Mary Ellen Schneider

When Dr. Lisa Larkin started her practice in 2002, she traded in a stable, academic career for nightly call and a $150,000 business loan.

Today, the Cincinnati practice is thriving, with about 4,800 patients and seven providers who work as a team to provide comprehensive care. And Dr. Larkin is able to practice medicine on her own terms—providing patients with a medical home and offering her all-female staff of physicians the opportunity to work flexible, part-time schedules.

“I really have a model that's working great that I think both patients and physicians are really, really happy with,” Dr. Larkin said.

But getting to that point was a challenge. Dr. Larkin, who spent more than a decade working at the University of Cincinnati, decided in 2002 to strike out on her own and build an innovative practice. So with the help of her medical assistant—now her practice manager—and a hefty business loan, she started a solo practice.

For the first year, she worked 5 days a week and took call every day. She didn't make any money in the first 12 months. Even though some of her university patients followed her.

“It was a big financial gamble, but something that I really felt like I wanted to do to create a model that wasn't being done elsewhere,” Dr. Larkin said.

One of the big differences between Dr. Larkin's practice and most primary care practices is the length of patient visits. New patient appointments are 40 minutes and follow-up appointments are 20 minutes. On average, Dr. Larkin and her colleagues each see about 22–24 patients a day, not the typical 35.

To support coordinated care, Dr. Larkin subleases space in her office to a variety of subspecialists, such as gynecologists and cardiologists. She works with other providers to offer a group weight-loss program, monthly diabetes classes, and special lectures on health and wellness topics. She also distributes a regular e-newsletter and plans to expand access to the lectures through a podcast featured on her Web site.

The other focus of the practice is on customer service. Dr. Larkin said the staff aims to be as accessible as possible by phone and e-mail for billing questions, health advice, and appointment scheduling. The staff also tries to go the extra mile for patients when they run into problems getting insurance authorization for medications and tests.

Staffing was one of the areas where Dr. Larkin wanted her practice to be different. Rather than recruiting a full complement of full-time internists, Dr. Larkin made a point of looking for female physicians who were interested in part-time medical practice. The plan fit in to her goal of providing more opportunities for women in their childbearing years, and it turned out to be a recruiting advantage because the large primary care organizations in the Cincinnati area weren't interested in hiring part-time employees.

“I really want to make it work for other women,” said Dr. Larkin, the mother of two teenagers. “I believe that it can work. I believe that women bring tremendous things to the practice of medicine and really offer things different than men sometimes.”

Managing the schedules of several part-time employees isn't as straightforward as a traditional work schedule, but it can be achieved with effective communication, a supportive team environment, and creative scheduling, Dr. Larkin said. Currently, she is the only full-time physician in the practice; most of the other physicians work 2 or 3 days a week. In order to keep the exam rooms full and appointments running on time, the physicians plan their group schedule a year in advance, and they cover for each other when their colleagues are on vacation.

That type of teamwork and camaraderie is central to successfully creating a medical home for patients, said Dr. Eric Warm, an associate professor of clinical medicine at the University of Cincinnati, who is familiar with Dr. Larkin's practice.

In an effort to cover rising costs, Dr. Larkin has introduced an annual administrative fee in her practice. The fee—$75 the first year and $50 a year thereafter—covers administrative services not covered by insurance.

When Dr. Lisa Larkin started her practice in 2002, she traded in a stable, academic career for nightly call and a $150,000 business loan.

Today, the Cincinnati practice is thriving, with about 4,800 patients and seven providers who work as a team to provide comprehensive care. And Dr. Larkin is able to practice medicine on her own terms—providing patients with a medical home and offering her all-female staff of physicians the opportunity to work flexible, part-time schedules.

“I really have a model that's working great that I think both patients and physicians are really, really happy with,” Dr. Larkin said.

But getting to that point was a challenge. Dr. Larkin, who spent more than a decade working at the University of Cincinnati, decided in 2002 to strike out on her own and build an innovative practice. So with the help of her medical assistant—now her practice manager—and a hefty business loan, she started a solo practice.

For the first year, she worked 5 days a week and took call every day. She didn't make any money in the first 12 months. Even though some of her university patients followed her.

“It was a big financial gamble, but something that I really felt like I wanted to do to create a model that wasn't being done elsewhere,” Dr. Larkin said.

One of the big differences between Dr. Larkin's practice and most primary care practices is the length of patient visits. New patient appointments are 40 minutes and follow-up appointments are 20 minutes. On average, Dr. Larkin and her colleagues each see about 22–24 patients a day, not the typical 35.

To support coordinated care, Dr. Larkin subleases space in her office to a variety of subspecialists, such as gynecologists and cardiologists. She works with other providers to offer a group weight-loss program, monthly diabetes classes, and special lectures on health and wellness topics. She also distributes a regular e-newsletter and plans to expand access to the lectures through a podcast featured on her Web site.

The other focus of the practice is on customer service. Dr. Larkin said the staff aims to be as accessible as possible by phone and e-mail for billing questions, health advice, and appointment scheduling. The staff also tries to go the extra mile for patients when they run into problems getting insurance authorization for medications and tests.

Staffing was one of the areas where Dr. Larkin wanted her practice to be different. Rather than recruiting a full complement of full-time internists, Dr. Larkin made a point of looking for female physicians who were interested in part-time medical practice. The plan fit in to her goal of providing more opportunities for women in their childbearing years, and it turned out to be a recruiting advantage because the large primary care organizations in the Cincinnati area weren't interested in hiring part-time employees.

“I really want to make it work for other women,” said Dr. Larkin, the mother of two teenagers. “I believe that it can work. I believe that women bring tremendous things to the practice of medicine and really offer things different than men sometimes.”

Managing the schedules of several part-time employees isn't as straightforward as a traditional work schedule, but it can be achieved with effective communication, a supportive team environment, and creative scheduling, Dr. Larkin said. Currently, she is the only full-time physician in the practice; most of the other physicians work 2 or 3 days a week. In order to keep the exam rooms full and appointments running on time, the physicians plan their group schedule a year in advance, and they cover for each other when their colleagues are on vacation.

That type of teamwork and camaraderie is central to successfully creating a medical home for patients, said Dr. Eric Warm, an associate professor of clinical medicine at the University of Cincinnati, who is familiar with Dr. Larkin's practice.

In an effort to cover rising costs, Dr. Larkin has introduced an annual administrative fee in her practice. The fee—$75 the first year and $50 a year thereafter—covers administrative services not covered by insurance.

When Dr. Lisa Larkin started her practice in 2002, she traded in a stable, academic career for nightly call and a $150,000 business loan.

Today, the Cincinnati practice is thriving, with about 4,800 patients and seven providers who work as a team to provide comprehensive care. And Dr. Larkin is able to practice medicine on her own terms—providing patients with a medical home and offering her all-female staff of physicians the opportunity to work flexible, part-time schedules.

“I really have a model that's working great that I think both patients and physicians are really, really happy with,” Dr. Larkin said.

But getting to that point was a challenge. Dr. Larkin, who spent more than a decade working at the University of Cincinnati, decided in 2002 to strike out on her own and build an innovative practice. So with the help of her medical assistant—now her practice manager—and a hefty business loan, she started a solo practice.

For the first year, she worked 5 days a week and took call every day. She didn't make any money in the first 12 months. Even though some of her university patients followed her.

“It was a big financial gamble, but something that I really felt like I wanted to do to create a model that wasn't being done elsewhere,” Dr. Larkin said.

One of the big differences between Dr. Larkin's practice and most primary care practices is the length of patient visits. New patient appointments are 40 minutes and follow-up appointments are 20 minutes. On average, Dr. Larkin and her colleagues each see about 22–24 patients a day, not the typical 35.

To support coordinated care, Dr. Larkin subleases space in her office to a variety of subspecialists, such as gynecologists and cardiologists. She works with other providers to offer a group weight-loss program, monthly diabetes classes, and special lectures on health and wellness topics. She also distributes a regular e-newsletter and plans to expand access to the lectures through a podcast featured on her Web site.

The other focus of the practice is on customer service. Dr. Larkin said the staff aims to be as accessible as possible by phone and e-mail for billing questions, health advice, and appointment scheduling. The staff also tries to go the extra mile for patients when they run into problems getting insurance authorization for medications and tests.

Staffing was one of the areas where Dr. Larkin wanted her practice to be different. Rather than recruiting a full complement of full-time internists, Dr. Larkin made a point of looking for female physicians who were interested in part-time medical practice. The plan fit in to her goal of providing more opportunities for women in their childbearing years, and it turned out to be a recruiting advantage because the large primary care organizations in the Cincinnati area weren't interested in hiring part-time employees.

“I really want to make it work for other women,” said Dr. Larkin, the mother of two teenagers. “I believe that it can work. I believe that women bring tremendous things to the practice of medicine and really offer things different than men sometimes.”

Managing the schedules of several part-time employees isn't as straightforward as a traditional work schedule, but it can be achieved with effective communication, a supportive team environment, and creative scheduling, Dr. Larkin said. Currently, she is the only full-time physician in the practice; most of the other physicians work 2 or 3 days a week. In order to keep the exam rooms full and appointments running on time, the physicians plan their group schedule a year in advance, and they cover for each other when their colleagues are on vacation.

That type of teamwork and camaraderie is central to successfully creating a medical home for patients, said Dr. Eric Warm, an associate professor of clinical medicine at the University of Cincinnati, who is familiar with Dr. Larkin's practice.

In an effort to cover rising costs, Dr. Larkin has introduced an annual administrative fee in her practice. The fee—$75 the first year and $50 a year thereafter—covers administrative services not covered by insurance.

The Food and Drug Administration is vowing to get tougher and act faster when it comes to protecting public health.

The changes aim to make FDA “as transparent as possible about our expectations [while] industry commits to working in as responsive a way as possible to address our concerns,” said Dr. Margaret A. Hamburg, the agency's new commissioner. Over the past several years, the FDA's enforcement activities have declined significantly, and those enforcement actions taken have been hamstrung by delays, mostly due to internal red tape, she said.

