal year 2006 budget proposed reducing Medicaid funding by reforming the program's drug purchasing system and limiting asset transfers that qualify seniors for long-term care.

Although limits on spending and benefits are not part of any current federal budget plans, lawmakers are looking broadly at Medicaid reform proposals this year; caps could be considered as part of those, Mr. Dorn pointed out at the forum, which was cosponsored by the Joint Center for Political and Economic Studies.

Not only would caps affect Medicaid recipients, but they also could prove detrimental to the economy, Mr. Dorn said.

Since Medicaid must provide benefits to all of those eligible, the bulk of the program is economically “countercyclical,” he said, meaning it expands as the economy contracts.

Not only does this ensure health benefits are available to low income individuals, but it also contributes to the flow of funds to health care providers and, in turn, other sectors of the economy.

To capitalize on Medicaid's stabilizing effects, Mr. Dorn suggested that federal matching rates could automatically rise when the economy slows. Using national and state unemployment rates as triggers, automatic adjustment would not require waiting for new federal legislation each time a recession begins and the increase would end promptly when economic conditions improved.

“It would be better timed and come into effect immediately,” Mr. Dorn noted.

Congress passed a 2.95% increase in the federal matching rate for the 15 months ending on June 30, 2004. Studies show the boost allowed states to continue Medicaid benefits even though state revenues shrank.

WASHINGTON — Private bounty hunters are one way to fight fraud in the Medicaid program, according to Stan Dorn, J.D., who is senior analyst at the Economic and Social Research Institute.

Successfully used by Medicare, the bounty hunter approach allows whistle-blowers to share in funds recovered through prosecutions under the False Claims Act. According to recommendations developed by Andy Schneider, J.D., Medicaid policy expert for Taxpayers Against Fraud, Congress could bolster Medicaid whistle-blower opportunities by increasing federal payments to states that enact their own False Claims Act and by offering whistle-blowers a minimum of 20% of the federal share of any recovered funds.

At a policy forum sponsored by the American Public Health Association, Mr. Dorn included enhanced fraud reduction efforts among nine budget cutting options that would trim the cost of the program without capping spending or enrollment. Congress is expected to propose Medicaid program changes this year that will result in $10 billon in reduced federal spending over 5 years.

Mr. Dorn offered other cost savings alternatives, such as improving case management for the chronically ill and implementing community-based obesity prevention strategies. The Bush administration in its fiscal year 2006 budget proposed reducing Medicaid funding by reforming the program's drug purchasing system and limiting asset transfers that qualify seniors for long-term care.

Although limits on spending and benefits are not part of any current federal budget plans, lawmakers are looking broadly at Medicaid reform proposals this year; caps could be considered as part of those, Mr. Dorn pointed out at the forum, which was cosponsored by the Joint Center for Political and Economic Studies.

Not only would caps affect Medicaid recipients, but they also could prove detrimental to the economy, Mr. Dorn said.

Since Medicaid must provide benefits to all of those eligible, the bulk of the program is economically “countercyclical,” he said, meaning it expands as the economy contracts.

Not only does this ensure health benefits are available to low income individuals, but it also contributes to the flow of funds to health care providers and, in turn, other sectors of the economy.

To capitalize on Medicaid's stabilizing effects, Mr. Dorn suggested that federal matching rates could automatically rise when the economy slows. Using national and state unemployment rates as triggers, automatic adjustment would not require waiting for new federal legislation each time a recession begins and the increase would end promptly when economic conditions improved.

“It would be better timed and come into effect immediately,” Mr. Dorn noted.

Congress passed a 2.95% increase in the federal matching rate for the 15 months ending on June 30, 2004. Studies show the boost allowed states to continue Medicaid benefits even though state revenues shrank.

WASHINGTON — The Centers for Medicare and Medicaid Services will review national provider identifier protocols that now require separate numbers for each covered entity. The requirement could mean some physicians who are also part of group practices and other arrangements would have multiple NPI numbers.

At a meeting of the Practicing Physicians Advisory Council, members brought the issue to the attention of CMS's director of program integrity, Kimberly Brandt. “The goal here was to have less numbers, not more. So I appreciate your point, and it's a very good one. And that's something I will definitely look into,” Ms. Brandt said.

PPAC member Barbara McAneny, M.D., an oncologist from Albuquerque, suggested the review as part of a draft recommendation approved by the council. The recommendation suggests CMS clarify which current provider numbers would be replaced by the NPI number and which entities would need their own numbers.

Dr. McAneny also suggested CMS “put pressure” on other groups, including state licensure boards, “to eliminate some of the numbers and not to just add them on and add them on and add them on.…”

NPI enrollment began May 2 and continues through May 2007, when all providers will be required to use the system for standard electronic health care transactions. “With national standards and identifiers in place for electronic claims and other transactions, health care providers will be able to submit transactions to any health plan in the United States,” CMS Administrator Mark McClellan, M.D., said in a letter to health care providers. “Health plans will be able to send standard transactions such as remittance advices and referral authorization to health care providers.”

As a requirement of the Health Insurance Portability and Accountability Act, many health plans—including Medicare, Medicaid, private health insurance issuers, and health care clearinghouses—must use NPIs in standard transactions by May 2007. Small health plans have an additional year to comply. The number is intended to replace current numbers, including the unique physician identification number (UPIN).

Ms. Brandt told the advisory council that CMS is conducting a “massive outreach effort” to inform providers of the change and encourages them to apply for an NPI. Applications can be made electronically or through the mail.

To demonstrate the process of getting an NPI, PPAC Chairman Ronald Castellanos, M.D., got his number at the council's meeting, in a process that took approximately 8 minutes. “I'm not bleeding,” he said when asked how painful the process was.

PPAC member Geraldine O'Shea, D.O., an internist who practices in Jackson, Calif., also tried the NPI application process. She found that it “took some effort” and was more complicated than she expected.

“It appeared to be pretty simple, but you had to have many numbers available for the filing,” including a state license and a Medicare identifier. It would be helpful to have filing instructions, including a list of what is required, before starting the electronic application, Dr. O'Shea told this newspaper.

“Hopefully, that kind of instruction will be on Medlearn Matters,” she said, referring to articles issued by CMS to help providers understand Medicare policy.

CMS is encouraging health plans to devise a transition plan for a system that accepts both the UPIN and NPI until the May 2007 compliance deadline. Ms. Bryant said that although a few health plans already have systems developed, most do not—including Medicare, which she said will not have the “capacity to be fully changed over” until 2007.

“We need the next year and a half to finish getting our claims-processing system completely converted over, and then we'll begin the phase-out, I would say about 6–8 months ahead” of the May 2007 deadline, she said.

CMS advises that members of groups not sign up individually now but wait until fall, when “batch enumeration” systems will be in place to accept group applications.

Once assigned an NPI, providers will have that number for the remainder of their careers and need only contact CMS to make changes. The system will be meshed with Social Security information to track provider deaths, and the agency hopes to be able to coordinate with state licensing groups as well, Ms. Brandt told the council.

WASHINGTON — The Centers for Medicare and Medicaid Services will review national provider identifier protocols that now require separate numbers for each covered entity. The requirement could mean some physicians who are also part of group practices and other arrangements would have multiple NPI numbers.

At a meeting of the Practicing Physicians Advisory Council, members brought the issue to the attention of CMS's director of program integrity, Kimberly Brandt. “The goal here was to have less numbers, not more. So I appreciate your point, and it's a very good one. And that's something I will definitely look into,” Ms. Brandt said.

PPAC member Barbara McAneny, M.D., an oncologist from Albuquerque, suggested the review as part of a draft recommendation approved by the council. The recommendation suggests CMS clarify which current provider numbers would be replaced by the NPI number and which entities would need their own numbers.

Dr. McAneny also suggested CMS “put pressure” on other groups, including state licensure boards, “to eliminate some of the numbers and not to just add them on and add them on and add them on.…”

NPI enrollment began May 2 and continues through May 2007, when all providers will be required to use the system for standard electronic health care transactions. “With national standards and identifiers in place for electronic claims and other transactions, health care providers will be able to submit transactions to any health plan in the United States,” CMS Administrator Mark McClellan, M.D., said in a letter to health care providers. “Health plans will be able to send standard transactions such as remittance advices and referral authorization to health care providers.”

As a requirement of the Health Insurance Portability and Accountability Act, many health plans—including Medicare, Medicaid, private health insurance issuers, and health care clearinghouses—must use NPIs in standard transactions by May 2007. Small health plans have an additional year to comply. The number is intended to replace current numbers, including the unique physician identification number (UPIN).

Ms. Brandt told the advisory council that CMS is conducting a “massive outreach effort” to inform providers of the change and encourages them to apply for an NPI. Applications can be made electronically or through the mail.

To demonstrate the process of getting an NPI, PPAC Chairman Ronald Castellanos, M.D., got his number at the council's meeting, in a process that took approximately 8 minutes. “I'm not bleeding,” he said when asked how painful the process was.

PPAC member Geraldine O'Shea, D.O., an internist who practices in Jackson, Calif., also tried the NPI application process. She found that it “took some effort” and was more complicated than she expected.

“It appeared to be pretty simple, but you had to have many numbers available for the filing,” including a state license and a Medicare identifier. It would be helpful to have filing instructions, including a list of what is required, before starting the electronic application, Dr. O'Shea told this newspaper.

“Hopefully, that kind of instruction will be on Medlearn Matters,” she said, referring to articles issued by CMS to help providers understand Medicare policy.

CMS is encouraging health plans to devise a transition plan for a system that accepts both the UPIN and NPI until the May 2007 compliance deadline. Ms. Bryant said that although a few health plans already have systems developed, most do not—including Medicare, which she said will not have the “capacity to be fully changed over” until 2007.

“We need the next year and a half to finish getting our claims-processing system completely converted over, and then we'll begin the phase-out, I would say about 6–8 months ahead” of the May 2007 deadline, she said.

CMS advises that members of groups not sign up individually now but wait until fall, when “batch enumeration” systems will be in place to accept group applications.

Once assigned an NPI, providers will have that number for the remainder of their careers and need only contact CMS to make changes. The system will be meshed with Social Security information to track provider deaths, and the agency hopes to be able to coordinate with state licensing groups as well, Ms. Brandt told the council.

WASHINGTON — The Centers for Medicare and Medicaid Services will review national provider identifier protocols that now require separate numbers for each covered entity. The requirement could mean some physicians who are also part of group practices and other arrangements would have multiple NPI numbers.

At a meeting of the Practicing Physicians Advisory Council, members brought the issue to the attention of CMS's director of program integrity, Kimberly Brandt. “The goal here was to have less numbers, not more. So I appreciate your point, and it's a very good one. And that's something I will definitely look into,” Ms. Brandt said.

