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Obama calls opposition to ACA subsidies ‘cynical’
As the country awaits a U.S. Supreme Court ruling on the constitutionality of federal health insurance subsidies to millions of Americans, President Obama praised the impact of the Affordable Care Act and called attempts to roll back the law “cynical.”
“We need more governors and state legislators to expand Medicaid, which was a central part of the architecture of the overall plan,” the president said, addressing the Catholic Health Association’s annual meeting in Washington. “It’s not perfect, but it’s serving so many people so much better, and we’re not going to go backwards.”
The Supreme Court is expected to rule sometime in June on King v. Burwell, a controversial case that affects health care coverage for millions of Americans who are receiving subsidies to purchase insurance through the federally run ACA marketplace.
President Obama’s remarks came on the heels of similar signs he is frustrated with the Supreme Court for its handling of the King v. Burwell case. “This should be an easy case. Frankly, it probably shouldn’t even have been taken up,” he told reporters after the G-7 Summit in Krun, Germany.
If the Supreme Court sides with the plaintiff in this case, federally funded health insurance subsidies paid to beneficiaries in states that did not establish their own insurance marketplaces would become unconstitutional, leaving as many as 7.5 million people without subsidies, according to an estimate from the Kaiser Family Foundation.
The White House has not announced a contingency plan if King wins. While there are some plans circulating in Congress to maintain subsidies, the GOP majority has not coalesced around a specific option.
“Instead of bullying the Supreme Court, the president should spend his time preparing for the reality that the court may soon rule against his decision to illegally issue tax penalties and subsidies on Americans in two-thirds of the country,” Sen. John Barrasso (R-Wyo.) said in a statement. “Let’s be clear: If the Supreme Court rules against the administration, Congress will not pass a so called ‘one-sentence’ fake fix.”
On Twitter @whitneymcknight
As the country awaits a U.S. Supreme Court ruling on the constitutionality of federal health insurance subsidies to millions of Americans, President Obama praised the impact of the Affordable Care Act and called attempts to roll back the law “cynical.”
“We need more governors and state legislators to expand Medicaid, which was a central part of the architecture of the overall plan,” the president said, addressing the Catholic Health Association’s annual meeting in Washington. “It’s not perfect, but it’s serving so many people so much better, and we’re not going to go backwards.”
The Supreme Court is expected to rule sometime in June on King v. Burwell, a controversial case that affects health care coverage for millions of Americans who are receiving subsidies to purchase insurance through the federally run ACA marketplace.
President Obama’s remarks came on the heels of similar signs he is frustrated with the Supreme Court for its handling of the King v. Burwell case. “This should be an easy case. Frankly, it probably shouldn’t even have been taken up,” he told reporters after the G-7 Summit in Krun, Germany.
If the Supreme Court sides with the plaintiff in this case, federally funded health insurance subsidies paid to beneficiaries in states that did not establish their own insurance marketplaces would become unconstitutional, leaving as many as 7.5 million people without subsidies, according to an estimate from the Kaiser Family Foundation.
The White House has not announced a contingency plan if King wins. While there are some plans circulating in Congress to maintain subsidies, the GOP majority has not coalesced around a specific option.
“Instead of bullying the Supreme Court, the president should spend his time preparing for the reality that the court may soon rule against his decision to illegally issue tax penalties and subsidies on Americans in two-thirds of the country,” Sen. John Barrasso (R-Wyo.) said in a statement. “Let’s be clear: If the Supreme Court rules against the administration, Congress will not pass a so called ‘one-sentence’ fake fix.”
On Twitter @whitneymcknight
As the country awaits a U.S. Supreme Court ruling on the constitutionality of federal health insurance subsidies to millions of Americans, President Obama praised the impact of the Affordable Care Act and called attempts to roll back the law “cynical.”
“We need more governors and state legislators to expand Medicaid, which was a central part of the architecture of the overall plan,” the president said, addressing the Catholic Health Association’s annual meeting in Washington. “It’s not perfect, but it’s serving so many people so much better, and we’re not going to go backwards.”
The Supreme Court is expected to rule sometime in June on King v. Burwell, a controversial case that affects health care coverage for millions of Americans who are receiving subsidies to purchase insurance through the federally run ACA marketplace.
President Obama’s remarks came on the heels of similar signs he is frustrated with the Supreme Court for its handling of the King v. Burwell case. “This should be an easy case. Frankly, it probably shouldn’t even have been taken up,” he told reporters after the G-7 Summit in Krun, Germany.
If the Supreme Court sides with the plaintiff in this case, federally funded health insurance subsidies paid to beneficiaries in states that did not establish their own insurance marketplaces would become unconstitutional, leaving as many as 7.5 million people without subsidies, according to an estimate from the Kaiser Family Foundation.
The White House has not announced a contingency plan if King wins. While there are some plans circulating in Congress to maintain subsidies, the GOP majority has not coalesced around a specific option.
“Instead of bullying the Supreme Court, the president should spend his time preparing for the reality that the court may soon rule against his decision to illegally issue tax penalties and subsidies on Americans in two-thirds of the country,” Sen. John Barrasso (R-Wyo.) said in a statement. “Let’s be clear: If the Supreme Court rules against the administration, Congress will not pass a so called ‘one-sentence’ fake fix.”
On Twitter @whitneymcknight
AMA HOD: Delegates back ICD-10 reprieve, but gun proposals draw fire
CHICAGO – Physicians would have a 2-year reprieve from penalties while using the new ICD-10 coding set, under a resolution easily passed June 8 by the American Medical Association’s House of Delegates.
However, two proposals related to gun violence generated more heat than consensus among the AMA delegates at their annual meeting.
The ICD-10 resolution calls for the AMA to push the Centers for Medicare & Medicaid Services and other payers for a 2-year grace period from penalties physicians would otherwise face due to coding errors, mistakes, or other issues that might arise after the Oct. 1, 2015, transition to the new coding set.
The resolution passed without any discussion, other than a request that its reference committee report be considered at the top of the voting agenda so the AMA could begin working on it immediately.
The rest of the ICD-10 resolution calls for the AMA to educate physicians on how to meet obligations to Medicare and private payers if they choose to become a cash-only practice that no longer accepts insurance. The resolution also calls for the AMA to collect data on how ICD-10 implementation affects patients and changes practice patterns.
In contrast, two resolutions on gun-related violence produced far less agreement among the delegates.
The first resolution addressed prevention of firearm-related injuries and deaths among youth by calling on the AMA to work with other organizations to identify materials that could be handed out as educational material in clinical practice.
Some delegates were concerned that the resolution could open the door to partnerships with organizations such as the National Rifle Association. However, others saw that as a good thing, because it could open the door to the organizations working together and finding common ground. Some delegates also noted that the NRA has the ability to reach people to promote gun safety whom the AMA might not be able to reach.
After discussion, delegates passed the resolution with a voice vote.
Delegates also considered a resolution in favor of background checks for gun purchases. An earlier AMA Board of Trustees report recommended support for background checks for anyone buying firearms.
A number of delegates rose in support of this proposal. Speaking on behalf of the American Academy of Family Physicians, AAFP President Dr. Robert L. Wergin noted the recent statement of support signed by a number of medical societies and the American Bar Association.
