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CDC: Physician adoption of EHRs nears 80%
Nearly 80% of office-based physicians had adopted some type of electronic health record system in 2013, according to figures from the Centers for Disease Control and Prevention.
Findings from the report, which is based on a survey of about 10,000 office-based physicians, show that adoption has skyrocketed over the past decade. Between 2001 and 2013, the use of any type of electronic health record (EHR) system jumped from 18% to 78%. And adoption climbed from 48% to 78% between 2009 and 2013, following the enactment of the Health Information Technology for Economic and Clinical Health (HITECH) Act in 2009, which allowed the federal government to make bonus payments to physicians for adopting certified EHR systems.
Even the use of more advanced systems that include a set of "basic" functionals has increased. Those basic systems include computerized orders for prescriptions, the ability to view laboratory and imaging results electronically, a comprehensive list of a patient’s medications and allergies, physician notes, problem lists, and patient history and demographics.
In 2013, nearly half (48%) of physicians reported having an EHR system that met the criteria for a basic system. That’s up from 11% in 2006, the first year that the CDC collected data on basic systems.
But adoption of EHRs varies greatly by geography. The lowest adoption rate for a basic EHR system was in New Jersey (21%), and the highest was in North Dakota (83%).
Physician interest in the Medicare and Medicaid Incentive Programs is also high, according to the survey results. But the ability to meet the "meaningful use" criteria lags behind the interest. In 2013, 69% of physicians reported that they intended to participate in the incentive programs. But only 13% of physicians both intended to participate in the programs and had an EHR system capable of meeting most of the Stage 2 core requirements of meaningful use.
But Dr. Karen DeSalvo, the new National Coordinator for Health Information Technology of the Department of Health and Human Services, said the survey results show that the incentive programs are "healthy and growing steadily." In a blog post about the survey, Dr. DeSalvo said even the fact that only 13% of physicians could meet Stage 2 requirements in 2013 is a good sign, since it means that they were ready for Stage 2 a year ahead of schedule.
"The deadline to begin attesting for Meaningful Use Stage 2 is October 2014 for the earliest adopters of Meaningful Use Stage 1, so more than one in ten physicians decided on their own to participate [in] Meaningful Use Stage 2 capabilities more than a year earlier than necessary," Dr. DeSalvo wrote. "These are early adopters who recognize the benefits of EHRs."
Nearly 80% of office-based physicians had adopted some type of electronic health record system in 2013, according to figures from the Centers for Disease Control and Prevention.
Findings from the report, which is based on a survey of about 10,000 office-based physicians, show that adoption has skyrocketed over the past decade. Between 2001 and 2013, the use of any type of electronic health record (EHR) system jumped from 18% to 78%. And adoption climbed from 48% to 78% between 2009 and 2013, following the enactment of the Health Information Technology for Economic and Clinical Health (HITECH) Act in 2009, which allowed the federal government to make bonus payments to physicians for adopting certified EHR systems.
Even the use of more advanced systems that include a set of "basic" functionals has increased. Those basic systems include computerized orders for prescriptions, the ability to view laboratory and imaging results electronically, a comprehensive list of a patient’s medications and allergies, physician notes, problem lists, and patient history and demographics.
In 2013, nearly half (48%) of physicians reported having an EHR system that met the criteria for a basic system. That’s up from 11% in 2006, the first year that the CDC collected data on basic systems.
But adoption of EHRs varies greatly by geography. The lowest adoption rate for a basic EHR system was in New Jersey (21%), and the highest was in North Dakota (83%).
Physician interest in the Medicare and Medicaid Incentive Programs is also high, according to the survey results. But the ability to meet the "meaningful use" criteria lags behind the interest. In 2013, 69% of physicians reported that they intended to participate in the incentive programs. But only 13% of physicians both intended to participate in the programs and had an EHR system capable of meeting most of the Stage 2 core requirements of meaningful use.
But Dr. Karen DeSalvo, the new National Coordinator for Health Information Technology of the Department of Health and Human Services, said the survey results show that the incentive programs are "healthy and growing steadily." In a blog post about the survey, Dr. DeSalvo said even the fact that only 13% of physicians could meet Stage 2 requirements in 2013 is a good sign, since it means that they were ready for Stage 2 a year ahead of schedule.
"The deadline to begin attesting for Meaningful Use Stage 2 is October 2014 for the earliest adopters of Meaningful Use Stage 1, so more than one in ten physicians decided on their own to participate [in] Meaningful Use Stage 2 capabilities more than a year earlier than necessary," Dr. DeSalvo wrote. "These are early adopters who recognize the benefits of EHRs."
Nearly 80% of office-based physicians had adopted some type of electronic health record system in 2013, according to figures from the Centers for Disease Control and Prevention.
Findings from the report, which is based on a survey of about 10,000 office-based physicians, show that adoption has skyrocketed over the past decade. Between 2001 and 2013, the use of any type of electronic health record (EHR) system jumped from 18% to 78%. And adoption climbed from 48% to 78% between 2009 and 2013, following the enactment of the Health Information Technology for Economic and Clinical Health (HITECH) Act in 2009, which allowed the federal government to make bonus payments to physicians for adopting certified EHR systems.
Even the use of more advanced systems that include a set of "basic" functionals has increased. Those basic systems include computerized orders for prescriptions, the ability to view laboratory and imaging results electronically, a comprehensive list of a patient’s medications and allergies, physician notes, problem lists, and patient history and demographics.
In 2013, nearly half (48%) of physicians reported having an EHR system that met the criteria for a basic system. That’s up from 11% in 2006, the first year that the CDC collected data on basic systems.
But adoption of EHRs varies greatly by geography. The lowest adoption rate for a basic EHR system was in New Jersey (21%), and the highest was in North Dakota (83%).
Physician interest in the Medicare and Medicaid Incentive Programs is also high, according to the survey results. But the ability to meet the "meaningful use" criteria lags behind the interest. In 2013, 69% of physicians reported that they intended to participate in the incentive programs. But only 13% of physicians both intended to participate in the programs and had an EHR system capable of meeting most of the Stage 2 core requirements of meaningful use.
But Dr. Karen DeSalvo, the new National Coordinator for Health Information Technology of the Department of Health and Human Services, said the survey results show that the incentive programs are "healthy and growing steadily." In a blog post about the survey, Dr. DeSalvo said even the fact that only 13% of physicians could meet Stage 2 requirements in 2013 is a good sign, since it means that they were ready for Stage 2 a year ahead of schedule.
"The deadline to begin attesting for Meaningful Use Stage 2 is October 2014 for the earliest adopters of Meaningful Use Stage 1, so more than one in ten physicians decided on their own to participate [in] Meaningful Use Stage 2 capabilities more than a year earlier than necessary," Dr. DeSalvo wrote. "These are early adopters who recognize the benefits of EHRs."
United States Earns D+ on Support for Emergency Care
State and federal lawmakers are doing a dismal job of supporting the nation’s emergency departments, creating poor access to emergency care, a volatile medical liability environment, and providing insufficient resources for disaster preparedness, according to a national and state-level report card from the American College of Emergency Physicians.
The organization gave the nation an overall grade of D+ for its policies on emergency care.
The report does not address the quality of care provided directly by emergency physicians and other providers.
The emergency care environment has worsened over the last few years, ACEP found. In 2009, the last time the college issued a report card, the U.S. earned an overall grade of C-. The lower grade this year is due in part to state-level funding cuts for emergency departments.
"This report card is sounding an alarm. Rhetoric and policy for the past several years has focused primarily on preventing emergency visits. Is it any surprise that our national grade has dropped to a D+?" said Dr. Alex Rosenau, president of the American College of Emergency Physicians.
The report card is also a call to action for Congress and the president, Dr. Rosenau said, because the Affordable Care Act is likely to put an even greater strain on struggling emergency departments.
EDs can expect an influx of patients as millions of Americans are insured for the first time, said Dr. Rosenau, senior vice chair of emergency medicine at Lehigh Valley Health Network in Allentown, Pa. Primary care physician shortages – combined with low Medicaid payments – mean that the ED is likely to be the main source of care for many of these newly insured patients, he said.
"More patients are coming," he said. "We want to be ready."
The report card scores the measures related to access to emergency care, quality and patient safety, the medical liability environment, public health and injury prevention, and disaster preparedness. An ACEP task force analyzed data from the Centers for Disease Control and Prevention, the National Highway Traffic Safety Administration, the Centers for Medicare and Medicaid Services, and the American Medical Association.
The nation’s lowest grade was for access to emergency care (D–), which examines the number of emergency physicians, access to treatment centers, financial barriers, and hospital capacity. The poor grade reflects recent hospital closures, coupled with the growing shortage of psychiatric care beds and hospital inpatient beds.
In the area of quality and patient safety, which measures the implementation of triage policies, as well as the use of computerized practitioner order entry, the U.S. received a C.
The United States received a C– in the area of medical liability, which examines state tort reform efforts and the general legal atmosphere for physicians.
The country also got a C for policies related to public health, including traffic safety and drunk driving, immunizations, and injury prevention.
Finally, ACEP awarded a grade of C– for disaster preparedness, which includes funding for state coordination and training not only during natural disasters, but also during terrorist events and health outbreaks.
"I am alarmed by the lack of support for emergency care," said Dr. Jon Mark Hirshon, chair of the report card task force who is with the department of emergency medicine at the University of Maryland, Baltimore. "When you need an emergency department, you need it. We must send a clear message to our state and federal legislators to support this crucial part of the health care system."
The report card also graded state-level support of emergency medicine. The District of Columbia earned the highest overall (B-) and was joined in the top five by Massachusetts, Maine, Nebraska, and Colorado. In contrast, Wyoming ranked last, earned a failing grade overall. The other bottom-ranked states were Arkansas, New Mexico, Montana, and Kentucky.
ACEP officials called the report a "roadmap" for improving emergency care in this country. The college called on Congress to:
• Fund the Workforce Commission, created under the ACA, to investigate health provider shortages.
• Pass legislation to provide limited liability protections for emergency and on-call physicians who perform services mandated by the federal Emergency Medical Treatment & Labor Act (EMTALA).
