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Medicare to Begin Testing Bundled Payments
Physicians and hospitals now have the chance to test out bundled payments on a range of conditions under a new Medicare initiative.
On Aug. 23, officials at the Centers for Medicare and Medicaid Services released a request for applications (RFA) inviting physicians, hospitals, and other health care providers to participate in the Bundled Payments for Care Improvement initiative. The program, which was mandated under the Affordable Care Act, offers a variety of options for bundling payments for a hospital stay, for post-discharge services, or for both the hospital stay and the post-discharge care.
The move toward bundled payments is a major shift in how the government pays for medical care. Instead of paying hospitals, physicians, and other providers separately, this initiative would combine the payment over an episode of care for a specific condition. The aim of the program is to incentivize clinicians to work together and provide better continuity of care, resulting in better quality and lower costs.
"Today, Medicare pays for care the wrong way," Health and Human Services Secretary Kathleen Sebelius said during a teleconference to announce the bundling program. "Payments are based on the quantity of care, the amount of services delivered, not the quality of that care. And that leaves us too often with a system that actually can punish the providers that are most successful at getting and keeping their patients healthy."
The new bundling program offers four ways that health care providers can receive a bundled payment, three of which provide payment retrospectively, and one that offers a prospective payment. For example, under some of the retrospective payment models, CMS and the providers would agree on a target payment amount for the episode of care and providers would be paid under the original Medicare fee-for-service system, but at a negotiated discount of 2% to 3% or greater. At the end of the care episode, the total payment would be compared with the target price and providers would be able to share in the savings, according to CMS.
The prospective payment model would work differently. Under that option, CMS would make a single bundled payment to the hospital to cover all services provided during the inpatient stay by the hospital, physicians, and other providers. That payment would offer at least a 3% discount to Medicare. Under this option, physicians and other providers would submit "no pay" claims to Medicare and the hospital would pay them out of the single bundled payment.
In addition to the options of prospective or retrospective payment, providers could choose how long the episode of care will be and what conditions they want to bundle payment for, and what services would be included in the payment. CMS officials said they wanted to make the program flexible so that a range of hospitals, physicians, and other providers could participate.
Organizations interested in applying must submit a letter of intent by Sept. 22 for Model 1 and by Nov. 4 for Models 2, 3, and 4.
Dr. Richard Gilfillan, the acting director of the CMS Innovation Center, which is overseeing the bundling initiative, said he expects that hundreds of organizations will apply. CMS will consider a number of factors in choosing participants for the program including the best proposals for care improvement, the number of patients involved, and the conditions addressed, and the price discounts offered, he said.
The program is a unique opportunity for hospitals to redesign their systems to promote better care coordination, Dr. Gilfillan said, and have that effort supported through Medicare payments.
Physicians and hospitals now have the chance to test out bundled payments on a range of conditions under a new Medicare initiative.
On Aug. 23, officials at the Centers for Medicare and Medicaid Services released a request for applications (RFA) inviting physicians, hospitals, and other health care providers to participate in the Bundled Payments for Care Improvement initiative. The program, which was mandated under the Affordable Care Act, offers a variety of options for bundling payments for a hospital stay, for post-discharge services, or for both the hospital stay and the post-discharge care.
The move toward bundled payments is a major shift in how the government pays for medical care. Instead of paying hospitals, physicians, and other providers separately, this initiative would combine the payment over an episode of care for a specific condition. The aim of the program is to incentivize clinicians to work together and provide better continuity of care, resulting in better quality and lower costs.
"Today, Medicare pays for care the wrong way," Health and Human Services Secretary Kathleen Sebelius said during a teleconference to announce the bundling program. "Payments are based on the quantity of care, the amount of services delivered, not the quality of that care. And that leaves us too often with a system that actually can punish the providers that are most successful at getting and keeping their patients healthy."
The new bundling program offers four ways that health care providers can receive a bundled payment, three of which provide payment retrospectively, and one that offers a prospective payment. For example, under some of the retrospective payment models, CMS and the providers would agree on a target payment amount for the episode of care and providers would be paid under the original Medicare fee-for-service system, but at a negotiated discount of 2% to 3% or greater. At the end of the care episode, the total payment would be compared with the target price and providers would be able to share in the savings, according to CMS.
The prospective payment model would work differently. Under that option, CMS would make a single bundled payment to the hospital to cover all services provided during the inpatient stay by the hospital, physicians, and other providers. That payment would offer at least a 3% discount to Medicare. Under this option, physicians and other providers would submit "no pay" claims to Medicare and the hospital would pay them out of the single bundled payment.
In addition to the options of prospective or retrospective payment, providers could choose how long the episode of care will be and what conditions they want to bundle payment for, and what services would be included in the payment. CMS officials said they wanted to make the program flexible so that a range of hospitals, physicians, and other providers could participate.
Organizations interested in applying must submit a letter of intent by Sept. 22 for Model 1 and by Nov. 4 for Models 2, 3, and 4.
Dr. Richard Gilfillan, the acting director of the CMS Innovation Center, which is overseeing the bundling initiative, said he expects that hundreds of organizations will apply. CMS will consider a number of factors in choosing participants for the program including the best proposals for care improvement, the number of patients involved, and the conditions addressed, and the price discounts offered, he said.
The program is a unique opportunity for hospitals to redesign their systems to promote better care coordination, Dr. Gilfillan said, and have that effort supported through Medicare payments.
Physicians and hospitals now have the chance to test out bundled payments on a range of conditions under a new Medicare initiative.
On Aug. 23, officials at the Centers for Medicare and Medicaid Services released a request for applications (RFA) inviting physicians, hospitals, and other health care providers to participate in the Bundled Payments for Care Improvement initiative. The program, which was mandated under the Affordable Care Act, offers a variety of options for bundling payments for a hospital stay, for post-discharge services, or for both the hospital stay and the post-discharge care.
The move toward bundled payments is a major shift in how the government pays for medical care. Instead of paying hospitals, physicians, and other providers separately, this initiative would combine the payment over an episode of care for a specific condition. The aim of the program is to incentivize clinicians to work together and provide better continuity of care, resulting in better quality and lower costs.
"Today, Medicare pays for care the wrong way," Health and Human Services Secretary Kathleen Sebelius said during a teleconference to announce the bundling program. "Payments are based on the quantity of care, the amount of services delivered, not the quality of that care. And that leaves us too often with a system that actually can punish the providers that are most successful at getting and keeping their patients healthy."
The new bundling program offers four ways that health care providers can receive a bundled payment, three of which provide payment retrospectively, and one that offers a prospective payment. For example, under some of the retrospective payment models, CMS and the providers would agree on a target payment amount for the episode of care and providers would be paid under the original Medicare fee-for-service system, but at a negotiated discount of 2% to 3% or greater. At the end of the care episode, the total payment would be compared with the target price and providers would be able to share in the savings, according to CMS.
The prospective payment model would work differently. Under that option, CMS would make a single bundled payment to the hospital to cover all services provided during the inpatient stay by the hospital, physicians, and other providers. That payment would offer at least a 3% discount to Medicare. Under this option, physicians and other providers would submit "no pay" claims to Medicare and the hospital would pay them out of the single bundled payment.
In addition to the options of prospective or retrospective payment, providers could choose how long the episode of care will be and what conditions they want to bundle payment for, and what services would be included in the payment. CMS officials said they wanted to make the program flexible so that a range of hospitals, physicians, and other providers could participate.
Organizations interested in applying must submit a letter of intent by Sept. 22 for Model 1 and by Nov. 4 for Models 2, 3, and 4.
Dr. Richard Gilfillan, the acting director of the CMS Innovation Center, which is overseeing the bundling initiative, said he expects that hundreds of organizations will apply. CMS will consider a number of factors in choosing participants for the program including the best proposals for care improvement, the number of patients involved, and the conditions addressed, and the price discounts offered, he said.
The program is a unique opportunity for hospitals to redesign their systems to promote better care coordination, Dr. Gilfillan said, and have that effort supported through Medicare payments.
Report: Trend of Hospital-Employed Docs Could Raise Costs
Hospital employment of physicians continues to rise rapidly around the country, but the trend could drive up costs at least in the short term, according to a report from the Center for Studying Health System Change.
Physicians who are employed by hospitals are often paid based on their productivity, which offers an incentive to increase the volume of services. And in some cases, physicians are under pressure from their hospitals to order more expensive tests, according to the report, released this month.
The researchers from the Center for Studying Health System Change based their analysis on interviews with nearly 550 physicians, hospital executives, health plan officials, and others, in 12 nationally representative metropolitan communities (Findings From HSC 2011 August [Issue Brief No. 13]). The communities are Boston; Cleveland; Greenville, S.C.; Indianapolis; Lansing, Mich.; Little Rock, Ark.; Miami; northern New Jersey, Orange County, Calif.; Phoenix; Seattle; and Syracuse, N.Y.
In one area, at least two cardiologists said they declined job offers from a local hospital because they believed the pressure to drive up volume would be stronger there than in their independent cardiology practice, according to the report.
"The acceleration in hospital employment of physicians risks raising costs and not improving quality of care unless payment reforms shift provider incentives away from volume toward higher quality and efficiency," said Dr. Ann S. O’Malley, a senior health researcher at the Center for Studying Health System Change and a coauthor of the study.
The trend toward hospitals’ employing more physicians can also drive up costs for the health system because hospitals are able to charge hospital facility fees for office visits and procedures, even when those services are administered in a physician’s office. That means that Medicare – and in some cases private insurers – are paying significantly more for the same services simply because the physician is employed by the hospital.
Hospital employment of physicians does have the potential to improve quality through better integration of care and communication between physicians. The problem, the researchers noted, is that integration and communication can be slow to improve just because physicians get their paychecks from the hospital. Interview respondents from the 12 communities said that the hospital employment model is generally helpful in coordinating care for a single diagnosis, such as heart failure. But integration across all of a patient’s medical needs requires more time and effort, they said.
The research was funded by the Robert Wood Johnson Foundation and the National Institute for Health Care Reform.
Hospital employment of physicians continues to rise rapidly around the country, but the trend could drive up costs at least in the short term, according to a report from the Center for Studying Health System Change.
Physicians who are employed by hospitals are often paid based on their productivity, which offers an incentive to increase the volume of services. And in some cases, physicians are under pressure from their hospitals to order more expensive tests, according to the report, released this month.
The researchers from the Center for Studying Health System Change based their analysis on interviews with nearly 550 physicians, hospital executives, health plan officials, and others, in 12 nationally representative metropolitan communities (Findings From HSC 2011 August [Issue Brief No. 13]). The communities are Boston; Cleveland; Greenville, S.C.; Indianapolis; Lansing, Mich.; Little Rock, Ark.; Miami; northern New Jersey, Orange County, Calif.; Phoenix; Seattle; and Syracuse, N.Y.
In one area, at least two cardiologists said they declined job offers from a local hospital because they believed the pressure to drive up volume would be stronger there than in their independent cardiology practice, according to the report.
"The acceleration in hospital employment of physicians risks raising costs and not improving quality of care unless payment reforms shift provider incentives away from volume toward higher quality and efficiency," said Dr. Ann S. O’Malley, a senior health researcher at the Center for Studying Health System Change and a coauthor of the study.
