Mary Ellen Schneider

Starting July 1, physicians who report on selected quality measures will have a chance to earn a small bonus payment from Medicare.

The program, called the Physician Quality Reporting Initiative, was mandated by Congress and offers incentive payments to physicians who report on one to three quality measures. By doing so, physicians can earn a bonus of up to 1.5% of their total allowed Medicare charges during the 6-month reporting period.

Although even the maximum compensation isn't enough to make anyone rich, some physician organizations are advising their members to take a good look at the program because it may be the first step toward a performance-based payment system.

“By involving ourselves in the process we can have feedback,” said Dr. James Stevens, a neurologist in Fort Wayne, Ind., and a member of the medical economics and management committee of the American Academy of Neurology.

Deciding whether participation makes sense is a calculation that has to be made by each practice, Dr. Stevens said. Those who give it a try will get a confidential report from the Centers for Medicare and Medicaid Services about how they are doing and have a chance to provide information on what works and what doesn't.

“This experience will likely be helpful in the future,” said Brett Baker, director of regulatory affairs at the American College of Physicians, adding that although the bonus payment is not significant, having some type of financial incentive attached may be enough to get people's attention.

To get started, physicians must familiarize themselves with the program and the measures and figure out for how many patients they will be able to gather and report data, Mr. Baker said. They also should consider the technical issues involved in reporting and how feasible it will be to make those changes. “It's certainly a challenge for everyone to ramp up to do this in a short period of time,” he said.

CMS officials have selected 74 quality measures that can be used by physicians across specialties. If four or more measures apply, physicians must report on at least three measures for at least 80% of cases in which the measure was reportable. If no more than three measures apply, each measure must be reported for at least 80% of the cases in which a measure was reportable.

Although payments will be provided to the holder of the tax identification number, the results will be analyzed at the physician level, the CMS said. As a result, Medicare officials are requiring that the National Provider Identifier (NPI) number be used on all claims.

The reporting period will run from July 1 through Dec. 31, 2007, and all claims must reach the National Claims History File by Feb. 29, 2008.

Any Medicare-enrolled eligible professional can participate in the program, regardless of whether they have signed a participation agreement with Medicare to accept assignment on all claims. In addition, physicians are not required to register to participate in the Physician Quality Reporting Initiative.

Medicare will use a claims-based reporting system for the program and will require practices to enter either CPT Category II codes or temporary G-codes where CPT-II codes are not available. The codes can be reported on either paper-based CMS 1500 forms or electronic 837-P claims. The quality codes should be reported with a $0.00 charge.

The bonus payments earned will be made in a lump sum in mid-2008, CMS officials said. Physicians can earn up to a 1.5% bonus, subject to a cap. The cap is structured to ensure that physicians who do more reporting will receive higher payments.

In addition to the bonus payment, physicians who participate will receive a confidential feedback report from the CMS sometime in 2008. Those reports are expected to include reporting and performance rates. However, the quality data reported in 2007 will not be publicly reported.

For 2008, the CMS is required under statute to propose the new measures in August 2007 and finalize them by Nov. 15, 2007. Because the CMS has selected measures that have been vetted by physician organizations and reflect current medical practice, most physicians should not have a problem with that aspect of the program, said Dr. Janet Wright, a cardiologist in Chico, Calif., and chair of the performance assessment task force of the American College of Cardiology.

The hurdle will be in changing the workflow in the office, she said. For some, the bonus payment will not be enough to offset the cost of making these administrative changes. However, the ACC is developing a special coding form that can be attached to the visit encounter form in an effort to streamline the process. In addition, participation in the program will help provide the CMS with information on the real-life experiences of cardiologists, Dr. Wright said.

More information on the Physician Quality Reporting Initiative is available online at www.cms.hhs.gov/PQRI

This Month's Talk Back Question

What are your plans regarding participation in Medicare's Physician Quality Reporting Initiative?

Starting July 1, physicians who report on selected quality measures will have a chance to earn a small bonus payment from Medicare.

The program, called the Physician Quality Reporting Initiative, was mandated by Congress and offers incentive payments to physicians who report on one to three quality measures. By doing so, physicians can earn a bonus of up to 1.5% of their total allowed Medicare charges during the 6-month reporting period.

Although even the maximum compensation isn't enough to make anyone rich, some physician organizations are advising their members to take a good look at the program because it may be the first step toward a performance-based payment system.

“By involving ourselves in the process we can have feedback,” said Dr. James Stevens, a neurologist in Fort Wayne, Ind., and a member of the medical economics and management committee of the American Academy of Neurology.

Deciding whether participation makes sense is a calculation that has to be made by each practice, Dr. Stevens said. Those who give it a try will get a confidential report from the Centers for Medicare and Medicaid Services about how they are doing and have a chance to provide information on what works and what doesn't.

“This experience will likely be helpful in the future,” said Brett Baker, director of regulatory affairs at the American College of Physicians, adding that although the bonus payment is not significant, having some type of financial incentive attached may be enough to get people's attention.

To get started, physicians must familiarize themselves with the program and the measures and figure out for how many patients they will be able to gather and report data, Mr. Baker said. They also should consider the technical issues involved in reporting and how feasible it will be to make those changes. “It's certainly a challenge for everyone to ramp up to do this in a short period of time,” he said.

CMS officials have selected 74 quality measures that can be used by physicians across specialties. If four or more measures apply, physicians must report on at least three measures for at least 80% of cases in which the measure was reportable. If no more than three measures apply, each measure must be reported for at least 80% of the cases in which a measure was reportable.

Although payments will be provided to the holder of the tax identification number, the results will be analyzed at the physician level, the CMS said. As a result, Medicare officials are requiring that the National Provider Identifier (NPI) number be used on all claims.

The reporting period will run from July 1 through Dec. 31, 2007, and all claims must reach the National Claims History File by Feb. 29, 2008.

Any Medicare-enrolled eligible professional can participate in the program, regardless of whether they have signed a participation agreement with Medicare to accept assignment on all claims. In addition, physicians are not required to register to participate in the Physician Quality Reporting Initiative.

Medicare will use a claims-based reporting system for the program and will require practices to enter either CPT Category II codes or temporary G-codes where CPT-II codes are not available. The codes can be reported on either paper-based CMS 1500 forms or electronic 837-P claims. The quality codes should be reported with a $0.00 charge.

The bonus payments earned will be made in a lump sum in mid-2008, CMS officials said. Physicians can earn up to a 1.5% bonus, subject to a cap. The cap is structured to ensure that physicians who do more reporting will receive higher payments.

In addition to the bonus payment, physicians who participate will receive a confidential feedback report from the CMS sometime in 2008. Those reports are expected to include reporting and performance rates. However, the quality data reported in 2007 will not be publicly reported.

For 2008, the CMS is required under statute to propose the new measures in August 2007 and finalize them by Nov. 15, 2007. Because the CMS has selected measures that have been vetted by physician organizations and reflect current medical practice, most physicians should not have a problem with that aspect of the program, said Dr. Janet Wright, a cardiologist in Chico, Calif., and chair of the performance assessment task force of the American College of Cardiology.

The hurdle will be in changing the workflow in the office, she said. For some, the bonus payment will not be enough to offset the cost of making these administrative changes. However, the ACC is developing a special coding form that can be attached to the visit encounter form in an effort to streamline the process. In addition, participation in the program will help provide the CMS with information on the real-life experiences of cardiologists, Dr. Wright said.

More information on the Physician Quality Reporting Initiative is available online at www.cms.hhs.gov/PQRI

This Month's Talk Back Question

What are your plans regarding participation in Medicare's Physician Quality Reporting Initiative?

Starting July 1, physicians who report on selected quality measures will have a chance to earn a small bonus payment from Medicare.

The program, called the Physician Quality Reporting Initiative, was mandated by Congress and offers incentive payments to physicians who report on one to three quality measures. By doing so, physicians can earn a bonus of up to 1.5% of their total allowed Medicare charges during the 6-month reporting period.

Although even the maximum compensation isn't enough to make anyone rich, some physician organizations are advising their members to take a good look at the program because it may be the first step toward a performance-based payment system.

“By involving ourselves in the process we can have feedback,” said Dr. James Stevens, a neurologist in Fort Wayne, Ind., and a member of the medical economics and management committee of the American Academy of Neurology.

Deciding whether participation makes sense is a calculation that has to be made by each practice, Dr. Stevens said. Those who give it a try will get a confidential report from the Centers for Medicare and Medicaid Services about how they are doing and have a chance to provide information on what works and what doesn't.

“This experience will likely be helpful in the future,” said Brett Baker, director of regulatory affairs at the American College of Physicians, adding that although the bonus payment is not significant, having some type of financial incentive attached may be enough to get people's attention.

To get started, physicians must familiarize themselves with the program and the measures and figure out for how many patients they will be able to gather and report data, Mr. Baker said. They also should consider the technical issues involved in reporting and how feasible it will be to make those changes. “It's certainly a challenge for everyone to ramp up to do this in a short period of time,” he said.

CMS officials have selected 74 quality measures that can be used by physicians across specialties. If four or more measures apply, physicians must report on at least three measures for at least 80% of cases in which the measure was reportable. If no more than three measures apply, each measure must be reported for at least 80% of the cases in which a measure was reportable.

Although payments will be provided to the holder of the tax identification number, the results will be analyzed at the physician level, the CMS said. As a result, Medicare officials are requiring that the National Provider Identifier (NPI) number be used on all claims.

The reporting period will run from July 1 through Dec. 31, 2007, and all claims must reach the National Claims History File by Feb. 29, 2008.

Any Medicare-enrolled eligible professional can participate in the program, regardless of whether they have signed a participation agreement with Medicare to accept assignment on all claims. In addition, physicians are not required to register to participate in the Physician Quality Reporting Initiative.

Medicare will use a claims-based reporting system for the program and will require practices to enter either CPT Category II codes or temporary G-codes where CPT-II codes are not available. The codes can be reported on either paper-based CMS 1500 forms or electronic 837-P claims. The quality codes should be reported with a $0.00 charge.

The bonus payments earned will be made in a lump sum in mid-2008, CMS officials said. Physicians can earn up to a 1.5% bonus, subject to a cap. The cap is structured to ensure that physicians who do more reporting will receive higher payments.

In addition to the bonus payment, physicians who participate will receive a confidential feedback report from the CMS sometime in 2008. Those reports are expected to include reporting and performance rates. However, the quality data reported in 2007 will not be publicly reported.

For 2008, the CMS is required under statute to propose the new measures in August 2007 and finalize them by Nov. 15, 2007. Because the CMS has selected measures that have been vetted by physician organizations and reflect current medical practice, most physicians should not have a problem with that aspect of the program, said Dr. Janet Wright, a cardiologist in Chico, Calif., and chair of the performance assessment task force of the American College of Cardiology.

The hurdle will be in changing the workflow in the office, she said. For some, the bonus payment will not be enough to offset the cost of making these administrative changes. However, the ACC is developing a special coding form that can be attached to the visit encounter form in an effort to streamline the process. In addition, participation in the program will help provide the CMS with information on the real-life experiences of cardiologists, Dr. Wright said.

More information on the Physician Quality Reporting Initiative is available online at www.cms.hhs.gov/PQRI

This Month's Talk Back Question

What are your plans regarding participation in Medicare's Physician Quality Reporting Initiative?

NEW ORLEANS — Get educated about state and federal regulations and policies on the prescription of controlled substances, advised David Joranson, director of the Pain and Policy Studies Group at the University of Wisconsin Paul P. Carbone Comprehensive Cancer Center in Madison.

Mr. Joranson, who spoke at the annual meeting of the American Academy of Pain Medicine, said that understanding current regulations is critical to avoiding unnecessary fears over the risk of sanctions from prescribing pain medication.

In recent years there has been increasing agreement reached between pain medicine specialists, law enforcement, and regulators, he said. For example, from 2003 to 2006, 19 states either repealed or added language to their state's controlled substances prescribing policies to take a more balanced approach—recognizing opioids are necessary but also pose risks and need to be controlled.

“The state policies are becoming more balanced,” he said.

Importantly, 39 states have adopted a policy aimed at directly addressing physicians' concerns about regulatory scrutiny, he added.

Nearly 10 years ago, the Federation of State Medical Boards made it clear that physicians should recognize that tolerance and physical dependence are the normal consequences of the sustained use of opioid analgesics and are not synonymous with addiction. As a result, many state medical board guidelines now reflect that statement, Mr. Joranson said.

Last year, at the federal level the Drug Enforcement Administration issued a statement that nearly every prescription issued in the United States is for a legitimate medical purpose and that the amount of dosage units per prescription will never be a basis for investigation for the overwhelming majority of physicians.

Research findings indicated, however, that physicians may not be paying attention to this policy shift. In a study published in the Journal of Family Practice in 2001, investigators from the University of California, San Francisco/Stanford Collaborative Research Network surveyed 230 primary care physicians on pain treatment, the use of opioids, and their familiarity with state prescribing and documentation guidelines.

In particular, the investigation focused on whether physicians were aware of guidelines on prescribing opioids for chronic non- malignant pain that were issued by the Medical Board of California in 1994. The guidelines were aimed in part at reducing physicians' fear of regulatory scrutiny. The guidelines were mailed to all licensed physician in the state three times between 1994 and 1996.

Of the 161 physicians who completed the survey, only 39% remembered reading the guidelines 1 year after the third mailing. And 40% of respondents said that fear of legal investigation influenced their opioid prescribing habits.

“It can be an uphill battle to get physicians to pay attention to policy,” Mr. Joranson said.

Despite the growing areas of agreement on proper pain prescriptions, there are still some areas surrounding prescribing of controlled substances that need to be worked out, he said. For example, prescribing opioids to pain patients who may have a substance abuse problem is an area where law enforcement and physicians have the potential to clash. More dialogue is needed between the pain medicine community and DEA on this issue, he said.

