Mary Ellen Schneider

On April 1, President Obama officially halted the 24% Medicare physician pay cut when he signed into law a bill that provides a 12-month pay patch.

The legislation (H.R. 4302) replaces the scheduled fee cut with a 0.5% pay increase through the end of 2014. It then freezes payment levels for the first three months of 2015, giving Congress another year to figure out if it can pass legislation to permanently repeal Medicare's Sustainable Growth Rate (SGR) formula.

The biggest policy change is the one-year delay of the implementation of the ICD-10 coding sets, which had been scheduled to go into effect on Oct. 1, 2014. Under the recently passed law, the Department of Health & Human Services is barred from implementing the new coding sets until at least Oct. 1, 2015.

The delay was greeted with relief from most physician groups, which had already warned the government that many physicians, especially those in small practices, weren't ready to make the switch. But a coalition that includes health information technology companies, health plans, and the American Hospital Association decried the delay. The industry has already invested time and money in the switch, and a delay will cause only disruption, according to the Coalition for ICD-10.

The SGR legislation also further delays the full implementation of the two-midnight rule governing when Medicare patients should be admitted to the hospital versus placed under observation. Enforcement of the controversial policy by Recovery Audit Contractors (RACs) had already been delayed until Oct. 1, 2014. Under H.R. 4302, most postpayment claim audits by RACs are now delayed until March 31, 2015. However, RACs are allowed to perform audits in cases where there is evidence of systematic gaming, fraud, abuse, or delays in delivering care, according to the legislation.

The bill also includes a provision to target more aggressively potentially misvalued codes. For instance, it directs HHS to examine codes that

• have experienced the fastest growth

•  have undergone substantial changes in practice expenses

•  describe new technologies

•  account for the majority of spending under the Physician Fee Schedule

•  have high-cost supplies.

The bill sets a target for reducing misvalued services from 2017 through 2020 (0.5% of the estimated amount of the Fee Schedule spending). If the target is met, the savings are redistributed to other services in the Fee Schedule. However, if the target is not meet, payments are reduced. Cuts of 20% or more in a year will be phased in over a 2-year period, according to the legislation.

While primary care groups have been urging the government to shift payments toward cognitive services and away from procedural work for years, they said the bill's misvalued code provision is likely bad news for physicians.

The problem, said Norman E. Vinn, D.O., president of the American Osteopathic Association, is that it doesn't just redirect payments from one area to another but instead appears to cut payments to physicians across the board.  "We agree with the goal, but not the method," said Dr. Reid Blackwelder, president of the American Academy of Family Physicians.

But physicians praised the bill's increased funding for mental health services. The bill funds a 2-year pilot project aimed at improving community mental health services and a grant program for assisted outpatient treatment for people with serious mental illness.

In the pilot project, which will include eight states, community behavior health clinics will certify that they have met certain standards, including offering 24-hour crisis management; screening assessments and diagnosis services; and outpatient mental health and substance abuse services. In exchange, they can qualify for higher federal matching funds through Medicaid.

[email protected]
On Twitter @maryellenny

On April 1, President Obama officially halted the 24% Medicare physician pay cut when he signed into law a bill that provides a 12-month pay patch.

The legislation (H.R. 4302) replaces the scheduled fee cut with a 0.5% pay increase through the end of 2014. It then freezes payment levels for the first three months of 2015, giving Congress another year to figure out if it can pass legislation to permanently repeal Medicare's Sustainable Growth Rate (SGR) formula.

The biggest policy change is the one-year delay of the implementation of the ICD-10 coding sets, which had been scheduled to go into effect on Oct. 1, 2014. Under the recently passed law, the Department of Health & Human Services is barred from implementing the new coding sets until at least Oct. 1, 2015.

The delay was greeted with relief from most physician groups, which had already warned the government that many physicians, especially those in small practices, weren't ready to make the switch. But a coalition that includes health information technology companies, health plans, and the American Hospital Association decried the delay. The industry has already invested time and money in the switch, and a delay will cause only disruption, according to the Coalition for ICD-10.

The SGR legislation also further delays the full implementation of the two-midnight rule governing when Medicare patients should be admitted to the hospital versus placed under observation. Enforcement of the controversial policy by Recovery Audit Contractors (RACs) had already been delayed until Oct. 1, 2014. Under H.R. 4302, most postpayment claim audits by RACs are now delayed until March 31, 2015. However, RACs are allowed to perform audits in cases where there is evidence of systematic gaming, fraud, abuse, or delays in delivering care, according to the legislation.

The bill also includes a provision to target more aggressively potentially misvalued codes. For instance, it directs HHS to examine codes that

• have experienced the fastest growth

•  have undergone substantial changes in practice expenses

•  describe new technologies

•  account for the majority of spending under the Physician Fee Schedule

•  have high-cost supplies.

The bill sets a target for reducing misvalued services from 2017 through 2020 (0.5% of the estimated amount of the Fee Schedule spending). If the target is met, the savings are redistributed to other services in the Fee Schedule. However, if the target is not meet, payments are reduced. Cuts of 20% or more in a year will be phased in over a 2-year period, according to the legislation.

While primary care groups have been urging the government to shift payments toward cognitive services and away from procedural work for years, they said the bill's misvalued code provision is likely bad news for physicians.

The problem, said Norman E. Vinn, D.O., president of the American Osteopathic Association, is that it doesn't just redirect payments from one area to another but instead appears to cut payments to physicians across the board.  "We agree with the goal, but not the method," said Dr. Reid Blackwelder, president of the American Academy of Family Physicians.

But physicians praised the bill's increased funding for mental health services. The bill funds a 2-year pilot project aimed at improving community mental health services and a grant program for assisted outpatient treatment for people with serious mental illness.

In the pilot project, which will include eight states, community behavior health clinics will certify that they have met certain standards, including offering 24-hour crisis management; screening assessments and diagnosis services; and outpatient mental health and substance abuse services. In exchange, they can qualify for higher federal matching funds through Medicaid.

[email protected]
On Twitter @maryellenny

On April 1, President Obama officially halted the 24% Medicare physician pay cut when he signed into law a bill that provides a 12-month pay patch.

The legislation (H.R. 4302) replaces the scheduled fee cut with a 0.5% pay increase through the end of 2014. It then freezes payment levels for the first three months of 2015, giving Congress another year to figure out if it can pass legislation to permanently repeal Medicare's Sustainable Growth Rate (SGR) formula.

The biggest policy change is the one-year delay of the implementation of the ICD-10 coding sets, which had been scheduled to go into effect on Oct. 1, 2014. Under the recently passed law, the Department of Health & Human Services is barred from implementing the new coding sets until at least Oct. 1, 2015.

The delay was greeted with relief from most physician groups, which had already warned the government that many physicians, especially those in small practices, weren't ready to make the switch. But a coalition that includes health information technology companies, health plans, and the American Hospital Association decried the delay. The industry has already invested time and money in the switch, and a delay will cause only disruption, according to the Coalition for ICD-10.

The SGR legislation also further delays the full implementation of the two-midnight rule governing when Medicare patients should be admitted to the hospital versus placed under observation. Enforcement of the controversial policy by Recovery Audit Contractors (RACs) had already been delayed until Oct. 1, 2014. Under H.R. 4302, most postpayment claim audits by RACs are now delayed until March 31, 2015. However, RACs are allowed to perform audits in cases where there is evidence of systematic gaming, fraud, abuse, or delays in delivering care, according to the legislation.