PPAC member Barbara McAneny, M.D., an oncologist from Albuquerque, suggested the review as part of a draft recommendation approved by the council. The recommendation suggests CMS clarify which current provider numbers would be replaced by the NPI number and which entities would need their own numbers.

Dr. McAneny also suggested CMS “put pressure” on other groups, including state licensure boards, “to eliminate some of the numbers and not to just add them on and add them on and add them on.…”

NPI enrollment began May 2 and continues through May 2007, when all providers will be required to use the system for standard electronic health care transactions. “With national standards and identifiers in place for electronic claims and other transactions, health care providers will be able to submit transactions to any health plan in the United States,” CMS Administrator Mark McClellan, M.D., said in a letter to health care providers. “Health plans will be able to send standard transactions such as remittance advices and referral authorization to health care providers.”

As a requirement of the Health Insurance Portability and Accountability Act, many health plans—including Medicare, Medicaid, private health insurance issuers, and health care clearinghouses—must use NPIs in standard transactions by May 2007. Small health plans have an additional year to comply. The number is intended to replace current numbers, including the unique physician identification number (UPIN).

Ms. Brandt told the advisory council that CMS is conducting a “massive outreach effort” to inform providers of the change and encourages them to apply for an NPI. Applications can be made electronically or through the mail.

To demonstrate the process of getting an NPI, PPAC Chairman Ronald Castellanos, M.D., got his number at the council's meeting, in a process that took approximately 8 minutes. “I'm not bleeding,” he said when asked how painful the process was.

PPAC member Geraldine O'Shea, D.O., an internist who practices in Jackson, Calif., also tried the NPI application process. She found that it “took some effort” and was more complicated than she expected.

“It appeared to be pretty simple, but you had to have many numbers available for the filing,” including a state license and a Medicare identifier. It would be helpful to have filing instructions, including a list of what is required, before starting the electronic application, Dr. O'Shea told this newspaper.

“Hopefully, that kind of instruction will be on Medlearn Matters,” she said, referring to articles issued by CMS to help providers understand Medicare policy.

CMS is encouraging health plans to devise a transition plan for a system that accepts both the UPIN and NPI until the May 2007 compliance deadline. Ms. Bryant said that although a few health plans already have systems developed, most do not—including Medicare, which she said will not have the “capacity to be fully changed over” until 2007.

“We need the next year and a half to finish getting our claims-processing system completely converted over, and then we'll begin the phase-out, I would say about 6–8 months ahead” of the May 2007 deadline, she said.

CMS advises that members of groups not sign up individually now but wait until fall, when “batch enumeration” systems will be in place to accept group applications.

Once assigned an NPI, providers will have that number for the remainder of their careers and need only contact CMS to make changes. The system will be meshed with Social Security information to track provider deaths, and the agency hopes to be able to coordinate with state licensing groups as well, Ms. Brandt told the council.

WASHINGTON — The House and Senate are negotiating legislation that would establish a voluntary medical error reporting system with the goal of passing a consensus measure soon, lawmakers and staffers say.

Following a June hearing of the House Energy and Commerce subcommittee on health, Nathan Deal (R-Ga.), chairman of the subcommittee, said the measure is likely to have some variations from last year's versions of the bill, but said the scope of the proposed legislation is the same.

The House and Senate each passed similar patient safety bills last year—the House on a vote of 418–6 and the Senate by voice vote. But the bills got bogged down in conference and died in the waning days of the 108th Congress.

The lawmakers are trying to establish a voluntary system in which providers could confidentially report errors to official patient safety organizations. The previously proposed bills differed in the degree to which information was legally protected and in approaches to health information technology interoperability.

Now, as lawmakers negotiate a new measure, Agency for Healthcare Research and Quality (AHRQ) Director Carolyn Clancy, M.D., is calling for increased training of data analysts.

“While an increasing number of hospitals are developing the capacity to analyze the causes of medical errors, we need to recognize that the ability to conduct these analyses is uneven both in terms of experience and skill level,” Dr. Clancy said. Moving to a system where the errors are routinely analyzed will require “significant skill development and technical assistance.”

Dr. Clancy also warned that as the environment for patient safety improves, the number of reported errors is likely to rise as “previously hidden errors are disclosed.” An initial increase in the number of reported errors, therefore, “is a sign of success, not failure.”

She also called for increased information on care improvement in outpatient settings.

The day before the hearing, AHRQ announced it will award more than $8 million for 15 projects designed to help clinicians, facilities, and patients implement evidence-based safety practices. More than half of the projects focus on reducing medication errors. Another area of interest is improved communications among health care teams.

Despite efforts in the public and private sectors to improve patient safety, Joint Commission on Accreditation of Healthcare Organizations President Dennis O'Leary, M.D., told the House panel that “we may actually be falling further behind as new drugs, procedures, and technologies are introduced every day.”

Each new intervention carries its own risks that have not been identified, Dr. O'Leary said, and “they will be introduced into care delivery systems where patient safety and systems thinking … are not constantly top of mind.”

Dr. O'Leary also said more should be done to ensure adherence to clinical guidelines, which he said can reduce legal risk for providers. He suggested providing incentives to focus on improvements in patient safety and health care quality as one way to increase guideline adherence.

Dr. O'Leary also recommended finding a private sector alternative for the National Provider Data Bank, which he said “has probably never met its full expectations.” He said the data bank tends not to record information about whether a standard of care was violated, making the information “relatively unhelpful” for patient safety analysis. He suggested an approach that may include a network of databases.

Health subcommittee members asked about patient safety as part of medical education. William Bornstein, M.D., of the Medical Association of Georgia, testified that training in systems thinking for patient safety should occur at the level of residents and interns.

WASHINGTON — The House and Senate are negotiating legislation that would establish a voluntary medical error reporting system with the goal of passing a consensus measure soon, lawmakers and staffers say.

Following a June hearing of the House Energy and Commerce subcommittee on health, Nathan Deal (R-Ga.), chairman of the subcommittee, said the measure is likely to have some variations from last year's versions of the bill, but said the scope of the proposed legislation is the same.

The House and Senate each passed similar patient safety bills last year—the House on a vote of 418–6 and the Senate by voice vote. But the bills got bogged down in conference and died in the waning days of the 108th Congress.

The lawmakers are trying to establish a voluntary system in which providers could confidentially report errors to official patient safety organizations. The previously proposed bills differed in the degree to which information was legally protected and in approaches to health information technology interoperability.

Now, as lawmakers negotiate a new measure, Agency for Healthcare Research and Quality (AHRQ) Director Carolyn Clancy, M.D., is calling for increased training of data analysts.

“While an increasing number of hospitals are developing the capacity to analyze the causes of medical errors, we need to recognize that the ability to conduct these analyses is uneven both in terms of experience and skill level,” Dr. Clancy said. Moving to a system where the errors are routinely analyzed will require “significant skill development and technical assistance.”

Dr. Clancy also warned that as the environment for patient safety improves, the number of reported errors is likely to rise as “previously hidden errors are disclosed.” An initial increase in the number of reported errors, therefore, “is a sign of success, not failure.”

She also called for increased information on care improvement in outpatient settings.

The day before the hearing, AHRQ announced it will award more than $8 million for 15 projects designed to help clinicians, facilities, and patients implement evidence-based safety practices. More than half of the projects focus on reducing medication errors. Another area of interest is improved communications among health care teams.

Despite efforts in the public and private sectors to improve patient safety, Joint Commission on Accreditation of Healthcare Organizations President Dennis O'Leary, M.D., told the House panel that “we may actually be falling further behind as new drugs, procedures, and technologies are introduced every day.”

Each new intervention carries its own risks that have not been identified, Dr. O'Leary said, and “they will be introduced into care delivery systems where patient safety and systems thinking … are not constantly top of mind.”

Dr. O'Leary also said more should be done to ensure adherence to clinical guidelines, which he said can reduce legal risk for providers. He suggested providing incentives to focus on improvements in patient safety and health care quality as one way to increase guideline adherence.

Dr. O'Leary also recommended finding a private sector alternative for the National Provider Data Bank, which he said “has probably never met its full expectations.” He said the data bank tends not to record information about whether a standard of care was violated, making the information “relatively unhelpful” for patient safety analysis. He suggested an approach that may include a network of databases.

Health subcommittee members asked about patient safety as part of medical education. William Bornstein, M.D., of the Medical Association of Georgia, testified that training in systems thinking for patient safety should occur at the level of residents and interns.

WASHINGTON — The House and Senate are negotiating legislation that would establish a voluntary medical error reporting system with the goal of passing a consensus measure soon, lawmakers and staffers say.

Following a June hearing of the House Energy and Commerce subcommittee on health, Nathan Deal (R-Ga.), chairman of the subcommittee, said the measure is likely to have some variations from last year's versions of the bill, but said the scope of the proposed legislation is the same.

The House and Senate each passed similar patient safety bills last year—the House on a vote of 418–6 and the Senate by voice vote. But the bills got bogged down in conference and died in the waning days of the 108th Congress.

The lawmakers are trying to establish a voluntary system in which providers could confidentially report errors to official patient safety organizations. The previously proposed bills differed in the degree to which information was legally protected and in approaches to health information technology interoperability.

Now, as lawmakers negotiate a new measure, Agency for Healthcare Research and Quality (AHRQ) Director Carolyn Clancy, M.D., is calling for increased training of data analysts.

“While an increasing number of hospitals are developing the capacity to analyze the causes of medical errors, we need to recognize that the ability to conduct these analyses is uneven both in terms of experience and skill level,” Dr. Clancy said. Moving to a system where the errors are routinely analyzed will require “significant skill development and technical assistance.”

Dr. Clancy also warned that as the environment for patient safety improves, the number of reported errors is likely to rise as “previously hidden errors are disclosed.” An initial increase in the number of reported errors, therefore, “is a sign of success, not failure.”

She also called for increased information on care improvement in outpatient settings.

The day before the hearing, AHRQ announced it will award more than $8 million for 15 projects designed to help clinicians, facilities, and patients implement evidence-based safety practices. More than half of the projects focus on reducing medication errors. Another area of interest is improved communications among health care teams.

Despite efforts in the public and private sectors to improve patient safety, Joint Commission on Accreditation of Healthcare Organizations President Dennis O'Leary, M.D., told the House panel that “we may actually be falling further behind as new drugs, procedures, and technologies are introduced every day.”

Each new intervention carries its own risks that have not been identified, Dr. O'Leary said, and “they will be introduced into care delivery systems where patient safety and systems thinking … are not constantly top of mind.”

Dr. O'Leary also said more should be done to ensure adherence to clinical guidelines, which he said can reduce legal risk for providers. He suggested providing incentives to focus on improvements in patient safety and health care quality as one way to increase guideline adherence.

Dr. O'Leary also recommended finding a private sector alternative for the National Provider Data Bank, which he said “has probably never met its full expectations.” He said the data bank tends not to record information about whether a standard of care was violated, making the information “relatively unhelpful” for patient safety analysis. He suggested an approach that may include a network of databases.

