Jennifer Lubell

Medicare Patients Welcome

Most physicians have kept their doors open to Medicare patients despite previous reductions in their pay, according to a study from the Center for Studying Health System Change (HSC). The proportion of U.S. physicians willing to treat Medicare patients stabilized during the last half of 2004 and the first half of 2005, with nearly 75% reporting their practices were open to all new Medicare patients. In 2004–2005, 73% of physicians reported accepting all new Medicare patients, an increase from 71% in 2000–2001, but not statistically different. Physicians' willingness to treat Medicare patients remained high, despite a 5.4% payment cut in 2002 that was not fully offset by smaller increases in subsequent years. Only 3.4% of physicians reported closing their practices to new Medicare patients in 2004–2005, also statistically unchanged from 2000–2001. Moreover, the proportion of primary care physicians accepting all new Medicare patients increased significantly from 62% in 2000–2001 to 65% in 2004–2005. “While concerns about Medicare beneficiary access have focused on physician payment, policy makers should recognize that Medicare fees are only one factor in physician decisions to accept new patients,” said HSC president Paul B. Ginsburg, Ph.D.

Ban on False Information

The Health and Human Services Department may not deliberately disseminate false or misleading scientific information under a recent federal law. The provision, part of the fiscal 2006 HHS appropriations law, also prohibits the questioning of scientific advisory panel nominees about their political affiliation, voting history, and positions on topics unrelated to the capacity in which they are to serve. “If your doctor gives you misleading scientific information, it's called malpractice,” said Dr. Francesca Grifo, senior scientist and director of the scientific integrity program at the Union of Concerned Scientists. “It should already have been illegal for political appointees in government posts to knowingly provide false information, so this ban at HHS represents a modest but important first step in ensuring scientific integrity in federal policy-making and better health care for us all.”

Cardiac Rehab Coverage Expanded

Medicare is proposing to expand national coverage for cardiac rehabilitation services to three additional groups of beneficiaries: those who have had heart valve repair or replacement, percutaneous transluminal coronary angioplasty (PTCA), and heart or combined heart-lung transplant. “With this proposed coverage decision, [the Centers for Medicare and Medicaid Services] seeks to expand coverage to a greater number of beneficiaries with cardiac illness,” said Administrator Dr. Mark B. McClellan. “But just as importantly, we hope that our proposed decision will raise the public's awareness regarding cardiac rehabilitation services in general.” The agency further proposed that cardiac rehabilitation services be comprehensive and include medical evaluation, education, and nutrition services. Medicare has covered cardiac rehabilitation services for beneficiaries following heart attack, coronary artery bypass surgery, and angina since the 1980s and this coverage will continue. A comment period on the proposed decision ended on Jan. 23. CMS plans to issue a final decision within 60 days following the close of the comment period.

Patterns of Trial Registration

The act of clinical trial registration alone is not a good indicator of adherence to registration policies, according to a study that analyzed the quality of information provided during the registration process, and patterns of trial registration (N. Engl. J. Med. 2005;353:2779–87). The researchers reviewed clinicaltrials.gov records to determine patterns of completion of the “Intervention Name” and “Primary Outcome Measure” data fields for trials registered on May 20 and Oct. 11, 2005, and for trials registered during the interval between these two dates. “When trial sponsors have the option of providing information of marginal clinical value in a particular data field, our findings show that some companies provide useful information and others do not,” the researchers found. This may indicate varying degrees of comfort with different levels of disclosure. For example, of the 2,670 studies registered by industry between the two dates, 76% provided information in the Primary Outcome measure field, although these entries varied markedly in their degree of specificity. “It is unacceptable for a trial sponsor not to register its trial in a complete, meaningful, and timely fashion,” Dr. Jeffrey Drazen and Dr. Alastair J.J. Wood wrote in a related editorial. “If a company continues to register trials using meaningless data, with no respect for the registration process and the patients who participate in those trials, investigators and patients should refuse to participate.”

Top Stories of 2005

The growing number of uninsured patients, the public health impact of Hurricane Katrina, and registration for the new Medicare drug benefit were among the top health policy stories of 2005, according to an informal Commonwealth Fund/Health Affairs survey. The survey listed 15 policy stories, compiled by fund staff and journal editors, and asked Web site visitors to select the five they considered the most important. Other top vote-getters among the 1,100 respondents were stories indicating that the U.S. health care system doesn't perform as well as those of several other industrialized nations on various clinical indicators and in reported patient experiences, and that health care costs continue to increase.

Medicare Patients Welcome

Most physicians have kept their doors open to Medicare patients despite previous reductions in their pay, according to a study from the Center for Studying Health System Change (HSC). The proportion of U.S. physicians willing to treat Medicare patients stabilized during the last half of 2004 and the first half of 2005, with nearly 75% reporting their practices were open to all new Medicare patients. In 2004–2005, 73% of physicians reported accepting all new Medicare patients, an increase from 71% in 2000–2001, but not statistically different. Physicians' willingness to treat Medicare patients remained high, despite a 5.4% payment cut in 2002 that was not fully offset by smaller increases in subsequent years. Only 3.4% of physicians reported closing their practices to new Medicare patients in 2004–2005, also statistically unchanged from 2000–2001. Moreover, the proportion of primary care physicians accepting all new Medicare patients increased significantly from 62% in 2000–2001 to 65% in 2004–2005. “While concerns about Medicare beneficiary access have focused on physician payment, policy makers should recognize that Medicare fees are only one factor in physician decisions to accept new patients,” said HSC president Paul B. Ginsburg, Ph.D.

Ban on False Information

The Health and Human Services Department may not deliberately disseminate false or misleading scientific information under a recent federal law. The provision, part of the fiscal 2006 HHS appropriations law, also prohibits the questioning of scientific advisory panel nominees about their political affiliation, voting history, and positions on topics unrelated to the capacity in which they are to serve. “If your doctor gives you misleading scientific information, it's called malpractice,” said Dr. Francesca Grifo, senior scientist and director of the scientific integrity program at the Union of Concerned Scientists. “It should already have been illegal for political appointees in government posts to knowingly provide false information, so this ban at HHS represents a modest but important first step in ensuring scientific integrity in federal policy-making and better health care for us all.”

Cardiac Rehab Coverage Expanded

Medicare is proposing to expand national coverage for cardiac rehabilitation services to three additional groups of beneficiaries: those who have had heart valve repair or replacement, percutaneous transluminal coronary angioplasty (PTCA), and heart or combined heart-lung transplant. “With this proposed coverage decision, [the Centers for Medicare and Medicaid Services] seeks to expand coverage to a greater number of beneficiaries with cardiac illness,” said Administrator Dr. Mark B. McClellan. “But just as importantly, we hope that our proposed decision will raise the public's awareness regarding cardiac rehabilitation services in general.” The agency further proposed that cardiac rehabilitation services be comprehensive and include medical evaluation, education, and nutrition services. Medicare has covered cardiac rehabilitation services for beneficiaries following heart attack, coronary artery bypass surgery, and angina since the 1980s and this coverage will continue. A comment period on the proposed decision ended on Jan. 23. CMS plans to issue a final decision within 60 days following the close of the comment period.

Patterns of Trial Registration

The act of clinical trial registration alone is not a good indicator of adherence to registration policies, according to a study that analyzed the quality of information provided during the registration process, and patterns of trial registration (N. Engl. J. Med. 2005;353:2779–87). The researchers reviewed clinicaltrials.gov records to determine patterns of completion of the “Intervention Name” and “Primary Outcome Measure” data fields for trials registered on May 20 and Oct. 11, 2005, and for trials registered during the interval between these two dates. “When trial sponsors have the option of providing information of marginal clinical value in a particular data field, our findings show that some companies provide useful information and others do not,” the researchers found. This may indicate varying degrees of comfort with different levels of disclosure. For example, of the 2,670 studies registered by industry between the two dates, 76% provided information in the Primary Outcome measure field, although these entries varied markedly in their degree of specificity. “It is unacceptable for a trial sponsor not to register its trial in a complete, meaningful, and timely fashion,” Dr. Jeffrey Drazen and Dr. Alastair J.J. Wood wrote in a related editorial. “If a company continues to register trials using meaningless data, with no respect for the registration process and the patients who participate in those trials, investigators and patients should refuse to participate.”

Top Stories of 2005

The growing number of uninsured patients, the public health impact of Hurricane Katrina, and registration for the new Medicare drug benefit were among the top health policy stories of 2005, according to an informal Commonwealth Fund/Health Affairs survey. The survey listed 15 policy stories, compiled by fund staff and journal editors, and asked Web site visitors to select the five they considered the most important. Other top vote-getters among the 1,100 respondents were stories indicating that the U.S. health care system doesn't perform as well as those of several other industrialized nations on various clinical indicators and in reported patient experiences, and that health care costs continue to increase.

Medicare Patients Welcome

Most physicians have kept their doors open to Medicare patients despite previous reductions in their pay, according to a study from the Center for Studying Health System Change (HSC). The proportion of U.S. physicians willing to treat Medicare patients stabilized during the last half of 2004 and the first half of 2005, with nearly 75% reporting their practices were open to all new Medicare patients. In 2004–2005, 73% of physicians reported accepting all new Medicare patients, an increase from 71% in 2000–2001, but not statistically different. Physicians' willingness to treat Medicare patients remained high, despite a 5.4% payment cut in 2002 that was not fully offset by smaller increases in subsequent years. Only 3.4% of physicians reported closing their practices to new Medicare patients in 2004–2005, also statistically unchanged from 2000–2001. Moreover, the proportion of primary care physicians accepting all new Medicare patients increased significantly from 62% in 2000–2001 to 65% in 2004–2005. “While concerns about Medicare beneficiary access have focused on physician payment, policy makers should recognize that Medicare fees are only one factor in physician decisions to accept new patients,” said HSC president Paul B. Ginsburg, Ph.D.

Ban on False Information

The Health and Human Services Department may not deliberately disseminate false or misleading scientific information under a recent federal law. The provision, part of the fiscal 2006 HHS appropriations law, also prohibits the questioning of scientific advisory panel nominees about their political affiliation, voting history, and positions on topics unrelated to the capacity in which they are to serve. “If your doctor gives you misleading scientific information, it's called malpractice,” said Dr. Francesca Grifo, senior scientist and director of the scientific integrity program at the Union of Concerned Scientists. “It should already have been illegal for political appointees in government posts to knowingly provide false information, so this ban at HHS represents a modest but important first step in ensuring scientific integrity in federal policy-making and better health care for us all.”

Cardiac Rehab Coverage Expanded

Medicare is proposing to expand national coverage for cardiac rehabilitation services to three additional groups of beneficiaries: those who have had heart valve repair or replacement, percutaneous transluminal coronary angioplasty (PTCA), and heart or combined heart-lung transplant. “With this proposed coverage decision, [the Centers for Medicare and Medicaid Services] seeks to expand coverage to a greater number of beneficiaries with cardiac illness,” said Administrator Dr. Mark B. McClellan. “But just as importantly, we hope that our proposed decision will raise the public's awareness regarding cardiac rehabilitation services in general.” The agency further proposed that cardiac rehabilitation services be comprehensive and include medical evaluation, education, and nutrition services. Medicare has covered cardiac rehabilitation services for beneficiaries following heart attack, coronary artery bypass surgery, and angina since the 1980s and this coverage will continue. A comment period on the proposed decision ended on Jan. 23. CMS plans to issue a final decision within 60 days following the close of the comment period.

Patterns of Trial Registration

The act of clinical trial registration alone is not a good indicator of adherence to registration policies, according to a study that analyzed the quality of information provided during the registration process, and patterns of trial registration (N. Engl. J. Med. 2005;353:2779–87). The researchers reviewed clinicaltrials.gov records to determine patterns of completion of the “Intervention Name” and “Primary Outcome Measure” data fields for trials registered on May 20 and Oct. 11, 2005, and for trials registered during the interval between these two dates. “When trial sponsors have the option of providing information of marginal clinical value in a particular data field, our findings show that some companies provide useful information and others do not,” the researchers found. This may indicate varying degrees of comfort with different levels of disclosure. For example, of the 2,670 studies registered by industry between the two dates, 76% provided information in the Primary Outcome measure field, although these entries varied markedly in their degree of specificity. “It is unacceptable for a trial sponsor not to register its trial in a complete, meaningful, and timely fashion,” Dr. Jeffrey Drazen and Dr. Alastair J.J. Wood wrote in a related editorial. “If a company continues to register trials using meaningless data, with no respect for the registration process and the patients who participate in those trials, investigators and patients should refuse to participate.”

Top Stories of 2005

The growing number of uninsured patients, the public health impact of Hurricane Katrina, and registration for the new Medicare drug benefit were among the top health policy stories of 2005, according to an informal Commonwealth Fund/Health Affairs survey. The survey listed 15 policy stories, compiled by fund staff and journal editors, and asked Web site visitors to select the five they considered the most important. Other top vote-getters among the 1,100 respondents were stories indicating that the U.S. health care system doesn't perform as well as those of several other industrialized nations on various clinical indicators and in reported patient experiences, and that health care costs continue to increase.

WASHINGTON — Delegates to the 2005 White House Conference on Aging made it clear that they weren't happy with Medicare's new prescription drug benefit.

Challenging administration claims that the benefit's tools were accessible and easy to use, delegates recommended that Part D be simplified to create one prescription drug program for beneficiaries.

The Medicare drug benefit was one of 50 resolutions chosen as the “top” issues on aging by the 1,200 delegates at the meeting. Delegates were then charged with drafting implementation strategies suggesting how these resolutions might be put into action. Nearly half of the resolutions addressed health care issues, including Medicare and Medicaid, long-term care, and training health care personnel.

The new drug benefit is “clearly in line” with the principles of the White House Conference on Aging to promote the dignity, health, and economic security for current and future generations, Mike Leavitt, secretary of the Department of Health and Human Services, said in his address to the delegates. “The benefit will be of immediate help to older Americans now,” plus the next group of rapidly expanding aging Americans, the baby boomers, said Mr. Leavitt, who said he helped his own parents enroll in the drug benefit.