However, the background-check provision met resistance. Some delegates said it would not do anything to stop criminals who are obtaining guns illegally, while others said it was too far-reaching to require all sales to be accompanied with a criminal background check.
The proposal does not address those who can legally own guns, such as law enforcement officials and those who recently purchased a gun and already underwent a check, cautioned Dr. Michael Greene, of Macon, Ga. Others mentioned the potential impact on situations such as nonoperative weapons that are transferred as heirlooms, as well as guns given as gifts.
In the end, delegates sent the resolution back to committee for further consideration.
Delegates did approve an electronic health records resolution that called for holding vendors accountable for system downtime and other technology disruptions, and working with the CMS to earn physicians partial credit if some meaningful use objectives are met, rather than the current all-or-none situation.
Delegates also approved provisions to increase the use of prescription drug monitoring programs (PDMP). Under those provisions, the AMA would support voluntary use of state PDMP programs, encourage states to modernize their programs, and support allowing access to PDMPs by a delegate appointed by a physician.
CHICAGO – Physicians would have a 2-year reprieve from penalties while using the new ICD-10 coding set, under a resolution easily passed June 8 by the American Medical Association’s House of Delegates.
However, two proposals related to gun violence generated more heat than consensus among the AMA delegates at their annual meeting.
The ICD-10 resolution calls for the AMA to push the Centers for Medicare & Medicaid Services and other payers for a 2-year grace period from penalties physicians would otherwise face due to coding errors, mistakes, or other issues that might arise after the Oct. 1, 2015, transition to the new coding set.
The resolution passed without any discussion, other than a request that its reference committee report be considered at the top of the voting agenda so the AMA could begin working on it immediately.
The rest of the ICD-10 resolution calls for the AMA to educate physicians on how to meet obligations to Medicare and private payers if they choose to become a cash-only practice that no longer accepts insurance. The resolution also calls for the AMA to collect data on how ICD-10 implementation affects patients and changes practice patterns.
In contrast, two resolutions on gun-related violence produced far less agreement among the delegates.
The first resolution addressed prevention of firearm-related injuries and deaths among youth by calling on the AMA to work with other organizations to identify materials that could be handed out as educational material in clinical practice.
Some delegates were concerned that the resolution could open the door to partnerships with organizations such as the National Rifle Association. However, others saw that as a good thing, because it could open the door to the organizations working together and finding common ground. Some delegates also noted that the NRA has the ability to reach people to promote gun safety whom the AMA might not be able to reach.
After discussion, delegates passed the resolution with a voice vote.
Delegates also considered a resolution in favor of background checks for gun purchases. An earlier AMA Board of Trustees report recommended support for background checks for anyone buying firearms.
A number of delegates rose in support of this proposal. Speaking on behalf of the American Academy of Family Physicians, AAFP President Dr. Robert L. Wergin noted the recent statement of support signed by a number of medical societies and the American Bar Association.
However, the background-check provision met resistance. Some delegates said it would not do anything to stop criminals who are obtaining guns illegally, while others said it was too far-reaching to require all sales to be accompanied with a criminal background check.
The proposal does not address those who can legally own guns, such as law enforcement officials and those who recently purchased a gun and already underwent a check, cautioned Dr. Michael Greene, of Macon, Ga. Others mentioned the potential impact on situations such as nonoperative weapons that are transferred as heirlooms, as well as guns given as gifts.
In the end, delegates sent the resolution back to committee for further consideration.
Delegates did approve an electronic health records resolution that called for holding vendors accountable for system downtime and other technology disruptions, and working with the CMS to earn physicians partial credit if some meaningful use objectives are met, rather than the current all-or-none situation.
Delegates also approved provisions to increase the use of prescription drug monitoring programs (PDMP). Under those provisions, the AMA would support voluntary use of state PDMP programs, encourage states to modernize their programs, and support allowing access to PDMPs by a delegate appointed by a physician.
CHICAGO – Physicians would have a 2-year reprieve from penalties while using the new ICD-10 coding set, under a resolution easily passed June 8 by the American Medical Association’s House of Delegates.
However, two proposals related to gun violence generated more heat than consensus among the AMA delegates at their annual meeting.
The ICD-10 resolution calls for the AMA to push the Centers for Medicare & Medicaid Services and other payers for a 2-year grace period from penalties physicians would otherwise face due to coding errors, mistakes, or other issues that might arise after the Oct. 1, 2015, transition to the new coding set.
The resolution passed without any discussion, other than a request that its reference committee report be considered at the top of the voting agenda so the AMA could begin working on it immediately.
The rest of the ICD-10 resolution calls for the AMA to educate physicians on how to meet obligations to Medicare and private payers if they choose to become a cash-only practice that no longer accepts insurance. The resolution also calls for the AMA to collect data on how ICD-10 implementation affects patients and changes practice patterns.
In contrast, two resolutions on gun-related violence produced far less agreement among the delegates.
The first resolution addressed prevention of firearm-related injuries and deaths among youth by calling on the AMA to work with other organizations to identify materials that could be handed out as educational material in clinical practice.
Some delegates were concerned that the resolution could open the door to partnerships with organizations such as the National Rifle Association. However, others saw that as a good thing, because it could open the door to the organizations working together and finding common ground. Some delegates also noted that the NRA has the ability to reach people to promote gun safety whom the AMA might not be able to reach.
After discussion, delegates passed the resolution with a voice vote.
Delegates also considered a resolution in favor of background checks for gun purchases. An earlier AMA Board of Trustees report recommended support for background checks for anyone buying firearms.
A number of delegates rose in support of this proposal. Speaking on behalf of the American Academy of Family Physicians, AAFP President Dr. Robert L. Wergin noted the recent statement of support signed by a number of medical societies and the American Bar Association.
However, the background-check provision met resistance. Some delegates said it would not do anything to stop criminals who are obtaining guns illegally, while others said it was too far-reaching to require all sales to be accompanied with a criminal background check.
The proposal does not address those who can legally own guns, such as law enforcement officials and those who recently purchased a gun and already underwent a check, cautioned Dr. Michael Greene, of Macon, Ga. Others mentioned the potential impact on situations such as nonoperative weapons that are transferred as heirlooms, as well as guns given as gifts.
In the end, delegates sent the resolution back to committee for further consideration.
Delegates did approve an electronic health records resolution that called for holding vendors accountable for system downtime and other technology disruptions, and working with the CMS to earn physicians partial credit if some meaningful use objectives are met, rather than the current all-or-none situation.
Delegates also approved provisions to increase the use of prescription drug monitoring programs (PDMP). Under those provisions, the AMA would support voluntary use of state PDMP programs, encourage states to modernize their programs, and support allowing access to PDMPs by a delegate appointed by a physician.
AT THE AMA HOD MEETING
AMA launches online tool to help address physician burnout
CHICAGO – The American Medical Association has launched an interactive tool to help physicians deal with burnout.