Speaking at a Food and Drug Law Institute conference, she outlined six steps to streamline the way the FDA handles enforcement across all regulated areas—drugs, devices, and food.

In cases where agency officials deem that public health is at risk, the FDA is prepared to take enforcement action before issuing a formal warning letter. Agency officials will also work with state, local, and international regulators to determine who can act fastest in an emergency.

The FDA also plans to change some of its internal processes, Dr. Hamburg said. The agency will establish a 15-day deadline for industry to respond once a significant problem is identified during an inspection. In addition, it will aim to get warning letters out the door more quickly by limiting review to significant legal issues.

Prompt follow-up on warning letters and other enforcement actions is also part of Dr. Hamburg's plan. The FDA will move more quickly in assessing corrective actions taken by industry after a warning letter is issued or a major product recall occurs. And in an effort to motivate industry to act quickly, the FDA is developing a formal warning letter “close-out” process. Once the FDA has confirmed that a firm has fully corrected its violations, the agency will issue a close-out notice and post the information online.

The Food and Drug Administration is vowing to get tougher and act faster when it comes to protecting public health.

The changes aim to make FDA “as transparent as possible about our expectations [while] industry commits to working in as responsive a way as possible to address our concerns,” said Dr. Margaret A. Hamburg, the agency's new commissioner. Over the past several years, the FDA's enforcement activities have declined significantly, and those enforcement actions taken have been hamstrung by delays, mostly due to internal red tape, she said.

Speaking at a Food and Drug Law Institute conference, she outlined six steps to streamline the way the FDA handles enforcement across all regulated areas—drugs, devices, and food.

In cases where agency officials deem that public health is at risk, the FDA is prepared to take enforcement action before issuing a formal warning letter. Agency officials will also work with state, local, and international regulators to determine who can act fastest in an emergency.

The FDA also plans to change some of its internal processes, Dr. Hamburg said. The agency will establish a 15-day deadline for industry to respond once a significant problem is identified during an inspection. In addition, it will aim to get warning letters out the door more quickly by limiting review to significant legal issues.

Prompt follow-up on warning letters and other enforcement actions is also part of Dr. Hamburg's plan. The FDA will move more quickly in assessing corrective actions taken by industry after a warning letter is issued or a major product recall occurs. And in an effort to motivate industry to act quickly, the FDA is developing a formal warning letter “close-out” process. Once the FDA has confirmed that a firm has fully corrected its violations, the agency will issue a close-out notice and post the information online.

The Food and Drug Administration is vowing to get tougher and act faster when it comes to protecting public health.

The changes aim to make FDA “as transparent as possible about our expectations [while] industry commits to working in as responsive a way as possible to address our concerns,” said Dr. Margaret A. Hamburg, the agency's new commissioner. Over the past several years, the FDA's enforcement activities have declined significantly, and those enforcement actions taken have been hamstrung by delays, mostly due to internal red tape, she said.

Speaking at a Food and Drug Law Institute conference, she outlined six steps to streamline the way the FDA handles enforcement across all regulated areas—drugs, devices, and food.

In cases where agency officials deem that public health is at risk, the FDA is prepared to take enforcement action before issuing a formal warning letter. Agency officials will also work with state, local, and international regulators to determine who can act fastest in an emergency.

The FDA also plans to change some of its internal processes, Dr. Hamburg said. The agency will establish a 15-day deadline for industry to respond once a significant problem is identified during an inspection. In addition, it will aim to get warning letters out the door more quickly by limiting review to significant legal issues.

Prompt follow-up on warning letters and other enforcement actions is also part of Dr. Hamburg's plan. The FDA will move more quickly in assessing corrective actions taken by industry after a warning letter is issued or a major product recall occurs. And in an effort to motivate industry to act quickly, the FDA is developing a formal warning letter “close-out” process. Once the FDA has confirmed that a firm has fully corrected its violations, the agency will issue a close-out notice and post the information online.

Physicians have a little more than 2 years to complete their transition to new HIPAA X12 standards for submitting administrative transactions electronically, according to Medicare officials.

As of Jan. 1, 2012, physicians and all other entities covered under HIPAA (Health Insurance Portability and Accountability Act) will be required to use the HIPAA X12 version 5010 format when submitting claims, receiving remittances, and sending claim status or eligibility inquiries electronically. The new standard replaces the version 4010A1 currently in use. The change will affect dealings not only with Medicare, but also with all private payers.

The Medicare fee-for-service program will begin its own system testing next year and will begin accepting administrative transactions using the 5010 version as of Jan. 1, 2011. Throughout 2011, the Centers for Medicare and Medicaid Services will accept both the 5010 and 4010A1 versions. However, beginning on Jan. 1, 2012, only transactions submitted using the 5010 version will be accepted.

During a recent conference call to update providers, officials at the Centers for Medicare and Medicaid Services urged physicians not to wait until the last minute to make the transition to the new format.

“There's no room to delay. We cannot possibly convert all of the Medicare trading partners at the 11th hour,” said Christine Stahlecker, director of the Division of Medicare Billing Procedures in the CMS Office of Information Services.

The switch is necessary, according to the CMS, because the 4010A1 version is outdated. For example, the industry currently relies heavily on companion guides to implement the standards, which limits their value. The new version includes some new functions aimed at improving claims processing, such as resolving ambiguities in the situational rules and providing more consistency across transactions.

But Medicare officials urged physicians to analyze the new version carefully prior to implementation. Billing software will need to be updated, and business processes may need to be changed as well. “There are real changes in these formats,” Ms. Stahlecker said.

A comparison of the current and new formats can be viewed at www.cms.hhs.gov/ElectronicBillingEDITrans/18_5010D0.asp

Ms. Stahlecker advised physicians to contact their system vendors as soon as possible to find out if their licensing agreement includes regulatory updates and to get the vendor's timeline for upgrading its systems.

Physicians have a little more than 2 years to complete their transition to new HIPAA X12 standards for submitting administrative transactions electronically, according to Medicare officials.

As of Jan. 1, 2012, physicians and all other entities covered under HIPAA (Health Insurance Portability and Accountability Act) will be required to use the HIPAA X12 version 5010 format when submitting claims, receiving remittances, and sending claim status or eligibility inquiries electronically. The new standard replaces the version 4010A1 currently in use. The change will affect dealings not only with Medicare, but also with all private payers.

The Medicare fee-for-service program will begin its own system testing next year and will begin accepting administrative transactions using the 5010 version as of Jan. 1, 2011. Throughout 2011, the Centers for Medicare and Medicaid Services will accept both the 5010 and 4010A1 versions. However, beginning on Jan. 1, 2012, only transactions submitted using the 5010 version will be accepted.

During a recent conference call to update providers, officials at the Centers for Medicare and Medicaid Services urged physicians not to wait until the last minute to make the transition to the new format.

“There's no room to delay. We cannot possibly convert all of the Medicare trading partners at the 11th hour,” said Christine Stahlecker, director of the Division of Medicare Billing Procedures in the CMS Office of Information Services.

The switch is necessary, according to the CMS, because the 4010A1 version is outdated. For example, the industry currently relies heavily on companion guides to implement the standards, which limits their value. The new version includes some new functions aimed at improving claims processing, such as resolving ambiguities in the situational rules and providing more consistency across transactions.

But Medicare officials urged physicians to analyze the new version carefully prior to implementation. Billing software will need to be updated, and business processes may need to be changed as well. “There are real changes in these formats,” Ms. Stahlecker said.

A comparison of the current and new formats can be viewed at www.cms.hhs.gov/ElectronicBillingEDITrans/18_5010D0.asp

Ms. Stahlecker advised physicians to contact their system vendors as soon as possible to find out if their licensing agreement includes regulatory updates and to get the vendor's timeline for upgrading its systems.

Physicians have a little more than 2 years to complete their transition to new HIPAA X12 standards for submitting administrative transactions electronically, according to Medicare officials.

As of Jan. 1, 2012, physicians and all other entities covered under HIPAA (Health Insurance Portability and Accountability Act) will be required to use the HIPAA X12 version 5010 format when submitting claims, receiving remittances, and sending claim status or eligibility inquiries electronically. The new standard replaces the version 4010A1 currently in use. The change will affect dealings not only with Medicare, but also with all private payers.

The Medicare fee-for-service program will begin its own system testing next year and will begin accepting administrative transactions using the 5010 version as of Jan. 1, 2011. Throughout 2011, the Centers for Medicare and Medicaid Services will accept both the 5010 and 4010A1 versions. However, beginning on Jan. 1, 2012, only transactions submitted using the 5010 version will be accepted.

During a recent conference call to update providers, officials at the Centers for Medicare and Medicaid Services urged physicians not to wait until the last minute to make the transition to the new format.

“There's no room to delay. We cannot possibly convert all of the Medicare trading partners at the 11th hour,” said Christine Stahlecker, director of the Division of Medicare Billing Procedures in the CMS Office of Information Services.

The switch is necessary, according to the CMS, because the 4010A1 version is outdated. For example, the industry currently relies heavily on companion guides to implement the standards, which limits their value. The new version includes some new functions aimed at improving claims processing, such as resolving ambiguities in the situational rules and providing more consistency across transactions.

But Medicare officials urged physicians to analyze the new version carefully prior to implementation. Billing software will need to be updated, and business processes may need to be changed as well. “There are real changes in these formats,” Ms. Stahlecker said.

A comparison of the current and new formats can be viewed at www.cms.hhs.gov/ElectronicBillingEDITrans/18_5010D0.asp

Ms. Stahlecker advised physicians to contact their system vendors as soon as possible to find out if their licensing agreement includes regulatory updates and to get the vendor's timeline for upgrading its systems.