His remarks were a hard sell for the delegates, which included governors, members of Congress, and representatives from the National Congress of American Indians, national organizations, academia, business, and industry.

The main source of frustration has been the complexity of the plan, said Ellen Camerieri, a delegate from the Bronx, N.Y., and executive director of Riverdale Senior Services Inc. “Secretary Leavitt talked about how easy it is to sign up … and to get your family together to do it. But what if [you're an aging patient] and you don't have a family?”

In her own community, she said, there's a sense of “confusion and paralysis” over the drug benefit.

Opting into a new drug program under the benefit can be daunting, especially if a beneficiary has a Medigap policy that's not a union or government pension, “but a policy to help them bridge the gap between what Medicare covers and what the actual costs are. You have a vast number of seniors who have had a relationship with a policy, and now must decide whether to continue in the new version of that policy under Part D, or go to the [numerous] other odd policies [offered] within their state.”

Dr. Mark McClellan, CMS administrator, assured delegates that the agency is taking steps to ensure that there is not any lapse in drug coverage. “For example, we have worked closely with states over the past year to obtain very high match rates between their enrollment information and Part D enrollment—match rates well over 99%.”

The agency also has developed a process for a “point of sale” solution, if the beneficiary somehow has not been automatically enrolled in Part D. In addition, multiple efforts are taking place to provide counseling and assistance to beneficiaries, he said.

Seniors “can ask” before they sign up for the plan whether all of the drugs they are taking now are covered, and the agency has tools so that patients can find the lowest cost for a particular drug, Dr. McClellan said.

Yet, his praise of the new 800-MEDICARE customer service line evoked jeers from some delegates. “He claims that every call was answered right away,” said Steve Kofahl, a delegate from Seattle. But when one of Mr. Kofahl's employees tried to call the number to get information, that person “could not get through.”

The problem is a patient has to be able to predict the future to know which plan he or she should sign up for, Ms. Camerieri said. Certain plans under the new benefit cover certain drugs and not others “and you might not be on a medication you'll be needing in 6 months” when you sign up, she said. There's a limited ability to change your plan without some penalty, she said.

Many in the health care field would like to think that Part D is for the people, Ms. Camerieri said. “But the underlying suspicion is that it was drafted to benefit the pharmaceutical and insurance companies who are the people putting together these plans,” she said.

“We want Medicare—not the private insurance companies—to negotiate drug prices,” agreed Marilyn Askin, a delegate from West Orange, N.J.

Delegates drew up language insisting that the White House recognize the work that comes out of the conference. In the meantime, they agreed to follow through on their grassroots efforts and to meet to disseminate the recommendations.

WASHINGTON — Delegates to the 2005 White House Conference on Aging made it clear that they weren't happy with Medicare's new prescription drug benefit.

Challenging administration claims that the benefit's tools were accessible and easy to use, delegates recommended that Part D be simplified to create one prescription drug program for beneficiaries.

The Medicare drug benefit was one of 50 resolutions chosen as the “top” issues on aging by the 1,200 delegates at the meeting. Delegates were then charged with drafting implementation strategies suggesting how these resolutions might be put into action. Nearly half of the resolutions addressed health care issues, including Medicare and Medicaid, long-term care, and training health care personnel.

The new drug benefit is “clearly in line” with the principles of the White House Conference on Aging to promote the dignity, health, and economic security for current and future generations, Mike Leavitt, secretary of the Department of Health and Human Services, said in his address to the delegates. “The benefit will be of immediate help to older Americans now,” plus the next group of rapidly expanding aging Americans, the baby boomers, said Mr. Leavitt, who said he helped his own parents enroll in the drug benefit.

His remarks were a hard sell for the delegates, which included governors, members of Congress, and representatives from the National Congress of American Indians, national organizations, academia, business, and industry.

The main source of frustration has been the complexity of the plan, said Ellen Camerieri, a delegate from the Bronx, N.Y., and executive director of Riverdale Senior Services Inc. “Secretary Leavitt talked about how easy it is to sign up … and to get your family together to do it. But what if [you're an aging patient] and you don't have a family?”

In her own community, she said, there's a sense of “confusion and paralysis” over the drug benefit.

Opting into a new drug program under the benefit can be daunting, especially if a beneficiary has a Medigap policy that's not a union or government pension, “but a policy to help them bridge the gap between what Medicare covers and what the actual costs are. You have a vast number of seniors who have had a relationship with a policy, and now must decide whether to continue in the new version of that policy under Part D, or go to the [numerous] other odd policies [offered] within their state.”

Dr. Mark McClellan, CMS administrator, assured delegates that the agency is taking steps to ensure that there is not any lapse in drug coverage. “For example, we have worked closely with states over the past year to obtain very high match rates between their enrollment information and Part D enrollment—match rates well over 99%.”

The agency also has developed a process for a “point of sale” solution, if the beneficiary somehow has not been automatically enrolled in Part D. In addition, multiple efforts are taking place to provide counseling and assistance to beneficiaries, he said.

Seniors “can ask” before they sign up for the plan whether all of the drugs they are taking now are covered, and the agency has tools so that patients can find the lowest cost for a particular drug, Dr. McClellan said.

Yet, his praise of the new 800-MEDICARE customer service line evoked jeers from some delegates. “He claims that every call was answered right away,” said Steve Kofahl, a delegate from Seattle. But when one of Mr. Kofahl's employees tried to call the number to get information, that person “could not get through.”

The problem is a patient has to be able to predict the future to know which plan he or she should sign up for, Ms. Camerieri said. Certain plans under the new benefit cover certain drugs and not others “and you might not be on a medication you'll be needing in 6 months” when you sign up, she said. There's a limited ability to change your plan without some penalty, she said.

Many in the health care field would like to think that Part D is for the people, Ms. Camerieri said. “But the underlying suspicion is that it was drafted to benefit the pharmaceutical and insurance companies who are the people putting together these plans,” she said.

“We want Medicare—not the private insurance companies—to negotiate drug prices,” agreed Marilyn Askin, a delegate from West Orange, N.J.

Delegates drew up language insisting that the White House recognize the work that comes out of the conference. In the meantime, they agreed to follow through on their grassroots efforts and to meet to disseminate the recommendations.

WASHINGTON — Delegates to the 2005 White House Conference on Aging made it clear that they weren't happy with Medicare's new prescription drug benefit.

Challenging administration claims that the benefit's tools were accessible and easy to use, delegates recommended that Part D be simplified to create one prescription drug program for beneficiaries.

The Medicare drug benefit was one of 50 resolutions chosen as the “top” issues on aging by the 1,200 delegates at the meeting. Delegates were then charged with drafting implementation strategies suggesting how these resolutions might be put into action. Nearly half of the resolutions addressed health care issues, including Medicare and Medicaid, long-term care, and training health care personnel.

The new drug benefit is “clearly in line” with the principles of the White House Conference on Aging to promote the dignity, health, and economic security for current and future generations, Mike Leavitt, secretary of the Department of Health and Human Services, said in his address to the delegates. “The benefit will be of immediate help to older Americans now,” plus the next group of rapidly expanding aging Americans, the baby boomers, said Mr. Leavitt, who said he helped his own parents enroll in the drug benefit.

His remarks were a hard sell for the delegates, which included governors, members of Congress, and representatives from the National Congress of American Indians, national organizations, academia, business, and industry.

The main source of frustration has been the complexity of the plan, said Ellen Camerieri, a delegate from the Bronx, N.Y., and executive director of Riverdale Senior Services Inc. “Secretary Leavitt talked about how easy it is to sign up … and to get your family together to do it. But what if [you're an aging patient] and you don't have a family?”

In her own community, she said, there's a sense of “confusion and paralysis” over the drug benefit.

Opting into a new drug program under the benefit can be daunting, especially if a beneficiary has a Medigap policy that's not a union or government pension, “but a policy to help them bridge the gap between what Medicare covers and what the actual costs are. You have a vast number of seniors who have had a relationship with a policy, and now must decide whether to continue in the new version of that policy under Part D, or go to the [numerous] other odd policies [offered] within their state.”

Dr. Mark McClellan, CMS administrator, assured delegates that the agency is taking steps to ensure that there is not any lapse in drug coverage. “For example, we have worked closely with states over the past year to obtain very high match rates between their enrollment information and Part D enrollment—match rates well over 99%.”

The agency also has developed a process for a “point of sale” solution, if the beneficiary somehow has not been automatically enrolled in Part D. In addition, multiple efforts are taking place to provide counseling and assistance to beneficiaries, he said.

Seniors “can ask” before they sign up for the plan whether all of the drugs they are taking now are covered, and the agency has tools so that patients can find the lowest cost for a particular drug, Dr. McClellan said.

Yet, his praise of the new 800-MEDICARE customer service line evoked jeers from some delegates. “He claims that every call was answered right away,” said Steve Kofahl, a delegate from Seattle. But when one of Mr. Kofahl's employees tried to call the number to get information, that person “could not get through.”

The problem is a patient has to be able to predict the future to know which plan he or she should sign up for, Ms. Camerieri said. Certain plans under the new benefit cover certain drugs and not others “and you might not be on a medication you'll be needing in 6 months” when you sign up, she said. There's a limited ability to change your plan without some penalty, she said.

Many in the health care field would like to think that Part D is for the people, Ms. Camerieri said. “But the underlying suspicion is that it was drafted to benefit the pharmaceutical and insurance companies who are the people putting together these plans,” she said.

“We want Medicare—not the private insurance companies—to negotiate drug prices,” agreed Marilyn Askin, a delegate from West Orange, N.J.

Delegates drew up language insisting that the White House recognize the work that comes out of the conference. In the meantime, they agreed to follow through on their grassroots efforts and to meet to disseminate the recommendations.

Medicare's new prescription drug benefit offers meager savings on drug prices, according to a Families USA survey.

For 19 of the top 20 drugs prescribed to seniors in 2004 in several parts of the country, Families USA found that Medicare's prices were much higher than those negotiated by the Department of Veterans Affairs (VA). “The median price difference for the top 20 drugs was 48.2%,” the survey indicated. “For half of the top 20 drugs prescribed to seniors, the lowest price offered by any Medicare prescription drug plan was at least 48.2% higher than the lowest price available through the VA.”

“The huge prices paid by seniors and taxpayers could have been avoided if Congress and the president had not caved in to the pressure of the drug lobby,” said Ron Pollack, executive director of Families USA. “They prohibited Medicare from bargaining for cheaper prices and, to ensure that this would never change, they delegated the administration of the benefit to private plans, which have far less bargaining clout.”

Peter Ashkenaz, deputy director of the Office of Public Affairs for the Centers for Medicare and Medicaid Services, said that Families USA rehashed the old argument that there should be government price controls and a one-size-fits-all benefit.

The VA has a restricted formulary and limits where patients can get their drugs, he said. “You have to get your drugs from a VA doctor, at a VA facility. For example, in Georgia there are 9 VA pharmacies, compared [with] 1,833 local pharmacies in that state,” Mr. Ashkenaz said in an interview. Also, the Government Accountability Office looked at using the VA model for the Medicare Part D drug benefit, “and found that doing so would raise prices in the commercial market and thus in Medicare.”

The survey also compared the difference between the lowest VA prices and lowest Medicare drug plan prices of the top seven drugs prescribed for seniors, and found huge differences for a few drugs. (See chart.) The total percentage difference between VA and Medicare plan prices may be even higher than 48%, since no single Medicare plan offers the lowest price for all 20 drugs compared with its plan competitors, the survey noted. VA prices are lower for both generic and brand-name drugs, Families USA noted; 18 of the 20 most-prescribed medicines for seniors are brand-name drugs. For the two generic drugs, the median difference between the lowest Medicare drug plan and the lowest VA price was 95%.

Jeff Trewhitt, a spokesman for the Pharmaceutical Research and Manufacturers of America, agreed with CMS that it was unfair to compare Medicare's new drug plan—a private marketplace system—to a government-mandated price control system such as the VA. “The VA is not a competitive marketplace. It has a mandatory 24% rebate, one of those special occasions where we have price controls in this country,” he said in an interview. Still, VA hospitals often try to negotiate something even higher than that percentage, he noted.

One thing to keep in mind is that VA hospitals and clinics make up only 1%–2% of the marketplace, Mr. Trewhitt said. “If we extended that type of mandatory rebate across the market, it would hurt the ability of the worlds' leading pharmaceutical and biotechnology companies to create new medicines.” He expressed support for a report from the nonpartisan Congressional Budget Office that said the best way to achieve cost savings was to provide drug coverage using a wide range of competitive private health plans.

Medicare's new prescription drug benefit offers meager savings on drug prices, according to a Families USA survey.

For 19 of the top 20 drugs prescribed to seniors in 2004 in several parts of the country, Families USA found that Medicare's prices were much higher than those negotiated by the Department of Veterans Affairs (VA). “The median price difference for the top 20 drugs was 48.2%,” the survey indicated. “For half of the top 20 drugs prescribed to seniors, the lowest price offered by any Medicare prescription drug plan was at least 48.2% higher than the lowest price available through the VA.”

“The huge prices paid by seniors and taxpayers could have been avoided if Congress and the president had not caved in to the pressure of the drug lobby,” said Ron Pollack, executive director of Families USA. “They prohibited Medicare from bargaining for cheaper prices and, to ensure that this would never change, they delegated the administration of the benefit to private plans, which have far less bargaining clout.”

Peter Ashkenaz, deputy director of the Office of Public Affairs for the Centers for Medicare and Medicaid Services, said that Families USA rehashed the old argument that there should be government price controls and a one-size-fits-all benefit.

The VA has a restricted formulary and limits where patients can get their drugs, he said. “You have to get your drugs from a VA doctor, at a VA facility. For example, in Georgia there are 9 VA pharmacies, compared [with] 1,833 local pharmacies in that state,” Mr. Ashkenaz said in an interview. Also, the Government Accountability Office looked at using the VA model for the Medicare Part D drug benefit, “and found that doing so would raise prices in the commercial market and thus in Medicare.”