Dr. Steven Stack, who takes over as AMA president on June 9, said the organization wants “to the restore the joy to the practice of medicine. I think physicians feel besieged right now by an overburdened regulatory environment, too much paperwork, too much time doing clerical tasks that support the provision of care, and too little time actually interacting with patients.”
The “STEPS Forward” program gives physicians access to online modules to help them improve their practices. Currently, 16 modules are available addressing practice efficiency and patient care, patient health, physician health, and technology and innovation. Each module includes steps for implementation and case studies as well as downloadable tools, videos, and resources. CME credits are available for completed modules.
The modules were designed by physician teams, and all include real-world examples of how the processes that are displayed have been implemented.
We “recognize that in a complex world where everyone’s busy, giving someone a PDF outlining what to do does not get much traction,” AMA CEO Dr. James Madara said during a June 8 press conference at the annual meeting of the American Medical Association House of Delegates..
The AMA, in partnership with the Medical Group Management Association (MGMA), also are looking for solutions to add to the STEPS Forward program and plan to award several $10,000 prizes for those who propose the best solutions that help physicians adapt to the changing work environment. Entries are due Sept. 1. Dr. Madara said he hopes to give awards to at least five physicians and their practices for their ideas, but if more come in, AMA and MGMA will make more awards. He hopes those winners will be ready to be announced at MGMA’s annual meeting in October.
CHICAGO – The American Medical Association has launched an interactive tool to help physicians deal with burnout.
Dr. Steven Stack, who takes over as AMA president on June 9, said the organization wants “to the restore the joy to the practice of medicine. I think physicians feel besieged right now by an overburdened regulatory environment, too much paperwork, too much time doing clerical tasks that support the provision of care, and too little time actually interacting with patients.”
The “STEPS Forward” program gives physicians access to online modules to help them improve their practices. Currently, 16 modules are available addressing practice efficiency and patient care, patient health, physician health, and technology and innovation. Each module includes steps for implementation and case studies as well as downloadable tools, videos, and resources. CME credits are available for completed modules.
The modules were designed by physician teams, and all include real-world examples of how the processes that are displayed have been implemented.
We “recognize that in a complex world where everyone’s busy, giving someone a PDF outlining what to do does not get much traction,” AMA CEO Dr. James Madara said during a June 8 press conference at the annual meeting of the American Medical Association House of Delegates..
The AMA, in partnership with the Medical Group Management Association (MGMA), also are looking for solutions to add to the STEPS Forward program and plan to award several $10,000 prizes for those who propose the best solutions that help physicians adapt to the changing work environment. Entries are due Sept. 1. Dr. Madara said he hopes to give awards to at least five physicians and their practices for their ideas, but if more come in, AMA and MGMA will make more awards. He hopes those winners will be ready to be announced at MGMA’s annual meeting in October.
CHICAGO – The American Medical Association has launched an interactive tool to help physicians deal with burnout.
Dr. Steven Stack, who takes over as AMA president on June 9, said the organization wants “to the restore the joy to the practice of medicine. I think physicians feel besieged right now by an overburdened regulatory environment, too much paperwork, too much time doing clerical tasks that support the provision of care, and too little time actually interacting with patients.”
The “STEPS Forward” program gives physicians access to online modules to help them improve their practices. Currently, 16 modules are available addressing practice efficiency and patient care, patient health, physician health, and technology and innovation. Each module includes steps for implementation and case studies as well as downloadable tools, videos, and resources. CME credits are available for completed modules.
The modules were designed by physician teams, and all include real-world examples of how the processes that are displayed have been implemented.
We “recognize that in a complex world where everyone’s busy, giving someone a PDF outlining what to do does not get much traction,” AMA CEO Dr. James Madara said during a June 8 press conference at the annual meeting of the American Medical Association House of Delegates..
The AMA, in partnership with the Medical Group Management Association (MGMA), also are looking for solutions to add to the STEPS Forward program and plan to award several $10,000 prizes for those who propose the best solutions that help physicians adapt to the changing work environment. Entries are due Sept. 1. Dr. Madara said he hopes to give awards to at least five physicians and their practices for their ideas, but if more come in, AMA and MGMA will make more awards. He hopes those winners will be ready to be announced at MGMA’s annual meeting in October.
AT THE AMA HOD MEETING
AMA HOD: Delegates call for ICD-10 grace period
CHICAGO – With the ICD-10 transition looming, delegates to the annual meeting of the American Medical Association House of Delegates want their organization to advocate for giving some room to physicians to adjust.
A resolution submitted by the Alabama delegation calls on the AMA to push for a 2-year grace period during which physicians would not be penalized for errors, mistakes, and other system malfunctions, and payments would not be withheld due to coding errors.
Dr. W. Jeff Terry, chairman of the Alabama delegation, noted that, despite the AMA’s policies and efforts against ICD-10, the government stands firm on its Oct. 1 implementation date.
“I truly believe that we have just not educated Congress well enough as to the issues of the consequences of ICD-10,” Dr. Terry said.
“We – as our AMA, me, and all of you – just haven’t done our job well enough. … I want to stress here today what our AMA message should be from out of this meeting. Even though the American Medical Association is firm in its view that the switch to ICD-10 is a mistake, we also recognized that there are other groups that are fighting to maintain the Oct. 1 implementation date. In order to maintain patients’ access to care and protect physicians’ practices, we offer a compromise solution that will allow ICD-10 to be implemented as planned on Oct. 1, and at same time, protect physicians from suffering financial consequences as a result of coding errors and mistakes for a 2-year period,” he said.
He called for the AMA to put in motion a letter-writing campaign to advocate for the grace period. “This should be our number-one priority, at least from now until Oct. 1, when it won’t matter.”
Dr. Wanda Filer, delegate from the American Academy of Family Physicians, echoed Dr. Terry.
“At this point, we believe that the adoption of ICD-10 is inevitable and, recognizing that advocacy resources are finite, we would like to encourage our AMA to work with CMS to prepare for this and ensure a soft landing for all physicians and patients … rather than a hard start,” said Dr. Filer, who is also AAFP president-elect.
Delegates suggested that the organization focus on how ICD-10 requirements could affect small practices and their patients. They called on the AMA to track data on rejected claims, payment delays resulting from coding errors, and the impact on patient volume.
Reference Committee B, which addresses matters of federal legislation, considered a number of other issues, almost without dissent. One exception was a resolution advocating for background checks on all gun sales, which met with some resistance as being onerous for certain people in specific situations.
Resolutions will be voted on by the full House of Delegates June 8-10.
CHICAGO – With the ICD-10 transition looming, delegates to the annual meeting of the American Medical Association House of Delegates want their organization to advocate for giving some room to physicians to adjust.
A resolution submitted by the Alabama delegation calls on the AMA to push for a 2-year grace period during which physicians would not be penalized for errors, mistakes, and other system malfunctions, and payments would not be withheld due to coding errors.
Dr. W. Jeff Terry, chairman of the Alabama delegation, noted that, despite the AMA’s policies and efforts against ICD-10, the government stands firm on its Oct. 1 implementation date.
“I truly believe that we have just not educated Congress well enough as to the issues of the consequences of ICD-10,” Dr. Terry said.