Can't get enough Policy & Practice? Check out our new podcast each Monday. egmnblog.wordpress.com

Bill Would Compromise on Abortion

Members of Congress are seeking a compromise on government efforts to reduce abortions. A new bill (H.R. 3312) aims to decrease the number of abortions by preventing unintended pregnancies and providing assistance to women who become pregnant. Specifically, the bill would provide increased access to contraception for low-income women and new mothers, and would expand health coverage for pregnant women and children. It also calls for a national adoption campaign and would support students who are pregnant or are already parents. “With this legislation, we have found common ground on one of the most divisive debates in America,” Rep. Tim Ryan (D-Ohio), said in a statement. Rep. Ryan, one of the cosponsors of the bill, is a member of the Congressional Pro-Life Caucus. The other chief sponsor is Rep. Rosa DeLauro (D-Conn.), a member of the Congressional Pro-Choice Caucus. The bill also has support from nongovernment organizations on both sides of the abortion debate.

NARAL Supports Sotomayor

The Senate's confirmation of Judge Sonia Sotomayor as the newest associate justice on the Supreme Court was praised because of her anticipated support of abortion rights. In a statement, Nancy Keenan, president of NARAL Pro-Choice America, said the organization supported Judge Sotomayor's nomination because of her answers to questions on privacy rights as well as her backing from key abortion-rights supporters in the Senate. Nevertheless, in 2002 she sided with the Bush administration in a key reproductive rights case, Center for Reproductive Law and Policy v. Bush. She authored the decision to uphold the administration's prohibition of U.S. support for overseas family planning organizations that provided or advocated abortions. That policy, referred to as the “Mexico City policy” or the “global gag rule,” has since been overturned by the Obama administration.

Senate Confirms New NIH Chief

The Senate also recently confirmed another one of President Obama's nominees. Dr. Francis Collins, known for his leadership of the Human Genome Project, is the new director of the National Institutes of Health. Dr. Collins' research has resulted in the discovery of genes responsible for cystic fibrosis, neurofibromatosis, Huntington's disease, a familial endocrine cancer syndrome, and type 2 diabetes. He also wrote a best-selling book on the relationship between faith and science.

Medical Liability Reform

With all the talk about health care reform this year, little has been said about changing the medical liability system. But Doctors for Medical Liability Reform, a group of about 230,000 specialists and several medical organizations, is urging physicians to contact members of Congress with the message that real health care reform can only be achieved if it addresses medical liability. The group's online petition asserts that defensive medicine is driving up the cost of health care by billions of dollars annually and that frivolous lawsuits are forcing physicians out of practice across the country. The petition, available at

www.protectpatientsnow.org

Family Insurance Tops $12K

Employer-sponsored insurance for a family of four in 2008 cost employers and workers an average of $12,298, according to the Agency for Healthcare Research and Quality. The employees' contribution averaged $3,394 for family-of-four plans and $882 for single workers, the agency reported. Employers paid the entire premium for 22% of workers with single-coverage plans, for 11% of workers with family-of-four plans, and for 9% of employees with one covered family member. About 31 million of the more than 62 million workers enrolled in employer-based insurance in 2008 had single plans, while 20 million had family-of-four coverage.

Information Tech Is Growing

The electronic exchange of health information among physicians, hospitals, health plans, and patients has increased substantially in the past year, the nonprofit group eHealth Initiative (eHI) found in its annual survey of 150 community-based “health information electronically” initiatives. Respondents reported a nearly 40% increase in the number of initiatives that were advanced enough to be exchanging information. According to eHI, these groups said that information technology is cutting redundant tests, avoiding some medication errors, and reducing staff time spent handling lab results and doing clerical tasks. The federal government is to spend at least $300 million on health information technology over the next 2 years as part of the economic stimulus of the American Recovery and Reinvestment Act of 2009. “We have a great opportunity to expand [health information technology] efforts with the new funding coming out in 2009 and 2010,” eHI chief operating officer Jennifer Covich said in a statement.

Can't get enough Policy & Practice? Check out our new podcast each Monday. egmnblog.wordpress.com

Bill Would Compromise on Abortion

Members of Congress are seeking a compromise on government efforts to reduce abortions. A new bill (H.R. 3312) aims to decrease the number of abortions by preventing unintended pregnancies and providing assistance to women who become pregnant. Specifically, the bill would provide increased access to contraception for low-income women and new mothers, and would expand health coverage for pregnant women and children. It also calls for a national adoption campaign and would support students who are pregnant or are already parents. “With this legislation, we have found common ground on one of the most divisive debates in America,” Rep. Tim Ryan (D-Ohio), said in a statement. Rep. Ryan, one of the cosponsors of the bill, is a member of the Congressional Pro-Life Caucus. The other chief sponsor is Rep. Rosa DeLauro (D-Conn.), a member of the Congressional Pro-Choice Caucus. The bill also has support from nongovernment organizations on both sides of the abortion debate.

NARAL Supports Sotomayor

The Senate's confirmation of Judge Sonia Sotomayor as the newest associate justice on the Supreme Court was praised because of her anticipated support of abortion rights. In a statement, Nancy Keenan, president of NARAL Pro-Choice America, said the organization supported Judge Sotomayor's nomination because of her answers to questions on privacy rights as well as her backing from key abortion-rights supporters in the Senate. Nevertheless, in 2002 she sided with the Bush administration in a key reproductive rights case, Center for Reproductive Law and Policy v. Bush. She authored the decision to uphold the administration's prohibition of U.S. support for overseas family planning organizations that provided or advocated abortions. That policy, referred to as the “Mexico City policy” or the “global gag rule,” has since been overturned by the Obama administration.

Senate Confirms New NIH Chief

The Senate also recently confirmed another one of President Obama's nominees. Dr. Francis Collins, known for his leadership of the Human Genome Project, is the new director of the National Institutes of Health. Dr. Collins' research has resulted in the discovery of genes responsible for cystic fibrosis, neurofibromatosis, Huntington's disease, a familial endocrine cancer syndrome, and type 2 diabetes. He also wrote a best-selling book on the relationship between faith and science.

Medical Liability Reform

With all the talk about health care reform this year, little has been said about changing the medical liability system. But Doctors for Medical Liability Reform, a group of about 230,000 specialists and several medical organizations, is urging physicians to contact members of Congress with the message that real health care reform can only be achieved if it addresses medical liability. The group's online petition asserts that defensive medicine is driving up the cost of health care by billions of dollars annually and that frivolous lawsuits are forcing physicians out of practice across the country. The petition, available at

www.protectpatientsnow.org

Family Insurance Tops $12K

Employer-sponsored insurance for a family of four in 2008 cost employers and workers an average of $12,298, according to the Agency for Healthcare Research and Quality. The employees' contribution averaged $3,394 for family-of-four plans and $882 for single workers, the agency reported. Employers paid the entire premium for 22% of workers with single-coverage plans, for 11% of workers with family-of-four plans, and for 9% of employees with one covered family member. About 31 million of the more than 62 million workers enrolled in employer-based insurance in 2008 had single plans, while 20 million had family-of-four coverage.

Information Tech Is Growing

The electronic exchange of health information among physicians, hospitals, health plans, and patients has increased substantially in the past year, the nonprofit group eHealth Initiative (eHI) found in its annual survey of 150 community-based “health information electronically” initiatives. Respondents reported a nearly 40% increase in the number of initiatives that were advanced enough to be exchanging information. According to eHI, these groups said that information technology is cutting redundant tests, avoiding some medication errors, and reducing staff time spent handling lab results and doing clerical tasks. The federal government is to spend at least $300 million on health information technology over the next 2 years as part of the economic stimulus of the American Recovery and Reinvestment Act of 2009. “We have a great opportunity to expand [health information technology] efforts with the new funding coming out in 2009 and 2010,” eHI chief operating officer Jennifer Covich said in a statement.

Can't get enough Policy & Practice? Check out our new podcast each Monday. egmnblog.wordpress.com

Bill Would Compromise on Abortion

Members of Congress are seeking a compromise on government efforts to reduce abortions. A new bill (H.R. 3312) aims to decrease the number of abortions by preventing unintended pregnancies and providing assistance to women who become pregnant. Specifically, the bill would provide increased access to contraception for low-income women and new mothers, and would expand health coverage for pregnant women and children. It also calls for a national adoption campaign and would support students who are pregnant or are already parents. “With this legislation, we have found common ground on one of the most divisive debates in America,” Rep. Tim Ryan (D-Ohio), said in a statement. Rep. Ryan, one of the cosponsors of the bill, is a member of the Congressional Pro-Life Caucus. The other chief sponsor is Rep. Rosa DeLauro (D-Conn.), a member of the Congressional Pro-Choice Caucus. The bill also has support from nongovernment organizations on both sides of the abortion debate.

NARAL Supports Sotomayor

The Senate's confirmation of Judge Sonia Sotomayor as the newest associate justice on the Supreme Court was praised because of her anticipated support of abortion rights. In a statement, Nancy Keenan, president of NARAL Pro-Choice America, said the organization supported Judge Sotomayor's nomination because of her answers to questions on privacy rights as well as her backing from key abortion-rights supporters in the Senate. Nevertheless, in 2002 she sided with the Bush administration in a key reproductive rights case, Center for Reproductive Law and Policy v. Bush. She authored the decision to uphold the administration's prohibition of U.S. support for overseas family planning organizations that provided or advocated abortions. That policy, referred to as the “Mexico City policy” or the “global gag rule,” has since been overturned by the Obama administration.

Senate Confirms New NIH Chief

The Senate also recently confirmed another one of President Obama's nominees. Dr. Francis Collins, known for his leadership of the Human Genome Project, is the new director of the National Institutes of Health. Dr. Collins' research has resulted in the discovery of genes responsible for cystic fibrosis, neurofibromatosis, Huntington's disease, a familial endocrine cancer syndrome, and type 2 diabetes. He also wrote a best-selling book on the relationship between faith and science.