The survey also compared the difference between the lowest VA prices and lowest Medicare drug plan prices of the top seven drugs prescribed for seniors, and found huge differences for a few drugs. (See chart.) The total percentage difference between VA and Medicare plan prices may be even higher than 48%, since no single Medicare plan offers the lowest price for all 20 drugs compared with its plan competitors, the survey noted. VA prices are lower for both generic and brand-name drugs, Families USA noted; 18 of the 20 most-prescribed medicines for seniors are brand-name drugs. For the two generic drugs, the median difference between the lowest Medicare drug plan and the lowest VA price was 95%.

Jeff Trewhitt, a spokesman for the Pharmaceutical Research and Manufacturers of America, agreed with CMS that it was unfair to compare Medicare's new drug plan—a private marketplace system—to a government-mandated price control system such as the VA. “The VA is not a competitive marketplace. It has a mandatory 24% rebate, one of those special occasions where we have price controls in this country,” he said in an interview. Still, VA hospitals often try to negotiate something even higher than that percentage, he noted.

One thing to keep in mind is that VA hospitals and clinics make up only 1%–2% of the marketplace, Mr. Trewhitt said. “If we extended that type of mandatory rebate across the market, it would hurt the ability of the worlds' leading pharmaceutical and biotechnology companies to create new medicines.” He expressed support for a report from the nonpartisan Congressional Budget Office that said the best way to achieve cost savings was to provide drug coverage using a wide range of competitive private health plans.

Medicare's new prescription drug benefit offers meager savings on drug prices, according to a Families USA survey.

For 19 of the top 20 drugs prescribed to seniors in 2004 in several parts of the country, Families USA found that Medicare's prices were much higher than those negotiated by the Department of Veterans Affairs (VA). “The median price difference for the top 20 drugs was 48.2%,” the survey indicated. “For half of the top 20 drugs prescribed to seniors, the lowest price offered by any Medicare prescription drug plan was at least 48.2% higher than the lowest price available through the VA.”

“The huge prices paid by seniors and taxpayers could have been avoided if Congress and the president had not caved in to the pressure of the drug lobby,” said Ron Pollack, executive director of Families USA. “They prohibited Medicare from bargaining for cheaper prices and, to ensure that this would never change, they delegated the administration of the benefit to private plans, which have far less bargaining clout.”

Peter Ashkenaz, deputy director of the Office of Public Affairs for the Centers for Medicare and Medicaid Services, said that Families USA rehashed the old argument that there should be government price controls and a one-size-fits-all benefit.

The VA has a restricted formulary and limits where patients can get their drugs, he said. “You have to get your drugs from a VA doctor, at a VA facility. For example, in Georgia there are 9 VA pharmacies, compared [with] 1,833 local pharmacies in that state,” Mr. Ashkenaz said in an interview. Also, the Government Accountability Office looked at using the VA model for the Medicare Part D drug benefit, “and found that doing so would raise prices in the commercial market and thus in Medicare.”

The survey also compared the difference between the lowest VA prices and lowest Medicare drug plan prices of the top seven drugs prescribed for seniors, and found huge differences for a few drugs. (See chart.) The total percentage difference between VA and Medicare plan prices may be even higher than 48%, since no single Medicare plan offers the lowest price for all 20 drugs compared with its plan competitors, the survey noted. VA prices are lower for both generic and brand-name drugs, Families USA noted; 18 of the 20 most-prescribed medicines for seniors are brand-name drugs. For the two generic drugs, the median difference between the lowest Medicare drug plan and the lowest VA price was 95%.

Jeff Trewhitt, a spokesman for the Pharmaceutical Research and Manufacturers of America, agreed with CMS that it was unfair to compare Medicare's new drug plan—a private marketplace system—to a government-mandated price control system such as the VA. “The VA is not a competitive marketplace. It has a mandatory 24% rebate, one of those special occasions where we have price controls in this country,” he said in an interview. Still, VA hospitals often try to negotiate something even higher than that percentage, he noted.

One thing to keep in mind is that VA hospitals and clinics make up only 1%–2% of the marketplace, Mr. Trewhitt said. “If we extended that type of mandatory rebate across the market, it would hurt the ability of the worlds' leading pharmaceutical and biotechnology companies to create new medicines.” He expressed support for a report from the nonpartisan Congressional Budget Office that said the best way to achieve cost savings was to provide drug coverage using a wide range of competitive private health plans.

WASHINGTON — Whether Medicare's oncology demonstration program is a good idea depends on which federal advisory committee you ask.

Members of the Practicing Physicians Advisory Council (PPAC), which advises Medicare officials on issues of concern to physicians, said they think the program—which pays hematologists and oncologists to report on whether they are following practice guidelines in the treatment of patients with certain types of cancer—is a great idea.

Dr. Peter B. Bach, senior policy adviser at the Centers for Medicare and Medicaid Services (CMS), reminded council members that program participants are paid for data submission, regardless of whether the guidelines are being adhered to. “This is not pay for performance,” he said.

Physicians who participate in the demonstration must report on the reason for the patient's visit, the patient's condition, and their use of clinical guidelines to treat the patient. Those who comply will receive an additional payment of $23.00.

Payments for reporting the data are tied to visits for evaluation and management by Medicare beneficiaries with any of 13 different cancers. This is a change from last year, when the payments were tied to chemotherapy visits. CMS also has replaced some of the G-codes used in the 2005 program with new G-codes, and has added 81 new codes, most of which deal with current disease status.

PPAC members said that they liked the program so much that they would like to see it extended to other specialists who treat cancer patients. For example, when it comes to prostate cancer patients, “oncologists are not the appropriate physician to evaluate [the treatment for] that cancer,” said Dr. Peter D. Grimm, a radiation oncologist in Seattle. “I manage prostate cancer almost exclusively; only a very small percentage of prostate cancer patients are seen by oncologists.”

Council member Dr. Barbara L. McAneny, a clinical oncologist in Albuquerque, agreed. “We're the people who find [prostate cancer] when we're looking for other stuff, or see them if they become hormone refractory and are sent on.”

The council recommended that CMS open up the program to include other specialties that “have the primary responsibility for treating the particular types of cancer [involved].”

PPAC Chair Dr. Ronald D. Castellanos, a urologist in Cape Coral, Fla., said this was not the first time the issue of extending the demonstration had been raised. “We went through this last year … and there was lot of discussion about opening the program up to other specialties,” he said. “As I remember, the discussion at that time was, 'This is a program for next year; next year we'll consider it.' You say you want a spectrum of care of each of these disease processes; you're not going to get that by just talking to the oncologist or the hematologist.”

In contrast, members of the Medicare Payment Advisory Commission (MedPAC) said that such demonstration projects should not be used solely to increase payments for oncology services.

Instead, the secretary of the Department of Health and Human Services should use these demonstrations to test innovations in delivery of quality health care, according to MedPAC, which advises Congress on Medicare payment issues. This should result in long-term benefits to both providers and beneficiaries.

The demonstration project has limited the ability of both MedPAC and Congress to assess the impact of payment changes for oncology drugs and drug administration services, said Joan Sokolovsky, a MedPAC senior analyst. “These projects are not budget neutral. They are designed to increase payments to specific specialties,” she said.

If the payment rates aren't accurate, CMS or Congress should address it, she continued. “It should not make payment policy through the creation of demonstration projects.”

MedPAC Commissioner David A. Smith, a senior fellow for business and society with Demos, a research and advocacy organization in New York, thought the demonstration should be scrapped altogether.

“We're spending another $150 million of taxpayer money, and we argue—I think, convincingly … that there's no value from this demonstration.” Other commissioners agreed that the project would increase costs for beneficiaries but not provide foreseeable benefits.

However, some cautioned that pulling the plug might be a premature move.

At press time, MedPAC was preparing to release a report on oncology payment issues to Congress in January, which would include its recommendation on the proper use of demonstration projects.

“By the time our report comes out, [the demonstration] will be a month and a half down the road,” commented Robert D. Reischauer, Ph.D., a MedPAC commissioner and president of the Urban Institute, Washington. “I think the real issue is whether we should provide guidance for 2007 … and say something about ensuring that payments are adequate so you don't have to 'phony' them up with a demonstration.”

The dilemma is finding a payment system that ensures access to quality care for oncology patients. “We still don't know what the right level is,” said MedPAC Chair Glenn M. Hackbarth.

WASHINGTON — Whether Medicare's oncology demonstration program is a good idea depends on which federal advisory committee you ask.

Members of the Practicing Physicians Advisory Council (PPAC), which advises Medicare officials on issues of concern to physicians, said they think the program—which pays hematologists and oncologists to report on whether they are following practice guidelines in the treatment of patients with certain types of cancer—is a great idea.

Dr. Peter B. Bach, senior policy adviser at the Centers for Medicare and Medicaid Services (CMS), reminded council members that program participants are paid for data submission, regardless of whether the guidelines are being adhered to. “This is not pay for performance,” he said.

Physicians who participate in the demonstration must report on the reason for the patient's visit, the patient's condition, and their use of clinical guidelines to treat the patient. Those who comply will receive an additional payment of $23.00.

Payments for reporting the data are tied to visits for evaluation and management by Medicare beneficiaries with any of 13 different cancers. This is a change from last year, when the payments were tied to chemotherapy visits. CMS also has replaced some of the G-codes used in the 2005 program with new G-codes, and has added 81 new codes, most of which deal with current disease status.

PPAC members said that they liked the program so much that they would like to see it extended to other specialists who treat cancer patients. For example, when it comes to prostate cancer patients, “oncologists are not the appropriate physician to evaluate [the treatment for] that cancer,” said Dr. Peter D. Grimm, a radiation oncologist in Seattle. “I manage prostate cancer almost exclusively; only a very small percentage of prostate cancer patients are seen by oncologists.”

Council member Dr. Barbara L. McAneny, a clinical oncologist in Albuquerque, agreed. “We're the people who find [prostate cancer] when we're looking for other stuff, or see them if they become hormone refractory and are sent on.”

The council recommended that CMS open up the program to include other specialties that “have the primary responsibility for treating the particular types of cancer [involved].”

PPAC Chair Dr. Ronald D. Castellanos, a urologist in Cape Coral, Fla., said this was not the first time the issue of extending the demonstration had been raised. “We went through this last year … and there was lot of discussion about opening the program up to other specialties,” he said. “As I remember, the discussion at that time was, 'This is a program for next year; next year we'll consider it.' You say you want a spectrum of care of each of these disease processes; you're not going to get that by just talking to the oncologist or the hematologist.”

In contrast, members of the Medicare Payment Advisory Commission (MedPAC) said that such demonstration projects should not be used solely to increase payments for oncology services.

Instead, the secretary of the Department of Health and Human Services should use these demonstrations to test innovations in delivery of quality health care, according to MedPAC, which advises Congress on Medicare payment issues. This should result in long-term benefits to both providers and beneficiaries.

The demonstration project has limited the ability of both MedPAC and Congress to assess the impact of payment changes for oncology drugs and drug administration services, said Joan Sokolovsky, a MedPAC senior analyst. “These projects are not budget neutral. They are designed to increase payments to specific specialties,” she said.

If the payment rates aren't accurate, CMS or Congress should address it, she continued. “It should not make payment policy through the creation of demonstration projects.”

MedPAC Commissioner David A. Smith, a senior fellow for business and society with Demos, a research and advocacy organization in New York, thought the demonstration should be scrapped altogether.

“We're spending another $150 million of taxpayer money, and we argue—I think, convincingly … that there's no value from this demonstration.” Other commissioners agreed that the project would increase costs for beneficiaries but not provide foreseeable benefits.

However, some cautioned that pulling the plug might be a premature move.

At press time, MedPAC was preparing to release a report on oncology payment issues to Congress in January, which would include its recommendation on the proper use of demonstration projects.

“By the time our report comes out, [the demonstration] will be a month and a half down the road,” commented Robert D. Reischauer, Ph.D., a MedPAC commissioner and president of the Urban Institute, Washington. “I think the real issue is whether we should provide guidance for 2007 … and say something about ensuring that payments are adequate so you don't have to 'phony' them up with a demonstration.”

The dilemma is finding a payment system that ensures access to quality care for oncology patients. “We still don't know what the right level is,” said MedPAC Chair Glenn M. Hackbarth.

WASHINGTON — Whether Medicare's oncology demonstration program is a good idea depends on which federal advisory committee you ask.

Members of the Practicing Physicians Advisory Council (PPAC), which advises Medicare officials on issues of concern to physicians, said they think the program—which pays hematologists and oncologists to report on whether they are following practice guidelines in the treatment of patients with certain types of cancer—is a great idea.

Dr. Peter B. Bach, senior policy adviser at the Centers for Medicare and Medicaid Services (CMS), reminded council members that program participants are paid for data submission, regardless of whether the guidelines are being adhered to. “This is not pay for performance,” he said.

Physicians who participate in the demonstration must report on the reason for the patient's visit, the patient's condition, and their use of clinical guidelines to treat the patient. Those who comply will receive an additional payment of $23.00.

Payments for reporting the data are tied to visits for evaluation and management by Medicare beneficiaries with any of 13 different cancers. This is a change from last year, when the payments were tied to chemotherapy visits. CMS also has replaced some of the G-codes used in the 2005 program with new G-codes, and has added 81 new codes, most of which deal with current disease status.

PPAC members said that they liked the program so much that they would like to see it extended to other specialists who treat cancer patients. For example, when it comes to prostate cancer patients, “oncologists are not the appropriate physician to evaluate [the treatment for] that cancer,” said Dr. Peter D. Grimm, a radiation oncologist in Seattle. “I manage prostate cancer almost exclusively; only a very small percentage of prostate cancer patients are seen by oncologists.”

Council member Dr. Barbara L. McAneny, a clinical oncologist in Albuquerque, agreed. “We're the people who find [prostate cancer] when we're looking for other stuff, or see them if they become hormone refractory and are sent on.”