• Fund ACA pilot programs to design innovative models of regionalized emergency care and trauma systems.
• Fund the Emergency Care Coordination Center at the Health and Human Services department.
• Fund graduate medical education program in emergency care.
• Hold hearings to examine how the ACA is impacting the emergency department safety net.
On Twitter @MaryEllenNY
State and federal lawmakers are doing a dismal job of supporting the nation’s emergency departments, creating poor access to emergency care, a volatile medical liability environment, and providing insufficient resources for disaster preparedness, according to a national and state-level report card from the American College of Emergency Physicians.
The organization gave the nation an overall grade of D+ for its policies on emergency care.
The report does not address the quality of care provided directly by emergency physicians and other providers.
The emergency care environment has worsened over the last few years, ACEP found. In 2009, the last time the college issued a report card, the U.S. earned an overall grade of C-. The lower grade this year is due in part to state-level funding cuts for emergency departments.
"This report card is sounding an alarm. Rhetoric and policy for the past several years has focused primarily on preventing emergency visits. Is it any surprise that our national grade has dropped to a D+?" said Dr. Alex Rosenau, president of the American College of Emergency Physicians.
The report card is also a call to action for Congress and the president, Dr. Rosenau said, because the Affordable Care Act is likely to put an even greater strain on struggling emergency departments.
EDs can expect an influx of patients as millions of Americans are insured for the first time, said Dr. Rosenau, senior vice chair of emergency medicine at Lehigh Valley Health Network in Allentown, Pa. Primary care physician shortages – combined with low Medicaid payments – mean that the ED is likely to be the main source of care for many of these newly insured patients, he said.
"More patients are coming," he said. "We want to be ready."
The report card scores the measures related to access to emergency care, quality and patient safety, the medical liability environment, public health and injury prevention, and disaster preparedness. An ACEP task force analyzed data from the Centers for Disease Control and Prevention, the National Highway Traffic Safety Administration, the Centers for Medicare and Medicaid Services, and the American Medical Association.
The nation’s lowest grade was for access to emergency care (D–), which examines the number of emergency physicians, access to treatment centers, financial barriers, and hospital capacity. The poor grade reflects recent hospital closures, coupled with the growing shortage of psychiatric care beds and hospital inpatient beds.
In the area of quality and patient safety, which measures the implementation of triage policies, as well as the use of computerized practitioner order entry, the U.S. received a C.
The United States received a C– in the area of medical liability, which examines state tort reform efforts and the general legal atmosphere for physicians.
The country also got a C for policies related to public health, including traffic safety and drunk driving, immunizations, and injury prevention.
Finally, ACEP awarded a grade of C– for disaster preparedness, which includes funding for state coordination and training not only during natural disasters, but also during terrorist events and health outbreaks.
"I am alarmed by the lack of support for emergency care," said Dr. Jon Mark Hirshon, chair of the report card task force who is with the department of emergency medicine at the University of Maryland, Baltimore. "When you need an emergency department, you need it. We must send a clear message to our state and federal legislators to support this crucial part of the health care system."
The report card also graded state-level support of emergency medicine. The District of Columbia earned the highest overall (B-) and was joined in the top five by Massachusetts, Maine, Nebraska, and Colorado. In contrast, Wyoming ranked last, earned a failing grade overall. The other bottom-ranked states were Arkansas, New Mexico, Montana, and Kentucky.
ACEP officials called the report a "roadmap" for improving emergency care in this country. The college called on Congress to:
• Fund the Workforce Commission, created under the ACA, to investigate health provider shortages.
• Pass legislation to provide limited liability protections for emergency and on-call physicians who perform services mandated by the federal Emergency Medical Treatment & Labor Act (EMTALA).
• Fund ACA pilot programs to design innovative models of regionalized emergency care and trauma systems.
• Fund the Emergency Care Coordination Center at the Health and Human Services department.
• Fund graduate medical education program in emergency care.
• Hold hearings to examine how the ACA is impacting the emergency department safety net.
On Twitter @MaryEllenNY
State and federal lawmakers are doing a dismal job of supporting the nation’s emergency departments, creating poor access to emergency care, a volatile medical liability environment, and providing insufficient resources for disaster preparedness, according to a national and state-level report card from the American College of Emergency Physicians.
The organization gave the nation an overall grade of D+ for its policies on emergency care.
The report does not address the quality of care provided directly by emergency physicians and other providers.
The emergency care environment has worsened over the last few years, ACEP found. In 2009, the last time the college issued a report card, the U.S. earned an overall grade of C-. The lower grade this year is due in part to state-level funding cuts for emergency departments.
"This report card is sounding an alarm. Rhetoric and policy for the past several years has focused primarily on preventing emergency visits. Is it any surprise that our national grade has dropped to a D+?" said Dr. Alex Rosenau, president of the American College of Emergency Physicians.
The report card is also a call to action for Congress and the president, Dr. Rosenau said, because the Affordable Care Act is likely to put an even greater strain on struggling emergency departments.
EDs can expect an influx of patients as millions of Americans are insured for the first time, said Dr. Rosenau, senior vice chair of emergency medicine at Lehigh Valley Health Network in Allentown, Pa. Primary care physician shortages – combined with low Medicaid payments – mean that the ED is likely to be the main source of care for many of these newly insured patients, he said.
"More patients are coming," he said. "We want to be ready."
The report card scores the measures related to access to emergency care, quality and patient safety, the medical liability environment, public health and injury prevention, and disaster preparedness. An ACEP task force analyzed data from the Centers for Disease Control and Prevention, the National Highway Traffic Safety Administration, the Centers for Medicare and Medicaid Services, and the American Medical Association.
The nation’s lowest grade was for access to emergency care (D–), which examines the number of emergency physicians, access to treatment centers, financial barriers, and hospital capacity. The poor grade reflects recent hospital closures, coupled with the growing shortage of psychiatric care beds and hospital inpatient beds.
In the area of quality and patient safety, which measures the implementation of triage policies, as well as the use of computerized practitioner order entry, the U.S. received a C.
The United States received a C– in the area of medical liability, which examines state tort reform efforts and the general legal atmosphere for physicians.
The country also got a C for policies related to public health, including traffic safety and drunk driving, immunizations, and injury prevention.
Finally, ACEP awarded a grade of C– for disaster preparedness, which includes funding for state coordination and training not only during natural disasters, but also during terrorist events and health outbreaks.
"I am alarmed by the lack of support for emergency care," said Dr. Jon Mark Hirshon, chair of the report card task force who is with the department of emergency medicine at the University of Maryland, Baltimore. "When you need an emergency department, you need it. We must send a clear message to our state and federal legislators to support this crucial part of the health care system."
The report card also graded state-level support of emergency medicine. The District of Columbia earned the highest overall (B-) and was joined in the top five by Massachusetts, Maine, Nebraska, and Colorado. In contrast, Wyoming ranked last, earned a failing grade overall. The other bottom-ranked states were Arkansas, New Mexico, Montana, and Kentucky.
ACEP officials called the report a "roadmap" for improving emergency care in this country. The college called on Congress to:
• Fund the Workforce Commission, created under the ACA, to investigate health provider shortages.
• Pass legislation to provide limited liability protections for emergency and on-call physicians who perform services mandated by the federal Emergency Medical Treatment & Labor Act (EMTALA).
• Fund ACA pilot programs to design innovative models of regionalized emergency care and trauma systems.
• Fund the Emergency Care Coordination Center at the Health and Human Services department.
• Fund graduate medical education program in emergency care.
• Hold hearings to examine how the ACA is impacting the emergency department safety net.
On Twitter @MaryEllenNY
United States earns D+ on support for emergency care
State and federal lawmakers are doing a dismal job of supporting the nation’s emergency departments, creating poor access to emergency care, a volatile medical liability environment, and providing insufficient resources for disaster preparedness, according to a national and state-level report card from the American College of Emergency Physicians.
The organization gave the nation an overall grade of D+ for its policies on emergency care.
The report does not address the quality of care provided directly by emergency physicians and other providers.
The emergency care environment has worsened over the last few years, ACEP found. In 2009, the last time the college issued a report card, the U.S. earned an overall grade of C-. The lower grade this year is due in part to state-level funding cuts for emergency departments.
"This report card is sounding an alarm. Rhetoric and policy for the past several years has focused primarily on preventing emergency visits. Is it any surprise that our national grade has dropped to a D+?" said Dr. Alex Rosenau, president of the American College of Emergency Physicians.
The report card is also a call to action for Congress and the president, Dr. Rosenau said, because the Affordable Care Act is likely to put an even greater strain on struggling emergency departments.
EDs can expect an influx of patients as millions of Americans are insured for the first time, said Dr. Rosenau, senior vice chair of emergency medicine at Lehigh Valley Health Network in Allentown, Pa. Primary care physician shortages – combined with low Medicaid payments – mean that the ED is likely to be the main source of care for many of these newly insured patients, he said.
"More patients are coming," he said. "We want to be ready."
The report card scores the measures related to access to emergency care, quality and patient safety, the medical liability environment, public health and injury prevention, and disaster preparedness. An ACEP task force analyzed data from the Centers for Disease Control and Prevention, the National Highway Traffic Safety Administration, the Centers for Medicare and Medicaid Services, and the American Medical Association.
The nation’s lowest grade was for access to emergency care (D–), which examines the number of emergency physicians, access to treatment centers, financial barriers, and hospital capacity. The poor grade reflects recent hospital closures, coupled with the growing shortage of psychiatric care beds and hospital inpatient beds.
In the area of quality and patient safety, which measures the implementation of triage policies, as well as the use of computerized practitioner order entry, the U.S. received a C.
The United States received a C– in the area of medical liability, which examines state tort reform efforts and the general legal atmosphere for physicians.
The country also got a C for policies related to public health, including traffic safety and drunk driving, immunizations, and injury prevention.
Finally, ACEP awarded a grade of C– for disaster preparedness, which includes funding for state coordination and training not only during natural disasters, but also during terrorist events and health outbreaks.
"I am alarmed by the lack of support for emergency care," said Dr. Jon Mark Hirshon, chair of the report card task force who is with the department of emergency medicine at the University of Maryland, Baltimore. "When you need an emergency department, you need it. We must send a clear message to our state and federal legislators to support this crucial part of the health care system."