Medical Liability Reform

With all the talk about health care reform this year, little has been said about changing the medical liability system. But Doctors for Medical Liability Reform, a group of about 230,000 specialists and several medical organizations, is urging physicians to contact members of Congress with the message that real health care reform can only be achieved if it addresses medical liability. The group's online petition asserts that defensive medicine is driving up the cost of health care by billions of dollars annually and that frivolous lawsuits are forcing physicians out of practice across the country. The petition, available at

www.protectpatientsnow.org

Family Insurance Tops $12K

Employer-sponsored insurance for a family of four in 2008 cost employers and workers an average of $12,298, according to the Agency for Healthcare Research and Quality. The employees' contribution averaged $3,394 for family-of-four plans and $882 for single workers, the agency reported. Employers paid the entire premium for 22% of workers with single-coverage plans, for 11% of workers with family-of-four plans, and for 9% of employees with one covered family member. About 31 million of the more than 62 million workers enrolled in employer-based insurance in 2008 had single plans, while 20 million had family-of-four coverage.

Information Tech Is Growing

The electronic exchange of health information among physicians, hospitals, health plans, and patients has increased substantially in the past year, the nonprofit group eHealth Initiative (eHI) found in its annual survey of 150 community-based “health information electronically” initiatives. Respondents reported a nearly 40% increase in the number of initiatives that were advanced enough to be exchanging information. According to eHI, these groups said that information technology is cutting redundant tests, avoiding some medication errors, and reducing staff time spent handling lab results and doing clerical tasks. The federal government is to spend at least $300 million on health information technology over the next 2 years as part of the economic stimulus of the American Recovery and Reinvestment Act of 2009. “We have a great opportunity to expand [health information technology] efforts with the new funding coming out in 2009 and 2010,” eHI chief operating officer Jennifer Covich said in a statement.

Neurosurgeons Oppose Reform Bill

The American Association of Neurological Surgeons (AANS) and the Congress of Neurological Surgeons (CNS) have come out strongly against the health reform legislation currently under consideration in the House. “America's Affordable Health Choices Act of 2009” (H.R. 3200), which includes a public health insurance option, goes too far, according to the groups. AANS and CNS said the public plan could lead the United States to a single-payer, government-run health care system. They also voiced concerns about the high cost of the proposals in the bill and the failure to include medical liability reform. “America's neurosurgeons strongly support improving our nation's health care system by ensuring insurance coverage for all our citizens,” Dr. Troy M. Tippett, president of the AANS, said in a statement. “Unfortunately, as it is currently constructed, this bill goes far beyond what is necessary to fix what is broken with our health care system.” The AANS and CNS are supporting a Republican alternative, the “Empowering Patients First Act” (H.R. 3400). It advocates tax incentives as the way to expand health coverage and would limit noneconomic damages and attorneys' contingency fees in medical malpractice cases.

Huntington's Drug in Phase III

The investigational drug dimebon (latrepirdine) will advance to phase III trials to evaluate its effects on cognition in people with Huntington's disease. Partnering drugmakers Pfizer Inc. and Medivation Inc. said that in preclinical trials, dimebon protected brain cells from damage, perhaps by improving mitochondrial function. For the phase III trial, called HORIZON, researchers will enroll about 350 patients at 50 sites in North America, Europe, and Australia to receive either dimebon (20 mg) 3 times daily or placebo for 6 months. In the meantime, the Food and Drug Administration has granted dimebon orphan drug status for the treatment of Huntington's disease.

NIH Launches Brain Mapping Project

Officials at the National Institutes of Health are launching a $30 million initiative to map the circuitry of the adult brain. The Human Connectome Project will rely on brain imaging and other data from investigators funded at up to $6 million per year for 5 years. The NIH will collect brain images, DNA samples, demographic information, and behavioral data from hundreds of subjects. When all the pieces come together, the information could provide clues as to how brain connectivity is influenced by genetics and the environment, according to the NIH. “Neuroscientists have only a piecemeal understanding of brain connectivity,” Story Landis, Ph.D., director of the National Institute of Neurological Disorders and Stroke, said in a statement.

Agent Orange–Parkinson's Link Studied

The Institute of Medicine has found limited but suggestive evidence of a link between soldiers' exposure to herbicides during the Vietnam War and an increased risk of Parkinson's disease. The IOM reviewed 16 studies that examined Agent Orange and other herbicide exposures among individuals with Parkinson's disease or Parkinson's-like symptoms. The finding of a suggestive link is based on several studies showing that compounds similar to the herbicides used in Vietnam are linked to Parkinson's. The committee couldn't be more definite because it lacked studies that looked at Parkinson's disease specifically in Vietnam veterans. The IOM committee recommended more research, including animal studies of the effects of chemical components of Agent Orange.

Neurosurgeons Oppose Reform Bill

The American Association of Neurological Surgeons (AANS) and the Congress of Neurological Surgeons (CNS) have come out strongly against the health reform legislation currently under consideration in the House. “America's Affordable Health Choices Act of 2009” (H.R. 3200), which includes a public health insurance option, goes too far, according to the groups. AANS and CNS said the public plan could lead the United States to a single-payer, government-run health care system. They also voiced concerns about the high cost of the proposals in the bill and the failure to include medical liability reform. “America's neurosurgeons strongly support improving our nation's health care system by ensuring insurance coverage for all our citizens,” Dr. Troy M. Tippett, president of the AANS, said in a statement. “Unfortunately, as it is currently constructed, this bill goes far beyond what is necessary to fix what is broken with our health care system.” The AANS and CNS are supporting a Republican alternative, the “Empowering Patients First Act” (H.R. 3400). It advocates tax incentives as the way to expand health coverage and would limit noneconomic damages and attorneys' contingency fees in medical malpractice cases.

Huntington's Drug in Phase III

The investigational drug dimebon (latrepirdine) will advance to phase III trials to evaluate its effects on cognition in people with Huntington's disease. Partnering drugmakers Pfizer Inc. and Medivation Inc. said that in preclinical trials, dimebon protected brain cells from damage, perhaps by improving mitochondrial function. For the phase III trial, called HORIZON, researchers will enroll about 350 patients at 50 sites in North America, Europe, and Australia to receive either dimebon (20 mg) 3 times daily or placebo for 6 months. In the meantime, the Food and Drug Administration has granted dimebon orphan drug status for the treatment of Huntington's disease.

NIH Launches Brain Mapping Project

Officials at the National Institutes of Health are launching a $30 million initiative to map the circuitry of the adult brain. The Human Connectome Project will rely on brain imaging and other data from investigators funded at up to $6 million per year for 5 years. The NIH will collect brain images, DNA samples, demographic information, and behavioral data from hundreds of subjects. When all the pieces come together, the information could provide clues as to how brain connectivity is influenced by genetics and the environment, according to the NIH. “Neuroscientists have only a piecemeal understanding of brain connectivity,” Story Landis, Ph.D., director of the National Institute of Neurological Disorders and Stroke, said in a statement.

Agent Orange–Parkinson's Link Studied

The Institute of Medicine has found limited but suggestive evidence of a link between soldiers' exposure to herbicides during the Vietnam War and an increased risk of Parkinson's disease. The IOM reviewed 16 studies that examined Agent Orange and other herbicide exposures among individuals with Parkinson's disease or Parkinson's-like symptoms. The finding of a suggestive link is based on several studies showing that compounds similar to the herbicides used in Vietnam are linked to Parkinson's. The committee couldn't be more definite because it lacked studies that looked at Parkinson's disease specifically in Vietnam veterans. The IOM committee recommended more research, including animal studies of the effects of chemical components of Agent Orange.

Neurosurgeons Oppose Reform Bill

The American Association of Neurological Surgeons (AANS) and the Congress of Neurological Surgeons (CNS) have come out strongly against the health reform legislation currently under consideration in the House. “America's Affordable Health Choices Act of 2009” (H.R. 3200), which includes a public health insurance option, goes too far, according to the groups. AANS and CNS said the public plan could lead the United States to a single-payer, government-run health care system. They also voiced concerns about the high cost of the proposals in the bill and the failure to include medical liability reform. “America's neurosurgeons strongly support improving our nation's health care system by ensuring insurance coverage for all our citizens,” Dr. Troy M. Tippett, president of the AANS, said in a statement. “Unfortunately, as it is currently constructed, this bill goes far beyond what is necessary to fix what is broken with our health care system.” The AANS and CNS are supporting a Republican alternative, the “Empowering Patients First Act” (H.R. 3400). It advocates tax incentives as the way to expand health coverage and would limit noneconomic damages and attorneys' contingency fees in medical malpractice cases.

Huntington's Drug in Phase III

The investigational drug dimebon (latrepirdine) will advance to phase III trials to evaluate its effects on cognition in people with Huntington's disease. Partnering drugmakers Pfizer Inc. and Medivation Inc. said that in preclinical trials, dimebon protected brain cells from damage, perhaps by improving mitochondrial function. For the phase III trial, called HORIZON, researchers will enroll about 350 patients at 50 sites in North America, Europe, and Australia to receive either dimebon (20 mg) 3 times daily or placebo for 6 months. In the meantime, the Food and Drug Administration has granted dimebon orphan drug status for the treatment of Huntington's disease.

NIH Launches Brain Mapping Project

Officials at the National Institutes of Health are launching a $30 million initiative to map the circuitry of the adult brain. The Human Connectome Project will rely on brain imaging and other data from investigators funded at up to $6 million per year for 5 years. The NIH will collect brain images, DNA samples, demographic information, and behavioral data from hundreds of subjects. When all the pieces come together, the information could provide clues as to how brain connectivity is influenced by genetics and the environment, according to the NIH. “Neuroscientists have only a piecemeal understanding of brain connectivity,” Story Landis, Ph.D., director of the National Institute of Neurological Disorders and Stroke, said in a statement.