The bill also includes a provision to target more aggressively potentially misvalued codes. For instance, it directs HHS to examine codes that

• have experienced the fastest growth

•  have undergone substantial changes in practice expenses

•  describe new technologies

•  account for the majority of spending under the Physician Fee Schedule

•  have high-cost supplies.

The bill sets a target for reducing misvalued services from 2017 through 2020 (0.5% of the estimated amount of the Fee Schedule spending). If the target is met, the savings are redistributed to other services in the Fee Schedule. However, if the target is not meet, payments are reduced. Cuts of 20% or more in a year will be phased in over a 2-year period, according to the legislation.

While primary care groups have been urging the government to shift payments toward cognitive services and away from procedural work for years, they said the bill's misvalued code provision is likely bad news for physicians.

The problem, said Norman E. Vinn, D.O., president of the American Osteopathic Association, is that it doesn't just redirect payments from one area to another but instead appears to cut payments to physicians across the board.  "We agree with the goal, but not the method," said Dr. Reid Blackwelder, president of the American Academy of Family Physicians.

But physicians praised the bill's increased funding for mental health services. The bill funds a 2-year pilot project aimed at improving community mental health services and a grant program for assisted outpatient treatment for people with serious mental illness.

In the pilot project, which will include eight states, community behavior health clinics will certify that they have met certain standards, including offering 24-hour crisis management; screening assessments and diagnosis services; and outpatient mental health and substance abuse services. In exchange, they can qualify for higher federal matching funds through Medicaid.

[email protected]
On Twitter @maryellenny

Public support for contraceptive coverage under the Affordable Care Act lags behind support for other preventive care benefits, according to a survey of 2,124 adults.

The survey, conducted by researchers at the University of Michigan in Ann Arbor and published April 22 in JAMA (doi:10.1001/jama.2014.4766]), comes as the Supreme Court debates whether to strike down the health reform law’s contraceptive mandate. A decision is expected in June.

©Tina Sbrigato/iStockphoto.com

Overall, 69% of respondents said that all health plans in the United States should be required to include coverage for birth control medications. But support was higher for other preventive services mandated under the ACA, including mammograms and colonoscopies (85%), recommended vaccines (84%), screening tests for diabetes and high cholesterol (82%), and mental health care (77%).

Support for contraceptive coverage was highest among women, black and Hispanic respondents, parents with children living at home, and respondents who had health insurance. Education and income did not play a role, according to the researchers.

The study was funded by the Robert Wood Johnson Foundation Clinical Scholars program and the University of Michigan Health System. Dr. Matthew M. Davis, one of the study authors, reported that he serves as chief medical executive for the Michigan Department of Community Health. No other disclosures were reported.

[email protected]

On Twitter @maryellenny

Public support for contraceptive coverage under the Affordable Care Act lags behind support for other preventive care benefits, according to a survey of 2,124 adults.

The survey, conducted by researchers at the University of Michigan in Ann Arbor and published April 22 in JAMA (doi:10.1001/jama.2014.4766]), comes as the Supreme Court debates whether to strike down the health reform law’s contraceptive mandate. A decision is expected in June.

©Tina Sbrigato/iStockphoto.com

Overall, 69% of respondents said that all health plans in the United States should be required to include coverage for birth control medications. But support was higher for other preventive services mandated under the ACA, including mammograms and colonoscopies (85%), recommended vaccines (84%), screening tests for diabetes and high cholesterol (82%), and mental health care (77%).

Support for contraceptive coverage was highest among women, black and Hispanic respondents, parents with children living at home, and respondents who had health insurance. Education and income did not play a role, according to the researchers.

The study was funded by the Robert Wood Johnson Foundation Clinical Scholars program and the University of Michigan Health System. Dr. Matthew M. Davis, one of the study authors, reported that he serves as chief medical executive for the Michigan Department of Community Health. No other disclosures were reported.

[email protected]

On Twitter @maryellenny

Public support for contraceptive coverage under the Affordable Care Act lags behind support for other preventive care benefits, according to a survey of 2,124 adults.

The survey, conducted by researchers at the University of Michigan in Ann Arbor and published April 22 in JAMA (doi:10.1001/jama.2014.4766]), comes as the Supreme Court debates whether to strike down the health reform law’s contraceptive mandate. A decision is expected in June.

©Tina Sbrigato/iStockphoto.com

Overall, 69% of respondents said that all health plans in the United States should be required to include coverage for birth control medications. But support was higher for other preventive services mandated under the ACA, including mammograms and colonoscopies (85%), recommended vaccines (84%), screening tests for diabetes and high cholesterol (82%), and mental health care (77%).

Support for contraceptive coverage was highest among women, black and Hispanic respondents, parents with children living at home, and respondents who had health insurance. Education and income did not play a role, according to the researchers.

The study was funded by the Robert Wood Johnson Foundation Clinical Scholars program and the University of Michigan Health System. Dr. Matthew M. Davis, one of the study authors, reported that he serves as chief medical executive for the Michigan Department of Community Health. No other disclosures were reported.

[email protected]

On Twitter @maryellenny

The American Hospital Association, along with a small group of health systems and hospital associations, is suing the federal government to overturn the so-called "two-midnight" rule governing whether to classify Medicare beneficiaries as inpatients or outpatients.

In two related lawsuits filed in the U.S. District Court for the District of Columbia on April 14, the plaintiffs contend that the controversial two-midnight policy is bad for hospitals, physicians, and patients because it "permits the government to supplant treating physicians’ judgment."

In August 2013, officials at the Centers for Medicare & Medicaid Services (CMS) finalized the two-midnight policy as part of the 2014 Hospital Inpatient Prospective Payment System final rule. The policy aims to clarify when patients should be admitted to the hospital as inpatients and when they can be treated in the hospital as outpatients, often under observation status.

Under the rule, patients should be considered inpatients if physicians expect it will be medically necessary for them to stay in the hospital over the course of two midnights. If physicians anticipate that patients will leave the hospital earlier, then their stay is generally classified as outpatient.

The rule officially took effect on Oct. 1, 2013, but Congress has delayed postpayment audits from the Recovery Audit Contractors until March 31, 2015.

The rule has significant financial implications for hospitals since Medicare’s Part A payments for inpatient services are typically higher than the Part B payments for outpatient services.

Although CMS estimates that the policy will lead to more inpatient admissions, the AHA and the other plaintiffs said it is likely to do the opposite.

The lawsuits also challenge the new requirement that each inpatient admission have a written physician order as a condition of payment by Medicare. The additional paperwork will not protect patient health, they wrote.

"The new requirement serves only to give CMS a reason to deny otherwise valid Part A claims – a ‘gotcha’ for those hospitals that fail to use the specific language mandated in the rule," the plaintiffs wrote.

The AHA-led lawsuits also seek to overturn the 1-year time limit for seeking Medicare Part B payment after an audit has determined that a hospital stay was inappropriately billed as an inpatient or Part A claim. AHA said that effectively bars hospitals from receiving any payments for those claims because Medicare’s Recovery Audit Contractors almost never begin their review process until a least a year after the date of service.

"In other words, the time limit has already expired on the first day a hospital could seek payment," the plaintiffs wrote.

Lawrence Hughes, AHA’s assistant general counsel, said that the litigation process is expected to move slowly and may not be resolved by the time the enforcement delay expires on March 31, 2015.

[email protected]

On Twitter @maryellenny

The American Hospital Association, along with a small group of health systems and hospital associations, is suing the federal government to overturn the so-called "two-midnight" rule governing whether to classify Medicare beneficiaries as inpatients or outpatients.

