Jennifer Lubell

Outlook 2006

Facing yet another year with an unfixed sustainable growth rate that threatens to reduce Medicare payments, primary care physicians in 2006 will continue to focus on the developing pay-for-performance initiative, while advocating for funds to support health information technology. Medical liability reform was on the back burner in 2005, but fueled by a promise from Senate Majority Leader Bill Frist (R-Tenn.) it should appear on the table again in 2006.

Pay for Performance

Getting Congress and the federal government to understand the physician's point of view on pay for performance is a goal for primary care groups in 2006. The American Academy of Family Physicians plans to work with the Centers for Medicare and Medicaid Services to either moderate or do away with this approach in favor of more reliable data sets tied to payment reform. “Any pay-for-performance initiative that occurs should be tied to a positive Medicare update,” said AAFP President Dr. Larry Fields. The system should be simple and easy to comply with, regardless of the presence or absence of electronic health records. This is why primary care groups are advocating for a consistent data set, such as the 26 quality measures that have been vetted by the Ambulatory Care Quality Alliance. These measures have been widely accepted throughout the insurance industry, he said.

Resolving Coding Concerns

CMS should make changes to its new voluntary reporting program, which has fueled concerns about using unfamiliar G codes to measure physician performance. Until changes are made, the AAFP plans to educate its members on the voluntary reporting program. “We also want changes to the relative work values that go into evaluation and management codes, to more accurately reflect the work of physicians primarily engaged in cognitive versus procedural specialties,” Dr. Fields said.

Health Information Technology

The AAFP has made headway regarding the information technology boom—use of electronic records have increased among its members from 7% in 2003 to 30% in 2005, “a tribute to the academy's diligence,” Dr. Fields said. The federal government and private insurers should invest some money into the adoption of electronic medical records, however, “so implementation is not such a financial burden,” he said. Pay-for-performance funds, for example, should be directed at small physician offices to help them adopt this technology.

Medical Liability Reform

Sen. Frist has promised to have a medical liability reform bill on the floor in 2006, specifically one that includes a cap on noneconomic damages, Dr. Fields said. “What happens every year is the House passes a fairly reasonable bill and the Senate doesn't act.” A hard cap on pain and suffering damages at $350,000 or less “is the only proven way” to reduce skyrocketing medical liability premiums, he said. The AAFP would like state legislators to use the academy's 2005 “strike force” report on what is effective in controlling liability costs, he said.

Help for Low-Income Patients

More states should adopt North Carolina's approach to Medicaid reform, Dr. Fields said. Changes brought about by the state have improved Medicaid for patients and physicians by providing beneficiaries with a medical home. “It's been shown that primary care physicians are more cost efficient and provide better outcomes than subspecialists,” he said. The AAFP has also developed a new task force on health care coverage to look at updating its 5-year-old plan to provide coverage for all patients. Evidence pointing to a health care system breakdown continues to mount. A recent study by the Center for Studying Health System Change noted that unequal access to high-quality health care is widening the gap between rich and poor patients. “Increasingly, America is turning into a country of health care haves and have-nots, driven primarily by the type of—or lack of—health coverage people have,” said lead author Robert E. Hurley, Ph.D., a senior consulting researcher at the center. The study was published as a Web-exclusive article in the journal Health Affairs.

Medicare Drug Changes in 2007

The U.S. Pharmacopeia recently issued draft revisions to the voluntary model guidelines used by Medicare Part D prescription drug plans. The revisions will apply to formularies for 2007. The revised guidelines contain the same number of unique drug categories and classes as the previous version; however, the USP is proposing changes within and across several categories. For example, the document proposes to eliminate the distinction between NSAIDs and cyclo-oxygenase-2 inhibitors and between selective serotonin reuptake inhibitors and serotonin norepinephrine reuptake inhibitors. The document also proposes to add a number of medicines that might be covered either by Medicare Part B or Part D, depending on the setting. The revisions are based on the review of newly approved and discontinued drugs, changes to approved therapeutic uses, new information on the safety and efficacy of drugs, and comments since the first version of the model guidelines was issued in 2004. The 2004 model guidelines were widely used by Medicare prescription drug plans in designing their formularies, USP Vice President William A. Zeruld said at a press briefing. Three of every four formularies used the USP model guidelines in designing plans for 2006, Mr. Zeruld said. USP will submit its final proposal to CMS on Jan. 30.

Outlook 2006

Facing yet another year with an unfixed sustainable growth rate that threatens to reduce Medicare payments, primary care physicians in 2006 will continue to focus on the developing pay-for-performance initiative, while advocating for funds to support health information technology. Medical liability reform was on the back burner in 2005, but fueled by a promise from Senate Majority Leader Bill Frist (R-Tenn.) it should appear on the table again in 2006.

Pay for Performance

Getting Congress and the federal government to understand the physician's point of view on pay for performance is a goal for primary care groups in 2006. The American Academy of Family Physicians plans to work with the Centers for Medicare and Medicaid Services to either moderate or do away with this approach in favor of more reliable data sets tied to payment reform. “Any pay-for-performance initiative that occurs should be tied to a positive Medicare update,” said AAFP President Dr. Larry Fields. The system should be simple and easy to comply with, regardless of the presence or absence of electronic health records. This is why primary care groups are advocating for a consistent data set, such as the 26 quality measures that have been vetted by the Ambulatory Care Quality Alliance. These measures have been widely accepted throughout the insurance industry, he said.

Resolving Coding Concerns

CMS should make changes to its new voluntary reporting program, which has fueled concerns about using unfamiliar G codes to measure physician performance. Until changes are made, the AAFP plans to educate its members on the voluntary reporting program. “We also want changes to the relative work values that go into evaluation and management codes, to more accurately reflect the work of physicians primarily engaged in cognitive versus procedural specialties,” Dr. Fields said.

Health Information Technology

The AAFP has made headway regarding the information technology boom—use of electronic records have increased among its members from 7% in 2003 to 30% in 2005, “a tribute to the academy's diligence,” Dr. Fields said. The federal government and private insurers should invest some money into the adoption of electronic medical records, however, “so implementation is not such a financial burden,” he said. Pay-for-performance funds, for example, should be directed at small physician offices to help them adopt this technology.

Medical Liability Reform

Sen. Frist has promised to have a medical liability reform bill on the floor in 2006, specifically one that includes a cap on noneconomic damages, Dr. Fields said. “What happens every year is the House passes a fairly reasonable bill and the Senate doesn't act.” A hard cap on pain and suffering damages at $350,000 or less “is the only proven way” to reduce skyrocketing medical liability premiums, he said. The AAFP would like state legislators to use the academy's 2005 “strike force” report on what is effective in controlling liability costs, he said.

Help for Low-Income Patients

More states should adopt North Carolina's approach to Medicaid reform, Dr. Fields said. Changes brought about by the state have improved Medicaid for patients and physicians by providing beneficiaries with a medical home. “It's been shown that primary care physicians are more cost efficient and provide better outcomes than subspecialists,” he said. The AAFP has also developed a new task force on health care coverage to look at updating its 5-year-old plan to provide coverage for all patients. Evidence pointing to a health care system breakdown continues to mount. A recent study by the Center for Studying Health System Change noted that unequal access to high-quality health care is widening the gap between rich and poor patients. “Increasingly, America is turning into a country of health care haves and have-nots, driven primarily by the type of—or lack of—health coverage people have,” said lead author Robert E. Hurley, Ph.D., a senior consulting researcher at the center. The study was published as a Web-exclusive article in the journal Health Affairs.

Medicare Drug Changes in 2007

The U.S. Pharmacopeia recently issued draft revisions to the voluntary model guidelines used by Medicare Part D prescription drug plans. The revisions will apply to formularies for 2007. The revised guidelines contain the same number of unique drug categories and classes as the previous version; however, the USP is proposing changes within and across several categories. For example, the document proposes to eliminate the distinction between NSAIDs and cyclo-oxygenase-2 inhibitors and between selective serotonin reuptake inhibitors and serotonin norepinephrine reuptake inhibitors. The document also proposes to add a number of medicines that might be covered either by Medicare Part B or Part D, depending on the setting. The revisions are based on the review of newly approved and discontinued drugs, changes to approved therapeutic uses, new information on the safety and efficacy of drugs, and comments since the first version of the model guidelines was issued in 2004. The 2004 model guidelines were widely used by Medicare prescription drug plans in designing their formularies, USP Vice President William A. Zeruld said at a press briefing. Three of every four formularies used the USP model guidelines in designing plans for 2006, Mr. Zeruld said. USP will submit its final proposal to CMS on Jan. 30.

Outlook 2006

Facing yet another year with an unfixed sustainable growth rate that threatens to reduce Medicare payments, primary care physicians in 2006 will continue to focus on the developing pay-for-performance initiative, while advocating for funds to support health information technology. Medical liability reform was on the back burner in 2005, but fueled by a promise from Senate Majority Leader Bill Frist (R-Tenn.) it should appear on the table again in 2006.

Pay for Performance

Getting Congress and the federal government to understand the physician's point of view on pay for performance is a goal for primary care groups in 2006. The American Academy of Family Physicians plans to work with the Centers for Medicare and Medicaid Services to either moderate or do away with this approach in favor of more reliable data sets tied to payment reform. “Any pay-for-performance initiative that occurs should be tied to a positive Medicare update,” said AAFP President Dr. Larry Fields. The system should be simple and easy to comply with, regardless of the presence or absence of electronic health records. This is why primary care groups are advocating for a consistent data set, such as the 26 quality measures that have been vetted by the Ambulatory Care Quality Alliance. These measures have been widely accepted throughout the insurance industry, he said.

Resolving Coding Concerns

CMS should make changes to its new voluntary reporting program, which has fueled concerns about using unfamiliar G codes to measure physician performance. Until changes are made, the AAFP plans to educate its members on the voluntary reporting program. “We also want changes to the relative work values that go into evaluation and management codes, to more accurately reflect the work of physicians primarily engaged in cognitive versus procedural specialties,” Dr. Fields said.

Health Information Technology

The AAFP has made headway regarding the information technology boom—use of electronic records have increased among its members from 7% in 2003 to 30% in 2005, “a tribute to the academy's diligence,” Dr. Fields said. The federal government and private insurers should invest some money into the adoption of electronic medical records, however, “so implementation is not such a financial burden,” he said. Pay-for-performance funds, for example, should be directed at small physician offices to help them adopt this technology.

Medical Liability Reform

Sen. Frist has promised to have a medical liability reform bill on the floor in 2006, specifically one that includes a cap on noneconomic damages, Dr. Fields said. “What happens every year is the House passes a fairly reasonable bill and the Senate doesn't act.” A hard cap on pain and suffering damages at $350,000 or less “is the only proven way” to reduce skyrocketing medical liability premiums, he said. The AAFP would like state legislators to use the academy's 2005 “strike force” report on what is effective in controlling liability costs, he said.

Help for Low-Income Patients

More states should adopt North Carolina's approach to Medicaid reform, Dr. Fields said. Changes brought about by the state have improved Medicaid for patients and physicians by providing beneficiaries with a medical home. “It's been shown that primary care physicians are more cost efficient and provide better outcomes than subspecialists,” he said. The AAFP has also developed a new task force on health care coverage to look at updating its 5-year-old plan to provide coverage for all patients. Evidence pointing to a health care system breakdown continues to mount. A recent study by the Center for Studying Health System Change noted that unequal access to high-quality health care is widening the gap between rich and poor patients. “Increasingly, America is turning into a country of health care haves and have-nots, driven primarily by the type of—or lack of—health coverage people have,” said lead author Robert E. Hurley, Ph.D., a senior consulting researcher at the center. The study was published as a Web-exclusive article in the journal Health Affairs.

Medicare Drug Changes in 2007

The U.S. Pharmacopeia recently issued draft revisions to the voluntary model guidelines used by Medicare Part D prescription drug plans. The revisions will apply to formularies for 2007. The revised guidelines contain the same number of unique drug categories and classes as the previous version; however, the USP is proposing changes within and across several categories. For example, the document proposes to eliminate the distinction between NSAIDs and cyclo-oxygenase-2 inhibitors and between selective serotonin reuptake inhibitors and serotonin norepinephrine reuptake inhibitors. The document also proposes to add a number of medicines that might be covered either by Medicare Part B or Part D, depending on the setting. The revisions are based on the review of newly approved and discontinued drugs, changes to approved therapeutic uses, new information on the safety and efficacy of drugs, and comments since the first version of the model guidelines was issued in 2004. The 2004 model guidelines were widely used by Medicare prescription drug plans in designing their formularies, USP Vice President William A. Zeruld said at a press briefing. Three of every four formularies used the USP model guidelines in designing plans for 2006, Mr. Zeruld said. USP will submit its final proposal to CMS on Jan. 30.

While various organizations have made substantial progress developing health care performance measures, it's time for Congress to establish an entity that can standardize these measures across the health care system, according to a report from the Institute of Medicine.

Such a board should be part of the Department of Health and Human Services, according to the report.

In particular, any participating provider should be required to submit performance data to the board, so that Medicare could use the information for quality improvement activities or as a basis for payment incentives and public reporting, the IOM committee wrote. The committee's efforts were mandated by Congress and sponsored by the HHS.

In a statement, Dr. C. Anderson Hedberg, president of the American College of Physicians, praised the IOM's intention to establish a centralized organizing structure.

“This may be one way to set clear quality goals, coordinate performance measurement efforts, support fair comparisons of cost and quality, and ensure stable funding for organizations involved in performance measurement,” Dr. Hedberg said.

A standard nationwide set of measures “would avoid the morass of everyone developing their own, including the government,” Dr. Larry Fields, president of the American Academy of Family Physicians, said in an interview.

But it may not necessarily take a national board to get people to adopt a consensus on measures, he added. The key is to have a set of measures that are accepted as reasonable by these programs. “Other measures can be added as necessary.”

Performance measures are benchmarks by which health care providers and organizations can determine their success in delivering care. Examples include regular blood and urine tests for diabetic patients, a facility's 30-day survival rate among cardiac bypass patients, or perceptions of care collected from patient surveys.

The problem is all of these independent initiatives have led to duplication in some areas and neglect in others that are important to national health goals, the committee noted. Individual stakeholders understandably focus on certain features of care that they consider to be the highest priority for improvement. “But they frequently overlook areas of national interest that are difficult to quantify, such as whether care is equitable, efficient, and well coordinated.”