The trend toward hospitals’ employing more physicians can also drive up costs for the health system because hospitals are able to charge hospital facility fees for office visits and procedures, even when those services are administered in a physician’s office. That means that Medicare – and in some cases private insurers – are paying significantly more for the same services simply because the physician is employed by the hospital.
Hospital employment of physicians does have the potential to improve quality through better integration of care and communication between physicians. The problem, the researchers noted, is that integration and communication can be slow to improve just because physicians get their paychecks from the hospital. Interview respondents from the 12 communities said that the hospital employment model is generally helpful in coordinating care for a single diagnosis, such as heart failure. But integration across all of a patient’s medical needs requires more time and effort, they said.
The research was funded by the Robert Wood Johnson Foundation and the National Institute for Health Care Reform.
Hospital employment of physicians continues to rise rapidly around the country, but the trend could drive up costs at least in the short term, according to a report from the Center for Studying Health System Change.
Physicians who are employed by hospitals are often paid based on their productivity, which offers an incentive to increase the volume of services. And in some cases, physicians are under pressure from their hospitals to order more expensive tests, according to the report, released this month.
The researchers from the Center for Studying Health System Change based their analysis on interviews with nearly 550 physicians, hospital executives, health plan officials, and others, in 12 nationally representative metropolitan communities (Findings From HSC 2011 August [Issue Brief No. 13]). The communities are Boston; Cleveland; Greenville, S.C.; Indianapolis; Lansing, Mich.; Little Rock, Ark.; Miami; northern New Jersey, Orange County, Calif.; Phoenix; Seattle; and Syracuse, N.Y.
In one area, at least two cardiologists said they declined job offers from a local hospital because they believed the pressure to drive up volume would be stronger there than in their independent cardiology practice, according to the report.
"The acceleration in hospital employment of physicians risks raising costs and not improving quality of care unless payment reforms shift provider incentives away from volume toward higher quality and efficiency," said Dr. Ann S. O’Malley, a senior health researcher at the Center for Studying Health System Change and a coauthor of the study.
The trend toward hospitals’ employing more physicians can also drive up costs for the health system because hospitals are able to charge hospital facility fees for office visits and procedures, even when those services are administered in a physician’s office. That means that Medicare – and in some cases private insurers – are paying significantly more for the same services simply because the physician is employed by the hospital.
Hospital employment of physicians does have the potential to improve quality through better integration of care and communication between physicians. The problem, the researchers noted, is that integration and communication can be slow to improve just because physicians get their paychecks from the hospital. Interview respondents from the 12 communities said that the hospital employment model is generally helpful in coordinating care for a single diagnosis, such as heart failure. But integration across all of a patient’s medical needs requires more time and effort, they said.
The research was funded by the Robert Wood Johnson Foundation and the National Institute for Health Care Reform.
AN ANALYSIS FROM THE CENTER FOR STUDYING HEALTH SYSTEM CHANGE
Profiteers Take Advantage of Drug Shortages
A gray market of secondary pharmaceutical suppliers is driving up the price of lifesaving drugs that are in short supply, with markups ranging from 100% to 4,500%.
An analysis released Aug. 16 by the Premier Healthcare Alliance found that, on average, drugs are being marked up 650% on the gray market. Premier compiled and analyzed 636 unsolicited sales offers received by acute care facilities in its network. All of the drugs offered were either back-ordered or unavailable through the manufacturer. While the average markup for these drugs was 650%, the top 10 highest markups were more than 1,000% over base contract prices.
The top 10 highest markups were seen in pharmaceuticals used in cardiology, sedation, critical care, and oncology:
• Labetalol – 4,533%
• Cytarabine – 3,980%
• Dexamethasone 4 mg injection – 3,857%
• Leucovorin – 3,170%
• Propofol – 3,161%
• Papaverine – 2,979%
• Protamine sulfate– 2,752%
• Levophed – 2,642%
• Sodium chloride concentrate – 2,350%
• Furosemide injection – 1,721%
Gray market vendors generally advertise drugs through e-mails and faxes that tout the shortage of the products, Premier officials said, with language such as "we only have 20 [units] of this drug left and quantities are going fast."
The reported price gouging comes as the country faces an unprecedented shortage of drugs. By the end of 2011, there could be more than 360 drugs in short supply, according to projections by Premier.
Hospitals and pharmacies must beware when purchasing drugs on the gray market, not just because of the inflated price but also because of safety risks, Premier officials warned. Products sold on the gray market may have been mishandled, rendering them ineffective or harmful; they also could be counterfeit or diluted.
Stolen, counterfeit, and mishandled drugs are also difficult to recognize. Even the original manufacturers may not be able to spot fake drugs, according to analysts for Premier. And hospitals that try to avoid gray market vendors may encounter problems because these vendors have sophisticated methods of impersonating legitimate, licensed distributors, according to Premier.
Drug shortages are also getting increased attention in Washington, where a bipartisan group of senators has been urging the Food and Drug Administration to do more to address these shortages. The FDA will hold a public meeting on the issue on Sept. 26.
Sen. Amy Klobuchar (D-Minn.), a member of the bipartisan group, told reporters on Aug. 16 that one short-term solution would be for drug manufacturers to alert the FDA to any problems that could result in a drug shortage; she is sponsoring a bill (S. 296) that would require manufacturers to do so.
This would allow the FDA to begin looking across the United States and overseas for alternative drugs before a shortage occurs, Sen. Klobuchar said, adding that a range of options needs to be on the table to address drug shortages and the price gouging coming from the gray market.
"I don’t care how much fighting is going on in Congress," she said. "I don’t think anyone wants to be responsible for a little kid dying because he doesn’t get a cancer drug because we haven’t been able to figure out the bureaucracy of this."
A gray market of secondary pharmaceutical suppliers is driving up the price of lifesaving drugs that are in short supply, with markups ranging from 100% to 4,500%.
An analysis released Aug. 16 by the Premier Healthcare Alliance found that, on average, drugs are being marked up 650% on the gray market. Premier compiled and analyzed 636 unsolicited sales offers received by acute care facilities in its network. All of the drugs offered were either back-ordered or unavailable through the manufacturer. While the average markup for these drugs was 650%, the top 10 highest markups were more than 1,000% over base contract prices.
The top 10 highest markups were seen in pharmaceuticals used in cardiology, sedation, critical care, and oncology:
• Labetalol – 4,533%
• Cytarabine – 3,980%
• Dexamethasone 4 mg injection – 3,857%
• Leucovorin – 3,170%
• Propofol – 3,161%
• Papaverine – 2,979%
• Protamine sulfate– 2,752%
• Levophed – 2,642%
• Sodium chloride concentrate – 2,350%
• Furosemide injection – 1,721%
Gray market vendors generally advertise drugs through e-mails and faxes that tout the shortage of the products, Premier officials said, with language such as "we only have 20 [units] of this drug left and quantities are going fast."
The reported price gouging comes as the country faces an unprecedented shortage of drugs. By the end of 2011, there could be more than 360 drugs in short supply, according to projections by Premier.
Hospitals and pharmacies must beware when purchasing drugs on the gray market, not just because of the inflated price but also because of safety risks, Premier officials warned. Products sold on the gray market may have been mishandled, rendering them ineffective or harmful; they also could be counterfeit or diluted.
Stolen, counterfeit, and mishandled drugs are also difficult to recognize. Even the original manufacturers may not be able to spot fake drugs, according to analysts for Premier. And hospitals that try to avoid gray market vendors may encounter problems because these vendors have sophisticated methods of impersonating legitimate, licensed distributors, according to Premier.
Drug shortages are also getting increased attention in Washington, where a bipartisan group of senators has been urging the Food and Drug Administration to do more to address these shortages. The FDA will hold a public meeting on the issue on Sept. 26.
Sen. Amy Klobuchar (D-Minn.), a member of the bipartisan group, told reporters on Aug. 16 that one short-term solution would be for drug manufacturers to alert the FDA to any problems that could result in a drug shortage; she is sponsoring a bill (S. 296) that would require manufacturers to do so.
This would allow the FDA to begin looking across the United States and overseas for alternative drugs before a shortage occurs, Sen. Klobuchar said, adding that a range of options needs to be on the table to address drug shortages and the price gouging coming from the gray market.
"I don’t care how much fighting is going on in Congress," she said. "I don’t think anyone wants to be responsible for a little kid dying because he doesn’t get a cancer drug because we haven’t been able to figure out the bureaucracy of this."
A gray market of secondary pharmaceutical suppliers is driving up the price of lifesaving drugs that are in short supply, with markups ranging from 100% to 4,500%.
An analysis released Aug. 16 by the Premier Healthcare Alliance found that, on average, drugs are being marked up 650% on the gray market. Premier compiled and analyzed 636 unsolicited sales offers received by acute care facilities in its network. All of the drugs offered were either back-ordered or unavailable through the manufacturer. While the average markup for these drugs was 650%, the top 10 highest markups were more than 1,000% over base contract prices.
The top 10 highest markups were seen in pharmaceuticals used in cardiology, sedation, critical care, and oncology:
• Labetalol – 4,533%
• Cytarabine – 3,980%
• Dexamethasone 4 mg injection – 3,857%
• Leucovorin – 3,170%
• Propofol – 3,161%
• Papaverine – 2,979%
• Protamine sulfate– 2,752%
• Levophed – 2,642%
• Sodium chloride concentrate – 2,350%
• Furosemide injection – 1,721%
Gray market vendors generally advertise drugs through e-mails and faxes that tout the shortage of the products, Premier officials said, with language such as "we only have 20 [units] of this drug left and quantities are going fast."
The reported price gouging comes as the country faces an unprecedented shortage of drugs. By the end of 2011, there could be more than 360 drugs in short supply, according to projections by Premier.
Hospitals and pharmacies must beware when purchasing drugs on the gray market, not just because of the inflated price but also because of safety risks, Premier officials warned. Products sold on the gray market may have been mishandled, rendering them ineffective or harmful; they also could be counterfeit or diluted.
Stolen, counterfeit, and mishandled drugs are also difficult to recognize. Even the original manufacturers may not be able to spot fake drugs, according to analysts for Premier. And hospitals that try to avoid gray market vendors may encounter problems because these vendors have sophisticated methods of impersonating legitimate, licensed distributors, according to Premier.
Drug shortages are also getting increased attention in Washington, where a bipartisan group of senators has been urging the Food and Drug Administration to do more to address these shortages. The FDA will hold a public meeting on the issue on Sept. 26.
Sen. Amy Klobuchar (D-Minn.), a member of the bipartisan group, told reporters on Aug. 16 that one short-term solution would be for drug manufacturers to alert the FDA to any problems that could result in a drug shortage; she is sponsoring a bill (S. 296) that would require manufacturers to do so.
This would allow the FDA to begin looking across the United States and overseas for alternative drugs before a shortage occurs, Sen. Klobuchar said, adding that a range of options needs to be on the table to address drug shortages and the price gouging coming from the gray market.
"I don’t care how much fighting is going on in Congress," she said. "I don’t think anyone wants to be responsible for a little kid dying because he doesn’t get a cancer drug because we haven’t been able to figure out the bureaucracy of this."