“We – as our AMA, me, and all of you – just haven’t done our job well enough. … I want to stress here today what our AMA message should be from out of this meeting. Even though the American Medical Association is firm in its view that the switch to ICD-10 is a mistake, we also recognized that there are other groups that are fighting to maintain the Oct. 1 implementation date. In order to maintain patients’ access to care and protect physicians’ practices, we offer a compromise solution that will allow ICD-10 to be implemented as planned on Oct. 1, and at same time, protect physicians from suffering financial consequences as a result of coding errors and mistakes for a 2-year period,” he said.
He called for the AMA to put in motion a letter-writing campaign to advocate for the grace period. “This should be our number-one priority, at least from now until Oct. 1, when it won’t matter.”
Dr. Wanda Filer, delegate from the American Academy of Family Physicians, echoed Dr. Terry.
“At this point, we believe that the adoption of ICD-10 is inevitable and, recognizing that advocacy resources are finite, we would like to encourage our AMA to work with CMS to prepare for this and ensure a soft landing for all physicians and patients … rather than a hard start,” said Dr. Filer, who is also AAFP president-elect.
Delegates suggested that the organization focus on how ICD-10 requirements could affect small practices and their patients. They called on the AMA to track data on rejected claims, payment delays resulting from coding errors, and the impact on patient volume.
Reference Committee B, which addresses matters of federal legislation, considered a number of other issues, almost without dissent. One exception was a resolution advocating for background checks on all gun sales, which met with some resistance as being onerous for certain people in specific situations.
Resolutions will be voted on by the full House of Delegates June 8-10.
CHICAGO – With the ICD-10 transition looming, delegates to the annual meeting of the American Medical Association House of Delegates want their organization to advocate for giving some room to physicians to adjust.
A resolution submitted by the Alabama delegation calls on the AMA to push for a 2-year grace period during which physicians would not be penalized for errors, mistakes, and other system malfunctions, and payments would not be withheld due to coding errors.
Dr. W. Jeff Terry, chairman of the Alabama delegation, noted that, despite the AMA’s policies and efforts against ICD-10, the government stands firm on its Oct. 1 implementation date.
“I truly believe that we have just not educated Congress well enough as to the issues of the consequences of ICD-10,” Dr. Terry said.
“We – as our AMA, me, and all of you – just haven’t done our job well enough. … I want to stress here today what our AMA message should be from out of this meeting. Even though the American Medical Association is firm in its view that the switch to ICD-10 is a mistake, we also recognized that there are other groups that are fighting to maintain the Oct. 1 implementation date. In order to maintain patients’ access to care and protect physicians’ practices, we offer a compromise solution that will allow ICD-10 to be implemented as planned on Oct. 1, and at same time, protect physicians from suffering financial consequences as a result of coding errors and mistakes for a 2-year period,” he said.
He called for the AMA to put in motion a letter-writing campaign to advocate for the grace period. “This should be our number-one priority, at least from now until Oct. 1, when it won’t matter.”
Dr. Wanda Filer, delegate from the American Academy of Family Physicians, echoed Dr. Terry.
“At this point, we believe that the adoption of ICD-10 is inevitable and, recognizing that advocacy resources are finite, we would like to encourage our AMA to work with CMS to prepare for this and ensure a soft landing for all physicians and patients … rather than a hard start,” said Dr. Filer, who is also AAFP president-elect.
Delegates suggested that the organization focus on how ICD-10 requirements could affect small practices and their patients. They called on the AMA to track data on rejected claims, payment delays resulting from coding errors, and the impact on patient volume.
Reference Committee B, which addresses matters of federal legislation, considered a number of other issues, almost without dissent. One exception was a resolution advocating for background checks on all gun sales, which met with some resistance as being onerous for certain people in specific situations.
Resolutions will be voted on by the full House of Delegates June 8-10.
AT THE AMA HOD MEETING
User errors are top reason for EHR-related malpractice claims
User error, such as incorrect data input, contributes to the majority of medical malpractice claims that involve electronic health records.
Of 97 EHR-related malpractice claims that closed from January 2007 to June 2014, 64% involved user errors, while 42% related to system factors, according to an analysis from national medical liability insurer The Doctors Company. (Numbers do not add up to 100% because some claims contained more than one contributing factor.)
The most common user errors included incorrect information in the EHR (16%), hybrid health records/EHR conversion (15%), and problems regarding prepopulating/copy and pasting (13%). Less common user factors involved training/education, EHR alert issue or fatigue, and workarounds, according to the report.
EHR-related malpractice claims appear to be on the rise, said Dr. David B. Troxel, medical director for The Doctors Company. Of the 97 EHR-related claims, 26 claims closed in the first half of 2014, compared with 28 claims that closed in 2013, 22 that closed in 2012, 19 that closed in 2011, and 2 that closed between 2007 and 2010.
“Electronic health records provide benefits but also create risks that can contribute to medical malpractice claims,” Dr. Troxel said in an interview. “Their widespread use is too recent to tell whether the benefits will outweigh the risks and result in a decrease in adverse patient events. In the meantime, I believe we will see an increase in claims over the next few years in which EHRs are a contributing factor.”
Of system-related EHR claims, 10% involved system design failures. Electronic systems/technology failures contributed to 9% of cases, and 7% involved a lack of EHR alert or alarm/decision support. Other system-related claims were attributed to inappropriate data routing, insufficient scope/area for documentation, and fragmentation.
In one such case examined, a plaintiff claimed the lack of a medication risk alert led to the death of a dialysis patient. The patient was transferred to a skilled nursing facility with an active hospital transfer order for enoxaparin. A physician evaluated the patient upon admission but made no comment about the enoxaparin order. During the first dialysis treatment, there was active bleeding at the fistula site, but a nurse did not inform the physician. During the second dialysis treatment, there was uncontrolled bleeding from the fistula, and the patient later died.
As for practice area, internal medicine subspecialists – including cardiologists, hospitalists, oncologists, and gastroenterologists – were the most likely to see EHR-related claims at 20%. Primary care physicians – family physicians and general internists – faced claims in 16% of cases, while ob.gyns. were accused in 15% of cases. Other cases involved claims against surgeons (14%), nurses (7%), radiologists (5%), anesthesiologists, (4%), general surgeons (4%), pediatricians (2%), emergency medicine physicians (2%), psychiatrists (2%), orthopedists (2%), and pathologists (1%). Other claims were against nonphysician providers.
Among all EHR-related claims, the top allegations made were diagnosis failure and medication error, including allegedly ordering the wrong medication, prescribing an incorrect dosage, or improper medication management.
User error, such as incorrect data input, contributes to the majority of medical malpractice claims that involve electronic health records.
Of 97 EHR-related malpractice claims that closed from January 2007 to June 2014, 64% involved user errors, while 42% related to system factors, according to an analysis from national medical liability insurer The Doctors Company. (Numbers do not add up to 100% because some claims contained more than one contributing factor.)
The most common user errors included incorrect information in the EHR (16%), hybrid health records/EHR conversion (15%), and problems regarding prepopulating/copy and pasting (13%). Less common user factors involved training/education, EHR alert issue or fatigue, and workarounds, according to the report.
