Mary Ellen Schneider

Physicians and their staff may have a little less insurance paperwork to do, thanks to a coming Medicare regulation.

Scheduled to be published July 8 in the Federal Register, the interim final rule puts into place two rules on electronic health care transactions: One to make it easier to determine patients’ health care coverage and the other to ascertain the status of a submitted claim.

Currently, when a physician’s office staff seeks information on patient health care coverage, they may have to make their request in a different format for each health plan. But under the operating rules set out by Medicare, the format will be standardized across all health plans. The changes, which were mandated under the Affordable Care Act, will go into effect on Jan. 1, 2013.

The new Centers for Medicare & Medicaid Services requirements are based largely on operating rules developed by the Council for Affordable and Quality Healthcare’s Committee on Operating Rules for Information Exchange (CAQH CORE), an industry coalition that works on administrative simplification issues. The CAQH CORE rules are currently in use on a voluntary basis, CMS officials said.

The CMS estimates that the adoption of these two operating rules will result in about $12 billion in savings to physicians and health plans over the next decade, largely from fewer phone calls between physicians and health plans, reduced paperwork and postage costs, increased opportunities to automate the claims process, and fewer denials.

In the future, the CMS plans to issue additional rules mandating the adoption of standards for electronic funds transfer and remittance advice, a standard unique identifier for health plans, a standard for claims attachments, and requirements that health plans certify compliance with the standards and HIPAA operating rules.

The interim final rule was released by CMS on June 30; the deadline to submit comments on the rule is Sept. 6.

Physicians and their staff may have a little less insurance paperwork to do, thanks to a coming Medicare regulation.

Scheduled to be published July 8 in the Federal Register, the interim final rule puts into place two rules on electronic health care transactions: One to make it easier to determine patients’ health care coverage and the other to ascertain the status of a submitted claim.

Currently, when a physician’s office staff seeks information on patient health care coverage, they may have to make their request in a different format for each health plan. But under the operating rules set out by Medicare, the format will be standardized across all health plans. The changes, which were mandated under the Affordable Care Act, will go into effect on Jan. 1, 2013.

The new Centers for Medicare & Medicaid Services requirements are based largely on operating rules developed by the Council for Affordable and Quality Healthcare’s Committee on Operating Rules for Information Exchange (CAQH CORE), an industry coalition that works on administrative simplification issues. The CAQH CORE rules are currently in use on a voluntary basis, CMS officials said.

The CMS estimates that the adoption of these two operating rules will result in about $12 billion in savings to physicians and health plans over the next decade, largely from fewer phone calls between physicians and health plans, reduced paperwork and postage costs, increased opportunities to automate the claims process, and fewer denials.

In the future, the CMS plans to issue additional rules mandating the adoption of standards for electronic funds transfer and remittance advice, a standard unique identifier for health plans, a standard for claims attachments, and requirements that health plans certify compliance with the standards and HIPAA operating rules.

The interim final rule was released by CMS on June 30; the deadline to submit comments on the rule is Sept. 6.

Physicians and their staff may have a little less insurance paperwork to do, thanks to a coming Medicare regulation.

Scheduled to be published July 8 in the Federal Register, the interim final rule puts into place two rules on electronic health care transactions: One to make it easier to determine patients’ health care coverage and the other to ascertain the status of a submitted claim.

Currently, when a physician’s office staff seeks information on patient health care coverage, they may have to make their request in a different format for each health plan. But under the operating rules set out by Medicare, the format will be standardized across all health plans. The changes, which were mandated under the Affordable Care Act, will go into effect on Jan. 1, 2013.

The new Centers for Medicare & Medicaid Services requirements are based largely on operating rules developed by the Council for Affordable and Quality Healthcare’s Committee on Operating Rules for Information Exchange (CAQH CORE), an industry coalition that works on administrative simplification issues. The CAQH CORE rules are currently in use on a voluntary basis, CMS officials said.

The CMS estimates that the adoption of these two operating rules will result in about $12 billion in savings to physicians and health plans over the next decade, largely from fewer phone calls between physicians and health plans, reduced paperwork and postage costs, increased opportunities to automate the claims process, and fewer denials.

In the future, the CMS plans to issue additional rules mandating the adoption of standards for electronic funds transfer and remittance advice, a standard unique identifier for health plans, a standard for claims attachments, and requirements that health plans certify compliance with the standards and HIPAA operating rules.

The interim final rule was released by CMS on June 30; the deadline to submit comments on the rule is Sept. 6.

Physicians and their staff may have a little less insurance paperwork to do, thanks to a coming Medicare regulation.

Scheduled to be published July 8 in the Federal Register, the interim final rule puts into place two rules on electronic health care transactions: One to make it easier to determine patients’ health care coverage and the other to ascertain the status of a submitted claim.

Currently, when a physician’s office staff seeks information on patient health care coverage, they may have to make their request in a different format for each health plan. But under the operating rules set out by Medicare, the format will be standardized across all health plans. The changes, which were mandated under the Affordable Care Act, will go into effect on Jan. 1, 2013.

The new Centers for Medicare & Medicaid Services requirements are based largely on operating rules developed by the Council for Affordable and Quality Healthcare’s Committee on Operating Rules for Information Exchange (CAQH CORE), an industry coalition that works on administrative simplification issues. The CAQH CORE rules are currently in use on a voluntary basis, CMS officials said.

The CMS estimates that the adoption of these two operating rules will result in about $12 billion in savings to physicians and health plans over the next decade, largely from fewer phone calls between physicians and health plans, reduced paperwork and postage costs, increased opportunities to automate the claims process, and fewer denials.

In the future, the CMS plans to issue additional rules mandating the adoption of standards for electronic funds transfer and remittance advice, a standard unique identifier for health plans, a standard for claims attachments, and requirements that health plans certify compliance with the standards and HIPAA operating rules.

The interim final rule was released by CMS on June 30; the deadline to submit comments on the rule is Sept. 6.

Physicians and their staff may have a little less insurance paperwork to do, thanks to a coming Medicare regulation.

Scheduled to be published July 8 in the Federal Register, the interim final rule puts into place two rules on electronic health care transactions: One to make it easier to determine patients’ health care coverage and the other to ascertain the status of a submitted claim.

Currently, when a physician’s office staff seeks information on patient health care coverage, they may have to make their request in a different format for each health plan. But under the operating rules set out by Medicare, the format will be standardized across all health plans. The changes, which were mandated under the Affordable Care Act, will go into effect on Jan. 1, 2013.

The new Centers for Medicare & Medicaid Services requirements are based largely on operating rules developed by the Council for Affordable and Quality Healthcare’s Committee on Operating Rules for Information Exchange (CAQH CORE), an industry coalition that works on administrative simplification issues. The CAQH CORE rules are currently in use on a voluntary basis, CMS officials said.

The CMS estimates that the adoption of these two operating rules will result in about $12 billion in savings to physicians and health plans over the next decade, largely from fewer phone calls between physicians and health plans, reduced paperwork and postage costs, increased opportunities to automate the claims process, and fewer denials.

In the future, the CMS plans to issue additional rules mandating the adoption of standards for electronic funds transfer and remittance advice, a standard unique identifier for health plans, a standard for claims attachments, and requirements that health plans certify compliance with the standards and HIPAA operating rules.

The interim final rule was released by CMS on June 30; the deadline to submit comments on the rule is Sept. 6.

Physicians and their staff may have a little less insurance paperwork to do, thanks to a coming Medicare regulation.

Scheduled to be published July 8 in the Federal Register, the interim final rule puts into place two rules on electronic health care transactions: One to make it easier to determine patients’ health care coverage and the other to ascertain the status of a submitted claim.

Currently, when a physician’s office staff seeks information on patient health care coverage, they may have to make their request in a different format for each health plan. But under the operating rules set out by Medicare, the format will be standardized across all health plans. The changes, which were mandated under the Affordable Care Act, will go into effect on Jan. 1, 2013.

The new Centers for Medicare & Medicaid Services requirements are based largely on operating rules developed by the Council for Affordable and Quality Healthcare’s Committee on Operating Rules for Information Exchange (CAQH CORE), an industry coalition that works on administrative simplification issues. The CAQH CORE rules are currently in use on a voluntary basis, CMS officials said.

The CMS estimates that the adoption of these two operating rules will result in about $12 billion in savings to physicians and health plans over the next decade, largely from fewer phone calls between physicians and health plans, reduced paperwork and postage costs, increased opportunities to automate the claims process, and fewer denials.