AN ANALYSIS FROM THE PREMIER HEALTHCARE ALLIANCE
Federal Court Rules Health Law's Mandate Unconstitutional
A federal appeals court in Atlanta has struck down the Affordable Care Act’s requirement that individuals purchase health insurance.
In a 2-1 ruling issued Aug. 12, the court declared that the so-called individual mandate violates the Commerce Clause of the U.S. Constitution and that Congress overstepped its authority in creating the requirement to buy insurance. The lawsuit was brought by a coalition of 26 states that oppose the Affordable Care Act on the grounds that the individual mandate infringes on the constitutional rights of individuals not to purchase insurance, and that the expansion of Medicaid will create an undue burden on state governments.
By ruling the individual mandate is unconstitutional, the appeals court affirms in part a ruling issued by U.S. District Court Judge Roger Vinson of Pensacola, Fla., in January. The appeals court disagreed with Judge Vinson’s decision to declare the entire Affordable Care Act unconstitutional, however. The higher court concluded that the individual mandate could be stripped out, allowing the rest of the law to stand.
Stephanie Cutter, a deputy senior adviser to President Obama, wrote in a blog post Aug. 12 that the White House was disappointed in the ruling but confident that it would be overturned.
"The individual responsibility provision – the main part of the law at issue in these cases – is constitutional," Ms. Cutter wrote. "Those who claim this provision exceeds Congress’ power to regulate interstate commerce are incorrect. Individuals who choose to go without health insurance are making an economic decision that affects all of us – when people without insurance obtain health care they cannot pay for, those with insurance and taxpayers are often left to pick up the tab."
The ruling in Atlanta is one of more than 25 legal challenges to the Affordable Care Act that are happening in courthouses around the country. Legal scholars expect that one of these challenges is likely to be decided by the Supreme Court in the next few years.
A federal appeals court in Atlanta has struck down the Affordable Care Act’s requirement that individuals purchase health insurance.
In a 2-1 ruling issued Aug. 12, the court declared that the so-called individual mandate violates the Commerce Clause of the U.S. Constitution and that Congress overstepped its authority in creating the requirement to buy insurance. The lawsuit was brought by a coalition of 26 states that oppose the Affordable Care Act on the grounds that the individual mandate infringes on the constitutional rights of individuals not to purchase insurance, and that the expansion of Medicaid will create an undue burden on state governments.
By ruling the individual mandate is unconstitutional, the appeals court affirms in part a ruling issued by U.S. District Court Judge Roger Vinson of Pensacola, Fla., in January. The appeals court disagreed with Judge Vinson’s decision to declare the entire Affordable Care Act unconstitutional, however. The higher court concluded that the individual mandate could be stripped out, allowing the rest of the law to stand.
Stephanie Cutter, a deputy senior adviser to President Obama, wrote in a blog post Aug. 12 that the White House was disappointed in the ruling but confident that it would be overturned.
"The individual responsibility provision – the main part of the law at issue in these cases – is constitutional," Ms. Cutter wrote. "Those who claim this provision exceeds Congress’ power to regulate interstate commerce are incorrect. Individuals who choose to go without health insurance are making an economic decision that affects all of us – when people without insurance obtain health care they cannot pay for, those with insurance and taxpayers are often left to pick up the tab."
The ruling in Atlanta is one of more than 25 legal challenges to the Affordable Care Act that are happening in courthouses around the country. Legal scholars expect that one of these challenges is likely to be decided by the Supreme Court in the next few years.
A federal appeals court in Atlanta has struck down the Affordable Care Act’s requirement that individuals purchase health insurance.
In a 2-1 ruling issued Aug. 12, the court declared that the so-called individual mandate violates the Commerce Clause of the U.S. Constitution and that Congress overstepped its authority in creating the requirement to buy insurance. The lawsuit was brought by a coalition of 26 states that oppose the Affordable Care Act on the grounds that the individual mandate infringes on the constitutional rights of individuals not to purchase insurance, and that the expansion of Medicaid will create an undue burden on state governments.
By ruling the individual mandate is unconstitutional, the appeals court affirms in part a ruling issued by U.S. District Court Judge Roger Vinson of Pensacola, Fla., in January. The appeals court disagreed with Judge Vinson’s decision to declare the entire Affordable Care Act unconstitutional, however. The higher court concluded that the individual mandate could be stripped out, allowing the rest of the law to stand.
Stephanie Cutter, a deputy senior adviser to President Obama, wrote in a blog post Aug. 12 that the White House was disappointed in the ruling but confident that it would be overturned.
"The individual responsibility provision – the main part of the law at issue in these cases – is constitutional," Ms. Cutter wrote. "Those who claim this provision exceeds Congress’ power to regulate interstate commerce are incorrect. Individuals who choose to go without health insurance are making an economic decision that affects all of us – when people without insurance obtain health care they cannot pay for, those with insurance and taxpayers are often left to pick up the tab."
The ruling in Atlanta is one of more than 25 legal challenges to the Affordable Care Act that are happening in courthouses around the country. Legal scholars expect that one of these challenges is likely to be decided by the Supreme Court in the next few years.
Federal Agencies Set Stage for Health Exchanges
Federal officials are laying the groundwork for the launch of state-based health insurance exchanges in 2014, handing out millions of dollars in grants to states, designing tools to determine eligibility to buy insurance, and proposing details on how the refundable premium tax credits will work.
The Health and Human Services department announced during a teleconference Aug. 12 that it is awarding $185 million in "establishment" grants to 13 states and the District of Columbia to help them build their insurance exchanges. These grants follow planning grants awarded last year by HHS. More than half of the states have already taken some action to begin building their exchanges, according to HHS.
HHS, along with the Treasury Department, also issued three proposed rules aimed at creating a system that’s easy for consumers and small businesses to navigate. The first proposal, issued by HHS, outlines the standards and processes for consumers to enroll in a health plan and to seek financial assistance. It also explains the standards for small employers to participate in the exchange. Another proposal attempts to simplify the process for determining eligibility in Medicaid and the Children’s Health Insurance Program and coordinate these processes with the insurance exchanges, so that individuals can move from Medicaid to another health plans without losing coverage.
Finally, the Treasury Department issued a proposed regulation that explains how individuals and families can receive premium tax credits for purchasing insurance. Under the Affordable Care Act, taxpayers with incomes between 100% and 400% of the federal poverty level will be eligible for premium tax credits if they purchase insurance through the exchange for themselves or a family member. The tax credits are paid in advance to the health plan to reduce the individual’s monthly premium.
Federal officials are laying the groundwork for the launch of state-based health insurance exchanges in 2014, handing out millions of dollars in grants to states, designing tools to determine eligibility to buy insurance, and proposing details on how the refundable premium tax credits will work.
The Health and Human Services department announced during a teleconference Aug. 12 that it is awarding $185 million in "establishment" grants to 13 states and the District of Columbia to help them build their insurance exchanges. These grants follow planning grants awarded last year by HHS. More than half of the states have already taken some action to begin building their exchanges, according to HHS.
HHS, along with the Treasury Department, also issued three proposed rules aimed at creating a system that’s easy for consumers and small businesses to navigate. The first proposal, issued by HHS, outlines the standards and processes for consumers to enroll in a health plan and to seek financial assistance. It also explains the standards for small employers to participate in the exchange. Another proposal attempts to simplify the process for determining eligibility in Medicaid and the Children’s Health Insurance Program and coordinate these processes with the insurance exchanges, so that individuals can move from Medicaid to another health plans without losing coverage.
Finally, the Treasury Department issued a proposed regulation that explains how individuals and families can receive premium tax credits for purchasing insurance. Under the Affordable Care Act, taxpayers with incomes between 100% and 400% of the federal poverty level will be eligible for premium tax credits if they purchase insurance through the exchange for themselves or a family member. The tax credits are paid in advance to the health plan to reduce the individual’s monthly premium.
Federal officials are laying the groundwork for the launch of state-based health insurance exchanges in 2014, handing out millions of dollars in grants to states, designing tools to determine eligibility to buy insurance, and proposing details on how the refundable premium tax credits will work.
The Health and Human Services department announced during a teleconference Aug. 12 that it is awarding $185 million in "establishment" grants to 13 states and the District of Columbia to help them build their insurance exchanges. These grants follow planning grants awarded last year by HHS. More than half of the states have already taken some action to begin building their exchanges, according to HHS.
HHS, along with the Treasury Department, also issued three proposed rules aimed at creating a system that’s easy for consumers and small businesses to navigate. The first proposal, issued by HHS, outlines the standards and processes for consumers to enroll in a health plan and to seek financial assistance. It also explains the standards for small employers to participate in the exchange. Another proposal attempts to simplify the process for determining eligibility in Medicaid and the Children’s Health Insurance Program and coordinate these processes with the insurance exchanges, so that individuals can move from Medicaid to another health plans without losing coverage.
Finally, the Treasury Department issued a proposed regulation that explains how individuals and families can receive premium tax credits for purchasing insurance. Under the Affordable Care Act, taxpayers with incomes between 100% and 400% of the federal poverty level will be eligible for premium tax credits if they purchase insurance through the exchange for themselves or a family member. The tax credits are paid in advance to the health plan to reduce the individual’s monthly premium.
FROM A TELECONFERENCE SPONSORED BY THE DEPARTMENT OF HEALTH AND HUMAN SERVICES
Docs Could Face More Cuts in Debt Deal
Legislation to raise the debt ceiling and cut the deficit, signed by the president Aug. 2, leaves physicians in limbo regarding their Medicare payments next year and in the future.
The biggest question is whether the 29.5% cut to Medicare physician fees scheduled for Jan. 1, 2012, will go into effect. This massive payment cut is called for under the Sustainable Growth Rate (SGR) formula, the formula used to set Medicare payments to physicians.
Physicians’ groups, led by the American Medical Association lobbied Congress to include a permanent fix to the SGR in the deficit reduction package. They argued that while fixing the SGR carries a $300 billion price tag, getting the job done now would save the government money down the road. Instead, lawmakers left the SGR out of the package completely.
The new law of the land, the Budget Control Act of 2011 puts into place about $1 trillion in spending cuts over the next decade from the discretionary side of the federal budget. While these immediate cuts do not directly affect physicians, they do impact graduate medical education: Medical students who take out subsidized graduate student loans on or after July 1, 2012, will have to start paying the interest on those loans earlier.
The next round of budget cuts will be determined by the Joint Select Committee on Deficit Reduction, also known as the super committee. The 12-member panel is composed of legislators from both parties and both houses of Congress.
Before the joint committee can forward its recommendations to the full Congress, those recommendations must be approved by a majority vote.
“There’s a lot of concern that the committee will be deadlocked,” said Edwin Park, vice president for health policy at the Center on Budget and Policy Priorities.
The law requires the joint committee to draft legislation cutting another $1.2 trillion to $1.5 trillion in federal spending over 10 years. The committee has broad authority to consider spending cuts, taxes, and other changes across both discretionary and mandatory government programs. Funding for Affordable Care Act programs is also on the table.
The joint committee must vote on recommendations by Nov. 23, and lawmakers must vote on the joint committee’s bill by Dec. 23.