EHR-related malpractice claims appear to be on the rise, said Dr. David B. Troxel, medical director for The Doctors Company. Of the 97 EHR-related claims, 26 claims closed in the first half of 2014, compared with 28 claims that closed in 2013, 22 that closed in 2012, 19 that closed in 2011, and 2 that closed between 2007 and 2010.
“Electronic health records provide benefits but also create risks that can contribute to medical malpractice claims,” Dr. Troxel said in an interview. “Their widespread use is too recent to tell whether the benefits will outweigh the risks and result in a decrease in adverse patient events. In the meantime, I believe we will see an increase in claims over the next few years in which EHRs are a contributing factor.”
Of system-related EHR claims, 10% involved system design failures. Electronic systems/technology failures contributed to 9% of cases, and 7% involved a lack of EHR alert or alarm/decision support. Other system-related claims were attributed to inappropriate data routing, insufficient scope/area for documentation, and fragmentation.
In one such case examined, a plaintiff claimed the lack of a medication risk alert led to the death of a dialysis patient. The patient was transferred to a skilled nursing facility with an active hospital transfer order for enoxaparin. A physician evaluated the patient upon admission but made no comment about the enoxaparin order. During the first dialysis treatment, there was active bleeding at the fistula site, but a nurse did not inform the physician. During the second dialysis treatment, there was uncontrolled bleeding from the fistula, and the patient later died.
As for practice area, internal medicine subspecialists – including cardiologists, hospitalists, oncologists, and gastroenterologists – were the most likely to see EHR-related claims at 20%. Primary care physicians – family physicians and general internists – faced claims in 16% of cases, while ob.gyns. were accused in 15% of cases. Other cases involved claims against surgeons (14%), nurses (7%), radiologists (5%), anesthesiologists, (4%), general surgeons (4%), pediatricians (2%), emergency medicine physicians (2%), psychiatrists (2%), orthopedists (2%), and pathologists (1%). Other claims were against nonphysician providers.
Among all EHR-related claims, the top allegations made were diagnosis failure and medication error, including allegedly ordering the wrong medication, prescribing an incorrect dosage, or improper medication management.
User error, such as incorrect data input, contributes to the majority of medical malpractice claims that involve electronic health records.
Of 97 EHR-related malpractice claims that closed from January 2007 to June 2014, 64% involved user errors, while 42% related to system factors, according to an analysis from national medical liability insurer The Doctors Company. (Numbers do not add up to 100% because some claims contained more than one contributing factor.)
The most common user errors included incorrect information in the EHR (16%), hybrid health records/EHR conversion (15%), and problems regarding prepopulating/copy and pasting (13%). Less common user factors involved training/education, EHR alert issue or fatigue, and workarounds, according to the report.
EHR-related malpractice claims appear to be on the rise, said Dr. David B. Troxel, medical director for The Doctors Company. Of the 97 EHR-related claims, 26 claims closed in the first half of 2014, compared with 28 claims that closed in 2013, 22 that closed in 2012, 19 that closed in 2011, and 2 that closed between 2007 and 2010.
“Electronic health records provide benefits but also create risks that can contribute to medical malpractice claims,” Dr. Troxel said in an interview. “Their widespread use is too recent to tell whether the benefits will outweigh the risks and result in a decrease in adverse patient events. In the meantime, I believe we will see an increase in claims over the next few years in which EHRs are a contributing factor.”
Of system-related EHR claims, 10% involved system design failures. Electronic systems/technology failures contributed to 9% of cases, and 7% involved a lack of EHR alert or alarm/decision support. Other system-related claims were attributed to inappropriate data routing, insufficient scope/area for documentation, and fragmentation.
In one such case examined, a plaintiff claimed the lack of a medication risk alert led to the death of a dialysis patient. The patient was transferred to a skilled nursing facility with an active hospital transfer order for enoxaparin. A physician evaluated the patient upon admission but made no comment about the enoxaparin order. During the first dialysis treatment, there was active bleeding at the fistula site, but a nurse did not inform the physician. During the second dialysis treatment, there was uncontrolled bleeding from the fistula, and the patient later died.
As for practice area, internal medicine subspecialists – including cardiologists, hospitalists, oncologists, and gastroenterologists – were the most likely to see EHR-related claims at 20%. Primary care physicians – family physicians and general internists – faced claims in 16% of cases, while ob.gyns. were accused in 15% of cases. Other cases involved claims against surgeons (14%), nurses (7%), radiologists (5%), anesthesiologists, (4%), general surgeons (4%), pediatricians (2%), emergency medicine physicians (2%), psychiatrists (2%), orthopedists (2%), and pathologists (1%). Other claims were against nonphysician providers.
Among all EHR-related claims, the top allegations made were diagnosis failure and medication error, including allegedly ordering the wrong medication, prescribing an incorrect dosage, or improper medication management.
Report identifies hiring trends emerging after ACA implementation
Full implementation of the Affordable Care Act has brought change to the hiring needs of medical practices and the health care industry.
While staff turnover and the physician shortage remain the key problems, recruiting a new set of staff members has become the third biggest concern, according to a report from Health eCareers.
To keep in step with the ACA, practices might consider the following staff changes:
• Integrate technologists across the continuum of care.
• Hire more case management professionals.
• Keep hiring more educated nurses.
• Emphasize data.
Data from the Health eCareers’ 2015 Healthcare Recruiting Trends Survey Report came from 565 healthcare employers and recruiters, customers of Health eCareers, who were surveyed in late 2014 and early 2015.
For the full report, click here.
Full implementation of the Affordable Care Act has brought change to the hiring needs of medical practices and the health care industry.
While staff turnover and the physician shortage remain the key problems, recruiting a new set of staff members has become the third biggest concern, according to a report from Health eCareers.
To keep in step with the ACA, practices might consider the following staff changes:
• Integrate technologists across the continuum of care.
• Hire more case management professionals.
• Keep hiring more educated nurses.
• Emphasize data.
Data from the Health eCareers’ 2015 Healthcare Recruiting Trends Survey Report came from 565 healthcare employers and recruiters, customers of Health eCareers, who were surveyed in late 2014 and early 2015.
For the full report, click here.
Full implementation of the Affordable Care Act has brought change to the hiring needs of medical practices and the health care industry.
While staff turnover and the physician shortage remain the key problems, recruiting a new set of staff members has become the third biggest concern, according to a report from Health eCareers.
To keep in step with the ACA, practices might consider the following staff changes:
• Integrate technologists across the continuum of care.
• Hire more case management professionals.
• Keep hiring more educated nurses.
• Emphasize data.
Data from the Health eCareers’ 2015 Healthcare Recruiting Trends Survey Report came from 565 healthcare employers and recruiters, customers of Health eCareers, who were surveyed in late 2014 and early 2015.
For the full report, click here.
VIDEO: Can women physicians have it all? Absolutely, says AMWA past president
CHICAGO – Can women physicians succeed professionally while also meeting their personal goals?
Absolutely, says Dr. Farzanna Haffizulla, immediate past president of the American Medical Women’s Association and founder of a concierge practice in Davie, Fla.