Agent Orange–Parkinson's Link Studied

The Institute of Medicine has found limited but suggestive evidence of a link between soldiers' exposure to herbicides during the Vietnam War and an increased risk of Parkinson's disease. The IOM reviewed 16 studies that examined Agent Orange and other herbicide exposures among individuals with Parkinson's disease or Parkinson's-like symptoms. The finding of a suggestive link is based on several studies showing that compounds similar to the herbicides used in Vietnam are linked to Parkinson's. The committee couldn't be more definite because it lacked studies that looked at Parkinson's disease specifically in Vietnam veterans. The IOM committee recommended more research, including animal studies of the effects of chemical components of Agent Orange.

Physicians have a little more than 2 years to complete their transition to new HIPAA X12 standards for submitting administrative transactions electronically, according to Medicare officials.

As of Jan. 1, 2012, physicians and all other entities covered under HIPAA (Health Insurance Portability and Accountability Act) will be required to use the HIPAA X12 version 5010 format when submitting claims, receiving remittances, and sending claim status or eligibility inquiries electronically. The new standard replaces the version 4010A1 currently in use. The change will affect dealings not only with Medicare, but also with all private payers.

The Medicare fee-for-service program will begin its own system testing next year and will begin accepting administrative transactions using the 5010 version as of Jan. 1, 2011. Throughout 2011, the Centers for Medicare and Medicaid Services will accept both the 5010 and 4010A1 versions. However, beginning on Jan. 1, 2012, only transactions submitted using the 5010 version will be accepted.

During a recent conference call to update providers, officials at the Centers for Medicare and Medicaid Services urged physicians not to wait until the last minute to make the transition to the new format.

“There's no room to delay. We cannot possibly convert all of the Medicare trading partners at the 11th hour,” said Christine Stahlecker, director of the Division of Medicare Billing Procedures in the CMS Office of Information Services.

The switch is necessary, according to the CMS, because the 4010A1 version is outdated. For example, the industry currently relies heavily on companion guides to implement the standards, which limits their value. The new version includes some new functions aimed at improving claims processing, such as resolving ambiguities in the situational rules and providing more consistency across transactions.

But Medicare officials urged physicians to analyze the new version carefully prior to implementation. Billing software will need to be updated, and business processes may need to be changed as well. “There are real changes in these formats,” Ms. Stahlecker said.

A comparison of the current and new formats can be viewed online at www.cms.hhs.gov/ElectronicBillingEDITrans/18_5010D0.asp

Another reason that physicians should pay attention to the 5010 transition is that it paves the way for the move from the International Classification of Diseases, 9th Edition, Clinical Modification (ICD-9-CM) code sets now used to the significantly expanded ICD-10 code sets on Oct. 1, 2013.

Ms. Stahlecker advised physicians to contact their system vendors as soon as possible to find out if their licensing agreement includes regulatory updates and to get the vendor's timeline for upgrading its systems.

Physicians have a little more than 2 years to complete their transition to new HIPAA X12 standards for submitting administrative transactions electronically, according to Medicare officials.

As of Jan. 1, 2012, physicians and all other entities covered under HIPAA (Health Insurance Portability and Accountability Act) will be required to use the HIPAA X12 version 5010 format when submitting claims, receiving remittances, and sending claim status or eligibility inquiries electronically. The new standard replaces the version 4010A1 currently in use. The change will affect dealings not only with Medicare, but also with all private payers.

The Medicare fee-for-service program will begin its own system testing next year and will begin accepting administrative transactions using the 5010 version as of Jan. 1, 2011. Throughout 2011, the Centers for Medicare and Medicaid Services will accept both the 5010 and 4010A1 versions. However, beginning on Jan. 1, 2012, only transactions submitted using the 5010 version will be accepted.

During a recent conference call to update providers, officials at the Centers for Medicare and Medicaid Services urged physicians not to wait until the last minute to make the transition to the new format.

“There's no room to delay. We cannot possibly convert all of the Medicare trading partners at the 11th hour,” said Christine Stahlecker, director of the Division of Medicare Billing Procedures in the CMS Office of Information Services.

The switch is necessary, according to the CMS, because the 4010A1 version is outdated. For example, the industry currently relies heavily on companion guides to implement the standards, which limits their value. The new version includes some new functions aimed at improving claims processing, such as resolving ambiguities in the situational rules and providing more consistency across transactions.

But Medicare officials urged physicians to analyze the new version carefully prior to implementation. Billing software will need to be updated, and business processes may need to be changed as well. “There are real changes in these formats,” Ms. Stahlecker said.

A comparison of the current and new formats can be viewed online at www.cms.hhs.gov/ElectronicBillingEDITrans/18_5010D0.asp

Another reason that physicians should pay attention to the 5010 transition is that it paves the way for the move from the International Classification of Diseases, 9th Edition, Clinical Modification (ICD-9-CM) code sets now used to the significantly expanded ICD-10 code sets on Oct. 1, 2013.

Ms. Stahlecker advised physicians to contact their system vendors as soon as possible to find out if their licensing agreement includes regulatory updates and to get the vendor's timeline for upgrading its systems.

Physicians have a little more than 2 years to complete their transition to new HIPAA X12 standards for submitting administrative transactions electronically, according to Medicare officials.

As of Jan. 1, 2012, physicians and all other entities covered under HIPAA (Health Insurance Portability and Accountability Act) will be required to use the HIPAA X12 version 5010 format when submitting claims, receiving remittances, and sending claim status or eligibility inquiries electronically. The new standard replaces the version 4010A1 currently in use. The change will affect dealings not only with Medicare, but also with all private payers.

The Medicare fee-for-service program will begin its own system testing next year and will begin accepting administrative transactions using the 5010 version as of Jan. 1, 2011. Throughout 2011, the Centers for Medicare and Medicaid Services will accept both the 5010 and 4010A1 versions. However, beginning on Jan. 1, 2012, only transactions submitted using the 5010 version will be accepted.

During a recent conference call to update providers, officials at the Centers for Medicare and Medicaid Services urged physicians not to wait until the last minute to make the transition to the new format.

“There's no room to delay. We cannot possibly convert all of the Medicare trading partners at the 11th hour,” said Christine Stahlecker, director of the Division of Medicare Billing Procedures in the CMS Office of Information Services.

The switch is necessary, according to the CMS, because the 4010A1 version is outdated. For example, the industry currently relies heavily on companion guides to implement the standards, which limits their value. The new version includes some new functions aimed at improving claims processing, such as resolving ambiguities in the situational rules and providing more consistency across transactions.

But Medicare officials urged physicians to analyze the new version carefully prior to implementation. Billing software will need to be updated, and business processes may need to be changed as well. “There are real changes in these formats,” Ms. Stahlecker said.

A comparison of the current and new formats can be viewed online at www.cms.hhs.gov/ElectronicBillingEDITrans/18_5010D0.asp

Another reason that physicians should pay attention to the 5010 transition is that it paves the way for the move from the International Classification of Diseases, 9th Edition, Clinical Modification (ICD-9-CM) code sets now used to the significantly expanded ICD-10 code sets on Oct. 1, 2013.

Ms. Stahlecker advised physicians to contact their system vendors as soon as possible to find out if their licensing agreement includes regulatory updates and to get the vendor's timeline for upgrading its systems.

HHS Issues Privacy Breach Rules

The federal government is requiring physicians and other entities covered under the Health Insurance Portability and Accountability Act to notify individuals when their protected health information has been breached. The interim final rule, issued in August, goes into effect this month. Under the rule, physicians have up to 60 calendar days from the detection of unauthorized access of protected health information to notify the patient. If the breach involves more than 500 individuals, the Health and Human Services secretary and a major media outlet in their area must be notified. “This new federal law ensures that covered entities and business associates are accountable to [HHS] and to individuals for proper safeguarding of the private information entrusted to their care,” said Robinsue Frohboese, acting director of the Office of Civil Rights at HHS. “These protections will be a cornerstone of maintaining consumer trust as we move forward with meaningful use of electronic health records and electronic exchange of health information.” But there are exceptions to the breach rules: Notifications are not necessary if the information that was disclosed is unlikely to be retained. For example, if a nurse gives a patient the wrong discharge papers but quickly takes them back, it's reasonable to assume that the patient could not have retained that protected information, according to HHS. More information about the regulation is available at

www.hhs.gov/ocr/privacy

Osteoporosis Hospitalizations Rise

The hospitalization rate resulting from injuries associated with osteoporosis climbed by 55% between 1995 and 2006, according to data from the Agency for Healthcare Research and Quality. Hospitalizations from an osteoporosis injury climbed from 55 stays per 100,000 individuals in 1995 to 85 stays per 100,000 individuals in 2006. The increase brought the number of hospital stays up to 254,000 in 2006, resulting in $2.4 billion in hospital costs. Injuries from osteoporosis accounted for about a quarter of the total number of hospital stays associated with a diagnosis of osteoporosis in 2006. Some of the most common injuries reported included spontaneous and stress fractures, hip fractures, pelvic fractures, contusions, and leg and arm fractures. The AHRQ findings are based on a nationally representative sample of community hospitals around the country.

Bill Would Cap Monthly Drug Costs

Patients with rheumatoid diseases could benefit from new federal legislation introduced last month. The Affordable Access to Prescription Medications Act (S. 1630) would establish a national cap on the cost of prescription drugs. Drug costs would be capped at $200 per prescription and $500 per month for all prescriptions, if the bill is enacted. The caps would apply to all public and private insurance plans, including Medicare prescription drug plans, according to Sen. Jay Rockefeller (D-W.Va.), who introduced the bill. Enacting a national cap on drug expenditures could cut costs in half for some individuals, Sen. Rockefeller estimated. The bill would also expand the Medicare exceptions process to help more patients get access to specialty drugs at lower costs. The bill is supported by the Arthritis Foundation and the Lupus Foundation of America.