To keep the legislation from getting bogged down in the Senate, the Budget Control Act requires that the joint committee’s bill be given a fast-track, up-or-down vote requiring a simple majority to pass each chamber.
Should the joint committee’s bill fail, or if the committee deadlocks, the Budget Control Act calls for automatic cuts across the federal government totaling $1.2 trillion over 10 years.
Those cuts would include up to a 2% reduction in Medicare physician payments beginning in 2013. Under a worst-case scenario, physicians could face not only the 29.5% SGR cut in January 2012, but another 2% annual fee cut starting the following year.
“I don’t know anyone who can continue very well with a 30% reduction in payment for a significant segment of their business,” said Dr. Roland Goertz, president of the American Academy of Family Physicians. “It just makes it very, very tough.”
Surveys of AAFP members show that about a quarter of all patients seen by family physicians are Medicare beneficiaries. But in some practices, such as those in rural areas or underserved urban areas, that number can be as high as 50%. In those cases, it becomes a major challenge to figure out a viable business plan that can absorb 30% cuts to half of the business, Dr. Goertz said.
Physicians won’t stop practicing medicine, Dr. Goertz said, but they may move into another community with fewer Medicare patients or join a group that sees fewer Medicare patients.
“Altruism is great, and all of our members have a dedication to patient care, but they also have to understand what their families need,” he said.
Dr. Timothy J. Laing, a rheumatologist at the University of Michigan and chairman of the government affairs committee for the American College of Rheumatology, agreed that physicians would be forced to make tough choices if the cuts went into effect.
“I think it would make a lot of rheumatologists think very hard about access for Medicare patients,” Dr. Laing said. “What had always been taken for granted since the inception of the program – that Medicare was welcome in every office – would now begin to be questioned.”
The hope for physicians, Dr. Laing said, is that the 29.5% cut mandated by the SGR is simply so large that it would be unthinkable for members of Congress to let it go into effect.
Dr. Jonathan Leffert, an endocrinologist in Dallas and chairman of the legislative and regulatory committee for the American Association of Clinical Endocrinologists, said he thinks it is likely that Congress will do something to avert the massive SGR cut, even if it’s a temporary fix.
“Medicare patients not being able to see their physicians is pretty toxic for both Democrats and Republicans,” he said.
But anything beyond a temporary fix is likely to depend on the makeup and philosophy of the members of the joint committee. “We’re in a wait-and-see mode here,” Dr. Leffert said.
In the meantime, Dr. Leffert predicted that physicians will keep on seeing their patients as usual because the environment is simply too uncertain to do anything else.
Shawn Martin, director of government relations for the American Osteopathic Association, said the joint committee’s deliberations could give physicians a chance to open up a real debate over permanently fixing the SGR.
“We think it’s an opportunity to have a very real and meaningful conversation regarding what the SGR baseline debt really means to the long-term stability of the program,” Mr. Martin said.
There’s no guarantee that the joint committee would repeal the SGR, Mr. Martin said, but it will at least get people talking about the problem.
***This story was updated on Aug. 12, 2011.
Sustainable Growth Rate formula, Budget Control Act of 2011, SGR cut
Legislation to raise the debt ceiling and cut the deficit, signed by the president Aug. 2, leaves physicians in limbo regarding their Medicare payments next year and in the future.
The biggest question is whether the 29.5% cut to Medicare physician fees scheduled for Jan. 1, 2012, will go into effect. This massive payment cut is called for under the Sustainable Growth Rate (SGR) formula, the formula used to set Medicare payments to physicians.
Physicians’ groups, led by the American Medical Association lobbied Congress to include a permanent fix to the SGR in the deficit reduction package. They argued that while fixing the SGR carries a $300 billion price tag, getting the job done now would save the government money down the road. Instead, lawmakers left the SGR out of the package completely.
The new law of the land, the Budget Control Act of 2011 puts into place about $1 trillion in spending cuts over the next decade from the discretionary side of the federal budget. While these immediate cuts do not directly affect physicians, they do impact graduate medical education: Medical students who take out subsidized graduate student loans on or after July 1, 2012, will have to start paying the interest on those loans earlier.
The next round of budget cuts will be determined by the Joint Select Committee on Deficit Reduction, also known as the super committee. The 12-member panel is composed of legislators from both parties and both houses of Congress.
Before the joint committee can forward its recommendations to the full Congress, those recommendations must be approved by a majority vote.
“There’s a lot of concern that the committee will be deadlocked,” said Edwin Park, vice president for health policy at the Center on Budget and Policy Priorities.
The law requires the joint committee to draft legislation cutting another $1.2 trillion to $1.5 trillion in federal spending over 10 years. The committee has broad authority to consider spending cuts, taxes, and other changes across both discretionary and mandatory government programs. Funding for Affordable Care Act programs is also on the table.
The joint committee must vote on recommendations by Nov. 23, and lawmakers must vote on the joint committee’s bill by Dec. 23.
To keep the legislation from getting bogged down in the Senate, the Budget Control Act requires that the joint committee’s bill be given a fast-track, up-or-down vote requiring a simple majority to pass each chamber.
Should the joint committee’s bill fail, or if the committee deadlocks, the Budget Control Act calls for automatic cuts across the federal government totaling $1.2 trillion over 10 years.
Those cuts would include up to a 2% reduction in Medicare physician payments beginning in 2013. Under a worst-case scenario, physicians could face not only the 29.5% SGR cut in January 2012, but another 2% annual fee cut starting the following year.
“I don’t know anyone who can continue very well with a 30% reduction in payment for a significant segment of their business,” said Dr. Roland Goertz, president of the American Academy of Family Physicians. “It just makes it very, very tough.”
Surveys of AAFP members show that about a quarter of all patients seen by family physicians are Medicare beneficiaries. But in some practices, such as those in rural areas or underserved urban areas, that number can be as high as 50%. In those cases, it becomes a major challenge to figure out a viable business plan that can absorb 30% cuts to half of the business, Dr. Goertz said.
Physicians won’t stop practicing medicine, Dr. Goertz said, but they may move into another community with fewer Medicare patients or join a group that sees fewer Medicare patients.
“Altruism is great, and all of our members have a dedication to patient care, but they also have to understand what their families need,” he said.
Dr. Timothy J. Laing, a rheumatologist at the University of Michigan and chairman of the government affairs committee for the American College of Rheumatology, agreed that physicians would be forced to make tough choices if the cuts went into effect.
“I think it would make a lot of rheumatologists think very hard about access for Medicare patients,” Dr. Laing said. “What had always been taken for granted since the inception of the program – that Medicare was welcome in every office – would now begin to be questioned.”
The hope for physicians, Dr. Laing said, is that the 29.5% cut mandated by the SGR is simply so large that it would be unthinkable for members of Congress to let it go into effect.
Dr. Jonathan Leffert, an endocrinologist in Dallas and chairman of the legislative and regulatory committee for the American Association of Clinical Endocrinologists, said he thinks it is likely that Congress will do something to avert the massive SGR cut, even if it’s a temporary fix.
“Medicare patients not being able to see their physicians is pretty toxic for both Democrats and Republicans,” he said.
But anything beyond a temporary fix is likely to depend on the makeup and philosophy of the members of the joint committee. “We’re in a wait-and-see mode here,” Dr. Leffert said.
In the meantime, Dr. Leffert predicted that physicians will keep on seeing their patients as usual because the environment is simply too uncertain to do anything else.
Shawn Martin, director of government relations for the American Osteopathic Association, said the joint committee’s deliberations could give physicians a chance to open up a real debate over permanently fixing the SGR.
“We think it’s an opportunity to have a very real and meaningful conversation regarding what the SGR baseline debt really means to the long-term stability of the program,” Mr. Martin said.
There’s no guarantee that the joint committee would repeal the SGR, Mr. Martin said, but it will at least get people talking about the problem.
***This story was updated on Aug. 12, 2011.
Legislation to raise the debt ceiling and cut the deficit, signed by the president Aug. 2, leaves physicians in limbo regarding their Medicare payments next year and in the future.
The biggest question is whether the 29.5% cut to Medicare physician fees scheduled for Jan. 1, 2012, will go into effect. This massive payment cut is called for under the Sustainable Growth Rate (SGR) formula, the formula used to set Medicare payments to physicians.
Physicians’ groups, led by the American Medical Association lobbied Congress to include a permanent fix to the SGR in the deficit reduction package. They argued that while fixing the SGR carries a $300 billion price tag, getting the job done now would save the government money down the road. Instead, lawmakers left the SGR out of the package completely.
The new law of the land, the Budget Control Act of 2011 puts into place about $1 trillion in spending cuts over the next decade from the discretionary side of the federal budget. While these immediate cuts do not directly affect physicians, they do impact graduate medical education: Medical students who take out subsidized graduate student loans on or after July 1, 2012, will have to start paying the interest on those loans earlier.
The next round of budget cuts will be determined by the Joint Select Committee on Deficit Reduction, also known as the super committee. The 12-member panel is composed of legislators from both parties and both houses of Congress.
Before the joint committee can forward its recommendations to the full Congress, those recommendations must be approved by a majority vote.
“There’s a lot of concern that the committee will be deadlocked,” said Edwin Park, vice president for health policy at the Center on Budget and Policy Priorities.
The law requires the joint committee to draft legislation cutting another $1.2 trillion to $1.5 trillion in federal spending over 10 years. The committee has broad authority to consider spending cuts, taxes, and other changes across both discretionary and mandatory government programs. Funding for Affordable Care Act programs is also on the table.
The joint committee must vote on recommendations by Nov. 23, and lawmakers must vote on the joint committee’s bill by Dec. 23.
To keep the legislation from getting bogged down in the Senate, the Budget Control Act requires that the joint committee’s bill be given a fast-track, up-or-down vote requiring a simple majority to pass each chamber.
Should the joint committee’s bill fail, or if the committee deadlocks, the Budget Control Act calls for automatic cuts across the federal government totaling $1.2 trillion over 10 years.
Those cuts would include up to a 2% reduction in Medicare physician payments beginning in 2013. Under a worst-case scenario, physicians could face not only the 29.5% SGR cut in January 2012, but another 2% annual fee cut starting the following year.
“I don’t know anyone who can continue very well with a 30% reduction in payment for a significant segment of their business,” said Dr. Roland Goertz, president of the American Academy of Family Physicians. “It just makes it very, very tough.”
Surveys of AAFP members show that about a quarter of all patients seen by family physicians are Medicare beneficiaries. But in some practices, such as those in rural areas or underserved urban areas, that number can be as high as 50%. In those cases, it becomes a major challenge to figure out a viable business plan that can absorb 30% cuts to half of the business, Dr. Goertz said.
Physicians won’t stop practicing medicine, Dr. Goertz said, but they may move into another community with fewer Medicare patients or join a group that sees fewer Medicare patients.
“Altruism is great, and all of our members have a dedication to patient care, but they also have to understand what their families need,” he said.
Dr. Timothy J. Laing, a rheumatologist at the University of Michigan and chairman of the government affairs committee for the American College of Rheumatology, agreed that physicians would be forced to make tough choices if the cuts went into effect.
“I think it would make a lot of rheumatologists think very hard about access for Medicare patients,” Dr. Laing said. “What had always been taken for granted since the inception of the program – that Medicare was welcome in every office – would now begin to be questioned.”