The council recommended that CMS open up the program to include other specialties that “have the primary responsibility for treating the particular types of cancer [involved].”

PPAC Chair Dr. Ronald D. Castellanos, a urologist in Cape Coral, Fla., said this was not the first time the issue of extending the demonstration had been raised. “We went through this last year … and there was lot of discussion about opening the program up to other specialties,” he said. “As I remember, the discussion at that time was, 'This is a program for next year; next year we'll consider it.' You say you want a spectrum of care of each of these disease processes; you're not going to get that by just talking to the oncologist or the hematologist.”

In contrast, members of the Medicare Payment Advisory Commission (MedPAC) said that such demonstration projects should not be used solely to increase payments for oncology services.

Instead, the secretary of the Department of Health and Human Services should use these demonstrations to test innovations in delivery of quality health care, according to MedPAC, which advises Congress on Medicare payment issues. This should result in long-term benefits to both providers and beneficiaries.

The demonstration project has limited the ability of both MedPAC and Congress to assess the impact of payment changes for oncology drugs and drug administration services, said Joan Sokolovsky, a MedPAC senior analyst. “These projects are not budget neutral. They are designed to increase payments to specific specialties,” she said.

If the payment rates aren't accurate, CMS or Congress should address it, she continued. “It should not make payment policy through the creation of demonstration projects.”

MedPAC Commissioner David A. Smith, a senior fellow for business and society with Demos, a research and advocacy organization in New York, thought the demonstration should be scrapped altogether.

“We're spending another $150 million of taxpayer money, and we argue—I think, convincingly … that there's no value from this demonstration.” Other commissioners agreed that the project would increase costs for beneficiaries but not provide foreseeable benefits.

However, some cautioned that pulling the plug might be a premature move.

At press time, MedPAC was preparing to release a report on oncology payment issues to Congress in January, which would include its recommendation on the proper use of demonstration projects.

“By the time our report comes out, [the demonstration] will be a month and a half down the road,” commented Robert D. Reischauer, Ph.D., a MedPAC commissioner and president of the Urban Institute, Washington. “I think the real issue is whether we should provide guidance for 2007 … and say something about ensuring that payments are adequate so you don't have to 'phony' them up with a demonstration.”

The dilemma is finding a payment system that ensures access to quality care for oncology patients. “We still don't know what the right level is,” said MedPAC Chair Glenn M. Hackbarth.

Medicare Patients Welcome

Most physicians have kept their doors open to Medicare patients despite previous reductions in their pay, according to a study from the Center for Studying Health System Change (HSC). The proportion of U.S. physicians willing to treat Medicare patients stabilized during the last half of 2004 and the first half of 2005, with nearly 75% reporting their practices were open to all new Medicare patients. In 2004–2005, 73% of physicians reported accepting all new Medicare patients, an increase from 71% in 2000–2001, but not statistically different. Physicians' willingness to treat Medicare patients remained high, despite a 5.4% payment cut in 2002 that was not fully offset by smaller increases in subsequent years. Only 3.4% of physicians reported closing their practices to new Medicare patients in 2004–2005, also statistically unchanged from 2000–2001. Moreover, the proportion of primary care physicians accepting all new Medicare patients increased significantly from 62% in 2000–2001 to 65% in 2004–2005. “While concerns about Medicare beneficiary access have focused on physician payment, policymakers should recognize that Medicare fees are only one factor in physician decisions to accept new patients,” said HSC President Paul B. Ginsburg, Ph.D.

Ban on False Information

The Health and Human Services Department may not deliberately disseminate false or misleading scientific information under a recent federal law. The provision, part of the fiscal 2006 HHS appropriations law, also prohibits the questioning of scientific advisory panel nominees about their political affiliation, voting history, and positions on topics unrelated to the capacity in which they are to serve. “If your doctor gives you misleading scientific information, it's called malpractice,” said Dr. Francesca Grifo, senior scientist and director of the scientific integrity program at the Union of Concerned Scientists. “It should already have been illegal for political appointees in government posts to knowingly provide false information, so this ban at HHS represents a modest but important first step in ensuring scientific integrity in federal policy-making and better health care for us all.”

Cardiac Rehab Coverage Expanded

Medicare is proposing to expand national coverage for cardiac rehabilitation services to three additional groups of beneficiaries: those who have had heart valve repair or replacement, percutaneous transluminal coronary angioplasty (PTCA), and heart or combined heart-lung transplant. “With this proposed coverage decision, [the Centers for Medicare and Medicaid Services] seeks to expand coverage to a greater number of beneficiaries with cardiac illness,” said Administrator Dr. Mark B. McClellan. “But just as importantly, we hope that our proposed decision will raise the public's awareness regarding cardiac rehabilitation services in general.” The agency further proposed that cardiac rehabilitation services be comprehensive and include medical evaluation, education, and nutrition services. Medicare has covered cardiac rehabilitation services for beneficiaries following heart attack, coronary artery bypass surgery, and angina since the 1980s and this coverage will continue. A comment period on the proposed decision ended Jan. 23. CMS plans to issue a final decision within 60 days of the close of the comment period.

Patterns of Trial Registration

The act of clinical trial registration alone is not a good indicator of adherence to registration policies, according to a study of the quality of information provided during the registration process, and patterns of trial registration (N. Engl. J. Med. 2005;353:2779–87). The researchers reviewed clinicaltrials.gov records to assess patterns of completion of the “Intervention Name” and “Primary Outcome Measure” data fields for trials registered during the period from May 20 to Oct. 11, 2005. “When trial sponsors have the option of providing information of marginal clinical value in a particular data field, our findings show that some companies provide useful information and others do not,” the researchers found. This may indicate varying degrees of comfort with different levels of disclosure. For example, of the 2,670 studies registered by industry between the two dates, 76% provided information in the Primary Outcome measure field, although these entries varied markedly in their degree of specificity. “It is unacceptable for a trial sponsor not to register its trial in a complete, meaningful, and timely fashion,” Dr. Jeffrey Drazen and Dr. Alastair J.J. Wood wrote in a related editorial. “If a company continues to register trials using meaningless data, with no respect for the registration process and the patients who participate in those trials, investigators and patients should refuse to participate.”

Top Stories of 2005

The growing number of uninsured patients, the public health impact of Hurricane Katrina, and registration for the new Medicare drug benefit were among the top health policy stories of 2005, according to an informal Commonwealth Fund/Health Affairs survey. The survey listed 15 policy stories, compiled by fund staff and journal editors, and asked Web site visitors to select the five they considered the most important. Other top vote-getters among the 1,100 respondents were stories indicating that the U.S. health care system, the most expensive in the world, doesn't perform as well as those of several other industrialized nations on various clinical indicators and in reported patient experiences, and that health care costs continue to increase.

Medicare Patients Welcome

Most physicians have kept their doors open to Medicare patients despite previous reductions in their pay, according to a study from the Center for Studying Health System Change (HSC). The proportion of U.S. physicians willing to treat Medicare patients stabilized during the last half of 2004 and the first half of 2005, with nearly 75% reporting their practices were open to all new Medicare patients. In 2004–2005, 73% of physicians reported accepting all new Medicare patients, an increase from 71% in 2000–2001, but not statistically different. Physicians' willingness to treat Medicare patients remained high, despite a 5.4% payment cut in 2002 that was not fully offset by smaller increases in subsequent years. Only 3.4% of physicians reported closing their practices to new Medicare patients in 2004–2005, also statistically unchanged from 2000–2001. Moreover, the proportion of primary care physicians accepting all new Medicare patients increased significantly from 62% in 2000–2001 to 65% in 2004–2005. “While concerns about Medicare beneficiary access have focused on physician payment, policymakers should recognize that Medicare fees are only one factor in physician decisions to accept new patients,” said HSC President Paul B. Ginsburg, Ph.D.

Ban on False Information

The Health and Human Services Department may not deliberately disseminate false or misleading scientific information under a recent federal law. The provision, part of the fiscal 2006 HHS appropriations law, also prohibits the questioning of scientific advisory panel nominees about their political affiliation, voting history, and positions on topics unrelated to the capacity in which they are to serve. “If your doctor gives you misleading scientific information, it's called malpractice,” said Dr. Francesca Grifo, senior scientist and director of the scientific integrity program at the Union of Concerned Scientists. “It should already have been illegal for political appointees in government posts to knowingly provide false information, so this ban at HHS represents a modest but important first step in ensuring scientific integrity in federal policy-making and better health care for us all.”

Cardiac Rehab Coverage Expanded

Medicare is proposing to expand national coverage for cardiac rehabilitation services to three additional groups of beneficiaries: those who have had heart valve repair or replacement, percutaneous transluminal coronary angioplasty (PTCA), and heart or combined heart-lung transplant. “With this proposed coverage decision, [the Centers for Medicare and Medicaid Services] seeks to expand coverage to a greater number of beneficiaries with cardiac illness,” said Administrator Dr. Mark B. McClellan. “But just as importantly, we hope that our proposed decision will raise the public's awareness regarding cardiac rehabilitation services in general.” The agency further proposed that cardiac rehabilitation services be comprehensive and include medical evaluation, education, and nutrition services. Medicare has covered cardiac rehabilitation services for beneficiaries following heart attack, coronary artery bypass surgery, and angina since the 1980s and this coverage will continue. A comment period on the proposed decision ended Jan. 23. CMS plans to issue a final decision within 60 days of the close of the comment period.

Patterns of Trial Registration

The act of clinical trial registration alone is not a good indicator of adherence to registration policies, according to a study of the quality of information provided during the registration process, and patterns of trial registration (N. Engl. J. Med. 2005;353:2779–87). The researchers reviewed clinicaltrials.gov records to assess patterns of completion of the “Intervention Name” and “Primary Outcome Measure” data fields for trials registered during the period from May 20 to Oct. 11, 2005. “When trial sponsors have the option of providing information of marginal clinical value in a particular data field, our findings show that some companies provide useful information and others do not,” the researchers found. This may indicate varying degrees of comfort with different levels of disclosure. For example, of the 2,670 studies registered by industry between the two dates, 76% provided information in the Primary Outcome measure field, although these entries varied markedly in their degree of specificity. “It is unacceptable for a trial sponsor not to register its trial in a complete, meaningful, and timely fashion,” Dr. Jeffrey Drazen and Dr. Alastair J.J. Wood wrote in a related editorial. “If a company continues to register trials using meaningless data, with no respect for the registration process and the patients who participate in those trials, investigators and patients should refuse to participate.”

Top Stories of 2005

The growing number of uninsured patients, the public health impact of Hurricane Katrina, and registration for the new Medicare drug benefit were among the top health policy stories of 2005, according to an informal Commonwealth Fund/Health Affairs survey. The survey listed 15 policy stories, compiled by fund staff and journal editors, and asked Web site visitors to select the five they considered the most important. Other top vote-getters among the 1,100 respondents were stories indicating that the U.S. health care system, the most expensive in the world, doesn't perform as well as those of several other industrialized nations on various clinical indicators and in reported patient experiences, and that health care costs continue to increase.

Medicare Patients Welcome

Most physicians have kept their doors open to Medicare patients despite previous reductions in their pay, according to a study from the Center for Studying Health System Change (HSC). The proportion of U.S. physicians willing to treat Medicare patients stabilized during the last half of 2004 and the first half of 2005, with nearly 75% reporting their practices were open to all new Medicare patients. In 2004–2005, 73% of physicians reported accepting all new Medicare patients, an increase from 71% in 2000–2001, but not statistically different. Physicians' willingness to treat Medicare patients remained high, despite a 5.4% payment cut in 2002 that was not fully offset by smaller increases in subsequent years. Only 3.4% of physicians reported closing their practices to new Medicare patients in 2004–2005, also statistically unchanged from 2000–2001. Moreover, the proportion of primary care physicians accepting all new Medicare patients increased significantly from 62% in 2000–2001 to 65% in 2004–2005. “While concerns about Medicare beneficiary access have focused on physician payment, policymakers should recognize that Medicare fees are only one factor in physician decisions to accept new patients,” said HSC President Paul B. Ginsburg, Ph.D.

Ban on False Information

The Health and Human Services Department may not deliberately disseminate false or misleading scientific information under a recent federal law. The provision, part of the fiscal 2006 HHS appropriations law, also prohibits the questioning of scientific advisory panel nominees about their political affiliation, voting history, and positions on topics unrelated to the capacity in which they are to serve. “If your doctor gives you misleading scientific information, it's called malpractice,” said Dr. Francesca Grifo, senior scientist and director of the scientific integrity program at the Union of Concerned Scientists. “It should already have been illegal for political appointees in government posts to knowingly provide false information, so this ban at HHS represents a modest but important first step in ensuring scientific integrity in federal policy-making and better health care for us all.”

Cardiac Rehab Coverage Expanded

Medicare is proposing to expand national coverage for cardiac rehabilitation services to three additional groups of beneficiaries: those who have had heart valve repair or replacement, percutaneous transluminal coronary angioplasty (PTCA), and heart or combined heart-lung transplant. “With this proposed coverage decision, [the Centers for Medicare and Medicaid Services] seeks to expand coverage to a greater number of beneficiaries with cardiac illness,” said Administrator Dr. Mark B. McClellan. “But just as importantly, we hope that our proposed decision will raise the public's awareness regarding cardiac rehabilitation services in general.” The agency further proposed that cardiac rehabilitation services be comprehensive and include medical evaluation, education, and nutrition services. Medicare has covered cardiac rehabilitation services for beneficiaries following heart attack, coronary artery bypass surgery, and angina since the 1980s and this coverage will continue. A comment period on the proposed decision ended Jan. 23. CMS plans to issue a final decision within 60 days of the close of the comment period.

