New Medicare Fee Schedule Provides Boost for Evaluation and Management Services

The Centers for Medicare and Medicaid Services’ (CMS’) 2009 Medicare physician fee schedule includes changes that could benefit family physicians. Because of these changes, family physicians should see a total increase of about 2 percent for allowed Medicare charges. Specifically, CMS was required to change its method of implementing budget-neutrality adjustments, increasing payments for most evaluation and management services. For example, payment for office visit code 99213 increased by 0.5 percent, and payment for initial hospital care code 99233 increased by 3 percent. In December 2008, American Academy of Family Physicians (AAFP) Board Chair Jim King, MD, Selmer, Tenn., sent a letter to CMS Acting Administrator Kerry Weems praising the agency on several decisions reflected in the 2009 physician fee schedule. However, King also expressed disappointment with some of the decisions, such as adding follow-up inpatient telehealth codes to the Medicare telehealth benefit, and awarding contractors the ability to revoke Medicare billing privileges in certain situations. For more information, visit https://www.aafp.org/news-now/practice-management/20090121e-m-code-boost.html.

Witnesses Lobby Congress to Invest in Health Information Technology

Six witnesses recently testified before the Senate Health, Education, Labor, and Pensions (HELP) Committee to ask Congress to invest in health information technology (HIT). The $20 billion investment in HIT, which is part of a proposed $825 billion economic stimulus package, would be used to provide loans and grants to further the adoption of HIT systems. Witnesses said the priority is to help physicians implement HIT in their practices. The next step is to improve the interoperability of current systems and to facilitate the ability of physicians to share certain types of patient data, such as prescriptions and laboratory results. These changes would improve safety, quality, and efficiency for patients and physicians. Although HIT has the potential to enhance care coordination and improve health outcomes at a lower cost, witnesses stressed that implementing the technology is a slow process without immediate cost savings. Without physician leadership, health care payment reform, and a new health care delivery system, HIT could lead to a large investment without yielding any returns. For more information, visit https://www.aafp.org/news-now/government-medicine/20090121hit-testimony.html or the HELP Committee Web site at http://help.senate.gov/Hearings/2009_01_15/2009_01_15.html.

Physicians Reconsider Offering Childhood Vaccines as Costs Continue to Rise

A growing number of physicians cannot afford to offer recommended childhood vaccines, according to a study in the December 2008 issue of Pediatrics. Five percent of pediatricians and 21 percent of family physicians surveyed reported that they had considered not offering vaccines to privately insured patients because of rising costs and declining reimbursement rates. The study found that the cost of purchasing all doses of recommended childhood vaccines jumped from $600 per child in 2000 to $1,500 per child in 2008. This reflects increases in the total number of doses recommended for existing vaccines, as well as new recommendations for recently approved vaccines. More than one half of physicians surveyed said their practices had experienced a decrease in profit margin from pediatric immunizations in the previous three years. Also, 65 percent said they would not give a vaccine if the reimbursement amount was less than the purchase price. Some physicians are taking advantage of group buying programs, such as Atlantic Health Partners, which can help make vaccines more affordable. Currently, 17 AAFP constituent chapters participate in the program. For more information, visit https://www.aafp.org/news-now/clinical-care-research/20090120kids-vacc-costs.html or the Pediatrics Web site at http://pediatrics.aappublications.org/cgi/content/abstract/122/6/1319 (subscription required).

Family Health History Tool Allows Patients to Share Information With Physicians

The U.S. Department of Health and Human Services (HHS) has released an updated and improved version of the Surgeon General’s online family health history tool. The Web-based tool makes it easy for patients to assemble and share their family health history. Patients may choose to share this information with their physician, who can use it to provide more informed and personalized care. The tool is available for use in electronic health records, and its software code is available to other health organizations who may customize it to meet their needs. Patients can complete their family history profile on the Web in about 15 to 20 minutes, and can control how the information is used and who sees it. For example, patients may choose to share their information with relatives, who can then use it to start their own family health histories. For more information, visit the HHS Web site at http://hhs.gov/news/press/2009pres/01/20090113a.html or the family health history tool at http://familyhistory.hhs.gov.

