Healthcare groups seeking IPAB repeal

Originally designed as a board of impartial experts to oversee the health care system and develop recommendations regarding the procedures, medications and spending priorities for Medicare and Medicaid, criticism against the Independent Payment Advisory Board (IPAB) reached a new level last week, when  a robust cross-section of health care stakeholders signed a letter to members of Congress urging them to repeal the controversial cost-cutting IPAB panel established under health care reform

The IPAB, which will not make it's first recommendation until 2014, is under intense scrutiny by stakeholders  concerned with it's ability to make rational recommendations to payment methods and the belief that the IPAB might lead the way to rate setting for all payers.    As currently defined, any IPAB recommendations would take effect without Congressional approval,  and as such, removes elected officials from the decision making process when changes occur in the Medicare and Medicaid programs.

Proponents point out that Market forces alone cannot control health care costs and by implementing best practices and devising methods by which Medicare and Medicaid may provide better services at lower costs, the IPAB is an impartial process that will control skyrocketing costs and allow the Medicare and Medicaid programs to continue.  A three-fifths Senate vote could override any recommended payment cuts, and Congress could always increase Medicare funding through independent legislation.



The House Energy and Commerce Committee is planning a hearing on the panel in July. 

Medicare Data Will Become Publicly Available

On June 3rd, the Centers for Medicare and Medicaid Services (CMS) announced proposed rules that will give certain organizations access to Medicare data.  The proposed rule supports efforts of the health reform law to improve health care quality and lower costs. 

Currently, private insurance companies sometimes make quality assessments on physicians based on their own claims data.  While the goal of the reports was and is to identify hospitals and physicians with the highest quality and cost-effective care, providers can receive multiple and sometimes contradictory reports from a variety of insurers and are often unable to appeal or correct inaccuracies in those reports.

Because Medicare is the largest payer in the US health care system, it's claims data can make quality measures more accurate.  The proposed rule will allow certain organizations access to Medicare claims data and would offer a more accurate snapshot of the performance of physicians and hospitals by ensuring the organizations that crunch the data combine both private sector claims data with Medicare data.  These organization would be required to share the reports confidentially with the providers prior to their public release.  In this way, physicians will have an opportunity to review and work with the company to prevent mistakes in the reports.    Public reports will contain aggregated information only, and no individual patient data will be shared.

CMS will formally publish the rule in the June 8th Federal Register and accept public comment for 60 days.

AMA names James L. Madara MD, as top executive

The American Medical Association has announced it's new executive vice president and CEO.  Effective July 1, 2011, James L. Madara, MD will become the top executive of the AMA. He will replace Michael Maves, who announced last November that he would be stepping down.

Madara, a pathologist and gastroenterologist, has most recently served as senior adviser at Leavitt Partners, a health care consulting firm founded and chaired by former Health and Human Services Secretary Michael O. Leavitt.  He has also served as the CEO of the University of Chicago Medical Center and Chair of the Department of Pathology and Laboratory Medicine at Emory University School of Medicine in Atlanta.  Dr Madara has published more than 200 research papers. 

In a Thursday conference call with reporters, Madara, an 11-year AMA member, said he was "enthusiastic" about his new job and vowed to "refocus" the nation's largest, oldest physicians' organization on its "core mission" of promoting medicine and the public health.

Medicare E-Prescribing Exemptions Are Expanding

On May 26th, CMS released a proposed rule that would give physicians another way to avoid a 1% cut in Medicare payments in 2012 if they have failed to complete at least 10 paperless drug orders using an e-prescribing system in the first half of 2011.

While the original E-prescribing rule made exemptions for rural physicians with limited Internet access or doctors in areas with few pharmacies accepting electronic prescriptions (and only if the exemption was claimed before June 30, 2011), the proposed rule includes recognizing the following hardships:

• Physicians who have limited prescribing activity
• Physicians who have delayed purchasing an e-prescribing system because they intend to participate in the Medicare electronic medical record incentive program in 2011
• Physicians who live in an area where regulations prevent e-prescribing, including prohibition of paperless orders for narcotics
• Physicians who e-prescribe, but only for types of visits that do not count towards the 10-order minimum necessary to avoid the mandated reduction in Medicare payments

The CMS proposal  includes the plan to develop a website where physicians would report such hardships.  In addition to having multiple ways to register their hardship, the proposal would allow more time for physicians to indicate the reason(s) they were unable to e-prescribe, by setting a new deadline of October 1, 2011. Additionally, the proposed rule will make it easier for practices that already utilize certified EMRs to use those systems to satisfy the e-prescribing requirements.  

CMS is accepting public comments on this proposal until July 25th.  The entire proposed rule can be found here:   (www.ofr.gov/ofrupload/ofrdata/2011-13463_pi.pdf).

Administration Offers New Path for ACOs

The Centers for Medicare & Medicaid Services on Tuesday announced three new ideas to drive interest among healthcare providers for forming an accountable care organization.  The initiatives will be run by the newly created Center for Medicare and Medicaid Innovation, which is a byproduct of the Affordable Care Act.  