Health subcommittee members asked about patient safety as part of medical education. William Bornstein, M.D., of the Medical Association of Georgia, testified that training in systems thinking for patient safety should occur at the level of residents and interns.

WASHINGTON — The House and Senate are negotiating legislation that would establish a voluntary medical error reporting system with the goal of passing a consensus measure by the August recess, lawmakers and staffers say.

Following a June 9 hearing of the House Energy and Commerce subcommittee on Health, Nathan Deal (R-Ga.), chairman of the subcommittee on Health, told reporters that the measure is likely to have some variations from last year's versions of the bill, but said the scope of the proposed legislation is the same. "Hopefully, if we can get a consensus worked out, it would be a bill that I think would move rather quickly" to gain approval, he said.

The House and Senate each passed similar patient safety bills last year—the House on a 418–6 vote and the Senate by voice vote. But the bills got bogged down in conference and died in the waning days of the 108th Congress.

The lawmakers are trying to establish a voluntary system where providers could confidentially report errors to official patient safety organizations. The previously proposed bills differed in the degree to which information was legally protected and in approaches to health information technology interoperability.

Now, as lawmakers negotiate a new measure, Agency for Healthcare Research and Quality (AHRQ) Director Carolyn Clancy, M.D., is calling for increased training of data analysts.

She recently testified that her agency continues its patient safety efforts. "While an increasing number of hospitals are developing the capacity to analyze the causes of medical errors, we need to recognize that the ability to conduct these analyses is uneven both in terms of experience and skill level," Dr. Clancy said. Moving to a system where the errors are routinely analyzed will require "significant skill development and technical assistance."

Dr. Clancy also warned that as the environment for patient safety improves, the number of reported errors is likely to rise as "previously hidden errors are disclosed." An initial increase in the number of reported errors, therefore, "is a sign of success, not failure."

She also called for increased information on care improvement in outpatient settings. "There is a significant amount of information on how to improve the safety of hospital care, but the evidence base is less robust for other settings of care."

The day before the hearing, AHRQ announced it will award more than $8 million for 15 projects designed to help clinicians, facilities, and patients implement evidence-based safety practices. More than half of the projects focus on reducing medication errors. Another area of interest is improved communications among health care teams.

Despite efforts in the public and private sectors to improve patient safety, Joint Commission on Accreditation of Healthcare Organizations President Dennis O'Leary, M.D., told the House panel that "we may actually be falling further behind as new drugs, procedures, and technologies are introduced every day."

Each new intervention carries its own risks that have not been identified, Dr. O'Leary said, and "they will be introduced into care delivery systems where patient safety and systems thinking … are not constantly top of mind."

Dr. O'Leary also said more should be done to ensure adherence to clinical guidelines, which he said can reduce legal risk for providers. He suggested providing incentives to focus on improvements in patient safety and health care quality as one way to increase guideline adherence.

Dr. O'Leary also recommended finding a private sector alternative for the National Provider Data Bank, which he said "has probably never met its full expectations." He said the data bank tends not to record information about whether a standard of care was violated, making the information "relatively unhelpful" for patient safety analysis. He suggested an approach that may include a network of databases.

Health subcommittee members asked about patient safety as part of medical education. William Bornstein, M.D., of the Medical Association of Georgia, testified that training in systems thinking for patient safety should occur at the level of residents and interns.

But, he said, one downside of the effort to limit the number of hours worked by medical students is limitations on the time available for additional training.

WASHINGTON — The House and Senate are negotiating legislation that would establish a voluntary medical error reporting system with the goal of passing a consensus measure by the August recess, lawmakers and staffers say.

Following a June 9 hearing of the House Energy and Commerce subcommittee on Health, Nathan Deal (R-Ga.), chairman of the subcommittee on Health, told reporters that the measure is likely to have some variations from last year's versions of the bill, but said the scope of the proposed legislation is the same. "Hopefully, if we can get a consensus worked out, it would be a bill that I think would move rather quickly" to gain approval, he said.

The House and Senate each passed similar patient safety bills last year—the House on a 418–6 vote and the Senate by voice vote. But the bills got bogged down in conference and died in the waning days of the 108th Congress.

The lawmakers are trying to establish a voluntary system where providers could confidentially report errors to official patient safety organizations. The previously proposed bills differed in the degree to which information was legally protected and in approaches to health information technology interoperability.

Now, as lawmakers negotiate a new measure, Agency for Healthcare Research and Quality (AHRQ) Director Carolyn Clancy, M.D., is calling for increased training of data analysts.

She recently testified that her agency continues its patient safety efforts. "While an increasing number of hospitals are developing the capacity to analyze the causes of medical errors, we need to recognize that the ability to conduct these analyses is uneven both in terms of experience and skill level," Dr. Clancy said. Moving to a system where the errors are routinely analyzed will require "significant skill development and technical assistance."

Dr. Clancy also warned that as the environment for patient safety improves, the number of reported errors is likely to rise as "previously hidden errors are disclosed." An initial increase in the number of reported errors, therefore, "is a sign of success, not failure."

She also called for increased information on care improvement in outpatient settings. "There is a significant amount of information on how to improve the safety of hospital care, but the evidence base is less robust for other settings of care."

The day before the hearing, AHRQ announced it will award more than $8 million for 15 projects designed to help clinicians, facilities, and patients implement evidence-based safety practices. More than half of the projects focus on reducing medication errors. Another area of interest is improved communications among health care teams.

Despite efforts in the public and private sectors to improve patient safety, Joint Commission on Accreditation of Healthcare Organizations President Dennis O'Leary, M.D., told the House panel that "we may actually be falling further behind as new drugs, procedures, and technologies are introduced every day."

Each new intervention carries its own risks that have not been identified, Dr. O'Leary said, and "they will be introduced into care delivery systems where patient safety and systems thinking … are not constantly top of mind."

Dr. O'Leary also said more should be done to ensure adherence to clinical guidelines, which he said can reduce legal risk for providers. He suggested providing incentives to focus on improvements in patient safety and health care quality as one way to increase guideline adherence.

Dr. O'Leary also recommended finding a private sector alternative for the National Provider Data Bank, which he said "has probably never met its full expectations." He said the data bank tends not to record information about whether a standard of care was violated, making the information "relatively unhelpful" for patient safety analysis. He suggested an approach that may include a network of databases.

Health subcommittee members asked about patient safety as part of medical education. William Bornstein, M.D., of the Medical Association of Georgia, testified that training in systems thinking for patient safety should occur at the level of residents and interns.

But, he said, one downside of the effort to limit the number of hours worked by medical students is limitations on the time available for additional training.

WASHINGTON — The House and Senate are negotiating legislation that would establish a voluntary medical error reporting system with the goal of passing a consensus measure by the August recess, lawmakers and staffers say.

Following a June 9 hearing of the House Energy and Commerce subcommittee on Health, Nathan Deal (R-Ga.), chairman of the subcommittee on Health, told reporters that the measure is likely to have some variations from last year's versions of the bill, but said the scope of the proposed legislation is the same. "Hopefully, if we can get a consensus worked out, it would be a bill that I think would move rather quickly" to gain approval, he said.

The House and Senate each passed similar patient safety bills last year—the House on a 418–6 vote and the Senate by voice vote. But the bills got bogged down in conference and died in the waning days of the 108th Congress.

The lawmakers are trying to establish a voluntary system where providers could confidentially report errors to official patient safety organizations. The previously proposed bills differed in the degree to which information was legally protected and in approaches to health information technology interoperability.

Now, as lawmakers negotiate a new measure, Agency for Healthcare Research and Quality (AHRQ) Director Carolyn Clancy, M.D., is calling for increased training of data analysts.

She recently testified that her agency continues its patient safety efforts. "While an increasing number of hospitals are developing the capacity to analyze the causes of medical errors, we need to recognize that the ability to conduct these analyses is uneven both in terms of experience and skill level," Dr. Clancy said. Moving to a system where the errors are routinely analyzed will require "significant skill development and technical assistance."

Dr. Clancy also warned that as the environment for patient safety improves, the number of reported errors is likely to rise as "previously hidden errors are disclosed." An initial increase in the number of reported errors, therefore, "is a sign of success, not failure."

She also called for increased information on care improvement in outpatient settings. "There is a significant amount of information on how to improve the safety of hospital care, but the evidence base is less robust for other settings of care."

The day before the hearing, AHRQ announced it will award more than $8 million for 15 projects designed to help clinicians, facilities, and patients implement evidence-based safety practices. More than half of the projects focus on reducing medication errors. Another area of interest is improved communications among health care teams.

Despite efforts in the public and private sectors to improve patient safety, Joint Commission on Accreditation of Healthcare Organizations President Dennis O'Leary, M.D., told the House panel that "we may actually be falling further behind as new drugs, procedures, and technologies are introduced every day."

Each new intervention carries its own risks that have not been identified, Dr. O'Leary said, and "they will be introduced into care delivery systems where patient safety and systems thinking … are not constantly top of mind."

Dr. O'Leary also said more should be done to ensure adherence to clinical guidelines, which he said can reduce legal risk for providers. He suggested providing incentives to focus on improvements in patient safety and health care quality as one way to increase guideline adherence.

Dr. O'Leary also recommended finding a private sector alternative for the National Provider Data Bank, which he said "has probably never met its full expectations." He said the data bank tends not to record information about whether a standard of care was violated, making the information "relatively unhelpful" for patient safety analysis. He suggested an approach that may include a network of databases.

Health subcommittee members asked about patient safety as part of medical education. William Bornstein, M.D., of the Medical Association of Georgia, testified that training in systems thinking for patient safety should occur at the level of residents and interns.

But, he said, one downside of the effort to limit the number of hours worked by medical students is limitations on the time available for additional training.

WASHINGTON — The Centers for Medicare and Medicaid Services will review national provider identifier protocols that now require separate numbers for each covered entity. The requirement could mean some physicians who are also part of group practices and other arrangements would have multiple NPI numbers.

At a meeting of the Practicing Physicians Advisory Council, members brought the issue to the attention of CMS's director of program integrity, Kimberly Brandt.

"The goal here was to have less numbers, not more. So I appreciate your point, and it's a very good one. And that's something I will definitely look into," Ms. Brandt said.

PPAC member Barbara McAneny, M.D., an oncologist from Albuquerque, suggested the review as part of a draft recommendation approved by the council. The recommendation suggests CMS clarify which current provider numbers would be replaced by the NPI number and which entities would need their own numbers.

Dr. McAneny also suggested CMS "put pressure" on other groups, including state licensure boards, "to eliminate some of the numbers."

NPI enrollment began May 2 and continues through May 2007, when providers will be required to use the system for standard electronic health care transactions.