While women physicians face challenges during every stage of their training and career, they should never give up personal goals for professional ambitions, or vice versa, Dr. Haffizulla said at the annual meeting of the American Medical Women’s Association.
Women doctors can meet dual objectives through strong organization, dedicated support systems, and steady determination, said Dr. Haffizulla, a nationally recognized speaker on work/life balance who has authored two books on the subject and runs the work/life balance website www.BusyMomMD.com.
In this video, Dr. Haffizulla shares her personal story of raising a family while also meeting her professional aspirations. She offers guidance and wisdom for other women physicians about how they can achieve a healthy work/life balance and remain fulfilled in all arenas.
CHICAGO – Can women physicians succeed professionally while also meeting their personal goals?
Absolutely, says Dr. Farzanna Haffizulla, immediate past president of the American Medical Women’s Association and founder of a concierge practice in Davie, Fla.
While women physicians face challenges during every stage of their training and career, they should never give up personal goals for professional ambitions, or vice versa, Dr. Haffizulla said at the annual meeting of the American Medical Women’s Association.
Women doctors can meet dual objectives through strong organization, dedicated support systems, and steady determination, said Dr. Haffizulla, a nationally recognized speaker on work/life balance who has authored two books on the subject and runs the work/life balance website www.BusyMomMD.com.
In this video, Dr. Haffizulla shares her personal story of raising a family while also meeting her professional aspirations. She offers guidance and wisdom for other women physicians about how they can achieve a healthy work/life balance and remain fulfilled in all arenas.
CHICAGO – Can women physicians succeed professionally while also meeting their personal goals?
Absolutely, says Dr. Farzanna Haffizulla, immediate past president of the American Medical Women’s Association and founder of a concierge practice in Davie, Fla.
While women physicians face challenges during every stage of their training and career, they should never give up personal goals for professional ambitions, or vice versa, Dr. Haffizulla said at the annual meeting of the American Medical Women’s Association.
Women doctors can meet dual objectives through strong organization, dedicated support systems, and steady determination, said Dr. Haffizulla, a nationally recognized speaker on work/life balance who has authored two books on the subject and runs the work/life balance website www.BusyMomMD.com.
In this video, Dr. Haffizulla shares her personal story of raising a family while also meeting her professional aspirations. She offers guidance and wisdom for other women physicians about how they can achieve a healthy work/life balance and remain fulfilled in all arenas.
EXPERT ANALYSIS FROM THE AMWA ANNUAL MEETING
Data will drive evolution to value-based care, CMS chief says
WASHINGTON – Data are so integral to the transition to value-based care that the health care industry must begin to think of itself as an information industry, according to Centers for Medicare & Medicaid Services Acting Administrator Andy Slavitt.
“Health care will either remain a series of best guesses or it will turn into an information industry,” Mr. Slavitt said during his keynote address at an annual conference on health data transparency. This “requires an enormous amount of change and it is our job to help everyone adapt and succeed. The implication for us at CMS is that we need to be more modern, more strategic, and culturally a fast-moving, responsive, and transparent agency that leads and enables change.”
Mr. Slavitt identified four key areas for focus: privacy and security, real consumer benefit, learning and productivity, and connectivity. To improve his agency’s connectivity to providers, Mr. Slavitt said that it has recently created a new email box – [email protected] – to allow doctors and others who are experiencing information blocking issues to help the agency address concerns.
“Data blocking will not be tolerated,” Mr. Slavitt said. “We don’t experience care in silos and our data can’t live in silos.”
To spur the transition to a more information-based health care industry, Mr. Slavitt announced a number of data-sharing initiatives aimed at spurring on further data transparency.
First, the agency will be releasing its data to commercial entities. “We are aiming directly at shaking up health care innovation and setting a new standard for data transparency,” Mr. Slavitt said.
Innovators will have access to granular CMS program data, including de-identified Medicare fee-for-service claims data, with the hopes that they will be able to create care management and predictive modeling tools.
“While this is a big departure, we do this with a clear expectation that you will create a new stream of tools that will improve care and personalized decision-making and we are allowing companies to combine CMS data with other data so even what were small silos of data can have enough credibility to have meaning,” he said, challenging other organizations to open up their proprietary databases and match CMS’ move to open its data to commercial interests.
Mr. Slavitt also announced that data updates will be available on a quarterly basis. “In an information age, it is just not acceptable that the most recent Medicare data available to researchers is from 2013.”
He called on innovators to build products not for just the healthiest and wealthiest, but for the sickest in the population.
WASHINGTON – Data are so integral to the transition to value-based care that the health care industry must begin to think of itself as an information industry, according to Centers for Medicare & Medicaid Services Acting Administrator Andy Slavitt.
“Health care will either remain a series of best guesses or it will turn into an information industry,” Mr. Slavitt said during his keynote address at an annual conference on health data transparency. This “requires an enormous amount of change and it is our job to help everyone adapt and succeed. The implication for us at CMS is that we need to be more modern, more strategic, and culturally a fast-moving, responsive, and transparent agency that leads and enables change.”
Mr. Slavitt identified four key areas for focus: privacy and security, real consumer benefit, learning and productivity, and connectivity. To improve his agency’s connectivity to providers, Mr. Slavitt said that it has recently created a new email box – [email protected] – to allow doctors and others who are experiencing information blocking issues to help the agency address concerns.
“Data blocking will not be tolerated,” Mr. Slavitt said. “We don’t experience care in silos and our data can’t live in silos.”
To spur the transition to a more information-based health care industry, Mr. Slavitt announced a number of data-sharing initiatives aimed at spurring on further data transparency.
First, the agency will be releasing its data to commercial entities. “We are aiming directly at shaking up health care innovation and setting a new standard for data transparency,” Mr. Slavitt said.
Innovators will have access to granular CMS program data, including de-identified Medicare fee-for-service claims data, with the hopes that they will be able to create care management and predictive modeling tools.
“While this is a big departure, we do this with a clear expectation that you will create a new stream of tools that will improve care and personalized decision-making and we are allowing companies to combine CMS data with other data so even what were small silos of data can have enough credibility to have meaning,” he said, challenging other organizations to open up their proprietary databases and match CMS’ move to open its data to commercial interests.
Mr. Slavitt also announced that data updates will be available on a quarterly basis. “In an information age, it is just not acceptable that the most recent Medicare data available to researchers is from 2013.”
He called on innovators to build products not for just the healthiest and wealthiest, but for the sickest in the population.
WASHINGTON – Data are so integral to the transition to value-based care that the health care industry must begin to think of itself as an information industry, according to Centers for Medicare & Medicaid Services Acting Administrator Andy Slavitt.
“Health care will either remain a series of best guesses or it will turn into an information industry,” Mr. Slavitt said during his keynote address at an annual conference on health data transparency. This “requires an enormous amount of change and it is our job to help everyone adapt and succeed. The implication for us at CMS is that we need to be more modern, more strategic, and culturally a fast-moving, responsive, and transparent agency that leads and enables change.”
Mr. Slavitt identified four key areas for focus: privacy and security, real consumer benefit, learning and productivity, and connectivity. To improve his agency’s connectivity to providers, Mr. Slavitt said that it has recently created a new email box – [email protected] – to allow doctors and others who are experiencing information blocking issues to help the agency address concerns.