As an initial step toward achieving a universally accepted set of measures, the report recommended the adoption of an evidence-based “starter set” of existing measures that would cover care delivered in ambulatory, acute care, and long-term care settings and in dialysis centers. As one of the founding members of the Ambulatory Care Quality Alliance (AQA), the ACP was pleased that the starter set proposed by the IOM comprised the AQA's 26 clinical performance measures for the ambulatory care setting.

The board should also guide development in areas that are currently lacking in performance measures, such as efficiency, equity, and patient-centered care, the committee noted.

“One of the biggest obstacles to overcoming shortfalls in the quality of health care is the absence of a coherent, national system for assessing and reporting on the performance of providers and organizations,” said IOM committee chair Steven Schroeder, Ph.D., professor of health and health care, University of California, San Francisco. Leadership at the federal level is needed to ensure that performance measures achieve national goals for health care improvement, he said.

The committee recommended that Congress should authorize $100 million to $200 million in annual funding for the national board from the Medicare Trust Fund. This amounts to less than one-tenth of 1 percent of annual Medicare expenditures.

What's lacking in the report is a recommendation for Congress and the private payers to put money into the system to help defray costs of this type of reporting, Dr. Fields said. “The two must go hand in hand, because this type of reporting costs money.” Otherwise, pay for performance is going to be an extreme burden to physicians–primary care physicians in particular–if they don't have technology to do pay for performance, he said.

Questions remain on whether pay for performance can improve quality, Dr. Fields noted. “Some of the private payers don't buy into that. When they talk about quality, what they really mean is saving money.” For certain diseases, this type of reporting has been effective, “but it's not yet been shown to be effective over a wide series of medical problems.”

If a universal system is instituted, it needs to be pilot tested first, to find out if it can improve quality, he said. “There needs to be a gradual shift from reporting aspects [of clinical measures] to actual quality measures.”

Requested by Congress, the report is the first in a series that will focus on the redesign of health insurance to accelerate the pace of quality improvement efforts in the United States. Subsequent reports will evaluate Medicare's Quality Improvement Organization program and analyze payment incentives.

While various organizations have made substantial progress developing health care performance measures, it's time for Congress to establish an entity that can standardize these measures across the health care system, according to a report from the Institute of Medicine.

Such a board should be part of the Department of Health and Human Services, according to the report.

In particular, any participating provider should be required to submit performance data to the board, so that Medicare could use the information for quality improvement activities or as a basis for payment incentives and public reporting, the IOM committee wrote. The committee's efforts were mandated by Congress and sponsored by the HHS.

In a statement, Dr. C. Anderson Hedberg, president of the American College of Physicians, praised the IOM's intention to establish a centralized organizing structure.

“This may be one way to set clear quality goals, coordinate performance measurement efforts, support fair comparisons of cost and quality, and ensure stable funding for organizations involved in performance measurement,” Dr. Hedberg said.

A standard nationwide set of measures “would avoid the morass of everyone developing their own, including the government,” Dr. Larry Fields, president of the American Academy of Family Physicians, said in an interview.

But it may not necessarily take a national board to get people to adopt a consensus on measures, he added. The key is to have a set of measures that are accepted as reasonable by these programs. “Other measures can be added as necessary.”

Performance measures are benchmarks by which health care providers and organizations can determine their success in delivering care. Examples include regular blood and urine tests for diabetic patients, a facility's 30-day survival rate among cardiac bypass patients, or perceptions of care collected from patient surveys.

The problem is all of these independent initiatives have led to duplication in some areas and neglect in others that are important to national health goals, the committee noted. Individual stakeholders understandably focus on certain features of care that they consider to be the highest priority for improvement. “But they frequently overlook areas of national interest that are difficult to quantify, such as whether care is equitable, efficient, and well coordinated.”

As an initial step toward achieving a universally accepted set of measures, the report recommended the adoption of an evidence-based “starter set” of existing measures that would cover care delivered in ambulatory, acute care, and long-term care settings and in dialysis centers. As one of the founding members of the Ambulatory Care Quality Alliance (AQA), the ACP was pleased that the starter set proposed by the IOM comprised the AQA's 26 clinical performance measures for the ambulatory care setting.

The board should also guide development in areas that are currently lacking in performance measures, such as efficiency, equity, and patient-centered care, the committee noted.

“One of the biggest obstacles to overcoming shortfalls in the quality of health care is the absence of a coherent, national system for assessing and reporting on the performance of providers and organizations,” said IOM committee chair Steven Schroeder, Ph.D., professor of health and health care, University of California, San Francisco. Leadership at the federal level is needed to ensure that performance measures achieve national goals for health care improvement, he said.

The committee recommended that Congress should authorize $100 million to $200 million in annual funding for the national board from the Medicare Trust Fund. This amounts to less than one-tenth of 1 percent of annual Medicare expenditures.

What's lacking in the report is a recommendation for Congress and the private payers to put money into the system to help defray costs of this type of reporting, Dr. Fields said. “The two must go hand in hand, because this type of reporting costs money.” Otherwise, pay for performance is going to be an extreme burden to physicians–primary care physicians in particular–if they don't have technology to do pay for performance, he said.

Questions remain on whether pay for performance can improve quality, Dr. Fields noted. “Some of the private payers don't buy into that. When they talk about quality, what they really mean is saving money.” For certain diseases, this type of reporting has been effective, “but it's not yet been shown to be effective over a wide series of medical problems.”

If a universal system is instituted, it needs to be pilot tested first, to find out if it can improve quality, he said. “There needs to be a gradual shift from reporting aspects [of clinical measures] to actual quality measures.”

Requested by Congress, the report is the first in a series that will focus on the redesign of health insurance to accelerate the pace of quality improvement efforts in the United States. Subsequent reports will evaluate Medicare's Quality Improvement Organization program and analyze payment incentives.

While various organizations have made substantial progress developing health care performance measures, it's time for Congress to establish an entity that can standardize these measures across the health care system, according to a report from the Institute of Medicine.

Such a board should be part of the Department of Health and Human Services, according to the report.

In particular, any participating provider should be required to submit performance data to the board, so that Medicare could use the information for quality improvement activities or as a basis for payment incentives and public reporting, the IOM committee wrote. The committee's efforts were mandated by Congress and sponsored by the HHS.

In a statement, Dr. C. Anderson Hedberg, president of the American College of Physicians, praised the IOM's intention to establish a centralized organizing structure.

“This may be one way to set clear quality goals, coordinate performance measurement efforts, support fair comparisons of cost and quality, and ensure stable funding for organizations involved in performance measurement,” Dr. Hedberg said.

A standard nationwide set of measures “would avoid the morass of everyone developing their own, including the government,” Dr. Larry Fields, president of the American Academy of Family Physicians, said in an interview.

But it may not necessarily take a national board to get people to adopt a consensus on measures, he added. The key is to have a set of measures that are accepted as reasonable by these programs. “Other measures can be added as necessary.”

Performance measures are benchmarks by which health care providers and organizations can determine their success in delivering care. Examples include regular blood and urine tests for diabetic patients, a facility's 30-day survival rate among cardiac bypass patients, or perceptions of care collected from patient surveys.

The problem is all of these independent initiatives have led to duplication in some areas and neglect in others that are important to national health goals, the committee noted. Individual stakeholders understandably focus on certain features of care that they consider to be the highest priority for improvement. “But they frequently overlook areas of national interest that are difficult to quantify, such as whether care is equitable, efficient, and well coordinated.”

As an initial step toward achieving a universally accepted set of measures, the report recommended the adoption of an evidence-based “starter set” of existing measures that would cover care delivered in ambulatory, acute care, and long-term care settings and in dialysis centers. As one of the founding members of the Ambulatory Care Quality Alliance (AQA), the ACP was pleased that the starter set proposed by the IOM comprised the AQA's 26 clinical performance measures for the ambulatory care setting.

The board should also guide development in areas that are currently lacking in performance measures, such as efficiency, equity, and patient-centered care, the committee noted.

“One of the biggest obstacles to overcoming shortfalls in the quality of health care is the absence of a coherent, national system for assessing and reporting on the performance of providers and organizations,” said IOM committee chair Steven Schroeder, Ph.D., professor of health and health care, University of California, San Francisco. Leadership at the federal level is needed to ensure that performance measures achieve national goals for health care improvement, he said.

The committee recommended that Congress should authorize $100 million to $200 million in annual funding for the national board from the Medicare Trust Fund. This amounts to less than one-tenth of 1 percent of annual Medicare expenditures.

What's lacking in the report is a recommendation for Congress and the private payers to put money into the system to help defray costs of this type of reporting, Dr. Fields said. “The two must go hand in hand, because this type of reporting costs money.” Otherwise, pay for performance is going to be an extreme burden to physicians–primary care physicians in particular–if they don't have technology to do pay for performance, he said.

Questions remain on whether pay for performance can improve quality, Dr. Fields noted. “Some of the private payers don't buy into that. When they talk about quality, what they really mean is saving money.” For certain diseases, this type of reporting has been effective, “but it's not yet been shown to be effective over a wide series of medical problems.”

If a universal system is instituted, it needs to be pilot tested first, to find out if it can improve quality, he said. “There needs to be a gradual shift from reporting aspects [of clinical measures] to actual quality measures.”

Requested by Congress, the report is the first in a series that will focus on the redesign of health insurance to accelerate the pace of quality improvement efforts in the United States. Subsequent reports will evaluate Medicare's Quality Improvement Organization program and analyze payment incentives.

The American College of Physicians is testing a new resource that would provide direct assistance to physicians interested in practice redesign.

Starting this month, the ACP's Center for Practice Innovation (CPI) will work with 25-50 small- and medium-sized internal medicine practices to help them prepare for the ever-developing pay-for-performance movement and technology boom, and the complexities of the new recertification process.

“Our belief,” said Dr. C. Anderson Hedberg, ACP president, “is that the financial concerns of physicians regarding the implementation and management of the changing practice environment will be addressed through office redesign, attention to quality innovation, enhanced patient satisfaction, and practice growth.”

Funding for the center was provided in a 2-year, $996,000 grant from the Physicians' Foundation for Health Systems Excellence (PFHSE). “The grant will enable ACP to provide new practice-level support and to test innovative approaches aimed at changes in practice management, physician education and patient safety/disease management, and patient satisfaction,” said Dr. Michael S. Barr, ACP's vice president of practice advocacy and improvement and director of the project.

In an interview, Dr. Barr said the center would be selecting practices from across the country, “probably in regional clusters.” Specifically, it wants to target practices of 10 physicians or smaller–practices that don't always have outside support to improve their practice environment.

“We will aim to have a group of practices that are fairly representative of the types of practices in the United States, and will seek to balance the set of practices based on fairly typical demographic factors,” he said.

The 2-year project includes an implementation phase, during which the 25-50 practices will be actively engaged in practice redesign efforts, Dr. Barr said. “We're not going into these practices with a specific, cookie cutter model,” he said. The idea is to adapt different tools and resources, and put together a “menu” of options for these practices based upon their unique situation. The practices will determine which interventions are right for them.

Success will be measured through data collected for selected clinical measures, as well as patient satisfaction, physician/staff satisfaction, and economic indicators of practice function.

Dr. Barr said the CPI will be urging practices to select clinical measures most appropriate for the populations they serve. The center will encourage practices to use clinical measures endorsed by the Ambulatory Care Quality Alliance. Those measures would allow for “adequate comparisons to be made across practices reporting on the same measures,” he said.

These measurements “will help us assess the outcomes for a final report,” he said. “Based on the lessons learned, we hope that the activities continue beyond this 2-year project.” The CPI plans to convene a steering committee to help guide its progress.

None of the practices will be getting direct monetary assistance from the center, he said. “The assistance will come in the form of on-the-ground consultation, support, giving them tools and services, connection with their peers,” and help with recertification.

For now, the project will be limited only to the selected practices, Dr. Barr said. “Unless we are able to obtain additional funding during this 2-year period, it will be difficult to provide the level of assistance to other practices. However, we'll certainly be sharing information along the way through the new CPI Web site.” ACP's Practice Management Center will continue to provide the advice and support that it currently offers for practices looking for more resources, he said.

The CPI is aware of the American Board of Internal Medicine's work with its practice improvement modules, Dr. Barr said. As it develops its own interventions, the center will be mindful of these developments in recertification.

Although health information technology won't be the central focus of the center's activities, there's no denying that health IT is a good way for practices to generate these types of quality improvement outcomes, Dr. Barr said.

“Health information technology and performance measurement have the potential to improve the consistency of outpatient medicine. This new approach will require some time for assimilation, but the external pressure for rapid change might cause future shock for established practitioners,” commented Dr. William Golden, a professor of medicine and public health at the University of Arkansas, who has also worked on a special liaison panel between the American College of Physicians and the ABIM to develop pathways to recertification.

The American College of Physicians is testing a new resource that would provide direct assistance to physicians interested in practice redesign.

Starting this month, the ACP's Center for Practice Innovation (CPI) will work with 25-50 small- and medium-sized internal medicine practices to help them prepare for the ever-developing pay-for-performance movement and technology boom, and the complexities of the new recertification process.

“Our belief,” said Dr. C. Anderson Hedberg, ACP president, “is that the financial concerns of physicians regarding the implementation and management of the changing practice environment will be addressed through office redesign, attention to quality innovation, enhanced patient satisfaction, and practice growth.”

Funding for the center was provided in a 2-year, $996,000 grant from the Physicians' Foundation for Health Systems Excellence (PFHSE). “The grant will enable ACP to provide new practice-level support and to test innovative approaches aimed at changes in practice management, physician education and patient safety/disease management, and patient satisfaction,” said Dr. Michael S. Barr, ACP's vice president of practice advocacy and improvement and director of the project.

In an interview, Dr. Barr said the center would be selecting practices from across the country, “probably in regional clusters.” Specifically, it wants to target practices of 10 physicians or smaller–practices that don't always have outside support to improve their practice environment.

“We will aim to have a group of practices that are fairly representative of the types of practices in the United States, and will seek to balance the set of practices based on fairly typical demographic factors,” he said.

The 2-year project includes an implementation phase, during which the 25-50 practices will be actively engaged in practice redesign efforts, Dr. Barr said. “We're not going into these practices with a specific, cookie cutter model,” he said. The idea is to adapt different tools and resources, and put together a “menu” of options for these practices based upon their unique situation. The practices will determine which interventions are right for them.

Success will be measured through data collected for selected clinical measures, as well as patient satisfaction, physician/staff satisfaction, and economic indicators of practice function.