The report card also graded state-level support of emergency medicine. The District of Columbia earned the highest overall (B-) and was joined in the top five by Massachusetts, Maine, Nebraska, and Colorado. In contrast, Wyoming ranked last, earned a failing grade overall. The other bottom-ranked states were Arkansas, New Mexico, Montana, and Kentucky.
ACEP officials called the report a "roadmap" for improving emergency care in this country. The college called on Congress to:
• Fund the Workforce Commission, created under the ACA, to investigate health provider shortages.
• Pass legislation to provide limited liability protections for emergency and on-call physicians who perform services mandated by the federal Emergency Medical Treatment & Labor Act (EMTALA).
• Fund ACA pilot programs to design innovative models of regionalized emergency care and trauma systems.
• Fund the Emergency Care Coordination Center at the Health and Human Services department.
• Fund graduate medical education program in emergency care.
• Hold hearings to examine how the ACA is impacting the emergency department safety net.
On Twitter @MaryEllenNY
State and federal lawmakers are doing a dismal job of supporting the nation’s emergency departments, creating poor access to emergency care, a volatile medical liability environment, and providing insufficient resources for disaster preparedness, according to a national and state-level report card from the American College of Emergency Physicians.
The organization gave the nation an overall grade of D+ for its policies on emergency care.
The report does not address the quality of care provided directly by emergency physicians and other providers.
The emergency care environment has worsened over the last few years, ACEP found. In 2009, the last time the college issued a report card, the U.S. earned an overall grade of C-. The lower grade this year is due in part to state-level funding cuts for emergency departments.
"This report card is sounding an alarm. Rhetoric and policy for the past several years has focused primarily on preventing emergency visits. Is it any surprise that our national grade has dropped to a D+?" said Dr. Alex Rosenau, president of the American College of Emergency Physicians.
The report card is also a call to action for Congress and the president, Dr. Rosenau said, because the Affordable Care Act is likely to put an even greater strain on struggling emergency departments.
EDs can expect an influx of patients as millions of Americans are insured for the first time, said Dr. Rosenau, senior vice chair of emergency medicine at Lehigh Valley Health Network in Allentown, Pa. Primary care physician shortages – combined with low Medicaid payments – mean that the ED is likely to be the main source of care for many of these newly insured patients, he said.
"More patients are coming," he said. "We want to be ready."
The report card scores the measures related to access to emergency care, quality and patient safety, the medical liability environment, public health and injury prevention, and disaster preparedness. An ACEP task force analyzed data from the Centers for Disease Control and Prevention, the National Highway Traffic Safety Administration, the Centers for Medicare and Medicaid Services, and the American Medical Association.
The nation’s lowest grade was for access to emergency care (D–), which examines the number of emergency physicians, access to treatment centers, financial barriers, and hospital capacity. The poor grade reflects recent hospital closures, coupled with the growing shortage of psychiatric care beds and hospital inpatient beds.
In the area of quality and patient safety, which measures the implementation of triage policies, as well as the use of computerized practitioner order entry, the U.S. received a C.
The United States received a C– in the area of medical liability, which examines state tort reform efforts and the general legal atmosphere for physicians.
The country also got a C for policies related to public health, including traffic safety and drunk driving, immunizations, and injury prevention.
Finally, ACEP awarded a grade of C– for disaster preparedness, which includes funding for state coordination and training not only during natural disasters, but also during terrorist events and health outbreaks.
"I am alarmed by the lack of support for emergency care," said Dr. Jon Mark Hirshon, chair of the report card task force who is with the department of emergency medicine at the University of Maryland, Baltimore. "When you need an emergency department, you need it. We must send a clear message to our state and federal legislators to support this crucial part of the health care system."
The report card also graded state-level support of emergency medicine. The District of Columbia earned the highest overall (B-) and was joined in the top five by Massachusetts, Maine, Nebraska, and Colorado. In contrast, Wyoming ranked last, earned a failing grade overall. The other bottom-ranked states were Arkansas, New Mexico, Montana, and Kentucky.
ACEP officials called the report a "roadmap" for improving emergency care in this country. The college called on Congress to:
• Fund the Workforce Commission, created under the ACA, to investigate health provider shortages.
• Pass legislation to provide limited liability protections for emergency and on-call physicians who perform services mandated by the federal Emergency Medical Treatment & Labor Act (EMTALA).
• Fund ACA pilot programs to design innovative models of regionalized emergency care and trauma systems.
• Fund the Emergency Care Coordination Center at the Health and Human Services department.
• Fund graduate medical education program in emergency care.
• Hold hearings to examine how the ACA is impacting the emergency department safety net.
On Twitter @MaryEllenNY
State and federal lawmakers are doing a dismal job of supporting the nation’s emergency departments, creating poor access to emergency care, a volatile medical liability environment, and providing insufficient resources for disaster preparedness, according to a national and state-level report card from the American College of Emergency Physicians.
The organization gave the nation an overall grade of D+ for its policies on emergency care.
The report does not address the quality of care provided directly by emergency physicians and other providers.
The emergency care environment has worsened over the last few years, ACEP found. In 2009, the last time the college issued a report card, the U.S. earned an overall grade of C-. The lower grade this year is due in part to state-level funding cuts for emergency departments.
"This report card is sounding an alarm. Rhetoric and policy for the past several years has focused primarily on preventing emergency visits. Is it any surprise that our national grade has dropped to a D+?" said Dr. Alex Rosenau, president of the American College of Emergency Physicians.
The report card is also a call to action for Congress and the president, Dr. Rosenau said, because the Affordable Care Act is likely to put an even greater strain on struggling emergency departments.
EDs can expect an influx of patients as millions of Americans are insured for the first time, said Dr. Rosenau, senior vice chair of emergency medicine at Lehigh Valley Health Network in Allentown, Pa. Primary care physician shortages – combined with low Medicaid payments – mean that the ED is likely to be the main source of care for many of these newly insured patients, he said.
"More patients are coming," he said. "We want to be ready."
The report card scores the measures related to access to emergency care, quality and patient safety, the medical liability environment, public health and injury prevention, and disaster preparedness. An ACEP task force analyzed data from the Centers for Disease Control and Prevention, the National Highway Traffic Safety Administration, the Centers for Medicare and Medicaid Services, and the American Medical Association.
The nation’s lowest grade was for access to emergency care (D–), which examines the number of emergency physicians, access to treatment centers, financial barriers, and hospital capacity. The poor grade reflects recent hospital closures, coupled with the growing shortage of psychiatric care beds and hospital inpatient beds.
In the area of quality and patient safety, which measures the implementation of triage policies, as well as the use of computerized practitioner order entry, the U.S. received a C.
The United States received a C– in the area of medical liability, which examines state tort reform efforts and the general legal atmosphere for physicians.
The country also got a C for policies related to public health, including traffic safety and drunk driving, immunizations, and injury prevention.
Finally, ACEP awarded a grade of C– for disaster preparedness, which includes funding for state coordination and training not only during natural disasters, but also during terrorist events and health outbreaks.
"I am alarmed by the lack of support for emergency care," said Dr. Jon Mark Hirshon, chair of the report card task force who is with the department of emergency medicine at the University of Maryland, Baltimore. "When you need an emergency department, you need it. We must send a clear message to our state and federal legislators to support this crucial part of the health care system."
The report card also graded state-level support of emergency medicine. The District of Columbia earned the highest overall (B-) and was joined in the top five by Massachusetts, Maine, Nebraska, and Colorado. In contrast, Wyoming ranked last, earned a failing grade overall. The other bottom-ranked states were Arkansas, New Mexico, Montana, and Kentucky.
ACEP officials called the report a "roadmap" for improving emergency care in this country. The college called on Congress to:
• Fund the Workforce Commission, created under the ACA, to investigate health provider shortages.
• Pass legislation to provide limited liability protections for emergency and on-call physicians who perform services mandated by the federal Emergency Medical Treatment & Labor Act (EMTALA).
• Fund ACA pilot programs to design innovative models of regionalized emergency care and trauma systems.
• Fund the Emergency Care Coordination Center at the Health and Human Services department.
• Fund graduate medical education program in emergency care.
• Hold hearings to examine how the ACA is impacting the emergency department safety net.
On Twitter @MaryEllenNY
Medicare to start releasing individual physician payment data
Reversing more than 30 years of policy, federal officials announced they would soon begin releasing data on how much Medicare pays to individual physicians.
Officials at the Centers for Medicare and Medicaid Services (CMS) announced Jan. 14 that they would take a "case-by-case" approach to the release of individual physician payment information, weighing the right for privacy against the value to the public in each Freedom of Information Act request they receive.
In addition to fielding individual requests for physician data, the agency plans to generate and publish aggregate data sets on physician services.
The policy change will take effect on March 18.
"As CMS makes a determination about how and when to disclose any information on a physician’s Medicare payment, we intend to consider the importance of protecting physicians’ privacy and ensuring the accuracy of any data released as well as appropriate protections to limit potential misuse of the information," Jonathan Blum, CMS Principal Deputy Administrator, wrote in a blog post on Jan. 14.
Last May, a federal judge cleared the way for this policy shift back by lifting an injunction that had previously barred the agency from making public its database of Medicare physician claims.
The new policy has plenty of benefits, Mr. Blum wrote, including allowing providers to collaborate on better care management, giving consumers more reliable measures of quality and performance, and allowing journalists and researchers to identify Medicare waste, fraud, and abuse.
The change is also part of a broader effort at the CMS to make health care prices more transparent.
Last May, the CMS published the average charges for the 100 most common inpatient services at hospitals around the country. And in June, the agency released average charges for 30 selected outpatient procedures, ranging from echocardiograms to pulmonary tests.
Physicians’ groups have been urging caution as the CMS evaluated the release of physician data. In a Sept. 5 letter signed by the American Medical Association as well as several specialty and state medical societies, physicians said that the CMS must educate the public about the limitations of analyzing Medicare claims data. For example, Medicare claims may not include many factors that influence the cost of medical care, including specialty, location, patient mix, other demographics, and practice costs.