In two related lawsuits filed in the U.S. District Court for the District of Columbia on April 14, the plaintiffs contend that the controversial two-midnight policy is bad for hospitals, physicians, and patients because it "permits the government to supplant treating physicians’ judgment."

In August 2013, officials at the Centers for Medicare & Medicaid Services (CMS) finalized the two-midnight policy as part of the 2014 Hospital Inpatient Prospective Payment System final rule. The policy aims to clarify when patients should be admitted to the hospital as inpatients and when they can be treated in the hospital as outpatients, often under observation status.

Under the rule, patients should be considered inpatients if physicians expect it will be medically necessary for them to stay in the hospital over the course of two midnights. If physicians anticipate that patients will leave the hospital earlier, then their stay is generally classified as outpatient.

The rule officially took effect on Oct. 1, 2013, but Congress has delayed postpayment audits from the Recovery Audit Contractors until March 31, 2015.

The rule has significant financial implications for hospitals since Medicare’s Part A payments for inpatient services are typically higher than the Part B payments for outpatient services.

Although CMS estimates that the policy will lead to more inpatient admissions, the AHA and the other plaintiffs said it is likely to do the opposite.

The lawsuits also challenge the new requirement that each inpatient admission have a written physician order as a condition of payment by Medicare. The additional paperwork will not protect patient health, they wrote.

"The new requirement serves only to give CMS a reason to deny otherwise valid Part A claims – a ‘gotcha’ for those hospitals that fail to use the specific language mandated in the rule," the plaintiffs wrote.

The AHA-led lawsuits also seek to overturn the 1-year time limit for seeking Medicare Part B payment after an audit has determined that a hospital stay was inappropriately billed as an inpatient or Part A claim. AHA said that effectively bars hospitals from receiving any payments for those claims because Medicare’s Recovery Audit Contractors almost never begin their review process until a least a year after the date of service.

"In other words, the time limit has already expired on the first day a hospital could seek payment," the plaintiffs wrote.

Lawrence Hughes, AHA’s assistant general counsel, said that the litigation process is expected to move slowly and may not be resolved by the time the enforcement delay expires on March 31, 2015.

[email protected]

On Twitter @maryellenny

The American Hospital Association, along with a small group of health systems and hospital associations, is suing the federal government to overturn the so-called "two-midnight" rule governing whether to classify Medicare beneficiaries as inpatients or outpatients.

In two related lawsuits filed in the U.S. District Court for the District of Columbia on April 14, the plaintiffs contend that the controversial two-midnight policy is bad for hospitals, physicians, and patients because it "permits the government to supplant treating physicians’ judgment."

In August 2013, officials at the Centers for Medicare & Medicaid Services (CMS) finalized the two-midnight policy as part of the 2014 Hospital Inpatient Prospective Payment System final rule. The policy aims to clarify when patients should be admitted to the hospital as inpatients and when they can be treated in the hospital as outpatients, often under observation status.

Under the rule, patients should be considered inpatients if physicians expect it will be medically necessary for them to stay in the hospital over the course of two midnights. If physicians anticipate that patients will leave the hospital earlier, then their stay is generally classified as outpatient.

The rule officially took effect on Oct. 1, 2013, but Congress has delayed postpayment audits from the Recovery Audit Contractors until March 31, 2015.

The rule has significant financial implications for hospitals since Medicare’s Part A payments for inpatient services are typically higher than the Part B payments for outpatient services.

Although CMS estimates that the policy will lead to more inpatient admissions, the AHA and the other plaintiffs said it is likely to do the opposite.

The lawsuits also challenge the new requirement that each inpatient admission have a written physician order as a condition of payment by Medicare. The additional paperwork will not protect patient health, they wrote.

"The new requirement serves only to give CMS a reason to deny otherwise valid Part A claims – a ‘gotcha’ for those hospitals that fail to use the specific language mandated in the rule," the plaintiffs wrote.

The AHA-led lawsuits also seek to overturn the 1-year time limit for seeking Medicare Part B payment after an audit has determined that a hospital stay was inappropriately billed as an inpatient or Part A claim. AHA said that effectively bars hospitals from receiving any payments for those claims because Medicare’s Recovery Audit Contractors almost never begin their review process until a least a year after the date of service.

"In other words, the time limit has already expired on the first day a hospital could seek payment," the plaintiffs wrote.

Lawrence Hughes, AHA’s assistant general counsel, said that the litigation process is expected to move slowly and may not be resolved by the time the enforcement delay expires on March 31, 2015.

[email protected]

On Twitter @maryellenny

The controversial "two-midnight rule" governing when Medicare patients are considered inpatients could change how hospitals operate their observation or short-stay units.

The rule technically went into effect on Oct. 1, 2013, but enforcement through postpayment claims audits by Recovery Audit Contractors (RACs) has been delayed until March 31, 2015. Although most audits are on hold, RACs are allowed to perform audits in cases for which there is evidence of systematic gaming, fraud, abuse, or delays in delivering care, under the latest delay of the policy.

In the meantime, hospitalists, who are often in charge of hospital observation units, are figuring out how the new policy will impact who goes to an observation unit and who is admitted as an inpatient.

Under the rule, the decision to admit a Medicare patient as an inpatient depends on two factors: whether the condition meets medical necessity requiring a patient to be in a hospital setting and the expectation that their time in the hospital will surpass two midnights.

Dr. Aziz Ansari, the medical director of the observation unit at Loyola University Medical Center in Chicago, said that, while the observation units vary across hospital systems, most are set up to handle low-acuity patients with high turnover. The challenge with the two-midnight rule is that sicker patients will now be classified as observation status simply because of the duration of their time in the hospital.

"The challenge is whether these patients should come to the observation unit," Dr. Ansari said.

The answer depends on how much acuity the facility’s observation unit can handle, he said.

At Loyola, which has a 19-bed observation unit with dedicated hospitalists and nurses, they can take on a wide range of patients, with a few exceptions. For instance, they don’t take patients who require one-on-one care from the attending physician, patients withdrawing from alcohol, or patients who are under observation prior to a psychiatric admission.

For a specialty unit that only handles chest pain, or a unit that can’t handle high-acuity patients, the sicker, short-stay Medicare patients would need to be kept under observation but placed on an inpatient floor where they could receive more intensive medical care from the attending physician, he said.

Dr. Ansari recommended that, in light of the two-midnight rule, hospital medicine groups set up clinical parameters that can guide clinicians about where to send high-acuity observation patients.

He predicted that, over time, observation units will evolve so that they can accept more of the sicker patients. One important change is to hire more physician assistants or advanced practice nurses so that hospitalists can spend more time with the sickest patients.

Another key element to making the observation model work with sicker patients is having a mechanism in place to move patients out of the observation unit and admitted to the floors once their status changes to inpatient. These patients should be quickly moved to an inpatient floor bed, Dr. Ansari said.

"The boarding of inpatients in the observation unit is not best for patient care, nor is it an efficient use of resources," he said.

[email protected]

On Twitter @maryellenny

The controversial "two-midnight rule" governing when Medicare patients are considered inpatients could change how hospitals operate their observation or short-stay units.

The rule technically went into effect on Oct. 1, 2013, but enforcement through postpayment claims audits by Recovery Audit Contractors (RACs) has been delayed until March 31, 2015. Although most audits are on hold, RACs are allowed to perform audits in cases for which there is evidence of systematic gaming, fraud, abuse, or delays in delivering care, under the latest delay of the policy.

In the meantime, hospitalists, who are often in charge of hospital observation units, are figuring out how the new policy will impact who goes to an observation unit and who is admitted as an inpatient.