In the future, the CMS plans to issue additional rules mandating the adoption of standards for electronic funds transfer and remittance advice, a standard unique identifier for health plans, a standard for claims attachments, and requirements that health plans certify compliance with the standards and HIPAA operating rules.

The interim final rule was released by CMS on June 30; the deadline to submit comments on the rule is Sept. 6.

Physicians and their staff may have a little less insurance paperwork to do, thanks to a coming Medicare regulation.

Scheduled to be published July 8 in the Federal Register, the interim final rule puts into place two rules on electronic health care transactions: One to make it easier to determine patients’ health care coverage and the other to ascertain the status of a submitted claim.

Currently, when a physician’s office staff seeks information on patient health care coverage, they may have to make their request in a different format for each health plan. But under the operating rules set out by Medicare, the format will be standardized across all health plans. The changes, which were mandated under the Affordable Care Act, will go into effect on Jan. 1, 2013.

The new Centers for Medicare & Medicaid Services requirements are based largely on operating rules developed by the Council for Affordable and Quality Healthcare’s Committee on Operating Rules for Information Exchange (CAQH CORE), an industry coalition that works on administrative simplification issues. The CAQH CORE rules are currently in use on a voluntary basis, CMS officials said.

The CMS estimates that the adoption of these two operating rules will result in about $12 billion in savings to physicians and health plans over the next decade, largely from fewer phone calls between physicians and health plans, reduced paperwork and postage costs, increased opportunities to automate the claims process, and fewer denials.

In the future, the CMS plans to issue additional rules mandating the adoption of standards for electronic funds transfer and remittance advice, a standard unique identifier for health plans, a standard for claims attachments, and requirements that health plans certify compliance with the standards and HIPAA operating rules.

The interim final rule was released by CMS on June 30; the deadline to submit comments on the rule is Sept. 6.

Physicians and their staff may have a little less insurance paperwork to do, thanks to a coming Medicare regulation.

Scheduled to be published July 8 in the Federal Register, the interim final rule puts into place two rules on electronic health care transactions: One to make it easier to determine patients’ health care coverage and the other to ascertain the status of a submitted claim.

Currently, when a physician’s office staff seeks information on patient health care coverage, they may have to make their request in a different format for each health plan. But under the operating rules set out by Medicare, the format will be standardized across all health plans. The changes, which were mandated under the Affordable Care Act, will go into effect on Jan. 1, 2013.

The new Centers for Medicare & Medicaid Services requirements are based largely on operating rules developed by the Council for Affordable and Quality Healthcare’s Committee on Operating Rules for Information Exchange (CAQH CORE), an industry coalition that works on administrative simplification issues. The CAQH CORE rules are currently in use on a voluntary basis, CMS officials said.

The CMS estimates that the adoption of these two operating rules will result in about $12 billion in savings to physicians and health plans over the next decade, largely from fewer phone calls between physicians and health plans, reduced paperwork and postage costs, increased opportunities to automate the claims process, and fewer denials.

In the future, the CMS plans to issue additional rules mandating the adoption of standards for electronic funds transfer and remittance advice, a standard unique identifier for health plans, a standard for claims attachments, and requirements that health plans certify compliance with the standards and HIPAA operating rules.

The interim final rule was released by CMS on June 30; the deadline to submit comments on the rule is Sept. 6.

Physicians and their staff may have a little less insurance paperwork to do, thanks to a coming Medicare regulation.

Scheduled to be published July 8 in the Federal Register, the interim final rule puts into place two rules on electronic health care transactions: One to make it easier to determine patients’ health care coverage and the other to ascertain the status of a submitted claim.

Currently, when a physician’s office staff seeks information on patient health care coverage, they may have to make their request in a different format for each health plan. But under the operating rules set out by Medicare, the format will be standardized across all health plans. The changes, which were mandated under the Affordable Care Act, will go into effect on Jan. 1, 2013.

The new Centers for Medicare & Medicaid Services requirements are based largely on operating rules developed by the Council for Affordable and Quality Healthcare’s Committee on Operating Rules for Information Exchange (CAQH CORE), an industry coalition that works on administrative simplification issues. The CAQH CORE rules are currently in use on a voluntary basis, CMS officials said.

The CMS estimates that the adoption of these two operating rules will result in about $12 billion in savings to physicians and health plans over the next decade, largely from fewer phone calls between physicians and health plans, reduced paperwork and postage costs, increased opportunities to automate the claims process, and fewer denials.

In the future, the CMS plans to issue additional rules mandating the adoption of standards for electronic funds transfer and remittance advice, a standard unique identifier for health plans, a standard for claims attachments, and requirements that health plans certify compliance with the standards and HIPAA operating rules.

The interim final rule was released by CMS on June 30; the deadline to submit comments on the rule is Sept. 6.

Medicare officials plan to require ambulatory surgical centers to report on quality measures for the first time starting in 2012.

The plan is part of a proposed rule released July 1 by the Centers for Medicare and Medicaid Services. The proposal covers Medicare payment rates and policies for hospital outpatient services and ambulatory surgical centers. In the nearly 900-page regulation, CMS officials projected that payment rates for hospital outpatient departments, not including cancer hospitals, would increase by 1.1% in 2012 and payments to ambulatory surgical centers would rise by 0.9%.

The CMS plans to launch the new quality reporting program for ambulatory surgical centers (ASCs) with eight quality measures. ASCs would report on the measures beginning in January 2012 and the information would be used to set payments for those facilities in 2014. The starter set of eight measures includes seven outcome and surgical infections measures, and one health care–associated infection measure.

Beginning in 2013, ASCs would be required to report on two more measures to be used in setting payments in 2015. Those structural measures include the use of a safe surgery checklist and the collection of ASC volume data on selected surgical procedures. Also in 2013, ASCs would begin reporting on a measure on influenza vaccination coverage among health care workers. That information wouldn’t be used for payment purposes until 2016.

The Medicare proposed rule also expands the quality reporting program for hospital outpatient departments. The CMS is proposing to add nine quality measures for outpatient departments, bringing the total number of measures to 32.

The nine new measures include six chart abstracted measures, one health care–associated infection measure, one measure on the use of a safe surgery checklist, and one measure collecting hospital outpatient department volume for selected surgical procedures. The data collected through these new measures would be used in setting payment rates for 2014, according to the CMS.

The agency also is proposing that outpatient departments begin measuring influenza vaccination coverage among their staff. That information would be used in setting the 2015 Medicare payment rates.

The proposed rule provides new details on what the Hospital Inpatient Value-Based Purchasing Program will look like in 2014. The program is a new initiative that will take 1% of the Medicare payments to hospitals and put them in a fund to pay for care based on quality starting in October 2012. Under the hospital outpatient proposed rule, the CMS outlined its plans to add a new clinical process of care measure on infections from urinary catheters in fiscal year 2014. This measure would be added to the 12 clinical process of care measures that are already part of the program. The hospital outpatient department proposed rule also includes new details on the performance periods, standards, and weighting schemes that would be used for the Hospital Inpatient Value-Based Purchasing Program in fiscal year 2014.

The CMS will accept comments on the proposal until Aug. 30. A final rule is expected by November.

Medicare officials plan to require ambulatory surgical centers to report on quality measures for the first time starting in 2012.

The plan is part of a proposed rule released July 1 by the Centers for Medicare and Medicaid Services. The proposal covers Medicare payment rates and policies for hospital outpatient services and ambulatory surgical centers. In the nearly 900-page regulation, CMS officials projected that payment rates for hospital outpatient departments, not including cancer hospitals, would increase by 1.1% in 2012 and payments to ambulatory surgical centers would rise by 0.9%.

The CMS plans to launch the new quality reporting program for ambulatory surgical centers (ASCs) with eight quality measures. ASCs would report on the measures beginning in January 2012 and the information would be used to set payments for those facilities in 2014. The starter set of eight measures includes seven outcome and surgical infections measures, and one health care–associated infection measure.

Beginning in 2013, ASCs would be required to report on two more measures to be used in setting payments in 2015. Those structural measures include the use of a safe surgery checklist and the collection of ASC volume data on selected surgical procedures. Also in 2013, ASCs would begin reporting on a measure on influenza vaccination coverage among health care workers. That information wouldn’t be used for payment purposes until 2016.

The Medicare proposed rule also expands the quality reporting program for hospital outpatient departments. The CMS is proposing to add nine quality measures for outpatient departments, bringing the total number of measures to 32.

The nine new measures include six chart abstracted measures, one health care–associated infection measure, one measure on the use of a safe surgery checklist, and one measure collecting hospital outpatient department volume for selected surgical procedures. The data collected through these new measures would be used in setting payment rates for 2014, according to the CMS.