"With national standards and identifiers in place for electronic claims and other transactions, health care providers will be able to submit transactions to any health plan in the United States," CMS Administrator Mark McClellan, M.D., said in a May letter to health care providers. "Health plans will be able to send standard transactions such as remittance advices and referral authorization to health care providers."

As a requirement of the Health Insurance Portability and Accountability Act, many health plans—including Medicare, Medicaid, private health insurance issuers, and health care clearinghouses—must use NPIs in standard transactions by May 2007. Small health plans have an additional year to comply. The number is intended to replace current numbers, including the unique physician identification number (UPIN).

Ms. Brandt told the advisory council that CMS is conducting a "massive outreach effort" to inform providers of the change and encourages them to apply for an NPI. Applications can be made electronically or through the mail.

To demonstrate the process of getting an NPI, PPAC Chairman Ronald Castellanos, M.D., got his number at the council's meeting, in a process that took approximately 8 minutes.

"I'm not bleeding," Dr. Castellanos said when asked how painful the process was.

PPAC member Geraldine O'Shea, D.O., an internist who practices in Jackson, Calif., also tried the NPI application process. She found that it "took some effort" and was more complicated than she expected.

"It appeared to be pretty simple, but you had to have many numbers available for the filing," including a state license and a Medicare identifier. Dr. O'Shea said.

CMS is encouraging health plans to devise a transition plan for a system that accepts both the UPIN and NPI until the May 2007 compliance deadline. Ms. Bryant said that although a few health plans already have systems developed, most do not—including Medicare, which she said will not have the "capacity to be fully changed over" until 2007.

CMS is recommending that members of groups not sign up individually now but wait until fall, when "batch enumeration" systems will be in place to accept group applications.

Once assigned a random NPI, providers will have that number for the remainder of their careers. The system will be meshed with Social Security information to track provider deaths, and the agency hopes to be able to coordinate with state licensing groups as well, Ms. Brandt told the council.

Please, May We Have a Directory?

Security concerns are currently keeping CMS from developing a directory of all NPI numbers for all health providers and covered entities, but one may be developed in the future, Ms. Brandt told PPAC members.

"We may get to a point where we have a directory, but right at the moment, we don't have a [list] like the unique physician identification number directory in the works," she stated.

Instead, the agency is planning to publish in the Federal Register in October a notice on how NPIs can be obtained from other health care providers and covered entities.

PPAC members encouraged Ms. Brandt to look into a directory for referring physicians, even if it's a subscriber service.

"I would strongly advocate that you [develop a directory] even if there's a subscription fee because one of the more problematic things when you bill for a consult is to try to track down Dr. Jones' [UPIN], and it's a significant hurdle and a big burden on the practice," said surgeon Anthony Senagore, M.D., of the Cleveland Clinic Foundation.

Ms. Brandt noted that an encrypted or password-accessed system would be necessary, given that "people have been able to get access to [the UPIN directory] who shouldn't have been able to get access to it." Council members' recommendation for a subscription fee or encryption is "a good one," she said.

WASHINGTON — The Centers for Medicare and Medicaid Services will review national provider identifier protocols that now require separate numbers for each covered entity. The requirement could mean some physicians who are also part of group practices and other arrangements would have multiple NPI numbers.

At a meeting of the Practicing Physicians Advisory Council, members brought the issue to the attention of CMS's director of program integrity, Kimberly Brandt.

"The goal here was to have less numbers, not more. So I appreciate your point, and it's a very good one. And that's something I will definitely look into," Ms. Brandt said.

PPAC member Barbara McAneny, M.D., an oncologist from Albuquerque, suggested the review as part of a draft recommendation approved by the council. The recommendation suggests CMS clarify which current provider numbers would be replaced by the NPI number and which entities would need their own numbers.

Dr. McAneny also suggested CMS "put pressure" on other groups, including state licensure boards, "to eliminate some of the numbers."

NPI enrollment began May 2 and continues through May 2007, when providers will be required to use the system for standard electronic health care transactions.

"With national standards and identifiers in place for electronic claims and other transactions, health care providers will be able to submit transactions to any health plan in the United States," CMS Administrator Mark McClellan, M.D., said in a May letter to health care providers. "Health plans will be able to send standard transactions such as remittance advices and referral authorization to health care providers."

As a requirement of the Health Insurance Portability and Accountability Act, many health plans—including Medicare, Medicaid, private health insurance issuers, and health care clearinghouses—must use NPIs in standard transactions by May 2007. Small health plans have an additional year to comply. The number is intended to replace current numbers, including the unique physician identification number (UPIN).

Ms. Brandt told the advisory council that CMS is conducting a "massive outreach effort" to inform providers of the change and encourages them to apply for an NPI. Applications can be made electronically or through the mail.

To demonstrate the process of getting an NPI, PPAC Chairman Ronald Castellanos, M.D., got his number at the council's meeting, in a process that took approximately 8 minutes.

"I'm not bleeding," Dr. Castellanos said when asked how painful the process was.

PPAC member Geraldine O'Shea, D.O., an internist who practices in Jackson, Calif., also tried the NPI application process. She found that it "took some effort" and was more complicated than she expected.

"It appeared to be pretty simple, but you had to have many numbers available for the filing," including a state license and a Medicare identifier. Dr. O'Shea said.

CMS is encouraging health plans to devise a transition plan for a system that accepts both the UPIN and NPI until the May 2007 compliance deadline. Ms. Bryant said that although a few health plans already have systems developed, most do not—including Medicare, which she said will not have the "capacity to be fully changed over" until 2007.

CMS is recommending that members of groups not sign up individually now but wait until fall, when "batch enumeration" systems will be in place to accept group applications.

Once assigned a random NPI, providers will have that number for the remainder of their careers. The system will be meshed with Social Security information to track provider deaths, and the agency hopes to be able to coordinate with state licensing groups as well, Ms. Brandt told the council.

Please, May We Have a Directory?

Security concerns are currently keeping CMS from developing a directory of all NPI numbers for all health providers and covered entities, but one may be developed in the future, Ms. Brandt told PPAC members.

"We may get to a point where we have a directory, but right at the moment, we don't have a [list] like the unique physician identification number directory in the works," she stated.

Instead, the agency is planning to publish in the Federal Register in October a notice on how NPIs can be obtained from other health care providers and covered entities.

PPAC members encouraged Ms. Brandt to look into a directory for referring physicians, even if it's a subscriber service.

"I would strongly advocate that you [develop a directory] even if there's a subscription fee because one of the more problematic things when you bill for a consult is to try to track down Dr. Jones' [UPIN], and it's a significant hurdle and a big burden on the practice," said surgeon Anthony Senagore, M.D., of the Cleveland Clinic Foundation.

Ms. Brandt noted that an encrypted or password-accessed system would be necessary, given that "people have been able to get access to [the UPIN directory] who shouldn't have been able to get access to it." Council members' recommendation for a subscription fee or encryption is "a good one," she said.

WASHINGTON — The Centers for Medicare and Medicaid Services will review national provider identifier protocols that now require separate numbers for each covered entity. The requirement could mean some physicians who are also part of group practices and other arrangements would have multiple NPI numbers.

At a meeting of the Practicing Physicians Advisory Council, members brought the issue to the attention of CMS's director of program integrity, Kimberly Brandt.

"The goal here was to have less numbers, not more. So I appreciate your point, and it's a very good one. And that's something I will definitely look into," Ms. Brandt said.

PPAC member Barbara McAneny, M.D., an oncologist from Albuquerque, suggested the review as part of a draft recommendation approved by the council. The recommendation suggests CMS clarify which current provider numbers would be replaced by the NPI number and which entities would need their own numbers.

Dr. McAneny also suggested CMS "put pressure" on other groups, including state licensure boards, "to eliminate some of the numbers."

NPI enrollment began May 2 and continues through May 2007, when providers will be required to use the system for standard electronic health care transactions.

"With national standards and identifiers in place for electronic claims and other transactions, health care providers will be able to submit transactions to any health plan in the United States," CMS Administrator Mark McClellan, M.D., said in a May letter to health care providers. "Health plans will be able to send standard transactions such as remittance advices and referral authorization to health care providers."

As a requirement of the Health Insurance Portability and Accountability Act, many health plans—including Medicare, Medicaid, private health insurance issuers, and health care clearinghouses—must use NPIs in standard transactions by May 2007. Small health plans have an additional year to comply. The number is intended to replace current numbers, including the unique physician identification number (UPIN).

Ms. Brandt told the advisory council that CMS is conducting a "massive outreach effort" to inform providers of the change and encourages them to apply for an NPI. Applications can be made electronically or through the mail.

To demonstrate the process of getting an NPI, PPAC Chairman Ronald Castellanos, M.D., got his number at the council's meeting, in a process that took approximately 8 minutes.

"I'm not bleeding," Dr. Castellanos said when asked how painful the process was.

PPAC member Geraldine O'Shea, D.O., an internist who practices in Jackson, Calif., also tried the NPI application process. She found that it "took some effort" and was more complicated than she expected.

"It appeared to be pretty simple, but you had to have many numbers available for the filing," including a state license and a Medicare identifier. Dr. O'Shea said.

CMS is encouraging health plans to devise a transition plan for a system that accepts both the UPIN and NPI until the May 2007 compliance deadline. Ms. Bryant said that although a few health plans already have systems developed, most do not—including Medicare, which she said will not have the "capacity to be fully changed over" until 2007.

CMS is recommending that members of groups not sign up individually now but wait until fall, when "batch enumeration" systems will be in place to accept group applications.

Once assigned a random NPI, providers will have that number for the remainder of their careers. The system will be meshed with Social Security information to track provider deaths, and the agency hopes to be able to coordinate with state licensing groups as well, Ms. Brandt told the council.

Please, May We Have a Directory?

Security concerns are currently keeping CMS from developing a directory of all NPI numbers for all health providers and covered entities, but one may be developed in the future, Ms. Brandt told PPAC members.

"We may get to a point where we have a directory, but right at the moment, we don't have a [list] like the unique physician identification number directory in the works," she stated.

Instead, the agency is planning to publish in the Federal Register in October a notice on how NPIs can be obtained from other health care providers and covered entities.

PPAC members encouraged Ms. Brandt to look into a directory for referring physicians, even if it's a subscriber service.

"I would strongly advocate that you [develop a directory] even if there's a subscription fee because one of the more problematic things when you bill for a consult is to try to track down Dr. Jones' [UPIN], and it's a significant hurdle and a big burden on the practice," said surgeon Anthony Senagore, M.D., of the Cleveland Clinic Foundation.

Ms. Brandt noted that an encrypted or password-accessed system would be necessary, given that "people have been able to get access to [the UPIN directory] who shouldn't have been able to get access to it." Council members' recommendation for a subscription fee or encryption is "a good one," she said.