Patterns of Trial Registration

The act of clinical trial registration alone is not a good indicator of adherence to registration policies, according to a study of the quality of information provided during the registration process, and patterns of trial registration (N. Engl. J. Med. 2005;353:2779–87). The researchers reviewed clinicaltrials.gov records to assess patterns of completion of the “Intervention Name” and “Primary Outcome Measure” data fields for trials registered during the period from May 20 to Oct. 11, 2005. “When trial sponsors have the option of providing information of marginal clinical value in a particular data field, our findings show that some companies provide useful information and others do not,” the researchers found. This may indicate varying degrees of comfort with different levels of disclosure. For example, of the 2,670 studies registered by industry between the two dates, 76% provided information in the Primary Outcome measure field, although these entries varied markedly in their degree of specificity. “It is unacceptable for a trial sponsor not to register its trial in a complete, meaningful, and timely fashion,” Dr. Jeffrey Drazen and Dr. Alastair J.J. Wood wrote in a related editorial. “If a company continues to register trials using meaningless data, with no respect for the registration process and the patients who participate in those trials, investigators and patients should refuse to participate.”

Top Stories of 2005

The growing number of uninsured patients, the public health impact of Hurricane Katrina, and registration for the new Medicare drug benefit were among the top health policy stories of 2005, according to an informal Commonwealth Fund/Health Affairs survey. The survey listed 15 policy stories, compiled by fund staff and journal editors, and asked Web site visitors to select the five they considered the most important. Other top vote-getters among the 1,100 respondents were stories indicating that the U.S. health care system, the most expensive in the world, doesn't perform as well as those of several other industrialized nations on various clinical indicators and in reported patient experiences, and that health care costs continue to increase.

WASHINGTON — States should have the flexibility to experiment with innovative measures to improve the Medicaid program, Rep. Nathan Deal (R-Ga.) said during a meeting sponsored by the Center for Health Transformation.

"One size fits all" was the concept at Medicaid's inception, but the truth is "no one size fits everybody, every state," said Rep. Deal, chairman of the House Committee on Energy and Commerce Subcommittee on Health. States over the years have gotten out of this one-size-fits-all approach by applying for waivers, which has resulted in a patchwork of Medicaid programs, he said.

States are the testing ground for what works, he said. For that reason, the congressional role in Medicaid reform should be to make broad program outlines that would give "states the ability to tailor their programs as best as they think meets their needs, without having to come to Washington to ask for waivers all the time," he said.

Medicaid is the single largest component of every state's budget, Rep. Deal noted. Even though it's technically a federal-state partnership, many states can't pay their portion. "It's breaking their budget."

The nation's governors have proposed a framework that Congress has been working to implement, he said. One of the things the governors asked of Congress "is to be more selective in the way we allow them to present and manage their programs."

Instilling a sense of personal responsibility in the beneficiaries and giving them more choice in their care will help the states achieve that goal, he said.

The irony about Medicaid is that "we have created a tax-supported health delivery system that's much more generous than what any of us can buy in the private insurance market. And certainly much better than what you could buy as an individual insurance policy."

The problem is that once you cross the Medicaid eligibility threshold, "all of sudden you're in a vast land of health care delivery, where you have all of these benefits whether you need them or not." This entitlement structure does not allow the health delivery system to do disease management, to focus resources on particular medical needs, or to do overall management of the health care system, he said.

Medicaid also has limited deductibles and copays built into its federal formulation. "The governors have asked us to change that," he said. Making copays mandatory or enforceable "goes a long way for putting the idea of personal responsibility back into the system."

Obviously, the mandate would have to exclude certain categories, such as children below the poverty level and certain disabled beneficiaries. However, for those with eligibility levels in the upper categories, "that's certainly an appropriate place to go," he said.

Instead of walking behind that "magic curtain" and being eligible for everything, the governors are saying "let us make the benefits flexible, tailored to the needs of the beneficiary, and thereby allow us to save money, and in the process do a better job of delivering better health care," Rep. Deal said.

A difficult area in need of reform is reimbursement for drugs, he said. The current system "is very complicated and, I think, subject to manipulation."

The hope is to abandon the old formulas and convert to the "average manufacturer's price," he said. "The AMP is an effort to come at a price formulation that is as close to reflecting the true cost [of the drug] as possible," he said. Differentiations between chain drugstores, community pharmacists, and mail-order drug companies are distorting the actual cost of the drug. The goal of the AMP is to arrive at a realistic reimbursement number, "so we don't make pharmacists bear the brunt of reforms. Expecting the dispensing agent to absorb the cost differentials, I don't think that's fair or realistic."

In long-term health care, "we also need to begin the cycle of taking care of ourselves when we can, by buying long-term health care insurance," he said. The federal government could set an example with its own employees, and provide some tax incentives to spur that effort, he said. Getting federal and state employees into a long-term heath care insurance plan would dramatically reduce the cost of Medicaid in the long term, he said.

WASHINGTON — States should have the flexibility to experiment with innovative measures to improve the Medicaid program, Rep. Nathan Deal (R-Ga.) said during a meeting sponsored by the Center for Health Transformation.

"One size fits all" was the concept at Medicaid's inception, but the truth is "no one size fits everybody, every state," said Rep. Deal, chairman of the House Committee on Energy and Commerce Subcommittee on Health. States over the years have gotten out of this one-size-fits-all approach by applying for waivers, which has resulted in a patchwork of Medicaid programs, he said.

States are the testing ground for what works, he said. For that reason, the congressional role in Medicaid reform should be to make broad program outlines that would give "states the ability to tailor their programs as best as they think meets their needs, without having to come to Washington to ask for waivers all the time," he said.

Medicaid is the single largest component of every state's budget, Rep. Deal noted. Even though it's technically a federal-state partnership, many states can't pay their portion. "It's breaking their budget."

The nation's governors have proposed a framework that Congress has been working to implement, he said. One of the things the governors asked of Congress "is to be more selective in the way we allow them to present and manage their programs."

Instilling a sense of personal responsibility in the beneficiaries and giving them more choice in their care will help the states achieve that goal, he said.

The irony about Medicaid is that "we have created a tax-supported health delivery system that's much more generous than what any of us can buy in the private insurance market. And certainly much better than what you could buy as an individual insurance policy."

The problem is that once you cross the Medicaid eligibility threshold, "all of sudden you're in a vast land of health care delivery, where you have all of these benefits whether you need them or not." This entitlement structure does not allow the health delivery system to do disease management, to focus resources on particular medical needs, or to do overall management of the health care system, he said.

Medicaid also has limited deductibles and copays built into its federal formulation. "The governors have asked us to change that," he said. Making copays mandatory or enforceable "goes a long way for putting the idea of personal responsibility back into the system."

Obviously, the mandate would have to exclude certain categories, such as children below the poverty level and certain disabled beneficiaries. However, for those with eligibility levels in the upper categories, "that's certainly an appropriate place to go," he said.

Instead of walking behind that "magic curtain" and being eligible for everything, the governors are saying "let us make the benefits flexible, tailored to the needs of the beneficiary, and thereby allow us to save money, and in the process do a better job of delivering better health care," Rep. Deal said.

A difficult area in need of reform is reimbursement for drugs, he said. The current system "is very complicated and, I think, subject to manipulation."

The hope is to abandon the old formulas and convert to the "average manufacturer's price," he said. "The AMP is an effort to come at a price formulation that is as close to reflecting the true cost [of the drug] as possible," he said. Differentiations between chain drugstores, community pharmacists, and mail-order drug companies are distorting the actual cost of the drug. The goal of the AMP is to arrive at a realistic reimbursement number, "so we don't make pharmacists bear the brunt of reforms. Expecting the dispensing agent to absorb the cost differentials, I don't think that's fair or realistic."

In long-term health care, "we also need to begin the cycle of taking care of ourselves when we can, by buying long-term health care insurance," he said. The federal government could set an example with its own employees, and provide some tax incentives to spur that effort, he said. Getting federal and state employees into a long-term heath care insurance plan would dramatically reduce the cost of Medicaid in the long term, he said.

WASHINGTON — States should have the flexibility to experiment with innovative measures to improve the Medicaid program, Rep. Nathan Deal (R-Ga.) said during a meeting sponsored by the Center for Health Transformation.

"One size fits all" was the concept at Medicaid's inception, but the truth is "no one size fits everybody, every state," said Rep. Deal, chairman of the House Committee on Energy and Commerce Subcommittee on Health. States over the years have gotten out of this one-size-fits-all approach by applying for waivers, which has resulted in a patchwork of Medicaid programs, he said.

States are the testing ground for what works, he said. For that reason, the congressional role in Medicaid reform should be to make broad program outlines that would give "states the ability to tailor their programs as best as they think meets their needs, without having to come to Washington to ask for waivers all the time," he said.

Medicaid is the single largest component of every state's budget, Rep. Deal noted. Even though it's technically a federal-state partnership, many states can't pay their portion. "It's breaking their budget."

The nation's governors have proposed a framework that Congress has been working to implement, he said. One of the things the governors asked of Congress "is to be more selective in the way we allow them to present and manage their programs."

Instilling a sense of personal responsibility in the beneficiaries and giving them more choice in their care will help the states achieve that goal, he said.

The irony about Medicaid is that "we have created a tax-supported health delivery system that's much more generous than what any of us can buy in the private insurance market. And certainly much better than what you could buy as an individual insurance policy."

The problem is that once you cross the Medicaid eligibility threshold, "all of sudden you're in a vast land of health care delivery, where you have all of these benefits whether you need them or not." This entitlement structure does not allow the health delivery system to do disease management, to focus resources on particular medical needs, or to do overall management of the health care system, he said.

Medicaid also has limited deductibles and copays built into its federal formulation. "The governors have asked us to change that," he said. Making copays mandatory or enforceable "goes a long way for putting the idea of personal responsibility back into the system."

Obviously, the mandate would have to exclude certain categories, such as children below the poverty level and certain disabled beneficiaries. However, for those with eligibility levels in the upper categories, "that's certainly an appropriate place to go," he said.

Instead of walking behind that "magic curtain" and being eligible for everything, the governors are saying "let us make the benefits flexible, tailored to the needs of the beneficiary, and thereby allow us to save money, and in the process do a better job of delivering better health care," Rep. Deal said.

A difficult area in need of reform is reimbursement for drugs, he said. The current system "is very complicated and, I think, subject to manipulation."

The hope is to abandon the old formulas and convert to the "average manufacturer's price," he said. "The AMP is an effort to come at a price formulation that is as close to reflecting the true cost [of the drug] as possible," he said. Differentiations between chain drugstores, community pharmacists, and mail-order drug companies are distorting the actual cost of the drug. The goal of the AMP is to arrive at a realistic reimbursement number, "so we don't make pharmacists bear the brunt of reforms. Expecting the dispensing agent to absorb the cost differentials, I don't think that's fair or realistic."

In long-term health care, "we also need to begin the cycle of taking care of ourselves when we can, by buying long-term health care insurance," he said. The federal government could set an example with its own employees, and provide some tax incentives to spur that effort, he said. Getting federal and state employees into a long-term heath care insurance plan would dramatically reduce the cost of Medicaid in the long term, he said.

Medicare is attempting to simplify the requirements of a new voluntary reporting system that physicians claim is too burdensome.

Under the latest revision from the Centers for Medicare and Medicaid Services, physicians participating in the Physician Voluntary Reporting Program (PVRP) will have only 16 measures to choose to report on instead of 36. CMS also is working to revise the program's reporting system to provide more options for physicians.

Primary care groups opposed CMs' decision to collect clinical data through a set of Healthcare Common Procedure Coding System (HCPCS) codes or G-codes—a system most physicians do not use. The agency is working with the American Medical Association to add the option to use CPT II codes as well as G-codes, CMS spokesman Peter Ashkenaz told this newspaper. "This will provide clinicians with the flexibility of utilizing either G-codes or CPT II codes" for the program, he said.

The 16 starter measures address a wide spectrum of clinical care, including administration of aspirin at arrival for acute myocardial infarction; control of lipids, blood pressure, and glycosylated hemoglobin for patients with diabetes; and assessment of fall risk in elderly patients.

The 20 measures removed from the original set won't necessarily be thrown out. In a fact sheet, CMS said it intended to pursue further development of those and other measures suggested by physician groups.

Reactions to the changes varied. Dr. C. Anderson Hedberg, president of the American College of Physicians, called the revisions "critically important." As reporting and pay-for-performance programs become more widespread, "uniformity and a realistic set of measures that don't create huge administrative reporting burdens are essential for physician acceptance and the success of any quality improvement and measurement program."

Any simplification of reporting is welcome, Dr. Larry Fields, president of the American Academy of Family Physicians, noted in an interview. Yet "this is still a voluntary program with no immediate benefit to patients or physicians."

In light of the 4.4% cut in physician pay that went into effect Jan. 1, physicians "will be even less able to comply with any reporting, voluntary or not," Dr. Fields said. Without a positive incentive to participate, "I expect that CMs' announcement will be met with indifference."

At a meeting of Medicare's Practicing Physicians Advisory Council (PPAC) held before the changes were announced, several physicians said the program would be a hassle for them to implement. For instance, PPAC chair Dr. Ronald Castellanos said it would cost him $15,000 to make the necessary changes in his practice to accommodate the program.

"I'm going to have to redesign my workflow between the clinical and office buildings, change the clearinghouse software, and change the software I use to send things to other providers" and to CMS, he said. "I had [a company] give me an estimate, and it's about $15,000. That's a lot of money to do a voluntary program."

In return for submitting data to the program, physicians get a report telling them how well they did on each measure within their own patient population, as well as a comparison of their performance with that of other physicians regionally and nationally. Although physicians do not need to register with CMS to submit data, they must register to receive the reports.

Dr. Michael Rapp, director of the quality measurement and health assessment group at CMS, said that although there was no money attached to the reporting process, "We want to make it beneficial to physicians." The reports are one way of doing that, but CMS would welcome any other ideas, he added.

Council member Dr. Peter Grimm, a radiation oncologist in Seattle, asked why hospitals receive a 0.4% payment incentive to report data under another reporting program, but physicians do not. "What is the rationale for that? Doctors don't need [the money], or hospitals deserve it more?"

Dr. Trent Haywood, a deputy chief medical officer at CMS, said that when the hospital reporting program started in 2002, hospitals didn't get paid either—that started later on.