The agency also is proposing that outpatient departments begin measuring influenza vaccination coverage among their staff. That information would be used in setting the 2015 Medicare payment rates.

The proposed rule provides new details on what the Hospital Inpatient Value-Based Purchasing Program will look like in 2014. The program is a new initiative that will take 1% of the Medicare payments to hospitals and put them in a fund to pay for care based on quality starting in October 2012. Under the hospital outpatient proposed rule, the CMS outlined its plans to add a new clinical process of care measure on infections from urinary catheters in fiscal year 2014. This measure would be added to the 12 clinical process of care measures that are already part of the program. The hospital outpatient department proposed rule also includes new details on the performance periods, standards, and weighting schemes that would be used for the Hospital Inpatient Value-Based Purchasing Program in fiscal year 2014.

The CMS will accept comments on the proposal until Aug. 30. A final rule is expected by November.

Medicare officials plan to require ambulatory surgical centers to report on quality measures for the first time starting in 2012.

The plan is part of a proposed rule released July 1 by the Centers for Medicare and Medicaid Services. The proposal covers Medicare payment rates and policies for hospital outpatient services and ambulatory surgical centers. In the nearly 900-page regulation, CMS officials projected that payment rates for hospital outpatient departments, not including cancer hospitals, would increase by 1.1% in 2012 and payments to ambulatory surgical centers would rise by 0.9%.

The CMS plans to launch the new quality reporting program for ambulatory surgical centers (ASCs) with eight quality measures. ASCs would report on the measures beginning in January 2012 and the information would be used to set payments for those facilities in 2014. The starter set of eight measures includes seven outcome and surgical infections measures, and one health care–associated infection measure.

Beginning in 2013, ASCs would be required to report on two more measures to be used in setting payments in 2015. Those structural measures include the use of a safe surgery checklist and the collection of ASC volume data on selected surgical procedures. Also in 2013, ASCs would begin reporting on a measure on influenza vaccination coverage among health care workers. That information wouldn’t be used for payment purposes until 2016.

The Medicare proposed rule also expands the quality reporting program for hospital outpatient departments. The CMS is proposing to add nine quality measures for outpatient departments, bringing the total number of measures to 32.

The nine new measures include six chart abstracted measures, one health care–associated infection measure, one measure on the use of a safe surgery checklist, and one measure collecting hospital outpatient department volume for selected surgical procedures. The data collected through these new measures would be used in setting payment rates for 2014, according to the CMS.

The agency also is proposing that outpatient departments begin measuring influenza vaccination coverage among their staff. That information would be used in setting the 2015 Medicare payment rates.

The proposed rule provides new details on what the Hospital Inpatient Value-Based Purchasing Program will look like in 2014. The program is a new initiative that will take 1% of the Medicare payments to hospitals and put them in a fund to pay for care based on quality starting in October 2012. Under the hospital outpatient proposed rule, the CMS outlined its plans to add a new clinical process of care measure on infections from urinary catheters in fiscal year 2014. This measure would be added to the 12 clinical process of care measures that are already part of the program. The hospital outpatient department proposed rule also includes new details on the performance periods, standards, and weighting schemes that would be used for the Hospital Inpatient Value-Based Purchasing Program in fiscal year 2014.

The CMS will accept comments on the proposal until Aug. 30. A final rule is expected by November.

Medicare officials plan to require ambulatory surgical centers to report on quality measures for the first time starting in 2012.

The plan is part of a proposed rule released July 1 by the Centers for Medicare and Medicaid Services. The proposal covers Medicare payment rates and policies for hospital outpatient services and ambulatory surgical centers. In the nearly 900-page regulation, CMS officials projected that payment rates for hospital outpatient departments, not including cancer hospitals, would increase by 1.1% in 2012 and payments to ambulatory surgical centers would rise by 0.9%.

The CMS plans to launch the new quality reporting program for ambulatory surgical centers (ASCs) with eight quality measures. ASCs would report on the measures beginning in January 2012 and the information would be used to set payments for those facilities in 2014. The starter set of eight measures includes seven outcome and surgical infections measures, and one health care–associated infection measure.

Beginning in 2013, ASCs would be required to report on two more measures to be used in setting payments in 2015. Those structural measures include the use of a safe surgery checklist and the collection of ASC volume data on selected surgical procedures. Also in 2013, ASCs would begin reporting on a measure on influenza vaccination coverage among health care workers. That information wouldn’t be used for payment purposes until 2016.

The Medicare proposed rule also expands the quality reporting program for hospital outpatient departments. The CMS is proposing to add nine quality measures for outpatient departments, bringing the total number of measures to 32.

The nine new measures include six chart abstracted measures, one health care–associated infection measure, one measure on the use of a safe surgery checklist, and one measure collecting hospital outpatient department volume for selected surgical procedures. The data collected through these new measures would be used in setting payment rates for 2014, according to the CMS.

The agency also is proposing that outpatient departments begin measuring influenza vaccination coverage among their staff. That information would be used in setting the 2015 Medicare payment rates.

The proposed rule provides new details on what the Hospital Inpatient Value-Based Purchasing Program will look like in 2014. The program is a new initiative that will take 1% of the Medicare payments to hospitals and put them in a fund to pay for care based on quality starting in October 2012. Under the hospital outpatient proposed rule, the CMS outlined its plans to add a new clinical process of care measure on infections from urinary catheters in fiscal year 2014. This measure would be added to the 12 clinical process of care measures that are already part of the program. The hospital outpatient department proposed rule also includes new details on the performance periods, standards, and weighting schemes that would be used for the Hospital Inpatient Value-Based Purchasing Program in fiscal year 2014.

The CMS will accept comments on the proposal until Aug. 30. A final rule is expected by November.

Medicare officials plan to require ambulatory surgical centers to report on quality measures for the first time starting in 2012.

The plan is part of a proposed rule released July 1 by the Centers for Medicare and Medicaid Services. The proposal covers Medicare payment rates and policies for hospital outpatient services and ambulatory surgical centers. In the nearly 900-page regulation, CMS officials projected that payment rates for hospital outpatient departments, not including cancer hospitals, would increase by 1.1% in 2012 and payments to ambulatory surgical centers would rise by 0.9%.

The CMS plans to launch the new quality reporting program for ambulatory surgical centers (ASCs) with eight quality measures. ASCs would report on the measures beginning in January 2012 and the information would be used to set payments for those facilities in 2014. The starter set of eight measures includes seven outcome and surgical infections measures, and one health care–associated infection measure.

Beginning in 2013, ASCs would be required to report on two more measures to be used in setting payments in 2015. Those structural measures include the use of a safe surgery checklist and the collection of ASC volume data on selected surgical procedures. Also in 2013, ASCs would begin reporting on a measure on influenza vaccination coverage among health care workers. That information wouldn’t be used for payment purposes until 2016.

The Medicare proposed rule also expands the quality reporting program for hospital outpatient departments. The CMS is proposing to add nine quality measures for outpatient departments, bringing the total number of measures to 32.

The nine new measures include six chart abstracted measures, one health care–associated infection measure, one measure on the use of a safe surgery checklist, and one measure collecting hospital outpatient department volume for selected surgical procedures. The data collected through these new measures would be used in setting payment rates for 2014, according to the CMS.

The agency also is proposing that outpatient departments begin measuring influenza vaccination coverage among their staff. That information would be used in setting the 2015 Medicare payment rates.

The proposed rule provides new details on what the Hospital Inpatient Value-Based Purchasing Program will look like in 2014. The program is a new initiative that will take 1% of the Medicare payments to hospitals and put them in a fund to pay for care based on quality starting in October 2012. Under the hospital outpatient proposed rule, the CMS outlined its plans to add a new clinical process of care measure on infections from urinary catheters in fiscal year 2014. This measure would be added to the 12 clinical process of care measures that are already part of the program. The hospital outpatient department proposed rule also includes new details on the performance periods, standards, and weighting schemes that would be used for the Hospital Inpatient Value-Based Purchasing Program in fiscal year 2014.

The CMS will accept comments on the proposal until Aug. 30. A final rule is expected by November.

Medicare officials plan to require ambulatory surgical centers to report on quality measures for the first time starting in 2012.

The plan is part of a proposed rule released July 1 by the Centers for Medicare and Medicaid Services. The proposal covers Medicare payment rates and policies for hospital outpatient services and ambulatory surgical centers. In the nearly 900-page regulation, CMS officials projected that payment rates for hospital outpatient departments, not including cancer hospitals, would increase by 1.1% in 2012 and payments to ambulatory surgical centers would rise by 0.9%.