WASHINGTON — The Centers for Medicare and Medicaid Services will review national provider identifier protocols that now require separate numbers for each covered entity. The requirement could mean some physicians who are also part of group practices and other arrangements would have multiple NPI numbers.

At a meeting of the Practicing Physicians Advisory Council, members brought the issue to the attention of CMS's director of program integrity, Kimberly Brandt. “The goal here was to have less numbers, not more. So I appreciate your point, and it's a very good one. And that's something I will definitely look into,” Ms. Brandt said.

PPAC member Barbara McAneny, M.D., an oncologist from Albuquerque, suggested the review as part of a draft recommendation approved by the council. The recommendation suggests CMS clarify which current provider numbers would be replaced by the NPI number and which entities would need their own numbers.

Dr. McAneny also suggested CMS “put pressure” on other groups, including state licensure boards, “to eliminate some of the numbers and not to just add them on and add them on and add them on …”

NPI enrollment began May 2 and continues through May 2007, when all providers will be required to use the system for standard electronic health care transactions. “With national standards and identifiers in place for electronic claims and other transactions, health care providers will be able to submit transactions to any health plan in the United States,” CMS Administrator Mark McClellan, M.D., said in a May letter to health care providers. “Health plans will be able to send standard transactions such as remittance advices and referral authorization to health care providers.”

As a requirement of the Health Insurance Portability and Accountability Act, many health plans—including Medicare, Medicaid, private health insurance issuers, and health care clearinghouses—must use NPIs in standard transactions by May 2007. Small health plans have an additional year to comply. The number is intended to replace current numbers, including the unique physician identification number (UPIN).

Ms. Brandt told the advisory council that CMS is conducting a “massive outreach effort” to inform providers of the change and encourages them to apply for an NPI. Applications can be made electronically or through the mail.

To demonstrate the process of getting an NPI, PPAC Chairman Ronald Castellanos, M.D., got his number at the council's meeting, in a process that took approximately 8 minutes.

“I'm not bleeding,” Dr. Castellanos said when asked how painful the process was.

CMS is encouraging health plans to devise a transition plan for a system that accepts both the UPIN and NPI until the May 2007 compliance deadline. Ms. Bryant said that although a few health plans already have systems developed, most do not—including Medicare, which she said will not have the “capacity to be fully changed over” until 2007.

“We need the next year and a half to finish getting our claims-processing system completely converted over, and then we'll begin the phase-out I would say about 6–8 months ahead” of the May 2007 deadline, she said.

CMS is recommending that members of groups not sign up individually now but wait until fall, when “batch enumeration” systems will be in place to accept group applications.

PPAC member Dr. Geraldine O'Shea applied for her national provider identifier number during a break at a recent council meeting. Vivian E. Lee

NPI Directory Hits Security Roadblock

Security concerns are currently keeping CMS from developing a directory of all NPI numbers for all health providers and covered entities, but one may be developed in the future, Ms. Brandt told PPAC members.

“We may get to a point where we have a directory, but right at the moment, we don't have a [list] like the unique physician identification number directory in the works,” she said.

Instead, the agency is planning to publish in the Federal Register in October a notice on how NPIs can be obtained from other health care providers and covered entities.

PPAC members at the council meeting encouraged Ms. Brandt to look into a directory for referring physicians, even if it's a subscriber service.

“I would strongly advocate that you [develop a directory] even if there's a subscription fee because one of the more problematic things when you bill for a consult is to try to track down Dr. Jones' [UPIN], and it's a significant hurdle and a big burden on the practice,” said surgeon Anthony Senagore, M.D., of the Cleveland Clinic Foundation.

Ms. Brandt noted that an encrypted or password-accessed system would be necessary, given that “people have been able to get access to [the UPIN director] who shouldn't have been able to get access to it.” Council members' recommendation for a subscription fee or encryption is “a good one,” she said.

WASHINGTON — The Centers for Medicare and Medicaid Services will review national provider identifier protocols that now require separate numbers for each covered entity. The requirement could mean some physicians who are also part of group practices and other arrangements would have multiple NPI numbers.

At a meeting of the Practicing Physicians Advisory Council, members brought the issue to the attention of CMS's director of program integrity, Kimberly Brandt. “The goal here was to have less numbers, not more. So I appreciate your point, and it's a very good one. And that's something I will definitely look into,” Ms. Brandt said.

PPAC member Barbara McAneny, M.D., an oncologist from Albuquerque, suggested the review as part of a draft recommendation approved by the council. The recommendation suggests CMS clarify which current provider numbers would be replaced by the NPI number and which entities would need their own numbers.

Dr. McAneny also suggested CMS “put pressure” on other groups, including state licensure boards, “to eliminate some of the numbers and not to just add them on and add them on and add them on …”

NPI enrollment began May 2 and continues through May 2007, when all providers will be required to use the system for standard electronic health care transactions. “With national standards and identifiers in place for electronic claims and other transactions, health care providers will be able to submit transactions to any health plan in the United States,” CMS Administrator Mark McClellan, M.D., said in a May letter to health care providers. “Health plans will be able to send standard transactions such as remittance advices and referral authorization to health care providers.”

As a requirement of the Health Insurance Portability and Accountability Act, many health plans—including Medicare, Medicaid, private health insurance issuers, and health care clearinghouses—must use NPIs in standard transactions by May 2007. Small health plans have an additional year to comply. The number is intended to replace current numbers, including the unique physician identification number (UPIN).

Ms. Brandt told the advisory council that CMS is conducting a “massive outreach effort” to inform providers of the change and encourages them to apply for an NPI. Applications can be made electronically or through the mail.

To demonstrate the process of getting an NPI, PPAC Chairman Ronald Castellanos, M.D., got his number at the council's meeting, in a process that took approximately 8 minutes.

“I'm not bleeding,” Dr. Castellanos said when asked how painful the process was.

CMS is encouraging health plans to devise a transition plan for a system that accepts both the UPIN and NPI until the May 2007 compliance deadline. Ms. Bryant said that although a few health plans already have systems developed, most do not—including Medicare, which she said will not have the “capacity to be fully changed over” until 2007.

“We need the next year and a half to finish getting our claims-processing system completely converted over, and then we'll begin the phase-out I would say about 6–8 months ahead” of the May 2007 deadline, she said.

CMS is recommending that members of groups not sign up individually now but wait until fall, when “batch enumeration” systems will be in place to accept group applications.

PPAC member Dr. Geraldine O'Shea applied for her national provider identifier number during a break at a recent council meeting. Vivian E. Lee

NPI Directory Hits Security Roadblock

Security concerns are currently keeping CMS from developing a directory of all NPI numbers for all health providers and covered entities, but one may be developed in the future, Ms. Brandt told PPAC members.

“We may get to a point where we have a directory, but right at the moment, we don't have a [list] like the unique physician identification number directory in the works,” she said.

Instead, the agency is planning to publish in the Federal Register in October a notice on how NPIs can be obtained from other health care providers and covered entities.

PPAC members at the council meeting encouraged Ms. Brandt to look into a directory for referring physicians, even if it's a subscriber service.

“I would strongly advocate that you [develop a directory] even if there's a subscription fee because one of the more problematic things when you bill for a consult is to try to track down Dr. Jones' [UPIN], and it's a significant hurdle and a big burden on the practice,” said surgeon Anthony Senagore, M.D., of the Cleveland Clinic Foundation.

Ms. Brandt noted that an encrypted or password-accessed system would be necessary, given that “people have been able to get access to [the UPIN director] who shouldn't have been able to get access to it.” Council members' recommendation for a subscription fee or encryption is “a good one,” she said.

WASHINGTON — The Centers for Medicare and Medicaid Services will review national provider identifier protocols that now require separate numbers for each covered entity. The requirement could mean some physicians who are also part of group practices and other arrangements would have multiple NPI numbers.

At a meeting of the Practicing Physicians Advisory Council, members brought the issue to the attention of CMS's director of program integrity, Kimberly Brandt. “The goal here was to have less numbers, not more. So I appreciate your point, and it's a very good one. And that's something I will definitely look into,” Ms. Brandt said.

PPAC member Barbara McAneny, M.D., an oncologist from Albuquerque, suggested the review as part of a draft recommendation approved by the council. The recommendation suggests CMS clarify which current provider numbers would be replaced by the NPI number and which entities would need their own numbers.

Dr. McAneny also suggested CMS “put pressure” on other groups, including state licensure boards, “to eliminate some of the numbers and not to just add them on and add them on and add them on …”

NPI enrollment began May 2 and continues through May 2007, when all providers will be required to use the system for standard electronic health care transactions. “With national standards and identifiers in place for electronic claims and other transactions, health care providers will be able to submit transactions to any health plan in the United States,” CMS Administrator Mark McClellan, M.D., said in a May letter to health care providers. “Health plans will be able to send standard transactions such as remittance advices and referral authorization to health care providers.”

As a requirement of the Health Insurance Portability and Accountability Act, many health plans—including Medicare, Medicaid, private health insurance issuers, and health care clearinghouses—must use NPIs in standard transactions by May 2007. Small health plans have an additional year to comply. The number is intended to replace current numbers, including the unique physician identification number (UPIN).

Ms. Brandt told the advisory council that CMS is conducting a “massive outreach effort” to inform providers of the change and encourages them to apply for an NPI. Applications can be made electronically or through the mail.

To demonstrate the process of getting an NPI, PPAC Chairman Ronald Castellanos, M.D., got his number at the council's meeting, in a process that took approximately 8 minutes.

“I'm not bleeding,” Dr. Castellanos said when asked how painful the process was.

CMS is encouraging health plans to devise a transition plan for a system that accepts both the UPIN and NPI until the May 2007 compliance deadline. Ms. Bryant said that although a few health plans already have systems developed, most do not—including Medicare, which she said will not have the “capacity to be fully changed over” until 2007.

“We need the next year and a half to finish getting our claims-processing system completely converted over, and then we'll begin the phase-out I would say about 6–8 months ahead” of the May 2007 deadline, she said.

CMS is recommending that members of groups not sign up individually now but wait until fall, when “batch enumeration” systems will be in place to accept group applications.

PPAC member Dr. Geraldine O'Shea applied for her national provider identifier number during a break at a recent council meeting. Vivian E. Lee

NPI Directory Hits Security Roadblock

Security concerns are currently keeping CMS from developing a directory of all NPI numbers for all health providers and covered entities, but one may be developed in the future, Ms. Brandt told PPAC members.

“We may get to a point where we have a directory, but right at the moment, we don't have a [list] like the unique physician identification number directory in the works,” she said.

Instead, the agency is planning to publish in the Federal Register in October a notice on how NPIs can be obtained from other health care providers and covered entities.

PPAC members at the council meeting encouraged Ms. Brandt to look into a directory for referring physicians, even if it's a subscriber service.