Council member Dr. Laura Powers, a Knoxville neurologist, said outcomes measures wouldn't work well in a practice such as hers, where many patients have terminal illnesses. "I take care of patients who are going to die no matter what you do, but I have to make sure their quality of life is better for however long they have to live. That's why we need to have process measures."

The council passed a resolution noting that because the voluntary reporting program will require additional staff, training on use of G codes, and reconfiguration of computer programs, "PPAC advises that any effort at implementing quality measures and reporting must come after physician payment reform and a reduction in current regulatory and administrative demands. Otherwise, efforts to improve care will be impeded."

The council also passed a resolution asking that CMS seek comments from the appropriate specialty societies regarding the issues raised by the voluntary reporting program, "and, like the hospital program, pay for data collection."

Medicare is attempting to simplify the requirements of a new voluntary reporting system that physicians claim is too burdensome.

Under the latest revision from the Centers for Medicare and Medicaid Services, physicians participating in the Physician Voluntary Reporting Program (PVRP) will have only 16 measures to choose to report on instead of 36. CMS also is working to revise the program's reporting system to provide more options for physicians.

Primary care groups opposed CMs' decision to collect clinical data through a set of Healthcare Common Procedure Coding System (HCPCS) codes or G-codes—a system most physicians do not use. The agency is working with the American Medical Association to add the option to use CPT II codes as well as G-codes, CMS spokesman Peter Ashkenaz told this newspaper. "This will provide clinicians with the flexibility of utilizing either G-codes or CPT II codes" for the program, he said.

The 16 starter measures address a wide spectrum of clinical care, including administration of aspirin at arrival for acute myocardial infarction; control of lipids, blood pressure, and glycosylated hemoglobin for patients with diabetes; and assessment of fall risk in elderly patients.

The 20 measures removed from the original set won't necessarily be thrown out. In a fact sheet, CMS said it intended to pursue further development of those and other measures suggested by physician groups.

Reactions to the changes varied. Dr. C. Anderson Hedberg, president of the American College of Physicians, called the revisions "critically important." As reporting and pay-for-performance programs become more widespread, "uniformity and a realistic set of measures that don't create huge administrative reporting burdens are essential for physician acceptance and the success of any quality improvement and measurement program."

Any simplification of reporting is welcome, Dr. Larry Fields, president of the American Academy of Family Physicians, noted in an interview. Yet "this is still a voluntary program with no immediate benefit to patients or physicians."

In light of the 4.4% cut in physician pay that went into effect Jan. 1, physicians "will be even less able to comply with any reporting, voluntary or not," Dr. Fields said. Without a positive incentive to participate, "I expect that CMs' announcement will be met with indifference."

At a meeting of Medicare's Practicing Physicians Advisory Council (PPAC) held before the changes were announced, several physicians said the program would be a hassle for them to implement. For instance, PPAC chair Dr. Ronald Castellanos said it would cost him $15,000 to make the necessary changes in his practice to accommodate the program.

"I'm going to have to redesign my workflow between the clinical and office buildings, change the clearinghouse software, and change the software I use to send things to other providers" and to CMS, he said. "I had [a company] give me an estimate, and it's about $15,000. That's a lot of money to do a voluntary program."

In return for submitting data to the program, physicians get a report telling them how well they did on each measure within their own patient population, as well as a comparison of their performance with that of other physicians regionally and nationally. Although physicians do not need to register with CMS to submit data, they must register to receive the reports.

Dr. Michael Rapp, director of the quality measurement and health assessment group at CMS, said that although there was no money attached to the reporting process, "We want to make it beneficial to physicians." The reports are one way of doing that, but CMS would welcome any other ideas, he added.

Council member Dr. Peter Grimm, a radiation oncologist in Seattle, asked why hospitals receive a 0.4% payment incentive to report data under another reporting program, but physicians do not. "What is the rationale for that? Doctors don't need [the money], or hospitals deserve it more?"

Dr. Trent Haywood, a deputy chief medical officer at CMS, said that when the hospital reporting program started in 2002, hospitals didn't get paid either—that started later on.

Council member Dr. Laura Powers, a Knoxville neurologist, said outcomes measures wouldn't work well in a practice such as hers, where many patients have terminal illnesses. "I take care of patients who are going to die no matter what you do, but I have to make sure their quality of life is better for however long they have to live. That's why we need to have process measures."

The council passed a resolution noting that because the voluntary reporting program will require additional staff, training on use of G codes, and reconfiguration of computer programs, "PPAC advises that any effort at implementing quality measures and reporting must come after physician payment reform and a reduction in current regulatory and administrative demands. Otherwise, efforts to improve care will be impeded."

The council also passed a resolution asking that CMS seek comments from the appropriate specialty societies regarding the issues raised by the voluntary reporting program, "and, like the hospital program, pay for data collection."

Medicare is attempting to simplify the requirements of a new voluntary reporting system that physicians claim is too burdensome.

Under the latest revision from the Centers for Medicare and Medicaid Services, physicians participating in the Physician Voluntary Reporting Program (PVRP) will have only 16 measures to choose to report on instead of 36. CMS also is working to revise the program's reporting system to provide more options for physicians.

Primary care groups opposed CMs' decision to collect clinical data through a set of Healthcare Common Procedure Coding System (HCPCS) codes or G-codes—a system most physicians do not use. The agency is working with the American Medical Association to add the option to use CPT II codes as well as G-codes, CMS spokesman Peter Ashkenaz told this newspaper. "This will provide clinicians with the flexibility of utilizing either G-codes or CPT II codes" for the program, he said.

The 16 starter measures address a wide spectrum of clinical care, including administration of aspirin at arrival for acute myocardial infarction; control of lipids, blood pressure, and glycosylated hemoglobin for patients with diabetes; and assessment of fall risk in elderly patients.

The 20 measures removed from the original set won't necessarily be thrown out. In a fact sheet, CMS said it intended to pursue further development of those and other measures suggested by physician groups.

Reactions to the changes varied. Dr. C. Anderson Hedberg, president of the American College of Physicians, called the revisions "critically important." As reporting and pay-for-performance programs become more widespread, "uniformity and a realistic set of measures that don't create huge administrative reporting burdens are essential for physician acceptance and the success of any quality improvement and measurement program."

Any simplification of reporting is welcome, Dr. Larry Fields, president of the American Academy of Family Physicians, noted in an interview. Yet "this is still a voluntary program with no immediate benefit to patients or physicians."

In light of the 4.4% cut in physician pay that went into effect Jan. 1, physicians "will be even less able to comply with any reporting, voluntary or not," Dr. Fields said. Without a positive incentive to participate, "I expect that CMs' announcement will be met with indifference."

At a meeting of Medicare's Practicing Physicians Advisory Council (PPAC) held before the changes were announced, several physicians said the program would be a hassle for them to implement. For instance, PPAC chair Dr. Ronald Castellanos said it would cost him $15,000 to make the necessary changes in his practice to accommodate the program.

"I'm going to have to redesign my workflow between the clinical and office buildings, change the clearinghouse software, and change the software I use to send things to other providers" and to CMS, he said. "I had [a company] give me an estimate, and it's about $15,000. That's a lot of money to do a voluntary program."

In return for submitting data to the program, physicians get a report telling them how well they did on each measure within their own patient population, as well as a comparison of their performance with that of other physicians regionally and nationally. Although physicians do not need to register with CMS to submit data, they must register to receive the reports.

Dr. Michael Rapp, director of the quality measurement and health assessment group at CMS, said that although there was no money attached to the reporting process, "We want to make it beneficial to physicians." The reports are one way of doing that, but CMS would welcome any other ideas, he added.

Council member Dr. Peter Grimm, a radiation oncologist in Seattle, asked why hospitals receive a 0.4% payment incentive to report data under another reporting program, but physicians do not. "What is the rationale for that? Doctors don't need [the money], or hospitals deserve it more?"

Dr. Trent Haywood, a deputy chief medical officer at CMS, said that when the hospital reporting program started in 2002, hospitals didn't get paid either—that started later on.

Council member Dr. Laura Powers, a Knoxville neurologist, said outcomes measures wouldn't work well in a practice such as hers, where many patients have terminal illnesses. "I take care of patients who are going to die no matter what you do, but I have to make sure their quality of life is better for however long they have to live. That's why we need to have process measures."

The council passed a resolution noting that because the voluntary reporting program will require additional staff, training on use of G codes, and reconfiguration of computer programs, "PPAC advises that any effort at implementing quality measures and reporting must come after physician payment reform and a reduction in current regulatory and administrative demands. Otherwise, efforts to improve care will be impeded."

The council also passed a resolution asking that CMS seek comments from the appropriate specialty societies regarding the issues raised by the voluntary reporting program, "and, like the hospital program, pay for data collection."

Without the proper technology, physician practices may find it difficult to participate in Medicare's new “e-prescribing” standards under the Part D drug benefit, physician groups claim.

“Most primary care physicians will be unable to afford to implement this technology on their own, particularly with the projected cuts in Medicare physician payments of 4.4% in 2006 and a cumulative 26% reduction from 2006 to 2011,” Neil Kirschner, Ph.D., senior associate for regulatory and insurer affairs with the American College of Physicians, said in an interview.

The Centers for Medicare and Medicaid Services in a final rule established the standards for electronic prescribing, or e-prescribing, of drugs covered by Medicare's prescription drug benefit that started Jan. 1, 2006, according to the Federal Register. CMS also plans to pilot test initial e-prescribing standards, which may be included in a final rule to be issued by April 2008.

“These standards will allow Medicare, physicians, hospitals, group practices, other health providers, and prescription drug plan sponsors and Medicare Advantage organizations to take advantage of e-prescribing technology to improve medication prescribing for Medicare beneficiaries that participate in the new prescription drug program,” said Mike Leavitt secretary of the Department of Health and Human Services.

For the most part, medical organizations expressed support for the agency's e-prescribing initiative.

But few practices are currently employing this technology, Dr. Kirshner said. “Surveys vary, but the percentage of practices using it ranges somewhere from 5% to 18%.” The number is even lower for the typical small practice, he added.

Dr. Kirschner said the recent release of safe harbor antikickback and Stark exception rules allowing hospitals, group practices, and Medicare Part D drug plan sponsors to provide necessary e-prescribing technology to physicians may help facilitate its use.

E-prescribing is optional for physicians and pharmacies under the new standards, but as of Jan. 1, 2006, Medicare required drug plans participating in the new prescription benefit to support electronic prescribing.

Jeff Trewhitt, a spokesperson for the Pharmaceutical Research and Manufacturers of America, said PhRMA supported the development of a standardized e-prescribing system. In addition to reducing errors and the administrative costs associated with health care, the system would also promote more effective care of drug therapies for chronic conditions. He agreed, however, that such a system must be designed and implemented correctly. “Keep in mind that the systems needed to convert to an e-Rx system don't even exist yet.”

CMS's new standards for e-prescribing include the following technology:

▸ NCPDP SCRIPT, Version 5.0, for transactions between prescribers and dispensers for new prescriptions, refill requests and responses, prescription change requests and responses, prescription cancellation requests and responses, and related messaging and administrative transactions.

▸ ASC X12N 270/271, Version 4010 and addenda, for eligibility and benefits queries and responses between prescribers and Part D sponsors.

▸ NCPDP Telecommunication Standard, Version 5.1, and supporting NCPDP Batch Standard, Version 1.1, for eligibility queries between dispensers and Part D sponsors.

Without the proper technology, physician practices may find it difficult to participate in Medicare's new “e-prescribing” standards under the Part D drug benefit, physician groups claim.

“Most primary care physicians will be unable to afford to implement this technology on their own, particularly with the projected cuts in Medicare physician payments of 4.4% in 2006 and a cumulative 26% reduction from 2006 to 2011,” Neil Kirschner, Ph.D., senior associate for regulatory and insurer affairs with the American College of Physicians, said in an interview.

The Centers for Medicare and Medicaid Services in a final rule established the standards for electronic prescribing, or e-prescribing, of drugs covered by Medicare's prescription drug benefit that started Jan. 1, 2006, according to the Federal Register. CMS also plans to pilot test initial e-prescribing standards, which may be included in a final rule to be issued by April 2008.

“These standards will allow Medicare, physicians, hospitals, group practices, other health providers, and prescription drug plan sponsors and Medicare Advantage organizations to take advantage of e-prescribing technology to improve medication prescribing for Medicare beneficiaries that participate in the new prescription drug program,” said Mike Leavitt secretary of the Department of Health and Human Services.

For the most part, medical organizations expressed support for the agency's e-prescribing initiative.

But few practices are currently employing this technology, Dr. Kirshner said. “Surveys vary, but the percentage of practices using it ranges somewhere from 5% to 18%.” The number is even lower for the typical small practice, he added.

Dr. Kirschner said the recent release of safe harbor antikickback and Stark exception rules allowing hospitals, group practices, and Medicare Part D drug plan sponsors to provide necessary e-prescribing technology to physicians may help facilitate its use.

E-prescribing is optional for physicians and pharmacies under the new standards, but as of Jan. 1, 2006, Medicare required drug plans participating in the new prescription benefit to support electronic prescribing.

Jeff Trewhitt, a spokesperson for the Pharmaceutical Research and Manufacturers of America, said PhRMA supported the development of a standardized e-prescribing system. In addition to reducing errors and the administrative costs associated with health care, the system would also promote more effective care of drug therapies for chronic conditions. He agreed, however, that such a system must be designed and implemented correctly. “Keep in mind that the systems needed to convert to an e-Rx system don't even exist yet.”

CMS's new standards for e-prescribing include the following technology:

▸ NCPDP SCRIPT, Version 5.0, for transactions between prescribers and dispensers for new prescriptions, refill requests and responses, prescription change requests and responses, prescription cancellation requests and responses, and related messaging and administrative transactions.

▸ ASC X12N 270/271, Version 4010 and addenda, for eligibility and benefits queries and responses between prescribers and Part D sponsors.