Dr. Barr said the CPI will be urging practices to select clinical measures most appropriate for the populations they serve. The center will encourage practices to use clinical measures endorsed by the Ambulatory Care Quality Alliance. Those measures would allow for “adequate comparisons to be made across practices reporting on the same measures,” he said.

These measurements “will help us assess the outcomes for a final report,” he said. “Based on the lessons learned, we hope that the activities continue beyond this 2-year project.” The CPI plans to convene a steering committee to help guide its progress.

None of the practices will be getting direct monetary assistance from the center, he said. “The assistance will come in the form of on-the-ground consultation, support, giving them tools and services, connection with their peers,” and help with recertification.

For now, the project will be limited only to the selected practices, Dr. Barr said. “Unless we are able to obtain additional funding during this 2-year period, it will be difficult to provide the level of assistance to other practices. However, we'll certainly be sharing information along the way through the new CPI Web site.” ACP's Practice Management Center will continue to provide the advice and support that it currently offers for practices looking for more resources, he said.

The CPI is aware of the American Board of Internal Medicine's work with its practice improvement modules, Dr. Barr said. As it develops its own interventions, the center will be mindful of these developments in recertification.

Although health information technology won't be the central focus of the center's activities, there's no denying that health IT is a good way for practices to generate these types of quality improvement outcomes, Dr. Barr said.

“Health information technology and performance measurement have the potential to improve the consistency of outpatient medicine. This new approach will require some time for assimilation, but the external pressure for rapid change might cause future shock for established practitioners,” commented Dr. William Golden, a professor of medicine and public health at the University of Arkansas, who has also worked on a special liaison panel between the American College of Physicians and the ABIM to develop pathways to recertification.

The American College of Physicians is testing a new resource that would provide direct assistance to physicians interested in practice redesign.

Starting this month, the ACP's Center for Practice Innovation (CPI) will work with 25-50 small- and medium-sized internal medicine practices to help them prepare for the ever-developing pay-for-performance movement and technology boom, and the complexities of the new recertification process.

“Our belief,” said Dr. C. Anderson Hedberg, ACP president, “is that the financial concerns of physicians regarding the implementation and management of the changing practice environment will be addressed through office redesign, attention to quality innovation, enhanced patient satisfaction, and practice growth.”

Funding for the center was provided in a 2-year, $996,000 grant from the Physicians' Foundation for Health Systems Excellence (PFHSE). “The grant will enable ACP to provide new practice-level support and to test innovative approaches aimed at changes in practice management, physician education and patient safety/disease management, and patient satisfaction,” said Dr. Michael S. Barr, ACP's vice president of practice advocacy and improvement and director of the project.

In an interview, Dr. Barr said the center would be selecting practices from across the country, “probably in regional clusters.” Specifically, it wants to target practices of 10 physicians or smaller–practices that don't always have outside support to improve their practice environment.

“We will aim to have a group of practices that are fairly representative of the types of practices in the United States, and will seek to balance the set of practices based on fairly typical demographic factors,” he said.

The 2-year project includes an implementation phase, during which the 25-50 practices will be actively engaged in practice redesign efforts, Dr. Barr said. “We're not going into these practices with a specific, cookie cutter model,” he said. The idea is to adapt different tools and resources, and put together a “menu” of options for these practices based upon their unique situation. The practices will determine which interventions are right for them.

Success will be measured through data collected for selected clinical measures, as well as patient satisfaction, physician/staff satisfaction, and economic indicators of practice function.

Dr. Barr said the CPI will be urging practices to select clinical measures most appropriate for the populations they serve. The center will encourage practices to use clinical measures endorsed by the Ambulatory Care Quality Alliance. Those measures would allow for “adequate comparisons to be made across practices reporting on the same measures,” he said.

These measurements “will help us assess the outcomes for a final report,” he said. “Based on the lessons learned, we hope that the activities continue beyond this 2-year project.” The CPI plans to convene a steering committee to help guide its progress.

None of the practices will be getting direct monetary assistance from the center, he said. “The assistance will come in the form of on-the-ground consultation, support, giving them tools and services, connection with their peers,” and help with recertification.

For now, the project will be limited only to the selected practices, Dr. Barr said. “Unless we are able to obtain additional funding during this 2-year period, it will be difficult to provide the level of assistance to other practices. However, we'll certainly be sharing information along the way through the new CPI Web site.” ACP's Practice Management Center will continue to provide the advice and support that it currently offers for practices looking for more resources, he said.

The CPI is aware of the American Board of Internal Medicine's work with its practice improvement modules, Dr. Barr said. As it develops its own interventions, the center will be mindful of these developments in recertification.

Although health information technology won't be the central focus of the center's activities, there's no denying that health IT is a good way for practices to generate these types of quality improvement outcomes, Dr. Barr said.

“Health information technology and performance measurement have the potential to improve the consistency of outpatient medicine. This new approach will require some time for assimilation, but the external pressure for rapid change might cause future shock for established practitioners,” commented Dr. William Golden, a professor of medicine and public health at the University of Arkansas, who has also worked on a special liaison panel between the American College of Physicians and the ABIM to develop pathways to recertification.

Outlook 2006

Facing yet another year under the threat of lower Medicare payments, internists in 2006 will continue to focus on the developing pay-for-performance initiative, while advocating for funds to support health information technology. Medical liability reform was on the back burner in 2005, but fueled by a promise from Senate Majority Leader Bill Frist (R-Tenn.), it should appear on the table again in 2006.

Pay for Performance

Getting Congress and the federal government to understand the physician's point of view on pay for performance is a goal this year for the American College of Physicians. The ACP, along with other medical societies, is advocating for a consistent data set, such as the 26 quality measures that have been vetted by the Ambulatory Care Quality Alliance. In a document given to Congress, the ACP presented a time line for a pay-for-performance program. The program would be voluntary, but participating physicians would receive a higher payment update. Much of what will affect physician payment this year will be addressed in conference negotiations on the omnibus appropriations bill, which at press time have not been completed. Even if Congress stabilizes payments and provides a 1-year fix, “there still could be a long-term problem” with the sustainable growth rate, Robert B. Doherty, the ACP's senior vice president for governmental affairs and public policy, told INTERNAL MEDICINE NEWS. “We don't know if the conference agreement will include a legislative mandate for [the Centers for Medicare and Medicaid Services] to move forward on pay for performance in 2007” or whether the program would be punitive, he said. Based on current proposed language, physicians could receive an increase for participating in quality reporting, but those who aren't able to participate may get a 2% cut in payments, he said.

Voluntary Reporting Program

Primary care groups are pressing CMS to make changes to its new voluntary reporting program, which has fueled concerns about using unfamiliar G codes to measure physician performance. The ACP in particular wants CMS to agree on a smaller set of measures that are aligned with the Ambulatory Care Quality Alliance measures, Mr. Doherty said. Currently, the agency is calling for 36 measures, “which will load up physicians with too many measures,” he said. It's expected that this voluntary program will become the basis for a federal pay-for-performance program as early as 2007. For that reason, “it's really important to get this program right, once dollars are linked to it,” he said.

Health Information Technology

The ACP continues to support efforts to help small practices implement electronic health records, and is calling for payment incentives for health information technology. The ACP wants to keep breaking down the barriers to physicians using EHRs, Mr. Doherty said. It's not enough for the college to track how many internists use EHRs–what's more important is finding out how many of these electronic systems function well enough to allow internists to participate in a quality measurement reporting program. One tool to help track this trend is the Certification Commission on Health Information Technology, which was set up by the American Health Information Management Association to create voluntary standards for health information technology. The ACP was involved in the development of this commission on several levels, Mr. Doherty said. “It started out purely as a private sector initiative, but now it has the federal government behind it to develop these standards.” The standards, focusing on interoperability and functionality, are expected early this year. “For the first time, physicians will know that there's an independent commission that will be able to tell them whether the system they're purchasing is a quality EHR system, which will greatly ease anxiety,” he said. In addition, the ACP is pressing Congress to enact a bill (H.R. 747) that would reimburse physicians who have electronic medical record systems that meet these types of certification standards and who participate in a CMS-approved quality measurement reporting program.

Medicare Drug Changes in 2007

The U.S. Pharmacopeia recently issued draft revisions to the voluntary model guidelines used by Medicare Part D prescription drug plans. The revisions will apply to formularies for 2007. The revised guidelines contain the same number of unique drug categories and classes as the previous version; however, the USP is proposing changes within and across several categories. For example, the document proposes to eliminate the distinction between NSAIDs and cyclo-oxygenase-2 inhibitors and between selective serotonin reuptake inhibitors and serotonin norepinephrine reuptake inhibitors. The document also proposes to add a number of medicines that might be covered either by Medicare Part B or Part D, depending on the setting. The revisions are based on the review of newly approved and discontinued drugs, changes to approved therapeutic uses, new information on the safety and efficacy of drugs, and comments since the first version of the model guidelines was issued in 2004. The 2004 model guidelines were widely used by Medicare prescription drug plans in designing their formularies, USP Vice President William A. Zeruld said at a press briefing. Three of every four formularies used the USP model guidelines in designing plans for 2006, Mr. Zeruld said. USP will submit its final proposal to CMS on Jan. 30.

Outlook 2006

Facing yet another year under the threat of lower Medicare payments, internists in 2006 will continue to focus on the developing pay-for-performance initiative, while advocating for funds to support health information technology. Medical liability reform was on the back burner in 2005, but fueled by a promise from Senate Majority Leader Bill Frist (R-Tenn.), it should appear on the table again in 2006.

Pay for Performance

Getting Congress and the federal government to understand the physician's point of view on pay for performance is a goal this year for the American College of Physicians. The ACP, along with other medical societies, is advocating for a consistent data set, such as the 26 quality measures that have been vetted by the Ambulatory Care Quality Alliance. In a document given to Congress, the ACP presented a time line for a pay-for-performance program. The program would be voluntary, but participating physicians would receive a higher payment update. Much of what will affect physician payment this year will be addressed in conference negotiations on the omnibus appropriations bill, which at press time have not been completed. Even if Congress stabilizes payments and provides a 1-year fix, “there still could be a long-term problem” with the sustainable growth rate, Robert B. Doherty, the ACP's senior vice president for governmental affairs and public policy, told INTERNAL MEDICINE NEWS. “We don't know if the conference agreement will include a legislative mandate for [the Centers for Medicare and Medicaid Services] to move forward on pay for performance in 2007” or whether the program would be punitive, he said. Based on current proposed language, physicians could receive an increase for participating in quality reporting, but those who aren't able to participate may get a 2% cut in payments, he said.

Voluntary Reporting Program

Primary care groups are pressing CMS to make changes to its new voluntary reporting program, which has fueled concerns about using unfamiliar G codes to measure physician performance. The ACP in particular wants CMS to agree on a smaller set of measures that are aligned with the Ambulatory Care Quality Alliance measures, Mr. Doherty said. Currently, the agency is calling for 36 measures, “which will load up physicians with too many measures,” he said. It's expected that this voluntary program will become the basis for a federal pay-for-performance program as early as 2007. For that reason, “it's really important to get this program right, once dollars are linked to it,” he said.

Health Information Technology

The ACP continues to support efforts to help small practices implement electronic health records, and is calling for payment incentives for health information technology. The ACP wants to keep breaking down the barriers to physicians using EHRs, Mr. Doherty said. It's not enough for the college to track how many internists use EHRs–what's more important is finding out how many of these electronic systems function well enough to allow internists to participate in a quality measurement reporting program. One tool to help track this trend is the Certification Commission on Health Information Technology, which was set up by the American Health Information Management Association to create voluntary standards for health information technology. The ACP was involved in the development of this commission on several levels, Mr. Doherty said. “It started out purely as a private sector initiative, but now it has the federal government behind it to develop these standards.” The standards, focusing on interoperability and functionality, are expected early this year. “For the first time, physicians will know that there's an independent commission that will be able to tell them whether the system they're purchasing is a quality EHR system, which will greatly ease anxiety,” he said. In addition, the ACP is pressing Congress to enact a bill (H.R. 747) that would reimburse physicians who have electronic medical record systems that meet these types of certification standards and who participate in a CMS-approved quality measurement reporting program.

Medicare Drug Changes in 2007

The U.S. Pharmacopeia recently issued draft revisions to the voluntary model guidelines used by Medicare Part D prescription drug plans. The revisions will apply to formularies for 2007. The revised guidelines contain the same number of unique drug categories and classes as the previous version; however, the USP is proposing changes within and across several categories. For example, the document proposes to eliminate the distinction between NSAIDs and cyclo-oxygenase-2 inhibitors and between selective serotonin reuptake inhibitors and serotonin norepinephrine reuptake inhibitors. The document also proposes to add a number of medicines that might be covered either by Medicare Part B or Part D, depending on the setting. The revisions are based on the review of newly approved and discontinued drugs, changes to approved therapeutic uses, new information on the safety and efficacy of drugs, and comments since the first version of the model guidelines was issued in 2004. The 2004 model guidelines were widely used by Medicare prescription drug plans in designing their formularies, USP Vice President William A. Zeruld said at a press briefing. Three of every four formularies used the USP model guidelines in designing plans for 2006, Mr. Zeruld said. USP will submit its final proposal to CMS on Jan. 30.

Outlook 2006

Facing yet another year under the threat of lower Medicare payments, internists in 2006 will continue to focus on the developing pay-for-performance initiative, while advocating for funds to support health information technology. Medical liability reform was on the back burner in 2005, but fueled by a promise from Senate Majority Leader Bill Frist (R-Tenn.), it should appear on the table again in 2006.

Pay for Performance

Getting Congress and the federal government to understand the physician's point of view on pay for performance is a goal this year for the American College of Physicians. The ACP, along with other medical societies, is advocating for a consistent data set, such as the 26 quality measures that have been vetted by the Ambulatory Care Quality Alliance. In a document given to Congress, the ACP presented a time line for a pay-for-performance program. The program would be voluntary, but participating physicians would receive a higher payment update. Much of what will affect physician payment this year will be addressed in conference negotiations on the omnibus appropriations bill, which at press time have not been completed. Even if Congress stabilizes payments and provides a 1-year fix, “there still could be a long-term problem” with the sustainable growth rate, Robert B. Doherty, the ACP's senior vice president for governmental affairs and public policy, told INTERNAL MEDICINE NEWS. “We don't know if the conference agreement will include a legislative mandate for [the Centers for Medicare and Medicaid Services] to move forward on pay for performance in 2007” or whether the program would be punitive, he said. Based on current proposed language, physicians could receive an increase for participating in quality reporting, but those who aren't able to participate may get a 2% cut in payments, he said.