The CMS plans to launch the new quality reporting program for ambulatory surgical centers (ASCs) with eight quality measures. ASCs would report on the measures beginning in January 2012 and the information would be used to set payments for those facilities in 2014. The starter set of eight measures includes seven outcome and surgical infections measures, and one health care–associated infection measure.

Beginning in 2013, ASCs would be required to report on two more measures to be used in setting payments in 2015. Those structural measures include the use of a safe surgery checklist and the collection of ASC volume data on selected surgical procedures. Also in 2013, ASCs would begin reporting on a measure on influenza vaccination coverage among health care workers. That information wouldn’t be used for payment purposes until 2016.

The Medicare proposed rule also expands the quality reporting program for hospital outpatient departments. The CMS is proposing to add nine quality measures for outpatient departments, bringing the total number of measures to 32.

The nine new measures include six chart abstracted measures, one health care–associated infection measure, one measure on the use of a safe surgery checklist, and one measure collecting hospital outpatient department volume for selected surgical procedures. The data collected through these new measures would be used in setting payment rates for 2014, according to the CMS.

The agency also is proposing that outpatient departments begin measuring influenza vaccination coverage among their staff. That information would be used in setting the 2015 Medicare payment rates.

The proposed rule provides new details on what the Hospital Inpatient Value-Based Purchasing Program will look like in 2014. The program is a new initiative that will take 1% of the Medicare payments to hospitals and put them in a fund to pay for care based on quality starting in October 2012. Under the hospital outpatient proposed rule, the CMS outlined its plans to add a new clinical process of care measure on infections from urinary catheters in fiscal year 2014. This measure would be added to the 12 clinical process of care measures that are already part of the program. The hospital outpatient department proposed rule also includes new details on the performance periods, standards, and weighting schemes that would be used for the Hospital Inpatient Value-Based Purchasing Program in fiscal year 2014.

The CMS will accept comments on the proposal until Aug. 30. A final rule is expected by November.

Medicare officials plan to require ambulatory surgical centers to report on quality measures for the first time starting in 2012.

The plan is part of a proposed rule released July 1 by the Centers for Medicare and Medicaid Services. The proposal covers Medicare payment rates and policies for hospital outpatient services and ambulatory surgical centers. In the nearly 900-page regulation, CMS officials projected that payment rates for hospital outpatient departments, not including cancer hospitals, would increase by 1.1% in 2012 and payments to ambulatory surgical centers would rise by 0.9%.

The CMS plans to launch the new quality reporting program for ambulatory surgical centers (ASCs) with eight quality measures. ASCs would report on the measures beginning in January 2012 and the information would be used to set payments for those facilities in 2014. The starter set of eight measures includes seven outcome and surgical infections measures, and one health care–associated infection measure.

Beginning in 2013, ASCs would be required to report on two more measures to be used in setting payments in 2015. Those structural measures include the use of a safe surgery checklist and the collection of ASC volume data on selected surgical procedures. Also in 2013, ASCs would begin reporting on a measure on influenza vaccination coverage among health care workers. That information wouldn’t be used for payment purposes until 2016.

The Medicare proposed rule also expands the quality reporting program for hospital outpatient departments. The CMS is proposing to add nine quality measures for outpatient departments, bringing the total number of measures to 32.

The nine new measures include six chart abstracted measures, one health care–associated infection measure, one measure on the use of a safe surgery checklist, and one measure collecting hospital outpatient department volume for selected surgical procedures. The data collected through these new measures would be used in setting payment rates for 2014, according to the CMS.

The agency also is proposing that outpatient departments begin measuring influenza vaccination coverage among their staff. That information would be used in setting the 2015 Medicare payment rates.

The proposed rule provides new details on what the Hospital Inpatient Value-Based Purchasing Program will look like in 2014. The program is a new initiative that will take 1% of the Medicare payments to hospitals and put them in a fund to pay for care based on quality starting in October 2012. Under the hospital outpatient proposed rule, the CMS outlined its plans to add a new clinical process of care measure on infections from urinary catheters in fiscal year 2014. This measure would be added to the 12 clinical process of care measures that are already part of the program. The hospital outpatient department proposed rule also includes new details on the performance periods, standards, and weighting schemes that would be used for the Hospital Inpatient Value-Based Purchasing Program in fiscal year 2014.

The CMS will accept comments on the proposal until Aug. 30. A final rule is expected by November.

Medicare officials plan to require ambulatory surgical centers to report on quality measures for the first time starting in 2012.

The plan is part of a proposed rule released July 1 by the Centers for Medicare and Medicaid Services. The proposal covers Medicare payment rates and policies for hospital outpatient services and ambulatory surgical centers. In the nearly 900-page regulation, CMS officials projected that payment rates for hospital outpatient departments, not including cancer hospitals, would increase by 1.1% in 2012 and payments to ambulatory surgical centers would rise by 0.9%.

The CMS plans to launch the new quality reporting program for ambulatory surgical centers (ASCs) with eight quality measures. ASCs would report on the measures beginning in January 2012 and the information would be used to set payments for those facilities in 2014. The starter set of eight measures includes seven outcome and surgical infections measures, and one health care–associated infection measure.

Beginning in 2013, ASCs would be required to report on two more measures to be used in setting payments in 2015. Those structural measures include the use of a safe surgery checklist and the collection of ASC volume data on selected surgical procedures. Also in 2013, ASCs would begin reporting on a measure on influenza vaccination coverage among health care workers. That information wouldn’t be used for payment purposes until 2016.

The Medicare proposed rule also expands the quality reporting program for hospital outpatient departments. The CMS is proposing to add nine quality measures for outpatient departments, bringing the total number of measures to 32.

The nine new measures include six chart abstracted measures, one health care–associated infection measure, one measure on the use of a safe surgery checklist, and one measure collecting hospital outpatient department volume for selected surgical procedures. The data collected through these new measures would be used in setting payment rates for 2014, according to the CMS.

The agency also is proposing that outpatient departments begin measuring influenza vaccination coverage among their staff. That information would be used in setting the 2015 Medicare payment rates.

The proposed rule provides new details on what the Hospital Inpatient Value-Based Purchasing Program will look like in 2014. The program is a new initiative that will take 1% of the Medicare payments to hospitals and put them in a fund to pay for care based on quality starting in October 2012. Under the hospital outpatient proposed rule, the CMS outlined its plans to add a new clinical process of care measure on infections from urinary catheters in fiscal year 2014. This measure would be added to the 12 clinical process of care measures that are already part of the program. The hospital outpatient department proposed rule also includes new details on the performance periods, standards, and weighting schemes that would be used for the Hospital Inpatient Value-Based Purchasing Program in fiscal year 2014.

The CMS will accept comments on the proposal until Aug. 30. A final rule is expected by November.

Medicare officials plan to require ambulatory surgical centers to report on quality measures for the first time starting in 2012.

The plan is part of a proposed rule released July 1 by the Centers for Medicare and Medicaid Services. The proposal covers Medicare payment rates and policies for hospital outpatient services and ambulatory surgical centers. In the nearly 900-page regulation, CMS officials projected that payment rates for hospital outpatient departments, not including cancer hospitals, would increase by 1.1% in 2012 and payments to ambulatory surgical centers would rise by 0.9%.

The CMS plans to launch the new quality reporting program for ambulatory surgical centers (ASCs) with eight quality measures. ASCs would report on the measures beginning in January 2012 and the information would be used to set payments for those facilities in 2014. The starter set of eight measures includes seven outcome and surgical infections measures, and one health care–associated infection measure.

Beginning in 2013, ASCs would be required to report on two more measures to be used in setting payments in 2015. Those structural measures include the use of a safe surgery checklist and the collection of ASC volume data on selected surgical procedures. Also in 2013, ASCs would begin reporting on a measure on influenza vaccination coverage among health care workers. That information wouldn’t be used for payment purposes until 2016.

The Medicare proposed rule also expands the quality reporting program for hospital outpatient departments. The CMS is proposing to add nine quality measures for outpatient departments, bringing the total number of measures to 32.

The nine new measures include six chart abstracted measures, one health care–associated infection measure, one measure on the use of a safe surgery checklist, and one measure collecting hospital outpatient department volume for selected surgical procedures. The data collected through these new measures would be used in setting payment rates for 2014, according to the CMS.

The agency also is proposing that outpatient departments begin measuring influenza vaccination coverage among their staff. That information would be used in setting the 2015 Medicare payment rates.