“Data blocking will not be tolerated,” Mr. Slavitt said. “We don’t experience care in silos and our data can’t live in silos.”
To spur the transition to a more information-based health care industry, Mr. Slavitt announced a number of data-sharing initiatives aimed at spurring on further data transparency.
First, the agency will be releasing its data to commercial entities. “We are aiming directly at shaking up health care innovation and setting a new standard for data transparency,” Mr. Slavitt said.
Innovators will have access to granular CMS program data, including de-identified Medicare fee-for-service claims data, with the hopes that they will be able to create care management and predictive modeling tools.
“While this is a big departure, we do this with a clear expectation that you will create a new stream of tools that will improve care and personalized decision-making and we are allowing companies to combine CMS data with other data so even what were small silos of data can have enough credibility to have meaning,” he said, challenging other organizations to open up their proprietary databases and match CMS’ move to open its data to commercial interests.
Mr. Slavitt also announced that data updates will be available on a quarterly basis. “In an information age, it is just not acceptable that the most recent Medicare data available to researchers is from 2013.”
He called on innovators to build products not for just the healthiest and wealthiest, but for the sickest in the population.
AT HEALTH DATAPALOOZA 2015
GAO questions CMS reliance on RUC to set Medicare pay rates
A government watchdog report suggests that the Centers for Medicare & Medicaid Services may be setting Medicare payment rates inaccurately based on biased recommendations from its panel of physician experts.
The Government Accountability Office (GAO) questions the transparency of the CMS’ rate calculation process and suggests that members of the American Medical Association/Specialty Society Relative Value Scale Update Committee (RUC) have conflicts of interest that affect their ability to fairly value physician services, according to a report published May 21.
The GAO report recommends that the CMS better document its process for establishing relative values and develop a process to inform the public of potentially misvalued services identified by the RUC. The CMS also should develop a plan for using funds appropriated for the collection and use of information on physicians’ services in the determination of relative values, the report stated.
In response, the American Medical Association defended the expertise and objectivity of the RUC, stressing that there is no substitute for input from experienced physicians regarding the time and resources that go into medical services.
“The RUC’s valuable expertise is balanced with the oversight of government officials who have the final say,” an AMA spokesperson said in an interview. “When CMS’ initial efforts to identify potentially misvalued services were unable to obtain reliable data from government contractors, physicians on the RUC took on this important task. When gauging how much time and resources go into one medical service compared with another, no one knows more about what is involved in providing services to Medicare patients than the physicians who care for them.”
Dr. Robert L. Wergin, president of the American Academy of Family Physicians (AAFP) said the GAO report findings are consistent with previous concerns raised by the AAFP about the RUC.
“We have advocated for more transparency” in the past, Dr. Wergin said in an interview. “We have requested that the RUC expose the survey process, and we’ve also given input that we improve it [and] make it more accurate. Adding transparency to the process might be a way to improve it.”
In its review, the GAO – a nonpartisan investigational agency of Congress – cited several weaknesses in the data collected by the RUC, including that some RUC survey data had low response rates, a low total number of responses, and large ranges in responses.
For example, the GAO found that the median number of responses to surveys for payment year 2015 was 52 but the median response rate was only 2%, and that 23 of the 231 surveys had under 30 respondents.
The report also questions the transparency of the CMS process for establishing relative values. Although the CMS states that it complies with statutory requirements to review all Medicare services every 5 years, the agency does not maintain a database to track when a service was last valued or have a documented standardized process for prioritizing its reviews, according to the GAO report.
The CMS also does not publish the potentially misvalued services identified by the RUC, so stakeholders are unaware that these services will be reviewed and payment rates for these services may change.
The report found that the CMS provides some information about its process in its rule-making but does not document the methods used to review specific RUC recommendations. For example, the CMS does not document which resources were considered during its review of RUC recommendations for specific services. The GAO report said the CMS relies too heavily on RUC recommendations when establishing relative values.
“GAO found that, in the majority of cases, CMS accepts the RUC’s recommendations, and participation by other stakeholders is limited,” the report authors said. “Given the process- and data-related weaknesses associated with the RUC’s recommendations, such heavy reliance on the RUC could result in inaccurate Medicare payment rates.”
The AMA argued that the GAO report should have better acknowledged the difficulty in obtaining data on services that are infrequently performed. For example, 80% of services paid with work valuation on the Medicare physician payment schedule have fewer than 10,000 Medicare claims per year, the association noted.
“A service performed 10,000 times per year, is done, on average, less than once per day in any state,” the AMA spokesperson said. “It would be nearly impossible to do accurate direct observation or time/motion studies to collect time data on these low volume services. The survey methodology, followed by rigorous cross-specialty RUC review, is the best way to accomplish this data collection.”
The current GAO report is far from the first to criticize the RUC. The AAFP has long argued that the RUC should include more family physicians, health plans, consumers, employers, and health care economists on its panel. In 2012, the committee added another seat for geriatric medicine and another rotating primary care seat.
In an interview, Dr. Wergin said these additions helped, but that the AAFP would like to see at least one more primary care slot, as well as slots for other stakeholders. In a January 2014 letter, the AAFP called on the CMS to correct what the AAFP referred to as “a disturbing trend seen in the recommendations of RUC.” Specifically, the AAFP urged the CMS to address undervalued services, such as office-based evaluation and management (E/M) codes.
The Medicare Payment Advisory Commission (MedPAC), an independent advisory commission to Congress, has also issued several reports questioning the effectiveness of the RUC, including a 2011 white paper that expressed skepticism about the way in which data is collected by the panel. In 2013, MedPAC executive director Mark E. Miller, in testimony before the Senate Finance Committee, criticized how the RUC operated.
In the last Congress, Rep. Jim McDermott (D-Wash.), ranking member of the Ways and Means Committee’s Subcommittee on Health, introduced the Accuracy in Medicare Physician Payment Act of 2013, which would supplement the work of RUC by establishing an expert panel within Medicare to oversee the valuation of physician services and to help correct distortions in the physician fee schedule. The bill was not considered by the House.
On Twitter @legal_med
A government watchdog report suggests that the Centers for Medicare & Medicaid Services may be setting Medicare payment rates inaccurately based on biased recommendations from its panel of physician experts.
The Government Accountability Office (GAO) questions the transparency of the CMS’ rate calculation process and suggests that members of the American Medical Association/Specialty Society Relative Value Scale Update Committee (RUC) have conflicts of interest that affect their ability to fairly value physician services, according to a report published May 21.
The GAO report recommends that the CMS better document its process for establishing relative values and develop a process to inform the public of potentially misvalued services identified by the RUC. The CMS also should develop a plan for using funds appropriated for the collection and use of information on physicians’ services in the determination of relative values, the report stated.
In response, the American Medical Association defended the expertise and objectivity of the RUC, stressing that there is no substitute for input from experienced physicians regarding the time and resources that go into medical services.