“I would strongly advocate that you [develop a directory] even if there's a subscription fee because one of the more problematic things when you bill for a consult is to try to track down Dr. Jones' [UPIN], and it's a significant hurdle and a big burden on the practice,” said surgeon Anthony Senagore, M.D., of the Cleveland Clinic Foundation.

Ms. Brandt noted that an encrypted or password-accessed system would be necessary, given that “people have been able to get access to [the UPIN director] who shouldn't have been able to get access to it.” Council members' recommendation for a subscription fee or encryption is “a good one,” she said.

WASHINGTON — Physician obligation to help patients negotiate the upcoming Medicare Part D outpatient drug benefit will result in “another unfunded mandate” for Medicare providers, Ronald Castellanos, M.D., chairman of the Practicing Physicians Advisory Council said at the group's recent meeting.

Noting that patients are most likely to rely on their physicians for aid in choosing among the new drug plans, Dr. Castellanos said, “Basically what you're doing is putting the burden on physicians in their offices to really educate the Medicare recipient.”

PPAC members asked the Centers for Medicare and Medicaid Services to make educational materials as simple as possible, including information on whether beneficiaries are eligible for the low-income portion of the program.

“I really want a lot of information, very digestible,” said PPAC member Geraldine O'Shea, D.O., an internist from Jackson, Calif. “Something very easy for them to understand, because I do not want to take time out of my time to do medicine with my patient to say, 'Well, let me see your tax return.'”

“We are trying to make the information available as simple as possible,” said Jeffrey Kelman, M.D., medical officer for the CMS Center for Beneficiary Choices, noting that he would bring educational material to the council's next meeting.

Council member Barbara McAneny, M.D., an oncologist from Albuquerque, requested that the agency develop a computer program that would allow physicians to type in the drugs a patient is using and come up with the plan that would cover all of them.

She also proposed a draft recommendation that would require CMS to develop a reimbursement code for physician time spent on drug plan education, but it was voted down by the panel, with members saying it wasn't practical.

Walking through the benefit, Dr. Kelman said CMS is getting “much more robust formularies” from drug plans than officials had anticipated. “They're looking like commercial formularies,” he said. He added that the formularies would be available on the Web site in October.

All drugs approved by the Food and Drug Administration must be on the formularies, Dr. Kelman said. If a drug is not included, a beneficiary can appeal, based on medical necessity, but “preferably with a physician's help,” he said.

“All medically necessary drugs that are approved by the FDA with certain exceptions … have to be available.” Off-label prescriptions will be covered, Dr. Kelman said.

In a move important to rare drug organizations, Dr. Kelman said if there is only one drug to treat a disease, it must be included in the formulary.

Part D also will ensure drugs are available for chronic conditions by “favorably risk adjusting” those diseases, Dr. Kelman said. The plans also will “overadjust” for low-income individuals and nursing homes. “We went to a lot to trouble to ensure nobody was discriminated against on the formulary or based on the Part D benefit,” Dr. Kelman said. He said formularies would be compared to others in their region and to commercial plans.

Council member Laura Powers, M.D., a neurologist from Knoxville, Tenn., said she was relieved by Dr. Kelman's comments. “We were so worried that our patients with very expensive drugs were going to be eliminated from all the formularies.”

Dr. Kelman urged physicians to begin moving patients to the new formularies before the benefit is effective Jan. 1, 2006. “The last thing we want is 40 million exceptions and appeals in the first week,” he said. Beneficiaries can enroll in the program from Nov. 15 through May 15.

Dr. Kelman pointed out that by law, barbiturates and benzodiazepines will not be covered by the plans. He said the hope is that states will continue to pay for them for beneficiaries on both Medicaid and Medicare. Also not covered are cosmetic agents and weight-loss and weight-gain products.

WASHINGTON — Physician obligation to help patients negotiate the upcoming Medicare Part D outpatient drug benefit will result in “another unfunded mandate” for Medicare providers, Ronald Castellanos, M.D., chairman of the Practicing Physicians Advisory Council said at the group's recent meeting.

Noting that patients are most likely to rely on their physicians for aid in choosing among the new drug plans, Dr. Castellanos said, “Basically what you're doing is putting the burden on physicians in their offices to really educate the Medicare recipient.”

PPAC members asked the Centers for Medicare and Medicaid Services to make educational materials as simple as possible, including information on whether beneficiaries are eligible for the low-income portion of the program.

“I really want a lot of information, very digestible,” said PPAC member Geraldine O'Shea, D.O., an internist from Jackson, Calif. “Something very easy for them to understand, because I do not want to take time out of my time to do medicine with my patient to say, 'Well, let me see your tax return.'”

“We are trying to make the information available as simple as possible,” said Jeffrey Kelman, M.D., medical officer for the CMS Center for Beneficiary Choices, noting that he would bring educational material to the council's next meeting.

Council member Barbara McAneny, M.D., an oncologist from Albuquerque, requested that the agency develop a computer program that would allow physicians to type in the drugs a patient is using and come up with the plan that would cover all of them.

She also proposed a draft recommendation that would require CMS to develop a reimbursement code for physician time spent on drug plan education, but it was voted down by the panel, with members saying it wasn't practical.

Walking through the benefit, Dr. Kelman said CMS is getting “much more robust formularies” from drug plans than officials had anticipated. “They're looking like commercial formularies,” he said. He added that the formularies would be available on the Web site in October.

All drugs approved by the Food and Drug Administration must be on the formularies, Dr. Kelman said. If a drug is not included, a beneficiary can appeal, based on medical necessity, but “preferably with a physician's help,” he said.

“All medically necessary drugs that are approved by the FDA with certain exceptions … have to be available.” Off-label prescriptions will be covered, Dr. Kelman said.

In a move important to rare drug organizations, Dr. Kelman said if there is only one drug to treat a disease, it must be included in the formulary.

Part D also will ensure drugs are available for chronic conditions by “favorably risk adjusting” those diseases, Dr. Kelman said. The plans also will “overadjust” for low-income individuals and nursing homes. “We went to a lot to trouble to ensure nobody was discriminated against on the formulary or based on the Part D benefit,” Dr. Kelman said. He said formularies would be compared to others in their region and to commercial plans.

Council member Laura Powers, M.D., a neurologist from Knoxville, Tenn., said she was relieved by Dr. Kelman's comments. “We were so worried that our patients with very expensive drugs were going to be eliminated from all the formularies.”

Dr. Kelman urged physicians to begin moving patients to the new formularies before the benefit is effective Jan. 1, 2006. “The last thing we want is 40 million exceptions and appeals in the first week,” he said. Beneficiaries can enroll in the program from Nov. 15 through May 15.

Dr. Kelman pointed out that by law, barbiturates and benzodiazepines will not be covered by the plans. He said the hope is that states will continue to pay for them for beneficiaries on both Medicaid and Medicare. Also not covered are cosmetic agents and weight-loss and weight-gain products.

WASHINGTON — Physician obligation to help patients negotiate the upcoming Medicare Part D outpatient drug benefit will result in “another unfunded mandate” for Medicare providers, Ronald Castellanos, M.D., chairman of the Practicing Physicians Advisory Council said at the group's recent meeting.

Noting that patients are most likely to rely on their physicians for aid in choosing among the new drug plans, Dr. Castellanos said, “Basically what you're doing is putting the burden on physicians in their offices to really educate the Medicare recipient.”

PPAC members asked the Centers for Medicare and Medicaid Services to make educational materials as simple as possible, including information on whether beneficiaries are eligible for the low-income portion of the program.

“I really want a lot of information, very digestible,” said PPAC member Geraldine O'Shea, D.O., an internist from Jackson, Calif. “Something very easy for them to understand, because I do not want to take time out of my time to do medicine with my patient to say, 'Well, let me see your tax return.'”

“We are trying to make the information available as simple as possible,” said Jeffrey Kelman, M.D., medical officer for the CMS Center for Beneficiary Choices, noting that he would bring educational material to the council's next meeting.

Council member Barbara McAneny, M.D., an oncologist from Albuquerque, requested that the agency develop a computer program that would allow physicians to type in the drugs a patient is using and come up with the plan that would cover all of them.

She also proposed a draft recommendation that would require CMS to develop a reimbursement code for physician time spent on drug plan education, but it was voted down by the panel, with members saying it wasn't practical.

Walking through the benefit, Dr. Kelman said CMS is getting “much more robust formularies” from drug plans than officials had anticipated. “They're looking like commercial formularies,” he said. He added that the formularies would be available on the Web site in October.

All drugs approved by the Food and Drug Administration must be on the formularies, Dr. Kelman said. If a drug is not included, a beneficiary can appeal, based on medical necessity, but “preferably with a physician's help,” he said.

“All medically necessary drugs that are approved by the FDA with certain exceptions … have to be available.” Off-label prescriptions will be covered, Dr. Kelman said.

In a move important to rare drug organizations, Dr. Kelman said if there is only one drug to treat a disease, it must be included in the formulary.

Part D also will ensure drugs are available for chronic conditions by “favorably risk adjusting” those diseases, Dr. Kelman said. The plans also will “overadjust” for low-income individuals and nursing homes. “We went to a lot to trouble to ensure nobody was discriminated against on the formulary or based on the Part D benefit,” Dr. Kelman said. He said formularies would be compared to others in their region and to commercial plans.

Council member Laura Powers, M.D., a neurologist from Knoxville, Tenn., said she was relieved by Dr. Kelman's comments. “We were so worried that our patients with very expensive drugs were going to be eliminated from all the formularies.”

Dr. Kelman urged physicians to begin moving patients to the new formularies before the benefit is effective Jan. 1, 2006. “The last thing we want is 40 million exceptions and appeals in the first week,” he said. Beneficiaries can enroll in the program from Nov. 15 through May 15.

Dr. Kelman pointed out that by law, barbiturates and benzodiazepines will not be covered by the plans. He said the hope is that states will continue to pay for them for beneficiaries on both Medicaid and Medicare. Also not covered are cosmetic agents and weight-loss and weight-gain products.

WASHINGTON — The Centers for Medicare and Medicaid Services will review national provider identifier protocols that now require separate numbers for each covered entity. The requirement could mean some physicians who are also part of group practices and other arrangements would have multiple NPI numbers.

Members of the Practicing Physicians Advisory Council brought the issue to the attention of CMS's director of program integrity, Kimberly Brandt. “The goal here was to have less numbers, not more. So I appreciate your point, and it's something I will definitely look into,” Ms. Brandt said.

NPI enrollment began May 2 and continues through May 2007, when all providers will be required to use the system for standard electronic health care transactions. “With national standards and identifiers in place for electronic claims and other transactions, health care providers will be able to submit transactions to any health plan in the United States,” CMS Administrator Mark McClellan, M.D., said in a letter to health care providers.