CMS Modifies Analytical Process for the Physician Quality Reporting Initiative

In response to concerns raised by several physician organizations, CMS has modified its analytical process for the Physician Quality Reporting Initiative (PQRI). It plans to rerun data from the 2007 reporting period based on the revised process to determine who successfully submitted a quality code and should receive a bonus under the rules of the program. Because of the time required to implement the new analytic algorithms, additional payments for 2007 will likely be delayed until October or November 2009, which is also when payments for 2008 are expected. For more information, visit https://www.aafp.org/news-now/practice-management/20090121pqri-changes.html or the CMS Web site at http://www.cms.hhs.gov/PQRI/.

HHS Agrees to Delay Implementation of ICD-10-CM Codes by Two Years

HHS Secretary Michael Leavitt has added two years to the compliance deadline for implementing the International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM). The new deadline for switching to the ICD-10-CM outpatient diagnosis codes is October 1, 2013. CMS received more than 3,000 comments on the proposed rule, which will increase the number of outpatient diagnosis codes from 13,500 to 68,000. Many of the comments were requests for a delay in the initially proposed deadline of 2011. The final rules on the ICD-10-CM were published in the January 16, 2009, Federal Register. For more information, visit https://www.aafp.org/news-now/practice-management/20090121icd-10-delay.html or the HHS Web site at http://www.hhs.gov/news/press/2009pres/01/20090115c.html.

AAFP Creates Guide to Assist Physicians With Medical Home Recognition

A new guide from the AAFP aims to help family physicians who are interested in achieving patient-centered medical home recognition from the National Committee for Quality Assurance (NCQA). “Road to Recognition—Your Guide to NCQA Medical Home,” provides tools, examples, and templates to make the recognition process easier for physicians. The NCQA program uses standards that are aligned with the Joint Principles of the Patient-Centered Medical Home to designate family medicine practices as medical homes. For a $450-per-physician fee, practices may achieve one of three levels of recognition by implementing and documenting program requirements for review and recognition. The NCQA designation process is voluntary. Members may download a free guide, and nonmembers may purchase it, on the AAFP Web site at https://www.aafp.org/online/en/home/membership/initiatives/pcmh/ncqaquide.html. For more information, visit https://www.aafp.org/news-now/practice-management/20090109med-home-guide.html.

CDC Study Shows Increase in Vaccination Rates for Children and Adolescents

Vaccination rates for children and adolescents are rising, according to the Centers for Disease Control and Prevention (CDC). The CDC’s 2007 National Immunization Survey sampled children 19 to 35 months of age who were born between January 2004 and July 2006. According to the survey, more than 77 percent of children received all of the recommended vaccines from the 4:3:1:3:3:1 vaccine series. The federal government’s Healthy People 2010 initiative has set a goal of 90 percent vaccination rates for all vaccines in the series. The CDC’s survey also sampled adolescents 13 to 17 years of age, and found that administration rates for the tetanus-diphtheria-acellular pertussis vaccine increased from 10.8 percent in 2006 to 30.4 percent in 2007. Administration rates for hepatitis B, measles-mumps-rubella, and quadrivalent meningococcal conjugate vaccines also increased during this period. For more information, visit https://www.aafp.org/news-now/clinical-care-research/20090114kids-teens-vacc-rates.html.

New Web Site Offers Guidance on Emerging Issues in Medical Therapeutics

The Agency for Healthcare Research and Quality’s Centers for Education and Research on Therapeutics (CERTs) has created a new Web site to offer advice on medications, biological products, and medical devices. The Web site, known as the Clinician-Consumer Health Advisory Information Network (CHAIN), provides educational and informational resources from research conducted by CERTs—a federally sponsored network of more than a dozen leading research centers across the country. The CHAIN Web site is designed to improve health care quality, safety, and effectiveness. For more information, visit http://www.ahrq.gov/news/press/pr2009/chainpr.htm or the CHAIN Web site at http://www.chainonline.org.

— AFP and AAFP NEWS NOW staff