Under the rule, the decision to admit a Medicare patient as an inpatient depends on two factors: whether the condition meets medical necessity requiring a patient to be in a hospital setting and the expectation that their time in the hospital will surpass two midnights.

Dr. Aziz Ansari, the medical director of the observation unit at Loyola University Medical Center in Chicago, said that, while the observation units vary across hospital systems, most are set up to handle low-acuity patients with high turnover. The challenge with the two-midnight rule is that sicker patients will now be classified as observation status simply because of the duration of their time in the hospital.

"The challenge is whether these patients should come to the observation unit," Dr. Ansari said.

The answer depends on how much acuity the facility’s observation unit can handle, he said.

At Loyola, which has a 19-bed observation unit with dedicated hospitalists and nurses, they can take on a wide range of patients, with a few exceptions. For instance, they don’t take patients who require one-on-one care from the attending physician, patients withdrawing from alcohol, or patients who are under observation prior to a psychiatric admission.

For a specialty unit that only handles chest pain, or a unit that can’t handle high-acuity patients, the sicker, short-stay Medicare patients would need to be kept under observation but placed on an inpatient floor where they could receive more intensive medical care from the attending physician, he said.

Dr. Ansari recommended that, in light of the two-midnight rule, hospital medicine groups set up clinical parameters that can guide clinicians about where to send high-acuity observation patients.

He predicted that, over time, observation units will evolve so that they can accept more of the sicker patients. One important change is to hire more physician assistants or advanced practice nurses so that hospitalists can spend more time with the sickest patients.

Another key element to making the observation model work with sicker patients is having a mechanism in place to move patients out of the observation unit and admitted to the floors once their status changes to inpatient. These patients should be quickly moved to an inpatient floor bed, Dr. Ansari said.

"The boarding of inpatients in the observation unit is not best for patient care, nor is it an efficient use of resources," he said.

[email protected]

On Twitter @maryellenny

The controversial "two-midnight rule" governing when Medicare patients are considered inpatients could change how hospitals operate their observation or short-stay units.

The rule technically went into effect on Oct. 1, 2013, but enforcement through postpayment claims audits by Recovery Audit Contractors (RACs) has been delayed until March 31, 2015. Although most audits are on hold, RACs are allowed to perform audits in cases for which there is evidence of systematic gaming, fraud, abuse, or delays in delivering care, under the latest delay of the policy.

In the meantime, hospitalists, who are often in charge of hospital observation units, are figuring out how the new policy will impact who goes to an observation unit and who is admitted as an inpatient.

Under the rule, the decision to admit a Medicare patient as an inpatient depends on two factors: whether the condition meets medical necessity requiring a patient to be in a hospital setting and the expectation that their time in the hospital will surpass two midnights.

Dr. Aziz Ansari, the medical director of the observation unit at Loyola University Medical Center in Chicago, said that, while the observation units vary across hospital systems, most are set up to handle low-acuity patients with high turnover. The challenge with the two-midnight rule is that sicker patients will now be classified as observation status simply because of the duration of their time in the hospital.

"The challenge is whether these patients should come to the observation unit," Dr. Ansari said.

The answer depends on how much acuity the facility’s observation unit can handle, he said.

At Loyola, which has a 19-bed observation unit with dedicated hospitalists and nurses, they can take on a wide range of patients, with a few exceptions. For instance, they don’t take patients who require one-on-one care from the attending physician, patients withdrawing from alcohol, or patients who are under observation prior to a psychiatric admission.

For a specialty unit that only handles chest pain, or a unit that can’t handle high-acuity patients, the sicker, short-stay Medicare patients would need to be kept under observation but placed on an inpatient floor where they could receive more intensive medical care from the attending physician, he said.

Dr. Ansari recommended that, in light of the two-midnight rule, hospital medicine groups set up clinical parameters that can guide clinicians about where to send high-acuity observation patients.

He predicted that, over time, observation units will evolve so that they can accept more of the sicker patients. One important change is to hire more physician assistants or advanced practice nurses so that hospitalists can spend more time with the sickest patients.

Another key element to making the observation model work with sicker patients is having a mechanism in place to move patients out of the observation unit and admitted to the floors once their status changes to inpatient. These patients should be quickly moved to an inpatient floor bed, Dr. Ansari said.

"The boarding of inpatients in the observation unit is not best for patient care, nor is it an efficient use of resources," he said.

[email protected]

On Twitter @maryellenny

In the Affordable Care Act’s first open enrollment period, 8 million Americans signed up for private health insurance through the state and federal health marketplaces.

President Obama announced the latest figures on April 17, more than 2 weeks after the close of the first open enrollment period. Though March 31 was the deadline for signing up, individuals who had started the process by the deadline were given until April 15 to complete the process. During that time, nearly 1 million additional people signed up for health plans.

healthcare.gov

More young people have signed up for coverage as well. President Obama reported that in the federally run marketplaces, 35% of the sign-ups were from individuals under age 35, including children. About 28% of sign-ups were from young adults aged 18-34 years. That’s similar to the percentage of young adults who signed up for insurance in Massachusetts during the first year of its health reform effort, according to the White House.

"The Affordable Care Act is working," President Obama said during a White House press conference.

He once again called on the ACA’s opponents to stop trying to repeal it.

Rep. Fred Upton (R- Mich.), chairman of the House Energy and Commerce Committee, said the law has disrupted health care for millions of Americans, limited access to physicians, and caused insurance premiums to skyrocket.

"The administration still has not answered basic questions about enrollment and why it will not support fairness for all," Rep. Upton said in a statement.

[email protected]

On Twitter @maryellenny

In the Affordable Care Act’s first open enrollment period, 8 million Americans signed up for private health insurance through the state and federal health marketplaces.

President Obama announced the latest figures on April 17, more than 2 weeks after the close of the first open enrollment period. Though March 31 was the deadline for signing up, individuals who had started the process by the deadline were given until April 15 to complete the process. During that time, nearly 1 million additional people signed up for health plans.

healthcare.gov

More young people have signed up for coverage as well. President Obama reported that in the federally run marketplaces, 35% of the sign-ups were from individuals under age 35, including children. About 28% of sign-ups were from young adults aged 18-34 years. That’s similar to the percentage of young adults who signed up for insurance in Massachusetts during the first year of its health reform effort, according to the White House.

"The Affordable Care Act is working," President Obama said during a White House press conference.

He once again called on the ACA’s opponents to stop trying to repeal it.

Rep. Fred Upton (R- Mich.), chairman of the House Energy and Commerce Committee, said the law has disrupted health care for millions of Americans, limited access to physicians, and caused insurance premiums to skyrocket.

"The administration still has not answered basic questions about enrollment and why it will not support fairness for all," Rep. Upton said in a statement.

[email protected]

On Twitter @maryellenny

In the Affordable Care Act’s first open enrollment period, 8 million Americans signed up for private health insurance through the state and federal health marketplaces.

President Obama announced the latest figures on April 17, more than 2 weeks after the close of the first open enrollment period. Though March 31 was the deadline for signing up, individuals who had started the process by the deadline were given until April 15 to complete the process. During that time, nearly 1 million additional people signed up for health plans.

healthcare.gov

More young people have signed up for coverage as well. President Obama reported that in the federally run marketplaces, 35% of the sign-ups were from individuals under age 35, including children. About 28% of sign-ups were from young adults aged 18-34 years. That’s similar to the percentage of young adults who signed up for insurance in Massachusetts during the first year of its health reform effort, according to the White House.

"The Affordable Care Act is working," President Obama said during a White House press conference.