In addition, some groups mistakenly believe that physicians and patients are the main source of drug diversion, he said.

And while it's likely that the majority of regulatory and law enforcement actions against physicians for prescribing of controlled substances are appropriate, there have been exceptions, he said. Some physicians have been charged and later acquitted in court, while others have been convicted only to have their cases overturned later. These cases need to be investigated to figure out what went wrong, he added.

NEW ORLEANS — Get educated about state and federal regulations and policies on the prescription of controlled substances, advised David Joranson, director of the Pain and Policy Studies Group at the University of Wisconsin Paul P. Carbone Comprehensive Cancer Center in Madison.

Mr. Joranson, who spoke at the annual meeting of the American Academy of Pain Medicine, said that understanding current regulations is critical to avoiding unnecessary fears over the risk of sanctions from prescribing pain medication.

In recent years there has been increasing agreement reached between pain medicine specialists, law enforcement, and regulators, he said. For example, from 2003 to 2006, 19 states either repealed or added language to their state's controlled substances prescribing policies to take a more balanced approach—recognizing opioids are necessary but also pose risks and need to be controlled.

“The state policies are becoming more balanced,” he said.

Importantly, 39 states have adopted a policy aimed at directly addressing physicians' concerns about regulatory scrutiny, he added.

Nearly 10 years ago, the Federation of State Medical Boards made it clear that physicians should recognize that tolerance and physical dependence are the normal consequences of the sustained use of opioid analgesics and are not synonymous with addiction. As a result, many state medical board guidelines now reflect that statement, Mr. Joranson said.

Last year, at the federal level the Drug Enforcement Administration issued a statement that nearly every prescription issued in the United States is for a legitimate medical purpose and that the amount of dosage units per prescription will never be a basis for investigation for the overwhelming majority of physicians.

Research findings indicated, however, that physicians may not be paying attention to this policy shift. In a study published in the Journal of Family Practice in 2001, investigators from the University of California, San Francisco/Stanford Collaborative Research Network surveyed 230 primary care physicians on pain treatment, the use of opioids, and their familiarity with state prescribing and documentation guidelines.

In particular, the investigation focused on whether physicians were aware of guidelines on prescribing opioids for chronic non- malignant pain that were issued by the Medical Board of California in 1994. The guidelines were aimed in part at reducing physicians' fear of regulatory scrutiny. The guidelines were mailed to all licensed physician in the state three times between 1994 and 1996.

Of the 161 physicians who completed the survey, only 39% remembered reading the guidelines 1 year after the third mailing. And 40% of respondents said that fear of legal investigation influenced their opioid prescribing habits.

“It can be an uphill battle to get physicians to pay attention to policy,” Mr. Joranson said.

Despite the growing areas of agreement on proper pain prescriptions, there are still some areas surrounding prescribing of controlled substances that need to be worked out, he said. For example, prescribing opioids to pain patients who may have a substance abuse problem is an area where law enforcement and physicians have the potential to clash. More dialogue is needed between the pain medicine community and DEA on this issue, he said.

In addition, some groups mistakenly believe that physicians and patients are the main source of drug diversion, he said.

And while it's likely that the majority of regulatory and law enforcement actions against physicians for prescribing of controlled substances are appropriate, there have been exceptions, he said. Some physicians have been charged and later acquitted in court, while others have been convicted only to have their cases overturned later. These cases need to be investigated to figure out what went wrong, he added.

NEW ORLEANS — Get educated about state and federal regulations and policies on the prescription of controlled substances, advised David Joranson, director of the Pain and Policy Studies Group at the University of Wisconsin Paul P. Carbone Comprehensive Cancer Center in Madison.

Mr. Joranson, who spoke at the annual meeting of the American Academy of Pain Medicine, said that understanding current regulations is critical to avoiding unnecessary fears over the risk of sanctions from prescribing pain medication.

In recent years there has been increasing agreement reached between pain medicine specialists, law enforcement, and regulators, he said. For example, from 2003 to 2006, 19 states either repealed or added language to their state's controlled substances prescribing policies to take a more balanced approach—recognizing opioids are necessary but also pose risks and need to be controlled.

“The state policies are becoming more balanced,” he said.

Importantly, 39 states have adopted a policy aimed at directly addressing physicians' concerns about regulatory scrutiny, he added.

Nearly 10 years ago, the Federation of State Medical Boards made it clear that physicians should recognize that tolerance and physical dependence are the normal consequences of the sustained use of opioid analgesics and are not synonymous with addiction. As a result, many state medical board guidelines now reflect that statement, Mr. Joranson said.

Last year, at the federal level the Drug Enforcement Administration issued a statement that nearly every prescription issued in the United States is for a legitimate medical purpose and that the amount of dosage units per prescription will never be a basis for investigation for the overwhelming majority of physicians.

Research findings indicated, however, that physicians may not be paying attention to this policy shift. In a study published in the Journal of Family Practice in 2001, investigators from the University of California, San Francisco/Stanford Collaborative Research Network surveyed 230 primary care physicians on pain treatment, the use of opioids, and their familiarity with state prescribing and documentation guidelines.

In particular, the investigation focused on whether physicians were aware of guidelines on prescribing opioids for chronic non- malignant pain that were issued by the Medical Board of California in 1994. The guidelines were aimed in part at reducing physicians' fear of regulatory scrutiny. The guidelines were mailed to all licensed physician in the state three times between 1994 and 1996.

Of the 161 physicians who completed the survey, only 39% remembered reading the guidelines 1 year after the third mailing. And 40% of respondents said that fear of legal investigation influenced their opioid prescribing habits.

“It can be an uphill battle to get physicians to pay attention to policy,” Mr. Joranson said.

Despite the growing areas of agreement on proper pain prescriptions, there are still some areas surrounding prescribing of controlled substances that need to be worked out, he said. For example, prescribing opioids to pain patients who may have a substance abuse problem is an area where law enforcement and physicians have the potential to clash. More dialogue is needed between the pain medicine community and DEA on this issue, he said.

In addition, some groups mistakenly believe that physicians and patients are the main source of drug diversion, he said.

And while it's likely that the majority of regulatory and law enforcement actions against physicians for prescribing of controlled substances are appropriate, there have been exceptions, he said. Some physicians have been charged and later acquitted in court, while others have been convicted only to have their cases overturned later. These cases need to be investigated to figure out what went wrong, he added.

Starting July 1, physicians who report on selected quality measures will have a chance to earn a small bonus payment from Medicare.

The program, called the Physician Quality Reporting Initiative, was mandated by Congress and offers incentive payments to physicians who report on one to three quality measures. By doing so, physicians can earn a bonus of up to 1.5% of their total allowed Medicare charges during the 6-month reporting period.

Although even the maximum compensation isn't enough to make anyone rich, some physician organizations are advising their members to take a good look at the program because it may be the first step toward a performance-based payment system.

Centers for Medicare and Medicaid Services officials have selected 74 quality measures that can be used by physicians across specialties. If 4 or more measures apply, physicians must report on at least 3 measures for at least 80% of cases in which the measure was reportable.

If no more than three measures apply, each measure must be reported for at least 80% of the cases in which a measure was reportable.

Of the 74 measures released by CMS, 21 apply to family medicine, said Dr. Rick Kellerman, president of the American Academy of Family Physicians. In an effort to make the process more user friendly, AAFP officials are strongly urging family physicians to report on the three diabetes measures available. This will make it easier for physicians to report because they can concentrate on a single diagnosis, Dr. Kellerman said.

The AAFP is developing a data collection sheet for physicians and another for the back office staff, he said. The academy also is developing tools to help physicians calculate their potential bonus payment under the program.

“It does not look like it will be overly burdensome,” Dr. Kellerman said.

“By involving ourselves in the process, we can have feedback,” said Dr. James Stevens, a neurologist in Fort Wayne, Ind., and a member of the medical economics and management committee of the American Academy of Neurology. Those who give it a try will get a confidential report from the CMS about how they are doing and have a chance to provide information on what works and what doesn't.

“This experience will likely be helpful in the future,” said Brett Baker, director of regulatory affairs at the American College of Physicians, adding that although the bonus payment is not significant, having some type of financial incentive attached may be enough to get people's attention.

To get started, physicians must familiarize themselves with the program and the measures and figure out for how many patients they will be able to gather and report data, Mr. Baker said.

They also should consider the technical issues involved in reporting and how feasible it will be to make those changes.

Although payments will be provided to the holder of the tax identification number, the results will be analyzed at the physician level, the CMS said. As a result, Medicare officials are requiring that the National Provider Identifier number be used on all claims.

The reporting period will run from July 1 through Dec. 31, 2007, and all claims must reach the National Claims History File by Feb. 29, 2008.

Any Medicare-enrolled eligible professional can participate in the program, regardless of whether they have signed a participation agreement with Medicare to accept assignment on all claims. In addition, physicians are not required to register to participate in the Physician Quality Reporting Initiative.

Medicare will use a claims-based reporting system for the program and will require practices to enter either CPT Category II codes or temporary G-codes where CPT-II codes are not available. The codes can be reported on either paper-based CMS 1500 forms or electronic 837-P claims. The quality codes should be reported with a $0.00 charge.

The bonus payments earned will be made in a lump sum in mid-2008. Physicians can earn up to a 1.5% bonus, subject to a cap. The cap is structured to ensure that physicians who do more reporting will receive higher payments.

Under the law that established the Physician Quality Reporting Initiative, the program is excluded from a formal appeals process. However, CMS officials said they plan to establish some type of informal inquiry process. They are currently developing a validation procedure for the reporting process that is likely to involve sampling.

In addition to the bonus payment, physicians who participate will receive a confidential feedback report from the CMS sometime in 2008. Those reports are expected to include reporting and performance rates. However, the quality data reported in 2007 will not be publicly reported.

For 2008, the CMS is required under statute to propose the new measures in August 2007 and finalize them by Nov. 15, 2007. Next year's measures are likely to include structural measures, such as the use of electronic health records. CMS officials are also working on the possibility of allowing physicians to report using either registry-based systems or electronic records systems in 2008.

More information on the Physician Quality Reporting Initiative is available online at www.cms.hhs.gov/PQRI

Starting July 1, physicians who report on selected quality measures will have a chance to earn a small bonus payment from Medicare.

The program, called the Physician Quality Reporting Initiative, was mandated by Congress and offers incentive payments to physicians who report on one to three quality measures. By doing so, physicians can earn a bonus of up to 1.5% of their total allowed Medicare charges during the 6-month reporting period.

Although even the maximum compensation isn't enough to make anyone rich, some physician organizations are advising their members to take a good look at the program because it may be the first step toward a performance-based payment system.

Centers for Medicare and Medicaid Services officials have selected 74 quality measures that can be used by physicians across specialties. If 4 or more measures apply, physicians must report on at least 3 measures for at least 80% of cases in which the measure was reportable.

If no more than three measures apply, each measure must be reported for at least 80% of the cases in which a measure was reportable.

Of the 74 measures released by CMS, 21 apply to family medicine, said Dr. Rick Kellerman, president of the American Academy of Family Physicians. In an effort to make the process more user friendly, AAFP officials are strongly urging family physicians to report on the three diabetes measures available. This will make it easier for physicians to report because they can concentrate on a single diagnosis, Dr. Kellerman said.

The AAFP is developing a data collection sheet for physicians and another for the back office staff, he said. The academy also is developing tools to help physicians calculate their potential bonus payment under the program.

“It does not look like it will be overly burdensome,” Dr. Kellerman said.

“By involving ourselves in the process, we can have feedback,” said Dr. James Stevens, a neurologist in Fort Wayne, Ind., and a member of the medical economics and management committee of the American Academy of Neurology. Those who give it a try will get a confidential report from the CMS about how they are doing and have a chance to provide information on what works and what doesn't.

“This experience will likely be helpful in the future,” said Brett Baker, director of regulatory affairs at the American College of Physicians, adding that although the bonus payment is not significant, having some type of financial incentive attached may be enough to get people's attention.

To get started, physicians must familiarize themselves with the program and the measures and figure out for how many patients they will be able to gather and report data, Mr. Baker said.

They also should consider the technical issues involved in reporting and how feasible it will be to make those changes.

Although payments will be provided to the holder of the tax identification number, the results will be analyzed at the physician level, the CMS said. As a result, Medicare officials are requiring that the National Provider Identifier number be used on all claims.

The reporting period will run from July 1 through Dec. 31, 2007, and all claims must reach the National Claims History File by Feb. 29, 2008.

Any Medicare-enrolled eligible professional can participate in the program, regardless of whether they have signed a participation agreement with Medicare to accept assignment on all claims. In addition, physicians are not required to register to participate in the Physician Quality Reporting Initiative.

Medicare will use a claims-based reporting system for the program and will require practices to enter either CPT Category II codes or temporary G-codes where CPT-II codes are not available. The codes can be reported on either paper-based CMS 1500 forms or electronic 837-P claims. The quality codes should be reported with a $0.00 charge.

The bonus payments earned will be made in a lump sum in mid-2008. Physicians can earn up to a 1.5% bonus, subject to a cap. The cap is structured to ensure that physicians who do more reporting will receive higher payments.

Under the law that established the Physician Quality Reporting Initiative, the program is excluded from a formal appeals process. However, CMS officials said they plan to establish some type of informal inquiry process. They are currently developing a validation procedure for the reporting process that is likely to involve sampling.

In addition to the bonus payment, physicians who participate will receive a confidential feedback report from the CMS sometime in 2008. Those reports are expected to include reporting and performance rates. However, the quality data reported in 2007 will not be publicly reported.

For 2008, the CMS is required under statute to propose the new measures in August 2007 and finalize them by Nov. 15, 2007. Next year's measures are likely to include structural measures, such as the use of electronic health records. CMS officials are also working on the possibility of allowing physicians to report using either registry-based systems or electronic records systems in 2008.