The proposed rule provides new details on what the Hospital Inpatient Value-Based Purchasing Program will look like in 2014. The program is a new initiative that will take 1% of the Medicare payments to hospitals and put them in a fund to pay for care based on quality starting in October 2012. Under the hospital outpatient proposed rule, the CMS outlined its plans to add a new clinical process of care measure on infections from urinary catheters in fiscal year 2014. This measure would be added to the 12 clinical process of care measures that are already part of the program. The hospital outpatient department proposed rule also includes new details on the performance periods, standards, and weighting schemes that would be used for the Hospital Inpatient Value-Based Purchasing Program in fiscal year 2014.

The CMS will accept comments on the proposal until Aug. 30. A final rule is expected by November.

Officials at the National Quality Forum are calling on physicians to do a better job communicating key clinical findings such as laboratory and pathology results.

As part of its updated list of serious reportable events, the NQF added a new adverse event for hospitals to track and report on: patient death or serious injury resulting from a failure to follow up or communicate laboratory, pathology, or radiology test results. The event takes into account findings that need to be communicated immediately like a chest x-ray that shows an acutely collapsed lung, as well as other important findings such as an x-ray that reveals a growing lung mass.

In June, the NQF released the updated list of 29 adverse health care events that it considers to be largely preventable, such as wrong site surgery and stage 3 or 4 pressure ulcers acquired post admission.

This time around the list includes four new events ranging from death or serious injury associated with bringing a metallic object into the MRI area to death or serious injury due to the loss of an irreplaceable biologic specimen.

The list, which was originally released in 2002 and last updated in 2006, is designed as a set of voluntary, consensus standards to be used in public reporting programs. More than half of the states currently use the list as the basis for their public reporting programs.

For hospitalists, a focus on better communication of lab, pathology, and radiology results is critical, said Dr. Janet Nagamine, a hospitalist at Kaiser Permanente Hospital in Santa Clara, Calif., and a mentor for the Society of Hospital Medicine’s Project BOOST. Project BOOST aims to reduce hospital readmissions by improving the hospital discharge process.

Literature published in the last few years shows that health care providers don’t have the best track record when it comes to communicating test results, as well as following up on recommended tests and referrals, she said. A 2005 study of patients discharged from hospitals in Boston found that of the 2,033 test results returned after discharge, physicians were unaware of 62% of the results. Of those, 37% had "actionable" results and 12% required "urgent action" (Ann. Intern. Med. 2005;143:121-8). And in terms of recommended work-ups, another study found that of 240 tests and referrals recommended by physicians in the hospital, about 36% were not completed (Arch. Intern. Med. 2007;167:1305-11).

Hospitalists will face challenges as they try to tackle these problems, said Dr. Gregg S. Meyer, cochair of NQF’s Serious Reportable Events Steering Committee. The first hurdle is that many patients have tests conducted during their hospital stay, but the results are pending at the time of discharge. The issue becomes who is responsible for obtaining those results and following up on them with the patient, said Dr. Meyer, who is also the senior vice president for quality and safety at Massachusetts General Hospital in Boston.

Another challenge is the communication between the hospitalist and the primary care physician, Dr. Meyer said. For example, a hospitalist may leave a phone message for a primary care physician about an important lab result, but what if the hospitalist leaves the message at the wrong place? Physicians need to have a system in place that guarantees "closed-loop communication," where the hospitalist would know that the message was received on the other end, Dr. Meyer said.

"Just leaving a phone message or just sending a fax or just sending a letter with something important like this may not be enough," he said.

Massachusetts General Hospital has used electronic tools to help tackle the problem of closed-loop communication. For instance, if a radiologist sees a critical finding, like a collapsed lung, he or she pages the appropriate physician immediately and documents that in the electronic system along with when the page was answered.

Another strategy is to use the discharge process to prompt hospitalists to follow up on tests, Dr. Nagamine said. At her hospital, the discharge summary includes the studies that were completed, those that are pending, and the ones that need to be ordered. "The real key is embedding it into your processes," she said.

Hospitalists also need to develop working relationships and agreements between themselves and the primary care physicians they work with to figure out whose job it is to order necessary follow-up tests, Dr. Nagamine said.

Officials at the National Quality Forum are calling on physicians to do a better job communicating key clinical findings such as laboratory and pathology results.

As part of its updated list of serious reportable events, the NQF added a new adverse event for hospitals to track and report on: patient death or serious injury resulting from a failure to follow up or communicate laboratory, pathology, or radiology test results. The event takes into account findings that need to be communicated immediately like a chest x-ray that shows an acutely collapsed lung, as well as other important findings such as an x-ray that reveals a growing lung mass.

In June, the NQF released the updated list of 29 adverse health care events that it considers to be largely preventable, such as wrong site surgery and stage 3 or 4 pressure ulcers acquired post admission.

This time around the list includes four new events ranging from death or serious injury associated with bringing a metallic object into the MRI area to death or serious injury due to the loss of an irreplaceable biologic specimen.

The list, which was originally released in 2002 and last updated in 2006, is designed as a set of voluntary, consensus standards to be used in public reporting programs. More than half of the states currently use the list as the basis for their public reporting programs.

For hospitalists, a focus on better communication of lab, pathology, and radiology results is critical, said Dr. Janet Nagamine, a hospitalist at Kaiser Permanente Hospital in Santa Clara, Calif., and a mentor for the Society of Hospital Medicine’s Project BOOST. Project BOOST aims to reduce hospital readmissions by improving the hospital discharge process.

Literature published in the last few years shows that health care providers don’t have the best track record when it comes to communicating test results, as well as following up on recommended tests and referrals, she said. A 2005 study of patients discharged from hospitals in Boston found that of the 2,033 test results returned after discharge, physicians were unaware of 62% of the results. Of those, 37% had "actionable" results and 12% required "urgent action" (Ann. Intern. Med. 2005;143:121-8). And in terms of recommended work-ups, another study found that of 240 tests and referrals recommended by physicians in the hospital, about 36% were not completed (Arch. Intern. Med. 2007;167:1305-11).

Hospitalists will face challenges as they try to tackle these problems, said Dr. Gregg S. Meyer, cochair of NQF’s Serious Reportable Events Steering Committee. The first hurdle is that many patients have tests conducted during their hospital stay, but the results are pending at the time of discharge. The issue becomes who is responsible for obtaining those results and following up on them with the patient, said Dr. Meyer, who is also the senior vice president for quality and safety at Massachusetts General Hospital in Boston.

Another challenge is the communication between the hospitalist and the primary care physician, Dr. Meyer said. For example, a hospitalist may leave a phone message for a primary care physician about an important lab result, but what if the hospitalist leaves the message at the wrong place? Physicians need to have a system in place that guarantees "closed-loop communication," where the hospitalist would know that the message was received on the other end, Dr. Meyer said.

"Just leaving a phone message or just sending a fax or just sending a letter with something important like this may not be enough," he said.

Massachusetts General Hospital has used electronic tools to help tackle the problem of closed-loop communication. For instance, if a radiologist sees a critical finding, like a collapsed lung, he or she pages the appropriate physician immediately and documents that in the electronic system along with when the page was answered.

Another strategy is to use the discharge process to prompt hospitalists to follow up on tests, Dr. Nagamine said. At her hospital, the discharge summary includes the studies that were completed, those that are pending, and the ones that need to be ordered. "The real key is embedding it into your processes," she said.

Hospitalists also need to develop working relationships and agreements between themselves and the primary care physicians they work with to figure out whose job it is to order necessary follow-up tests, Dr. Nagamine said.

Officials at the National Quality Forum are calling on physicians to do a better job communicating key clinical findings such as laboratory and pathology results.

As part of its updated list of serious reportable events, the NQF added a new adverse event for hospitals to track and report on: patient death or serious injury resulting from a failure to follow up or communicate laboratory, pathology, or radiology test results. The event takes into account findings that need to be communicated immediately like a chest x-ray that shows an acutely collapsed lung, as well as other important findings such as an x-ray that reveals a growing lung mass.

In June, the NQF released the updated list of 29 adverse health care events that it considers to be largely preventable, such as wrong site surgery and stage 3 or 4 pressure ulcers acquired post admission.

This time around the list includes four new events ranging from death or serious injury associated with bringing a metallic object into the MRI area to death or serious injury due to the loss of an irreplaceable biologic specimen.

The list, which was originally released in 2002 and last updated in 2006, is designed as a set of voluntary, consensus standards to be used in public reporting programs. More than half of the states currently use the list as the basis for their public reporting programs.