▸ NCPDP Telecommunication Standard, Version 5.1, and supporting NCPDP Batch Standard, Version 1.1, for eligibility queries between dispensers and Part D sponsors.

Without the proper technology, physician practices may find it difficult to participate in Medicare's new “e-prescribing” standards under the Part D drug benefit, physician groups claim.

“Most primary care physicians will be unable to afford to implement this technology on their own, particularly with the projected cuts in Medicare physician payments of 4.4% in 2006 and a cumulative 26% reduction from 2006 to 2011,” Neil Kirschner, Ph.D., senior associate for regulatory and insurer affairs with the American College of Physicians, said in an interview.

The Centers for Medicare and Medicaid Services in a final rule established the standards for electronic prescribing, or e-prescribing, of drugs covered by Medicare's prescription drug benefit that started Jan. 1, 2006, according to the Federal Register. CMS also plans to pilot test initial e-prescribing standards, which may be included in a final rule to be issued by April 2008.

“These standards will allow Medicare, physicians, hospitals, group practices, other health providers, and prescription drug plan sponsors and Medicare Advantage organizations to take advantage of e-prescribing technology to improve medication prescribing for Medicare beneficiaries that participate in the new prescription drug program,” said Mike Leavitt secretary of the Department of Health and Human Services.

For the most part, medical organizations expressed support for the agency's e-prescribing initiative.

But few practices are currently employing this technology, Dr. Kirshner said. “Surveys vary, but the percentage of practices using it ranges somewhere from 5% to 18%.” The number is even lower for the typical small practice, he added.

Dr. Kirschner said the recent release of safe harbor antikickback and Stark exception rules allowing hospitals, group practices, and Medicare Part D drug plan sponsors to provide necessary e-prescribing technology to physicians may help facilitate its use.

E-prescribing is optional for physicians and pharmacies under the new standards, but as of Jan. 1, 2006, Medicare required drug plans participating in the new prescription benefit to support electronic prescribing.

Jeff Trewhitt, a spokesperson for the Pharmaceutical Research and Manufacturers of America, said PhRMA supported the development of a standardized e-prescribing system. In addition to reducing errors and the administrative costs associated with health care, the system would also promote more effective care of drug therapies for chronic conditions. He agreed, however, that such a system must be designed and implemented correctly. “Keep in mind that the systems needed to convert to an e-Rx system don't even exist yet.”

CMS's new standards for e-prescribing include the following technology:

▸ NCPDP SCRIPT, Version 5.0, for transactions between prescribers and dispensers for new prescriptions, refill requests and responses, prescription change requests and responses, prescription cancellation requests and responses, and related messaging and administrative transactions.

▸ ASC X12N 270/271, Version 4010 and addenda, for eligibility and benefits queries and responses between prescribers and Part D sponsors.

▸ NCPDP Telecommunication Standard, Version 5.1, and supporting NCPDP Batch Standard, Version 1.1, for eligibility queries between dispensers and Part D sponsors.

Food Allergen Labeling

All food labels now must clearly state if a product contains any ingredients with protein derived from the eight major allergenic foods. Under the Food Allergen Labeling and Consumer Protection Act of 2004 (FALCPA), manufacturers are required to identify in plain English the presence of ingredients that contain protein derived from milk, eggs, fish, crustacean shellfish, tree nuts, peanuts, wheat, or soybeans in the list of ingredients or to say “contains” followed by name of the source of the food allergen after or adjacent to the list of ingredients. It is estimated that 2% of adults and about 5% of infants and young children in the United States have food allergies. Approximately 30,000 consumers require emergency department treatment, and 150 Americans die each year because of allergic reactions to food. “The eight major food allergens account for 90% of all documented food allergic reactions, and some reactions may be severe or life threatening,” said Robert E. Brackett, Ph.D., director of the Food and Drug Administration's Center for Food Safety and Applied Nutrition. The statute, however, does not require manufacturers or retailers to relabel or remove products that don't have the labeling because they were labeled before the effective date. For that reason, there will be a period of time where consumers will see packaged food on store shelves and in their homes without the revised allergen labeling, the FDA cautioned.

Rural Access to Part B Drugs

Access problems may prevent rural providers from participating in the new Competitive Acquisition Program (CAP) for Part B drugs and biologicals, Joan Sokolovsky, a senior analyst with the Medicare Payment Advisory Commission (MedPAC), said at a commission meeting last month. Physicians who elect to participate in the program will obtain drugs from a preselected list of vendors, who in turn will take on the responsibility of billing Medicare for the drugs and collecting coinsurance or deductibles from patients. Under CAP rules, drugs must be delivered to the facility where they will be administered. Chemotherapy in rural areas, however, is delivered through satellite facilities, where “sometimes drugs cannot be mixed,” Ms. Sokolovsky said. In a recommendation, MedPAC said that the Health and Human Services department should allow an exception to these delivery rules for rural satellite offices of providers.

Better Coordination for Medicare

Most Medicare beneficiaries see multiple physicians, pointing to a need for better care coordination, MedPAC research director Karen Milgate indicated at a commission meeting last month. Seeing multiple physicians puts beneficiaries at greater risk for duplication of services, increases the potential for adverse events, and may also increase health care costs, she said. In sampling inpatient, outpatient and physician supplier file claims from 2003, with various combinations of diabetes, coronary artery disease, and congestive heart failure, “we found that on average beneficiaries see five physicians. Those in our chronic condition groups on average saw seven physicians. And then, when we looked at those with all three conditions on average they saw 13 physicians” in 1 year, she said. Analysts also looked at the percentage of a patient's care that was billed to one physician. For patients with three conditions, only 25% had half or more of their care billed by one physician, “which of course means that they're seeing multiple physicians,” she said.

P4P: Not Local Yet

Despite the national buzz over pay for performance and the interest in Congress, such initiatives have yet to catch on in many local communities, the Center for Studying Health System Change reported in a study. “While there's been plenty of buzz about pay for performance as a way to improve health care quality, the reality is that these initiatives are off to a slow start in many communities,” said HSC President Paul B. Ginsburg, Ph.D. The study was based on site visits to 12 nationally representative communities: Boston; Cleveland; Greenville, S.C.; Indianapolis; Lansing, Mich.; Little Rock, Ark.; Miami; northern New Jersey; Orange County, Calif.; Phoenix; Seattle; and Syracuse, N.Y. Of these communities, only two, Orange County and Boston, had significant physician pay-for-performance programs. In the other communities, where to date almost no physicians had received quality-related payments, physician attitudes ranged from skeptical to hostile, according to study results.

Retiree Drug Coverage Continues

In a survey of 300 of the nation's largest private-sector employers, almost four in five (79%) said they would accept government subsidies to continue to provide retiree drug coverage, comparable with Medicare, when the new drug benefit started this month, according to a study by the Kaiser Family Foundation and Hewitt Associates. Another 10% will provide some drug coverage to supplement the new benefit. Only 9% said they planned to stop offering drug coverage to Medicare-eligible retirees. Firms accepting the retiree drug subsidy were less certain about whether they would continue to take this approach in future years, according to survey results. Among those firms that will accept the subsidy in 2006, about four in five (82%) said they were “very” or “somewhat” likely to accept the subsidy again in 2007. Looking ahead to 2010, only half (50%) said they were likely to maintain coverage and accept the subsidy, while 22% said they were unlikely to do so, and 28% said they didn't know.

Food Allergen Labeling

All food labels now must clearly state if a product contains any ingredients with protein derived from the eight major allergenic foods. Under the Food Allergen Labeling and Consumer Protection Act of 2004 (FALCPA), manufacturers are required to identify in plain English the presence of ingredients that contain protein derived from milk, eggs, fish, crustacean shellfish, tree nuts, peanuts, wheat, or soybeans in the list of ingredients or to say “contains” followed by name of the source of the food allergen after or adjacent to the list of ingredients. It is estimated that 2% of adults and about 5% of infants and young children in the United States have food allergies. Approximately 30,000 consumers require emergency department treatment, and 150 Americans die each year because of allergic reactions to food. “The eight major food allergens account for 90% of all documented food allergic reactions, and some reactions may be severe or life threatening,” said Robert E. Brackett, Ph.D., director of the Food and Drug Administration's Center for Food Safety and Applied Nutrition. The statute, however, does not require manufacturers or retailers to relabel or remove products that don't have the labeling because they were labeled before the effective date. For that reason, there will be a period of time where consumers will see packaged food on store shelves and in their homes without the revised allergen labeling, the FDA cautioned.

Rural Access to Part B Drugs

Access problems may prevent rural providers from participating in the new Competitive Acquisition Program (CAP) for Part B drugs and biologicals, Joan Sokolovsky, a senior analyst with the Medicare Payment Advisory Commission (MedPAC), said at a commission meeting last month. Physicians who elect to participate in the program will obtain drugs from a preselected list of vendors, who in turn will take on the responsibility of billing Medicare for the drugs and collecting coinsurance or deductibles from patients. Under CAP rules, drugs must be delivered to the facility where they will be administered. Chemotherapy in rural areas, however, is delivered through satellite facilities, where “sometimes drugs cannot be mixed,” Ms. Sokolovsky said. In a recommendation, MedPAC said that the Health and Human Services department should allow an exception to these delivery rules for rural satellite offices of providers.

Better Coordination for Medicare

Most Medicare beneficiaries see multiple physicians, pointing to a need for better care coordination, MedPAC research director Karen Milgate indicated at a commission meeting last month. Seeing multiple physicians puts beneficiaries at greater risk for duplication of services, increases the potential for adverse events, and may also increase health care costs, she said. In sampling inpatient, outpatient and physician supplier file claims from 2003, with various combinations of diabetes, coronary artery disease, and congestive heart failure, “we found that on average beneficiaries see five physicians. Those in our chronic condition groups on average saw seven physicians. And then, when we looked at those with all three conditions on average they saw 13 physicians” in 1 year, she said. Analysts also looked at the percentage of a patient's care that was billed to one physician. For patients with three conditions, only 25% had half or more of their care billed by one physician, “which of course means that they're seeing multiple physicians,” she said.

P4P: Not Local Yet

Despite the national buzz over pay for performance and the interest in Congress, such initiatives have yet to catch on in many local communities, the Center for Studying Health System Change reported in a study. “While there's been plenty of buzz about pay for performance as a way to improve health care quality, the reality is that these initiatives are off to a slow start in many communities,” said HSC President Paul B. Ginsburg, Ph.D. The study was based on site visits to 12 nationally representative communities: Boston; Cleveland; Greenville, S.C.; Indianapolis; Lansing, Mich.; Little Rock, Ark.; Miami; northern New Jersey; Orange County, Calif.; Phoenix; Seattle; and Syracuse, N.Y. Of these communities, only two, Orange County and Boston, had significant physician pay-for-performance programs. In the other communities, where to date almost no physicians had received quality-related payments, physician attitudes ranged from skeptical to hostile, according to study results.

Retiree Drug Coverage Continues

In a survey of 300 of the nation's largest private-sector employers, almost four in five (79%) said they would accept government subsidies to continue to provide retiree drug coverage, comparable with Medicare, when the new drug benefit started this month, according to a study by the Kaiser Family Foundation and Hewitt Associates. Another 10% will provide some drug coverage to supplement the new benefit. Only 9% said they planned to stop offering drug coverage to Medicare-eligible retirees. Firms accepting the retiree drug subsidy were less certain about whether they would continue to take this approach in future years, according to survey results. Among those firms that will accept the subsidy in 2006, about four in five (82%) said they were “very” or “somewhat” likely to accept the subsidy again in 2007. Looking ahead to 2010, only half (50%) said they were likely to maintain coverage and accept the subsidy, while 22% said they were unlikely to do so, and 28% said they didn't know.

Food Allergen Labeling

All food labels now must clearly state if a product contains any ingredients with protein derived from the eight major allergenic foods. Under the Food Allergen Labeling and Consumer Protection Act of 2004 (FALCPA), manufacturers are required to identify in plain English the presence of ingredients that contain protein derived from milk, eggs, fish, crustacean shellfish, tree nuts, peanuts, wheat, or soybeans in the list of ingredients or to say “contains” followed by name of the source of the food allergen after or adjacent to the list of ingredients. It is estimated that 2% of adults and about 5% of infants and young children in the United States have food allergies. Approximately 30,000 consumers require emergency department treatment, and 150 Americans die each year because of allergic reactions to food. “The eight major food allergens account for 90% of all documented food allergic reactions, and some reactions may be severe or life threatening,” said Robert E. Brackett, Ph.D., director of the Food and Drug Administration's Center for Food Safety and Applied Nutrition. The statute, however, does not require manufacturers or retailers to relabel or remove products that don't have the labeling because they were labeled before the effective date. For that reason, there will be a period of time where consumers will see packaged food on store shelves and in their homes without the revised allergen labeling, the FDA cautioned.

Rural Access to Part B Drugs

Access problems may prevent rural providers from participating in the new Competitive Acquisition Program (CAP) for Part B drugs and biologicals, Joan Sokolovsky, a senior analyst with the Medicare Payment Advisory Commission (MedPAC), said at a commission meeting last month. Physicians who elect to participate in the program will obtain drugs from a preselected list of vendors, who in turn will take on the responsibility of billing Medicare for the drugs and collecting coinsurance or deductibles from patients. Under CAP rules, drugs must be delivered to the facility where they will be administered. Chemotherapy in rural areas, however, is delivered through satellite facilities, where “sometimes drugs cannot be mixed,” Ms. Sokolovsky said. In a recommendation, MedPAC said that the Health and Human Services department should allow an exception to these delivery rules for rural satellite offices of providers.

Better Coordination for Medicare

Most Medicare beneficiaries see multiple physicians, pointing to a need for better care coordination, MedPAC research director Karen Milgate indicated at a commission meeting last month. Seeing multiple physicians puts beneficiaries at greater risk for duplication of services, increases the potential for adverse events, and may also increase health care costs, she said. In sampling inpatient, outpatient and physician supplier file claims from 2003, with various combinations of diabetes, coronary artery disease, and congestive heart failure, “we found that on average beneficiaries see five physicians. Those in our chronic condition groups on average saw seven physicians. And then, when we looked at those with all three conditions on average they saw 13 physicians” in 1 year, she said. Analysts also looked at the percentage of a patient's care that was billed to one physician. For patients with three conditions, only 25% had half or more of their care billed by one physician, “which of course means that they're seeing multiple physicians,” she said.