More information on the Physician Quality Reporting Initiative is available online at www.cms.hhs.gov/PQRI

Starting July 1, physicians who report on selected quality measures will have a chance to earn a small bonus payment from Medicare.

The program, called the Physician Quality Reporting Initiative, was mandated by Congress and offers incentive payments to physicians who report on one to three quality measures. By doing so, physicians can earn a bonus of up to 1.5% of their total allowed Medicare charges during the 6-month reporting period.

Although even the maximum compensation isn't enough to make anyone rich, some physician organizations are advising their members to take a good look at the program because it may be the first step toward a performance-based payment system.

Centers for Medicare and Medicaid Services officials have selected 74 quality measures that can be used by physicians across specialties. If 4 or more measures apply, physicians must report on at least 3 measures for at least 80% of cases in which the measure was reportable.

If no more than three measures apply, each measure must be reported for at least 80% of the cases in which a measure was reportable.

Of the 74 measures released by CMS, 21 apply to family medicine, said Dr. Rick Kellerman, president of the American Academy of Family Physicians. In an effort to make the process more user friendly, AAFP officials are strongly urging family physicians to report on the three diabetes measures available. This will make it easier for physicians to report because they can concentrate on a single diagnosis, Dr. Kellerman said.

The AAFP is developing a data collection sheet for physicians and another for the back office staff, he said. The academy also is developing tools to help physicians calculate their potential bonus payment under the program.

“It does not look like it will be overly burdensome,” Dr. Kellerman said.

“By involving ourselves in the process, we can have feedback,” said Dr. James Stevens, a neurologist in Fort Wayne, Ind., and a member of the medical economics and management committee of the American Academy of Neurology. Those who give it a try will get a confidential report from the CMS about how they are doing and have a chance to provide information on what works and what doesn't.

“This experience will likely be helpful in the future,” said Brett Baker, director of regulatory affairs at the American College of Physicians, adding that although the bonus payment is not significant, having some type of financial incentive attached may be enough to get people's attention.

To get started, physicians must familiarize themselves with the program and the measures and figure out for how many patients they will be able to gather and report data, Mr. Baker said.

They also should consider the technical issues involved in reporting and how feasible it will be to make those changes.

Although payments will be provided to the holder of the tax identification number, the results will be analyzed at the physician level, the CMS said. As a result, Medicare officials are requiring that the National Provider Identifier number be used on all claims.

The reporting period will run from July 1 through Dec. 31, 2007, and all claims must reach the National Claims History File by Feb. 29, 2008.

Any Medicare-enrolled eligible professional can participate in the program, regardless of whether they have signed a participation agreement with Medicare to accept assignment on all claims. In addition, physicians are not required to register to participate in the Physician Quality Reporting Initiative.

Medicare will use a claims-based reporting system for the program and will require practices to enter either CPT Category II codes or temporary G-codes where CPT-II codes are not available. The codes can be reported on either paper-based CMS 1500 forms or electronic 837-P claims. The quality codes should be reported with a $0.00 charge.

The bonus payments earned will be made in a lump sum in mid-2008. Physicians can earn up to a 1.5% bonus, subject to a cap. The cap is structured to ensure that physicians who do more reporting will receive higher payments.

Under the law that established the Physician Quality Reporting Initiative, the program is excluded from a formal appeals process. However, CMS officials said they plan to establish some type of informal inquiry process. They are currently developing a validation procedure for the reporting process that is likely to involve sampling.

In addition to the bonus payment, physicians who participate will receive a confidential feedback report from the CMS sometime in 2008. Those reports are expected to include reporting and performance rates. However, the quality data reported in 2007 will not be publicly reported.

For 2008, the CMS is required under statute to propose the new measures in August 2007 and finalize them by Nov. 15, 2007. Next year's measures are likely to include structural measures, such as the use of electronic health records. CMS officials are also working on the possibility of allowing physicians to report using either registry-based systems or electronic records systems in 2008.

More information on the Physician Quality Reporting Initiative is available online at www.cms.hhs.gov/PQRI

Starting July 1, physicians who report on selected quality measures will have a chance to earn a small bonus payment from Medicare.

The program, called the Physician Quality Reporting Initiative, was mandated by Congress and offers incentive payments to physicians who report on one to three quality measures. By doing so, physicians can earn a bonus of up to 1.5% of their total allowed Medicare charges during the 6-month reporting period.

Although even the maximum compensation isn't enough to make anyone rich, some physician organizations are advising their members to take a good look at the program because it may be the first step toward a performance-based payment system.

“This experience will likely be helpful in the future,” said Brett Baker, director of regulatory affairs at the American College of Physicians, adding that although the bonus payment is not significant, having some type of financial incentive attached may be enough to get people's attention.

To get started, physicians must familiarize themselves with the program and the measures and figure out for how many patients they will be able to gather and report data, Mr. Baker said.

They also should consider the technical issues involved in reporting and how feasible it will be to make those changes. “It's certainly a challenge for everyone to ramp up to do this in a short period of time,” he said.

Officials of the Centers for Medicare and Medicaid Services have selected 74 quality measures that can be used by physicians across specialties. If 4 or more measures apply, physicians must report on at least 3 measures for at least 80% of cases in which the measure was reportable.

If no more than three measures apply, each measure must be reported for at least 80% of the cases in which a measure was reportable.

Although payments will be provided to the holder of the tax identification number, the results will be analyzed at the physician level, the CMS said. As a result, Medicare officials are requiring that the National Provider Identifier number be used on all claims.

The reporting period will run from July 1 through Dec. 31, 2007, and all claims must reach the National Claims History File by Feb. 29, 2008.

Any Medicare-enrolled eligible professional can participate in the program, regardless of whether they have signed a participation agreement with Medicare to accept assignment on all claims. In addition, physicians are not required to register to participate in the Physician Quality Reporting Initiative.

Medicare will use a claims-based reporting system for the program and will require practices to enter either CPT Category II codes or temporary G-codes where CPT-II codes are not available. The codes can be reported on either paper-based CMS 1500 forms or electronic 837-P claims. The quality codes should be reported with a $0.00 charge.

The bonus payments earned will be made in a lump sum in mid-2008, CMS officials said. Physicians can earn up to a 1.5% bonus, subject to a cap. The cap is structured to ensure that physicians who do more reporting will receive higher payments.

Under the law that established the Physician Quality Reporting Initiative, the program is excluded from a formal appeals process. However, CMS officials said they plan to establish some type of informal inquiry process. In addition, they are currently developing a validation procedure for the reporting process that is likely to involve sampling.

In addition to the bonus payment, physicians who participate will receive a confidential feedback report from the CMS sometime in 2008. Those reports are expected to include reporting and performance rates. However, the quality data reported in 2007 will not be publicly reported.

For 2008, the CMS is required under statute to propose the new measures in August 2007 and finalize them by Nov. 15, 2007. Next year's measures are likely to include structural measures, such as the use of electronic health records or electronic prescribing technology.

CMS officials are also working on the possibility of allowing physicians to report using either registry-based systems or electronic records systems in 2008.

Of the 74 measures released by the CMS, 21 apply to family medicine, said Dr. Rick Kellerman, president of the American Academy of Family Physicians. In an effort to make the process more user friendly, AAFP officials are strongly urging family physicians to report on the three diabetes measures available. This will make it easier for physicians to report because they can concentrate on a single diagnosis, Dr. Kellerman said.

The AAFP is developing a data collection sheet for physicians and another for the back office staff, he said. The academy also is developing tools to help physicians calculate their potential bonus payment under the program.

“It does not look like it will be overly burdensome,” Dr. Kellerman said.

Because the CMS has selected measures that have been vetted by physician organizations and reflect current medical practice, few physicians should have a problem with that aspect of the program, said Dr. Janet Wright, a cardiologist in Chico, Calif., and chair of the performance assessment task force of the American College of Cardiology.

The hurdle will be in changing the workflow in the office, she said. For some, the bonus payment will not be enough to offset the cost of making these administrative changes. However, the ACC is developing a special coding form that can be attached to the visit encounter form in an effort to streamline the process.

In addition, participation in the program will help provide the CMS with information on the real-life experiences of cardiologists, Dr. Wright said.

Dr. James Stevens, a neurologist in Fort Wayne, Ind., said deciding whether participation in the program makes sense is a calculation that has to be made by each practice. Those who give it a try will get a confidential report from CMS about how they are doing and have a chance to provide information on what works and what does not.

But Dr. Stevens, a member of the medical economics and management committee of the American Academy of Neurology, sees additional benefits.

“By involving ourselves in the process, we can have feedback,” he said.

More information on the Physician Quality Reporting Initiative is available online at www.cms.hhs.gov/PQRI

Starting July 1, physicians who report on selected quality measures will have a chance to earn a small bonus payment from Medicare.

The program, called the Physician Quality Reporting Initiative, was mandated by Congress and offers incentive payments to physicians who report on one to three quality measures. By doing so, physicians can earn a bonus of up to 1.5% of their total allowed Medicare charges during the 6-month reporting period.

Although even the maximum compensation isn't enough to make anyone rich, some physician organizations are advising their members to take a good look at the program because it may be the first step toward a performance-based payment system.

“This experience will likely be helpful in the future,” said Brett Baker, director of regulatory affairs at the American College of Physicians, adding that although the bonus payment is not significant, having some type of financial incentive attached may be enough to get people's attention.

To get started, physicians must familiarize themselves with the program and the measures and figure out for how many patients they will be able to gather and report data, Mr. Baker said.

They also should consider the technical issues involved in reporting and how feasible it will be to make those changes. “It's certainly a challenge for everyone to ramp up to do this in a short period of time,” he said.

Officials of the Centers for Medicare and Medicaid Services have selected 74 quality measures that can be used by physicians across specialties. If 4 or more measures apply, physicians must report on at least 3 measures for at least 80% of cases in which the measure was reportable.

If no more than three measures apply, each measure must be reported for at least 80% of the cases in which a measure was reportable.

Although payments will be provided to the holder of the tax identification number, the results will be analyzed at the physician level, the CMS said. As a result, Medicare officials are requiring that the National Provider Identifier number be used on all claims.

The reporting period will run from July 1 through Dec. 31, 2007, and all claims must reach the National Claims History File by Feb. 29, 2008.

Any Medicare-enrolled eligible professional can participate in the program, regardless of whether they have signed a participation agreement with Medicare to accept assignment on all claims. In addition, physicians are not required to register to participate in the Physician Quality Reporting Initiative.

Medicare will use a claims-based reporting system for the program and will require practices to enter either CPT Category II codes or temporary G-codes where CPT-II codes are not available. The codes can be reported on either paper-based CMS 1500 forms or electronic 837-P claims. The quality codes should be reported with a $0.00 charge.

The bonus payments earned will be made in a lump sum in mid-2008, CMS officials said. Physicians can earn up to a 1.5% bonus, subject to a cap. The cap is structured to ensure that physicians who do more reporting will receive higher payments.

Under the law that established the Physician Quality Reporting Initiative, the program is excluded from a formal appeals process. However, CMS officials said they plan to establish some type of informal inquiry process. In addition, they are currently developing a validation procedure for the reporting process that is likely to involve sampling.

In addition to the bonus payment, physicians who participate will receive a confidential feedback report from the CMS sometime in 2008. Those reports are expected to include reporting and performance rates. However, the quality data reported in 2007 will not be publicly reported.

For 2008, the CMS is required under statute to propose the new measures in August 2007 and finalize them by Nov. 15, 2007. Next year's measures are likely to include structural measures, such as the use of electronic health records or electronic prescribing technology.

CMS officials are also working on the possibility of allowing physicians to report using either registry-based systems or electronic records systems in 2008.

Of the 74 measures released by the CMS, 21 apply to family medicine, said Dr. Rick Kellerman, president of the American Academy of Family Physicians. In an effort to make the process more user friendly, AAFP officials are strongly urging family physicians to report on the three diabetes measures available. This will make it easier for physicians to report because they can concentrate on a single diagnosis, Dr. Kellerman said.

The AAFP is developing a data collection sheet for physicians and another for the back office staff, he said. The academy also is developing tools to help physicians calculate their potential bonus payment under the program.

“It does not look like it will be overly burdensome,” Dr. Kellerman said.

Because the CMS has selected measures that have been vetted by physician organizations and reflect current medical practice, few physicians should have a problem with that aspect of the program, said Dr. Janet Wright, a cardiologist in Chico, Calif., and chair of the performance assessment task force of the American College of Cardiology.

The hurdle will be in changing the workflow in the office, she said. For some, the bonus payment will not be enough to offset the cost of making these administrative changes. However, the ACC is developing a special coding form that can be attached to the visit encounter form in an effort to streamline the process.

In addition, participation in the program will help provide the CMS with information on the real-life experiences of cardiologists, Dr. Wright said.

Dr. James Stevens, a neurologist in Fort Wayne, Ind., said deciding whether participation in the program makes sense is a calculation that has to be made by each practice. Those who give it a try will get a confidential report from CMS about how they are doing and have a chance to provide information on what works and what does not.

But Dr. Stevens, a member of the medical economics and management committee of the American Academy of Neurology, sees additional benefits.

“By involving ourselves in the process, we can have feedback,” he said.

More information on the Physician Quality Reporting Initiative is available online at www.cms.hhs.gov/PQRI

Starting July 1, physicians who report on selected quality measures will have a chance to earn a small bonus payment from Medicare.

The program, called the Physician Quality Reporting Initiative, was mandated by Congress and offers incentive payments to physicians who report on one to three quality measures. By doing so, physicians can earn a bonus of up to 1.5% of their total allowed Medicare charges during the 6-month reporting period.

Although even the maximum compensation isn't enough to make anyone rich, some physician organizations are advising their members to take a good look at the program because it may be the first step toward a performance-based payment system.

“This experience will likely be helpful in the future,” said Brett Baker, director of regulatory affairs at the American College of Physicians, adding that although the bonus payment is not significant, having some type of financial incentive attached may be enough to get people's attention.