Lilly Payment Data Now Public

Eli Lilly & Co. has made good on its promise to publish how much it pays physicians and other health care professionals in consulting fees, honoraria, and the like. The drugmaker detailed the payments for the first quarter of 2009 at

www.lillyfacultyregistry.com

Information Tech Is Growing

The electronic exchange of health information among physicians, hospitals, health plans, and patients has increased substantially, the nonprofit group eHealth Initiative (eHI) found in its annual survey of 150 community-based “health information electronically” initiatives. Respondents reported a nearly 40% increase in the number of initiatives that were advanced enough to be exchanging information. According to eHI, these groups said that information technology is cutting redundant tests, avoiding some medication errors, and reducing staff time spent handling lab results and doing clerical tasks. The federal government is to spend at least $300 million on health information technology over the next 2 years as part of the economic stimulus of the American Recovery and Reinvestment Act of 2009. “We have a great opportunity to expand [health information technology] efforts with the new funding coming out in 2009 and 2010,” said eHI chief operating officer Jennifer Covich in a statement.

HHS Issues Privacy Breach Rules

The federal government is requiring physicians and other entities covered under the Health Insurance Portability and Accountability Act to notify individuals when their protected health information has been breached. The interim final rule, issued in August, goes into effect this month. Under the rule, physicians have up to 60 calendar days from the detection of unauthorized access of protected health information to notify the patient. If the breach involves more than 500 individuals, the Health and Human Services secretary and a major media outlet in their area must be notified. “This new federal law ensures that covered entities and business associates are accountable to [HHS] and to individuals for proper safeguarding of the private information entrusted to their care,” said Robinsue Frohboese, acting director of the Office of Civil Rights at HHS. “These protections will be a cornerstone of maintaining consumer trust as we move forward with meaningful use of electronic health records and electronic exchange of health information.” But there are exceptions to the breach rules: Notifications are not necessary if the information that was disclosed is unlikely to be retained. For example, if a nurse gives a patient the wrong discharge papers but quickly takes them back, it's reasonable to assume that the patient could not have retained that protected information, according to HHS. More information about the regulation is available at

www.hhs.gov/ocr/privacy

Osteoporosis Hospitalizations Rise

The hospitalization rate resulting from injuries associated with osteoporosis climbed by 55% between 1995 and 2006, according to data from the Agency for Healthcare Research and Quality. Hospitalizations from an osteoporosis injury climbed from 55 stays per 100,000 individuals in 1995 to 85 stays per 100,000 individuals in 2006. The increase brought the number of hospital stays up to 254,000 in 2006, resulting in $2.4 billion in hospital costs. Injuries from osteoporosis accounted for about a quarter of the total number of hospital stays associated with a diagnosis of osteoporosis in 2006. Some of the most common injuries reported included spontaneous and stress fractures, hip fractures, pelvic fractures, contusions, and leg and arm fractures. The AHRQ findings are based on a nationally representative sample of community hospitals around the country.

Bill Would Cap Monthly Drug Costs

Patients with rheumatoid diseases could benefit from new federal legislation introduced last month. The Affordable Access to Prescription Medications Act (S. 1630) would establish a national cap on the cost of prescription drugs. Drug costs would be capped at $200 per prescription and $500 per month for all prescriptions, if the bill is enacted. The caps would apply to all public and private insurance plans, including Medicare prescription drug plans, according to Sen. Jay Rockefeller (D-W.Va.), who introduced the bill. Enacting a national cap on drug expenditures could cut costs in half for some individuals, Sen. Rockefeller estimated. The bill would also expand the Medicare exceptions process to help more patients get access to specialty drugs at lower costs. The bill is supported by the Arthritis Foundation and the Lupus Foundation of America.

Lilly Payment Data Now Public

Eli Lilly & Co. has made good on its promise to publish how much it pays physicians and other health care professionals in consulting fees, honoraria, and the like. The drugmaker detailed the payments for the first quarter of 2009 at

www.lillyfacultyregistry.com

Information Tech Is Growing

The electronic exchange of health information among physicians, hospitals, health plans, and patients has increased substantially, the nonprofit group eHealth Initiative (eHI) found in its annual survey of 150 community-based “health information electronically” initiatives. Respondents reported a nearly 40% increase in the number of initiatives that were advanced enough to be exchanging information. According to eHI, these groups said that information technology is cutting redundant tests, avoiding some medication errors, and reducing staff time spent handling lab results and doing clerical tasks. The federal government is to spend at least $300 million on health information technology over the next 2 years as part of the economic stimulus of the American Recovery and Reinvestment Act of 2009. “We have a great opportunity to expand [health information technology] efforts with the new funding coming out in 2009 and 2010,” said eHI chief operating officer Jennifer Covich in a statement.

HHS Issues Privacy Breach Rules

The federal government is requiring physicians and other entities covered under the Health Insurance Portability and Accountability Act to notify individuals when their protected health information has been breached. The interim final rule, issued in August, goes into effect this month. Under the rule, physicians have up to 60 calendar days from the detection of unauthorized access of protected health information to notify the patient. If the breach involves more than 500 individuals, the Health and Human Services secretary and a major media outlet in their area must be notified. “This new federal law ensures that covered entities and business associates are accountable to [HHS] and to individuals for proper safeguarding of the private information entrusted to their care,” said Robinsue Frohboese, acting director of the Office of Civil Rights at HHS. “These protections will be a cornerstone of maintaining consumer trust as we move forward with meaningful use of electronic health records and electronic exchange of health information.” But there are exceptions to the breach rules: Notifications are not necessary if the information that was disclosed is unlikely to be retained. For example, if a nurse gives a patient the wrong discharge papers but quickly takes them back, it's reasonable to assume that the patient could not have retained that protected information, according to HHS. More information about the regulation is available at

www.hhs.gov/ocr/privacy

Osteoporosis Hospitalizations Rise

The hospitalization rate resulting from injuries associated with osteoporosis climbed by 55% between 1995 and 2006, according to data from the Agency for Healthcare Research and Quality. Hospitalizations from an osteoporosis injury climbed from 55 stays per 100,000 individuals in 1995 to 85 stays per 100,000 individuals in 2006. The increase brought the number of hospital stays up to 254,000 in 2006, resulting in $2.4 billion in hospital costs. Injuries from osteoporosis accounted for about a quarter of the total number of hospital stays associated with a diagnosis of osteoporosis in 2006. Some of the most common injuries reported included spontaneous and stress fractures, hip fractures, pelvic fractures, contusions, and leg and arm fractures. The AHRQ findings are based on a nationally representative sample of community hospitals around the country.

Bill Would Cap Monthly Drug Costs

Patients with rheumatoid diseases could benefit from new federal legislation introduced last month. The Affordable Access to Prescription Medications Act (S. 1630) would establish a national cap on the cost of prescription drugs. Drug costs would be capped at $200 per prescription and $500 per month for all prescriptions, if the bill is enacted. The caps would apply to all public and private insurance plans, including Medicare prescription drug plans, according to Sen. Jay Rockefeller (D-W.Va.), who introduced the bill. Enacting a national cap on drug expenditures could cut costs in half for some individuals, Sen. Rockefeller estimated. The bill would also expand the Medicare exceptions process to help more patients get access to specialty drugs at lower costs. The bill is supported by the Arthritis Foundation and the Lupus Foundation of America.

Lilly Payment Data Now Public

Eli Lilly & Co. has made good on its promise to publish how much it pays physicians and other health care professionals in consulting fees, honoraria, and the like. The drugmaker detailed the payments for the first quarter of 2009 at

www.lillyfacultyregistry.com

Information Tech Is Growing

The electronic exchange of health information among physicians, hospitals, health plans, and patients has increased substantially, the nonprofit group eHealth Initiative (eHI) found in its annual survey of 150 community-based “health information electronically” initiatives. Respondents reported a nearly 40% increase in the number of initiatives that were advanced enough to be exchanging information. According to eHI, these groups said that information technology is cutting redundant tests, avoiding some medication errors, and reducing staff time spent handling lab results and doing clerical tasks. The federal government is to spend at least $300 million on health information technology over the next 2 years as part of the economic stimulus of the American Recovery and Reinvestment Act of 2009. “We have a great opportunity to expand [health information technology] efforts with the new funding coming out in 2009 and 2010,” said eHI chief operating officer Jennifer Covich in a statement.

Nearly 20% of Medicare patients admitted to a hospital after an acute myocardial infarction will be readmitted within 30 days, according to historical data released by the Centers for Medicare and Medicaid Services.

The all-cause, 30-day readmission rate for acute MI (19.9%) is similar to those for patients originally admitted for heart failure (24.5%) and pneumonia (18.2%).

The figures, based on 3 years of data, were posted to Medicare's Hospital Compare Web site. The readmission rates were produced with statistical models that rely on Medicare claims and enrollment information, according to the CMS.

The Web site (www.hospitalcompare.hhs.gov

The Hospital Compare readmissions data include hospital by hospital information, as well as national figures. They exclude planned hospital treatments such as readmission for a scheduled heart bypass or coronary angioplasty.

Nearly 20% of Medicare patients admitted to a hospital after an acute myocardial infarction will be readmitted within 30 days, according to historical data released by the Centers for Medicare and Medicaid Services.

The all-cause, 30-day readmission rate for acute MI (19.9%) is similar to those for patients originally admitted for heart failure (24.5%) and pneumonia (18.2%).

The figures, based on 3 years of data, were posted to Medicare's Hospital Compare Web site. The readmission rates were produced with statistical models that rely on Medicare claims and enrollment information, according to the CMS.

The Web site (www.hospitalcompare.hhs.gov

The Hospital Compare readmissions data include hospital by hospital information, as well as national figures. They exclude planned hospital treatments such as readmission for a scheduled heart bypass or coronary angioplasty.

Nearly 20% of Medicare patients admitted to a hospital after an acute myocardial infarction will be readmitted within 30 days, according to historical data released by the Centers for Medicare and Medicaid Services.

The all-cause, 30-day readmission rate for acute MI (19.9%) is similar to those for patients originally admitted for heart failure (24.5%) and pneumonia (18.2%).