As a requirement of the Health Insurance Portability and Accountability Act, many health plans—including Medicare, Medicaid, private health insurance issuers, and health care clearinghouses—must use NPIs in standard transactions by May 2007. Small health plans have an additional year to comply. The number is intended to replace current numbers, including the unique physician identification number (UPIN).

To demonstrate the process of getting an NPI, PPAC Chairman Ronald Castellanos, M.D., got his number at the council's meeting, in a process that took approximately 8 minutes.

Ms. Brandt said that CMS is encouraging health plans to devise a transition plan for a system that accepts both the UPIN and NPI until the May 2007 compliance deadline. CMS is recommending that members of groups not sign up individually now but wait until fall, when “batch enumeration” systems will be in place to accept group applications.

Once assigned a random NPI, providers will have that number for the remainder of their careers and need only contact CMS to make changes.

WASHINGTON — The Centers for Medicare and Medicaid Services will review national provider identifier protocols that now require separate numbers for each covered entity. The requirement could mean some physicians who are also part of group practices and other arrangements would have multiple NPI numbers.

Members of the Practicing Physicians Advisory Council brought the issue to the attention of CMS's director of program integrity, Kimberly Brandt. “The goal here was to have less numbers, not more. So I appreciate your point, and it's something I will definitely look into,” Ms. Brandt said.

NPI enrollment began May 2 and continues through May 2007, when all providers will be required to use the system for standard electronic health care transactions. “With national standards and identifiers in place for electronic claims and other transactions, health care providers will be able to submit transactions to any health plan in the United States,” CMS Administrator Mark McClellan, M.D., said in a letter to health care providers.

As a requirement of the Health Insurance Portability and Accountability Act, many health plans—including Medicare, Medicaid, private health insurance issuers, and health care clearinghouses—must use NPIs in standard transactions by May 2007. Small health plans have an additional year to comply. The number is intended to replace current numbers, including the unique physician identification number (UPIN).

To demonstrate the process of getting an NPI, PPAC Chairman Ronald Castellanos, M.D., got his number at the council's meeting, in a process that took approximately 8 minutes.

Ms. Brandt said that CMS is encouraging health plans to devise a transition plan for a system that accepts both the UPIN and NPI until the May 2007 compliance deadline. CMS is recommending that members of groups not sign up individually now but wait until fall, when “batch enumeration” systems will be in place to accept group applications.

Once assigned a random NPI, providers will have that number for the remainder of their careers and need only contact CMS to make changes.

WASHINGTON — The Centers for Medicare and Medicaid Services will review national provider identifier protocols that now require separate numbers for each covered entity. The requirement could mean some physicians who are also part of group practices and other arrangements would have multiple NPI numbers.

Members of the Practicing Physicians Advisory Council brought the issue to the attention of CMS's director of program integrity, Kimberly Brandt. “The goal here was to have less numbers, not more. So I appreciate your point, and it's something I will definitely look into,” Ms. Brandt said.

NPI enrollment began May 2 and continues through May 2007, when all providers will be required to use the system for standard electronic health care transactions. “With national standards and identifiers in place for electronic claims and other transactions, health care providers will be able to submit transactions to any health plan in the United States,” CMS Administrator Mark McClellan, M.D., said in a letter to health care providers.

As a requirement of the Health Insurance Portability and Accountability Act, many health plans—including Medicare, Medicaid, private health insurance issuers, and health care clearinghouses—must use NPIs in standard transactions by May 2007. Small health plans have an additional year to comply. The number is intended to replace current numbers, including the unique physician identification number (UPIN).

To demonstrate the process of getting an NPI, PPAC Chairman Ronald Castellanos, M.D., got his number at the council's meeting, in a process that took approximately 8 minutes.

Ms. Brandt said that CMS is encouraging health plans to devise a transition plan for a system that accepts both the UPIN and NPI until the May 2007 compliance deadline. CMS is recommending that members of groups not sign up individually now but wait until fall, when “batch enumeration” systems will be in place to accept group applications.

Once assigned a random NPI, providers will have that number for the remainder of their careers and need only contact CMS to make changes.

WASHINGTON — Physician obligation to help patients negotiate the upcoming Medicare Part D outpatient drug benefit will result in “another unfunded mandate” for Medicare providers, Ronald Castellanos, M.D., chairman of the Practicing Physicians Advisory Council said at the group's recent meeting.

Noting that patients are most likely to rely on their physicians for aid in choosing among the new drug plans, Dr. Castellanos said, “Basically what you're doing is putting the burden on physicians in their offices to really educate the Medicare recipient.”

PPAC members asked the Centers for Medicare and Medicaid Services to make educational materials as simple possible, including information on whether beneficiaries are eligible for the low-income portion of the program.

“I really want a lot of information, very digestible,” said PPAC member Geraldine O'Shea, D.O., an internist from Jackson, Calif. “Something very easy for them to understand, because I do not want to take time out of my time to do medicine with my patient to say, 'Well, let me see your tax return.'”

“We are trying to make the information available as simple as possible,” said Jeffrey Kelman, M.D., medical officer for the CMS Center for Beneficiary Choices.

Council member Barbara McAneny, M.D., an oncologist from Albuquerque, requested a computer program that would allow physicians to type in the drugs a patient is using and come up with the plan that would cover all of them. She also proposed that CMS be required to develop a reimbursement code for physician time spent on drug plan education, but it was voted down by the panel, with members saying it wasn't practical.

Dr. Kelman said CMS is getting “much more robust formularies” from drug plans than officials had anticipated. “They're looking like commercial formularies,” he said, adding that the formularies would be available on the Web site in October.

All drugs approved by the Food and Drug Administration must be on the formularies, Dr. Kelman said. If a drug is not included, a beneficiary can appeal, based on medical necessity, “preferably with a physician's help,” he said. “All medically necessary drugs that are approved by the FDA with certain exceptions … have to be available.” In a move important to rare drug organizations, Dr. Kelman said if there is only one drug to treat a disease, it must be included in the formulary.

Part D also will ensure drugs are available for chronic conditions by “favorably risk adjusting” those diseases, Dr. Kelman said. The plans also will “overadjust” for low-income individuals and nursing homes. “We went to a lot to trouble to ensure nobody was discriminated against on the formulary or based on the Part D benefit,” Dr. Kelman said. Dr. Kelman urged physicians to begin moving patients to the new formularies before the benefit is effective Jan. 1, 2006. “The last thing we want is 40 million exceptions and appeals in the first week,” he said. Beneficiaries can enroll in the program from November 15 through May 15.

In other issues, Dr. Kelman pointed out that by law, barbiturates and benzodiazepines will not be covered by the plans. He said the program was hoping states would continue to pay for these inexpensive drugs for dual-eligible beneficiaries (those receiving both Medicaid and Medicare benefits). Other drugs not covered include cosmetic agents and weight-loss and weight-gain products.

WASHINGTON — Physician obligation to help patients negotiate the upcoming Medicare Part D outpatient drug benefit will result in “another unfunded mandate” for Medicare providers, Ronald Castellanos, M.D., chairman of the Practicing Physicians Advisory Council said at the group's recent meeting.

Noting that patients are most likely to rely on their physicians for aid in choosing among the new drug plans, Dr. Castellanos said, “Basically what you're doing is putting the burden on physicians in their offices to really educate the Medicare recipient.”

PPAC members asked the Centers for Medicare and Medicaid Services to make educational materials as simple possible, including information on whether beneficiaries are eligible for the low-income portion of the program.

“I really want a lot of information, very digestible,” said PPAC member Geraldine O'Shea, D.O., an internist from Jackson, Calif. “Something very easy for them to understand, because I do not want to take time out of my time to do medicine with my patient to say, 'Well, let me see your tax return.'”

“We are trying to make the information available as simple as possible,” said Jeffrey Kelman, M.D., medical officer for the CMS Center for Beneficiary Choices.

Council member Barbara McAneny, M.D., an oncologist from Albuquerque, requested a computer program that would allow physicians to type in the drugs a patient is using and come up with the plan that would cover all of them. She also proposed that CMS be required to develop a reimbursement code for physician time spent on drug plan education, but it was voted down by the panel, with members saying it wasn't practical.

Dr. Kelman said CMS is getting “much more robust formularies” from drug plans than officials had anticipated. “They're looking like commercial formularies,” he said, adding that the formularies would be available on the Web site in October.

All drugs approved by the Food and Drug Administration must be on the formularies, Dr. Kelman said. If a drug is not included, a beneficiary can appeal, based on medical necessity, “preferably with a physician's help,” he said. “All medically necessary drugs that are approved by the FDA with certain exceptions … have to be available.” In a move important to rare drug organizations, Dr. Kelman said if there is only one drug to treat a disease, it must be included in the formulary.

Part D also will ensure drugs are available for chronic conditions by “favorably risk adjusting” those diseases, Dr. Kelman said. The plans also will “overadjust” for low-income individuals and nursing homes. “We went to a lot to trouble to ensure nobody was discriminated against on the formulary or based on the Part D benefit,” Dr. Kelman said. Dr. Kelman urged physicians to begin moving patients to the new formularies before the benefit is effective Jan. 1, 2006. “The last thing we want is 40 million exceptions and appeals in the first week,” he said. Beneficiaries can enroll in the program from November 15 through May 15.

In other issues, Dr. Kelman pointed out that by law, barbiturates and benzodiazepines will not be covered by the plans. He said the program was hoping states would continue to pay for these inexpensive drugs for dual-eligible beneficiaries (those receiving both Medicaid and Medicare benefits). Other drugs not covered include cosmetic agents and weight-loss and weight-gain products.

WASHINGTON — Physician obligation to help patients negotiate the upcoming Medicare Part D outpatient drug benefit will result in “another unfunded mandate” for Medicare providers, Ronald Castellanos, M.D., chairman of the Practicing Physicians Advisory Council said at the group's recent meeting.

Noting that patients are most likely to rely on their physicians for aid in choosing among the new drug plans, Dr. Castellanos said, “Basically what you're doing is putting the burden on physicians in their offices to really educate the Medicare recipient.”

PPAC members asked the Centers for Medicare and Medicaid Services to make educational materials as simple possible, including information on whether beneficiaries are eligible for the low-income portion of the program.

“I really want a lot of information, very digestible,” said PPAC member Geraldine O'Shea, D.O., an internist from Jackson, Calif. “Something very easy for them to understand, because I do not want to take time out of my time to do medicine with my patient to say, 'Well, let me see your tax return.'”

“We are trying to make the information available as simple as possible,” said Jeffrey Kelman, M.D., medical officer for the CMS Center for Beneficiary Choices.

Council member Barbara McAneny, M.D., an oncologist from Albuquerque, requested a computer program that would allow physicians to type in the drugs a patient is using and come up with the plan that would cover all of them. She also proposed that CMS be required to develop a reimbursement code for physician time spent on drug plan education, but it was voted down by the panel, with members saying it wasn't practical.