To get started, physicians must familiarize themselves with the program and the measures and figure out for how many patients they will be able to gather and report data, Mr. Baker said.

They also should consider the technical issues involved in reporting and how feasible it will be to make those changes. “It's certainly a challenge for everyone to ramp up to do this in a short period of time,” he said.

Officials of the Centers for Medicare and Medicaid Services have selected 74 quality measures that can be used by physicians across specialties. If 4 or more measures apply, physicians must report on at least 3 measures for at least 80% of cases in which the measure was reportable.

If no more than three measures apply, each measure must be reported for at least 80% of the cases in which a measure was reportable.

Although payments will be provided to the holder of the tax identification number, the results will be analyzed at the physician level, the CMS said. As a result, Medicare officials are requiring that the National Provider Identifier number be used on all claims.

The reporting period will run from July 1 through Dec. 31, 2007, and all claims must reach the National Claims History File by Feb. 29, 2008.

Any Medicare-enrolled eligible professional can participate in the program, regardless of whether they have signed a participation agreement with Medicare to accept assignment on all claims. In addition, physicians are not required to register to participate in the Physician Quality Reporting Initiative.

Medicare will use a claims-based reporting system for the program and will require practices to enter either CPT Category II codes or temporary G-codes where CPT-II codes are not available. The codes can be reported on either paper-based CMS 1500 forms or electronic 837-P claims. The quality codes should be reported with a $0.00 charge.

The bonus payments earned will be made in a lump sum in mid-2008, CMS officials said. Physicians can earn up to a 1.5% bonus, subject to a cap. The cap is structured to ensure that physicians who do more reporting will receive higher payments.

Under the law that established the Physician Quality Reporting Initiative, the program is excluded from a formal appeals process. However, CMS officials said they plan to establish some type of informal inquiry process. In addition, they are currently developing a validation procedure for the reporting process that is likely to involve sampling.

In addition to the bonus payment, physicians who participate will receive a confidential feedback report from the CMS sometime in 2008. Those reports are expected to include reporting and performance rates. However, the quality data reported in 2007 will not be publicly reported.

For 2008, the CMS is required under statute to propose the new measures in August 2007 and finalize them by Nov. 15, 2007. Next year's measures are likely to include structural measures, such as the use of electronic health records or electronic prescribing technology.

CMS officials are also working on the possibility of allowing physicians to report using either registry-based systems or electronic records systems in 2008.

Of the 74 measures released by the CMS, 21 apply to family medicine, said Dr. Rick Kellerman, president of the American Academy of Family Physicians. In an effort to make the process more user friendly, AAFP officials are strongly urging family physicians to report on the three diabetes measures available. This will make it easier for physicians to report because they can concentrate on a single diagnosis, Dr. Kellerman said.

The AAFP is developing a data collection sheet for physicians and another for the back office staff, he said. The academy also is developing tools to help physicians calculate their potential bonus payment under the program.

“It does not look like it will be overly burdensome,” Dr. Kellerman said.

Because the CMS has selected measures that have been vetted by physician organizations and reflect current medical practice, few physicians should have a problem with that aspect of the program, said Dr. Janet Wright, a cardiologist in Chico, Calif., and chair of the performance assessment task force of the American College of Cardiology.

The hurdle will be in changing the workflow in the office, she said. For some, the bonus payment will not be enough to offset the cost of making these administrative changes. However, the ACC is developing a special coding form that can be attached to the visit encounter form in an effort to streamline the process.

In addition, participation in the program will help provide the CMS with information on the real-life experiences of cardiologists, Dr. Wright said.

Dr. James Stevens, a neurologist in Fort Wayne, Ind., said deciding whether participation in the program makes sense is a calculation that has to be made by each practice. Those who give it a try will get a confidential report from CMS about how they are doing and have a chance to provide information on what works and what does not.

But Dr. Stevens, a member of the medical economics and management committee of the American Academy of Neurology, sees additional benefits.

“By involving ourselves in the process, we can have feedback,” he said.

More information on the Physician Quality Reporting Initiative is available online at www.cms.hhs.gov/PQRI

Hospitals are reluctant to offer physicians a portion of the savings generated by reducing clinical costs—a concept known as gainsharing—because of legal fears, D. McCarty Thornton said during an audioconference on gainsharing sponsored by the Integrated Healthcare Association.

“It's clear, I think, that gainsharing is not on the fast track,” said Mr. Thornton, a partner with the law firm of Sonnenschein, Nath, and Rosenthal LLP, based in Washington.

In the long run, gainsharing approaches that can save money without affecting patient care are likely to take hold, he said, but first hospitals need clarification from Congress, the Health and Human Services secretary, and the Office of Inspector General about what arrangements are allowed.

In 1999, the HHS Office of Inspector General issued a special advisory bulletin saying that the civil monetary penalty provision of the Social Security Act prohibits most gainsharing arrangements. Under that provision, hospitals are prohibited from making payments to physicians to reduce or limit services to Medicare and Medicaid beneficiaries.

The bulletin said that these types of arrangements could also trigger the antikickback provisions of the Social Security Act, which prohibit arrangements used to influence the referral of patients in federal health care programs.

“Historically, the office has been somewhat leery of gainsharing arrangements,” said Catherine A. Martin, OIG senior counsel.

Since the 1999 bulletin, the OIG has issued several advisory opinions that outline gainsharing arrangements that would be allowable. In general, in order to give the green light to a gainsharing arrangement, the OIG looks for transparency and accountability, quality of care controls, and safeguards against kickbacks, Ms. Martin said.

In order to be transparent, any actions taken to save costs need to be clearly and separately identified and fully disclosed to patients. Hospitals must also put in place controls to ensure that cost savings do not result in the inappropriate reduction of services. OIG officials also want to see ongoing monitoring of quality by the hospital and an independent outside reviewer, Ms. Martin said.

But the OIG is not the only regulator that hospitals and physicians need to consider when embarking on gainsharing arrangements, Ms. Martin said. Hospitals and physicians must also keep from running afoul of the Stark self-referral prohibitions, which fall under the purview of the Centers for Medicare and Medicaid Services. In addition, gainsharing arrangements must meet Internal Revenue Service rules, and hospitals are at risk for private lawsuits, she said.

But the industry is keeping an eye on two demonstration projects that test the gainsharing concept in the Medicare fee-for-service program. Both projects are set to begin this year.

The first project, which is required under the Deficit Reduction Act of 2005, will involve six hospitals and will focus on quality and efficiency for inpatient episodes and during the 30-day postdischarge period.

The DRA provision waives civil monetary penalty restrictions that would otherwise prohibit gainsharing.

The second project will focus on physician groups and integrated delivery systems and their affiliated hospitals. The demonstration will include inpatient episodes, as well as the pre- and posthospital care over the duration of the project. This demonstration was mandated by the Medicare Modernization Act of 2003.

Participants in both demonstrations will be required to standardize quality and efficiency improvement initiatives, internal cost savings measurement, and physician payment methodology, said Lisa R. Waters, a project officer with the division of payment policy demonstrations at CMS.

Hospitals are reluctant to offer physicians a portion of the savings generated by reducing clinical costs—a concept known as gainsharing—because of legal fears, D. McCarty Thornton said during an audioconference on gainsharing sponsored by the Integrated Healthcare Association.

“It's clear, I think, that gainsharing is not on the fast track,” said Mr. Thornton, a partner with the law firm of Sonnenschein, Nath, and Rosenthal LLP, based in Washington.

In the long run, gainsharing approaches that can save money without affecting patient care are likely to take hold, he said, but first hospitals need clarification from Congress, the Health and Human Services secretary, and the Office of Inspector General about what arrangements are allowed.

In 1999, the HHS Office of Inspector General issued a special advisory bulletin saying that the civil monetary penalty provision of the Social Security Act prohibits most gainsharing arrangements. Under that provision, hospitals are prohibited from making payments to physicians to reduce or limit services to Medicare and Medicaid beneficiaries.

The bulletin said that these types of arrangements could also trigger the antikickback provisions of the Social Security Act, which prohibit arrangements used to influence the referral of patients in federal health care programs.

“Historically, the office has been somewhat leery of gainsharing arrangements,” said Catherine A. Martin, OIG senior counsel.

Since the 1999 bulletin, the OIG has issued several advisory opinions that outline gainsharing arrangements that would be allowable. In general, in order to give the green light to a gainsharing arrangement, the OIG looks for transparency and accountability, quality of care controls, and safeguards against kickbacks, Ms. Martin said.

In order to be transparent, any actions taken to save costs need to be clearly and separately identified and fully disclosed to patients. Hospitals must also put in place controls to ensure that cost savings do not result in the inappropriate reduction of services. OIG officials also want to see ongoing monitoring of quality by the hospital and an independent outside reviewer, Ms. Martin said.

But the OIG is not the only regulator that hospitals and physicians need to consider when embarking on gainsharing arrangements, Ms. Martin said. Hospitals and physicians must also keep from running afoul of the Stark self-referral prohibitions, which fall under the purview of the Centers for Medicare and Medicaid Services. In addition, gainsharing arrangements must meet Internal Revenue Service rules, and hospitals are at risk for private lawsuits, she said.

But the industry is keeping an eye on two demonstration projects that test the gainsharing concept in the Medicare fee-for-service program. Both projects are set to begin this year.

The first project, which is required under the Deficit Reduction Act of 2005, will involve six hospitals and will focus on quality and efficiency for inpatient episodes and during the 30-day postdischarge period.

The DRA provision waives civil monetary penalty restrictions that would otherwise prohibit gainsharing.

The second project will focus on physician groups and integrated delivery systems and their affiliated hospitals. The demonstration will include inpatient episodes, as well as the pre- and posthospital care over the duration of the project. This demonstration was mandated by the Medicare Modernization Act of 2003.

Participants in both demonstrations will be required to standardize quality and efficiency improvement initiatives, internal cost savings measurement, and physician payment methodology, said Lisa R. Waters, a project officer with the division of payment policy demonstrations at CMS.

Hospitals are reluctant to offer physicians a portion of the savings generated by reducing clinical costs—a concept known as gainsharing—because of legal fears, D. McCarty Thornton said during an audioconference on gainsharing sponsored by the Integrated Healthcare Association.

“It's clear, I think, that gainsharing is not on the fast track,” said Mr. Thornton, a partner with the law firm of Sonnenschein, Nath, and Rosenthal LLP, based in Washington.

In the long run, gainsharing approaches that can save money without affecting patient care are likely to take hold, he said, but first hospitals need clarification from Congress, the Health and Human Services secretary, and the Office of Inspector General about what arrangements are allowed.

In 1999, the HHS Office of Inspector General issued a special advisory bulletin saying that the civil monetary penalty provision of the Social Security Act prohibits most gainsharing arrangements. Under that provision, hospitals are prohibited from making payments to physicians to reduce or limit services to Medicare and Medicaid beneficiaries.

The bulletin said that these types of arrangements could also trigger the antikickback provisions of the Social Security Act, which prohibit arrangements used to influence the referral of patients in federal health care programs.

“Historically, the office has been somewhat leery of gainsharing arrangements,” said Catherine A. Martin, OIG senior counsel.

Since the 1999 bulletin, the OIG has issued several advisory opinions that outline gainsharing arrangements that would be allowable. In general, in order to give the green light to a gainsharing arrangement, the OIG looks for transparency and accountability, quality of care controls, and safeguards against kickbacks, Ms. Martin said.

In order to be transparent, any actions taken to save costs need to be clearly and separately identified and fully disclosed to patients. Hospitals must also put in place controls to ensure that cost savings do not result in the inappropriate reduction of services. OIG officials also want to see ongoing monitoring of quality by the hospital and an independent outside reviewer, Ms. Martin said.

But the OIG is not the only regulator that hospitals and physicians need to consider when embarking on gainsharing arrangements, Ms. Martin said. Hospitals and physicians must also keep from running afoul of the Stark self-referral prohibitions, which fall under the purview of the Centers for Medicare and Medicaid Services. In addition, gainsharing arrangements must meet Internal Revenue Service rules, and hospitals are at risk for private lawsuits, she said.

But the industry is keeping an eye on two demonstration projects that test the gainsharing concept in the Medicare fee-for-service program. Both projects are set to begin this year.

The first project, which is required under the Deficit Reduction Act of 2005, will involve six hospitals and will focus on quality and efficiency for inpatient episodes and during the 30-day postdischarge period.

The DRA provision waives civil monetary penalty restrictions that would otherwise prohibit gainsharing.

The second project will focus on physician groups and integrated delivery systems and their affiliated hospitals. The demonstration will include inpatient episodes, as well as the pre- and posthospital care over the duration of the project. This demonstration was mandated by the Medicare Modernization Act of 2003.

Participants in both demonstrations will be required to standardize quality and efficiency improvement initiatives, internal cost savings measurement, and physician payment methodology, said Lisa R. Waters, a project officer with the division of payment policy demonstrations at CMS.

Endocrinologists are bracing for deep cuts in outpatient imaging services slated to be phased in over the next few years.

If nothing is done to stop the spiraling decline in payment under Medicare, some endocrinologists say they may have to stop providing services such as dual-energy x-ray absorptiometry (DXA) in their offices.

Though the Medicare payment cuts began in January, the impact will be felt over the next few years, said Dr. Nelson B. Watts, director of the Bone Health and Osteoporosis Center at the University of Cincinnati and a past president of the International Society for Clinical Densitometry.

And the situation is somewhat unpredictable because some private insurance plans are planning cuts as well, while others have not announced whether they will follow Medicare's lead in this area.

“The news is filtering down slowly. There are physicians who are hard hit but don't know it yet,” Dr. Watts said.

Dr. Watts, who splits his time between clinical trials and patient care, said he might have to stop performing DXA in the office outside of clinical trials. The loss in revenue from DXA scans also could mean further disruption to his practice since that money currently allows him to keep a nurse practitioner on staff.