The figures, based on 3 years of data, were posted to Medicare's Hospital Compare Web site. The readmission rates were produced with statistical models that rely on Medicare claims and enrollment information, according to the CMS.

The Web site (www.hospitalcompare.hhs.gov

The Hospital Compare readmissions data include hospital by hospital information, as well as national figures. They exclude planned hospital treatments such as readmission for a scheduled heart bypass or coronary angioplasty.

Dr. Gregory A. Maynard has spent most of his career working to improve patient care, not through new treatments, but by designing better care processes.

As a pioneer in developing protocols for venous thromboembolism prevention and glycemic control, Dr. Maynard has ushered in significant patient safety improvements at the University of California at San Diego. And he has been just as active in helping to roll out these protocols and techniques beyond his institution to hospitals around the country.

“The same principles basically get used over and over and over again,” he said. “While there's some nuances between the different projects, you're really using the same principles that should be adopted and adoptable at other places.”

Dr. Maynard, who is the chief of the division of hospital medicine at UC San Diego, is also the coleader of a national collaborative on VTE prevention and leads a national task force of the Society of Hospital Medicine to promote effective glycemic control in hospitalized patients.

His team has also tackled discharge processes and transitions of care, delirium detection and management, pneumonia management, infection prevention, and osteoporosis management.

When selecting areas to work on, Dr. Maynard and his team have several criteria. One of the key elements is choosing an area where there's a large gap between the best practices and the actual practices. “You have a chance to make a fairly large difference based on that gap,” he said.

They also try to look ahead and anticipate what areas will be targeted by groups like the Joint Commission or the National Quality Forum.

Once they select a clinical area, they often have to overcome a lack of awareness in the hospital staff. For example, a hospital may already have a protocol for delirium, but the physicians and nurses don't know about it. In that case, the key is to find ways to trigger the protocol, Dr. Maynard said.

Triggering the protocol has to involve some recognition of the condition either through an electronic health record or through a specific screen for the condition. “Something has to make it happen automatically so that it comes to the forefront,” Dr. Maynard said. “You can have the best protocol in the world to treat something, but if someone doesn't say, 'Hey, this is a good candidate for the protocol,' then it might never get used.”

One way to bridge that gap is to build a routine screening process into admission order sets or a nursing process, Dr. Maynard said. The prompt can also be as simple as a check box on the patient's history and physical form.

Dr. Maynard has some advice for hospitalists looking to start their own projects: “Quality improvement is not for sissies.” Implementing a successful quality improvement program is hard work, he said, and requires a team of persistent, driven individuals. It also helps to build a strong relationship with the hospital's informatics team and the people doing the data collection, he said.

Hospitalists should consider getting training in quality improvement, Dr. Maynard said. He recommended starting with the online offerings of organizations like the Society of Hospital Medicine and the Institute for Healthcare Improvement.

He advised hospitalists to think early on about how to make their projects generalizable, to think about whether improvements would be portable to other settings, and to use reliable metrics.

“I think people are hungry for this information about how to do quality improvement well,” Dr. Maynard said.

'I think people are hungry for this information about how to do quality improvement well.'

Source DR. MAYNARD

Dr. Gregory A. Maynard has spent most of his career working to improve patient care, not through new treatments, but by designing better care processes.

As a pioneer in developing protocols for venous thromboembolism prevention and glycemic control, Dr. Maynard has ushered in significant patient safety improvements at the University of California at San Diego. And he has been just as active in helping to roll out these protocols and techniques beyond his institution to hospitals around the country.

“The same principles basically get used over and over and over again,” he said. “While there's some nuances between the different projects, you're really using the same principles that should be adopted and adoptable at other places.”

Dr. Maynard, who is the chief of the division of hospital medicine at UC San Diego, is also the coleader of a national collaborative on VTE prevention and leads a national task force of the Society of Hospital Medicine to promote effective glycemic control in hospitalized patients.

His team has also tackled discharge processes and transitions of care, delirium detection and management, pneumonia management, infection prevention, and osteoporosis management.

When selecting areas to work on, Dr. Maynard and his team have several criteria. One of the key elements is choosing an area where there's a large gap between the best practices and the actual practices. “You have a chance to make a fairly large difference based on that gap,” he said.

They also try to look ahead and anticipate what areas will be targeted by groups like the Joint Commission or the National Quality Forum.

Once they select a clinical area, they often have to overcome a lack of awareness in the hospital staff. For example, a hospital may already have a protocol for delirium, but the physicians and nurses don't know about it. In that case, the key is to find ways to trigger the protocol, Dr. Maynard said.

Triggering the protocol has to involve some recognition of the condition either through an electronic health record or through a specific screen for the condition. “Something has to make it happen automatically so that it comes to the forefront,” Dr. Maynard said. “You can have the best protocol in the world to treat something, but if someone doesn't say, 'Hey, this is a good candidate for the protocol,' then it might never get used.”

One way to bridge that gap is to build a routine screening process into admission order sets or a nursing process, Dr. Maynard said. The prompt can also be as simple as a check box on the patient's history and physical form.

Dr. Maynard has some advice for hospitalists looking to start their own projects: “Quality improvement is not for sissies.” Implementing a successful quality improvement program is hard work, he said, and requires a team of persistent, driven individuals. It also helps to build a strong relationship with the hospital's informatics team and the people doing the data collection, he said.

Hospitalists should consider getting training in quality improvement, Dr. Maynard said. He recommended starting with the online offerings of organizations like the Society of Hospital Medicine and the Institute for Healthcare Improvement.

He advised hospitalists to think early on about how to make their projects generalizable, to think about whether improvements would be portable to other settings, and to use reliable metrics.

“I think people are hungry for this information about how to do quality improvement well,” Dr. Maynard said.

'I think people are hungry for this information about how to do quality improvement well.'

Source DR. MAYNARD

Dr. Gregory A. Maynard has spent most of his career working to improve patient care, not through new treatments, but by designing better care processes.

As a pioneer in developing protocols for venous thromboembolism prevention and glycemic control, Dr. Maynard has ushered in significant patient safety improvements at the University of California at San Diego. And he has been just as active in helping to roll out these protocols and techniques beyond his institution to hospitals around the country.

“The same principles basically get used over and over and over again,” he said. “While there's some nuances between the different projects, you're really using the same principles that should be adopted and adoptable at other places.”

Dr. Maynard, who is the chief of the division of hospital medicine at UC San Diego, is also the coleader of a national collaborative on VTE prevention and leads a national task force of the Society of Hospital Medicine to promote effective glycemic control in hospitalized patients.

His team has also tackled discharge processes and transitions of care, delirium detection and management, pneumonia management, infection prevention, and osteoporosis management.

When selecting areas to work on, Dr. Maynard and his team have several criteria. One of the key elements is choosing an area where there's a large gap between the best practices and the actual practices. “You have a chance to make a fairly large difference based on that gap,” he said.

They also try to look ahead and anticipate what areas will be targeted by groups like the Joint Commission or the National Quality Forum.

Once they select a clinical area, they often have to overcome a lack of awareness in the hospital staff. For example, a hospital may already have a protocol for delirium, but the physicians and nurses don't know about it. In that case, the key is to find ways to trigger the protocol, Dr. Maynard said.

Triggering the protocol has to involve some recognition of the condition either through an electronic health record or through a specific screen for the condition. “Something has to make it happen automatically so that it comes to the forefront,” Dr. Maynard said. “You can have the best protocol in the world to treat something, but if someone doesn't say, 'Hey, this is a good candidate for the protocol,' then it might never get used.”

One way to bridge that gap is to build a routine screening process into admission order sets or a nursing process, Dr. Maynard said. The prompt can also be as simple as a check box on the patient's history and physical form.

Dr. Maynard has some advice for hospitalists looking to start their own projects: “Quality improvement is not for sissies.” Implementing a successful quality improvement program is hard work, he said, and requires a team of persistent, driven individuals. It also helps to build a strong relationship with the hospital's informatics team and the people doing the data collection, he said.

Hospitalists should consider getting training in quality improvement, Dr. Maynard said. He recommended starting with the online offerings of organizations like the Society of Hospital Medicine and the Institute for Healthcare Improvement.

He advised hospitalists to think early on about how to make their projects generalizable, to think about whether improvements would be portable to other settings, and to use reliable metrics.

“I think people are hungry for this information about how to do quality improvement well,” Dr. Maynard said.

'I think people are hungry for this information about how to do quality improvement well.'

Source DR. MAYNARD

Policy makers are turning their attention to outpatient medical imaging services as they try to cut costs from the health care system.

But although physicians acknowledge the high price tag associated with advanced imaging modalities, some in the cardiology, rheumatology, and radiology communities say the types of cuts being proposed could hurt access, especially in rural and underserved communities. And they argue that the proposed cuts would not address the real problem of inappropriate use.

In July, officials at the Centers for Medicare and Medicaid Services issued the 2010 Physician Fee Schedule proposed rule, which includes a plan to increase the assumed utilization rate for certain imaging equipment from 50% to 90%. The utilization rate change would apply to all equipment priced at $1 million or more.

The CMS said the change will bring payment more in line with the actual costs for maintaining and operating the equipment without harming access, but opponents disagree.

Health reform legislation being considered in the House (H.R. 3200) includes its own cut to imaging services. The bill would change the utilization assumption from 50% to 75% for advanced diagnostic imaging services such as CT, magnetic resonance imaging, nuclear medicine, and positron emission tomography (PET). It would also adjust the technical component “discount” on single-session imaging to consecutive body parts from 25% to 50%. If enacted into law, the changes in the House bill would go into effect in January 2011.

As written, the proposals would not affect lower-cost imaging services such as bone density testing and ultrasound.

Nonetheless, the proposals could hurt the adoption of MRIs in rheumatology offices and have negative consequences for patient care and the overall cost of health care, said Dr. Norman B. Gaylis, a rheumatologist in Aventura, Fla., and the president of the International Society of Extremity MRI in Rheumatology (ISEMIR).