In the letter, the physician organizations urged the CMS to provide access to data to organizations that have experience in handling and analyzing Medicare data. And they called for the opportunity to review and correct their information in a timely manner.
"Medicare data is highly susceptible to misleading conclusions," the letter said. "CMS should undertake a detailed educational program to explain any Medicare data release program and openly address its limitations, including that the data may take into account only a small fraction of a physician’s patient population or may be outdated."
Reversing more than 30 years of policy, federal officials announced they would soon begin releasing data on how much Medicare pays to individual physicians.
Officials at the Centers for Medicare and Medicaid Services (CMS) announced Jan. 14 that they would take a "case-by-case" approach to the release of individual physician payment information, weighing the right for privacy against the value to the public in each Freedom of Information Act request they receive.
In addition to fielding individual requests for physician data, the agency plans to generate and publish aggregate data sets on physician services.
The policy change will take effect on March 18.
"As CMS makes a determination about how and when to disclose any information on a physician’s Medicare payment, we intend to consider the importance of protecting physicians’ privacy and ensuring the accuracy of any data released as well as appropriate protections to limit potential misuse of the information," Jonathan Blum, CMS Principal Deputy Administrator, wrote in a blog post on Jan. 14.
Last May, a federal judge cleared the way for this policy shift back by lifting an injunction that had previously barred the agency from making public its database of Medicare physician claims.
The new policy has plenty of benefits, Mr. Blum wrote, including allowing providers to collaborate on better care management, giving consumers more reliable measures of quality and performance, and allowing journalists and researchers to identify Medicare waste, fraud, and abuse.
The change is also part of a broader effort at the CMS to make health care prices more transparent.
Last May, the CMS published the average charges for the 100 most common inpatient services at hospitals around the country. And in June, the agency released average charges for 30 selected outpatient procedures, ranging from echocardiograms to pulmonary tests.
Physicians’ groups have been urging caution as the CMS evaluated the release of physician data. In a Sept. 5 letter signed by the American Medical Association as well as several specialty and state medical societies, physicians said that the CMS must educate the public about the limitations of analyzing Medicare claims data. For example, Medicare claims may not include many factors that influence the cost of medical care, including specialty, location, patient mix, other demographics, and practice costs.
In the letter, the physician organizations urged the CMS to provide access to data to organizations that have experience in handling and analyzing Medicare data. And they called for the opportunity to review and correct their information in a timely manner.
"Medicare data is highly susceptible to misleading conclusions," the letter said. "CMS should undertake a detailed educational program to explain any Medicare data release program and openly address its limitations, including that the data may take into account only a small fraction of a physician’s patient population or may be outdated."
Reversing more than 30 years of policy, federal officials announced they would soon begin releasing data on how much Medicare pays to individual physicians.
Officials at the Centers for Medicare and Medicaid Services (CMS) announced Jan. 14 that they would take a "case-by-case" approach to the release of individual physician payment information, weighing the right for privacy against the value to the public in each Freedom of Information Act request they receive.
In addition to fielding individual requests for physician data, the agency plans to generate and publish aggregate data sets on physician services.
The policy change will take effect on March 18.
"As CMS makes a determination about how and when to disclose any information on a physician’s Medicare payment, we intend to consider the importance of protecting physicians’ privacy and ensuring the accuracy of any data released as well as appropriate protections to limit potential misuse of the information," Jonathan Blum, CMS Principal Deputy Administrator, wrote in a blog post on Jan. 14.
Last May, a federal judge cleared the way for this policy shift back by lifting an injunction that had previously barred the agency from making public its database of Medicare physician claims.
The new policy has plenty of benefits, Mr. Blum wrote, including allowing providers to collaborate on better care management, giving consumers more reliable measures of quality and performance, and allowing journalists and researchers to identify Medicare waste, fraud, and abuse.
The change is also part of a broader effort at the CMS to make health care prices more transparent.
Last May, the CMS published the average charges for the 100 most common inpatient services at hospitals around the country. And in June, the agency released average charges for 30 selected outpatient procedures, ranging from echocardiograms to pulmonary tests.
Physicians’ groups have been urging caution as the CMS evaluated the release of physician data. In a Sept. 5 letter signed by the American Medical Association as well as several specialty and state medical societies, physicians said that the CMS must educate the public about the limitations of analyzing Medicare claims data. For example, Medicare claims may not include many factors that influence the cost of medical care, including specialty, location, patient mix, other demographics, and practice costs.
In the letter, the physician organizations urged the CMS to provide access to data to organizations that have experience in handling and analyzing Medicare data. And they called for the opportunity to review and correct their information in a timely manner.
"Medicare data is highly susceptible to misleading conclusions," the letter said. "CMS should undertake a detailed educational program to explain any Medicare data release program and openly address its limitations, including that the data may take into account only a small fraction of a physician’s patient population or may be outdated."
ACA marketplace enrollment nears 2.2 million
Nearly 2.2 million Americans enrolled in private health plans through federally or state-run insurance marketplaces during the first 3 months of the Affordable Care Act’s open enrollment period, nearly a quarter of whom are aged 18-34 years, according to figures released Jan. 13 by the Health and Human Services department.
"The numbers show that there is a very strong national demand for affordable health care made possible by the Affordable Care Act," Kathleen Sebelius, HHS secretary, said during a press briefing. "Among young adults, the momentum was particularly strong."
More women (54%) than men (46%) enrolled in a health care plan, according to preliminary demographic data provided by HHS. This is the first time demographic information has been released.
More than half of marketplace enrollees are between ages 45 and 64 years, with 22% aged 45-54 years and 33% in aged 55-64 years.
But HHS officials said they were encouraged by the number of younger Americans who had selected a plan through the marketplace. Young, and presumably healthy enrollees, are considered essential to ensuring a favorable risk mix for insurers. Over the first 3 months of open season, individuals aged 18-34 years made up 24% of enrollees. In comparison, 18-34 year olds make up 26% of the U.S. population under age 65 years.
"We think that more and more young people are going to sign up as time goes by, which was the experience in Massachusetts," Gary Cohen, director of the Center for Consumer Information and Insurance Oversight at the Centers for Medicare and Medicaid Services, said during the press briefing.
Overall, enrollment in health plans surged in December, outstripping the slow start of the online insurance marketplaces in October. The number of people enrolling in a health plan through the marketplaces, which HHS defines as selecting but not necessarily paying for a plan, was more than 1.7 million in December alone, up from about 364,000 in October and November.
Another 1.6 million Americans were deemed eligible for Medicaid or the Children’s Health Insurance Program through the marketplaces from Oct. 1 through Dec. 28, according to the report. That figure does not include individuals who applied to the program directly through their state agencies.
Most enrollees selected plans with lower premiums and higher out-of-pocket costs. A total of 60% selected a "silver" plan and another 20% selected a "bronze" plan.
Most enrollees (79%) are receiving some type of financial assistance in paying their premiums, according to the HHS report.
Nearly 2.2 million Americans enrolled in private health plans through federally or state-run insurance marketplaces during the first 3 months of the Affordable Care Act’s open enrollment period, nearly a quarter of whom are aged 18-34 years, according to figures released Jan. 13 by the Health and Human Services department.
"The numbers show that there is a very strong national demand for affordable health care made possible by the Affordable Care Act," Kathleen Sebelius, HHS secretary, said during a press briefing. "Among young adults, the momentum was particularly strong."
More women (54%) than men (46%) enrolled in a health care plan, according to preliminary demographic data provided by HHS. This is the first time demographic information has been released.
More than half of marketplace enrollees are between ages 45 and 64 years, with 22% aged 45-54 years and 33% in aged 55-64 years.
But HHS officials said they were encouraged by the number of younger Americans who had selected a plan through the marketplace. Young, and presumably healthy enrollees, are considered essential to ensuring a favorable risk mix for insurers. Over the first 3 months of open season, individuals aged 18-34 years made up 24% of enrollees. In comparison, 18-34 year olds make up 26% of the U.S. population under age 65 years.
"We think that more and more young people are going to sign up as time goes by, which was the experience in Massachusetts," Gary Cohen, director of the Center for Consumer Information and Insurance Oversight at the Centers for Medicare and Medicaid Services, said during the press briefing.
Overall, enrollment in health plans surged in December, outstripping the slow start of the online insurance marketplaces in October. The number of people enrolling in a health plan through the marketplaces, which HHS defines as selecting but not necessarily paying for a plan, was more than 1.7 million in December alone, up from about 364,000 in October and November.
Another 1.6 million Americans were deemed eligible for Medicaid or the Children’s Health Insurance Program through the marketplaces from Oct. 1 through Dec. 28, according to the report. That figure does not include individuals who applied to the program directly through their state agencies.
Most enrollees selected plans with lower premiums and higher out-of-pocket costs. A total of 60% selected a "silver" plan and another 20% selected a "bronze" plan.
Most enrollees (79%) are receiving some type of financial assistance in paying their premiums, according to the HHS report.
Nearly 2.2 million Americans enrolled in private health plans through federally or state-run insurance marketplaces during the first 3 months of the Affordable Care Act’s open enrollment period, nearly a quarter of whom are aged 18-34 years, according to figures released Jan. 13 by the Health and Human Services department.
"The numbers show that there is a very strong national demand for affordable health care made possible by the Affordable Care Act," Kathleen Sebelius, HHS secretary, said during a press briefing. "Among young adults, the momentum was particularly strong."
More women (54%) than men (46%) enrolled in a health care plan, according to preliminary demographic data provided by HHS. This is the first time demographic information has been released.
More than half of marketplace enrollees are between ages 45 and 64 years, with 22% aged 45-54 years and 33% in aged 55-64 years.
But HHS officials said they were encouraged by the number of younger Americans who had selected a plan through the marketplace. Young, and presumably healthy enrollees, are considered essential to ensuring a favorable risk mix for insurers. Over the first 3 months of open season, individuals aged 18-34 years made up 24% of enrollees. In comparison, 18-34 year olds make up 26% of the U.S. population under age 65 years.