He once again called on the ACA’s opponents to stop trying to repeal it.

Rep. Fred Upton (R- Mich.), chairman of the House Energy and Commerce Committee, said the law has disrupted health care for millions of Americans, limited access to physicians, and caused insurance premiums to skyrocket.

"The administration still has not answered basic questions about enrollment and why it will not support fairness for all," Rep. Upton said in a statement.

[email protected]

On Twitter @maryellenny

Sylvia Mathews Burwell, best known in Washington for managing last fall’s government shutdown, has been tapped to head the Department of Health & Human Services.

On April 11, President Obama announced that Kathleen Sebelius has resigned after 5 years as HHS secretary. The president will nominate Ms. Burwell, the current director of the White House Office of Management and Budget (OMB), to replace Ms. Sebelius.

Wikimedia Commons/SenRockefeller/Creative Commons

Ms. Burwell faces confirmation by the Senate, but new rules mean that she will need only a majority of senators to vote in her favor.

Ms. Burwell, a Rhodes Scholar from Hinton, W.Va., was confirmed unanimously by the Senate last year to head the OMB. Before coming to the White House, she served as president of the Walmart Foundation and as president of the global development program at the Bill & Melinda Gates Foundation.

During the Clinton administration, Ms. Burwell worked as deputy director of OMB, as well as in other roles at the White House.

President Obama praised Ms. Burwell as "experienced" and "competent" and said she will bring common sense to the HHS job. "She knows how to deliver results," he said.

President Obama also commended the work done by Ms. Sebelius, saying that she turned around the struggling healthcare.gov website and helped to get 7.5 million Americans signed up for health insurance during the Affordable Care Act’s first open enrollment period.

"The final score speaks for itself," he said.

Ms. Sebelius will remain at the HHS helm until her successor is confirmed.

[email protected]

On Twitter @maryellenny

Sylvia Mathews Burwell, best known in Washington for managing last fall’s government shutdown, has been tapped to head the Department of Health & Human Services.

On April 11, President Obama announced that Kathleen Sebelius has resigned after 5 years as HHS secretary. The president will nominate Ms. Burwell, the current director of the White House Office of Management and Budget (OMB), to replace Ms. Sebelius.

Wikimedia Commons/SenRockefeller/Creative Commons

Ms. Burwell faces confirmation by the Senate, but new rules mean that she will need only a majority of senators to vote in her favor.

Ms. Burwell, a Rhodes Scholar from Hinton, W.Va., was confirmed unanimously by the Senate last year to head the OMB. Before coming to the White House, she served as president of the Walmart Foundation and as president of the global development program at the Bill & Melinda Gates Foundation.

During the Clinton administration, Ms. Burwell worked as deputy director of OMB, as well as in other roles at the White House.

President Obama praised Ms. Burwell as "experienced" and "competent" and said she will bring common sense to the HHS job. "She knows how to deliver results," he said.

President Obama also commended the work done by Ms. Sebelius, saying that she turned around the struggling healthcare.gov website and helped to get 7.5 million Americans signed up for health insurance during the Affordable Care Act’s first open enrollment period.

"The final score speaks for itself," he said.

Ms. Sebelius will remain at the HHS helm until her successor is confirmed.

[email protected]

On Twitter @maryellenny

Sylvia Mathews Burwell, best known in Washington for managing last fall’s government shutdown, has been tapped to head the Department of Health & Human Services.

On April 11, President Obama announced that Kathleen Sebelius has resigned after 5 years as HHS secretary. The president will nominate Ms. Burwell, the current director of the White House Office of Management and Budget (OMB), to replace Ms. Sebelius.

Wikimedia Commons/SenRockefeller/Creative Commons

Ms. Burwell faces confirmation by the Senate, but new rules mean that she will need only a majority of senators to vote in her favor.

Ms. Burwell, a Rhodes Scholar from Hinton, W.Va., was confirmed unanimously by the Senate last year to head the OMB. Before coming to the White House, she served as president of the Walmart Foundation and as president of the global development program at the Bill & Melinda Gates Foundation.

During the Clinton administration, Ms. Burwell worked as deputy director of OMB, as well as in other roles at the White House.

President Obama praised Ms. Burwell as "experienced" and "competent" and said she will bring common sense to the HHS job. "She knows how to deliver results," he said.

President Obama also commended the work done by Ms. Sebelius, saying that she turned around the struggling healthcare.gov website and helped to get 7.5 million Americans signed up for health insurance during the Affordable Care Act’s first open enrollment period.

"The final score speaks for itself," he said.

Ms. Sebelius will remain at the HHS helm until her successor is confirmed.

[email protected]

On Twitter @maryellenny

Physician Compare, Medicare's online portal for checking on physician qualifications, has added quality scores for physicians in some group practices and Accountable Care Organizations. The site displays how a group of physicians performed on five quality indicators related to management of diabetes and heart disease. The website will display the ratings using stars, as well as the percentage score.

"This is an important first step in publicly reporting quality measures on Physician Compare," Dr. Patrick Conway, chief medical officer and deputy administrator for innovation and quality at the Centers for Medicare & Medicaid Services, said in a statement. "Offering a strong set of meaningful quality measures on the site will ultimately help consumers make decisions and it will encourage quality improvement among the clinician community, who shares the CMS's strong commitment to the best possible patient care."

The Physician Compare site, which was created under the Affordable Care Act, already displays the specialties offered by physicians, their board certification, and hospital affiliations. It also displays whether physicians participate in Medicare quality programs such as the Physician Quality Reporting System, the Electronic Prescribing Incentive Program, and the Electronic Health Records Incentive Program.

The information comes primarily from the Provider, Enrollment, Chain, and Ownership System and is checked against Medicare claims data. The site includes information on physicians enrolled in the Medicare program only.
This year, the CMS is posting quality data from 66 group practices and 141 ACOs. The data are reported at the group practice and ACO level. The quality measures include:

• Controlling hemoglobin A1c in patients with diabetes.

• Controlling blood pressure in patients with diabetes.

• Prescribing aspirin to patients with diabetes and heart disease.

• Reporting the number of diabetic patients who do not use tobacco.

• Prescribing medicine to improve the pumping action of the heart in patients who have both heart disease and certain other conditions.

Physician Compare, Medicare's online portal for checking on physician qualifications, has added quality scores for physicians in some group practices and Accountable Care Organizations. The site displays how a group of physicians performed on five quality indicators related to management of diabetes and heart disease. The website will display the ratings using stars, as well as the percentage score.

"This is an important first step in publicly reporting quality measures on Physician Compare," Dr. Patrick Conway, chief medical officer and deputy administrator for innovation and quality at the Centers for Medicare & Medicaid Services, said in a statement. "Offering a strong set of meaningful quality measures on the site will ultimately help consumers make decisions and it will encourage quality improvement among the clinician community, who shares the CMS's strong commitment to the best possible patient care."

The Physician Compare site, which was created under the Affordable Care Act, already displays the specialties offered by physicians, their board certification, and hospital affiliations. It also displays whether physicians participate in Medicare quality programs such as the Physician Quality Reporting System, the Electronic Prescribing Incentive Program, and the Electronic Health Records Incentive Program.

The information comes primarily from the Provider, Enrollment, Chain, and Ownership System and is checked against Medicare claims data. The site includes information on physicians enrolled in the Medicare program only.
This year, the CMS is posting quality data from 66 group practices and 141 ACOs. The data are reported at the group practice and ACO level. The quality measures include:

• Controlling hemoglobin A1c in patients with diabetes.

• Controlling blood pressure in patients with diabetes.