The cuts to imaging services under Medicare are coming largely from two areas—cuts mandated under the Deficit Reduction Act of 2005 (DRA) and changes made to practice expense methodology under the physician fee schedule. Under the DRA, Medicare is required to set the fee for the technical component of an imaging service at the hospital outpatient department rate as long as that rate is lower than the Medicare physician fee schedule payment rate.

The combined effect of these cuts is an immediate 40% decline in DXA reimbursement in 2007, dropping payments from about $139 to $82 for a DXA scan (77080). However, by the time the cuts are fully implemented in 2010, the reimbursement for DXA will drop a total of about 75% to $35, according to estimates from the International Society for Clinical Densitometry. Similar cuts are scheduled for payment for vertebral fracture assessment (77082), which will drop from $39 to $33 this year and to $19 in 2010.

In the area of thyroid imaging, the DRA has triggered approximately a 35% cut in payment for ultrasonic guidance for biopsy (76942) in 2007. Thyroid ultrasound (76536) is not cut this year under the DRA provision because the physician fee schedule payment already is lower than the hospital outpatient department payment rate, according to the American Association of Clinical Endocrinologists (AACE).

Those who already have made the investment in equipment may choose not to spend the money for upgrades or replacement, said Dr. Daniel S. Duick, an endocrinologist in Phoenix, and president-elect of AACE.

Over time, it will become a problem of patient access. “Physicians are going to kind of balk” at continuing to provide these services in their offices, Dr. Duick said.

As more physicians refer patients to hospitals or freestanding radiology clinics for imaging services, it also will become a quality of care problem, endocrinologists say.

Dr. Victor L. Roberts, an endocrinologist in Winter Park, Fla., does only a limited amount of imaging in his office and refers patients outside his practice for the rest. Besides the inconvenience for patients, the technical quality varies, he said.

However, when imaging services such as thyroid ultrasound are performed by the endocrinologist, they are done at the bedside by someone who is familiar with the patient's history. “It's better if it's done by the physician who knows the patient,” Dr. Roberts said.

But there may some relief on the horizon for endocrinologists and other physicians who provide in-office imaging services.

Rep. Carolyn McCarthy (D-N.Y.) recently introduced legislation calling for a 2-year moratorium on the imaging cuts included in the DRA. The Access to Medicare Imaging Act (H.R. 1293) also would require the Government Accountability Office to study the impact of the payment reductions in the DRA to see how they affect patient access and service issues. A similar bill was introduced in the last Congress but failed to gain traction.

This year's version of the legislation is slightly different because it also includes a provision that would permanently exempt the imaging procedures commonly performed in endocrinologists' offices from the DRA cuts. If the legislation passed, the DRA cuts would be applied to only “advanced diagnostic imaging services” such as MRI, CT, PET, and nuclear cardiology procedures.

The legislation already has garnered the endorsement of the Endocrine Society. AACE officials were reviewing the legislation but did not have an official position at press time.

The bill is an “intermediate fix,” said Dr. Jonathan D. Leffert, chair of the legislative and regulatory committee of AACE and an endocrinologist in Dallas. But if passed, it would offer a significant improvement in the payment situation, he said, and allow physicians to at least consider continuing to provide in-office imaging services.

The bottom line is that these imaging technologies have become the standard of care in the office, said Dr. R. Mack Harrell, chair of the AACE socioeconomics committee and an endocrinologist in Ft. Lauderdale, Fla. But physicians are fully aware of the cost issues involved and are not in favor of the uncontrolled use of in-office imaging, he said. In fact, groups like AACE are trying to help by certifying and licensing members who perform ultrasound and DXA in their offices. “We're not in favor of the unrestrained use of these technologies,” Dr. Harrell said.

Endocrinologists are bracing for deep cuts in outpatient imaging services slated to be phased in over the next few years.

If nothing is done to stop the spiraling decline in payment under Medicare, some endocrinologists say they may have to stop providing services such as dual-energy x-ray absorptiometry (DXA) in their offices.

Though the Medicare payment cuts began in January, the impact will be felt over the next few years, said Dr. Nelson B. Watts, director of the Bone Health and Osteoporosis Center at the University of Cincinnati and a past president of the International Society for Clinical Densitometry.

And the situation is somewhat unpredictable because some private insurance plans are planning cuts as well, while others have not announced whether they will follow Medicare's lead in this area.

“The news is filtering down slowly. There are physicians who are hard hit but don't know it yet,” Dr. Watts said.

Dr. Watts, who splits his time between clinical trials and patient care, said he might have to stop performing DXA in the office outside of clinical trials. The loss in revenue from DXA scans also could mean further disruption to his practice since that money currently allows him to keep a nurse practitioner on staff.

The cuts to imaging services under Medicare are coming largely from two areas—cuts mandated under the Deficit Reduction Act of 2005 (DRA) and changes made to practice expense methodology under the physician fee schedule. Under the DRA, Medicare is required to set the fee for the technical component of an imaging service at the hospital outpatient department rate as long as that rate is lower than the Medicare physician fee schedule payment rate.

The combined effect of these cuts is an immediate 40% decline in DXA reimbursement in 2007, dropping payments from about $139 to $82 for a DXA scan (77080). However, by the time the cuts are fully implemented in 2010, the reimbursement for DXA will drop a total of about 75% to $35, according to estimates from the International Society for Clinical Densitometry. Similar cuts are scheduled for payment for vertebral fracture assessment (77082), which will drop from $39 to $33 this year and to $19 in 2010.

In the area of thyroid imaging, the DRA has triggered approximately a 35% cut in payment for ultrasonic guidance for biopsy (76942) in 2007. Thyroid ultrasound (76536) is not cut this year under the DRA provision because the physician fee schedule payment already is lower than the hospital outpatient department payment rate, according to the American Association of Clinical Endocrinologists (AACE).

Those who already have made the investment in equipment may choose not to spend the money for upgrades or replacement, said Dr. Daniel S. Duick, an endocrinologist in Phoenix, and president-elect of AACE.

Over time, it will become a problem of patient access. “Physicians are going to kind of balk” at continuing to provide these services in their offices, Dr. Duick said.

As more physicians refer patients to hospitals or freestanding radiology clinics for imaging services, it also will become a quality of care problem, endocrinologists say.

Dr. Victor L. Roberts, an endocrinologist in Winter Park, Fla., does only a limited amount of imaging in his office and refers patients outside his practice for the rest. Besides the inconvenience for patients, the technical quality varies, he said.

However, when imaging services such as thyroid ultrasound are performed by the endocrinologist, they are done at the bedside by someone who is familiar with the patient's history. “It's better if it's done by the physician who knows the patient,” Dr. Roberts said.

But there may some relief on the horizon for endocrinologists and other physicians who provide in-office imaging services.

Rep. Carolyn McCarthy (D-N.Y.) recently introduced legislation calling for a 2-year moratorium on the imaging cuts included in the DRA. The Access to Medicare Imaging Act (H.R. 1293) also would require the Government Accountability Office to study the impact of the payment reductions in the DRA to see how they affect patient access and service issues. A similar bill was introduced in the last Congress but failed to gain traction.

This year's version of the legislation is slightly different because it also includes a provision that would permanently exempt the imaging procedures commonly performed in endocrinologists' offices from the DRA cuts. If the legislation passed, the DRA cuts would be applied to only “advanced diagnostic imaging services” such as MRI, CT, PET, and nuclear cardiology procedures.

The legislation already has garnered the endorsement of the Endocrine Society. AACE officials were reviewing the legislation but did not have an official position at press time.

The bill is an “intermediate fix,” said Dr. Jonathan D. Leffert, chair of the legislative and regulatory committee of AACE and an endocrinologist in Dallas. But if passed, it would offer a significant improvement in the payment situation, he said, and allow physicians to at least consider continuing to provide in-office imaging services.

The bottom line is that these imaging technologies have become the standard of care in the office, said Dr. R. Mack Harrell, chair of the AACE socioeconomics committee and an endocrinologist in Ft. Lauderdale, Fla. But physicians are fully aware of the cost issues involved and are not in favor of the uncontrolled use of in-office imaging, he said. In fact, groups like AACE are trying to help by certifying and licensing members who perform ultrasound and DXA in their offices. “We're not in favor of the unrestrained use of these technologies,” Dr. Harrell said.

Endocrinologists are bracing for deep cuts in outpatient imaging services slated to be phased in over the next few years.

If nothing is done to stop the spiraling decline in payment under Medicare, some endocrinologists say they may have to stop providing services such as dual-energy x-ray absorptiometry (DXA) in their offices.

Though the Medicare payment cuts began in January, the impact will be felt over the next few years, said Dr. Nelson B. Watts, director of the Bone Health and Osteoporosis Center at the University of Cincinnati and a past president of the International Society for Clinical Densitometry.

And the situation is somewhat unpredictable because some private insurance plans are planning cuts as well, while others have not announced whether they will follow Medicare's lead in this area.

“The news is filtering down slowly. There are physicians who are hard hit but don't know it yet,” Dr. Watts said.

Dr. Watts, who splits his time between clinical trials and patient care, said he might have to stop performing DXA in the office outside of clinical trials. The loss in revenue from DXA scans also could mean further disruption to his practice since that money currently allows him to keep a nurse practitioner on staff.

The cuts to imaging services under Medicare are coming largely from two areas—cuts mandated under the Deficit Reduction Act of 2005 (DRA) and changes made to practice expense methodology under the physician fee schedule. Under the DRA, Medicare is required to set the fee for the technical component of an imaging service at the hospital outpatient department rate as long as that rate is lower than the Medicare physician fee schedule payment rate.

The combined effect of these cuts is an immediate 40% decline in DXA reimbursement in 2007, dropping payments from about $139 to $82 for a DXA scan (77080). However, by the time the cuts are fully implemented in 2010, the reimbursement for DXA will drop a total of about 75% to $35, according to estimates from the International Society for Clinical Densitometry. Similar cuts are scheduled for payment for vertebral fracture assessment (77082), which will drop from $39 to $33 this year and to $19 in 2010.

In the area of thyroid imaging, the DRA has triggered approximately a 35% cut in payment for ultrasonic guidance for biopsy (76942) in 2007. Thyroid ultrasound (76536) is not cut this year under the DRA provision because the physician fee schedule payment already is lower than the hospital outpatient department payment rate, according to the American Association of Clinical Endocrinologists (AACE).

Those who already have made the investment in equipment may choose not to spend the money for upgrades or replacement, said Dr. Daniel S. Duick, an endocrinologist in Phoenix, and president-elect of AACE.

Over time, it will become a problem of patient access. “Physicians are going to kind of balk” at continuing to provide these services in their offices, Dr. Duick said.

As more physicians refer patients to hospitals or freestanding radiology clinics for imaging services, it also will become a quality of care problem, endocrinologists say.

Dr. Victor L. Roberts, an endocrinologist in Winter Park, Fla., does only a limited amount of imaging in his office and refers patients outside his practice for the rest. Besides the inconvenience for patients, the technical quality varies, he said.

However, when imaging services such as thyroid ultrasound are performed by the endocrinologist, they are done at the bedside by someone who is familiar with the patient's history. “It's better if it's done by the physician who knows the patient,” Dr. Roberts said.

But there may some relief on the horizon for endocrinologists and other physicians who provide in-office imaging services.

Rep. Carolyn McCarthy (D-N.Y.) recently introduced legislation calling for a 2-year moratorium on the imaging cuts included in the DRA. The Access to Medicare Imaging Act (H.R. 1293) also would require the Government Accountability Office to study the impact of the payment reductions in the DRA to see how they affect patient access and service issues. A similar bill was introduced in the last Congress but failed to gain traction.

This year's version of the legislation is slightly different because it also includes a provision that would permanently exempt the imaging procedures commonly performed in endocrinologists' offices from the DRA cuts. If the legislation passed, the DRA cuts would be applied to only “advanced diagnostic imaging services” such as MRI, CT, PET, and nuclear cardiology procedures.

The legislation already has garnered the endorsement of the Endocrine Society. AACE officials were reviewing the legislation but did not have an official position at press time.

The bill is an “intermediate fix,” said Dr. Jonathan D. Leffert, chair of the legislative and regulatory committee of AACE and an endocrinologist in Dallas. But if passed, it would offer a significant improvement in the payment situation, he said, and allow physicians to at least consider continuing to provide in-office imaging services.

The bottom line is that these imaging technologies have become the standard of care in the office, said Dr. R. Mack Harrell, chair of the AACE socioeconomics committee and an endocrinologist in Ft. Lauderdale, Fla. But physicians are fully aware of the cost issues involved and are not in favor of the uncontrolled use of in-office imaging, he said. In fact, groups like AACE are trying to help by certifying and licensing members who perform ultrasound and DXA in their offices. “We're not in favor of the unrestrained use of these technologies,” Dr. Harrell said.

Starting July 1, physicians who report on selected quality measures will have a chance to earn a small bonus payment from Medicare.

The program, called the Physician Quality Reporting Initiative, was mandated by Congress and offers incentive payments to physicians who report on one to three quality measures. By doing so, physicians can earn a bonus of up to 1.5% of their total allowed Medicare charges during the 6-month reporting period.

The three measures that dermatologists may report on apply to Medicare patients with melanoma or a history of melanoma. Those who report all three measures at least 80% of the time will be eligible to receive the bonus (SKIN & ALLERGY NEWS, April 2007, p. 12).

Although even the maximum compensation isn't enough to make anyone rich, some physician organizations are advising their members to take a good look at the program because it may be the first step toward a performance-based payment system.

"By involving ourselves in the process we can have feedback," said Dr. James Stevens, a neurologist in Fort Wayne, Ind., and a member of the medical economics and management committee of the American Academy of Neurology.