Dr. Kelman said CMS is getting “much more robust formularies” from drug plans than officials had anticipated. “They're looking like commercial formularies,” he said, adding that the formularies would be available on the Web site in October.

All drugs approved by the Food and Drug Administration must be on the formularies, Dr. Kelman said. If a drug is not included, a beneficiary can appeal, based on medical necessity, “preferably with a physician's help,” he said. “All medically necessary drugs that are approved by the FDA with certain exceptions … have to be available.” In a move important to rare drug organizations, Dr. Kelman said if there is only one drug to treat a disease, it must be included in the formulary.

Part D also will ensure drugs are available for chronic conditions by “favorably risk adjusting” those diseases, Dr. Kelman said. The plans also will “overadjust” for low-income individuals and nursing homes. “We went to a lot to trouble to ensure nobody was discriminated against on the formulary or based on the Part D benefit,” Dr. Kelman said. Dr. Kelman urged physicians to begin moving patients to the new formularies before the benefit is effective Jan. 1, 2006. “The last thing we want is 40 million exceptions and appeals in the first week,” he said. Beneficiaries can enroll in the program from November 15 through May 15.

In other issues, Dr. Kelman pointed out that by law, barbiturates and benzodiazepines will not be covered by the plans. He said the program was hoping states would continue to pay for these inexpensive drugs for dual-eligible beneficiaries (those receiving both Medicaid and Medicare benefits). Other drugs not covered include cosmetic agents and weight-loss and weight-gain products.

WASHINGTON — Physician obligation to help patients negotiate the upcoming Medicare Part D outpatient drug benefit will result in “another unfunded mandate” for Medicare providers, Ronald Castellanos, M.D., chairman of the Practicing Physicians Advisory Council said at the group's recent meeting.

Noting that patients are most likely to rely on their physicians for aid in choosing among the new drug plans, Dr. Castellanos said, “Basically what you're doing is putting the burden on physicians in their offices to really educate the Medicare recipient.”

PPAC members asked the Centers for Medicare and Medicaid Services to make educational materials as simple as possible, including information on whether beneficiaries are eligible for the low-income portion of the program.

“I really want a lot of information, very digestible,” said PPAC member Geraldine O'Shea, D.O., an internist in Jackson, Calif. “Something very easy for them to understand, because I do not want to take time out of my time to do medicine with my patient to say, 'Well, let me see your tax return.'”

“We are trying to make the information available as simple as possible,” said Jeffrey Kelman, M.D., medical officer for the CMS Center for Beneficiary Choices, noting that he would bring educational material to the council's next meeting.

Council member Barbara McAneny, M.D., an oncologist from Albuquerque, requested that the agency develop a computer program that would allow physicians to type in the drugs a patient is using and come up with the plan that would cover all of them. She also proposed a draft recommendation that would require CMS to develop a reimbursement code for physician time spent on drug plan education, but it was voted down by the panel, with members saying it wasn't practical.

Walking through the benefit, Dr. Kelman said CMS is getting “much more robust formularies” from drug plans than officials had anticipated. “They're looking like commercial formularies,” he said. He added that the formularies would be available on the Web site in October.

All drugs approved by the Food and Drug Administration must be on the formularies, Dr. Kelman said. If a drug is not included, a beneficiary can appeal, based on medical necessity, but “preferably with a physician's help,” he said. “All medically necessary drugs that are approved by the FDA with certain exceptions … have to be available.” However, off-label prescriptions will be covered, Dr. Kelman said.

In a move important to rare drug organizations, Dr. Kelman said if there is only one drug to treat a disease, it must be included in the formulary. Part D also will ensure drugs are available for chronic conditions by “favorably risk adjusting” those diseases, Dr. Kelman said. The plans also will “overadjust” for low-income individuals and nursing homes.

“We went to a lot of trouble to ensure nobody was discriminated against on the formulary or based on the Part D benefit,” Dr. Kelman said. He said formularies would be compared with others in their region and with commercial plans.

Council member Laura Powers, M.D., a neurologist in Knoxville, Tenn. said she was relieved by Dr. Kelman's comments. “We were so worried that our patients with very expensive drugs were going to be eliminated from all the formularies.”

Dr. Kelman urged physicians to begin moving patients to the new formularies before the benefit is effective Jan. 1, 2006. “The last thing we want is 40 million exceptions and appeals in the first week,” he said. Beneficiaries can enroll in the program from November 15 through May 15.

Dr. Kelman also pointed out that by law, barbiturates and benzodiazepines will not be covered by the plans. He said the medications are inexpensive and that the program was hoping states would continue to pay for them for dual-eligible (Medicaid- Medicare) beneficiaries.

WASHINGTON — Physician obligation to help patients negotiate the upcoming Medicare Part D outpatient drug benefit will result in “another unfunded mandate” for Medicare providers, Ronald Castellanos, M.D., chairman of the Practicing Physicians Advisory Council said at the group's recent meeting.

Noting that patients are most likely to rely on their physicians for aid in choosing among the new drug plans, Dr. Castellanos said, “Basically what you're doing is putting the burden on physicians in their offices to really educate the Medicare recipient.”

PPAC members asked the Centers for Medicare and Medicaid Services to make educational materials as simple as possible, including information on whether beneficiaries are eligible for the low-income portion of the program.

“I really want a lot of information, very digestible,” said PPAC member Geraldine O'Shea, D.O., an internist in Jackson, Calif. “Something very easy for them to understand, because I do not want to take time out of my time to do medicine with my patient to say, 'Well, let me see your tax return.'”

“We are trying to make the information available as simple as possible,” said Jeffrey Kelman, M.D., medical officer for the CMS Center for Beneficiary Choices, noting that he would bring educational material to the council's next meeting.

Council member Barbara McAneny, M.D., an oncologist from Albuquerque, requested that the agency develop a computer program that would allow physicians to type in the drugs a patient is using and come up with the plan that would cover all of them. She also proposed a draft recommendation that would require CMS to develop a reimbursement code for physician time spent on drug plan education, but it was voted down by the panel, with members saying it wasn't practical.

Walking through the benefit, Dr. Kelman said CMS is getting “much more robust formularies” from drug plans than officials had anticipated. “They're looking like commercial formularies,” he said. He added that the formularies would be available on the Web site in October.

All drugs approved by the Food and Drug Administration must be on the formularies, Dr. Kelman said. If a drug is not included, a beneficiary can appeal, based on medical necessity, but “preferably with a physician's help,” he said. “All medically necessary drugs that are approved by the FDA with certain exceptions … have to be available.” However, off-label prescriptions will be covered, Dr. Kelman said.

In a move important to rare drug organizations, Dr. Kelman said if there is only one drug to treat a disease, it must be included in the formulary. Part D also will ensure drugs are available for chronic conditions by “favorably risk adjusting” those diseases, Dr. Kelman said. The plans also will “overadjust” for low-income individuals and nursing homes.

“We went to a lot of trouble to ensure nobody was discriminated against on the formulary or based on the Part D benefit,” Dr. Kelman said. He said formularies would be compared with others in their region and with commercial plans.

Council member Laura Powers, M.D., a neurologist in Knoxville, Tenn. said she was relieved by Dr. Kelman's comments. “We were so worried that our patients with very expensive drugs were going to be eliminated from all the formularies.”

Dr. Kelman urged physicians to begin moving patients to the new formularies before the benefit is effective Jan. 1, 2006. “The last thing we want is 40 million exceptions and appeals in the first week,” he said. Beneficiaries can enroll in the program from November 15 through May 15.

Dr. Kelman also pointed out that by law, barbiturates and benzodiazepines will not be covered by the plans. He said the medications are inexpensive and that the program was hoping states would continue to pay for them for dual-eligible (Medicaid- Medicare) beneficiaries.

WASHINGTON — Physician obligation to help patients negotiate the upcoming Medicare Part D outpatient drug benefit will result in “another unfunded mandate” for Medicare providers, Ronald Castellanos, M.D., chairman of the Practicing Physicians Advisory Council said at the group's recent meeting.

Noting that patients are most likely to rely on their physicians for aid in choosing among the new drug plans, Dr. Castellanos said, “Basically what you're doing is putting the burden on physicians in their offices to really educate the Medicare recipient.”

PPAC members asked the Centers for Medicare and Medicaid Services to make educational materials as simple as possible, including information on whether beneficiaries are eligible for the low-income portion of the program.

“I really want a lot of information, very digestible,” said PPAC member Geraldine O'Shea, D.O., an internist in Jackson, Calif. “Something very easy for them to understand, because I do not want to take time out of my time to do medicine with my patient to say, 'Well, let me see your tax return.'”

“We are trying to make the information available as simple as possible,” said Jeffrey Kelman, M.D., medical officer for the CMS Center for Beneficiary Choices, noting that he would bring educational material to the council's next meeting.

Council member Barbara McAneny, M.D., an oncologist from Albuquerque, requested that the agency develop a computer program that would allow physicians to type in the drugs a patient is using and come up with the plan that would cover all of them. She also proposed a draft recommendation that would require CMS to develop a reimbursement code for physician time spent on drug plan education, but it was voted down by the panel, with members saying it wasn't practical.

Walking through the benefit, Dr. Kelman said CMS is getting “much more robust formularies” from drug plans than officials had anticipated. “They're looking like commercial formularies,” he said. He added that the formularies would be available on the Web site in October.

All drugs approved by the Food and Drug Administration must be on the formularies, Dr. Kelman said. If a drug is not included, a beneficiary can appeal, based on medical necessity, but “preferably with a physician's help,” he said. “All medically necessary drugs that are approved by the FDA with certain exceptions … have to be available.” However, off-label prescriptions will be covered, Dr. Kelman said.

In a move important to rare drug organizations, Dr. Kelman said if there is only one drug to treat a disease, it must be included in the formulary. Part D also will ensure drugs are available for chronic conditions by “favorably risk adjusting” those diseases, Dr. Kelman said. The plans also will “overadjust” for low-income individuals and nursing homes.

“We went to a lot of trouble to ensure nobody was discriminated against on the formulary or based on the Part D benefit,” Dr. Kelman said. He said formularies would be compared with others in their region and with commercial plans.

Council member Laura Powers, M.D., a neurologist in Knoxville, Tenn. said she was relieved by Dr. Kelman's comments. “We were so worried that our patients with very expensive drugs were going to be eliminated from all the formularies.”

Dr. Kelman urged physicians to begin moving patients to the new formularies before the benefit is effective Jan. 1, 2006. “The last thing we want is 40 million exceptions and appeals in the first week,” he said. Beneficiaries can enroll in the program from November 15 through May 15.

Dr. Kelman also pointed out that by law, barbiturates and benzodiazepines will not be covered by the plans. He said the medications are inexpensive and that the program was hoping states would continue to pay for them for dual-eligible (Medicaid- Medicare) beneficiaries.