MedPAC Considers Recommending Physician Payment Increase for 2010

The Medicare Payment Advisory Commission (Med-PAC) is considering recommending that Congress adopt a 1.1 percent increase in physician payment rates for 2010. The recommendation is based on an expected 2.4 percent increase in the inflation rate and a 1.3 percent productivity growth offset. The payment increase would avert deep reductions in payment rates that are expected to occur under the sustainable growth rate formula. A 1.1 percent increase is already scheduled for 2009. MedPAC also plans to reissue its 2008 recommendation to increase payments for primary care services provided by primary care–focused health care professionals. The recommendation includes a budget-neutral payment adjustment, which would take money from subspecialty services to pay for the payment increase for primary care services. MedPAC Chair Glenn Hackbarth, JD, contends that sub-specialists have a greater ability to increase productivity than primary care physicians. To address this inequity, he says that relative payments for primary care services need to be increased compared with high-volume subspecialities. The amount of the primary care payment increase is unknown, but it could be based on bonuses Medicare pays to physicians practicing in underserved areas. For more information, visit https://www.aafp.org/news-now/government-medicine/20081216medpac-rec.html.

Physician Organizations Urge CMS to Fix Problems with Medicare’s PQRI Program

Representatives from physician organizations, including the American Academy of Family Physicians (AAFP) Board Chair Jim King, MD, Selmer, Tenn., have called on the Centers for Medicare and Medicaid Services (CMS) to make changes to Medicare’s Physician Quality Reporting Initiative (PQRI). The physician organization representatives met with CMS Acting Administrator Kerry Weems and other high-ranking CMS officials in December 2008. They were seeking an explanation for why more than one half of physicians did not receive 1.5 percent Medicare bonus payments for participating in PQRI. CMS launched the PQRI program in 2007 and agreed to pay participating physicians for reporting on quality measures between July 1 and December 31, 2007. Although King concedes that coding and technical issues led to many of the problems before CMS received the claims, he says that CMS needs to fix every part of the program that does not work properly. CMS officials said that they would correct the problems that are occurring at the agency, run 2007 claims data again to determine whether they can pay physicians who were not paid because of missing data, and participate in a follow-up meeting with the physician organizations in January 2009. For more information, visit https://www.aafp.org/news-now/practice-management/20081216pqri-mtg.html.

AHRQ Study Shows That E-Prescribing Systems May Lead to Savings in Drug Costs

A recent study funded by the Agency for Healthcare Research and Quality (AHRQ) found that electronic prescribing (e-prescribing) systems that allow physicians to select lower-cost or generic medications can save $845,000 per 100,000 patients annually. These results represent a conservative estimate of potential cost savings, according to the study authors, and the savings could increase dramatically as more physicians begin to use e-prescribing systems. The article, “Effect of Electronic Prescribing with Formulary Decision Support on Medication Use and Cost,” in the December 8, 2008, issue of Archives of Internal Medicine, evaluated e-prescribing systems that offer decision support based on lists of tiered drugs, called formularies, used by insurers. Physicians in the study who used these systems increased their generic prescriptions by 3.3 percent, which is more than the increase occurring among all physicians. The authors conclude that complete use of the decision-support e-prescribing systems could reduce prescription drug spending by up to $3.9 million per 100,000 patients annually. For more information, visit the AHRQ Web site at http://www.ahrq.gov/news/press/pr2008/eprescribpr.htm or the Archives of Internal Medicine at http://archinte.ama-assn.org/cgi/content/full/168/22/2433.

HHS Secretary Releases New Principles and Toolkit for Protecting Patient Privacy

During a keynote address at the Nationwide Health Information Network Forum, U.S. Department of Health and Human Services (HHS) Secretary Michael Leavitt presented six principles that should be used to take advantage of new technology while protecting patient privacy. The principles include an easy-to-use method for consumers to obtain personal health information; a timely means for disputing incorrect information; openness and transparency; consumer choice about how the information is shared; limitations to collection, use, and disclosure of the information; data integrity; safeguards; and accountability. In addition to these principles, Leavitt announced the implementation of several tools to facilitate privacy during health information exchanges and when consumers access their information. One tool would allow consumers to easily compare personal health record products. For more information, visit the HHS Web site at http://www.hhs.gov/news/press/2008pres/12/20081215a.html.