For hospitalists, a focus on better communication of lab, pathology, and radiology results is critical, said Dr. Janet Nagamine, a hospitalist at Kaiser Permanente Hospital in Santa Clara, Calif., and a mentor for the Society of Hospital Medicine’s Project BOOST. Project BOOST aims to reduce hospital readmissions by improving the hospital discharge process.

Literature published in the last few years shows that health care providers don’t have the best track record when it comes to communicating test results, as well as following up on recommended tests and referrals, she said. A 2005 study of patients discharged from hospitals in Boston found that of the 2,033 test results returned after discharge, physicians were unaware of 62% of the results. Of those, 37% had "actionable" results and 12% required "urgent action" (Ann. Intern. Med. 2005;143:121-8). And in terms of recommended work-ups, another study found that of 240 tests and referrals recommended by physicians in the hospital, about 36% were not completed (Arch. Intern. Med. 2007;167:1305-11).

Hospitalists will face challenges as they try to tackle these problems, said Dr. Gregg S. Meyer, cochair of NQF’s Serious Reportable Events Steering Committee. The first hurdle is that many patients have tests conducted during their hospital stay, but the results are pending at the time of discharge. The issue becomes who is responsible for obtaining those results and following up on them with the patient, said Dr. Meyer, who is also the senior vice president for quality and safety at Massachusetts General Hospital in Boston.

Another challenge is the communication between the hospitalist and the primary care physician, Dr. Meyer said. For example, a hospitalist may leave a phone message for a primary care physician about an important lab result, but what if the hospitalist leaves the message at the wrong place? Physicians need to have a system in place that guarantees "closed-loop communication," where the hospitalist would know that the message was received on the other end, Dr. Meyer said.

"Just leaving a phone message or just sending a fax or just sending a letter with something important like this may not be enough," he said.

Massachusetts General Hospital has used electronic tools to help tackle the problem of closed-loop communication. For instance, if a radiologist sees a critical finding, like a collapsed lung, he or she pages the appropriate physician immediately and documents that in the electronic system along with when the page was answered.

Another strategy is to use the discharge process to prompt hospitalists to follow up on tests, Dr. Nagamine said. At her hospital, the discharge summary includes the studies that were completed, those that are pending, and the ones that need to be ordered. "The real key is embedding it into your processes," she said.

Hospitalists also need to develop working relationships and agreements between themselves and the primary care physicians they work with to figure out whose job it is to order necessary follow-up tests, Dr. Nagamine said.

Dr. Mitchell Wilson is a physician who spends a fair amount of his time advocating for the rights of nurse practitioners and physician assistants. Dr. Wilson, chief medical officer for Eagle Hospital Physicians in Atlanta, is a national expert on how to incorporate NPs and PAs into hospitalist practices with the goal of improving patient care, the bottom line, and physician satisfaction.

He helped develop the first-ever survey of nonphysician providers for the Society of Hospital Medicine and serves as an adviser on hospitalist medicine to the American Academy of Nurse Practitioners and the American Academy of Physician Assistants. In an interview, he shared his thoughts on how nonphysician providers can be part of the care team and why this trend is growing.

HN: How did you first get interested in incorporating PAs and NPs into hospital medicine?

Dr. Wilson: I became interested in incorporating PAs and NPs into hospital medicine early on in my career. I was assigned a PA as a result of a health-system acquisition, and as my inpatient practice expanded, I began to rely on the PA a lot more, and we learned how to provide inpatient care as a doctor/PA team. It quickly became evident to me that through incorporating a PA or NP, doctors gain the opportunity to extend their reach and oversight to more patients and greatly expand the capacity of the care they can provide. Through my work at Eagle, I have found that in the right environment, the addition of a PA or NP has the potential to significantly increase the hospitalist program’s efficiency and improve outcomes.

HN: Adding nonphysician providers to a hospitalist group is not a one-size-fits-all proposition. So how do you know if hiring PAs and NPs will actually work in your group?

Dr. Wilson: The single greatest determining factor of whether the hiring of a PA or NP will work for any given group is the doctors on the team. It is important to carefully and candidly assess the doctors’ previous experience and their willingness to work with PAs and NPs. The doctors’ personalities and management skills also are important factors to consider when hiring a PA and NP. Doctors who have the ability to serve in a more managerial or supervisory role tend to work better with PAs and NPs than do the doctors who prefer to be highly involved in the day-to-day details of their cases. Also, the culture and patient make-up of a hospital can play a part in the success of a PA or NP implementation.

HN: Do you see less reticence these days on the part of hospitalists to partner with nonphysician providers?

Dr. Wilson: There is more acceptance within the health care industry that the use of PAs and NPs is a workable model for healthcare facilities. It really depends on the system in place at each individual hospital. PA and NP programs can benefit both small and large facilities, helping to manage workloads and allowing the flexibility to adjust to admission variations. However, you also will see less willingness to incorporate PA and NP models in practices where the compensation model is work-effort based. Whether the impact on compensation is perceived or real, if a significant component of a hospitalist’s compensation is based on production metrics, sharing cases with a PA or NP will not be high on the priority list.

HN: What’s driving the trend to make PAs and NPs part of the team in the hospital?

Dr. Wilson: There are three main factors driving the trend to use PAs and NPs as part of the hospital team: workplace shortages, educational supply, and legislation. There is a large demand for hospitalist services to optimize length of stay, participate on hospital committees, lead quality–and process–improvement initiatives, and provide efficient, cost-effective care, but there is a short supply of hospitalist physicians to provide the services. Access to quality education is providing a solution to that demand by the continued emergence of qualified PAs and NPs in the marketplace. And let’s face it, there’s a subset of hospitalized patients who don’t require day-to-day physician involvement. Societies and associations are magnifying that emergence by pushing for the advancement of PA and NP practices. I believe that PAs and NPs are an important part of the inpatient health care landscape.

HN: How will the implementation of the Affordable Care Act and the move toward team-based care change how hospitalists work?

Dr. Wilson: It is difficult to determine what the Affordable Care Act will actually be in the future, but no matter what the government program becomes, it is important for all physicians and their hospitals to coordinate care in order to efficiently utilize resources while minimizing complications and optimizing outcomes across the continuum of care, from inpatient to outpatient and possibly back to inpatient. Hospitals will continue to be held more and more accountable for that team-based coordination and management of resources.

Dr. Mitchell Wilson is a physician who spends a fair amount of his time advocating for the rights of nurse practitioners and physician assistants. Dr. Wilson, chief medical officer for Eagle Hospital Physicians in Atlanta, is a national expert on how to incorporate NPs and PAs into hospitalist practices with the goal of improving patient care, the bottom line, and physician satisfaction.

He helped develop the first-ever survey of nonphysician providers for the Society of Hospital Medicine and serves as an adviser on hospitalist medicine to the American Academy of Nurse Practitioners and the American Academy of Physician Assistants. In an interview, he shared his thoughts on how nonphysician providers can be part of the care team and why this trend is growing.

HN: How did you first get interested in incorporating PAs and NPs into hospital medicine?

Dr. Wilson: I became interested in incorporating PAs and NPs into hospital medicine early on in my career. I was assigned a PA as a result of a health-system acquisition, and as my inpatient practice expanded, I began to rely on the PA a lot more, and we learned how to provide inpatient care as a doctor/PA team. It quickly became evident to me that through incorporating a PA or NP, doctors gain the opportunity to extend their reach and oversight to more patients and greatly expand the capacity of the care they can provide. Through my work at Eagle, I have found that in the right environment, the addition of a PA or NP has the potential to significantly increase the hospitalist program’s efficiency and improve outcomes.

HN: Adding nonphysician providers to a hospitalist group is not a one-size-fits-all proposition. So how do you know if hiring PAs and NPs will actually work in your group?

Dr. Wilson: The single greatest determining factor of whether the hiring of a PA or NP will work for any given group is the doctors on the team. It is important to carefully and candidly assess the doctors’ previous experience and their willingness to work with PAs and NPs. The doctors’ personalities and management skills also are important factors to consider when hiring a PA and NP. Doctors who have the ability to serve in a more managerial or supervisory role tend to work better with PAs and NPs than do the doctors who prefer to be highly involved in the day-to-day details of their cases. Also, the culture and patient make-up of a hospital can play a part in the success of a PA or NP implementation.

HN: Do you see less reticence these days on the part of hospitalists to partner with nonphysician providers?