The new "Pioneer" ACO would allow existing integrated-care organizations that have already begun coordinating care for patients to pocket more of the expected savings an ACO offers.  The plan allows providers to move more rapidly from a shared savings payment model to a population-based payment model consistent with, but separate from the Medicare Shared Savings Program.  CMS estimates the Pioneer model could save Medicare up to $430 million over three years by better managing care and eliminating duplication. Organizations interested in applying to the Pioneer ACO Model must submit a letter of intent on or before June 10, 2011.  To apply, go to: http://innovations.cms.gov/wp-content/uploads/2011/05/Pioneer-ACO-Letter-of-Intent.pdf.  Applications must be received on or before July 18, 2011. 

For less mature health systems, CMS is considering an "Advance Payment" initiative that would provide additional up-front funding to providers to support the formation of new ACOs.  The program would test whether and how pre-paying providers could increase participation in the Medicare Shared Savings Progarm.  Providers would be expected to use the funds (an advance on the shared savings they are expecting) to make the infrastructure and staff investments crucial to successfully coordinating and improving care for patients.  The agency is requesting comments on this idea by June 17th. To comment, go to http://www.regulations.gov./

CMS has also announced free learning sessions on ACOs for providers interested in learning more about how to coordinate patient care through ACOs.  Four on-site learning sessions will be held in 2011.  The plenary session will be made available to all interested organizations through a web-cast and all materials from the sessions will be publicly available.  Individuals wishing to attend the June Accelerated Development Learning Session in person may register at https://acoregister.rti.org. Registration is on a first come, first served basis.


For additional information, go to: 
http://www.cms.gov/apps/media/press/release.asp?Counter=3957&intNumPerPage=10&checkDate=&checkKey=&srchType=1&numDays=3500&srchOpt=0&srchData=&keywordType=All&chkNewsType=1%2C+2%2C+3%2C+4%2C+5&intPage=&showAll=&pYear=&year=&desc=&cboOrder=date

A Proposed Five Year Overhaul for Medicare

Three of the nation's largest physician groups told Congress on Thursday that Medicare needs to overhaul the way it pays for care.  The American Medical Association, along with the American Academy of Family Physicians and the American College of Surgeons testified before the House Energy and Commerce Health subpanel about proposals to replace the Sustainable Growth Rate (SGR) formula, which if left intact, will require a 29.5% cut to Medicare payment rates beginning on January 1, 2012.

Pointing out that the current formula "cannot pay for thought, analysis, deduction, discussion and persuasion and the value that comes from managing the care of the whole person, as well as the care that comes from avoiding unnecessary care" all three presenters advocated for repeal the SGR formula this year.

Each agreed that Congress should put in place a five-year transition period during which different payment models can be tested.  A new system that transitions to a new generation of payment models designed to reward physicians and hospitals for keeping patients healthy, managing chronic conditions in a way that avoids hospitalizations and delivering high quality care with efficient use of resources was one suggestion made to Congress.

Another was to create a system of separate service category growth rates that recognizes the unique nature of the various types of services that physicians provide to their patients, while allowing for increased payments for areas experience workforce shortages.  A third suggestion was to offer primary-care physicians a 2 percent higher payment update than others during the transition period.

Committee Chairman Fred Upton has previously indicated that the committee is committed to working together with physician organizations to implement a permanent, sustainable solution this year that lessens taxpayers’ burden and ensures providers have the resources they need to provide quality care to patients.

Minimum Payment Act of 2011 - Rhode Island attempts to guarantee payment

Last month, legislators in Rhode Island introduced bills in the House and Senate that set a minimum reimbursement rate for commercial payers. 

The bills are in response to a study that shows most Rhode Island physicians are paid substantially less by commercial insurers than their counterparts in Connecticut and Massachusetts.  This is particularly problematic for medical specialists.

Payment inequities have made it difficult to recruit and retain physicians in the "Ocean State."  As older physicians retire, there are few physicians to take their place. Medical speciality providers are already in short supply in the state and according to the bill's authors, without a network of qualified physicians, citizens could soon face long waits for appointments or be required to travel out of state to see a specialist. 

If the bill becomes law, physicians who participate in medical assistance and devote at least 5% of their practice to free care could receive insurance payments at 125% of the Medicare rates.   Increased payments are viewed as a way to attract practitioners to the State and to increase access to high quality medical care.

The Rhode Island Medical Society opposes the bill, saying it doesn't like the idea of setting rates by law.  A similar measure failed last year.

ONC Names Mostashari National Coordinator for HIT

Last week, the U.S. Department of Health & Human Services named Farzad Mostashari, MD, as the new National Coordinator for Health Information Technology, effective immediately. He replaces Dr. David Blumenthal, who is returning to Harvard University after leading Office for the past two years, the Department of Health and Human Services announced.

Trained at the Harvard School of Public Health and Yale Medical School, internal medicine residency at Massachusetts General Hospital, Mostashari completed the Centers for Disease Control and Prevention's Epidemic Intelligence Service.  Motashari joined the Office of the National Coordinator in July 2009, serving as deputy national coordinator for the office.  Before that he worked as an assistant commissioner for the Primary Care Information project at the New York City Department of Health & Mental Hygiene.  In that role, he helped adopt prevention-oriented HIT used by more than 1,500 providers in under served communities.

Motashari was among the first developers of real-time electronic disease surveillance systems and acted as lead investigator in the outbreaks of West Nile Virus and anthrax in New York City.  He is expected to continue Blumenthal's push for providers to adopt electronic health records in order to optimize care quality and enhance communication between multiple medical professionals.