The hope for physicians, Dr. Laing said, is that the 29.5% cut mandated by the SGR is simply so large that it would be unthinkable for members of Congress to let it go into effect.
Dr. Jonathan Leffert, an endocrinologist in Dallas and chairman of the legislative and regulatory committee for the American Association of Clinical Endocrinologists, said he thinks it is likely that Congress will do something to avert the massive SGR cut, even if it’s a temporary fix.
“Medicare patients not being able to see their physicians is pretty toxic for both Democrats and Republicans,” he said.
But anything beyond a temporary fix is likely to depend on the makeup and philosophy of the members of the joint committee. “We’re in a wait-and-see mode here,” Dr. Leffert said.
In the meantime, Dr. Leffert predicted that physicians will keep on seeing their patients as usual because the environment is simply too uncertain to do anything else.
Shawn Martin, director of government relations for the American Osteopathic Association, said the joint committee’s deliberations could give physicians a chance to open up a real debate over permanently fixing the SGR.
“We think it’s an opportunity to have a very real and meaningful conversation regarding what the SGR baseline debt really means to the long-term stability of the program,” Mr. Martin said.
There’s no guarantee that the joint committee would repeal the SGR, Mr. Martin said, but it will at least get people talking about the problem.
***This story was updated on Aug. 12, 2011.
Sustainable Growth Rate formula, Budget Control Act of 2011, SGR cut
Sustainable Growth Rate formula, Budget Control Act of 2011, SGR cut
Physicians Sue to Replace the RUC
A group of six primary care physicians in Augusta, Ga., has filed a lawsuit seeking to bar Medicare officials from using advice from the American Medical Association’s Specialty Society Relative Value Scale Update Committee (RUC) when setting payment rates for physicians.
The complaint, which was filed Aug. 8 in the U.S. District Court for the District of Maryland, contends that the Department of Health and Human Services and the Centers for Medicare and Medicaid Services are violating the Federal Advisory Committee Act, the Administrative Procedure Act, the Affordable Care Act, and the U.S. Constitution in their reliance on the RUC. And the physicians claim that both primary care physicians and patients are being harmed because the RUC overvalues procedures and undervalues primary care.
The RUC, which is operated by the AMA, makes annual recommendations to CMS on how to value a number of physician services under Medicare. The 29-member panel includes representatives from various medical specialties and primary care. CMS officials are under no obligation to accept the RUC’s suggestions, but for nearly 20 years, they have followed more than 90% of the panel’s recommendations.
The six plaintiffs, who are all physicians in the same primary care practice, allege that during the time that the CMS has used the RUC’s advice in determining physician payment under the Medicare Physician Fee Schedule, the process has become "irrational, arbitrary, and absolutely destined to lead to the continued devastation of primary care," according to the complaint.
The physicians involved in the lawsuit charge that the RUC is biased toward procedural specialties, particularly surgical specialties. That bias, they wrote, has led to a massive pay discrepancy between procedural specialties and primary care, which has contributed to a shortage of primary care physicians, limited access to primary care services, and increasingly shortened patient visits.
Dr. Paul M. Fischer, a family physician in Augusta, Ga., is one of the plaintiffs in the lawsuit and has been working for several months to replace the RUC. He said in an interview that he’s hopeful that they will win their legal battle and succeed in forcing CMS to move toward a new process for setting physician payments that is "more transparent, open, and fair."
Officials at CMS had no comment on the lawsuit since it is the agency’s policy not to comment on pending legal issues. However, the AMA defended the RUC and its processes.
"The RUC is an independent panel of physicians from all medical specialties, including primary care, who make recommendations to CMS as all citizens have a right to do," said Dr. Barbara Levy, the chairwoman of the RUC. "These volunteers provide physicians’ voice and expertise to Medicare decision makers through their recommendations."
A group of six primary care physicians in Augusta, Ga., has filed a lawsuit seeking to bar Medicare officials from using advice from the American Medical Association’s Specialty Society Relative Value Scale Update Committee (RUC) when setting payment rates for physicians.
The complaint, which was filed Aug. 8 in the U.S. District Court for the District of Maryland, contends that the Department of Health and Human Services and the Centers for Medicare and Medicaid Services are violating the Federal Advisory Committee Act, the Administrative Procedure Act, the Affordable Care Act, and the U.S. Constitution in their reliance on the RUC. And the physicians claim that both primary care physicians and patients are being harmed because the RUC overvalues procedures and undervalues primary care.
The RUC, which is operated by the AMA, makes annual recommendations to CMS on how to value a number of physician services under Medicare. The 29-member panel includes representatives from various medical specialties and primary care. CMS officials are under no obligation to accept the RUC’s suggestions, but for nearly 20 years, they have followed more than 90% of the panel’s recommendations.
The six plaintiffs, who are all physicians in the same primary care practice, allege that during the time that the CMS has used the RUC’s advice in determining physician payment under the Medicare Physician Fee Schedule, the process has become "irrational, arbitrary, and absolutely destined to lead to the continued devastation of primary care," according to the complaint.
The physicians involved in the lawsuit charge that the RUC is biased toward procedural specialties, particularly surgical specialties. That bias, they wrote, has led to a massive pay discrepancy between procedural specialties and primary care, which has contributed to a shortage of primary care physicians, limited access to primary care services, and increasingly shortened patient visits.
Dr. Paul M. Fischer, a family physician in Augusta, Ga., is one of the plaintiffs in the lawsuit and has been working for several months to replace the RUC. He said in an interview that he’s hopeful that they will win their legal battle and succeed in forcing CMS to move toward a new process for setting physician payments that is "more transparent, open, and fair."
Officials at CMS had no comment on the lawsuit since it is the agency’s policy not to comment on pending legal issues. However, the AMA defended the RUC and its processes.
"The RUC is an independent panel of physicians from all medical specialties, including primary care, who make recommendations to CMS as all citizens have a right to do," said Dr. Barbara Levy, the chairwoman of the RUC. "These volunteers provide physicians’ voice and expertise to Medicare decision makers through their recommendations."
A group of six primary care physicians in Augusta, Ga., has filed a lawsuit seeking to bar Medicare officials from using advice from the American Medical Association’s Specialty Society Relative Value Scale Update Committee (RUC) when setting payment rates for physicians.
The complaint, which was filed Aug. 8 in the U.S. District Court for the District of Maryland, contends that the Department of Health and Human Services and the Centers for Medicare and Medicaid Services are violating the Federal Advisory Committee Act, the Administrative Procedure Act, the Affordable Care Act, and the U.S. Constitution in their reliance on the RUC. And the physicians claim that both primary care physicians and patients are being harmed because the RUC overvalues procedures and undervalues primary care.
The RUC, which is operated by the AMA, makes annual recommendations to CMS on how to value a number of physician services under Medicare. The 29-member panel includes representatives from various medical specialties and primary care. CMS officials are under no obligation to accept the RUC’s suggestions, but for nearly 20 years, they have followed more than 90% of the panel’s recommendations.
The six plaintiffs, who are all physicians in the same primary care practice, allege that during the time that the CMS has used the RUC’s advice in determining physician payment under the Medicare Physician Fee Schedule, the process has become "irrational, arbitrary, and absolutely destined to lead to the continued devastation of primary care," according to the complaint.
The physicians involved in the lawsuit charge that the RUC is biased toward procedural specialties, particularly surgical specialties. That bias, they wrote, has led to a massive pay discrepancy between procedural specialties and primary care, which has contributed to a shortage of primary care physicians, limited access to primary care services, and increasingly shortened patient visits.
Dr. Paul M. Fischer, a family physician in Augusta, Ga., is one of the plaintiffs in the lawsuit and has been working for several months to replace the RUC. He said in an interview that he’s hopeful that they will win their legal battle and succeed in forcing CMS to move toward a new process for setting physician payments that is "more transparent, open, and fair."
Officials at CMS had no comment on the lawsuit since it is the agency’s policy not to comment on pending legal issues. However, the AMA defended the RUC and its processes.
"The RUC is an independent panel of physicians from all medical specialties, including primary care, who make recommendations to CMS as all citizens have a right to do," said Dr. Barbara Levy, the chairwoman of the RUC. "These volunteers provide physicians’ voice and expertise to Medicare decision makers through their recommendations."
CMS Releases New Hospital Data, Consumer Tool
New quality data released Aug. 5 by the Centers for Medicare and Medicaid Services shows only small changes in national 30-day mortality and readmission rates in the hospital over the last few years.
There is good news to report on national 30-day mortality rates for myocardial infarction. Those rates dropped 0.3% from 16.2% in the reporting period from 2006 through 2009, down to 15.9% from 2007 through 2010. During the same time periods, national mortality rates increased slightly for heart failure and pneumonia. The 30-day mortality rate for heart failure rose from 11.2% to 11.3%. In pneumonia, the 30-day mortality rate rose from 11.6% to 11.9%.
In readmissions, the new reporting data show that national 30-day readmission rates were slightly higher for pneumonia and heart failure and slightly lower for myocardial infarction. For example, readmission rates from myocardial infarction dropped from 19.9% (2006-2009) to 19.8% (2007-2010). The national inpatient readmission rates for heart failure increased from 24.5% (2006-2009) to 24.8% (2007-2010). Similarly, pneumonia readmission rates increased from 18.2% (2006-2009) to 18.4% (2007-2010).
These risk-adjusted national mortality and readmission rates are part of a set of new data that the CMS is adding to the government’s Hospital Compare database. The rates include 3 full years of claims data from July 1, 2007 to June 30, 2010.
"Our goal with hospital compare is to provide insights about the results that hospitals are achieving and to encourage efforts for hospitals to improve," Dr. Donald Berwick, administrator of the CMS said during a press conference on Aug. 5.
CMS officials also launched a new tool that can be used by physicians and their patients to gain quality information about a range of medical facilities and physicians. The "Quality Care Finder" is a single government website, which allows one-stop shopping for a number of quality sites including Hospital Compare, Nursing Home Compare, Home Health Compare, and Physician Compare, among others. The tools are still in place, but now consumers have the option of viewing them as a collection, according to the CMS.
New quality data released Aug. 5 by the Centers for Medicare and Medicaid Services shows only small changes in national 30-day mortality and readmission rates in the hospital over the last few years.
There is good news to report on national 30-day mortality rates for myocardial infarction. Those rates dropped 0.3% from 16.2% in the reporting period from 2006 through 2009, down to 15.9% from 2007 through 2010. During the same time periods, national mortality rates increased slightly for heart failure and pneumonia. The 30-day mortality rate for heart failure rose from 11.2% to 11.3%. In pneumonia, the 30-day mortality rate rose from 11.6% to 11.9%.
In readmissions, the new reporting data show that national 30-day readmission rates were slightly higher for pneumonia and heart failure and slightly lower for myocardial infarction. For example, readmission rates from myocardial infarction dropped from 19.9% (2006-2009) to 19.8% (2007-2010). The national inpatient readmission rates for heart failure increased from 24.5% (2006-2009) to 24.8% (2007-2010). Similarly, pneumonia readmission rates increased from 18.2% (2006-2009) to 18.4% (2007-2010).