Dr. Wilson: There is more acceptance within the health care industry that the use of PAs and NPs is a workable model for healthcare facilities. It really depends on the system in place at each individual hospital. PA and NP programs can benefit both small and large facilities, helping to manage workloads and allowing the flexibility to adjust to admission variations. However, you also will see less willingness to incorporate PA and NP models in practices where the compensation model is work-effort based. Whether the impact on compensation is perceived or real, if a significant component of a hospitalist’s compensation is based on production metrics, sharing cases with a PA or NP will not be high on the priority list.

HN: What’s driving the trend to make PAs and NPs part of the team in the hospital?

Dr. Wilson: There are three main factors driving the trend to use PAs and NPs as part of the hospital team: workplace shortages, educational supply, and legislation. There is a large demand for hospitalist services to optimize length of stay, participate on hospital committees, lead quality–and process–improvement initiatives, and provide efficient, cost-effective care, but there is a short supply of hospitalist physicians to provide the services. Access to quality education is providing a solution to that demand by the continued emergence of qualified PAs and NPs in the marketplace. And let’s face it, there’s a subset of hospitalized patients who don’t require day-to-day physician involvement. Societies and associations are magnifying that emergence by pushing for the advancement of PA and NP practices. I believe that PAs and NPs are an important part of the inpatient health care landscape.

HN: How will the implementation of the Affordable Care Act and the move toward team-based care change how hospitalists work?

Dr. Wilson: It is difficult to determine what the Affordable Care Act will actually be in the future, but no matter what the government program becomes, it is important for all physicians and their hospitals to coordinate care in order to efficiently utilize resources while minimizing complications and optimizing outcomes across the continuum of care, from inpatient to outpatient and possibly back to inpatient. Hospitals will continue to be held more and more accountable for that team-based coordination and management of resources.

Dr. Mitchell Wilson is a physician who spends a fair amount of his time advocating for the rights of nurse practitioners and physician assistants. Dr. Wilson, chief medical officer for Eagle Hospital Physicians in Atlanta, is a national expert on how to incorporate NPs and PAs into hospitalist practices with the goal of improving patient care, the bottom line, and physician satisfaction.

He helped develop the first-ever survey of nonphysician providers for the Society of Hospital Medicine and serves as an adviser on hospitalist medicine to the American Academy of Nurse Practitioners and the American Academy of Physician Assistants. In an interview, he shared his thoughts on how nonphysician providers can be part of the care team and why this trend is growing.

HN: How did you first get interested in incorporating PAs and NPs into hospital medicine?

Dr. Wilson: I became interested in incorporating PAs and NPs into hospital medicine early on in my career. I was assigned a PA as a result of a health-system acquisition, and as my inpatient practice expanded, I began to rely on the PA a lot more, and we learned how to provide inpatient care as a doctor/PA team. It quickly became evident to me that through incorporating a PA or NP, doctors gain the opportunity to extend their reach and oversight to more patients and greatly expand the capacity of the care they can provide. Through my work at Eagle, I have found that in the right environment, the addition of a PA or NP has the potential to significantly increase the hospitalist program’s efficiency and improve outcomes.

HN: Adding nonphysician providers to a hospitalist group is not a one-size-fits-all proposition. So how do you know if hiring PAs and NPs will actually work in your group?

Dr. Wilson: The single greatest determining factor of whether the hiring of a PA or NP will work for any given group is the doctors on the team. It is important to carefully and candidly assess the doctors’ previous experience and their willingness to work with PAs and NPs. The doctors’ personalities and management skills also are important factors to consider when hiring a PA and NP. Doctors who have the ability to serve in a more managerial or supervisory role tend to work better with PAs and NPs than do the doctors who prefer to be highly involved in the day-to-day details of their cases. Also, the culture and patient make-up of a hospital can play a part in the success of a PA or NP implementation.

HN: Do you see less reticence these days on the part of hospitalists to partner with nonphysician providers?

Dr. Wilson: There is more acceptance within the health care industry that the use of PAs and NPs is a workable model for healthcare facilities. It really depends on the system in place at each individual hospital. PA and NP programs can benefit both small and large facilities, helping to manage workloads and allowing the flexibility to adjust to admission variations. However, you also will see less willingness to incorporate PA and NP models in practices where the compensation model is work-effort based. Whether the impact on compensation is perceived or real, if a significant component of a hospitalist’s compensation is based on production metrics, sharing cases with a PA or NP will not be high on the priority list.

HN: What’s driving the trend to make PAs and NPs part of the team in the hospital?

Dr. Wilson: There are three main factors driving the trend to use PAs and NPs as part of the hospital team: workplace shortages, educational supply, and legislation. There is a large demand for hospitalist services to optimize length of stay, participate on hospital committees, lead quality–and process–improvement initiatives, and provide efficient, cost-effective care, but there is a short supply of hospitalist physicians to provide the services. Access to quality education is providing a solution to that demand by the continued emergence of qualified PAs and NPs in the marketplace. And let’s face it, there’s a subset of hospitalized patients who don’t require day-to-day physician involvement. Societies and associations are magnifying that emergence by pushing for the advancement of PA and NP practices. I believe that PAs and NPs are an important part of the inpatient health care landscape.

HN: How will the implementation of the Affordable Care Act and the move toward team-based care change how hospitalists work?

Dr. Wilson: It is difficult to determine what the Affordable Care Act will actually be in the future, but no matter what the government program becomes, it is important for all physicians and their hospitals to coordinate care in order to efficiently utilize resources while minimizing complications and optimizing outcomes across the continuum of care, from inpatient to outpatient and possibly back to inpatient. Hospitals will continue to be held more and more accountable for that team-based coordination and management of resources.

The federal government plans to help Americans live healthier lives not only by focusing on improving access to health care services, but also by reducing pollution, keeping children from abusing drugs, and serving nutritious school lunches. That's according to the first-ever National Prevention Strategy, released last month.

The new strategy was mandated under the Affordable Care Act (ACA), and with it federal officials have created a blueprint for themselves, as well as states, businesses, and community leaders to follow in building healthier communities. The 122-page document lays out seven priority areas based on evidence-based recommendations for improving health and prolonging life: tobacco-free living, preventing drug abuse and excessive alcohol use, healthy eating, active living, injury- and violence-free living, reproductive and sexual health, and mental and emotional well-being.

The strategy document sets a number of goals and 10-year targets for measuring progress. For example, as part of the effort to increase the use of preventive services in the health care system, the strategy calls on physicians to inform patients about the benefits of preventive services, adopt and use certified electronic health records and personal health records, and adopt medical home- or team-based care models. One 10-year target is to increase the proportion of medical practices that use electronic health records from 25% to 27.5%.

Health and Human Services Secretary Kathleen Sebelius said the strategy was part of a “new focus on prevention” started by President Obama. The National Prevention Strategy will build off earlier efforts, some of which were included in the ACA, to curb tobacco use and give Americans free or low-cost access to preventive services such as mammograms.

“We know that prevention helps people live long and productive lives and can help combat rising health care costs,” Ms. Sebelius said.

The work on prevention was praised by Sen. Tom Harkin (D-Iowa), chair of the Senate Health, Education, Labor, and Pensions Committee, who has been a long-time advocate of moving the U.S. health care system away from a sick care system and toward a well care system.

The ACA created the National Prevention, Health Promotion, and Public Health Council (National Prevention Council), which developed the National Prevention Strategy, along with input from outside advisers. The council is made up of the heads of 17 federal agencies and is chaired by the U.S. Surgeon General. Along with the council, the ACA authorized the Prevention and Public Health Fund, which provides nearly $18 billion for public health programs. That fund is an important source of money for state and local governments looking to make improvements to their communities, Sen. Harkin said.

But the Prevention and Public Health Fund has been caught up in political fighting over the ACA. Earlier this year, Rep. Joe Pitts (R-Pa.) sponsored legislation (H.R. 1217) to eliminate the fund, calling it an “Obamacare slush fund.” In April, the House approved the legislation but the bill has not been taken up in the Senate, where Democrats hold the majority.

The federal government plans to help Americans live healthier lives not only by focusing on improving access to health care services, but also by reducing pollution, keeping children from abusing drugs, and serving nutritious school lunches. That's according to the first-ever National Prevention Strategy, released last month.

The new strategy was mandated under the Affordable Care Act (ACA), and with it federal officials have created a blueprint for themselves, as well as states, businesses, and community leaders to follow in building healthier communities. The 122-page document lays out seven priority areas based on evidence-based recommendations for improving health and prolonging life: tobacco-free living, preventing drug abuse and excessive alcohol use, healthy eating, active living, injury- and violence-free living, reproductive and sexual health, and mental and emotional well-being.