"We think that more and more young people are going to sign up as time goes by, which was the experience in Massachusetts," Gary Cohen, director of the Center for Consumer Information and Insurance Oversight at the Centers for Medicare and Medicaid Services, said during the press briefing.
Overall, enrollment in health plans surged in December, outstripping the slow start of the online insurance marketplaces in October. The number of people enrolling in a health plan through the marketplaces, which HHS defines as selecting but not necessarily paying for a plan, was more than 1.7 million in December alone, up from about 364,000 in October and November.
Another 1.6 million Americans were deemed eligible for Medicaid or the Children’s Health Insurance Program through the marketplaces from Oct. 1 through Dec. 28, according to the report. That figure does not include individuals who applied to the program directly through their state agencies.
Most enrollees selected plans with lower premiums and higher out-of-pocket costs. A total of 60% selected a "silver" plan and another 20% selected a "bronze" plan.
Most enrollees (79%) are receiving some type of financial assistance in paying their premiums, according to the HHS report.
Medicare takes aim at ‘abusive’ prescribing
Medicare officials are seeking new authority to allow them to kick out physicians who engage in "abusive" prescribing practices, according to a newly released proposed rule.
The Centers for Medicare and Medicaid Services (CMS) issued a proposal Jan. 6 with several provisions aimed at rooting out fraud and abuse by physicians. The rule is part of a larger effort to identify Medicare beneficiaries who are potentially overusing opioids, as well as identify prescribers and pharmacies that may be involved in fraudulent activities.
Beginning next year, the proposal would require Medicare Part D prescription drug plans to deny coverage for any drug claim that does not include a prescriber’s National Provider Identifier (NPI). Under the rule, physicians are not required to accept Medicare payments, but they must be enrolled in the program in an approved status or have a valid opt-out affidavit on file with the Medicare fee-for-service program.
The aim, according to CMS, is to ensure that anyone prescribing drugs to Medicare beneficiaries is properly qualified. The Affordable Care Act already requires physicians to be enrolled in the Medicare program for durable medical equipment, prosthetics, orthotics, and supplies, or if they certify home health care for Medicare beneficiaries.
Medicare officials also noted in the proposed rule that they want the right to revoke a physician’s Medicare enrollment if the physician exhibits a pattern of prescribing Part D drugs that is "abusive and represents a threat to the health and safety of Medicare beneficiaries." The agency also would be able to revoke Medicare enrollment if a physician’s Drug Enforcement Administration Certificate of Registration was suspended or revoked, or their state medical license was suspended or revoked.
The decision to revoke enrollment would only be made after a thorough and detailed investigation by CMS, according to the proposed rule.
"Honest physicians and eligible professionals who engage in reasonable prescribing activities would not be impacted by our proposal," the proposed rule states.
But the proposed rule does not define "abusive" or "threat to the health and safety of Medicare beneficiaries."
Instead, it includes a list of criteria for assessing prescribing practices:
• Are there diagnoses to support the indications for which the drugs were prescribed?
• Was the patient deceased or out of state at the time of an alleged office visit?
• Has the physician prescribed controlled substances in excessive dosages linked to patient overdoses?
• Has the physician been subject to disciplinary actions by the state medical board?
• Has the physician been sued for malpractice related to their drug prescribing and been found liable or paid a settlement?
• Has a public insurance program restricted or revoked the physician’s prescribing privileges?
Dr. Ardis Dee Hoven, president of the American Medical Association, said the organization has a zero tolerance policy for irresponsible prescribing that could harm patients and that the proposal is unlikely to affect physicians who are prescribing appropriately.
"The vast majority of physicians who appropriately and safely prescribe medications should not be targets of misguided government enforcement and driven out of practice," she said. "The AMA is carefully examining the details of the newly proposed rule to ensure the [CMS] does not compromise appropriate prescribing or exceed its statutory authority."
But CMS officials will need more data if they plan to identify fraud and abuse by physicians and beneficiaries. As a result, the agency is also proposing to collect information directly from pharmacy benefit managers, pharmacies, and others that contract with Part D drugs plans, rather than going through the drug plan for the information
The proposed rule will be published in the Federal Register on Jan. 10. The agency is accepting public comments at www.regulations.gov until March 7.
Medicare officials are seeking new authority to allow them to kick out physicians who engage in "abusive" prescribing practices, according to a newly released proposed rule.
The Centers for Medicare and Medicaid Services (CMS) issued a proposal Jan. 6 with several provisions aimed at rooting out fraud and abuse by physicians. The rule is part of a larger effort to identify Medicare beneficiaries who are potentially overusing opioids, as well as identify prescribers and pharmacies that may be involved in fraudulent activities.
Beginning next year, the proposal would require Medicare Part D prescription drug plans to deny coverage for any drug claim that does not include a prescriber’s National Provider Identifier (NPI). Under the rule, physicians are not required to accept Medicare payments, but they must be enrolled in the program in an approved status or have a valid opt-out affidavit on file with the Medicare fee-for-service program.
The aim, according to CMS, is to ensure that anyone prescribing drugs to Medicare beneficiaries is properly qualified. The Affordable Care Act already requires physicians to be enrolled in the Medicare program for durable medical equipment, prosthetics, orthotics, and supplies, or if they certify home health care for Medicare beneficiaries.
Medicare officials also noted in the proposed rule that they want the right to revoke a physician’s Medicare enrollment if the physician exhibits a pattern of prescribing Part D drugs that is "abusive and represents a threat to the health and safety of Medicare beneficiaries." The agency also would be able to revoke Medicare enrollment if a physician’s Drug Enforcement Administration Certificate of Registration was suspended or revoked, or their state medical license was suspended or revoked.
The decision to revoke enrollment would only be made after a thorough and detailed investigation by CMS, according to the proposed rule.
"Honest physicians and eligible professionals who engage in reasonable prescribing activities would not be impacted by our proposal," the proposed rule states.
But the proposed rule does not define "abusive" or "threat to the health and safety of Medicare beneficiaries."
Instead, it includes a list of criteria for assessing prescribing practices:
• Are there diagnoses to support the indications for which the drugs were prescribed?
• Was the patient deceased or out of state at the time of an alleged office visit?
• Has the physician prescribed controlled substances in excessive dosages linked to patient overdoses?
• Has the physician been subject to disciplinary actions by the state medical board?
• Has the physician been sued for malpractice related to their drug prescribing and been found liable or paid a settlement?
• Has a public insurance program restricted or revoked the physician’s prescribing privileges?
Dr. Ardis Dee Hoven, president of the American Medical Association, said the organization has a zero tolerance policy for irresponsible prescribing that could harm patients and that the proposal is unlikely to affect physicians who are prescribing appropriately.
"The vast majority of physicians who appropriately and safely prescribe medications should not be targets of misguided government enforcement and driven out of practice," she said. "The AMA is carefully examining the details of the newly proposed rule to ensure the [CMS] does not compromise appropriate prescribing or exceed its statutory authority."
But CMS officials will need more data if they plan to identify fraud and abuse by physicians and beneficiaries. As a result, the agency is also proposing to collect information directly from pharmacy benefit managers, pharmacies, and others that contract with Part D drugs plans, rather than going through the drug plan for the information
The proposed rule will be published in the Federal Register on Jan. 10. The agency is accepting public comments at www.regulations.gov until March 7.
Medicare officials are seeking new authority to allow them to kick out physicians who engage in "abusive" prescribing practices, according to a newly released proposed rule.
The Centers for Medicare and Medicaid Services (CMS) issued a proposal Jan. 6 with several provisions aimed at rooting out fraud and abuse by physicians. The rule is part of a larger effort to identify Medicare beneficiaries who are potentially overusing opioids, as well as identify prescribers and pharmacies that may be involved in fraudulent activities.
Beginning next year, the proposal would require Medicare Part D prescription drug plans to deny coverage for any drug claim that does not include a prescriber’s National Provider Identifier (NPI). Under the rule, physicians are not required to accept Medicare payments, but they must be enrolled in the program in an approved status or have a valid opt-out affidavit on file with the Medicare fee-for-service program.
The aim, according to CMS, is to ensure that anyone prescribing drugs to Medicare beneficiaries is properly qualified. The Affordable Care Act already requires physicians to be enrolled in the Medicare program for durable medical equipment, prosthetics, orthotics, and supplies, or if they certify home health care for Medicare beneficiaries.
Medicare officials also noted in the proposed rule that they want the right to revoke a physician’s Medicare enrollment if the physician exhibits a pattern of prescribing Part D drugs that is "abusive and represents a threat to the health and safety of Medicare beneficiaries." The agency also would be able to revoke Medicare enrollment if a physician’s Drug Enforcement Administration Certificate of Registration was suspended or revoked, or their state medical license was suspended or revoked.
The decision to revoke enrollment would only be made after a thorough and detailed investigation by CMS, according to the proposed rule.
"Honest physicians and eligible professionals who engage in reasonable prescribing activities would not be impacted by our proposal," the proposed rule states.
But the proposed rule does not define "abusive" or "threat to the health and safety of Medicare beneficiaries."
Instead, it includes a list of criteria for assessing prescribing practices:
• Are there diagnoses to support the indications for which the drugs were prescribed?
• Was the patient deceased or out of state at the time of an alleged office visit?
• Has the physician prescribed controlled substances in excessive dosages linked to patient overdoses?
• Has the physician been subject to disciplinary actions by the state medical board?
• Has the physician been sued for malpractice related to their drug prescribing and been found liable or paid a settlement?
• Has a public insurance program restricted or revoked the physician’s prescribing privileges?
Dr. Ardis Dee Hoven, president of the American Medical Association, said the organization has a zero tolerance policy for irresponsible prescribing that could harm patients and that the proposal is unlikely to affect physicians who are prescribing appropriately.
"The vast majority of physicians who appropriately and safely prescribe medications should not be targets of misguided government enforcement and driven out of practice," she said. "The AMA is carefully examining the details of the newly proposed rule to ensure the [CMS] does not compromise appropriate prescribing or exceed its statutory authority."
But CMS officials will need more data if they plan to identify fraud and abuse by physicians and beneficiaries. As a result, the agency is also proposing to collect information directly from pharmacy benefit managers, pharmacies, and others that contract with Part D drugs plans, rather than going through the drug plan for the information
The proposed rule will be published in the Federal Register on Jan. 10. The agency is accepting public comments at www.regulations.gov until March 7.