These risk-adjusted national mortality and readmission rates are part of a set of new data that the CMS is adding to the government’s Hospital Compare database. The rates include 3 full years of claims data from July 1, 2007 to June 30, 2010.
"Our goal with hospital compare is to provide insights about the results that hospitals are achieving and to encourage efforts for hospitals to improve," Dr. Donald Berwick, administrator of the CMS said during a press conference on Aug. 5.
CMS officials also launched a new tool that can be used by physicians and their patients to gain quality information about a range of medical facilities and physicians. The "Quality Care Finder" is a single government website, which allows one-stop shopping for a number of quality sites including Hospital Compare, Nursing Home Compare, Home Health Compare, and Physician Compare, among others. The tools are still in place, but now consumers have the option of viewing them as a collection, according to the CMS.
New quality data released Aug. 5 by the Centers for Medicare and Medicaid Services shows only small changes in national 30-day mortality and readmission rates in the hospital over the last few years.
There is good news to report on national 30-day mortality rates for myocardial infarction. Those rates dropped 0.3% from 16.2% in the reporting period from 2006 through 2009, down to 15.9% from 2007 through 2010. During the same time periods, national mortality rates increased slightly for heart failure and pneumonia. The 30-day mortality rate for heart failure rose from 11.2% to 11.3%. In pneumonia, the 30-day mortality rate rose from 11.6% to 11.9%.
In readmissions, the new reporting data show that national 30-day readmission rates were slightly higher for pneumonia and heart failure and slightly lower for myocardial infarction. For example, readmission rates from myocardial infarction dropped from 19.9% (2006-2009) to 19.8% (2007-2010). The national inpatient readmission rates for heart failure increased from 24.5% (2006-2009) to 24.8% (2007-2010). Similarly, pneumonia readmission rates increased from 18.2% (2006-2009) to 18.4% (2007-2010).
These risk-adjusted national mortality and readmission rates are part of a set of new data that the CMS is adding to the government’s Hospital Compare database. The rates include 3 full years of claims data from July 1, 2007 to June 30, 2010.
"Our goal with hospital compare is to provide insights about the results that hospitals are achieving and to encourage efforts for hospitals to improve," Dr. Donald Berwick, administrator of the CMS said during a press conference on Aug. 5.
CMS officials also launched a new tool that can be used by physicians and their patients to gain quality information about a range of medical facilities and physicians. The "Quality Care Finder" is a single government website, which allows one-stop shopping for a number of quality sites including Hospital Compare, Nursing Home Compare, Home Health Compare, and Physician Compare, among others. The tools are still in place, but now consumers have the option of viewing them as a collection, according to the CMS.
FROM A PRESS CONFERENCE SPONSORED BY THE CENTERS FOR MEDICARE AND MEDICAID SERVICES
Rheums, Patients Shift Views on CAM
Dr. Daniel Muller used to teach a class on complementary and alternative medicine at the University of Wisconsin, Madison, but he hasn’t offered it in 2 years. The once-popular elective just wasn’t attracting students.
But today’s medical students don’t see complementary and alternative medicine (CAM) as being out of the mainstream, said Dr. Muller, an associate professor of rheumatology at the university. "They know all about this stuff."
Dr. Muller has literally written the book on CAM in rheumatology. He is the author of "Integrative Rheumatology," which explains how lifestyle interventions and mind-body approaches can fill gaps where traditional therapies fall short. Acceptance of CAM is generally more widespread among younger physicians, he said. Some of them may be elite athletes who have used energy medicine, some suffer from chronic pain and have explored CAM for that reason, and others may be the children of hippies who grew up surrounded by unconventional ideas, Dr. Muller said.
And increasingly, practicing rheumatologists have a positive opinion of CAM approaches, at least according to a survey conducted in 2007 (BMC. Complement. Altern. Med. 2010;10:5). The poll of 345 rheumatologists under age 65 years found that physicians seemed very comfortable recommending certain forms of CAM. For instance, 70% of respondents said they considered body work like massage to be very beneficial or moderately beneficial. And 65% would be very or somewhat likely to recommend it to their patients. Other CAM approaches that were rated highly by physicians include meditation practices and acupuncture.
But rheumatologists who responded to the survey did not have favorable opinions about energy medicine practices like Reiki. Only 11% said energy medicine was beneficial, and only 10% would recommend it to patients. In other areas, such as the use of glucosamine and chondroitin, the findings were mixed. Less than 40% of rheumatologists found the supplements to be beneficial, but 57% would be likely to recommend their use anyway.
Accepting Complementary and Alternative Medicine
The findings generally show a widespread acceptance of CAM, said Dr. Nisha Manek, with the rheumatology department at the Mayo Clinic in Rochester, Minn., and the lead author of the study. Dr. Manek said the figures show that doctors aren’t just approving of these approaches, but they are also willing to give them their stamp of approval with patients.
"It’s one thing to believe in the benefits of a therapy; it’s quite another to recommend it to patients," she said.
Dr. Manek speculated that in the 4 years since the survey was conducted, rheumatologists’ views have likely grown warmer toward CAM. One of the drivers is the enthusiasm among patients.
"Our patients are saying, ‘Look, I want to do better than a prescription. I really want to take charge of my health,’ " she said. "I think complementary therapies are potentially a very powerful driver in preventive medicine."
Dr. Sharon L. Kolasinski, the interim division director of rheumatology at the University of Pennsylvania, Philadelphia, agrees that patients are driving not just the popularity of CAM, but its transformation. For instance, over the last decade, interest in herbal medicines has waned in favor of a greater focus on mind-body and physical interventions. And these physical techniques are adjunctive to conventional treatment, not done as stand-alone therapy, she said.
Yoga, mindfulness meditation, acupuncture, and cognitive therapy are all practices in which patients can participate, she said, and that has helped to spur their popularity. "Patients don’t want to just take pills," said Dr. Kolasinski, who has conducted research on yoga for osteoarthritis management.
Patients are also drawn to the sensibility of some alternative medicine practitioners who take a whole patient approach, she said, as they like the focus on their daily functioning.
Talking to Rheumatology Patients
While the popularity of CAM is still going strong, especially among rheumatology patients with chronic pain, many physicians continue to struggle with how to discuss CAM with their patients. The biggest problem seems to be how to find out what patients are doing besides taking their traditional medications, whether it’s taking dietary supplements or attending a yoga class.
A recent survey conducted by the National Center for Complimentary and Alternative Medicine (NCCAM), part of the National Institutes of Health, and the AARP found that people age 50 years and older don’t talk to their doctors about using CAM. The telephone survey of more than 1,000 people found that while 53% of respondents had used CAM at some point, only about 42% had discussed it with their health care provider. The major reasons respondents gave for not talking about it with their doctors was that their physician never asks and they didn’t know they should bring it up.
NCCAM is trying to address that problem with its "Time to Talk" campaign. It encourages physicians to start a conversation about CAM and includes tips for how find time to address it during a brief office visit.
Dr. Josephine Briggs, the NCCAM director, suggests that physicians begin the conversation by asking, "What are you trying to do to be healthy?" Physicians need to recognize that even if they have doubts about a certain CAM modality, patients are generally turning to CAM as a way to be healthy or to help better manage their symptoms, she said. "I think being open to that dialogue and making it a thoughtful one is the way all of us can best help our patients."
She also encouraged physicians to talk to their patients about how they manage pain, since this is often what drives the use of CAM. Ask patients what helps them relieve their pain outside of traditional medications, she suggested, and if they have tried alternative approaches just as relaxation techniques.
Another problem for physicians in talking about CAM is that they may not be familiar with the evidence around a particular CAM treatment. NCCAM is also trying to tackle that. As part of "Time to Talk," they have put together a list of reliable sources on the latest CAM research. And NCCAM is funding a wide portfolio of research on CAM modalities that could potentially be used to treat musculoskeletal conditions, such as tai chi and yoga in the management of fibromyalgia, back pain, and osteoarthritis of the knee.
"I see these as very promising adjuncts for certain patients," Dr. Briggs said. "The question partly is, ‘Is the patient motivated?’ "
NCCAM is also sponsoring studies on dietary supplements. For example, NCCAM funded a large investigation of glucosamine and chondroitin sulfate to treat pain associated with osteoarthritis of the knee in the Glucosamine /Chondroitin Arthritis Intervention Trial (GAIT). The results, which were originally published in 2006, showed that the combination did not provide significant relief from pain. In addition, a number of NCCAM-funded researchers are studying herb-drug interactions to see how over-the-counter dietary supplements could affect traditional treatments for chronic disease.
Dr. Muller, Dr. Briggs, Dr. Kolasinski, and Dr. Manek had no financial conflicts of interest to disclose.
Dr. Daniel Muller used to teach a class on complementary and alternative medicine at the University of Wisconsin, Madison, but he hasn’t offered it in 2 years. The once-popular elective just wasn’t attracting students.
But today’s medical students don’t see complementary and alternative medicine (CAM) as being out of the mainstream, said Dr. Muller, an associate professor of rheumatology at the university. "They know all about this stuff."
Dr. Muller has literally written the book on CAM in rheumatology. He is the author of "Integrative Rheumatology," which explains how lifestyle interventions and mind-body approaches can fill gaps where traditional therapies fall short. Acceptance of CAM is generally more widespread among younger physicians, he said. Some of them may be elite athletes who have used energy medicine, some suffer from chronic pain and have explored CAM for that reason, and others may be the children of hippies who grew up surrounded by unconventional ideas, Dr. Muller said.
And increasingly, practicing rheumatologists have a positive opinion of CAM approaches, at least according to a survey conducted in 2007 (BMC. Complement. Altern. Med. 2010;10:5). The poll of 345 rheumatologists under age 65 years found that physicians seemed very comfortable recommending certain forms of CAM. For instance, 70% of respondents said they considered body work like massage to be very beneficial or moderately beneficial. And 65% would be very or somewhat likely to recommend it to their patients. Other CAM approaches that were rated highly by physicians include meditation practices and acupuncture.
But rheumatologists who responded to the survey did not have favorable opinions about energy medicine practices like Reiki. Only 11% said energy medicine was beneficial, and only 10% would recommend it to patients. In other areas, such as the use of glucosamine and chondroitin, the findings were mixed. Less than 40% of rheumatologists found the supplements to be beneficial, but 57% would be likely to recommend their use anyway.
Accepting Complementary and Alternative Medicine
The findings generally show a widespread acceptance of CAM, said Dr. Nisha Manek, with the rheumatology department at the Mayo Clinic in Rochester, Minn., and the lead author of the study. Dr. Manek said the figures show that doctors aren’t just approving of these approaches, but they are also willing to give them their stamp of approval with patients.
"It’s one thing to believe in the benefits of a therapy; it’s quite another to recommend it to patients," she said.
Dr. Manek speculated that in the 4 years since the survey was conducted, rheumatologists’ views have likely grown warmer toward CAM. One of the drivers is the enthusiasm among patients.
"Our patients are saying, ‘Look, I want to do better than a prescription. I really want to take charge of my health,’ " she said. "I think complementary therapies are potentially a very powerful driver in preventive medicine."