Voluntary Reporting Program

Primary care groups are pressing CMS to make changes to its new voluntary reporting program, which has fueled concerns about using unfamiliar G codes to measure physician performance. The ACP in particular wants CMS to agree on a smaller set of measures that are aligned with the Ambulatory Care Quality Alliance measures, Mr. Doherty said. Currently, the agency is calling for 36 measures, “which will load up physicians with too many measures,” he said. It's expected that this voluntary program will become the basis for a federal pay-for-performance program as early as 2007. For that reason, “it's really important to get this program right, once dollars are linked to it,” he said.

Health Information Technology

The ACP continues to support efforts to help small practices implement electronic health records, and is calling for payment incentives for health information technology. The ACP wants to keep breaking down the barriers to physicians using EHRs, Mr. Doherty said. It's not enough for the college to track how many internists use EHRs–what's more important is finding out how many of these electronic systems function well enough to allow internists to participate in a quality measurement reporting program. One tool to help track this trend is the Certification Commission on Health Information Technology, which was set up by the American Health Information Management Association to create voluntary standards for health information technology. The ACP was involved in the development of this commission on several levels, Mr. Doherty said. “It started out purely as a private sector initiative, but now it has the federal government behind it to develop these standards.” The standards, focusing on interoperability and functionality, are expected early this year. “For the first time, physicians will know that there's an independent commission that will be able to tell them whether the system they're purchasing is a quality EHR system, which will greatly ease anxiety,” he said. In addition, the ACP is pressing Congress to enact a bill (H.R. 747) that would reimburse physicians who have electronic medical record systems that meet these types of certification standards and who participate in a CMS-approved quality measurement reporting program.

Medicare Drug Changes in 2007

The U.S. Pharmacopeia recently issued draft revisions to the voluntary model guidelines used by Medicare Part D prescription drug plans. The revisions will apply to formularies for 2007. The revised guidelines contain the same number of unique drug categories and classes as the previous version; however, the USP is proposing changes within and across several categories. For example, the document proposes to eliminate the distinction between NSAIDs and cyclo-oxygenase-2 inhibitors and between selective serotonin reuptake inhibitors and serotonin norepinephrine reuptake inhibitors. The document also proposes to add a number of medicines that might be covered either by Medicare Part B or Part D, depending on the setting. The revisions are based on the review of newly approved and discontinued drugs, changes to approved therapeutic uses, new information on the safety and efficacy of drugs, and comments since the first version of the model guidelines was issued in 2004. The 2004 model guidelines were widely used by Medicare prescription drug plans in designing their formularies, USP Vice President William A. Zeruld said at a press briefing. Three of every four formularies used the USP model guidelines in designing plans for 2006, Mr. Zeruld said. USP will submit its final proposal to CMS on Jan. 30.

WASHINGTON – Physician-directed interventions can increase rates of colorectal cancer screening in patients with low literacy skills, Dr. Charles Bennett reported at a conference on health literacy sponsored by the American College of Physicians Foundation.

Patients with limited literacy “may not be able to understand basic cancer screening information and educational materials, many of which are written at a literacy level above that of a significant portion of the American population,” noted Dr. Bennett, a hematologist/oncologist who is an associate director for the Veterans Administration Midwest Center for Health Services and Policy Research.

In a randomized, controlled trial among veterans age 50 years and older seen in two general primary care clinics, the use of provider-directed interventions led to a 26% increase in screening completion among patients with low literacy skills, he said.

No prior study has evaluated the cost effectiveness of health-promotion efforts for colorectal cancer (CRC), but successful interventions have been shown to improve breast and cervical cancer screening rates, he said.

CRC is the third most common cancer in the United States, with the third highest mortality. The American Cancer Society predicts that more than 145,000 adults will be diagnosed with colorectal cancer in 2005 and that 56,000 will die from the disease.

Screening can reduce CRC-related mortality by detecting early-stage CRC. Screening strategies available include the fecal occult blood test (FOBT), flexible sigmoidoscopy, colonoscopy, and double contrast barium enema.

The U.S. Preventive Services Task Force recommends CRC screening for average-risk individuals age 50 years and older, yet less than 53% of the eligible U.S. population has been screened for CRC. “Physician recommendation is the largest predictor of CRC screening guidance,” Dr. Bennett said.

The VA health care system measures screening rates at monthly intervals as part of its quality-enhancement research initiative. Of the 17 measures evaluated in this program, CRC screening has the lowest performance rates, he said. VA studies have not shown racial or ethnic differences in CRC survival rates, but African Americans insured by Medicare or private health insurance have lower 5-year survival rates than whites with the same insurance, Dr. Bennett said.

Veterans who use the VA health care services have especially low levels of health literacy. At the Jesse Brown VA Medical Center in Lakeside, Ill., only 42% of hospitalized VA patients have health literacy skills above the ninth-grade level, he said.

The trial to test health care provider-directed interventions took place at two primary care clinics at the Jesse Brown center from May 2001 to June 2003. One clinic served as the control site and the other was the intervention clinic. Each had three attending physicians and a staff of nurse practitioners and medical residents. Patients had to be at least age 50 years and be scheduled to be seen in one of the two outpatient clinics. Individuals were excluded if they had a personal or family history of polyps, CRC, or inflammatory bowel disease; had completed a FOBT in the preceding year; or had a flexible sigmoidoscopy or colonoscopy in the preceding 5 years.

In the intervention clinic, providers attended quarterly feedback sessions, focusing on individual and group feedback on CRC screening recommendation rates and patient adherence to recommended tests. The physicians and staff also received an overview of CRC screening guidelines as well as practical strategies to communicate with patients who have limited literacy skills. The “continuous quality improvement” (CQI) process–which applies scientific methods to the practice of medicine to help ease a physician's workload, increase patient satisfaction, and reduce malpractice exposure–was introduced to the participants.

Screening recommendation and completion were assessed by a review of electronic health records by research assistants.

Overall, the health care provider-directed intervention resulted in a 7% absolute increase in the rates of CRC screening recommendations, and a 9% absolute increase in the rates of CRC screening completion, Dr. Bennett reported.

Providers who attended at least one feedback session were more likely than those who attended no sessions to make a CRC screening recommendation. In addition, patients of providers who attended at least one feedback session were more likely than those who attended no sessions to adhere to CRC screening recommendations.

Respondents with limited literacy skills were more likely than others to be unfamiliar with CRC and other screening tests for CRC. They also appeared to be more skeptical about the screening process, complaining that an FOBT was inconvenient and messy, and stating they would not use an FOBT even if recommended by their physician. But they were more likely to believe that they were at average to high risk of developing CRC than higher literacy patients, Dr. Bennett said.

Among the patients with low literacy, the provider-directed intervention was associated with a 26% increase in screening completion, he reported.

“If information technology support could facilitate downloading of provider-specific CRC screening rates directly from the electronic medical records of the VA, then the intervention costs would substantially decrease,” Dr. Bennett said.

Because CRC screening rates have scored so low in the past within the VA, information technology improvements within the system are likely in the near future, he said.

WASHINGTON – Physician-directed interventions can increase rates of colorectal cancer screening in patients with low literacy skills, Dr. Charles Bennett reported at a conference on health literacy sponsored by the American College of Physicians Foundation.

Patients with limited literacy “may not be able to understand basic cancer screening information and educational materials, many of which are written at a literacy level above that of a significant portion of the American population,” noted Dr. Bennett, a hematologist/oncologist who is an associate director for the Veterans Administration Midwest Center for Health Services and Policy Research.

In a randomized, controlled trial among veterans age 50 years and older seen in two general primary care clinics, the use of provider-directed interventions led to a 26% increase in screening completion among patients with low literacy skills, he said.

No prior study has evaluated the cost effectiveness of health-promotion efforts for colorectal cancer (CRC), but successful interventions have been shown to improve breast and cervical cancer screening rates, he said.

CRC is the third most common cancer in the United States, with the third highest mortality. The American Cancer Society predicts that more than 145,000 adults will be diagnosed with colorectal cancer in 2005 and that 56,000 will die from the disease.

Screening can reduce CRC-related mortality by detecting early-stage CRC. Screening strategies available include the fecal occult blood test (FOBT), flexible sigmoidoscopy, colonoscopy, and double contrast barium enema.

The U.S. Preventive Services Task Force recommends CRC screening for average-risk individuals age 50 years and older, yet less than 53% of the eligible U.S. population has been screened for CRC. “Physician recommendation is the largest predictor of CRC screening guidance,” Dr. Bennett said.

The VA health care system measures screening rates at monthly intervals as part of its quality-enhancement research initiative. Of the 17 measures evaluated in this program, CRC screening has the lowest performance rates, he said. VA studies have not shown racial or ethnic differences in CRC survival rates, but African Americans insured by Medicare or private health insurance have lower 5-year survival rates than whites with the same insurance, Dr. Bennett said.

Veterans who use the VA health care services have especially low levels of health literacy. At the Jesse Brown VA Medical Center in Lakeside, Ill., only 42% of hospitalized VA patients have health literacy skills above the ninth-grade level, he said.

The trial to test health care provider-directed interventions took place at two primary care clinics at the Jesse Brown center from May 2001 to June 2003. One clinic served as the control site and the other was the intervention clinic. Each had three attending physicians and a staff of nurse practitioners and medical residents. Patients had to be at least age 50 years and be scheduled to be seen in one of the two outpatient clinics. Individuals were excluded if they had a personal or family history of polyps, CRC, or inflammatory bowel disease; had completed a FOBT in the preceding year; or had a flexible sigmoidoscopy or colonoscopy in the preceding 5 years.

In the intervention clinic, providers attended quarterly feedback sessions, focusing on individual and group feedback on CRC screening recommendation rates and patient adherence to recommended tests. The physicians and staff also received an overview of CRC screening guidelines as well as practical strategies to communicate with patients who have limited literacy skills. The “continuous quality improvement” (CQI) process–which applies scientific methods to the practice of medicine to help ease a physician's workload, increase patient satisfaction, and reduce malpractice exposure–was introduced to the participants.

Screening recommendation and completion were assessed by a review of electronic health records by research assistants.

Overall, the health care provider-directed intervention resulted in a 7% absolute increase in the rates of CRC screening recommendations, and a 9% absolute increase in the rates of CRC screening completion, Dr. Bennett reported.

Providers who attended at least one feedback session were more likely than those who attended no sessions to make a CRC screening recommendation. In addition, patients of providers who attended at least one feedback session were more likely than those who attended no sessions to adhere to CRC screening recommendations.

Respondents with limited literacy skills were more likely than others to be unfamiliar with CRC and other screening tests for CRC. They also appeared to be more skeptical about the screening process, complaining that an FOBT was inconvenient and messy, and stating they would not use an FOBT even if recommended by their physician. But they were more likely to believe that they were at average to high risk of developing CRC than higher literacy patients, Dr. Bennett said.

Among the patients with low literacy, the provider-directed intervention was associated with a 26% increase in screening completion, he reported.

“If information technology support could facilitate downloading of provider-specific CRC screening rates directly from the electronic medical records of the VA, then the intervention costs would substantially decrease,” Dr. Bennett said.

Because CRC screening rates have scored so low in the past within the VA, information technology improvements within the system are likely in the near future, he said.

WASHINGTON – Physician-directed interventions can increase rates of colorectal cancer screening in patients with low literacy skills, Dr. Charles Bennett reported at a conference on health literacy sponsored by the American College of Physicians Foundation.

Patients with limited literacy “may not be able to understand basic cancer screening information and educational materials, many of which are written at a literacy level above that of a significant portion of the American population,” noted Dr. Bennett, a hematologist/oncologist who is an associate director for the Veterans Administration Midwest Center for Health Services and Policy Research.

In a randomized, controlled trial among veterans age 50 years and older seen in two general primary care clinics, the use of provider-directed interventions led to a 26% increase in screening completion among patients with low literacy skills, he said.

No prior study has evaluated the cost effectiveness of health-promotion efforts for colorectal cancer (CRC), but successful interventions have been shown to improve breast and cervical cancer screening rates, he said.

CRC is the third most common cancer in the United States, with the third highest mortality. The American Cancer Society predicts that more than 145,000 adults will be diagnosed with colorectal cancer in 2005 and that 56,000 will die from the disease.

Screening can reduce CRC-related mortality by detecting early-stage CRC. Screening strategies available include the fecal occult blood test (FOBT), flexible sigmoidoscopy, colonoscopy, and double contrast barium enema.

The U.S. Preventive Services Task Force recommends CRC screening for average-risk individuals age 50 years and older, yet less than 53% of the eligible U.S. population has been screened for CRC. “Physician recommendation is the largest predictor of CRC screening guidance,” Dr. Bennett said.

The VA health care system measures screening rates at monthly intervals as part of its quality-enhancement research initiative. Of the 17 measures evaluated in this program, CRC screening has the lowest performance rates, he said. VA studies have not shown racial or ethnic differences in CRC survival rates, but African Americans insured by Medicare or private health insurance have lower 5-year survival rates than whites with the same insurance, Dr. Bennett said.

Veterans who use the VA health care services have especially low levels of health literacy. At the Jesse Brown VA Medical Center in Lakeside, Ill., only 42% of hospitalized VA patients have health literacy skills above the ninth-grade level, he said.

The trial to test health care provider-directed interventions took place at two primary care clinics at the Jesse Brown center from May 2001 to June 2003. One clinic served as the control site and the other was the intervention clinic. Each had three attending physicians and a staff of nurse practitioners and medical residents. Patients had to be at least age 50 years and be scheduled to be seen in one of the two outpatient clinics. Individuals were excluded if they had a personal or family history of polyps, CRC, or inflammatory bowel disease; had completed a FOBT in the preceding year; or had a flexible sigmoidoscopy or colonoscopy in the preceding 5 years.

In the intervention clinic, providers attended quarterly feedback sessions, focusing on individual and group feedback on CRC screening recommendation rates and patient adherence to recommended tests. The physicians and staff also received an overview of CRC screening guidelines as well as practical strategies to communicate with patients who have limited literacy skills. The “continuous quality improvement” (CQI) process–which applies scientific methods to the practice of medicine to help ease a physician's workload, increase patient satisfaction, and reduce malpractice exposure–was introduced to the participants.