P4P: Not Local Yet

Despite the national buzz over pay for performance and the interest in Congress, such initiatives have yet to catch on in many local communities, the Center for Studying Health System Change reported in a study. “While there's been plenty of buzz about pay for performance as a way to improve health care quality, the reality is that these initiatives are off to a slow start in many communities,” said HSC President Paul B. Ginsburg, Ph.D. The study was based on site visits to 12 nationally representative communities: Boston; Cleveland; Greenville, S.C.; Indianapolis; Lansing, Mich.; Little Rock, Ark.; Miami; northern New Jersey; Orange County, Calif.; Phoenix; Seattle; and Syracuse, N.Y. Of these communities, only two, Orange County and Boston, had significant physician pay-for-performance programs. In the other communities, where to date almost no physicians had received quality-related payments, physician attitudes ranged from skeptical to hostile, according to study results.

Retiree Drug Coverage Continues

In a survey of 300 of the nation's largest private-sector employers, almost four in five (79%) said they would accept government subsidies to continue to provide retiree drug coverage, comparable with Medicare, when the new drug benefit started this month, according to a study by the Kaiser Family Foundation and Hewitt Associates. Another 10% will provide some drug coverage to supplement the new benefit. Only 9% said they planned to stop offering drug coverage to Medicare-eligible retirees. Firms accepting the retiree drug subsidy were less certain about whether they would continue to take this approach in future years, according to survey results. Among those firms that will accept the subsidy in 2006, about four in five (82%) said they were “very” or “somewhat” likely to accept the subsidy again in 2007. Looking ahead to 2010, only half (50%) said they were likely to maintain coverage and accept the subsidy, while 22% said they were unlikely to do so, and 28% said they didn't know.

Medicare is attempting to simplify the requirements of a new voluntary reporting system that physicians claim is too burdensome.

Under the latest revision from the Centers for Medicare and Medicaid Services, physicians participating in the Physician Voluntary Reporting Program (PVRP) will have only 16 measures to choose to report on instead of 36. CMS also is working to revise the program's reporting system to provide more options for physicians.

Primary care groups opposed CMs' decision to collect clinical data through a set of Healthcare Common Procedure Coding System (HCPCS) codes or G codes—a system most physicians do not use. The agency is working with the American Medical Association to add the option to use CPT II codes as well as G codes, CMS spokesman Peter Ashkenaz told this newspaper. “This will provide clinicians with the flexibility of utilizing either G codes or CPT II codes” for the program, he said.

The 16 starter measures address a wide spectrum of clinical care, including administration of aspirin at arrival for acute myocardial infarction; control of lipids, blood pressure, and glycosylated hemoglobin for patients with diabetes; and assessment of fall risk in elderly patients.

The 20 measures removed from the original set won't necessarily be thrown out. In a fact sheet, CMS said it intended to pursue further development of those and other measures suggested by physician groups.

Reactions to the changes varied. Dr. C. Anderson Hedberg, president of the American College of Physicians, called the revisions “critically important.” As reporting and pay-for-performance programs become more widespread, “uniformity and a realistic set of measures that don't create huge administrative reporting burdens are essential for physician acceptance and the success of any quality improvement and measurement program.”

Any simplification of reporting is welcome, Dr. Larry Fields, president of the American Academy of Family Physicians, noted in an interview. Yet “this is still a voluntary program with no immediate benefit to patients or physicians.”

In light of the 4.4% cut in physician pay that went into effect Jan. 1, physicians “will be even less able to comply with any reporting, voluntary or not,” Dr. Fields said. Without a positive incentive to participate, “I expect that CMs' announcement will be met with indifference.”

At a meeting of Medicare's Practicing Physicians Advisory Council (PPAC) held before the changes were announced, several physicians said the program would be a hassle for them to implement. For instance, PPAC chair Dr. Ronald Castellanos said it would cost him $15,000 to make the necessary changes in his practice to accommodate the program.

“I'm going to have to redesign my workflow between the clinical and office buildings, change the clearinghouse software, and change the software I use to send things to other providers” and to CMS, he said. “I had [a company] give me an estimate, and it's about $15,000. That's a lot of money to do a voluntary program.”

In return for submitting data to the program, physicians get a report telling them how well they did on each measure within their own patient population, as well as a comparison of their performance with that of other physicians regionally and nationally. Although physicians do not need to register with CMS to submit data, they must register to receive the reports.

Dr. Michael Rapp, director of the quality measurement and health assessment group at CMS, said that although there was no money attached to the reporting process, “We want to make it beneficial to physicians.” The reports are one way of doing that, but CMS would welcome any other ideas, he added.

Council member Dr. Peter Grimm, a radiation oncologist in Seattle, asked why hospitals receive a 0.4% payment incentive to report data under another reporting program, but physicians do not. “What is the rationale for that? Doctors don't need [the money], or hospitals deserve it more?”

Dr. Trent Haywood, a deputy chief medical officer at CMS, said that when the hospital reporting program started in 2002, hospitals didn't get paid either—that started later on.

Council member Dr. Laura Powers, a Knoxville neurologist, said outcomes measures wouldn't work well in a practice such as hers, where many patients have terminal illnesses. “I take care of patients who are going to die no matter what you do, but I have to make sure their quality of life is better for however long they have to live. That's why we need to have process measures.”

The council passed a resolution noting that because the voluntary reporting program will require additional staff, training on use of G codes, and reconfiguration of computer program, “PPAC advises that any effort at implementing quality measures and reporting must come after physician payment reform and a reduction in current regulatory and administrative demands. Otherwise, efforts to improve care will be impeded.”

The council also passed a resolution asking that CMS seek comments from the appropriate specialty societies regarding the issues raised by the voluntary reporting program, “and, like the hospital program, pay for data collection.”

Medicare is attempting to simplify the requirements of a new voluntary reporting system that physicians claim is too burdensome.

Under the latest revision from the Centers for Medicare and Medicaid Services, physicians participating in the Physician Voluntary Reporting Program (PVRP) will have only 16 measures to choose to report on instead of 36. CMS also is working to revise the program's reporting system to provide more options for physicians.

Primary care groups opposed CMs' decision to collect clinical data through a set of Healthcare Common Procedure Coding System (HCPCS) codes or G codes—a system most physicians do not use. The agency is working with the American Medical Association to add the option to use CPT II codes as well as G codes, CMS spokesman Peter Ashkenaz told this newspaper. “This will provide clinicians with the flexibility of utilizing either G codes or CPT II codes” for the program, he said.

The 16 starter measures address a wide spectrum of clinical care, including administration of aspirin at arrival for acute myocardial infarction; control of lipids, blood pressure, and glycosylated hemoglobin for patients with diabetes; and assessment of fall risk in elderly patients.

The 20 measures removed from the original set won't necessarily be thrown out. In a fact sheet, CMS said it intended to pursue further development of those and other measures suggested by physician groups.

Reactions to the changes varied. Dr. C. Anderson Hedberg, president of the American College of Physicians, called the revisions “critically important.” As reporting and pay-for-performance programs become more widespread, “uniformity and a realistic set of measures that don't create huge administrative reporting burdens are essential for physician acceptance and the success of any quality improvement and measurement program.”

Any simplification of reporting is welcome, Dr. Larry Fields, president of the American Academy of Family Physicians, noted in an interview. Yet “this is still a voluntary program with no immediate benefit to patients or physicians.”

In light of the 4.4% cut in physician pay that went into effect Jan. 1, physicians “will be even less able to comply with any reporting, voluntary or not,” Dr. Fields said. Without a positive incentive to participate, “I expect that CMs' announcement will be met with indifference.”

At a meeting of Medicare's Practicing Physicians Advisory Council (PPAC) held before the changes were announced, several physicians said the program would be a hassle for them to implement. For instance, PPAC chair Dr. Ronald Castellanos said it would cost him $15,000 to make the necessary changes in his practice to accommodate the program.

“I'm going to have to redesign my workflow between the clinical and office buildings, change the clearinghouse software, and change the software I use to send things to other providers” and to CMS, he said. “I had [a company] give me an estimate, and it's about $15,000. That's a lot of money to do a voluntary program.”

In return for submitting data to the program, physicians get a report telling them how well they did on each measure within their own patient population, as well as a comparison of their performance with that of other physicians regionally and nationally. Although physicians do not need to register with CMS to submit data, they must register to receive the reports.

Dr. Michael Rapp, director of the quality measurement and health assessment group at CMS, said that although there was no money attached to the reporting process, “We want to make it beneficial to physicians.” The reports are one way of doing that, but CMS would welcome any other ideas, he added.

Council member Dr. Peter Grimm, a radiation oncologist in Seattle, asked why hospitals receive a 0.4% payment incentive to report data under another reporting program, but physicians do not. “What is the rationale for that? Doctors don't need [the money], or hospitals deserve it more?”

Dr. Trent Haywood, a deputy chief medical officer at CMS, said that when the hospital reporting program started in 2002, hospitals didn't get paid either—that started later on.

Council member Dr. Laura Powers, a Knoxville neurologist, said outcomes measures wouldn't work well in a practice such as hers, where many patients have terminal illnesses. “I take care of patients who are going to die no matter what you do, but I have to make sure their quality of life is better for however long they have to live. That's why we need to have process measures.”

The council passed a resolution noting that because the voluntary reporting program will require additional staff, training on use of G codes, and reconfiguration of computer program, “PPAC advises that any effort at implementing quality measures and reporting must come after physician payment reform and a reduction in current regulatory and administrative demands. Otherwise, efforts to improve care will be impeded.”

The council also passed a resolution asking that CMS seek comments from the appropriate specialty societies regarding the issues raised by the voluntary reporting program, “and, like the hospital program, pay for data collection.”

Medicare is attempting to simplify the requirements of a new voluntary reporting system that physicians claim is too burdensome.

Under the latest revision from the Centers for Medicare and Medicaid Services, physicians participating in the Physician Voluntary Reporting Program (PVRP) will have only 16 measures to choose to report on instead of 36. CMS also is working to revise the program's reporting system to provide more options for physicians.

Primary care groups opposed CMs' decision to collect clinical data through a set of Healthcare Common Procedure Coding System (HCPCS) codes or G codes—a system most physicians do not use. The agency is working with the American Medical Association to add the option to use CPT II codes as well as G codes, CMS spokesman Peter Ashkenaz told this newspaper. “This will provide clinicians with the flexibility of utilizing either G codes or CPT II codes” for the program, he said.

The 16 starter measures address a wide spectrum of clinical care, including administration of aspirin at arrival for acute myocardial infarction; control of lipids, blood pressure, and glycosylated hemoglobin for patients with diabetes; and assessment of fall risk in elderly patients.

The 20 measures removed from the original set won't necessarily be thrown out. In a fact sheet, CMS said it intended to pursue further development of those and other measures suggested by physician groups.

Reactions to the changes varied. Dr. C. Anderson Hedberg, president of the American College of Physicians, called the revisions “critically important.” As reporting and pay-for-performance programs become more widespread, “uniformity and a realistic set of measures that don't create huge administrative reporting burdens are essential for physician acceptance and the success of any quality improvement and measurement program.”

Any simplification of reporting is welcome, Dr. Larry Fields, president of the American Academy of Family Physicians, noted in an interview. Yet “this is still a voluntary program with no immediate benefit to patients or physicians.”

In light of the 4.4% cut in physician pay that went into effect Jan. 1, physicians “will be even less able to comply with any reporting, voluntary or not,” Dr. Fields said. Without a positive incentive to participate, “I expect that CMs' announcement will be met with indifference.”

At a meeting of Medicare's Practicing Physicians Advisory Council (PPAC) held before the changes were announced, several physicians said the program would be a hassle for them to implement. For instance, PPAC chair Dr. Ronald Castellanos said it would cost him $15,000 to make the necessary changes in his practice to accommodate the program.

“I'm going to have to redesign my workflow between the clinical and office buildings, change the clearinghouse software, and change the software I use to send things to other providers” and to CMS, he said. “I had [a company] give me an estimate, and it's about $15,000. That's a lot of money to do a voluntary program.”

In return for submitting data to the program, physicians get a report telling them how well they did on each measure within their own patient population, as well as a comparison of their performance with that of other physicians regionally and nationally. Although physicians do not need to register with CMS to submit data, they must register to receive the reports.

Dr. Michael Rapp, director of the quality measurement and health assessment group at CMS, said that although there was no money attached to the reporting process, “We want to make it beneficial to physicians.” The reports are one way of doing that, but CMS would welcome any other ideas, he added.

Council member Dr. Peter Grimm, a radiation oncologist in Seattle, asked why hospitals receive a 0.4% payment incentive to report data under another reporting program, but physicians do not. “What is the rationale for that? Doctors don't need [the money], or hospitals deserve it more?”

Dr. Trent Haywood, a deputy chief medical officer at CMS, said that when the hospital reporting program started in 2002, hospitals didn't get paid either—that started later on.

Council member Dr. Laura Powers, a Knoxville neurologist, said outcomes measures wouldn't work well in a practice such as hers, where many patients have terminal illnesses. “I take care of patients who are going to die no matter what you do, but I have to make sure their quality of life is better for however long they have to live. That's why we need to have process measures.”

The council passed a resolution noting that because the voluntary reporting program will require additional staff, training on use of G codes, and reconfiguration of computer program, “PPAC advises that any effort at implementing quality measures and reporting must come after physician payment reform and a reduction in current regulatory and administrative demands. Otherwise, efforts to improve care will be impeded.”

The council also passed a resolution asking that CMS seek comments from the appropriate specialty societies regarding the issues raised by the voluntary reporting program, “and, like the hospital program, pay for data collection.”