Dr. Sharon L. Kolasinski, the interim division director of rheumatology at the University of Pennsylvania, Philadelphia, agrees that patients are driving not just the popularity of CAM, but its transformation. For instance, over the last decade, interest in herbal medicines has waned in favor of a greater focus on mind-body and physical interventions. And these physical techniques are adjunctive to conventional treatment, not done as stand-alone therapy, she said.
Yoga, mindfulness meditation, acupuncture, and cognitive therapy are all practices in which patients can participate, she said, and that has helped to spur their popularity. "Patients don’t want to just take pills," said Dr. Kolasinski, who has conducted research on yoga for osteoarthritis management.
Patients are also drawn to the sensibility of some alternative medicine practitioners who take a whole patient approach, she said, as they like the focus on their daily functioning.
Talking to Rheumatology Patients
While the popularity of CAM is still going strong, especially among rheumatology patients with chronic pain, many physicians continue to struggle with how to discuss CAM with their patients. The biggest problem seems to be how to find out what patients are doing besides taking their traditional medications, whether it’s taking dietary supplements or attending a yoga class.
A recent survey conducted by the National Center for Complimentary and Alternative Medicine (NCCAM), part of the National Institutes of Health, and the AARP found that people age 50 years and older don’t talk to their doctors about using CAM. The telephone survey of more than 1,000 people found that while 53% of respondents had used CAM at some point, only about 42% had discussed it with their health care provider. The major reasons respondents gave for not talking about it with their doctors was that their physician never asks and they didn’t know they should bring it up.
NCCAM is trying to address that problem with its "Time to Talk" campaign. It encourages physicians to start a conversation about CAM and includes tips for how find time to address it during a brief office visit.
Dr. Josephine Briggs, the NCCAM director, suggests that physicians begin the conversation by asking, "What are you trying to do to be healthy?" Physicians need to recognize that even if they have doubts about a certain CAM modality, patients are generally turning to CAM as a way to be healthy or to help better manage their symptoms, she said. "I think being open to that dialogue and making it a thoughtful one is the way all of us can best help our patients."
She also encouraged physicians to talk to their patients about how they manage pain, since this is often what drives the use of CAM. Ask patients what helps them relieve their pain outside of traditional medications, she suggested, and if they have tried alternative approaches just as relaxation techniques.
Another problem for physicians in talking about CAM is that they may not be familiar with the evidence around a particular CAM treatment. NCCAM is also trying to tackle that. As part of "Time to Talk," they have put together a list of reliable sources on the latest CAM research. And NCCAM is funding a wide portfolio of research on CAM modalities that could potentially be used to treat musculoskeletal conditions, such as tai chi and yoga in the management of fibromyalgia, back pain, and osteoarthritis of the knee.
"I see these as very promising adjuncts for certain patients," Dr. Briggs said. "The question partly is, ‘Is the patient motivated?’ "
NCCAM is also sponsoring studies on dietary supplements. For example, NCCAM funded a large investigation of glucosamine and chondroitin sulfate to treat pain associated with osteoarthritis of the knee in the Glucosamine /Chondroitin Arthritis Intervention Trial (GAIT). The results, which were originally published in 2006, showed that the combination did not provide significant relief from pain. In addition, a number of NCCAM-funded researchers are studying herb-drug interactions to see how over-the-counter dietary supplements could affect traditional treatments for chronic disease.
Dr. Muller, Dr. Briggs, Dr. Kolasinski, and Dr. Manek had no financial conflicts of interest to disclose.
Dr. Daniel Muller used to teach a class on complementary and alternative medicine at the University of Wisconsin, Madison, but he hasn’t offered it in 2 years. The once-popular elective just wasn’t attracting students.
But today’s medical students don’t see complementary and alternative medicine (CAM) as being out of the mainstream, said Dr. Muller, an associate professor of rheumatology at the university. "They know all about this stuff."
Dr. Muller has literally written the book on CAM in rheumatology. He is the author of "Integrative Rheumatology," which explains how lifestyle interventions and mind-body approaches can fill gaps where traditional therapies fall short. Acceptance of CAM is generally more widespread among younger physicians, he said. Some of them may be elite athletes who have used energy medicine, some suffer from chronic pain and have explored CAM for that reason, and others may be the children of hippies who grew up surrounded by unconventional ideas, Dr. Muller said.
And increasingly, practicing rheumatologists have a positive opinion of CAM approaches, at least according to a survey conducted in 2007 (BMC. Complement. Altern. Med. 2010;10:5). The poll of 345 rheumatologists under age 65 years found that physicians seemed very comfortable recommending certain forms of CAM. For instance, 70% of respondents said they considered body work like massage to be very beneficial or moderately beneficial. And 65% would be very or somewhat likely to recommend it to their patients. Other CAM approaches that were rated highly by physicians include meditation practices and acupuncture.
But rheumatologists who responded to the survey did not have favorable opinions about energy medicine practices like Reiki. Only 11% said energy medicine was beneficial, and only 10% would recommend it to patients. In other areas, such as the use of glucosamine and chondroitin, the findings were mixed. Less than 40% of rheumatologists found the supplements to be beneficial, but 57% would be likely to recommend their use anyway.
Accepting Complementary and Alternative Medicine
The findings generally show a widespread acceptance of CAM, said Dr. Nisha Manek, with the rheumatology department at the Mayo Clinic in Rochester, Minn., and the lead author of the study. Dr. Manek said the figures show that doctors aren’t just approving of these approaches, but they are also willing to give them their stamp of approval with patients.
"It’s one thing to believe in the benefits of a therapy; it’s quite another to recommend it to patients," she said.
Dr. Manek speculated that in the 4 years since the survey was conducted, rheumatologists’ views have likely grown warmer toward CAM. One of the drivers is the enthusiasm among patients.
"Our patients are saying, ‘Look, I want to do better than a prescription. I really want to take charge of my health,’ " she said. "I think complementary therapies are potentially a very powerful driver in preventive medicine."
Dr. Sharon L. Kolasinski, the interim division director of rheumatology at the University of Pennsylvania, Philadelphia, agrees that patients are driving not just the popularity of CAM, but its transformation. For instance, over the last decade, interest in herbal medicines has waned in favor of a greater focus on mind-body and physical interventions. And these physical techniques are adjunctive to conventional treatment, not done as stand-alone therapy, she said.
Yoga, mindfulness meditation, acupuncture, and cognitive therapy are all practices in which patients can participate, she said, and that has helped to spur their popularity. "Patients don’t want to just take pills," said Dr. Kolasinski, who has conducted research on yoga for osteoarthritis management.
Patients are also drawn to the sensibility of some alternative medicine practitioners who take a whole patient approach, she said, as they like the focus on their daily functioning.
Talking to Rheumatology Patients
While the popularity of CAM is still going strong, especially among rheumatology patients with chronic pain, many physicians continue to struggle with how to discuss CAM with their patients. The biggest problem seems to be how to find out what patients are doing besides taking their traditional medications, whether it’s taking dietary supplements or attending a yoga class.
A recent survey conducted by the National Center for Complimentary and Alternative Medicine (NCCAM), part of the National Institutes of Health, and the AARP found that people age 50 years and older don’t talk to their doctors about using CAM. The telephone survey of more than 1,000 people found that while 53% of respondents had used CAM at some point, only about 42% had discussed it with their health care provider. The major reasons respondents gave for not talking about it with their doctors was that their physician never asks and they didn’t know they should bring it up.
NCCAM is trying to address that problem with its "Time to Talk" campaign. It encourages physicians to start a conversation about CAM and includes tips for how find time to address it during a brief office visit.
Dr. Josephine Briggs, the NCCAM director, suggests that physicians begin the conversation by asking, "What are you trying to do to be healthy?" Physicians need to recognize that even if they have doubts about a certain CAM modality, patients are generally turning to CAM as a way to be healthy or to help better manage their symptoms, she said. "I think being open to that dialogue and making it a thoughtful one is the way all of us can best help our patients."
She also encouraged physicians to talk to their patients about how they manage pain, since this is often what drives the use of CAM. Ask patients what helps them relieve their pain outside of traditional medications, she suggested, and if they have tried alternative approaches just as relaxation techniques.
Another problem for physicians in talking about CAM is that they may not be familiar with the evidence around a particular CAM treatment. NCCAM is also trying to tackle that. As part of "Time to Talk," they have put together a list of reliable sources on the latest CAM research. And NCCAM is funding a wide portfolio of research on CAM modalities that could potentially be used to treat musculoskeletal conditions, such as tai chi and yoga in the management of fibromyalgia, back pain, and osteoarthritis of the knee.
"I see these as very promising adjuncts for certain patients," Dr. Briggs said. "The question partly is, ‘Is the patient motivated?’ "
NCCAM is also sponsoring studies on dietary supplements. For example, NCCAM funded a large investigation of glucosamine and chondroitin sulfate to treat pain associated with osteoarthritis of the knee in the Glucosamine /Chondroitin Arthritis Intervention Trial (GAIT). The results, which were originally published in 2006, showed that the combination did not provide significant relief from pain. In addition, a number of NCCAM-funded researchers are studying herb-drug interactions to see how over-the-counter dietary supplements could affect traditional treatments for chronic disease.
Dr. Muller, Dr. Briggs, Dr. Kolasinski, and Dr. Manek had no financial conflicts of interest to disclose.
Young Internists Say 'No Way' to Office Practice
Dr. Carrie Jo Prather is finishing up the third year of her internal medicine residency at Palmetto General Hospital in Hialeah, Fla., in September and she’s starting to look for a job as a hospitalist.
Dr. Prather, who is in the residency’s hospital medicine training track, is sending out her CV sparingly and finding openings through word of mouth so that she can avoid the flood of unsolicited phone calls from potential employers and recruiters. And she’s only looking for jobs where she can work seven days on, seven days off.
"They’re long days. They’re hard days. They’re sick patients. But then you’ve got a whole week off," she said. For Dr. Prather, a schedule like that would allow her to stay in Florida, where she owns a house, and still travel to Michigan to see her family frequently.
Dr. Prather is fairly typical of young hospitalists entering the field these days. She’s enthusiastic about the pace and acuity offered in treating hospitalized patients. She’s attracted to the work/life balance of the hospitalist schedule. She wouldn’t consider an office-based practice, at least not for right now. And she’s in demand.
The latest figures from the health care recruiting firm Merritt Hawkins show that hospitalists were the third most-requested search assignment in 2010-2011. And hospitalists have been in the top four most-requested specialties for the last five years. The figures come from the firm’s "2011 Review of Physician Recruiting Incentives" report, which provides an overview of salaries, bonuses, and other incentives used in recruiting physicians.
The report also found that hospitalists can command salaries between $160,000 and $305,000, with an average salary of $217,000. That average salary has risen every year in the last five years.
Internal medicine has become one of the hardest search requests for the firm to fill, in part because so many internal medicine physicians are choosing to practice as hospitalists, according to the 2011 report.
Tommy Bohannon, vice president of hospital-based recruiting at Merritt Hawkins, said he doesn’t see young physicians flocking to hospital medicine instead of ambulatory internal medicine. However, he does see a stricter divide between the two practice settings, with new graduates choosing to join either a hospitalist practice or one where they only see patients in the office setting. The traditional practice style, where the general internist combined ambulatory and hospital work, is becoming much less common, he said.