• Prescribing aspirin to patients with diabetes and heart disease.

• Reporting the number of diabetic patients who do not use tobacco.

• Prescribing medicine to improve the pumping action of the heart in patients who have both heart disease and certain other conditions.

Physician Compare, Medicare's online portal for checking on physician qualifications, has added quality scores for physicians in some group practices and Accountable Care Organizations. The site displays how a group of physicians performed on five quality indicators related to management of diabetes and heart disease. The website will display the ratings using stars, as well as the percentage score.

"This is an important first step in publicly reporting quality measures on Physician Compare," Dr. Patrick Conway, chief medical officer and deputy administrator for innovation and quality at the Centers for Medicare & Medicaid Services, said in a statement. "Offering a strong set of meaningful quality measures on the site will ultimately help consumers make decisions and it will encourage quality improvement among the clinician community, who shares the CMS's strong commitment to the best possible patient care."

The Physician Compare site, which was created under the Affordable Care Act, already displays the specialties offered by physicians, their board certification, and hospital affiliations. It also displays whether physicians participate in Medicare quality programs such as the Physician Quality Reporting System, the Electronic Prescribing Incentive Program, and the Electronic Health Records Incentive Program.

The information comes primarily from the Provider, Enrollment, Chain, and Ownership System and is checked against Medicare claims data. The site includes information on physicians enrolled in the Medicare program only.
This year, the CMS is posting quality data from 66 group practices and 141 ACOs. The data are reported at the group practice and ACO level. The quality measures include:

• Controlling hemoglobin A1c in patients with diabetes.

• Controlling blood pressure in patients with diabetes.

• Prescribing aspirin to patients with diabetes and heart disease.

• Reporting the number of diabetic patients who do not use tobacco.

• Prescribing medicine to improve the pumping action of the heart in patients who have both heart disease and certain other conditions.

Federal officials are proposing new targets for reducing health care–associated infections, including a 75% reduction in invasive methicillin-resistant Staphylococcus aureus infections by 2020.

The targets are available at www.health.gov/hai/pdfs/HAI-Targets.pdf and were produced by a committee of experts in the prevention of HAIs, who were charged with updating the federal government’s National Action Plan to Prevent Health Care-Associated Infections. The 5-year goals outlined in that plan, originally released in 2009, expired last year.

CDC/D. Holdeman

The current proposal would make HAI reduction in U.S. hospitals more aggressive in some areas, while dropping five Surgical Care Improvement Project measures from the target list. The process measures, which aim to prevent surgical site infections, are now widely accepted as standards of practice and have adherence rates greater than 95%, according to HHS.

Some of the new targets will be based on 2015 baseline data, which are not yet available.

The seven proposed targets for 2020 are:

• Reduce central line–associated bloodstream infections by 50% from the 2015 baseline. Infections from mucosal barrier injury will be excluded from the calculation.

•  Reduce catheter-associated urinary tract infections by 25% from the 2015 baseline.

• Reduce invasive health care–associated MRSA infections by 75% from the 2007 to 2008 baseline (27.08 infections per 100,000 persons).

• Reduce facility-onset MRSA by 50% from the 2015 baseline.

• Reduce facility-onset Clostridium difficile infections by 30% from the 2015 baseline.

• Reduce the rate of C. difficile hospitalizations by 30% from the 2015 baseline.

• Reduce surgical site infection admission and readmission by 30% from the 2015 baseline.

Hospitals and health care providers are seeing mixed results in reducing HAIs so far, according to data from HHS. As of October 2012, there have been steady improvements in reducing central line–associated bloodstream infections, health-care–associated invasive MRSA infections, and surgical site infections. But progress on reducing hospitalizations with C. difficile infection has leveled off, and providers are also not on track to meet targets for catheter-associated urinary tract infections, according to HHS.

[email protected]

On Twitter @maryellenny

Federal officials are proposing new targets for reducing health care–associated infections, including a 75% reduction in invasive methicillin-resistant Staphylococcus aureus infections by 2020.

The targets are available at www.health.gov/hai/pdfs/HAI-Targets.pdf and were produced by a committee of experts in the prevention of HAIs, who were charged with updating the federal government’s National Action Plan to Prevent Health Care-Associated Infections. The 5-year goals outlined in that plan, originally released in 2009, expired last year.

CDC/D. Holdeman

The current proposal would make HAI reduction in U.S. hospitals more aggressive in some areas, while dropping five Surgical Care Improvement Project measures from the target list. The process measures, which aim to prevent surgical site infections, are now widely accepted as standards of practice and have adherence rates greater than 95%, according to HHS.

Some of the new targets will be based on 2015 baseline data, which are not yet available.

The seven proposed targets for 2020 are:

• Reduce central line–associated bloodstream infections by 50% from the 2015 baseline. Infections from mucosal barrier injury will be excluded from the calculation.

•  Reduce catheter-associated urinary tract infections by 25% from the 2015 baseline.

• Reduce invasive health care–associated MRSA infections by 75% from the 2007 to 2008 baseline (27.08 infections per 100,000 persons).

• Reduce facility-onset MRSA by 50% from the 2015 baseline.

• Reduce facility-onset Clostridium difficile infections by 30% from the 2015 baseline.

• Reduce the rate of C. difficile hospitalizations by 30% from the 2015 baseline.

• Reduce surgical site infection admission and readmission by 30% from the 2015 baseline.

Hospitals and health care providers are seeing mixed results in reducing HAIs so far, according to data from HHS. As of October 2012, there have been steady improvements in reducing central line–associated bloodstream infections, health-care–associated invasive MRSA infections, and surgical site infections. But progress on reducing hospitalizations with C. difficile infection has leveled off, and providers are also not on track to meet targets for catheter-associated urinary tract infections, according to HHS.

[email protected]

On Twitter @maryellenny

Federal officials are proposing new targets for reducing health care–associated infections, including a 75% reduction in invasive methicillin-resistant Staphylococcus aureus infections by 2020.

The targets are available at www.health.gov/hai/pdfs/HAI-Targets.pdf and were produced by a committee of experts in the prevention of HAIs, who were charged with updating the federal government’s National Action Plan to Prevent Health Care-Associated Infections. The 5-year goals outlined in that plan, originally released in 2009, expired last year.

CDC/D. Holdeman

The current proposal would make HAI reduction in U.S. hospitals more aggressive in some areas, while dropping five Surgical Care Improvement Project measures from the target list. The process measures, which aim to prevent surgical site infections, are now widely accepted as standards of practice and have adherence rates greater than 95%, according to HHS.

Some of the new targets will be based on 2015 baseline data, which are not yet available.

The seven proposed targets for 2020 are:

• Reduce central line–associated bloodstream infections by 50% from the 2015 baseline. Infections from mucosal barrier injury will be excluded from the calculation.

•  Reduce catheter-associated urinary tract infections by 25% from the 2015 baseline.

• Reduce invasive health care–associated MRSA infections by 75% from the 2007 to 2008 baseline (27.08 infections per 100,000 persons).

• Reduce facility-onset MRSA by 50% from the 2015 baseline.

• Reduce facility-onset Clostridium difficile infections by 30% from the 2015 baseline.

• Reduce the rate of C. difficile hospitalizations by 30% from the 2015 baseline.

• Reduce surgical site infection admission and readmission by 30% from the 2015 baseline.

Hospitals and health care providers are seeing mixed results in reducing HAIs so far, according to data from HHS. As of October 2012, there have been steady improvements in reducing central line–associated bloodstream infections, health-care–associated invasive MRSA infections, and surgical site infections. But progress on reducing hospitalizations with C. difficile infection has leveled off, and providers are also not on track to meet targets for catheter-associated urinary tract infections, according to HHS.