Legal battle over contraception mandate rages on
The question of whether organizations with religious ties should have to implement the Affordable Care Act’s mandate to cover contraceptives is once again before the Supreme Court.
On Dec. 31, Supreme Court Justice Sonia Sotomayor granted a stay to the Little Sisters of the Poor Home for the Aged in Denver, allowing them to temporarily avoid implementing the law’s contraception mandate. The nonprofit nursing homes sought relief from the Supreme Court, stating in court papers that complying with the mandate would violate their religious beliefs.
The organization would also like the Supreme Court to consider their objections to the mandate at the same time that it hears another related case, Hobby Lobby Stores, Inc. v. Sebelius.
But on Jan. 3, U.S. Solicitor General Donald B. Verrilli Jr., urged the Supreme Court not to take on the new case or provide the emergency injunction. Mr. Verrilli argued that the nursing home organization did not require any judicial relief from the law because it was eligible for a special "accommodation" for certain religious employers.
Under federal regulations, Little Sisters of the Poor Home for the Aged only has to self-certify that it is a nonprofit religious organization with objections to providing contraception services and then provide that documentation to the third-party administrator of their self-insured health plan, according to the Solicitor General. The organization will not need to pay for or arrange for the coverage, he said. And, in this specific case, the third-party administrator also will not provide the coverage to the organization’s employees, he argued.
The Supreme Court is expected to hear argument in the Hobby Lobby case later this year.
The question of whether organizations with religious ties should have to implement the Affordable Care Act’s mandate to cover contraceptives is once again before the Supreme Court.
On Dec. 31, Supreme Court Justice Sonia Sotomayor granted a stay to the Little Sisters of the Poor Home for the Aged in Denver, allowing them to temporarily avoid implementing the law’s contraception mandate. The nonprofit nursing homes sought relief from the Supreme Court, stating in court papers that complying with the mandate would violate their religious beliefs.
The organization would also like the Supreme Court to consider their objections to the mandate at the same time that it hears another related case, Hobby Lobby Stores, Inc. v. Sebelius.
But on Jan. 3, U.S. Solicitor General Donald B. Verrilli Jr., urged the Supreme Court not to take on the new case or provide the emergency injunction. Mr. Verrilli argued that the nursing home organization did not require any judicial relief from the law because it was eligible for a special "accommodation" for certain religious employers.
Under federal regulations, Little Sisters of the Poor Home for the Aged only has to self-certify that it is a nonprofit religious organization with objections to providing contraception services and then provide that documentation to the third-party administrator of their self-insured health plan, according to the Solicitor General. The organization will not need to pay for or arrange for the coverage, he said. And, in this specific case, the third-party administrator also will not provide the coverage to the organization’s employees, he argued.
The Supreme Court is expected to hear argument in the Hobby Lobby case later this year.
The question of whether organizations with religious ties should have to implement the Affordable Care Act’s mandate to cover contraceptives is once again before the Supreme Court.
On Dec. 31, Supreme Court Justice Sonia Sotomayor granted a stay to the Little Sisters of the Poor Home for the Aged in Denver, allowing them to temporarily avoid implementing the law’s contraception mandate. The nonprofit nursing homes sought relief from the Supreme Court, stating in court papers that complying with the mandate would violate their religious beliefs.
The organization would also like the Supreme Court to consider their objections to the mandate at the same time that it hears another related case, Hobby Lobby Stores, Inc. v. Sebelius.
But on Jan. 3, U.S. Solicitor General Donald B. Verrilli Jr., urged the Supreme Court not to take on the new case or provide the emergency injunction. Mr. Verrilli argued that the nursing home organization did not require any judicial relief from the law because it was eligible for a special "accommodation" for certain religious employers.
Under federal regulations, Little Sisters of the Poor Home for the Aged only has to self-certify that it is a nonprofit religious organization with objections to providing contraception services and then provide that documentation to the third-party administrator of their self-insured health plan, according to the Solicitor General. The organization will not need to pay for or arrange for the coverage, he said. And, in this specific case, the third-party administrator also will not provide the coverage to the organization’s employees, he argued.
The Supreme Court is expected to hear argument in the Hobby Lobby case later this year.
New health IT czar takes over in January
Dr. Karen B. DeSalvo has been tapped to become the federal government’s next national coordinator for health information technology, the Health and Human Services Department announced.
Dr. DeSalvo, who helped modernize the New Orleans health care infrastructure after Hurricane Katrina, will play a central role in setting policy around the Medicare and Medicaid Electronic Health Record Incentive Programs, which include "meaningful use" requirements for the use of health IT.
Her first day in the new post will be Jan. 13.
"Dr. DeSalvo’s hands-on experience with health delivery system reform and HIT and its potential to improve health care and public health will be invaluable assets to the Office of the National Coordinator and the [Health and Human Services] department," HHS Secretary Kathleen Sebelius said in an e-mail to ONC staff on Dec. 19.
Dr. DeSalvo, an internist, also currently serves as a senior health policy adviser to New Orleans Mayor Mitch Landrieu. Over the course of her career, she has been an advocate for increasing the use of health IT in primary care and public health, and as part of emergency preparedness efforts. She has also led the planning of the city’s new public hospital, which includes a fully integrated health IT network.
The Healthcare Information and Management Systems Society praised Dr. DeSalvo for her "deep understanding of the value of informatics, as well as the challenges and promise of interoperability."
Dr. DeSalvo replaces Dr. Jacob Reider, the acting national coordinator, who will return to his former role as chief medical officer at the Office of the National Coordinator for Health IT. Dr. Reider took over the top job in the fall, after the departure of Dr. Farzad Mostashari.
On Twitter @MaryEllenNY
Dr. Karen B. DeSalvo has been tapped to become the federal government’s next national coordinator for health information technology, the Health and Human Services Department announced.
Dr. DeSalvo, who helped modernize the New Orleans health care infrastructure after Hurricane Katrina, will play a central role in setting policy around the Medicare and Medicaid Electronic Health Record Incentive Programs, which include "meaningful use" requirements for the use of health IT.
Her first day in the new post will be Jan. 13.
"Dr. DeSalvo’s hands-on experience with health delivery system reform and HIT and its potential to improve health care and public health will be invaluable assets to the Office of the National Coordinator and the [Health and Human Services] department," HHS Secretary Kathleen Sebelius said in an e-mail to ONC staff on Dec. 19.
Dr. DeSalvo, an internist, also currently serves as a senior health policy adviser to New Orleans Mayor Mitch Landrieu. Over the course of her career, she has been an advocate for increasing the use of health IT in primary care and public health, and as part of emergency preparedness efforts. She has also led the planning of the city’s new public hospital, which includes a fully integrated health IT network.
The Healthcare Information and Management Systems Society praised Dr. DeSalvo for her "deep understanding of the value of informatics, as well as the challenges and promise of interoperability."
Dr. DeSalvo replaces Dr. Jacob Reider, the acting national coordinator, who will return to his former role as chief medical officer at the Office of the National Coordinator for Health IT. Dr. Reider took over the top job in the fall, after the departure of Dr. Farzad Mostashari.
On Twitter @MaryEllenNY
Dr. Karen B. DeSalvo has been tapped to become the federal government’s next national coordinator for health information technology, the Health and Human Services Department announced.
Dr. DeSalvo, who helped modernize the New Orleans health care infrastructure after Hurricane Katrina, will play a central role in setting policy around the Medicare and Medicaid Electronic Health Record Incentive Programs, which include "meaningful use" requirements for the use of health IT.
Her first day in the new post will be Jan. 13.
"Dr. DeSalvo’s hands-on experience with health delivery system reform and HIT and its potential to improve health care and public health will be invaluable assets to the Office of the National Coordinator and the [Health and Human Services] department," HHS Secretary Kathleen Sebelius said in an e-mail to ONC staff on Dec. 19.
Dr. DeSalvo, an internist, also currently serves as a senior health policy adviser to New Orleans Mayor Mitch Landrieu. Over the course of her career, she has been an advocate for increasing the use of health IT in primary care and public health, and as part of emergency preparedness efforts. She has also led the planning of the city’s new public hospital, which includes a fully integrated health IT network.
The Healthcare Information and Management Systems Society praised Dr. DeSalvo for her "deep understanding of the value of informatics, as well as the challenges and promise of interoperability."
Dr. DeSalvo replaces Dr. Jacob Reider, the acting national coordinator, who will return to his former role as chief medical officer at the Office of the National Coordinator for Health IT. Dr. Reider took over the top job in the fall, after the departure of Dr. Farzad Mostashari.
On Twitter @MaryEllenNY
Physicians, vendors behind schedule on ICD-10
Physicians, vendors, and health insurance plans are moving forward with their preparations for the ICD-10 coding set, but they aren’t moving fast enough, a survey has shown.
Unless the industry speeds up its work in early 2014, there won’t be adequate time for end-to-end testing and payments could be disrupted when the new code set – formally known as the International Statistical Classification of Diseases and Related Health Problems, 10th Revision – takes effect on Oct. 1, 2014, according to the survey from the Workgroup for Electronic Data Interchange (WEDI).
"Based on the survey results, it is clear the industry continues to make slow progress, but not the amount of progress that is needed for a smooth transition," Jim Daley, chairman of the WEDI, a public-private health information technology group that advises the Health and Human Services department, wrote in a letter to the agency.
The WEDI has been surveying the industry since 2009 to gauge progress toward ICD-10 implementation. The latest results come from an October 2013 survey of providers, vendors, and health plans.
Nearly a quarter of 196 physician practices, hospitals, and health systems surveyed planned to begin their own internal testing of business processes and systems changes by the end of 2013, and just under half said they would conduct internal testing in the first half of 2014. The remaining providers surveyed planned to begin internal testing later in 2014 or did not know when it would occur.
This is far behind the goals set in the WEDI/NCHICA timeline, which call for completing internal testing in July 2013 to leave time for external testing with payers throughout 2014.