Deciding whether participation makes sense is a calculation that has to be made by each practice, Dr. Stevens said. Those who give it a try will get a confidential report from the Centers for Medicare and Medicaid Services about how they are doing and have a chance to provide information on what works and what doesn't.

"This experience will likely be helpful in the future," said Brett Baker, director of regulatory affairs at the American College of Physicians, adding that although the bonus payment is not significant, having some type of financial incentive attached may be enough to get people's attention.

To get started, physicians must familiarize themselves with the program and the measures and figure out for how many patients they will be able to gather and report data, Mr. Baker said.

They also should consider the technical issues involved in reporting and how feasible it will be to make those changes. "It's certainly a challenge for everyone to ramp up to do this in a short period of time," he said.

CMS officials have selected 74 quality measures that can be used by physicians across specialties. If four or more measures apply, physicians must report on at least three measures for at least 80% of cases in which the measure was reportable. If no more than three measures apply, each measure must be reported for at least 80% of the cases in which a measure was reportable.

Although payments will be provided to the holder of the tax identification number, the results will be analyzed at the physician level, the CMS said. As a result, Medicare officials are requiring that the National Provider Identifier number be used on all claims.

The reporting period will run from July 1 through Dec. 31, 2007, and all claims must reach the National Claims History File by Feb. 29, 2008.

Any Medicare-enrolled eligible professional can participate in the program, regardless of whether they have signed a participation agreement with Medicare to accept assignment on all claims. In addition, physicians are not required to register to participate in the Physician Quality Reporting Initiative.

Medicare will use a claims-based reporting system for the program and will require practices to enter either CPT Category II codes or temporary G-codes where CPT-II codes are not available. The codes can be reported on either paper-based CMS 1500 forms or electronic 837-P claims. The quality codes should be reported with a $0.00 charge.

The bonus payments earned will be made in a lump sum in mid-2008, CMS officials said. Physicians can earn up to a 1.5% bonus, subject to a cap. The cap is structured to ensure that physicians who do more reporting will receive higher payments.

Under the law that established the Physician Quality Reporting Initiative, the program is excluded from a formal appeals process. However, CMS officials said they plan to establish some type of informal inquiry process. In addition, they are currently developing a validation procedure for the reporting process that is likely to involve sampling.

In addition to the bonus payment, physicians who participate will receive a confidential feedback report from the CMS sometime in 2008. Those reports are expected to include reporting and performance rates. However, the quality data reported in 2007 will not be publicly reported.

For 2008, the CMS is required under statute to propose the new measures in August 2007 and finalize them by Nov. 15, 2007. Next year's measures are likely to include structural measures, such as the use of electronic health records or electronic prescribing technology. CMS officials are also working on the possibility of allowing physicians to report using either registry-based systems or electronic records systems in 2008.

Of the 74 measures released by the CMS, 21 apply to family medicine, said Dr. Rick Kellerman, president of the American Academy of Family Physicians. In an effort to make the process more user friendly, AAFP officials are strongly urging family physicians to report on the three diabetes measures available. This will make it easier for physicians to report because they can concentrate on a single diagnosis, Dr. Kellerman said.

The AAFP is developing a data collection sheet for physicians and another for the back office staff, he said. The academy also is developing tools to help physicians calculate their potential bonus payment under the program.

"It does not look like it will be overly burdensome," Dr. Kellerman said.

Because the CMS has selected measures that have been vetted by physician organizations and reflect current medical practice, most physicians should not have a problem with that aspect of the program, said Dr. Janet Wright, a cardiologist in Chico, Calif., and chair of the performance assessment task force of the American College of Cardiology.

The hurdle will be in changing office workflow, she said. For some, the bonus payment will not be enough to offset the cost of the administrative changes.

More information on the Physician Quality Reporting Initiative is available online at www.cms.hhs.gov/PQRI

Starting July 1, physicians who report on selected quality measures will have a chance to earn a small bonus payment from Medicare.

The program, called the Physician Quality Reporting Initiative, was mandated by Congress and offers incentive payments to physicians who report on one to three quality measures. By doing so, physicians can earn a bonus of up to 1.5% of their total allowed Medicare charges during the 6-month reporting period.

The three measures that dermatologists may report on apply to Medicare patients with melanoma or a history of melanoma. Those who report all three measures at least 80% of the time will be eligible to receive the bonus (SKIN & ALLERGY NEWS, April 2007, p. 12).

Although even the maximum compensation isn't enough to make anyone rich, some physician organizations are advising their members to take a good look at the program because it may be the first step toward a performance-based payment system.

"By involving ourselves in the process we can have feedback," said Dr. James Stevens, a neurologist in Fort Wayne, Ind., and a member of the medical economics and management committee of the American Academy of Neurology.

Deciding whether participation makes sense is a calculation that has to be made by each practice, Dr. Stevens said. Those who give it a try will get a confidential report from the Centers for Medicare and Medicaid Services about how they are doing and have a chance to provide information on what works and what doesn't.

"This experience will likely be helpful in the future," said Brett Baker, director of regulatory affairs at the American College of Physicians, adding that although the bonus payment is not significant, having some type of financial incentive attached may be enough to get people's attention.

To get started, physicians must familiarize themselves with the program and the measures and figure out for how many patients they will be able to gather and report data, Mr. Baker said.

They also should consider the technical issues involved in reporting and how feasible it will be to make those changes. "It's certainly a challenge for everyone to ramp up to do this in a short period of time," he said.

CMS officials have selected 74 quality measures that can be used by physicians across specialties. If four or more measures apply, physicians must report on at least three measures for at least 80% of cases in which the measure was reportable. If no more than three measures apply, each measure must be reported for at least 80% of the cases in which a measure was reportable.

Although payments will be provided to the holder of the tax identification number, the results will be analyzed at the physician level, the CMS said. As a result, Medicare officials are requiring that the National Provider Identifier number be used on all claims.

The reporting period will run from July 1 through Dec. 31, 2007, and all claims must reach the National Claims History File by Feb. 29, 2008.

Any Medicare-enrolled eligible professional can participate in the program, regardless of whether they have signed a participation agreement with Medicare to accept assignment on all claims. In addition, physicians are not required to register to participate in the Physician Quality Reporting Initiative.

Medicare will use a claims-based reporting system for the program and will require practices to enter either CPT Category II codes or temporary G-codes where CPT-II codes are not available. The codes can be reported on either paper-based CMS 1500 forms or electronic 837-P claims. The quality codes should be reported with a $0.00 charge.

The bonus payments earned will be made in a lump sum in mid-2008, CMS officials said. Physicians can earn up to a 1.5% bonus, subject to a cap. The cap is structured to ensure that physicians who do more reporting will receive higher payments.

Under the law that established the Physician Quality Reporting Initiative, the program is excluded from a formal appeals process. However, CMS officials said they plan to establish some type of informal inquiry process. In addition, they are currently developing a validation procedure for the reporting process that is likely to involve sampling.

In addition to the bonus payment, physicians who participate will receive a confidential feedback report from the CMS sometime in 2008. Those reports are expected to include reporting and performance rates. However, the quality data reported in 2007 will not be publicly reported.

For 2008, the CMS is required under statute to propose the new measures in August 2007 and finalize them by Nov. 15, 2007. Next year's measures are likely to include structural measures, such as the use of electronic health records or electronic prescribing technology. CMS officials are also working on the possibility of allowing physicians to report using either registry-based systems or electronic records systems in 2008.

Of the 74 measures released by the CMS, 21 apply to family medicine, said Dr. Rick Kellerman, president of the American Academy of Family Physicians. In an effort to make the process more user friendly, AAFP officials are strongly urging family physicians to report on the three diabetes measures available. This will make it easier for physicians to report because they can concentrate on a single diagnosis, Dr. Kellerman said.

The AAFP is developing a data collection sheet for physicians and another for the back office staff, he said. The academy also is developing tools to help physicians calculate their potential bonus payment under the program.

"It does not look like it will be overly burdensome," Dr. Kellerman said.

Because the CMS has selected measures that have been vetted by physician organizations and reflect current medical practice, most physicians should not have a problem with that aspect of the program, said Dr. Janet Wright, a cardiologist in Chico, Calif., and chair of the performance assessment task force of the American College of Cardiology.

The hurdle will be in changing office workflow, she said. For some, the bonus payment will not be enough to offset the cost of the administrative changes.

More information on the Physician Quality Reporting Initiative is available online at www.cms.hhs.gov/PQRI

Starting July 1, physicians who report on selected quality measures will have a chance to earn a small bonus payment from Medicare.

The program, called the Physician Quality Reporting Initiative, was mandated by Congress and offers incentive payments to physicians who report on one to three quality measures. By doing so, physicians can earn a bonus of up to 1.5% of their total allowed Medicare charges during the 6-month reporting period.

The three measures that dermatologists may report on apply to Medicare patients with melanoma or a history of melanoma. Those who report all three measures at least 80% of the time will be eligible to receive the bonus (SKIN & ALLERGY NEWS, April 2007, p. 12).

Although even the maximum compensation isn't enough to make anyone rich, some physician organizations are advising their members to take a good look at the program because it may be the first step toward a performance-based payment system.

"By involving ourselves in the process we can have feedback," said Dr. James Stevens, a neurologist in Fort Wayne, Ind., and a member of the medical economics and management committee of the American Academy of Neurology.

Deciding whether participation makes sense is a calculation that has to be made by each practice, Dr. Stevens said. Those who give it a try will get a confidential report from the Centers for Medicare and Medicaid Services about how they are doing and have a chance to provide information on what works and what doesn't.

"This experience will likely be helpful in the future," said Brett Baker, director of regulatory affairs at the American College of Physicians, adding that although the bonus payment is not significant, having some type of financial incentive attached may be enough to get people's attention.

To get started, physicians must familiarize themselves with the program and the measures and figure out for how many patients they will be able to gather and report data, Mr. Baker said.

They also should consider the technical issues involved in reporting and how feasible it will be to make those changes. "It's certainly a challenge for everyone to ramp up to do this in a short period of time," he said.

CMS officials have selected 74 quality measures that can be used by physicians across specialties. If four or more measures apply, physicians must report on at least three measures for at least 80% of cases in which the measure was reportable. If no more than three measures apply, each measure must be reported for at least 80% of the cases in which a measure was reportable.

Although payments will be provided to the holder of the tax identification number, the results will be analyzed at the physician level, the CMS said. As a result, Medicare officials are requiring that the National Provider Identifier number be used on all claims.

The reporting period will run from July 1 through Dec. 31, 2007, and all claims must reach the National Claims History File by Feb. 29, 2008.

Any Medicare-enrolled eligible professional can participate in the program, regardless of whether they have signed a participation agreement with Medicare to accept assignment on all claims. In addition, physicians are not required to register to participate in the Physician Quality Reporting Initiative.

Medicare will use a claims-based reporting system for the program and will require practices to enter either CPT Category II codes or temporary G-codes where CPT-II codes are not available. The codes can be reported on either paper-based CMS 1500 forms or electronic 837-P claims. The quality codes should be reported with a $0.00 charge.

The bonus payments earned will be made in a lump sum in mid-2008, CMS officials said. Physicians can earn up to a 1.5% bonus, subject to a cap. The cap is structured to ensure that physicians who do more reporting will receive higher payments.

Under the law that established the Physician Quality Reporting Initiative, the program is excluded from a formal appeals process. However, CMS officials said they plan to establish some type of informal inquiry process. In addition, they are currently developing a validation procedure for the reporting process that is likely to involve sampling.

In addition to the bonus payment, physicians who participate will receive a confidential feedback report from the CMS sometime in 2008. Those reports are expected to include reporting and performance rates. However, the quality data reported in 2007 will not be publicly reported.

For 2008, the CMS is required under statute to propose the new measures in August 2007 and finalize them by Nov. 15, 2007. Next year's measures are likely to include structural measures, such as the use of electronic health records or electronic prescribing technology. CMS officials are also working on the possibility of allowing physicians to report using either registry-based systems or electronic records systems in 2008.

Of the 74 measures released by the CMS, 21 apply to family medicine, said Dr. Rick Kellerman, president of the American Academy of Family Physicians. In an effort to make the process more user friendly, AAFP officials are strongly urging family physicians to report on the three diabetes measures available. This will make it easier for physicians to report because they can concentrate on a single diagnosis, Dr. Kellerman said.

The AAFP is developing a data collection sheet for physicians and another for the back office staff, he said. The academy also is developing tools to help physicians calculate their potential bonus payment under the program.

"It does not look like it will be overly burdensome," Dr. Kellerman said.

Because the CMS has selected measures that have been vetted by physician organizations and reflect current medical practice, most physicians should not have a problem with that aspect of the program, said Dr. Janet Wright, a cardiologist in Chico, Calif., and chair of the performance assessment task force of the American College of Cardiology.

The hurdle will be in changing office workflow, she said. For some, the bonus payment will not be enough to offset the cost of the administrative changes.

More information on the Physician Quality Reporting Initiative is available online at www.cms.hhs.gov/PQRI

Birth Control Coverage Ruling

A major railroad company did not discriminate against its female employees when it refused to cover birth control under its health insurance plan, a federal appeals court ruled last month. The U.S. Court of Appeals for the 8th Circuit, based in St. Louis, overturned a lower court ruling that found against Union Pacific Railroad. The lower court had ordered the railroad to cover all prescription contraceptives approved by the Food and Drug Administration. Women's health advocates objected to the appeals court ruling, saying that it will open the door for other companies across the country to exclude contraceptive coverage. “This ruling is an outrageous step backwards for women's health,” Cecile Richards, president of Planned Parenthood Federation of America, said in a statement. “Birth control is basic health care, and health insurance should cover it.”