"Everybody’s kind of choosing sides, it seems, based on what kind of lifestyle they want and what type of practice they want," Mr. Bohannon said. "But there are very few left in the middle."
For Dr. Prather, the decision to go into hospital medicine came early in her training. She seized on the idea of hospital medicine early on when she realized it would fulfill her desire to treat sick, complicated patients. The other thing that convinced her to pursue hospital medicine was observing general internists in traditional practices that combine hospital and ambulatory work. The experience of seeing those doctors running all over town to visit their hospitalized patients, only to incur the ire of office patients who were always kept waiting, turned her off to that type of practice.
But the lifestyle offered by a career as a hospitalist was the biggest draw, she said.
"Lifestyle is huge. If I was an outpatient doctor and I was going back and forth, there’s no way [it would work]," Dr. Prather said. "I would like to get married someday. I would like to have children and I want to be able to have time for them."
For Dr. Joseph Sweigart, a third-year internal medicine resident at the University of Colorado in Denver, lifestyle is a perk, but he’s attracted to hospital medicine because it allows him to do primary care in a fast-paced setting.
"The thing that attracted me so much to internal medicine and continues to excite me about it is just all the energy and community that you get in the hospital," said Dr. Sweigart, who is participating in the residency’s hospital medicine training track.
Dr. Sweigart, who will graduate in June 2012, said he hopes to find a job as an academic hospitalist. Before deciding on hospital medicine, he considered pursuing a fellowship in interventional cardiology. But the decision came down to wanting to have greater involvement in the lives of patients. A hospitalist can be a primary care physician, just in an inpatient setting, he said. "You really take control of the patient, every aspect of their care, every family discussion, coordinating the multidisciplinary teams," he said.
Dr. Nichole G. Zehnder is a recent graduate of the University of Colorado’s internal medicine residency and was also a participant in the hospital medicine training track. She is now a faculty member and director of the hospitalized adult-care clerkship there. For her, one the biggest attractions of hospital medicine has been the chance to work as part of a team.
"In hospital medicine, you’re afforded a unique opportunity to get to interact with subspecialists and other teams, whether it be through perioperative care or comanagement," Dr. Zehnder said. "It’s a real-time team-based environment that I think the office setting lacks."
Dr. Zehnder is early in her career, but she expects to stick with hospital medicine for a long time. So far her job has allowed her to achieve a work/life balance, as well as a balance between clinical and academic time. "Right now, I’m incredibly happy and satisfied with my career."
Dr. Carrie Jo Prather is finishing up the third year of her internal medicine residency at Palmetto General Hospital in Hialeah, Fla., in September and she’s starting to look for a job as a hospitalist.
Dr. Prather, who is in the residency’s hospital medicine training track, is sending out her CV sparingly and finding openings through word of mouth so that she can avoid the flood of unsolicited phone calls from potential employers and recruiters. And she’s only looking for jobs where she can work seven days on, seven days off.
"They’re long days. They’re hard days. They’re sick patients. But then you’ve got a whole week off," she said. For Dr. Prather, a schedule like that would allow her to stay in Florida, where she owns a house, and still travel to Michigan to see her family frequently.
Dr. Prather is fairly typical of young hospitalists entering the field these days. She’s enthusiastic about the pace and acuity offered in treating hospitalized patients. She’s attracted to the work/life balance of the hospitalist schedule. She wouldn’t consider an office-based practice, at least not for right now. And she’s in demand.
The latest figures from the health care recruiting firm Merritt Hawkins show that hospitalists were the third most-requested search assignment in 2010-2011. And hospitalists have been in the top four most-requested specialties for the last five years. The figures come from the firm’s "2011 Review of Physician Recruiting Incentives" report, which provides an overview of salaries, bonuses, and other incentives used in recruiting physicians.
The report also found that hospitalists can command salaries between $160,000 and $305,000, with an average salary of $217,000. That average salary has risen every year in the last five years.
Internal medicine has become one of the hardest search requests for the firm to fill, in part because so many internal medicine physicians are choosing to practice as hospitalists, according to the 2011 report.
Tommy Bohannon, vice president of hospital-based recruiting at Merritt Hawkins, said he doesn’t see young physicians flocking to hospital medicine instead of ambulatory internal medicine. However, he does see a stricter divide between the two practice settings, with new graduates choosing to join either a hospitalist practice or one where they only see patients in the office setting. The traditional practice style, where the general internist combined ambulatory and hospital work, is becoming much less common, he said.
"Everybody’s kind of choosing sides, it seems, based on what kind of lifestyle they want and what type of practice they want," Mr. Bohannon said. "But there are very few left in the middle."
For Dr. Prather, the decision to go into hospital medicine came early in her training. She seized on the idea of hospital medicine early on when she realized it would fulfill her desire to treat sick, complicated patients. The other thing that convinced her to pursue hospital medicine was observing general internists in traditional practices that combine hospital and ambulatory work. The experience of seeing those doctors running all over town to visit their hospitalized patients, only to incur the ire of office patients who were always kept waiting, turned her off to that type of practice.
But the lifestyle offered by a career as a hospitalist was the biggest draw, she said.
"Lifestyle is huge. If I was an outpatient doctor and I was going back and forth, there’s no way [it would work]," Dr. Prather said. "I would like to get married someday. I would like to have children and I want to be able to have time for them."
For Dr. Joseph Sweigart, a third-year internal medicine resident at the University of Colorado in Denver, lifestyle is a perk, but he’s attracted to hospital medicine because it allows him to do primary care in a fast-paced setting.
"The thing that attracted me so much to internal medicine and continues to excite me about it is just all the energy and community that you get in the hospital," said Dr. Sweigart, who is participating in the residency’s hospital medicine training track.
Dr. Sweigart, who will graduate in June 2012, said he hopes to find a job as an academic hospitalist. Before deciding on hospital medicine, he considered pursuing a fellowship in interventional cardiology. But the decision came down to wanting to have greater involvement in the lives of patients. A hospitalist can be a primary care physician, just in an inpatient setting, he said. "You really take control of the patient, every aspect of their care, every family discussion, coordinating the multidisciplinary teams," he said.
Dr. Nichole G. Zehnder is a recent graduate of the University of Colorado’s internal medicine residency and was also a participant in the hospital medicine training track. She is now a faculty member and director of the hospitalized adult-care clerkship there. For her, one the biggest attractions of hospital medicine has been the chance to work as part of a team.
"In hospital medicine, you’re afforded a unique opportunity to get to interact with subspecialists and other teams, whether it be through perioperative care or comanagement," Dr. Zehnder said. "It’s a real-time team-based environment that I think the office setting lacks."
Dr. Zehnder is early in her career, but she expects to stick with hospital medicine for a long time. So far her job has allowed her to achieve a work/life balance, as well as a balance between clinical and academic time. "Right now, I’m incredibly happy and satisfied with my career."
Dr. Carrie Jo Prather is finishing up the third year of her internal medicine residency at Palmetto General Hospital in Hialeah, Fla., in September and she’s starting to look for a job as a hospitalist.
Dr. Prather, who is in the residency’s hospital medicine training track, is sending out her CV sparingly and finding openings through word of mouth so that she can avoid the flood of unsolicited phone calls from potential employers and recruiters. And she’s only looking for jobs where she can work seven days on, seven days off.
"They’re long days. They’re hard days. They’re sick patients. But then you’ve got a whole week off," she said. For Dr. Prather, a schedule like that would allow her to stay in Florida, where she owns a house, and still travel to Michigan to see her family frequently.
Dr. Prather is fairly typical of young hospitalists entering the field these days. She’s enthusiastic about the pace and acuity offered in treating hospitalized patients. She’s attracted to the work/life balance of the hospitalist schedule. She wouldn’t consider an office-based practice, at least not for right now. And she’s in demand.
The latest figures from the health care recruiting firm Merritt Hawkins show that hospitalists were the third most-requested search assignment in 2010-2011. And hospitalists have been in the top four most-requested specialties for the last five years. The figures come from the firm’s "2011 Review of Physician Recruiting Incentives" report, which provides an overview of salaries, bonuses, and other incentives used in recruiting physicians.
The report also found that hospitalists can command salaries between $160,000 and $305,000, with an average salary of $217,000. That average salary has risen every year in the last five years.
Internal medicine has become one of the hardest search requests for the firm to fill, in part because so many internal medicine physicians are choosing to practice as hospitalists, according to the 2011 report.
Tommy Bohannon, vice president of hospital-based recruiting at Merritt Hawkins, said he doesn’t see young physicians flocking to hospital medicine instead of ambulatory internal medicine. However, he does see a stricter divide between the two practice settings, with new graduates choosing to join either a hospitalist practice or one where they only see patients in the office setting. The traditional practice style, where the general internist combined ambulatory and hospital work, is becoming much less common, he said.
"Everybody’s kind of choosing sides, it seems, based on what kind of lifestyle they want and what type of practice they want," Mr. Bohannon said. "But there are very few left in the middle."
For Dr. Prather, the decision to go into hospital medicine came early in her training. She seized on the idea of hospital medicine early on when she realized it would fulfill her desire to treat sick, complicated patients. The other thing that convinced her to pursue hospital medicine was observing general internists in traditional practices that combine hospital and ambulatory work. The experience of seeing those doctors running all over town to visit their hospitalized patients, only to incur the ire of office patients who were always kept waiting, turned her off to that type of practice.
But the lifestyle offered by a career as a hospitalist was the biggest draw, she said.
"Lifestyle is huge. If I was an outpatient doctor and I was going back and forth, there’s no way [it would work]," Dr. Prather said. "I would like to get married someday. I would like to have children and I want to be able to have time for them."
For Dr. Joseph Sweigart, a third-year internal medicine resident at the University of Colorado in Denver, lifestyle is a perk, but he’s attracted to hospital medicine because it allows him to do primary care in a fast-paced setting.
"The thing that attracted me so much to internal medicine and continues to excite me about it is just all the energy and community that you get in the hospital," said Dr. Sweigart, who is participating in the residency’s hospital medicine training track.
Dr. Sweigart, who will graduate in June 2012, said he hopes to find a job as an academic hospitalist. Before deciding on hospital medicine, he considered pursuing a fellowship in interventional cardiology. But the decision came down to wanting to have greater involvement in the lives of patients. A hospitalist can be a primary care physician, just in an inpatient setting, he said. "You really take control of the patient, every aspect of their care, every family discussion, coordinating the multidisciplinary teams," he said.
Dr. Nichole G. Zehnder is a recent graduate of the University of Colorado’s internal medicine residency and was also a participant in the hospital medicine training track. She is now a faculty member and director of the hospitalized adult-care clerkship there. For her, one the biggest attractions of hospital medicine has been the chance to work as part of a team.
"In hospital medicine, you’re afforded a unique opportunity to get to interact with subspecialists and other teams, whether it be through perioperative care or comanagement," Dr. Zehnder said. "It’s a real-time team-based environment that I think the office setting lacks."
Dr. Zehnder is early in her career, but she expects to stick with hospital medicine for a long time. So far her job has allowed her to achieve a work/life balance, as well as a balance between clinical and academic time. "Right now, I’m incredibly happy and satisfied with my career."