Screening recommendation and completion were assessed by a review of electronic health records by research assistants.

Overall, the health care provider-directed intervention resulted in a 7% absolute increase in the rates of CRC screening recommendations, and a 9% absolute increase in the rates of CRC screening completion, Dr. Bennett reported.

Providers who attended at least one feedback session were more likely than those who attended no sessions to make a CRC screening recommendation. In addition, patients of providers who attended at least one feedback session were more likely than those who attended no sessions to adhere to CRC screening recommendations.

Respondents with limited literacy skills were more likely than others to be unfamiliar with CRC and other screening tests for CRC. They also appeared to be more skeptical about the screening process, complaining that an FOBT was inconvenient and messy, and stating they would not use an FOBT even if recommended by their physician. But they were more likely to believe that they were at average to high risk of developing CRC than higher literacy patients, Dr. Bennett said.

Among the patients with low literacy, the provider-directed intervention was associated with a 26% increase in screening completion, he reported.

“If information technology support could facilitate downloading of provider-specific CRC screening rates directly from the electronic medical records of the VA, then the intervention costs would substantially decrease,” Dr. Bennett said.

Because CRC screening rates have scored so low in the past within the VA, information technology improvements within the system are likely in the near future, he said.

WASHINGTON — Researchers with the Medicare Payment Advisory Commission are measuring the quality of care delivered by physicians as part of an overall analysis of physician resource use.

"We hope to look at variation in quality performance, to do this across conditions, regions, and to some extent across specialties," Karen Milgate, a research director for the commission (MedPAC) said at a recent commission meeting. "We also hope to identify any gaps in quality measurement development that we can."

The ongoing research supports the commission's long-term goal of identifying more "efficient" providers, as a tool to encourage greater efficiency in care.

Variation in resource use may include cost of a service, types of services provided, or types of specialists that patients see, Ms. Milgate said in an interview. It could also mean variation in resource use across regions.

Using preliminary computer models, MedPAC researchers found variation in the cost of certain conditions.

For example, treatment of end-stage renal disease is fairly well defined, as the patient either requires long-term dialysis or a kidney transplant to stay alive. For that reason, average versus median costs for end-stage renal disease episodes don't vary that much, said MedPAC researcher Niall Brennan.

Significantly more variation in cost was seen in the care of hypertension, diabetes, and heart failure. In areas where there is tremendous variation in resource use, "we might want to [see] if there are any guidelines in those areas that would better help us understand appropriate resource use levels," Ms. Milgate said.

MedPAC could identify conditions with variation in resource use where there might also be high variation in quality, Ms. Milgate said. Those might become priority areas for coordination of care.

Researchers hope to address questions such as "how do you attribute the care of a particular beneficiary to a specific physician?" she said. The minimum number of cases needed to get a reliable measurement and with whom you actually compare a physician's performance are other considerations, Ms. Milgate said.

Ms. Milgate clarified that these claims-based measures would not necessarily be used in a pay-for-performance system.

"That's a pretty easy decision because we don't have that information" yet, she said. Researchers are planning to base this analysis on currently available information: claims data.

More than 35 indicators on conditions important to Medicare will be used to measure quality, Ms. Milgate said. "Most of them are primarily what we've talked about before as process measures. For example, for beneficiaries with coronary artery disease, did they have an annual lipid profile?" Outcomes measures would also be used. For example, for beneficiaries with diabetes, what proportion of them ended up in the hospital with short- or long-term complications that were related to their diabetic conditions, she said.

MedPAC earlier this year advised the Department of Health and Human Services to test different types of provider payment differentials, which would essentially offer monetary rewards—bonuses, for example—for meeting certain goals on health care quality.

MedPAC Chair Glenn M. Hackbarth, J.D., said he hoped that Congress was prepared to move ahead with pay-for-performance legislation. Several bills are pending to link relief from the sustainable growth rate formula to the implementation of a pay-for-performance system for physicians, he said.

"Obviously we support both ends of that bargain. We have argued that in order to assure access to quality of care, there does need to be some relief from the SGR. But at the same time, we think that it should be not just more money into the existing system, but one that consistently, in a more focused way, rewards good practice and quality of care."

WASHINGTON — Researchers with the Medicare Payment Advisory Commission are measuring the quality of care delivered by physicians as part of an overall analysis of physician resource use.

"We hope to look at variation in quality performance, to do this across conditions, regions, and to some extent across specialties," Karen Milgate, a research director for the commission (MedPAC) said at a recent commission meeting. "We also hope to identify any gaps in quality measurement development that we can."

The ongoing research supports the commission's long-term goal of identifying more "efficient" providers, as a tool to encourage greater efficiency in care.

Variation in resource use may include cost of a service, types of services provided, or types of specialists that patients see, Ms. Milgate said in an interview. It could also mean variation in resource use across regions.

Using preliminary computer models, MedPAC researchers found variation in the cost of certain conditions.

For example, treatment of end-stage renal disease is fairly well defined, as the patient either requires long-term dialysis or a kidney transplant to stay alive. For that reason, average versus median costs for end-stage renal disease episodes don't vary that much, said MedPAC researcher Niall Brennan.

Significantly more variation in cost was seen in the care of hypertension, diabetes, and heart failure. In areas where there is tremendous variation in resource use, "we might want to [see] if there are any guidelines in those areas that would better help us understand appropriate resource use levels," Ms. Milgate said.

MedPAC could identify conditions with variation in resource use where there might also be high variation in quality, Ms. Milgate said. Those might become priority areas for coordination of care.

Researchers hope to address questions such as "how do you attribute the care of a particular beneficiary to a specific physician?" she said. The minimum number of cases needed to get a reliable measurement and with whom you actually compare a physician's performance are other considerations, Ms. Milgate said.

Ms. Milgate clarified that these claims-based measures would not necessarily be used in a pay-for-performance system.

"That's a pretty easy decision because we don't have that information" yet, she said. Researchers are planning to base this analysis on currently available information: claims data.

More than 35 indicators on conditions important to Medicare will be used to measure quality, Ms. Milgate said. "Most of them are primarily what we've talked about before as process measures. For example, for beneficiaries with coronary artery disease, did they have an annual lipid profile?" Outcomes measures would also be used. For example, for beneficiaries with diabetes, what proportion of them ended up in the hospital with short- or long-term complications that were related to their diabetic conditions, she said.

MedPAC earlier this year advised the Department of Health and Human Services to test different types of provider payment differentials, which would essentially offer monetary rewards—bonuses, for example—for meeting certain goals on health care quality.

MedPAC Chair Glenn M. Hackbarth, J.D., said he hoped that Congress was prepared to move ahead with pay-for-performance legislation. Several bills are pending to link relief from the sustainable growth rate formula to the implementation of a pay-for-performance system for physicians, he said.

"Obviously we support both ends of that bargain. We have argued that in order to assure access to quality of care, there does need to be some relief from the SGR. But at the same time, we think that it should be not just more money into the existing system, but one that consistently, in a more focused way, rewards good practice and quality of care."

WASHINGTON — Researchers with the Medicare Payment Advisory Commission are measuring the quality of care delivered by physicians as part of an overall analysis of physician resource use.

"We hope to look at variation in quality performance, to do this across conditions, regions, and to some extent across specialties," Karen Milgate, a research director for the commission (MedPAC) said at a recent commission meeting. "We also hope to identify any gaps in quality measurement development that we can."

The ongoing research supports the commission's long-term goal of identifying more "efficient" providers, as a tool to encourage greater efficiency in care.

Variation in resource use may include cost of a service, types of services provided, or types of specialists that patients see, Ms. Milgate said in an interview. It could also mean variation in resource use across regions.

Using preliminary computer models, MedPAC researchers found variation in the cost of certain conditions.

For example, treatment of end-stage renal disease is fairly well defined, as the patient either requires long-term dialysis or a kidney transplant to stay alive. For that reason, average versus median costs for end-stage renal disease episodes don't vary that much, said MedPAC researcher Niall Brennan.

Significantly more variation in cost was seen in the care of hypertension, diabetes, and heart failure. In areas where there is tremendous variation in resource use, "we might want to [see] if there are any guidelines in those areas that would better help us understand appropriate resource use levels," Ms. Milgate said.

MedPAC could identify conditions with variation in resource use where there might also be high variation in quality, Ms. Milgate said. Those might become priority areas for coordination of care.

Researchers hope to address questions such as "how do you attribute the care of a particular beneficiary to a specific physician?" she said. The minimum number of cases needed to get a reliable measurement and with whom you actually compare a physician's performance are other considerations, Ms. Milgate said.

Ms. Milgate clarified that these claims-based measures would not necessarily be used in a pay-for-performance system.

"That's a pretty easy decision because we don't have that information" yet, she said. Researchers are planning to base this analysis on currently available information: claims data.

More than 35 indicators on conditions important to Medicare will be used to measure quality, Ms. Milgate said. "Most of them are primarily what we've talked about before as process measures. For example, for beneficiaries with coronary artery disease, did they have an annual lipid profile?" Outcomes measures would also be used. For example, for beneficiaries with diabetes, what proportion of them ended up in the hospital with short- or long-term complications that were related to their diabetic conditions, she said.

MedPAC earlier this year advised the Department of Health and Human Services to test different types of provider payment differentials, which would essentially offer monetary rewards—bonuses, for example—for meeting certain goals on health care quality.

MedPAC Chair Glenn M. Hackbarth, J.D., said he hoped that Congress was prepared to move ahead with pay-for-performance legislation. Several bills are pending to link relief from the sustainable growth rate formula to the implementation of a pay-for-performance system for physicians, he said.

"Obviously we support both ends of that bargain. We have argued that in order to assure access to quality of care, there does need to be some relief from the SGR. But at the same time, we think that it should be not just more money into the existing system, but one that consistently, in a more focused way, rewards good practice and quality of care."

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 set of standards for electronic prescribing, or e-prescribing, of drugs covered by Medicare. The standards were expected to be available for immediate use when the new prescription drug benefit began Jan. 1, 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.

"Having standards is good. It will provide a common language for anyone using this method," Dr. Mary Frank, board chair of the American Academy of Family Physicians, said in an interview. E-prescribing would also reduce errors, increase patient safety, and when it is fully interoperable, increase quality in health care as well, she said.

Unfortunately, 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.

Only 25%–30% of the AAFP's members have electronic health records, Dr. Frank said. "They are, at present, the only ones who might be able to immediately adopt this approach. I say 'might' because not all EHR systems have the e-prescribing component."

Until there is some financial support to help doctors implement this technology, its use will not be widespread, she said.

Even if a physician does have the money to adopt e-prescribing, "he or she is at risk of purchasing a system that might not integrate" with a future electronic health record system, she said.

Dr. Kirschner noted that 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 as an isolated technology, however, "just won't cut it," Dr. Frank said. "It is only a small piece in the safety-quality continuum." While it may eliminate issues such as bad handwriting and sound-alike medications, it doesn't necessarily address issues such as drug-drug interactions, alerts about possible problems related to existing illnesses, or abnormal lab results.

"We really have to push for a more integrated approach if we really want to improve care," she said.

E-prescribing will be optional for physicians and pharmacies under the new standards, although Medicare will require drug plans participating in the new prescription benefit to support electronic prescribing. Compliance with these standards was required as of Jan. 1, 2006, so that they will be ready for immediate use when the Medicare drug benefit begins.

Jeff Trewhitt, who is a spokesperson for the Pharmaceutical Research and Manufacturers of America, said that PhRMA supported the development of a standardized e-prescribing system. In addition to reducing errors and the administrative costs that are 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 set of standards for electronic prescribing, or e-prescribing, of drugs covered by Medicare. The standards were expected to be available for immediate use when the new prescription drug benefit began Jan. 1, 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.

"Having standards is good. It will provide a common language for anyone using this method," Dr. Mary Frank, board chair of the American Academy of Family Physicians, said in an interview. E-prescribing would also reduce errors, increase patient safety, and when it is fully interoperable, increase quality in health care as well, she said.

Unfortunately, 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.

Only 25%–30% of the AAFP's members have electronic health records, Dr. Frank said. "They are, at present, the only ones who might be able to immediately adopt this approach. I say 'might' because not all EHR systems have the e-prescribing component."

Until there is some financial support to help doctors implement this technology, its use will not be widespread, she said.

Even if a physician does have the money to adopt e-prescribing, "he or she is at risk of purchasing a system that might not integrate" with a future electronic health record system, she said.

Dr. Kirschner noted that 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 as an isolated technology, however, "just won't cut it," Dr. Frank said. "It is only a small piece in the safety-quality continuum." While it may eliminate issues such as bad handwriting and sound-alike medications, it doesn't necessarily address issues such as drug-drug interactions, alerts about possible problems related to existing illnesses, or abnormal lab results.

"We really have to push for a more integrated approach if we really want to improve care," she said.

E-prescribing will be optional for physicians and pharmacies under the new standards, although Medicare will require drug plans participating in the new prescription benefit to support electronic prescribing. Compliance with these standards was required as of Jan. 1, 2006, so that they will be ready for immediate use when the Medicare drug benefit begins.

Jeff Trewhitt, who is a spokesperson for the Pharmaceutical Research and Manufacturers of America, said that PhRMA supported the development of a standardized e-prescribing system. In addition to reducing errors and the administrative costs that are 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 set of standards for electronic prescribing, or e-prescribing, of drugs covered by Medicare. The standards were expected to be available for immediate use when the new prescription drug benefit began Jan. 1, 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.

"Having standards is good. It will provide a common language for anyone using this method," Dr. Mary Frank, board chair of the American Academy of Family Physicians, said in an interview. E-prescribing would also reduce errors, increase patient safety, and when it is fully interoperable, increase quality in health care as well, she said.

Unfortunately, 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.

Only 25%–30% of the AAFP's members have electronic health records, Dr. Frank said. "They are, at present, the only ones who might be able to immediately adopt this approach. I say 'might' because not all EHR systems have the e-prescribing component."

Until there is some financial support to help doctors implement this technology, its use will not be widespread, she said.

Even if a physician does have the money to adopt e-prescribing, "he or she is at risk of purchasing a system that might not integrate" with a future electronic health record system, she said.

Dr. Kirschner noted that 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 as an isolated technology, however, "just won't cut it," Dr. Frank said. "It is only a small piece in the safety-quality continuum." While it may eliminate issues such as bad handwriting and sound-alike medications, it doesn't necessarily address issues such as drug-drug interactions, alerts about possible problems related to existing illnesses, or abnormal lab results.