Pregnancy Nutrition Survey

FDA officials plan to survey physicians and other health care providers to find out what information and advice they offer to pregnant women about nutrition and food safety. Officials are specifically seeking information on recommendations related to methylmercury and seafood consumption, listeriosis prevention, weight control and nutrition, dietary supplement usage, food allergies, toxoplasmosis prevention, and infant feeding practices. Agency officials issued advice for pregnant women in 2004 and 2005, and new insights from the survey of health providers will be used to evaluate whether the FDA advice is being used by providers to educate their patients. FDA officials are seeking a sample of 400 ob.gyns., 200 nurse-practitioners who specialize in obstetrics, 200 nurse-midwives who specialize in obstetrics, 200 physician assistants who specialize in obstetrics, and 200 dietitians from the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). The survey will also ask physicians and other health care providers what resources they use to stay current on nutrition and food safety risks among pregnant women.

Mississippi Abortion Ban Signed

Mississippi Gov. Haley Barbour has signed into law a bill that would make it a crime to perform an abortion in the event that Roe v. Wade were overturned. Under the new law, abortions in the state would be illegal except in the case of preserving the mother's life or cases of rape. If Roe v. Wade were overturned, physicians or others in the state who performed abortions would face between 1 and 10 years in prison. Also included in the legislation is a provision that requires physicians to perform fetal ultrasound imaging before an abortion and offer the patient a chance to see the image and hear the fetal heartbeat. The ultrasound requirement is not linked to Roe v. Wade and is scheduled to go into effect July 1. Patients are required under the law to sign a certification form saying they had a chance to see an ultrasound and hear the fetal heartbeat. Physicians are required to keep that form in the patient's medical record. “This law is a near-total ban on abortion. It would deny Mississippi women necessary reproductive health care,” Vicki Saporta, president of the National Abortion Federation, said in a statement.

Adding Contraception to Sex Ed

Federal lawmakers recently introduced legislation aimed at leveling the playing field when it comes to funding comprehensive sex education programs. The “Responsible Education About Life” or REAL Act (S. 972/H.R. 1653) was introduced in the Senate by Sen. Frank Lautenberg (D-N.J.) and in the House by Rep. Barbara Lee (D-Calif.) and Rep. Christopher Shays (R-Conn.). Under the legislation, the federal government would provide funds to states to offer “comprehensive” and “medically accurate” sexual education in their schools. Currently, the federal government offers funds to states for abstinence-only education but not for programs that teach about contraception to prevent pregnancy and sexually transmitted diseases, according to the bill's sponsors. “We should absolutely be teaching young people about abstinence, but we shouldn't be holding back information that can save lives and prevent unwanted pregnancies,” Rep. Lee said in a statement. “Instead of 'abstinence only,' what we're proposing is 'abstinence plus.'”

FDA to Study Ad Risk Data

Saying that it has become more concerned about how much risk information is disclosed to consumers in print ads, and that the information is not usually in a consumer-friendly format, the Food and Drug Administration announced that it will study how to better present those data. One study will look at whether giving consumers more context—instead of a list of risks, for instance—will aid their understanding of a product's potential downside. Another will look at the usefulness of several different formats for presenting the data.

Action vs. Underage Drinking

In its first Call to Action against underage drinking, the U.S. Surgeon General's office appealed to Americans to do more to stop the country's 11 million current underage drinkers from using alcohol, and to keep other young people from starting to drink. Acting Surgeon General Dr. Kenneth Moritsugu laid out recommendations for government and school officials, parents, other adults, and young people, saying that, while tobacco and illicit drug use has declined significantly, underage drinking has remained consistently high. “Research shows that young people who start drinking before the age of 15 are five times more likely to have alcohol-related problems later in life,” Dr. Moritsugu said in a statement.

Birth Control Coverage Ruling

A major railroad company did not discriminate against its female employees when it refused to cover birth control under its health insurance plan, a federal appeals court ruled last month. The U.S. Court of Appeals for the 8th Circuit, based in St. Louis, overturned a lower court ruling that found against Union Pacific Railroad. The lower court had ordered the railroad to cover all prescription contraceptives approved by the Food and Drug Administration. Women's health advocates objected to the appeals court ruling, saying that it will open the door for other companies across the country to exclude contraceptive coverage. “This ruling is an outrageous step backwards for women's health,” Cecile Richards, president of Planned Parenthood Federation of America, said in a statement. “Birth control is basic health care, and health insurance should cover it.”

Pregnancy Nutrition Survey

FDA officials plan to survey physicians and other health care providers to find out what information and advice they offer to pregnant women about nutrition and food safety. Officials are specifically seeking information on recommendations related to methylmercury and seafood consumption, listeriosis prevention, weight control and nutrition, dietary supplement usage, food allergies, toxoplasmosis prevention, and infant feeding practices. Agency officials issued advice for pregnant women in 2004 and 2005, and new insights from the survey of health providers will be used to evaluate whether the FDA advice is being used by providers to educate their patients. FDA officials are seeking a sample of 400 ob.gyns., 200 nurse-practitioners who specialize in obstetrics, 200 nurse-midwives who specialize in obstetrics, 200 physician assistants who specialize in obstetrics, and 200 dietitians from the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). The survey will also ask physicians and other health care providers what resources they use to stay current on nutrition and food safety risks among pregnant women.

Mississippi Abortion Ban Signed

Mississippi Gov. Haley Barbour has signed into law a bill that would make it a crime to perform an abortion in the event that Roe v. Wade were overturned. Under the new law, abortions in the state would be illegal except in the case of preserving the mother's life or cases of rape. If Roe v. Wade were overturned, physicians or others in the state who performed abortions would face between 1 and 10 years in prison. Also included in the legislation is a provision that requires physicians to perform fetal ultrasound imaging before an abortion and offer the patient a chance to see the image and hear the fetal heartbeat. The ultrasound requirement is not linked to Roe v. Wade and is scheduled to go into effect July 1. Patients are required under the law to sign a certification form saying they had a chance to see an ultrasound and hear the fetal heartbeat. Physicians are required to keep that form in the patient's medical record. “This law is a near-total ban on abortion. It would deny Mississippi women necessary reproductive health care,” Vicki Saporta, president of the National Abortion Federation, said in a statement.

Adding Contraception to Sex Ed

Federal lawmakers recently introduced legislation aimed at leveling the playing field when it comes to funding comprehensive sex education programs. The “Responsible Education About Life” or REAL Act (S. 972/H.R. 1653) was introduced in the Senate by Sen. Frank Lautenberg (D-N.J.) and in the House by Rep. Barbara Lee (D-Calif.) and Rep. Christopher Shays (R-Conn.). Under the legislation, the federal government would provide funds to states to offer “comprehensive” and “medically accurate” sexual education in their schools. Currently, the federal government offers funds to states for abstinence-only education but not for programs that teach about contraception to prevent pregnancy and sexually transmitted diseases, according to the bill's sponsors. “We should absolutely be teaching young people about abstinence, but we shouldn't be holding back information that can save lives and prevent unwanted pregnancies,” Rep. Lee said in a statement. “Instead of 'abstinence only,' what we're proposing is 'abstinence plus.'”

FDA to Study Ad Risk Data

Saying that it has become more concerned about how much risk information is disclosed to consumers in print ads, and that the information is not usually in a consumer-friendly format, the Food and Drug Administration announced that it will study how to better present those data. One study will look at whether giving consumers more context—instead of a list of risks, for instance—will aid their understanding of a product's potential downside. Another will look at the usefulness of several different formats for presenting the data.

Action vs. Underage Drinking

In its first Call to Action against underage drinking, the U.S. Surgeon General's office appealed to Americans to do more to stop the country's 11 million current underage drinkers from using alcohol, and to keep other young people from starting to drink. Acting Surgeon General Dr. Kenneth Moritsugu laid out recommendations for government and school officials, parents, other adults, and young people, saying that, while tobacco and illicit drug use has declined significantly, underage drinking has remained consistently high. “Research shows that young people who start drinking before the age of 15 are five times more likely to have alcohol-related problems later in life,” Dr. Moritsugu said in a statement.

Birth Control Coverage Ruling

A major railroad company did not discriminate against its female employees when it refused to cover birth control under its health insurance plan, a federal appeals court ruled last month. The U.S. Court of Appeals for the 8th Circuit, based in St. Louis, overturned a lower court ruling that found against Union Pacific Railroad. The lower court had ordered the railroad to cover all prescription contraceptives approved by the Food and Drug Administration. Women's health advocates objected to the appeals court ruling, saying that it will open the door for other companies across the country to exclude contraceptive coverage. “This ruling is an outrageous step backwards for women's health,” Cecile Richards, president of Planned Parenthood Federation of America, said in a statement. “Birth control is basic health care, and health insurance should cover it.”

Pregnancy Nutrition Survey

FDA officials plan to survey physicians and other health care providers to find out what information and advice they offer to pregnant women about nutrition and food safety. Officials are specifically seeking information on recommendations related to methylmercury and seafood consumption, listeriosis prevention, weight control and nutrition, dietary supplement usage, food allergies, toxoplasmosis prevention, and infant feeding practices. Agency officials issued advice for pregnant women in 2004 and 2005, and new insights from the survey of health providers will be used to evaluate whether the FDA advice is being used by providers to educate their patients. FDA officials are seeking a sample of 400 ob.gyns., 200 nurse-practitioners who specialize in obstetrics, 200 nurse-midwives who specialize in obstetrics, 200 physician assistants who specialize in obstetrics, and 200 dietitians from the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). The survey will also ask physicians and other health care providers what resources they use to stay current on nutrition and food safety risks among pregnant women.

Mississippi Abortion Ban Signed

Mississippi Gov. Haley Barbour has signed into law a bill that would make it a crime to perform an abortion in the event that Roe v. Wade were overturned. Under the new law, abortions in the state would be illegal except in the case of preserving the mother's life or cases of rape. If Roe v. Wade were overturned, physicians or others in the state who performed abortions would face between 1 and 10 years in prison. Also included in the legislation is a provision that requires physicians to perform fetal ultrasound imaging before an abortion and offer the patient a chance to see the image and hear the fetal heartbeat. The ultrasound requirement is not linked to Roe v. Wade and is scheduled to go into effect July 1. Patients are required under the law to sign a certification form saying they had a chance to see an ultrasound and hear the fetal heartbeat. Physicians are required to keep that form in the patient's medical record. “This law is a near-total ban on abortion. It would deny Mississippi women necessary reproductive health care,” Vicki Saporta, president of the National Abortion Federation, said in a statement.

Adding Contraception to Sex Ed

Federal lawmakers recently introduced legislation aimed at leveling the playing field when it comes to funding comprehensive sex education programs. The “Responsible Education About Life” or REAL Act (S. 972/H.R. 1653) was introduced in the Senate by Sen. Frank Lautenberg (D-N.J.) and in the House by Rep. Barbara Lee (D-Calif.) and Rep. Christopher Shays (R-Conn.). Under the legislation, the federal government would provide funds to states to offer “comprehensive” and “medically accurate” sexual education in their schools. Currently, the federal government offers funds to states for abstinence-only education but not for programs that teach about contraception to prevent pregnancy and sexually transmitted diseases, according to the bill's sponsors. “We should absolutely be teaching young people about abstinence, but we shouldn't be holding back information that can save lives and prevent unwanted pregnancies,” Rep. Lee said in a statement. “Instead of 'abstinence only,' what we're proposing is 'abstinence plus.'”

FDA to Study Ad Risk Data

Saying that it has become more concerned about how much risk information is disclosed to consumers in print ads, and that the information is not usually in a consumer-friendly format, the Food and Drug Administration announced that it will study how to better present those data. One study will look at whether giving consumers more context—instead of a list of risks, for instance—will aid their understanding of a product's potential downside. Another will look at the usefulness of several different formats for presenting the data.

Action vs. Underage Drinking

In its first Call to Action against underage drinking, the U.S. Surgeon General's office appealed to Americans to do more to stop the country's 11 million current underage drinkers from using alcohol, and to keep other young people from starting to drink. Acting Surgeon General Dr. Kenneth Moritsugu laid out recommendations for government and school officials, parents, other adults, and young people, saying that, while tobacco and illicit drug use has declined significantly, underage drinking has remained consistently high. “Research shows that young people who start drinking before the age of 15 are five times more likely to have alcohol-related problems later in life,” Dr. Moritsugu said in a statement.

ORLANDO — The use of a computer protocol to achieve tight glycemic control dramatically lowered insulin administration errors, compared with a paper-based protocol, according to a study of simulated patients in an intensive care unit.

The computer format also improved satisfaction among ICU nurses, Dr. Anthony Y. Lee of Columbus Children's Hospital in Ohio said at the annual congress of the Society of Critical Care Medicine.

Dr. Lee and colleagues at the University of Maryland Medical Center, Baltimore, recruited 51 medical ICU nurses to complete seven simulated patient scenarios using both the standard paper-based insulin protocol and a computer version of the protocol. The scenarios included a clinical case description, a current insulin dose, and new and previous blood glucose level. The nurses were given standardized instructions on how to use both paper and computer versions of the protocol and were required to indicate the new insulin dose and the time of the next blood glucose check.

The simulated situations produced 357 paper responses and 357 computer responses showing a significant reduction in errors using the computer format. Use of the paper protocol resulted in 82 insulin-dosing errors, compared with 4 errors using the computer system. It seemed that the same study participant committed all four errors using the computer protocol.

Errors in the timing of the next blood glucose check fell from 47 with the paper-based protocol to 8 with the computer format. The time to completion fell from 9 minutes with the paper-based protocol to 6 minutes with the computer program.

ORLANDO — The use of a computer protocol to achieve tight glycemic control dramatically lowered insulin administration errors, compared with a paper-based protocol, according to a study of simulated patients in an intensive care unit.

The computer format also improved satisfaction among ICU nurses, Dr. Anthony Y. Lee of Columbus Children's Hospital in Ohio said at the annual congress of the Society of Critical Care Medicine.