[email protected]

On Twitter @maryellenny

For the first time, federal officials have publicly released data on how much Medicare pays individual physicians.

On April 9, the Centers for Medicare & Medicaid Services posted searchable files with information on more than 880,000 health care providers, including their specialty, the number of services they provided, what they charged, and what they were paid by Medicare.

Collectively, the data reveal $77 billion in Medicare Part B payments made in 2012.

The data set also allows the public to search for specific procedures and find out how often they were performed and the variation in payments.

For instance, in 2012, more than 91 million outpatient office visits were billed to Medicare with the CPT code 99213. The average Medicare-allowed amount was $69.59, with a range of $12.42 to $144.56. Chest x-rays were performed more than 17 million times in 2012; the average Medicare-allowed amount was $8.94, with a range of $6.52 to $28.56.

The Medicare-allowed amount for the more than 10 million emergency department visits billed to Medicare in 2012 ranged from $108.29 to $231.27, with an average allowed charge of $167.62.

In the short term, the large-scale data dump has yielded a slew of news stories about outlier physicians who raked in tens of millions from the Medicare program. Medicare officials said they expect that in the long term, the data will help root out fraud and highlight geographic payment variations.

"For too long, this information was not made public," Jonathan Blum, CMS principal deputy administrator, said during a press conference on April 9. "We believe the public has a right to know this information. The Medicare program is by and large funded with taxpayer dollars, and taxpayers have the right to understand what is being paid for and how it’s being paid for."

Aside from increased transparency, Mr. Blum said the agency is also counting on researchers, journalists, and the public to find patterns of waste or fraud that the agency may have missed.

But mostly, the data release has left physicians with unanswered questions – most notably how to address errors in the data. CMS officials did not provide physicians a chance to review their data before they were released, and so far, there is no formal mechanism for requesting corrections. The agency is working on setting up an appeals process, but it’s not ready yet, said Dr. Reid Blackwelder, president of the American Academy of Family Physicians. "It’s not an ideal situation at all."

For now, physicians can try e-mailing questions or complaints to CMS at [email protected].

Another lingering question is how to explain the information to patients.

"Payment data are particularly confusing since various complex factors contribute to their variability," said Dr. Norman E. Vinn, president of the American Osteopathic Association.

Physicians will be forced to explain to their patients that the CMS data are "raw" and don’t reflect the quality or competency of the physician or the treatment provided.

But Dr. Blackwelder said that if patients do bring up the data, it could be an opportunity to discuss why certain tests are frequently ordered or how Medicare actually pays physicians. For instance, Dr. Blackwelder said the Medicare charges reflect the cost of services, while the payments from the CMS are usually much lower.

"It’s a really important issue for patients to be aware of," he said.

While nearly all physician organizations voice their support of greater transparency on health care payments, they also object to the lack of context provided by the CMS.

The American Medical Association released a guide to the media highlighting the potential for errors in the data, as well as the lack of information about quality. The raw data could also be misleading in other ways, the AMA noted. For instance, since residents, physician assistants, and nurse practitioners sometimes file claims under a physician’s NPI (National Provider Identifier) number, the data listed for a particular physician may not accurately portray the services performed by that physician. Also, the data do not account for the patient mix, the demographics of the practice, or drug and supply costs.

"The AMA is disappointed that CMS did not include reasonable safeguards that would help the public understand the limitations of this data," Dr. Ardis Dee Hoven, AMA president, said in a statement.

The Medical Group Management Association raised similar concerns. "This release could result in patients making decisions about their care based on faulty assumptions about physicians," Dr. Susan Turney, president and CEO of MGMA, said in a statement. "Claims data are not a proxy for quality, especially when provided in isolation from a single payer."

The MGMA is also concerned that publishing individual provider information, including their address and NPI number, could leave them vulnerable to fraud.

For decades, the federal government was prohibited from releasing their type of individual payment data. However, in 2013, a federal court lifted the injunction that had barred the government from releasing its database of Medicare physician claims to the public. Since then, CMS has received numerous Freedom of Information Act requests seeking the data.

[email protected]

On Twitter @maryellenny

For the first time, federal officials have publicly released data on how much Medicare pays individual physicians.

On April 9, the Centers for Medicare & Medicaid Services posted searchable files with information on more than 880,000 health care providers, including their specialty, the number of services they provided, what they charged, and what they were paid by Medicare.

Collectively, the data reveal $77 billion in Medicare Part B payments made in 2012.

The data set also allows the public to search for specific procedures and find out how often they were performed and the variation in payments.

For instance, in 2012, more than 91 million outpatient office visits were billed to Medicare with the CPT code 99213. The average Medicare-allowed amount was $69.59, with a range of $12.42 to $144.56. Chest x-rays were performed more than 17 million times in 2012; the average Medicare-allowed amount was $8.94, with a range of $6.52 to $28.56.

The Medicare-allowed amount for the more than 10 million emergency department visits billed to Medicare in 2012 ranged from $108.29 to $231.27, with an average allowed charge of $167.62.

In the short term, the large-scale data dump has yielded a slew of news stories about outlier physicians who raked in tens of millions from the Medicare program. Medicare officials said they expect that in the long term, the data will help root out fraud and highlight geographic payment variations.

"For too long, this information was not made public," Jonathan Blum, CMS principal deputy administrator, said during a press conference on April 9. "We believe the public has a right to know this information. The Medicare program is by and large funded with taxpayer dollars, and taxpayers have the right to understand what is being paid for and how it’s being paid for."

Aside from increased transparency, Mr. Blum said the agency is also counting on researchers, journalists, and the public to find patterns of waste or fraud that the agency may have missed.

But mostly, the data release has left physicians with unanswered questions – most notably how to address errors in the data. CMS officials did not provide physicians a chance to review their data before they were released, and so far, there is no formal mechanism for requesting corrections. The agency is working on setting up an appeals process, but it’s not ready yet, said Dr. Reid Blackwelder, president of the American Academy of Family Physicians. "It’s not an ideal situation at all."

For now, physicians can try e-mailing questions or complaints to CMS at [email protected].

Another lingering question is how to explain the information to patients.

"Payment data are particularly confusing since various complex factors contribute to their variability," said Dr. Norman E. Vinn, president of the American Osteopathic Association.

Physicians will be forced to explain to their patients that the CMS data are "raw" and don’t reflect the quality or competency of the physician or the treatment provided.

But Dr. Blackwelder said that if patients do bring up the data, it could be an opportunity to discuss why certain tests are frequently ordered or how Medicare actually pays physicians. For instance, Dr. Blackwelder said the Medicare charges reflect the cost of services, while the payments from the CMS are usually much lower.

"It’s a really important issue for patients to be aware of," he said.

While nearly all physician organizations voice their support of greater transparency on health care payments, they also object to the lack of context provided by the CMS.

The American Medical Association released a guide to the media highlighting the potential for errors in the data, as well as the lack of information about quality. The raw data could also be misleading in other ways, the AMA noted. For instance, since residents, physician assistants, and nurse practitioners sometimes file claims under a physician’s NPI (National Provider Identifier) number, the data listed for a particular physician may not accurately portray the services performed by that physician. Also, the data do not account for the patient mix, the demographics of the practice, or drug and supply costs.

"The AMA is disappointed that CMS did not include reasonable safeguards that would help the public understand the limitations of this data," Dr. Ardis Dee Hoven, AMA president, said in a statement.