Government Survey Examines Use of Complementary and Alternative Medicine

According to a survey conducted as part of the 2007 National Health Interview Survey (NHIS), 38 percent of adults and nearly 12 percent of children in the United States use some form of complementary and alternative medicine (CAM). The survey included questions about 10 CAM therapies requiring a health care professional, such as acupuncture and chiropractic treatment, and 26 therapies that do not, such as herbal supplementation and meditation. Overall use of CAM therapies among adults has remained stable since the 2002 survey, but the use of some therapies, such as deep breathing, meditation, massage therapy, and yoga, have increased significantly. The most common CAM therapies used by children include nonvitamin, nonmineral natural products; chiropractic or osteopathic manipulation; deep breathing; and yoga. The 2007 NHIS is the first to include questions related to CAM use among children. For more information, visit the National Institutes of Health Web site at http://www.nih.gov/news/health/dec2008/nccam-10.htm or http://nccam.nih.gov/news/camstats.htm.

CDC Increases Influenza Surveillance, Reaffirms Interim Vaccination Guidelines

The Centers for Disease Control and Prevention (CDC) is increasing its surveillance for Haemophilus influenzae type b (Hib) disease based on the continued shortage of the Hib conjugate vaccine. The CDC encourages physicians to contact local health departments to report suspected Hib disease. In December 2007, Merck voluntarily recalled and suspended production of its Hib conjugate vaccines because of possible contamination. In response to the recall, the CDC recommended that physicians defer the Hib booster dose, usually given to children 12 to 15 months of age, except in high-risk patients. According to the November 21, 2008, Morbidity and Mortality Weekly Report (MMWR), although there has been no increase in Hib infection in young children since the 2007 recall, the effects of prolonged Hib booster deferral is unknown. However, because of the continued delay in returning the vaccines to the market, the CDC’s interim guidelines on Hib boosters remain in place. To assist physicians in reporting Hib cases, the CDC provides a listing of state health department Web sites at http://www.cdc.gov/mmwr/international/relres.html. For more information, visit https://www.aafp.org/news-now/clinical-care-research/20081209hib-vacc.html or the MMWR Web site at http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5746a2.htm.

Changes in Inhaler Rules Mandated by the Government Are Now Effective

Beginning January 1, 2009, albuterol metered-dose inhalers using chlorofluorocarbons were no longer available. Instead, patients should have been transitioned to inhalers that use the more ozone-friendly propellant hydrofluoroalkane. The federal rule was mandated in 2005, giving physicians time to transition patients. However, many patients are still using chlorofluorocarbon-propelled inhalers, according to the nonprofit group Allergy and Asthma Network Mothers of Asthmatics (AANMA). The AANMA Web site includes resources to help patients manage the transition. The American Lung Association (ALA) also offers information about hydrofluoroalkane-propelled inhalers and how they compare with chlorofluorocarbon-propelled inhalers. For more information, visit https://www.aafp.org/news-now/health-of-the-public/20081211albut-inhaler.html, the AANMA Web site at http://www.aanma.org/pharmacy/ph_mdi_transition.htm, or the ALA Web site at http://www.lungusa.org/site/c.dvLUK9O0E/b.2222599/.

CMS Launches New Internet-Based System for Easier Medicare Enrollment

CMS has launched a Web-based system that allows registered users in 15 states and Washington, DC, to electronically manage Medicare enrollment information. The Provider Enrollment, Chain, and Ownership System (PECOS) processes enrollment applications 50 percent faster than the traditional method, according to CMS. Users can electronically submit an enrollment application to Medicare, view and update existing enrollment information, review the status of submitted applications, and withdraw enrollment as a Medicare provider. The system also helps physicians quickly report practice changes, such as new ownership or location, which is a federal requirement. CMS expects to expand the system to all states within two years. For more information, visit https://www.aafp.org/news-now/practice-management/20081208pecos.html or the PECOS Web site at https://pecos.cms.hhs.gov/pecos/login.do.

— AFPandAAFP NEWS NOWstaff