"We really have to push for a more integrated approach if we really want to improve care," she said.

E-prescribing will be optional for physicians and pharmacies under the new standards, although Medicare will require drug plans participating in the new prescription benefit to support electronic prescribing. Compliance with these standards was required as of Jan. 1, 2006, so that they will be ready for immediate use when the Medicare drug benefit begins.

Jeff Trewhitt, who is a spokesperson for the Pharmaceutical Research and Manufacturers of America, said that PhRMA supported the development of a standardized e-prescribing system. In addition to reducing errors and the administrative costs that are 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.

Part D Enrollment Begins

Starting last month, Medicare beneficiaries began enrolling in prescription drug plans as part of the new Medicare Part D benefit that will begin on Jan. 1. Beneficiaries who enroll in drug plans by the end of this year can begin receiving benefits on Jan. 1, but individuals who haven't made up their minds can continue to enroll until May 15, 2006. As the enrollment period kicked off last month, the health insurance industry was optimistic. Karen Ignagni, president and CEO of America's Health Insurance Plans (AHIP), said its member health plans were seeing higher than expected numbers of calls from Medicare beneficiaries with questions about the plans. And the questions are specific, with beneficiaries asking about drug availability, which pharmacies are participating in plans, and how much their out-of-pocket expenses will be with a plan, Ms. Ignagni said at a press conference. She recommended that Medicare beneficiaries who are evaluating different prescription drug plans consider five issues: Do they have drug coverage now? What drugs do they take? Do they purchase drugs from a particular pharmacy? How much will they pay in out-of-pocket costs for a particular plan? And do they want to stay in traditional Medicare and choose a separate drug plan or switch to a Medicare managed care plan that includes prescription drugs, physician services, and hospital care.

New Head for FDA Women's Health

Kathleen Uhl, M.D., has been named director of the Office of Women's Health at the Food and Drug Administration. Dr. Uhl, a family physician and a captain in the U.S. Public Health Service, most recently served as a supervisory medical officer in the FDA's Center for Drug Evaluation and Research. “Kathleen brings a breadth of professional experience, as well as a strong science background and passion for women's health, to her new position,” said FDA Acting Commissioner Andrew von Eschenbach, M.D. Dr. Uhl's experience includes clinical practice, basic science and clinical research, drug application review, drug safety oversight, and women's health issues. Dr. Uhl also has dual faculty appointments at the Uniformed Services University of the Health Sciences in family medicine and internal medicine.

Groups Sue Over Part D

Countless numbers of poor men and women “will fall through the cracks” during transition to the new Part D drug benefit, medical groups stated in a lawsuit against the federal government. More than 6 million “dual eligible” patients—those who are enrolled in both Medicare and Medicaid—will lose their Medicaid drug coverage on Jan. 1. The groups said that they are seeking protections for patients who are not seamlessly and immediately transitioned to the new Part D drug benefit program. “The poorest, sickest, and oldest Americans face grave risk of losing their life-saving medications once the clock strikes twelve on New Year's,” said Robert M. Hayes, president of the Medicare Rights Center, a national consumer service group and one of the plaintiffs. In particular, those beneficiaries who are cognitively impaired or only have a high school diploma will have problems mastering the complexity of the new drug benefit, the lawsuit indicated. A spokes-man with the Centers for Medicare and Medicaid Services said the agency was not commenting on the pending lawsuit.

Patients Satisfied Despite Cost

Most Americans remain satisfied with the quality of their health care despite rising health care costs, according to a survey from the Employee Benefit Research Institute (EBRI), a nonprofit group that disseminates data on employee benefits. “Satisfaction with health care quality is high, but few are happy about the cost of health care,” EBRI President Dallas Salisbury said in a statement. “Beyond that, the survey appears to confirm the notion that Americans tend to leave cost out of the equation when considering health care quality.” Almost 6 in 10 Americans are extremely or very satisfied with the quality of medical care they receive. However, only 28% were satisfied with the cost of health care coverage. A difference of opinion existed between lower and higher income patients about quality of care. Those with household incomes under $35,000 a year were less than half as likely as those with incomes of at least $75,000 a year to describe the health care system as excellent or very good. The survey represented telephone interviews with 1,003 individuals aged 21 years and older.

Improving Uncompensated Care

Hospitals have established more generous uncompensated-care guidelines for uninsured patients after a torrent of publicity about aggressive hospital billing and collection practices and a series of lawsuits alleging that hospitals overcharge these patients, the Center for Studying Health System Change (HSC) reported. The study is based on HSC's 2005 site visits to 12 nationally representative communities. “In every HSC community, most hospitals have either recently changed their pricing, billing, and collection policies or tried to improve the clarity of the information provided to patients,” said HSC research analyst Andrea B. Staiti, coauthor of the study. For example, it is now common for hospitals in the 12 surveyed communities to provide uncompensated care to uninsured patients with incomes of less than 200% of the federal poverty level, and to offer sliding-scale discounts for patients with incomes up to 400% or 500% of the federal poverty level.

Part D Enrollment Begins

Starting last month, Medicare beneficiaries began enrolling in prescription drug plans as part of the new Medicare Part D benefit that will begin on Jan. 1. Beneficiaries who enroll in drug plans by the end of this year can begin receiving benefits on Jan. 1, but individuals who haven't made up their minds can continue to enroll until May 15, 2006. As the enrollment period kicked off last month, the health insurance industry was optimistic. Karen Ignagni, president and CEO of America's Health Insurance Plans (AHIP), said its member health plans were seeing higher than expected numbers of calls from Medicare beneficiaries with questions about the plans. And the questions are specific, with beneficiaries asking about drug availability, which pharmacies are participating in plans, and how much their out-of-pocket expenses will be with a plan, Ms. Ignagni said at a press conference. She recommended that Medicare beneficiaries who are evaluating different prescription drug plans consider five issues: Do they have drug coverage now? What drugs do they take? Do they purchase drugs from a particular pharmacy? How much will they pay in out-of-pocket costs for a particular plan? And do they want to stay in traditional Medicare and choose a separate drug plan or switch to a Medicare managed care plan that includes prescription drugs, physician services, and hospital care.

New Head for FDA Women's Health

Kathleen Uhl, M.D., has been named director of the Office of Women's Health at the Food and Drug Administration. Dr. Uhl, a family physician and a captain in the U.S. Public Health Service, most recently served as a supervisory medical officer in the FDA's Center for Drug Evaluation and Research. “Kathleen brings a breadth of professional experience, as well as a strong science background and passion for women's health, to her new position,” said FDA Acting Commissioner Andrew von Eschenbach, M.D. Dr. Uhl's experience includes clinical practice, basic science and clinical research, drug application review, drug safety oversight, and women's health issues. Dr. Uhl also has dual faculty appointments at the Uniformed Services University of the Health Sciences in family medicine and internal medicine.

Groups Sue Over Part D

Countless numbers of poor men and women “will fall through the cracks” during transition to the new Part D drug benefit, medical groups stated in a lawsuit against the federal government. More than 6 million “dual eligible” patients—those who are enrolled in both Medicare and Medicaid—will lose their Medicaid drug coverage on Jan. 1. The groups said that they are seeking protections for patients who are not seamlessly and immediately transitioned to the new Part D drug benefit program. “The poorest, sickest, and oldest Americans face grave risk of losing their life-saving medications once the clock strikes twelve on New Year's,” said Robert M. Hayes, president of the Medicare Rights Center, a national consumer service group and one of the plaintiffs. In particular, those beneficiaries who are cognitively impaired or only have a high school diploma will have problems mastering the complexity of the new drug benefit, the lawsuit indicated. A spokes-man with the Centers for Medicare and Medicaid Services said the agency was not commenting on the pending lawsuit.

Patients Satisfied Despite Cost

Most Americans remain satisfied with the quality of their health care despite rising health care costs, according to a survey from the Employee Benefit Research Institute (EBRI), a nonprofit group that disseminates data on employee benefits. “Satisfaction with health care quality is high, but few are happy about the cost of health care,” EBRI President Dallas Salisbury said in a statement. “Beyond that, the survey appears to confirm the notion that Americans tend to leave cost out of the equation when considering health care quality.” Almost 6 in 10 Americans are extremely or very satisfied with the quality of medical care they receive. However, only 28% were satisfied with the cost of health care coverage. A difference of opinion existed between lower and higher income patients about quality of care. Those with household incomes under $35,000 a year were less than half as likely as those with incomes of at least $75,000 a year to describe the health care system as excellent or very good. The survey represented telephone interviews with 1,003 individuals aged 21 years and older.

Improving Uncompensated Care

Hospitals have established more generous uncompensated-care guidelines for uninsured patients after a torrent of publicity about aggressive hospital billing and collection practices and a series of lawsuits alleging that hospitals overcharge these patients, the Center for Studying Health System Change (HSC) reported. The study is based on HSC's 2005 site visits to 12 nationally representative communities. “In every HSC community, most hospitals have either recently changed their pricing, billing, and collection policies or tried to improve the clarity of the information provided to patients,” said HSC research analyst Andrea B. Staiti, coauthor of the study. For example, it is now common for hospitals in the 12 surveyed communities to provide uncompensated care to uninsured patients with incomes of less than 200% of the federal poverty level, and to offer sliding-scale discounts for patients with incomes up to 400% or 500% of the federal poverty level.

Part D Enrollment Begins

Starting last month, Medicare beneficiaries began enrolling in prescription drug plans as part of the new Medicare Part D benefit that will begin on Jan. 1. Beneficiaries who enroll in drug plans by the end of this year can begin receiving benefits on Jan. 1, but individuals who haven't made up their minds can continue to enroll until May 15, 2006. As the enrollment period kicked off last month, the health insurance industry was optimistic. Karen Ignagni, president and CEO of America's Health Insurance Plans (AHIP), said its member health plans were seeing higher than expected numbers of calls from Medicare beneficiaries with questions about the plans. And the questions are specific, with beneficiaries asking about drug availability, which pharmacies are participating in plans, and how much their out-of-pocket expenses will be with a plan, Ms. Ignagni said at a press conference. She recommended that Medicare beneficiaries who are evaluating different prescription drug plans consider five issues: Do they have drug coverage now? What drugs do they take? Do they purchase drugs from a particular pharmacy? How much will they pay in out-of-pocket costs for a particular plan? And do they want to stay in traditional Medicare and choose a separate drug plan or switch to a Medicare managed care plan that includes prescription drugs, physician services, and hospital care.

New Head for FDA Women's Health

Kathleen Uhl, M.D., has been named director of the Office of Women's Health at the Food and Drug Administration. Dr. Uhl, a family physician and a captain in the U.S. Public Health Service, most recently served as a supervisory medical officer in the FDA's Center for Drug Evaluation and Research. “Kathleen brings a breadth of professional experience, as well as a strong science background and passion for women's health, to her new position,” said FDA Acting Commissioner Andrew von Eschenbach, M.D. Dr. Uhl's experience includes clinical practice, basic science and clinical research, drug application review, drug safety oversight, and women's health issues. Dr. Uhl also has dual faculty appointments at the Uniformed Services University of the Health Sciences in family medicine and internal medicine.

Groups Sue Over Part D

Countless numbers of poor men and women “will fall through the cracks” during transition to the new Part D drug benefit, medical groups stated in a lawsuit against the federal government. More than 6 million “dual eligible” patients—those who are enrolled in both Medicare and Medicaid—will lose their Medicaid drug coverage on Jan. 1. The groups said that they are seeking protections for patients who are not seamlessly and immediately transitioned to the new Part D drug benefit program. “The poorest, sickest, and oldest Americans face grave risk of losing their life-saving medications once the clock strikes twelve on New Year's,” said Robert M. Hayes, president of the Medicare Rights Center, a national consumer service group and one of the plaintiffs. In particular, those beneficiaries who are cognitively impaired or only have a high school diploma will have problems mastering the complexity of the new drug benefit, the lawsuit indicated. A spokes-man with the Centers for Medicare and Medicaid Services said the agency was not commenting on the pending lawsuit.

Patients Satisfied Despite Cost

Most Americans remain satisfied with the quality of their health care despite rising health care costs, according to a survey from the Employee Benefit Research Institute (EBRI), a nonprofit group that disseminates data on employee benefits. “Satisfaction with health care quality is high, but few are happy about the cost of health care,” EBRI President Dallas Salisbury said in a statement. “Beyond that, the survey appears to confirm the notion that Americans tend to leave cost out of the equation when considering health care quality.” Almost 6 in 10 Americans are extremely or very satisfied with the quality of medical care they receive. However, only 28% were satisfied with the cost of health care coverage. A difference of opinion existed between lower and higher income patients about quality of care. Those with household incomes under $35,000 a year were less than half as likely as those with incomes of at least $75,000 a year to describe the health care system as excellent or very good. The survey represented telephone interviews with 1,003 individuals aged 21 years and older.

Improving Uncompensated Care

Hospitals have established more generous uncompensated-care guidelines for uninsured patients after a torrent of publicity about aggressive hospital billing and collection practices and a series of lawsuits alleging that hospitals overcharge these patients, the Center for Studying Health System Change (HSC) reported. The study is based on HSC's 2005 site visits to 12 nationally representative communities. “In every HSC community, most hospitals have either recently changed their pricing, billing, and collection policies or tried to improve the clarity of the information provided to patients,” said HSC research analyst Andrea B. Staiti, coauthor of the study. For example, it is now common for hospitals in the 12 surveyed communities to provide uncompensated care to uninsured patients with incomes of less than 200% of the federal poverty level, and to offer sliding-scale discounts for patients with incomes up to 400% or 500% of the federal poverty level.

Part D Enrollment Begins

Starting last month, Medicare beneficiaries began enrolling in prescription drug plans as part of the new Medicare Part D benefit that will begin on Jan. 1. Beneficiaries who enroll in drug plans by the end of this year can begin receiving benefits on Jan. 1, but individuals who haven't made up their minds can continue to enroll until May 15, 2006. As the enrollment period kicked off last month, the health insurance industry was optimistic. Karen Ignagni, president and CEO of America's Health Insurance Plans (AHIP), said its member health plans were seeing higher than expected numbers of calls from Medicare beneficiaries with questions about the plans. And the questions are specific, with beneficiaries asking about drug availability, which pharmacies are participating in plans, and how much their out-of-pocket expenses will be with a plan, Ms. Ignagni said at a press conference. She recommended that Medicare beneficiaries who are evaluating different prescription drug plans consider five issues: Do they have drug coverage now? What drugs do they take? Do they purchase drugs from a particular pharmacy? How much will they pay in out-of-pocket costs for a particular plan? And, finally, do they want to stay in traditional Medicare and choose a separate drug plan or switch to a Medicare managed care plan that includes prescription drugs, physician services, and hospital care?