ISEMIR estimates that about 75 rheumatology practices in the United States are using office-based MRIs. The MRI actually saves the health system money, he said, by picking up erosions far earlier than x-rays would, thus making an earlier diagnosis possible.

The technology also allows physicians to determine whether a patient should be taking an expensive biologic agent, Dr. Gaylis said. Moving forward, if the patient responds to the biologic, the physician can use the MRI to stop the medication when the patient shows signs of remission, something that can't be effectively measured without an MRI.

The American College of Cardiology (ACC) expects the proposals to result in payment cuts to cardiac magnetic resonance imaging, cardiac computed tomography, and nonhospital cardiac catheterization services.

Dr. Jack Lewin, CEO of the ACC, said that it's appropriate for Congress and the administration to investigate how to make imaging more efficient. But the best approach is not price cutting, he said in an interview. Instead, the ACC favors utilizing appropriate use criteria at the point of care so that the ordering physician can quickly see if the current science supports the use of a particular imaging study.

“We have the science,” Dr. Lewin commented. “We can give doctors who are ordering these tests for their patients the information as to which is the right test to order and when it's really indicated.”

The widespread use of appropriate-use criteria tools would save the same amount of money as the “blunt instrument cuts” proposed by Congress, Dr. Lewin said, but without some of the unintended consequences. For example, he predicted that the cuts as proposed would force some imaging centers to close their doors and would likely have the greatest impact on poor communities and ethnic minorities.

Dr. Michael Graham, president of the Society of Nuclear Medicine, said he is concerned about the impact these cuts would have on access in rural areas. If rural imaging facilities are forced to close, patients may have to drive twice as far and wait twice as long to get a study, he said in an interview. “The reality is that studies will not get done. It's going to be a major problem.”

Policy makers who are targeting advanced imaging modalities should also consider the impact on lower-cost imaging services, said Dr. James Borgstede of the University of Colorado, Denver, and a past chair of the Small and Rural Practice Commission at the American College of Radiology.

When physicians go to a rural area to perform imaging services, they often use the higher-cost imaging to support the lower-cost services like plain film x-rays and mammograms, he said in an interview.

“The government has to reimburse us appropriately,” Dr. Borgstede said. “We're small businessmen, and if you lose a dollar on every piece of imaging you do, you don't make it up on volume.”

Policy makers are turning their attention to outpatient medical imaging services as they try to cut costs from the health care system.

But although physicians acknowledge the high price tag associated with advanced imaging modalities, some in the cardiology, rheumatology, and radiology communities say the types of cuts being proposed could hurt access, especially in rural and underserved communities. And they argue that the proposed cuts would not address the real problem of inappropriate use.

In July, officials at the Centers for Medicare and Medicaid Services issued the 2010 Physician Fee Schedule proposed rule, which includes a plan to increase the assumed utilization rate for certain imaging equipment from 50% to 90%. The utilization rate change would apply to all equipment priced at $1 million or more.

The CMS said the change will bring payment more in line with the actual costs for maintaining and operating the equipment without harming access, but opponents disagree.

Health reform legislation being considered in the House (H.R. 3200) includes its own cut to imaging services. The bill would change the utilization assumption from 50% to 75% for advanced diagnostic imaging services such as CT, magnetic resonance imaging, nuclear medicine, and positron emission tomography (PET). It would also adjust the technical component “discount” on single-session imaging to consecutive body parts from 25% to 50%. If enacted into law, the changes in the House bill would go into effect in January 2011.

As written, the proposals would not affect lower-cost imaging services such as bone density testing and ultrasound.

Nonetheless, the proposals could hurt the adoption of MRIs in rheumatology offices and have negative consequences for patient care and the overall cost of health care, said Dr. Norman B. Gaylis, a rheumatologist in Aventura, Fla., and the president of the International Society of Extremity MRI in Rheumatology (ISEMIR).

ISEMIR estimates that about 75 rheumatology practices in the United States are using office-based MRIs. The MRI actually saves the health system money, he said, by picking up erosions far earlier than x-rays would, thus making an earlier diagnosis possible.

The technology also allows physicians to determine whether a patient should be taking an expensive biologic agent, Dr. Gaylis said. Moving forward, if the patient responds to the biologic, the physician can use the MRI to stop the medication when the patient shows signs of remission, something that can't be effectively measured without an MRI.

The American College of Cardiology (ACC) expects the proposals to result in payment cuts to cardiac magnetic resonance imaging, cardiac computed tomography, and nonhospital cardiac catheterization services.

Dr. Jack Lewin, CEO of the ACC, said that it's appropriate for Congress and the administration to investigate how to make imaging more efficient. But the best approach is not price cutting, he said in an interview. Instead, the ACC favors utilizing appropriate use criteria at the point of care so that the ordering physician can quickly see if the current science supports the use of a particular imaging study.

“We have the science,” Dr. Lewin commented. “We can give doctors who are ordering these tests for their patients the information as to which is the right test to order and when it's really indicated.”

The widespread use of appropriate-use criteria tools would save the same amount of money as the “blunt instrument cuts” proposed by Congress, Dr. Lewin said, but without some of the unintended consequences. For example, he predicted that the cuts as proposed would force some imaging centers to close their doors and would likely have the greatest impact on poor communities and ethnic minorities.

Dr. Michael Graham, president of the Society of Nuclear Medicine, said he is concerned about the impact these cuts would have on access in rural areas. If rural imaging facilities are forced to close, patients may have to drive twice as far and wait twice as long to get a study, he said in an interview. “The reality is that studies will not get done. It's going to be a major problem.”

Policy makers who are targeting advanced imaging modalities should also consider the impact on lower-cost imaging services, said Dr. James Borgstede of the University of Colorado, Denver, and a past chair of the Small and Rural Practice Commission at the American College of Radiology.

When physicians go to a rural area to perform imaging services, they often use the higher-cost imaging to support the lower-cost services like plain film x-rays and mammograms, he said in an interview.

“The government has to reimburse us appropriately,” Dr. Borgstede said. “We're small businessmen, and if you lose a dollar on every piece of imaging you do, you don't make it up on volume.”

Policy makers are turning their attention to outpatient medical imaging services as they try to cut costs from the health care system.

But although physicians acknowledge the high price tag associated with advanced imaging modalities, some in the cardiology, rheumatology, and radiology communities say the types of cuts being proposed could hurt access, especially in rural and underserved communities. And they argue that the proposed cuts would not address the real problem of inappropriate use.

In July, officials at the Centers for Medicare and Medicaid Services issued the 2010 Physician Fee Schedule proposed rule, which includes a plan to increase the assumed utilization rate for certain imaging equipment from 50% to 90%. The utilization rate change would apply to all equipment priced at $1 million or more.

The CMS said the change will bring payment more in line with the actual costs for maintaining and operating the equipment without harming access, but opponents disagree.

Health reform legislation being considered in the House (H.R. 3200) includes its own cut to imaging services. The bill would change the utilization assumption from 50% to 75% for advanced diagnostic imaging services such as CT, magnetic resonance imaging, nuclear medicine, and positron emission tomography (PET). It would also adjust the technical component “discount” on single-session imaging to consecutive body parts from 25% to 50%. If enacted into law, the changes in the House bill would go into effect in January 2011.

As written, the proposals would not affect lower-cost imaging services such as bone density testing and ultrasound.

Nonetheless, the proposals could hurt the adoption of MRIs in rheumatology offices and have negative consequences for patient care and the overall cost of health care, said Dr. Norman B. Gaylis, a rheumatologist in Aventura, Fla., and the president of the International Society of Extremity MRI in Rheumatology (ISEMIR).

ISEMIR estimates that about 75 rheumatology practices in the United States are using office-based MRIs. The MRI actually saves the health system money, he said, by picking up erosions far earlier than x-rays would, thus making an earlier diagnosis possible.

The technology also allows physicians to determine whether a patient should be taking an expensive biologic agent, Dr. Gaylis said. Moving forward, if the patient responds to the biologic, the physician can use the MRI to stop the medication when the patient shows signs of remission, something that can't be effectively measured without an MRI.

The American College of Cardiology (ACC) expects the proposals to result in payment cuts to cardiac magnetic resonance imaging, cardiac computed tomography, and nonhospital cardiac catheterization services.

Dr. Jack Lewin, CEO of the ACC, said that it's appropriate for Congress and the administration to investigate how to make imaging more efficient. But the best approach is not price cutting, he said in an interview. Instead, the ACC favors utilizing appropriate use criteria at the point of care so that the ordering physician can quickly see if the current science supports the use of a particular imaging study.

“We have the science,” Dr. Lewin commented. “We can give doctors who are ordering these tests for their patients the information as to which is the right test to order and when it's really indicated.”

The widespread use of appropriate-use criteria tools would save the same amount of money as the “blunt instrument cuts” proposed by Congress, Dr. Lewin said, but without some of the unintended consequences. For example, he predicted that the cuts as proposed would force some imaging centers to close their doors and would likely have the greatest impact on poor communities and ethnic minorities.

Dr. Michael Graham, president of the Society of Nuclear Medicine, said he is concerned about the impact these cuts would have on access in rural areas. If rural imaging facilities are forced to close, patients may have to drive twice as far and wait twice as long to get a study, he said in an interview. “The reality is that studies will not get done. It's going to be a major problem.”

Policy makers who are targeting advanced imaging modalities should also consider the impact on lower-cost imaging services, said Dr. James Borgstede of the University of Colorado, Denver, and a past chair of the Small and Rural Practice Commission at the American College of Radiology.

When physicians go to a rural area to perform imaging services, they often use the higher-cost imaging to support the lower-cost services like plain film x-rays and mammograms, he said in an interview.

“The government has to reimburse us appropriately,” Dr. Borgstede said. “We're small businessmen, and if you lose a dollar on every piece of imaging you do, you don't make it up on volume.”