Health plans and vendors also have some catching up to do, according to the survey results. Of the 59 vendors surveyed, about one-fifth said they were halfway or less than halfway complete with product development, a task that was supposed to be done by the end of 2011, according to the suggested timeline. And about one-third of the 98 health insurance plans that responded said they have already begun or expect to begin external testing by the end of 2013, leaving most health plans less than 9 months to complete external testing.
On Twitter @MaryEllenNY
Physicians, vendors, and health insurance plans are moving forward with their preparations for the ICD-10 coding set, but they aren’t moving fast enough, a survey has shown.
Unless the industry speeds up its work in early 2014, there won’t be adequate time for end-to-end testing and payments could be disrupted when the new code set – formally known as the International Statistical Classification of Diseases and Related Health Problems, 10th Revision – takes effect on Oct. 1, 2014, according to the survey from the Workgroup for Electronic Data Interchange (WEDI).
"Based on the survey results, it is clear the industry continues to make slow progress, but not the amount of progress that is needed for a smooth transition," Jim Daley, chairman of the WEDI, a public-private health information technology group that advises the Health and Human Services department, wrote in a letter to the agency.
The WEDI has been surveying the industry since 2009 to gauge progress toward ICD-10 implementation. The latest results come from an October 2013 survey of providers, vendors, and health plans.
Nearly a quarter of 196 physician practices, hospitals, and health systems surveyed planned to begin their own internal testing of business processes and systems changes by the end of 2013, and just under half said they would conduct internal testing in the first half of 2014. The remaining providers surveyed planned to begin internal testing later in 2014 or did not know when it would occur.
This is far behind the goals set in the WEDI/NCHICA timeline, which call for completing internal testing in July 2013 to leave time for external testing with payers throughout 2014.
Health plans and vendors also have some catching up to do, according to the survey results. Of the 59 vendors surveyed, about one-fifth said they were halfway or less than halfway complete with product development, a task that was supposed to be done by the end of 2011, according to the suggested timeline. And about one-third of the 98 health insurance plans that responded said they have already begun or expect to begin external testing by the end of 2013, leaving most health plans less than 9 months to complete external testing.
On Twitter @MaryEllenNY
Physicians, vendors, and health insurance plans are moving forward with their preparations for the ICD-10 coding set, but they aren’t moving fast enough, a survey has shown.
Unless the industry speeds up its work in early 2014, there won’t be adequate time for end-to-end testing and payments could be disrupted when the new code set – formally known as the International Statistical Classification of Diseases and Related Health Problems, 10th Revision – takes effect on Oct. 1, 2014, according to the survey from the Workgroup for Electronic Data Interchange (WEDI).
"Based on the survey results, it is clear the industry continues to make slow progress, but not the amount of progress that is needed for a smooth transition," Jim Daley, chairman of the WEDI, a public-private health information technology group that advises the Health and Human Services department, wrote in a letter to the agency.
The WEDI has been surveying the industry since 2009 to gauge progress toward ICD-10 implementation. The latest results come from an October 2013 survey of providers, vendors, and health plans.
Nearly a quarter of 196 physician practices, hospitals, and health systems surveyed planned to begin their own internal testing of business processes and systems changes by the end of 2013, and just under half said they would conduct internal testing in the first half of 2014. The remaining providers surveyed planned to begin internal testing later in 2014 or did not know when it would occur.
This is far behind the goals set in the WEDI/NCHICA timeline, which call for completing internal testing in July 2013 to leave time for external testing with payers throughout 2014.
Health plans and vendors also have some catching up to do, according to the survey results. Of the 59 vendors surveyed, about one-fifth said they were halfway or less than halfway complete with product development, a task that was supposed to be done by the end of 2011, according to the suggested timeline. And about one-third of the 98 health insurance plans that responded said they have already begun or expect to begin external testing by the end of 2013, leaving most health plans less than 9 months to complete external testing.
On Twitter @MaryEllenNY
House budget includes SGR patch; permanent fix sails through committees
WASHINGTON - Congress has moved the ball forward on permanently replacing the Medicare Sustainable Growth Rate formula, but with time short for a fix by year's end the House has voted to approve a temporary 3-month reprieve from the 20% cut due to take effect Jan. 1.
In a 332-94 vote, with eight abstentions, the House on Dec. 12 approved the Bipartisan Budget Act of 2013, a wide-ranging budget agreement that includes the 3-month patch. The bill also would increase physician pay by 0.5% through March.
The Congressional Budget Office estimated that the temporary fix would cost $3.3 billion in 2014 and a total of $7.3 billion through 2023. The fix would be paid for by cutting Medicaid payments for hospital-based charity care and to long-term care hospitals.
It also would extend the 2% sequestration cuts for Medicare providers by 2 years, from 2021 to 2023.
The Senate has yet to consider the budget package including the SGR patch; it is expected to do so before its holiday recess. President Obama has said that he supports the deal.
The agreement, brokered by House Budget Committee Chairman Paul Ryan (R-Wisc.) and Senate Budget Committee Chairman Patty Murray (D-Wash.), adds about $63 billion in discretionary federal spending over 2 years and makes targeted cuts and fee hikes to bring about overall deficit reduction of about $23 billion.
Although physician groups aren't thrilled about the continuation of the Medicare cuts under sequestration, most favor the temporary SGR reprieve and the restoration of some funding to federal health programs.
Dr. Ardis Dee Hoven, president of the American Medical Association, said that the continuation of the sequester cuts in Medicare is "frustrating" and poses the risk of destabilizing physician practices. "The concept of the sequester is probably not the best way to rein in spending," she said.
Dr. Clifford A. Hudis, president of the American Society of Clinical Oncology, praised the agreement for providing funds that could restore cuts in medical research and cancer care at the National Institutes of Health. He expressed disappointment, however, that the bill does not reverse cuts to Medicare, including reductions in the payments for physician-administered drugs under Medicare Part B.
"Oncologists are doing everything possible to continue providing care for Medicare patients, but this reduction has forced many in private practice to send patients to hospitals for chemotherapy because they cannot afford to administer these drugs in their office," Dr. Hudis said in a statement.
Physician organizations viewed the patch as necessary while Congress continues to work on a permanent SGR fix. Both the House and Senate took steps toward that goal on Dec. 12.
The House Ways and Means Committee voted 39-0 to approve its replacement proposal, which essentially adds on to the bill approved by the House Energy and Commerce Committee in July.
"This may not be the final step, it's a very important step forward," said Rep. Kevin Brady (R-Tex.), chairman of the Ways and Means Health Subcommittee.
The House did not address how to pay for the permanent replacement. House Ways and Means Chairman Dave Camp (R-Mich.) noted that the Congressional Budget Office has estimated that it will cost $116 billion over 10 years to repeal the SGR, which is "more than half the cost 2 years ago." Even though that is the lowest estimate ever, "I am of no illusion that finding pay-fors will be an easy task," he said.
The Senate Finance Committee also did not include a way to pay for repeal in its proposal.
The bill had widespread bipartisan support in the committee, but some Senators raised concerns about the lack of a funding mechanism. Sen. Pat Roberts (R-Kan.) said that he wouldn’t support the bill until he could see how it would be funded.
Sen. Orrin Hatch (R- Utah), the committee's top-ranking Republican, said that the offsets would be worked out once the bill had cleared the initial policymaking phase.
"This bill will be offset, period, or it's not going to go through both houses," he said. "This bill will be paid for."
The panel agreed to add a provision aimed at expanding access to community mental health services. The amendment, offered by Sen. Debbie Stabenow (D-Mich.) and Sen. Roy Blunt (R-Mo.), would create pilot programs in 10 states to ensure that community behavioral health clinics offer a full range of mental health services, including 24-hour crisis care, substance abuse treatment, and expanded support for families.
Physician groups praised the continued congressional action.
The AMA "strongly commends members of the House Ways and Means Committee and the Senate Finance Committee for the tremendous progress they have made toward repealing Medicare's failed Sustainable Growth Rate (SGR) formula and creating a stronger Medicare program," Dr. Hoven said in a statement. "The AMA will continue to work collaboratively with Congress so that a bipartisan agreement can be signed into law early next year to repeal the failed SGR payment formula."
The American College of Physicians said that it, too, would work to ensure that a bill moves through Congress and gets to the White House for approval soon.
"The bills reported today ... will help ensure that Medicare patients continue to have access to their physicians," said Dr. Charles Cutler, chairman of the ACP Board of Regents. "Their efforts will work to stabilize payments, provide multiple pathways for physicians to qualify for positive updates and to participate in alternative payment models, create positive incentives for patient-centered medical homes, provide assistance to small practices, and needed funding for development of quality measures."
The American College of Cardiology said in a statement that the proposals accomplished two of its highest priorities: eliminating the SGR and including provisions that will emphasize quality of care, including "provisions that emphasize the importance of clinical data registries, quality measure development, and appropriate use criteria to promote evidence-based care."
"We caution that our final support rests upon the caveat that paying for this legislation must not cause harm to patients and the physicians who care for them," Dr. John Gordon Harold, ACC president, said in the statement.
Legislators from the Finance Committee and the Ways and Means Committee celebrated their votes in a joint statement. In the statement, Sen. Hatch also issued a word of caution.
"Now that this legislation moves out of Committee and onto the floor, we need to continue to work together to ensure that this smart policy becomes law and ensure that it doesn't add one dime to our nation's debt."
WASHINGTON - Congress has moved the ball forward on permanently replacing the Medicare Sustainable Growth Rate formula, but with time short for a fix by year's end the House has voted to approve a temporary 3-month reprieve from the 20% cut due to take effect Jan. 1.
In a 332-94 vote, with eight abstentions, the House on Dec. 12 approved the Bipartisan Budget Act of 2013, a wide-ranging budget agreement that includes the 3-month patch. The bill also would increase physician pay by 0.5% through March.
The Congressional Budget Office estimated that the temporary fix would cost $3.3 billion in 2014 and a total of $7.3 billion through 2023. The fix would be paid for by cutting Medicaid payments for hospital-based charity care and to long-term care hospitals.
It also would extend the 2% sequestration cuts for Medicare providers by 2 years, from 2021 to 2023.