The strategy document sets a number of goals and 10-year targets for measuring progress. For example, as part of the effort to increase the use of preventive services in the health care system, the strategy calls on physicians to inform patients about the benefits of preventive services, adopt and use certified electronic health records and personal health records, and adopt medical home- or team-based care models. One 10-year target is to increase the proportion of medical practices that use electronic health records from 25% to 27.5%.

Health and Human Services Secretary Kathleen Sebelius said the strategy was part of a “new focus on prevention” started by President Obama. The National Prevention Strategy will build off earlier efforts, some of which were included in the ACA, to curb tobacco use and give Americans free or low-cost access to preventive services such as mammograms.

“We know that prevention helps people live long and productive lives and can help combat rising health care costs,” Ms. Sebelius said.

The work on prevention was praised by Sen. Tom Harkin (D-Iowa), chair of the Senate Health, Education, Labor, and Pensions Committee, who has been a long-time advocate of moving the U.S. health care system away from a sick care system and toward a well care system.

The ACA created the National Prevention, Health Promotion, and Public Health Council (National Prevention Council), which developed the National Prevention Strategy, along with input from outside advisers. The council is made up of the heads of 17 federal agencies and is chaired by the U.S. Surgeon General. Along with the council, the ACA authorized the Prevention and Public Health Fund, which provides nearly $18 billion for public health programs. That fund is an important source of money for state and local governments looking to make improvements to their communities, Sen. Harkin said.

But the Prevention and Public Health Fund has been caught up in political fighting over the ACA. Earlier this year, Rep. Joe Pitts (R-Pa.) sponsored legislation (H.R. 1217) to eliminate the fund, calling it an “Obamacare slush fund.” In April, the House approved the legislation but the bill has not been taken up in the Senate, where Democrats hold the majority.

The federal government plans to help Americans live healthier lives not only by focusing on improving access to health care services, but also by reducing pollution, keeping children from abusing drugs, and serving nutritious school lunches. That's according to the first-ever National Prevention Strategy, released last month.

The new strategy was mandated under the Affordable Care Act (ACA), and with it federal officials have created a blueprint for themselves, as well as states, businesses, and community leaders to follow in building healthier communities. The 122-page document lays out seven priority areas based on evidence-based recommendations for improving health and prolonging life: tobacco-free living, preventing drug abuse and excessive alcohol use, healthy eating, active living, injury- and violence-free living, reproductive and sexual health, and mental and emotional well-being.

The strategy document sets a number of goals and 10-year targets for measuring progress. For example, as part of the effort to increase the use of preventive services in the health care system, the strategy calls on physicians to inform patients about the benefits of preventive services, adopt and use certified electronic health records and personal health records, and adopt medical home- or team-based care models. One 10-year target is to increase the proportion of medical practices that use electronic health records from 25% to 27.5%.

Health and Human Services Secretary Kathleen Sebelius said the strategy was part of a “new focus on prevention” started by President Obama. The National Prevention Strategy will build off earlier efforts, some of which were included in the ACA, to curb tobacco use and give Americans free or low-cost access to preventive services such as mammograms.

“We know that prevention helps people live long and productive lives and can help combat rising health care costs,” Ms. Sebelius said.

The work on prevention was praised by Sen. Tom Harkin (D-Iowa), chair of the Senate Health, Education, Labor, and Pensions Committee, who has been a long-time advocate of moving the U.S. health care system away from a sick care system and toward a well care system.

The ACA created the National Prevention, Health Promotion, and Public Health Council (National Prevention Council), which developed the National Prevention Strategy, along with input from outside advisers. The council is made up of the heads of 17 federal agencies and is chaired by the U.S. Surgeon General. Along with the council, the ACA authorized the Prevention and Public Health Fund, which provides nearly $18 billion for public health programs. That fund is an important source of money for state and local governments looking to make improvements to their communities, Sen. Harkin said.

But the Prevention and Public Health Fund has been caught up in political fighting over the ACA. Earlier this year, Rep. Joe Pitts (R-Pa.) sponsored legislation (H.R. 1217) to eliminate the fund, calling it an “Obamacare slush fund.” In April, the House approved the legislation but the bill has not been taken up in the Senate, where Democrats hold the majority.

Medicare payments to physicians will be slashed by 29.4% on Jan. 1 unless Congress acts to avert the scheduled cut, according to an estimate from the Congressional Budget Office.

Last year, Congress passed a 1-year pay fix that kept Medicare fees to physicians at 2010 rates through the end of 2011. Come January, though, physicians will be faced with paying the bill on years of accumulated pay cuts.

The new report from the nonpartisan Congressional Budget Office (CBO) also outlines the costs of various proposals to replace or revamp Medicare's Sustainable Growth Rate (SGR), the formula that requires annual cuts to physician pay whenever actual spending on physician services exceeds spending targets. For example, if Congress were to throw out the SGR and simply freeze Medicare payments to physicians at current rates, the cost to the federal government would be almost $298 billion over 10 years. Offering physicians a 2% pay bump in each year through 2021 would raise the price of the fix to $389 billion over the decade.

A somewhat less expensive option would be to reset the SGR instead of replacing it. Under that option, Congress would forgive all spending above the cumulative targets as of the end of 2010. Going forward, 2011 would be the baseline period for the application of the SGR and in 2012 physicians would receive an increase equal to the Medicare Economic Index. That option would cost about $195 billion over 10 years.

Lawmakers on the House Energy and Commerce Committee are considering the options for replacing the SGR. They recently held a hearing in which they solicited ideas from several of the major professional medical societies on what could replace the SGR. Rep. Michael Burgess (R-Tex.), a member of the committee, said that the goal was to enact a permanent solution to the Medicare physician payment problem this year.

Medicare payments to physicians will be slashed by 29.4% on Jan. 1 unless Congress acts to avert the scheduled cut, according to an estimate from the Congressional Budget Office.

Last year, Congress passed a 1-year pay fix that kept Medicare fees to physicians at 2010 rates through the end of 2011. Come January, though, physicians will be faced with paying the bill on years of accumulated pay cuts.

The new report from the nonpartisan Congressional Budget Office (CBO) also outlines the costs of various proposals to replace or revamp Medicare's Sustainable Growth Rate (SGR), the formula that requires annual cuts to physician pay whenever actual spending on physician services exceeds spending targets. For example, if Congress were to throw out the SGR and simply freeze Medicare payments to physicians at current rates, the cost to the federal government would be almost $298 billion over 10 years. Offering physicians a 2% pay bump in each year through 2021 would raise the price of the fix to $389 billion over the decade.

A somewhat less expensive option would be to reset the SGR instead of replacing it. Under that option, Congress would forgive all spending above the cumulative targets as of the end of 2010. Going forward, 2011 would be the baseline period for the application of the SGR and in 2012 physicians would receive an increase equal to the Medicare Economic Index. That option would cost about $195 billion over 10 years.

Lawmakers on the House Energy and Commerce Committee are considering the options for replacing the SGR. They recently held a hearing in which they solicited ideas from several of the major professional medical societies on what could replace the SGR. Rep. Michael Burgess (R-Tex.), a member of the committee, said that the goal was to enact a permanent solution to the Medicare physician payment problem this year.

Medicare payments to physicians will be slashed by 29.4% on Jan. 1 unless Congress acts to avert the scheduled cut, according to an estimate from the Congressional Budget Office.

Last year, Congress passed a 1-year pay fix that kept Medicare fees to physicians at 2010 rates through the end of 2011. Come January, though, physicians will be faced with paying the bill on years of accumulated pay cuts.

The new report from the nonpartisan Congressional Budget Office (CBO) also outlines the costs of various proposals to replace or revamp Medicare's Sustainable Growth Rate (SGR), the formula that requires annual cuts to physician pay whenever actual spending on physician services exceeds spending targets. For example, if Congress were to throw out the SGR and simply freeze Medicare payments to physicians at current rates, the cost to the federal government would be almost $298 billion over 10 years. Offering physicians a 2% pay bump in each year through 2021 would raise the price of the fix to $389 billion over the decade.

A somewhat less expensive option would be to reset the SGR instead of replacing it. Under that option, Congress would forgive all spending above the cumulative targets as of the end of 2010. Going forward, 2011 would be the baseline period for the application of the SGR and in 2012 physicians would receive an increase equal to the Medicare Economic Index. That option would cost about $195 billion over 10 years.

Lawmakers on the House Energy and Commerce Committee are considering the options for replacing the SGR. They recently held a hearing in which they solicited ideas from several of the major professional medical societies on what could replace the SGR. Rep. Michael Burgess (R-Tex.), a member of the committee, said that the goal was to enact a permanent solution to the Medicare physician payment problem this year.