The Medical Group Management Association raised similar concerns. "This release could result in patients making decisions about their care based on faulty assumptions about physicians," Dr. Susan Turney, president and CEO of MGMA, said in a statement. "Claims data are not a proxy for quality, especially when provided in isolation from a single payer."

The MGMA is also concerned that publishing individual provider information, including their address and NPI number, could leave them vulnerable to fraud.

For decades, the federal government was prohibited from releasing their type of individual payment data. However, in 2013, a federal court lifted the injunction that had barred the government from releasing its database of Medicare physician claims to the public. Since then, CMS has received numerous Freedom of Information Act requests seeking the data.

[email protected]

On Twitter @maryellenny

For the first time, federal officials have publicly released data on how much Medicare pays individual physicians.

On April 9, the Centers for Medicare & Medicaid Services posted searchable files with information on more than 880,000 health care providers, including their specialty, the number of services they provided, what they charged, and what they were paid by Medicare.

Collectively, the data reveal $77 billion in Medicare Part B payments made in 2012.

The data set also allows the public to search for specific procedures and find out how often they were performed and the variation in payments.

For instance, in 2012, more than 91 million outpatient office visits were billed to Medicare with the CPT code 99213. The average Medicare-allowed amount was $69.59, with a range of $12.42 to $144.56. Chest x-rays were performed more than 17 million times in 2012; the average Medicare-allowed amount was $8.94, with a range of $6.52 to $28.56.

The Medicare-allowed amount for the more than 10 million emergency department visits billed to Medicare in 2012 ranged from $108.29 to $231.27, with an average allowed charge of $167.62.

In the short term, the large-scale data dump has yielded a slew of news stories about outlier physicians who raked in tens of millions from the Medicare program. Medicare officials said they expect that in the long term, the data will help root out fraud and highlight geographic payment variations.

"For too long, this information was not made public," Jonathan Blum, CMS principal deputy administrator, said during a press conference on April 9. "We believe the public has a right to know this information. The Medicare program is by and large funded with taxpayer dollars, and taxpayers have the right to understand what is being paid for and how it’s being paid for."

Aside from increased transparency, Mr. Blum said the agency is also counting on researchers, journalists, and the public to find patterns of waste or fraud that the agency may have missed.

But mostly, the data release has left physicians with unanswered questions – most notably how to address errors in the data. CMS officials did not provide physicians a chance to review their data before they were released, and so far, there is no formal mechanism for requesting corrections. The agency is working on setting up an appeals process, but it’s not ready yet, said Dr. Reid Blackwelder, president of the American Academy of Family Physicians. "It’s not an ideal situation at all."

For now, physicians can try e-mailing questions or complaints to CMS at [email protected].

Another lingering question is how to explain the information to patients.

"Payment data are particularly confusing since various complex factors contribute to their variability," said Dr. Norman E. Vinn, president of the American Osteopathic Association.

Physicians will be forced to explain to their patients that the CMS data are "raw" and don’t reflect the quality or competency of the physician or the treatment provided.

But Dr. Blackwelder said that if patients do bring up the data, it could be an opportunity to discuss why certain tests are frequently ordered or how Medicare actually pays physicians. For instance, Dr. Blackwelder said the Medicare charges reflect the cost of services, while the payments from the CMS are usually much lower.

"It’s a really important issue for patients to be aware of," he said.

While nearly all physician organizations voice their support of greater transparency on health care payments, they also object to the lack of context provided by the CMS.

The American Medical Association released a guide to the media highlighting the potential for errors in the data, as well as the lack of information about quality. The raw data could also be misleading in other ways, the AMA noted. For instance, since residents, physician assistants, and nurse practitioners sometimes file claims under a physician’s NPI (National Provider Identifier) number, the data listed for a particular physician may not accurately portray the services performed by that physician. Also, the data do not account for the patient mix, the demographics of the practice, or drug and supply costs.

"The AMA is disappointed that CMS did not include reasonable safeguards that would help the public understand the limitations of this data," Dr. Ardis Dee Hoven, AMA president, said in a statement.

The Medical Group Management Association raised similar concerns. "This release could result in patients making decisions about their care based on faulty assumptions about physicians," Dr. Susan Turney, president and CEO of MGMA, said in a statement. "Claims data are not a proxy for quality, especially when provided in isolation from a single payer."

The MGMA is also concerned that publishing individual provider information, including their address and NPI number, could leave them vulnerable to fraud.

For decades, the federal government was prohibited from releasing their type of individual payment data. However, in 2013, a federal court lifted the injunction that had barred the government from releasing its database of Medicare physician claims to the public. Since then, CMS has received numerous Freedom of Information Act requests seeking the data.

[email protected]

On Twitter @maryellenny

On April 9, officials at the Centers for Medicare & Medicaid Services released an unprecedented amount of data detailing the payments made to more than 880,000 physicians and other health care providers.

The searchable files released by CMS include the provider name, address, specialty, and National Provider Identifier, as well as Medicare charges submitted and allowed and total Medicare payment for the year.

The data dump was harshly criticized by the American Medical Association, which said that the government had not given physicians a chance to review and correct their data. The data also lack context about quality of care, patient population, and site of service, the AMA said.

"Thoughtful observers concluded long ago that payments or costs were not the only metric to evaluate medical care," Dr. Ardis Dee Hoven, president of the AMA, said in a statement. "Quality, value, and outcomes are critical yardsticks for patients. The information released by CMS will not allow patients or payers to draw meaningful conclusions about the value or quality of care."

CMS will hold a press conference on the data dump on April 9. For more information on how to manage this new development in your practice, visit this website later this afternoon.

[email protected]

On Twitter @maryellenny

On April 9, officials at the Centers for Medicare & Medicaid Services released an unprecedented amount of data detailing the payments made to more than 880,000 physicians and other health care providers.

The searchable files released by CMS include the provider name, address, specialty, and National Provider Identifier, as well as Medicare charges submitted and allowed and total Medicare payment for the year.

The data dump was harshly criticized by the American Medical Association, which said that the government had not given physicians a chance to review and correct their data. The data also lack context about quality of care, patient population, and site of service, the AMA said.

"Thoughtful observers concluded long ago that payments or costs were not the only metric to evaluate medical care," Dr. Ardis Dee Hoven, president of the AMA, said in a statement. "Quality, value, and outcomes are critical yardsticks for patients. The information released by CMS will not allow patients or payers to draw meaningful conclusions about the value or quality of care."

CMS will hold a press conference on the data dump on April 9. For more information on how to manage this new development in your practice, visit this website later this afternoon.

[email protected]

On Twitter @maryellenny

On April 9, officials at the Centers for Medicare & Medicaid Services released an unprecedented amount of data detailing the payments made to more than 880,000 physicians and other health care providers.

The searchable files released by CMS include the provider name, address, specialty, and National Provider Identifier, as well as Medicare charges submitted and allowed and total Medicare payment for the year.

The data dump was harshly criticized by the American Medical Association, which said that the government had not given physicians a chance to review and correct their data. The data also lack context about quality of care, patient population, and site of service, the AMA said.

"Thoughtful observers concluded long ago that payments or costs were not the only metric to evaluate medical care," Dr. Ardis Dee Hoven, president of the AMA, said in a statement. "Quality, value, and outcomes are critical yardsticks for patients. The information released by CMS will not allow patients or payers to draw meaningful conclusions about the value or quality of care."

CMS will hold a press conference on the data dump on April 9. For more information on how to manage this new development in your practice, visit this website later this afternoon.

[email protected]

On Twitter @maryellenny