Groups Sue Over Part D

Countless numbers of poor men and women “will fall through the cracks” during the transition to the new Part D drug benefit, medical groups stated in a lawsuit against the federal government. More than 6 million “dual eligible” patients—those who are enrolled in both Medicare and Medicaid—lost their Medicaid drug coverage on Jan. 1. The groups said that they're seeking protections for patients who are not seamlessly and immediately transitioned to the new drug program. “The poorest, sickest, and oldest Americans face grave risk of losing their life-saving medications once the clock strikes twelve on New Year's,” said Robert M. Hayes, president of the Medicare Rights Center, a national consumer service group and one of the plaintiffs. In particular, those beneficiaries who are cognitively impaired or have only a high school diploma will have problems mastering the complexity of the new drug benefit, the lawsuit indicated. A spokesman with the Centers for Medicare and Medicaid Services said that the agency was not commenting on the pending lawsuit.

New Head for FDA Women's Health

Kathleen Uhl, M.D., has been named director of the Office of Women's Health at the Food and Drug Administration. Dr. Uhl, a family physician and a captain in the U.S. Public Health Service, most recently served as a supervisory medical officer in the FDA's Center for Drug Evaluation and Research. “Kathleen brings a breadth of professional experience, as well as a strong science background and passion for women's health, to her new position,” said FDA Acting Commissioner Andrew von Eschenbach, M.D. Dr. Uhl's experience includes clinical practice, basic science and clinical research, drug application review, drug safety oversight, and women's health issues. She also holds dual faculty appointments at the Uniformed Services University of the Health Sciences in family medicine and internal medicine.

Patients Satisfied Despite Cost

Most Americans remain satisfied with the quality of their health care despite rising health care costs, according to a survey from the Employee Benefit Research Institute (EBRI), a nonprofit group that disseminates data on employee benefits. “Satisfaction with health care quality is high, but few are happy about the cost of health care,” EBRI President Dallas Salisbury said in a statement. “Beyond that, the survey appears to confirm the notion that Americans tend to leave cost out of the equation when considering health care quality.” Almost 6 in 10 Americans who were surveyed were extremely or very satisfied with the quality of medical care that they receive. However, only 28% were satisfied with the cost of their health coverage. The survey revealed a difference of opinion between lower and higher income patients about quality of care. Those with household incomes under $35,000 a year were less than half as likely as those with incomes of at least $75,000 to describe the health care system as excellent or very good. The survey represented telephone interviews with 1,003 individuals aged 21 and older.

Improving Uncompensated Care

Hospitals have established more generous uncompensated-care guidelines for uninsured patients after a torrent of publicity about aggressive hospital billing and collection practices and a series of lawsuits alleging that hospitals overcharge these patients, the Center for Studying Health System Change (HSC) reported. The study is based on HSC's 2005 site visits to 12 nationally representative communities. “In every HSC community, most hospitals have either recently changed their pricing, billing, and collection policies or tried to improve the clarity of the information provided to patients,” said HSC research analyst Andrea B. Staiti, coauthor of the study. For example, it is now common for hospitals in the 12 surveyed communities to provide uncompensated care to uninsured patients with incomes less than 200% of the federal poverty level, and to offer sliding-scale discounts for patients with incomes up to 400% or 500% of the poverty level.

Part D Enrollment Begins

Starting last month, Medicare beneficiaries began enrolling in prescription drug plans as part of the new Medicare Part D benefit that will begin on Jan. 1. Beneficiaries who enroll in drug plans by the end of this year can begin receiving benefits on Jan. 1, but individuals who haven't made up their minds can continue to enroll until May 15, 2006. As the enrollment period kicked off last month, the health insurance industry was optimistic. Karen Ignagni, president and CEO of America's Health Insurance Plans (AHIP), said its member health plans were seeing higher than expected numbers of calls from Medicare beneficiaries with questions about the plans. And the questions are specific, with beneficiaries asking about drug availability, which pharmacies are participating in plans, and how much their out-of-pocket expenses will be with a plan, Ms. Ignagni said at a press conference. She recommended that Medicare beneficiaries who are evaluating different prescription drug plans consider five issues: Do they have drug coverage now? What drugs do they take? Do they purchase drugs from a particular pharmacy? How much will they pay in out-of-pocket costs for a particular plan? And, finally, do they want to stay in traditional Medicare and choose a separate drug plan or switch to a Medicare managed care plan that includes prescription drugs, physician services, and hospital care?

Groups Sue Over Part D

Countless numbers of poor men and women “will fall through the cracks” during the transition to the new Part D drug benefit, medical groups stated in a lawsuit against the federal government. More than 6 million “dual eligible” patients—those who are enrolled in both Medicare and Medicaid—lost their Medicaid drug coverage on Jan. 1. The groups said that they're seeking protections for patients who are not seamlessly and immediately transitioned to the new drug program. “The poorest, sickest, and oldest Americans face grave risk of losing their life-saving medications once the clock strikes twelve on New Year's,” said Robert M. Hayes, president of the Medicare Rights Center, a national consumer service group and one of the plaintiffs. In particular, those beneficiaries who are cognitively impaired or have only a high school diploma will have problems mastering the complexity of the new drug benefit, the lawsuit indicated. A spokesman with the Centers for Medicare and Medicaid Services said that the agency was not commenting on the pending lawsuit.

New Head for FDA Women's Health

Kathleen Uhl, M.D., has been named director of the Office of Women's Health at the Food and Drug Administration. Dr. Uhl, a family physician and a captain in the U.S. Public Health Service, most recently served as a supervisory medical officer in the FDA's Center for Drug Evaluation and Research. “Kathleen brings a breadth of professional experience, as well as a strong science background and passion for women's health, to her new position,” said FDA Acting Commissioner Andrew von Eschenbach, M.D. Dr. Uhl's experience includes clinical practice, basic science and clinical research, drug application review, drug safety oversight, and women's health issues. She also holds dual faculty appointments at the Uniformed Services University of the Health Sciences in family medicine and internal medicine.

Patients Satisfied Despite Cost

Most Americans remain satisfied with the quality of their health care despite rising health care costs, according to a survey from the Employee Benefit Research Institute (EBRI), a nonprofit group that disseminates data on employee benefits. “Satisfaction with health care quality is high, but few are happy about the cost of health care,” EBRI President Dallas Salisbury said in a statement. “Beyond that, the survey appears to confirm the notion that Americans tend to leave cost out of the equation when considering health care quality.” Almost 6 in 10 Americans who were surveyed were extremely or very satisfied with the quality of medical care that they receive. However, only 28% were satisfied with the cost of their health coverage. The survey revealed a difference of opinion between lower and higher income patients about quality of care. Those with household incomes under $35,000 a year were less than half as likely as those with incomes of at least $75,000 to describe the health care system as excellent or very good. The survey represented telephone interviews with 1,003 individuals aged 21 and older.

Improving Uncompensated Care

Hospitals have established more generous uncompensated-care guidelines for uninsured patients after a torrent of publicity about aggressive hospital billing and collection practices and a series of lawsuits alleging that hospitals overcharge these patients, the Center for Studying Health System Change (HSC) reported. The study is based on HSC's 2005 site visits to 12 nationally representative communities. “In every HSC community, most hospitals have either recently changed their pricing, billing, and collection policies or tried to improve the clarity of the information provided to patients,” said HSC research analyst Andrea B. Staiti, coauthor of the study. For example, it is now common for hospitals in the 12 surveyed communities to provide uncompensated care to uninsured patients with incomes less than 200% of the federal poverty level, and to offer sliding-scale discounts for patients with incomes up to 400% or 500% of the poverty level.

Part D Enrollment Begins

Starting last month, Medicare beneficiaries began enrolling in prescription drug plans as part of the new Medicare Part D benefit that will begin on Jan. 1. Beneficiaries who enroll in drug plans by the end of this year can begin receiving benefits on Jan. 1, but individuals who haven't made up their minds can continue to enroll until May 15, 2006. As the enrollment period kicked off last month, the health insurance industry was optimistic. Karen Ignagni, president and CEO of America's Health Insurance Plans (AHIP), said its member health plans were seeing higher than expected numbers of calls from Medicare beneficiaries with questions about the plans. And the questions are specific, with beneficiaries asking about drug availability, which pharmacies are participating in plans, and how much their out-of-pocket expenses will be with a plan, Ms. Ignagni said at a press conference. She recommended that Medicare beneficiaries who are evaluating different prescription drug plans consider five issues: Do they have drug coverage now? What drugs do they take? Do they purchase drugs from a particular pharmacy? How much will they pay in out-of-pocket costs for a particular plan? And, finally, do they want to stay in traditional Medicare and choose a separate drug plan or switch to a Medicare managed care plan that includes prescription drugs, physician services, and hospital care?

Groups Sue Over Part D

Countless numbers of poor men and women “will fall through the cracks” during the transition to the new Part D drug benefit, medical groups stated in a lawsuit against the federal government. More than 6 million “dual eligible” patients—those who are enrolled in both Medicare and Medicaid—lost their Medicaid drug coverage on Jan. 1. The groups said that they're seeking protections for patients who are not seamlessly and immediately transitioned to the new drug program. “The poorest, sickest, and oldest Americans face grave risk of losing their life-saving medications once the clock strikes twelve on New Year's,” said Robert M. Hayes, president of the Medicare Rights Center, a national consumer service group and one of the plaintiffs. In particular, those beneficiaries who are cognitively impaired or have only a high school diploma will have problems mastering the complexity of the new drug benefit, the lawsuit indicated. A spokesman with the Centers for Medicare and Medicaid Services said that the agency was not commenting on the pending lawsuit.

New Head for FDA Women's Health

Kathleen Uhl, M.D., has been named director of the Office of Women's Health at the Food and Drug Administration. Dr. Uhl, a family physician and a captain in the U.S. Public Health Service, most recently served as a supervisory medical officer in the FDA's Center for Drug Evaluation and Research. “Kathleen brings a breadth of professional experience, as well as a strong science background and passion for women's health, to her new position,” said FDA Acting Commissioner Andrew von Eschenbach, M.D. Dr. Uhl's experience includes clinical practice, basic science and clinical research, drug application review, drug safety oversight, and women's health issues. She also holds dual faculty appointments at the Uniformed Services University of the Health Sciences in family medicine and internal medicine.

Patients Satisfied Despite Cost

Most Americans remain satisfied with the quality of their health care despite rising health care costs, according to a survey from the Employee Benefit Research Institute (EBRI), a nonprofit group that disseminates data on employee benefits. “Satisfaction with health care quality is high, but few are happy about the cost of health care,” EBRI President Dallas Salisbury said in a statement. “Beyond that, the survey appears to confirm the notion that Americans tend to leave cost out of the equation when considering health care quality.” Almost 6 in 10 Americans who were surveyed were extremely or very satisfied with the quality of medical care that they receive. However, only 28% were satisfied with the cost of their health coverage. The survey revealed a difference of opinion between lower and higher income patients about quality of care. Those with household incomes under $35,000 a year were less than half as likely as those with incomes of at least $75,000 to describe the health care system as excellent or very good. The survey represented telephone interviews with 1,003 individuals aged 21 and older.

Improving Uncompensated Care

Hospitals have established more generous uncompensated-care guidelines for uninsured patients after a torrent of publicity about aggressive hospital billing and collection practices and a series of lawsuits alleging that hospitals overcharge these patients, the Center for Studying Health System Change (HSC) reported. The study is based on HSC's 2005 site visits to 12 nationally representative communities. “In every HSC community, most hospitals have either recently changed their pricing, billing, and collection policies or tried to improve the clarity of the information provided to patients,” said HSC research analyst Andrea B. Staiti, coauthor of the study. For example, it is now common for hospitals in the 12 surveyed communities to provide uncompensated care to uninsured patients with incomes less than 200% of the federal poverty level, and to offer sliding-scale discounts for patients with incomes up to 400% or 500% of the poverty level.

DALLAS — Predicting more administrative burdens and an eventual mandate on performance measures, delegates at the interim meeting of the American Medical Association's House of Delegates voted to oppose the federal government's plans to implement a voluntary quality reporting program for Medicare.

Delegates adopted a report from the AMA's board of trustees that strongly objected to the coming system, and offered to assist the government in correcting the program's “strong deficiencies.”

The Centers for Medicare and Medicaid Services announced the “Physician Voluntary Reporting Program” in late October, and said that the new initiative would avoid unnecessary costs and improve quality of care.

Beginning next month, physicians who choose to participate will voluntarily send information to CMS about the quality of care they provide to beneficiaries. They will receive feedback on their performance from the agency as early as next summer.

In its report and in a letter to CMS administrator Mark B. McClellan, M.D., AMA trustees expressed doubts that the new system will improve the quality of health care.

“The physician community has made a good faith effort to develop, endorse, and implement physician performance measures,” some in collaboration with CMS, the letter said. “However, the excessive administrative requirements that this program will impose on physicians could doom this initiative.”

The program would force primary care physicians with an already busy patient load to develop a new reporting system from scratch, said Joseph Zebley, M.D., a delegate from the American Academy of Family Physicians, during committee debate on the board's report.

During the first phase of the program, CMS will collect clinical data through a set of Healthcare Common Procedure Coding System (HCPCS) codes—also called G-codes—that will be included in the claims physicians currently submit to CMS.

The data will then be used to measure the quality of services provided to Medicare patients.

In its letter to CMS, the trustees noted that a participating primary care physician treating a 70-year-old woman with common conditions like osteoporosis, diabetes, and heart disease would have to report on approximately 2–13 measures and consider 36–39 G-codes.

Not only don't physicians use G-codes, “electronic health records don't have G-codes as part of their software,” Mary Frank, M.D., AAFP board chair and delegate to the AMA House noted. “We put CPT codes [into the electronic health records], which is what we all use.”

Dr. Zebley added that the program “would place a tremendous burden on family physicians and other primary care physicians.”

G-codes would serve as an “interim step” until the electronic submission of data through electronic health records replaced this process, CMS said when announcing the voluntary program. The agency promised it would collaborate with participating physicians to develop such electronic data submission records.