Dr. Lee and colleagues at the University of Maryland Medical Center, Baltimore, recruited 51 medical ICU nurses to complete seven simulated patient scenarios using both the standard paper-based insulin protocol and a computer version of the protocol. The scenarios included a clinical case description, a current insulin dose, and new and previous blood glucose level. The nurses were given standardized instructions on how to use both paper and computer versions of the protocol and were required to indicate the new insulin dose and the time of the next blood glucose check.

The simulated situations produced 357 paper responses and 357 computer responses showing a significant reduction in errors using the computer format. Use of the paper protocol resulted in 82 insulin-dosing errors, compared with 4 errors using the computer system. It seemed that the same study participant committed all four errors using the computer protocol.

Errors in the timing of the next blood glucose check fell from 47 with the paper-based protocol to 8 with the computer format. The time to completion fell from 9 minutes with the paper-based protocol to 6 minutes with the computer program.

ORLANDO — The use of a computer protocol to achieve tight glycemic control dramatically lowered insulin administration errors, compared with a paper-based protocol, according to a study of simulated patients in an intensive care unit.

The computer format also improved satisfaction among ICU nurses, Dr. Anthony Y. Lee of Columbus Children's Hospital in Ohio said at the annual congress of the Society of Critical Care Medicine.

Dr. Lee and colleagues at the University of Maryland Medical Center, Baltimore, recruited 51 medical ICU nurses to complete seven simulated patient scenarios using both the standard paper-based insulin protocol and a computer version of the protocol. The scenarios included a clinical case description, a current insulin dose, and new and previous blood glucose level. The nurses were given standardized instructions on how to use both paper and computer versions of the protocol and were required to indicate the new insulin dose and the time of the next blood glucose check.

The simulated situations produced 357 paper responses and 357 computer responses showing a significant reduction in errors using the computer format. Use of the paper protocol resulted in 82 insulin-dosing errors, compared with 4 errors using the computer system. It seemed that the same study participant committed all four errors using the computer protocol.

Errors in the timing of the next blood glucose check fell from 47 with the paper-based protocol to 8 with the computer format. The time to completion fell from 9 minutes with the paper-based protocol to 6 minutes with the computer program.

Women Bear HIV/AIDS Burden

Women and girls are being infected with HIV/AIDS at an alarming rate, according to Dr. Anthony S. Fauci, director of the National Institute of Allergy and Infectious Diseases, part of the National Institutes of Health. In the United States, the proportion of AIDS cases among women aged 13 years and older has increased from 7% in 1985 to 27% in 2005, Dr. Fauci said in a statement last month to highlight National Women and Girls HIV/AIDS Awareness Day. Worldwide, women and girls now make up nearly half of the 39.5 million people who are living with HIV/AIDS. “The imperative to bolster our collective commitment to fighting HIV/AIDS among women and girls has never been stronger,” Dr. Fauci said. Researchers have found that women are affected by HIV/AIDS differently from the way men are and have a higher incidence of drug toxicity when taking antiretroviral therapy. In an effort to better understand and address these differences, NIH is supporting the Women's Interagency HIV Study, which aims to shed light on the course of HIV/AIDS in women.

Women Face Sleep Problems

About two-thirds of women report experiencing some type of sleep problem a few nights a week, according to a survey released by the National Sleep Foundation. The sleep problems include waking up unrefreshed, waking frequently during the night, difficulty falling asleep, and waking too early and being unable to return to sleep. About 42% of women surveyed reported signs of snoring, restless legs syndrome, or sleep apnea at least a few nights a week, with 28% saying they experienced one of these problems every night or almost every night. Older women reported more signs of sleep problems. For example, 36% of women aged 25–34 years reported signs of a sleep problem at least a few nights a week, compared with 44% of women aged 35–44 years and 48% of women aged 55–64 years. The random telephone survey included more than 1,000 women aged 18–64 years.

Pregnancy Discrimination Case

A federal judge has upped the stakes for an Illinois-based HMO that was found guilty of health care fraud for discriminating against pregnant women. The judge raised the $144 million verdict to $334 million, calling the company's conduct “egregious and calculated.” The lawsuit against Amerigroup Illinois and its parent company, Amerigroup Corporation, alleged that the insurer was paid $243 million to establish a Medicaid managed care health plan in Illinois aimed at providing insurance coverage, including prenatal care, to low-income residents. The jury concluded that Amerigroup avoided enrolling pregnant women and others with expensive health conditions while at the same time accepting state and federal money. The company plans to appeal the ruling.

FDA Women's Health Office Funded

Officials at the Food and Drug Administration plan to provide the full $4 million allocated by Congress to fund the Office of Women's Health in fiscal year 2007. In February, news reports circulated that the FDA commissioner intended to cut funding for the office by about 25% and use the money for other projects at the agency. That idea was met with swift criticism by members of Congress and women's health advocates, who said such a slash in funding would essentially shut down the Office of Women's Health for the rest of the year. With the announcement that FDA will retain full funding for the office, many of those critics applauded the agency's change in course. “The FDA has done the right thing for women's health,” Sen. Patty Murray (D-Wash.), Sen. Hillary Rodham Clinton (D-N.Y.), Sen. Barbara Mikulski (D-Md.), and Sen. Olympia Snowe (R-Maine) said in a statement. “By responding to our call and heeding Congress' clear intentions, the Office of Women's Health will have the funding needed to continue the leadership role it has served for 16 years in improving the health and well-being of women across the United States.”

New Imaging-Cut Moratorium

Several members of Congress have introduced legislation to put a 2-year moratorium on cuts to Medicare payments for medical imaging that started this year. The bill also requires a Government Accountability Office study of patient access to imaging. The bill—H.R. 1293—was introduced by Rep. Carolyn McCarthy (D-N.Y.), Rep. Gene Green (D-Tex.), and Rep. Joseph Pitts (R-Pa.) and had 49 cosponsors at press time. Rep. Pitts sponsored similar legislation in the last Congress; the cuts were mandated as part of the Deficit Reduction Act (DRA) of 2005. A Senate companion bill is expected soon. Under the DRA, payments for the technical component of an imaging service are to be set at the hospital outpatient department rate, if the payment under the Medicare physician fee schedule is higher.

Women Bear HIV/AIDS Burden

Women and girls are being infected with HIV/AIDS at an alarming rate, according to Dr. Anthony S. Fauci, director of the National Institute of Allergy and Infectious Diseases, part of the National Institutes of Health. In the United States, the proportion of AIDS cases among women aged 13 years and older has increased from 7% in 1985 to 27% in 2005, Dr. Fauci said in a statement last month to highlight National Women and Girls HIV/AIDS Awareness Day. Worldwide, women and girls now make up nearly half of the 39.5 million people who are living with HIV/AIDS. “The imperative to bolster our collective commitment to fighting HIV/AIDS among women and girls has never been stronger,” Dr. Fauci said. Researchers have found that women are affected by HIV/AIDS differently from the way men are and have a higher incidence of drug toxicity when taking antiretroviral therapy. In an effort to better understand and address these differences, NIH is supporting the Women's Interagency HIV Study, which aims to shed light on the course of HIV/AIDS in women.

Women Face Sleep Problems

About two-thirds of women report experiencing some type of sleep problem a few nights a week, according to a survey released by the National Sleep Foundation. The sleep problems include waking up unrefreshed, waking frequently during the night, difficulty falling asleep, and waking too early and being unable to return to sleep. About 42% of women surveyed reported signs of snoring, restless legs syndrome, or sleep apnea at least a few nights a week, with 28% saying they experienced one of these problems every night or almost every night. Older women reported more signs of sleep problems. For example, 36% of women aged 25–34 years reported signs of a sleep problem at least a few nights a week, compared with 44% of women aged 35–44 years and 48% of women aged 55–64 years. The random telephone survey included more than 1,000 women aged 18–64 years.

Pregnancy Discrimination Case

A federal judge has upped the stakes for an Illinois-based HMO that was found guilty of health care fraud for discriminating against pregnant women. The judge raised the $144 million verdict to $334 million, calling the company's conduct “egregious and calculated.” The lawsuit against Amerigroup Illinois and its parent company, Amerigroup Corporation, alleged that the insurer was paid $243 million to establish a Medicaid managed care health plan in Illinois aimed at providing insurance coverage, including prenatal care, to low-income residents. The jury concluded that Amerigroup avoided enrolling pregnant women and others with expensive health conditions while at the same time accepting state and federal money. The company plans to appeal the ruling.

FDA Women's Health Office Funded

Officials at the Food and Drug Administration plan to provide the full $4 million allocated by Congress to fund the Office of Women's Health in fiscal year 2007. In February, news reports circulated that the FDA commissioner intended to cut funding for the office by about 25% and use the money for other projects at the agency. That idea was met with swift criticism by members of Congress and women's health advocates, who said such a slash in funding would essentially shut down the Office of Women's Health for the rest of the year. With the announcement that FDA will retain full funding for the office, many of those critics applauded the agency's change in course. “The FDA has done the right thing for women's health,” Sen. Patty Murray (D-Wash.), Sen. Hillary Rodham Clinton (D-N.Y.), Sen. Barbara Mikulski (D-Md.), and Sen. Olympia Snowe (R-Maine) said in a statement. “By responding to our call and heeding Congress' clear intentions, the Office of Women's Health will have the funding needed to continue the leadership role it has served for 16 years in improving the health and well-being of women across the United States.”

New Imaging-Cut Moratorium

Several members of Congress have introduced legislation to put a 2-year moratorium on cuts to Medicare payments for medical imaging that started this year. The bill also requires a Government Accountability Office study of patient access to imaging. The bill—H.R. 1293—was introduced by Rep. Carolyn McCarthy (D-N.Y.), Rep. Gene Green (D-Tex.), and Rep. Joseph Pitts (R-Pa.) and had 49 cosponsors at press time. Rep. Pitts sponsored similar legislation in the last Congress; the cuts were mandated as part of the Deficit Reduction Act (DRA) of 2005. A Senate companion bill is expected soon. Under the DRA, payments for the technical component of an imaging service are to be set at the hospital outpatient department rate, if the payment under the Medicare physician fee schedule is higher.

Women Bear HIV/AIDS Burden

Women and girls are being infected with HIV/AIDS at an alarming rate, according to Dr. Anthony S. Fauci, director of the National Institute of Allergy and Infectious Diseases, part of the National Institutes of Health. In the United States, the proportion of AIDS cases among women aged 13 years and older has increased from 7% in 1985 to 27% in 2005, Dr. Fauci said in a statement last month to highlight National Women and Girls HIV/AIDS Awareness Day. Worldwide, women and girls now make up nearly half of the 39.5 million people who are living with HIV/AIDS. “The imperative to bolster our collective commitment to fighting HIV/AIDS among women and girls has never been stronger,” Dr. Fauci said. Researchers have found that women are affected by HIV/AIDS differently from the way men are and have a higher incidence of drug toxicity when taking antiretroviral therapy. In an effort to better understand and address these differences, NIH is supporting the Women's Interagency HIV Study, which aims to shed light on the course of HIV/AIDS in women.

Women Face Sleep Problems

About two-thirds of women report experiencing some type of sleep problem a few nights a week, according to a survey released by the National Sleep Foundation. The sleep problems include waking up unrefreshed, waking frequently during the night, difficulty falling asleep, and waking too early and being unable to return to sleep. About 42% of women surveyed reported signs of snoring, restless legs syndrome, or sleep apnea at least a few nights a week, with 28% saying they experienced one of these problems every night or almost every night. Older women reported more signs of sleep problems. For example, 36% of women aged 25–34 years reported signs of a sleep problem at least a few nights a week, compared with 44% of women aged 35–44 years and 48% of women aged 55–64 years. The random telephone survey included more than 1,000 women aged 18–64 years.

Pregnancy Discrimination Case

A federal judge has upped the stakes for an Illinois-based HMO that was found guilty of health care fraud for discriminating against pregnant women. The judge raised the $144 million verdict to $334 million, calling the company's conduct “egregious and calculated.” The lawsuit against Amerigroup Illinois and its parent company, Amerigroup Corporation, alleged that the insurer was paid $243 million to establish a Medicaid managed care health plan in Illinois aimed at providing insurance coverage, including prenatal care, to low-income residents. The jury concluded that Amerigroup avoided enrolling pregnant women and others with expensive health conditions while at the same time accepting state and federal money. The company plans to appeal the ruling.

FDA Women's Health Office Funded

Officials at the Food and Drug Administration plan to provide the full $4 million allocated by Congress to fund the Office of Women's Health in fiscal year 2007. In February, news reports circulated that the FDA commissioner intended to cut funding for the office by about 25% and use the money for other projects at the agency. That idea was met with swift criticism by members of Congress and women's health advocates, who said such a slash in funding would essentially shut down the Office of Women's Health for the rest of the year. With the announcement that FDA will retain full funding for the office, many of those critics applauded the agency's change in course. “The FDA has done the right thing for women's health,” Sen. Patty Murray (D-Wash.), Sen. Hillary Rodham Clinton (D-N.Y.), Sen. Barbara Mikulski (D-Md.), and Sen. Olympia Snowe (R-Maine) said in a statement. “By responding to our call and heeding Congress' clear intentions, the Office of Women's Health will have the funding needed to continue the leadership role it has served for 16 years in improving the health and well-being of women across the United States.”

New Imaging-Cut Moratorium

Several members of Congress have introduced legislation to put a 2-year moratorium on cuts to Medicare payments for medical imaging that started this year. The bill also requires a Government Accountability Office study of patient access to imaging. The bill—H.R. 1293—was introduced by Rep. Carolyn McCarthy (D-N.Y.), Rep. Gene Green (D-Tex.), and Rep. Joseph Pitts (R-Pa.) and had 49 cosponsors at press time. Rep. Pitts sponsored similar legislation in the last Congress; the cuts were mandated as part of the Deficit Reduction Act (DRA) of 2005. A Senate companion bill is expected soon. Under the DRA, payments for the technical component of an imaging service are to be set at the hospital outpatient department rate, if the payment under the Medicare physician fee schedule is higher.