The Senate has yet to consider the budget package including the SGR patch; it is expected to do so before its holiday recess. President Obama has said that he supports the deal.
The agreement, brokered by House Budget Committee Chairman Paul Ryan (R-Wisc.) and Senate Budget Committee Chairman Patty Murray (D-Wash.), adds about $63 billion in discretionary federal spending over 2 years and makes targeted cuts and fee hikes to bring about overall deficit reduction of about $23 billion.
Although physician groups aren't thrilled about the continuation of the Medicare cuts under sequestration, most favor the temporary SGR reprieve and the restoration of some funding to federal health programs.
Dr. Ardis Dee Hoven, president of the American Medical Association, said that the continuation of the sequester cuts in Medicare is "frustrating" and poses the risk of destabilizing physician practices. "The concept of the sequester is probably not the best way to rein in spending," she said.
Dr. Clifford A. Hudis, president of the American Society of Clinical Oncology, praised the agreement for providing funds that could restore cuts in medical research and cancer care at the National Institutes of Health. He expressed disappointment, however, that the bill does not reverse cuts to Medicare, including reductions in the payments for physician-administered drugs under Medicare Part B.
"Oncologists are doing everything possible to continue providing care for Medicare patients, but this reduction has forced many in private practice to send patients to hospitals for chemotherapy because they cannot afford to administer these drugs in their office," Dr. Hudis said in a statement.
Physician organizations viewed the patch as necessary while Congress continues to work on a permanent SGR fix. Both the House and Senate took steps toward that goal on Dec. 12.
The House Ways and Means Committee voted 39-0 to approve its replacement proposal, which essentially adds on to the bill approved by the House Energy and Commerce Committee in July.
"This may not be the final step, it's a very important step forward," said Rep. Kevin Brady (R-Tex.), chairman of the Ways and Means Health Subcommittee.
The House did not address how to pay for the permanent replacement. House Ways and Means Chairman Dave Camp (R-Mich.) noted that the Congressional Budget Office has estimated that it will cost $116 billion over 10 years to repeal the SGR, which is "more than half the cost 2 years ago." Even though that is the lowest estimate ever, "I am of no illusion that finding pay-fors will be an easy task," he said.
The Senate Finance Committee also did not include a way to pay for repeal in its proposal.
The bill had widespread bipartisan support in the committee, but some Senators raised concerns about the lack of a funding mechanism. Sen. Pat Roberts (R-Kan.) said that he wouldn’t support the bill until he could see how it would be funded.
Sen. Orrin Hatch (R- Utah), the committee's top-ranking Republican, said that the offsets would be worked out once the bill had cleared the initial policymaking phase.
"This bill will be offset, period, or it's not going to go through both houses," he said. "This bill will be paid for."
The panel agreed to add a provision aimed at expanding access to community mental health services. The amendment, offered by Sen. Debbie Stabenow (D-Mich.) and Sen. Roy Blunt (R-Mo.), would create pilot programs in 10 states to ensure that community behavioral health clinics offer a full range of mental health services, including 24-hour crisis care, substance abuse treatment, and expanded support for families.
Physician groups praised the continued congressional action.
The AMA "strongly commends members of the House Ways and Means Committee and the Senate Finance Committee for the tremendous progress they have made toward repealing Medicare's failed Sustainable Growth Rate (SGR) formula and creating a stronger Medicare program," Dr. Hoven said in a statement. "The AMA will continue to work collaboratively with Congress so that a bipartisan agreement can be signed into law early next year to repeal the failed SGR payment formula."
The American College of Physicians said that it, too, would work to ensure that a bill moves through Congress and gets to the White House for approval soon.
"The bills reported today ... will help ensure that Medicare patients continue to have access to their physicians," said Dr. Charles Cutler, chairman of the ACP Board of Regents. "Their efforts will work to stabilize payments, provide multiple pathways for physicians to qualify for positive updates and to participate in alternative payment models, create positive incentives for patient-centered medical homes, provide assistance to small practices, and needed funding for development of quality measures."
The American College of Cardiology said in a statement that the proposals accomplished two of its highest priorities: eliminating the SGR and including provisions that will emphasize quality of care, including "provisions that emphasize the importance of clinical data registries, quality measure development, and appropriate use criteria to promote evidence-based care."
"We caution that our final support rests upon the caveat that paying for this legislation must not cause harm to patients and the physicians who care for them," Dr. John Gordon Harold, ACC president, said in the statement.
Legislators from the Finance Committee and the Ways and Means Committee celebrated their votes in a joint statement. In the statement, Sen. Hatch also issued a word of caution.
"Now that this legislation moves out of Committee and onto the floor, we need to continue to work together to ensure that this smart policy becomes law and ensure that it doesn't add one dime to our nation's debt."
WASHINGTON - Congress has moved the ball forward on permanently replacing the Medicare Sustainable Growth Rate formula, but with time short for a fix by year's end the House has voted to approve a temporary 3-month reprieve from the 20% cut due to take effect Jan. 1.
In a 332-94 vote, with eight abstentions, the House on Dec. 12 approved the Bipartisan Budget Act of 2013, a wide-ranging budget agreement that includes the 3-month patch. The bill also would increase physician pay by 0.5% through March.
The Congressional Budget Office estimated that the temporary fix would cost $3.3 billion in 2014 and a total of $7.3 billion through 2023. The fix would be paid for by cutting Medicaid payments for hospital-based charity care and to long-term care hospitals.
It also would extend the 2% sequestration cuts for Medicare providers by 2 years, from 2021 to 2023.
The Senate has yet to consider the budget package including the SGR patch; it is expected to do so before its holiday recess. President Obama has said that he supports the deal.
The agreement, brokered by House Budget Committee Chairman Paul Ryan (R-Wisc.) and Senate Budget Committee Chairman Patty Murray (D-Wash.), adds about $63 billion in discretionary federal spending over 2 years and makes targeted cuts and fee hikes to bring about overall deficit reduction of about $23 billion.
Although physician groups aren't thrilled about the continuation of the Medicare cuts under sequestration, most favor the temporary SGR reprieve and the restoration of some funding to federal health programs.
Dr. Ardis Dee Hoven, president of the American Medical Association, said that the continuation of the sequester cuts in Medicare is "frustrating" and poses the risk of destabilizing physician practices. "The concept of the sequester is probably not the best way to rein in spending," she said.
Dr. Clifford A. Hudis, president of the American Society of Clinical Oncology, praised the agreement for providing funds that could restore cuts in medical research and cancer care at the National Institutes of Health. He expressed disappointment, however, that the bill does not reverse cuts to Medicare, including reductions in the payments for physician-administered drugs under Medicare Part B.
"Oncologists are doing everything possible to continue providing care for Medicare patients, but this reduction has forced many in private practice to send patients to hospitals for chemotherapy because they cannot afford to administer these drugs in their office," Dr. Hudis said in a statement.
Physician organizations viewed the patch as necessary while Congress continues to work on a permanent SGR fix. Both the House and Senate took steps toward that goal on Dec. 12.
The House Ways and Means Committee voted 39-0 to approve its replacement proposal, which essentially adds on to the bill approved by the House Energy and Commerce Committee in July.
"This may not be the final step, it's a very important step forward," said Rep. Kevin Brady (R-Tex.), chairman of the Ways and Means Health Subcommittee.
The House did not address how to pay for the permanent replacement. House Ways and Means Chairman Dave Camp (R-Mich.) noted that the Congressional Budget Office has estimated that it will cost $116 billion over 10 years to repeal the SGR, which is "more than half the cost 2 years ago." Even though that is the lowest estimate ever, "I am of no illusion that finding pay-fors will be an easy task," he said.
The Senate Finance Committee also did not include a way to pay for repeal in its proposal.
The bill had widespread bipartisan support in the committee, but some Senators raised concerns about the lack of a funding mechanism. Sen. Pat Roberts (R-Kan.) said that he wouldn’t support the bill until he could see how it would be funded.
Sen. Orrin Hatch (R- Utah), the committee's top-ranking Republican, said that the offsets would be worked out once the bill had cleared the initial policymaking phase.
"This bill will be offset, period, or it's not going to go through both houses," he said. "This bill will be paid for."
The panel agreed to add a provision aimed at expanding access to community mental health services. The amendment, offered by Sen. Debbie Stabenow (D-Mich.) and Sen. Roy Blunt (R-Mo.), would create pilot programs in 10 states to ensure that community behavioral health clinics offer a full range of mental health services, including 24-hour crisis care, substance abuse treatment, and expanded support for families.
Physician groups praised the continued congressional action.
The AMA "strongly commends members of the House Ways and Means Committee and the Senate Finance Committee for the tremendous progress they have made toward repealing Medicare's failed Sustainable Growth Rate (SGR) formula and creating a stronger Medicare program," Dr. Hoven said in a statement. "The AMA will continue to work collaboratively with Congress so that a bipartisan agreement can be signed into law early next year to repeal the failed SGR payment formula."
The American College of Physicians said that it, too, would work to ensure that a bill moves through Congress and gets to the White House for approval soon.
"The bills reported today ... will help ensure that Medicare patients continue to have access to their physicians," said Dr. Charles Cutler, chairman of the ACP Board of Regents. "Their efforts will work to stabilize payments, provide multiple pathways for physicians to qualify for positive updates and to participate in alternative payment models, create positive incentives for patient-centered medical homes, provide assistance to small practices, and needed funding for development of quality measures."
The American College of Cardiology said in a statement that the proposals accomplished two of its highest priorities: eliminating the SGR and including provisions that will emphasize quality of care, including "provisions that emphasize the importance of clinical data registries, quality measure development, and appropriate use criteria to promote evidence-based care."
"We caution that our final support rests upon the caveat that paying for this legislation must not cause harm to patients and the physicians who care for them," Dr. John Gordon Harold, ACC president, said in the statement.
Legislators from the Finance Committee and the Ways and Means Committee celebrated their votes in a joint statement. In the statement, Sen. Hatch also issued a word of caution.
"Now that this legislation moves out of Committee and onto the floor, we need to continue to work together to ensure that this smart policy becomes law and ensure that it doesn't add one dime to our nation's debt."