Although CMS said in its announcement that participation in the voluntary program would not affect physician reimbursement under Medicare, many delegates expressed concern that the system would eventually become mandatory.

CMS “has indicated that there could be a link between reporting data and receiving higher Medicare payments next year,” depending on the success of the voluntary reporting program, William Kobler, M.D., AMA delegate from Illinois, noted during committee proceedings.

Other business addressed by the AMA House of Delegates included:

▸ Medicaid reform. Delegates passed a resolution opposing Medicaid reform legislation—now pending in the U.S. House of Representatives—that would mandate premiums and copayments for acute care services and pharmaceuticals for children who live at or below 133% of the federal poverty level.

▸ Smoking bans. Applying a hard-line approach to kicking the habit, delegates voted that the AMA should actively support national, state, and local legislation and pursue regulations banning smoking in all workplaces. In addition, the AMA should work to ensure that federal legislation banning smoking in all workplaces does not prohibit or weaken existing and stricter state or local regulations.

The AMA should also actively pursue national legislation banning smoking in all cafeterias, restaurants, cafes, supermarkets, and other venues where food or drink is consumed on the premises.

▸ Prisoner interrogation. Delegates asked that the AMA's Council on Ethical and Judicial Affairs “clearly delineate” the boundaries of ethical practice with respect to participation in the interrogation of prisoners and detainees.

▸ Medicare Part D. Delegates voted that the AMA should support legislation and urge the Department of Health and Human Services to modify or eliminate the exclusion of various prescription drugs from coverage under Part D, and to ensure that Medicare contractors administering the new drug benefit include on their formularies medications to treat psychiatric and substance use disorders, including benzodiazepines, methadone, buprenorphine, acamprosate, disulfiram, and naltrexone.

▸ Disaster preparedness and response. Delegates called on state and local public health entities to develop a public health disaster plan specific to their locations. National legislation should also be enacted to give qualified physicians automatic medical liability immunity in the event of a declared disaster or federal emergency.

CMS's Reporting Criteria

Thirty-six evidence-based measures are to be reported in the first phase of the voluntary reporting program, according to CMS.

The final measures run the gamut of services, from influenza, pneumococcal vaccinations, and mammography to more complex surgery-related measures, such as prolonged intubation during isolated coronary artery bypass graft procedures. Other measures include the administration of aspirin and β-blockers at the time of arrival for acute MI, and the screening of elderly patients for falls and urinary incontinence.

According to CMS, the performance measures were developed in collaboration with physicians and physician organizations, as well as other stakeholders. Work by the National Quality Forum, the Ambulatory Care Alliance, the AMA's Physician Consortium for Quality Improvement, the National Committee for Quality Assurance, and RAND Corporation “provided the basis for the selection of these measures,” CMS indicated in a statement.

Yet many AMA delegates at the interim meeting said that they felt CMS had “sprung” the program on them at a time when they were facing a 4.4% reduction in Medicare payments.

Michael Barr, M.D., vice president of practice advocacy and improvement at the American College of Physicians (ACP), said that the ACP was discussing its concerns with CMS about the voluntary reporting program, including the fact that not all of the measures had been endorsed by the National Quality Forum.

“This is just the first step of the process” and it is voluntary, CMS spokesperson Peter Ashkenaz pointed out in an interview. “We want to be able to collect information and provide analysis to see how this works.” Ultimately, the goal is to establish a program in which CMS pays for services rendered on high quality of care, not on volume, he said.

DALLAS — Predicting more administrative burdens and an eventual mandate on performance measures, delegates at the interim meeting of the American Medical Association's House of Delegates voted to oppose the federal government's plans to implement a voluntary quality reporting program for Medicare.

Delegates adopted a report from the AMA's board of trustees that strongly objected to the coming system, and offered to assist the government in correcting the program's “strong deficiencies.”

The Centers for Medicare and Medicaid Services announced the “Physician Voluntary Reporting Program” in late October, and said that the new initiative would avoid unnecessary costs and improve quality of care.

Beginning next month, physicians who choose to participate will voluntarily send information to CMS about the quality of care they provide to beneficiaries. They will receive feedback on their performance from the agency as early as next summer.

In its report and in a letter to CMS administrator Mark B. McClellan, M.D., AMA trustees expressed doubts that the new system will improve the quality of health care.

“The physician community has made a good faith effort to develop, endorse, and implement physician performance measures,” some in collaboration with CMS, the letter said. “However, the excessive administrative requirements that this program will impose on physicians could doom this initiative.”

The program would force primary care physicians with an already busy patient load to develop a new reporting system from scratch, said Joseph Zebley, M.D., a delegate from the American Academy of Family Physicians, during committee debate on the board's report.

During the first phase of the program, CMS will collect clinical data through a set of Healthcare Common Procedure Coding System (HCPCS) codes—also called G-codes—that will be included in the claims physicians currently submit to CMS.

The data will then be used to measure the quality of services provided to Medicare patients.

In its letter to CMS, the trustees noted that a participating primary care physician treating a 70-year-old woman with common conditions like osteoporosis, diabetes, and heart disease would have to report on approximately 2–13 measures and consider 36–39 G-codes.

Not only don't physicians use G-codes, “electronic health records don't have G-codes as part of their software,” Mary Frank, M.D., AAFP board chair and delegate to the AMA House noted. “We put CPT codes [into the electronic health records], which is what we all use.”

Dr. Zebley added that the program “would place a tremendous burden on family physicians and other primary care physicians.”

G-codes would serve as an “interim step” until the electronic submission of data through electronic health records replaced this process, CMS said when announcing the voluntary program. The agency promised it would collaborate with participating physicians to develop such electronic data submission records.

Although CMS said in its announcement that participation in the voluntary program would not affect physician reimbursement under Medicare, many delegates expressed concern that the system would eventually become mandatory.

CMS “has indicated that there could be a link between reporting data and receiving higher Medicare payments next year,” depending on the success of the voluntary reporting program, William Kobler, M.D., AMA delegate from Illinois, noted during committee proceedings.

Other business addressed by the AMA House of Delegates included:

▸ Medicaid reform. Delegates passed a resolution opposing Medicaid reform legislation—now pending in the U.S. House of Representatives—that would mandate premiums and copayments for acute care services and pharmaceuticals for children who live at or below 133% of the federal poverty level.

▸ Smoking bans. Applying a hard-line approach to kicking the habit, delegates voted that the AMA should actively support national, state, and local legislation and pursue regulations banning smoking in all workplaces. In addition, the AMA should work to ensure that federal legislation banning smoking in all workplaces does not prohibit or weaken existing and stricter state or local regulations.

The AMA should also actively pursue national legislation banning smoking in all cafeterias, restaurants, cafes, supermarkets, and other venues where food or drink is consumed on the premises.

▸ Prisoner interrogation. Delegates asked that the AMA's Council on Ethical and Judicial Affairs “clearly delineate” the boundaries of ethical practice with respect to participation in the interrogation of prisoners and detainees.

▸ Medicare Part D. Delegates voted that the AMA should support legislation and urge the Department of Health and Human Services to modify or eliminate the exclusion of various prescription drugs from coverage under Part D, and to ensure that Medicare contractors administering the new drug benefit include on their formularies medications to treat psychiatric and substance use disorders, including benzodiazepines, methadone, buprenorphine, acamprosate, disulfiram, and naltrexone.

▸ Disaster preparedness and response. Delegates called on state and local public health entities to develop a public health disaster plan specific to their locations. National legislation should also be enacted to give qualified physicians automatic medical liability immunity in the event of a declared disaster or federal emergency.

CMS's Reporting Criteria

Thirty-six evidence-based measures are to be reported in the first phase of the voluntary reporting program, according to CMS.

The final measures run the gamut of services, from influenza, pneumococcal vaccinations, and mammography to more complex surgery-related measures, such as prolonged intubation during isolated coronary artery bypass graft procedures. Other measures include the administration of aspirin and β-blockers at the time of arrival for acute MI, and the screening of elderly patients for falls and urinary incontinence.

According to CMS, the performance measures were developed in collaboration with physicians and physician organizations, as well as other stakeholders. Work by the National Quality Forum, the Ambulatory Care Alliance, the AMA's Physician Consortium for Quality Improvement, the National Committee for Quality Assurance, and RAND Corporation “provided the basis for the selection of these measures,” CMS indicated in a statement.

Yet many AMA delegates at the interim meeting said that they felt CMS had “sprung” the program on them at a time when they were facing a 4.4% reduction in Medicare payments.

Michael Barr, M.D., vice president of practice advocacy and improvement at the American College of Physicians (ACP), said that the ACP was discussing its concerns with CMS about the voluntary reporting program, including the fact that not all of the measures had been endorsed by the National Quality Forum.

“This is just the first step of the process” and it is voluntary, CMS spokesperson Peter Ashkenaz pointed out in an interview. “We want to be able to collect information and provide analysis to see how this works.” Ultimately, the goal is to establish a program in which CMS pays for services rendered on high quality of care, not on volume, he said.

DALLAS — Predicting more administrative burdens and an eventual mandate on performance measures, delegates at the interim meeting of the American Medical Association's House of Delegates voted to oppose the federal government's plans to implement a voluntary quality reporting program for Medicare.

Delegates adopted a report from the AMA's board of trustees that strongly objected to the coming system, and offered to assist the government in correcting the program's “strong deficiencies.”

The Centers for Medicare and Medicaid Services announced the “Physician Voluntary Reporting Program” in late October, and said that the new initiative would avoid unnecessary costs and improve quality of care.

Beginning next month, physicians who choose to participate will voluntarily send information to CMS about the quality of care they provide to beneficiaries. They will receive feedback on their performance from the agency as early as next summer.

In its report and in a letter to CMS administrator Mark B. McClellan, M.D., AMA trustees expressed doubts that the new system will improve the quality of health care.

“The physician community has made a good faith effort to develop, endorse, and implement physician performance measures,” some in collaboration with CMS, the letter said. “However, the excessive administrative requirements that this program will impose on physicians could doom this initiative.”

The program would force primary care physicians with an already busy patient load to develop a new reporting system from scratch, said Joseph Zebley, M.D., a delegate from the American Academy of Family Physicians, during committee debate on the board's report.

During the first phase of the program, CMS will collect clinical data through a set of Healthcare Common Procedure Coding System (HCPCS) codes—also called G-codes—that will be included in the claims physicians currently submit to CMS.

The data will then be used to measure the quality of services provided to Medicare patients.

In its letter to CMS, the trustees noted that a participating primary care physician treating a 70-year-old woman with common conditions like osteoporosis, diabetes, and heart disease would have to report on approximately 2–13 measures and consider 36–39 G-codes.

Not only don't physicians use G-codes, “electronic health records don't have G-codes as part of their software,” Mary Frank, M.D., AAFP board chair and delegate to the AMA House noted. “We put CPT codes [into the electronic health records], which is what we all use.”

Dr. Zebley added that the program “would place a tremendous burden on family physicians and other primary care physicians.”

G-codes would serve as an “interim step” until the electronic submission of data through electronic health records replaced this process, CMS said when announcing the voluntary program. The agency promised it would collaborate with participating physicians to develop such electronic data submission records.

Although CMS said in its announcement that participation in the voluntary program would not affect physician reimbursement under Medicare, many delegates expressed concern that the system would eventually become mandatory.

CMS “has indicated that there could be a link between reporting data and receiving higher Medicare payments next year,” depending on the success of the voluntary reporting program, William Kobler, M.D., AMA delegate from Illinois, noted during committee proceedings.

Other business addressed by the AMA House of Delegates included:

▸ Medicaid reform. Delegates passed a resolution opposing Medicaid reform legislation—now pending in the U.S. House of Representatives—that would mandate premiums and copayments for acute care services and pharmaceuticals for children who live at or below 133% of the federal poverty level.

▸ Smoking bans. Applying a hard-line approach to kicking the habit, delegates voted that the AMA should actively support national, state, and local legislation and pursue regulations banning smoking in all workplaces. In addition, the AMA should work to ensure that federal legislation banning smoking in all workplaces does not prohibit or weaken existing and stricter state or local regulations.

The AMA should also actively pursue national legislation banning smoking in all cafeterias, restaurants, cafes, supermarkets, and other venues where food or drink is consumed on the premises.

▸ Prisoner interrogation. Delegates asked that the AMA's Council on Ethical and Judicial Affairs “clearly delineate” the boundaries of ethical practice with respect to participation in the interrogation of prisoners and detainees.

▸ Medicare Part D. Delegates voted that the AMA should support legislation and urge the Department of Health and Human Services to modify or eliminate the exclusion of various prescription drugs from coverage under Part D, and to ensure that Medicare contractors administering the new drug benefit include on their formularies medications to treat psychiatric and substance use disorders, including benzodiazepines, methadone, buprenorphine, acamprosate, disulfiram, and naltrexone.

▸ Disaster preparedness and response. Delegates called on state and local public health entities to develop a public health disaster plan specific to their locations. National legislation should also be enacted to give qualified physicians automatic medical liability immunity in the event of a declared disaster or federal emergency.

CMS's Reporting Criteria

Thirty-six evidence-based measures are to be reported in the first phase of the voluntary reporting program, according to CMS.

The final measures run the gamut of services, from influenza, pneumococcal vaccinations, and mammography to more complex surgery-related measures, such as prolonged intubation during isolated coronary artery bypass graft procedures. Other measures include the administration of aspirin and β-blockers at the time of arrival for acute MI, and the screening of elderly patients for falls and urinary incontinence.

According to CMS, the performance measures were developed in collaboration with physicians and physician organizations, as well as other stakeholders. Work by the National Quality Forum, the Ambulatory Care Alliance, the AMA's Physician Consortium for Quality Improvement, the National Committee for Quality Assurance, and RAND Corporation “provided the basis for the selection of these measures,” CMS indicated in a statement.

Yet many AMA delegates at the interim meeting said that they felt CMS had “sprung” the program on them at a time when they were facing a 4.4% reduction in Medicare payments.

Michael Barr, M.D., vice president of practice advocacy and improvement at the American College of Physicians (ACP), said that the ACP was discussing its concerns with CMS about the voluntary reporting program, including the fact that not all of the measures had been endorsed by the National Quality Forum.

“This is just the first step of the process” and it is voluntary, CMS spokesperson Peter Ashkenaz pointed out in an interview. “We want to be able to collect information and provide analysis to see how this works.” Ultimately, the goal is to establish a program in which CMS pays for services rendered on high quality of care, not on volume, he said.