“The RUC’s valuable expertise is balanced with the oversight of government officials who have the final say,” an AMA spokesperson said in an interview. “When CMS’ initial efforts to identify potentially misvalued services were unable to obtain reliable data from government contractors, physicians on the RUC took on this important task. When gauging how much time and resources go into one medical service compared with another, no one knows more about what is involved in providing services to Medicare patients than the physicians who care for them.”
Dr. Robert L. Wergin, president of the American Academy of Family Physicians (AAFP) said the GAO report findings are consistent with previous concerns raised by the AAFP about the RUC.
“We have advocated for more transparency” in the past, Dr. Wergin said in an interview. “We have requested that the RUC expose the survey process, and we’ve also given input that we improve it [and] make it more accurate. Adding transparency to the process might be a way to improve it.”
In its review, the GAO – a nonpartisan investigational agency of Congress – cited several weaknesses in the data collected by the RUC, including that some RUC survey data had low response rates, a low total number of responses, and large ranges in responses.
For example, the GAO found that the median number of responses to surveys for payment year 2015 was 52 but the median response rate was only 2%, and that 23 of the 231 surveys had under 30 respondents.
The report also questions the transparency of the CMS process for establishing relative values. Although the CMS states that it complies with statutory requirements to review all Medicare services every 5 years, the agency does not maintain a database to track when a service was last valued or have a documented standardized process for prioritizing its reviews, according to the GAO report.
The CMS also does not publish the potentially misvalued services identified by the RUC, so stakeholders are unaware that these services will be reviewed and payment rates for these services may change.
The report found that the CMS provides some information about its process in its rule-making but does not document the methods used to review specific RUC recommendations. For example, the CMS does not document which resources were considered during its review of RUC recommendations for specific services. The GAO report said the CMS relies too heavily on RUC recommendations when establishing relative values.
“GAO found that, in the majority of cases, CMS accepts the RUC’s recommendations, and participation by other stakeholders is limited,” the report authors said. “Given the process- and data-related weaknesses associated with the RUC’s recommendations, such heavy reliance on the RUC could result in inaccurate Medicare payment rates.”
The AMA argued that the GAO report should have better acknowledged the difficulty in obtaining data on services that are infrequently performed. For example, 80% of services paid with work valuation on the Medicare physician payment schedule have fewer than 10,000 Medicare claims per year, the association noted.
“A service performed 10,000 times per year, is done, on average, less than once per day in any state,” the AMA spokesperson said. “It would be nearly impossible to do accurate direct observation or time/motion studies to collect time data on these low volume services. The survey methodology, followed by rigorous cross-specialty RUC review, is the best way to accomplish this data collection.”
The current GAO report is far from the first to criticize the RUC. The AAFP has long argued that the RUC should include more family physicians, health plans, consumers, employers, and health care economists on its panel. In 2012, the committee added another seat for geriatric medicine and another rotating primary care seat.
In an interview, Dr. Wergin said these additions helped, but that the AAFP would like to see at least one more primary care slot, as well as slots for other stakeholders. In a January 2014 letter, the AAFP called on the CMS to correct what the AAFP referred to as “a disturbing trend seen in the recommendations of RUC.” Specifically, the AAFP urged the CMS to address undervalued services, such as office-based evaluation and management (E/M) codes.
The Medicare Payment Advisory Commission (MedPAC), an independent advisory commission to Congress, has also issued several reports questioning the effectiveness of the RUC, including a 2011 white paper that expressed skepticism about the way in which data is collected by the panel. In 2013, MedPAC executive director Mark E. Miller, in testimony before the Senate Finance Committee, criticized how the RUC operated.
In the last Congress, Rep. Jim McDermott (D-Wash.), ranking member of the Ways and Means Committee’s Subcommittee on Health, introduced the Accuracy in Medicare Physician Payment Act of 2013, which would supplement the work of RUC by establishing an expert panel within Medicare to oversee the valuation of physician services and to help correct distortions in the physician fee schedule. The bill was not considered by the House.
On Twitter @legal_med
A government watchdog report suggests that the Centers for Medicare & Medicaid Services may be setting Medicare payment rates inaccurately based on biased recommendations from its panel of physician experts.
The Government Accountability Office (GAO) questions the transparency of the CMS’ rate calculation process and suggests that members of the American Medical Association/Specialty Society Relative Value Scale Update Committee (RUC) have conflicts of interest that affect their ability to fairly value physician services, according to a report published May 21.
The GAO report recommends that the CMS better document its process for establishing relative values and develop a process to inform the public of potentially misvalued services identified by the RUC. The CMS also should develop a plan for using funds appropriated for the collection and use of information on physicians’ services in the determination of relative values, the report stated.
In response, the American Medical Association defended the expertise and objectivity of the RUC, stressing that there is no substitute for input from experienced physicians regarding the time and resources that go into medical services.
“The RUC’s valuable expertise is balanced with the oversight of government officials who have the final say,” an AMA spokesperson said in an interview. “When CMS’ initial efforts to identify potentially misvalued services were unable to obtain reliable data from government contractors, physicians on the RUC took on this important task. When gauging how much time and resources go into one medical service compared with another, no one knows more about what is involved in providing services to Medicare patients than the physicians who care for them.”
Dr. Robert L. Wergin, president of the American Academy of Family Physicians (AAFP) said the GAO report findings are consistent with previous concerns raised by the AAFP about the RUC.
“We have advocated for more transparency” in the past, Dr. Wergin said in an interview. “We have requested that the RUC expose the survey process, and we’ve also given input that we improve it [and] make it more accurate. Adding transparency to the process might be a way to improve it.”
In its review, the GAO – a nonpartisan investigational agency of Congress – cited several weaknesses in the data collected by the RUC, including that some RUC survey data had low response rates, a low total number of responses, and large ranges in responses.
For example, the GAO found that the median number of responses to surveys for payment year 2015 was 52 but the median response rate was only 2%, and that 23 of the 231 surveys had under 30 respondents.
The report also questions the transparency of the CMS process for establishing relative values. Although the CMS states that it complies with statutory requirements to review all Medicare services every 5 years, the agency does not maintain a database to track when a service was last valued or have a documented standardized process for prioritizing its reviews, according to the GAO report.
The CMS also does not publish the potentially misvalued services identified by the RUC, so stakeholders are unaware that these services will be reviewed and payment rates for these services may change.
The report found that the CMS provides some information about its process in its rule-making but does not document the methods used to review specific RUC recommendations. For example, the CMS does not document which resources were considered during its review of RUC recommendations for specific services. The GAO report said the CMS relies too heavily on RUC recommendations when establishing relative values.
“GAO found that, in the majority of cases, CMS accepts the RUC’s recommendations, and participation by other stakeholders is limited,” the report authors said. “Given the process- and data-related weaknesses associated with the RUC’s recommendations, such heavy reliance on the RUC could result in inaccurate Medicare payment rates.”
The AMA argued that the GAO report should have better acknowledged the difficulty in obtaining data on services that are infrequently performed. For example, 80% of services paid with work valuation on the Medicare physician payment schedule have fewer than 10,000 Medicare claims per year, the association noted.
“A service performed 10,000 times per year, is done, on average, less than once per day in any state,” the AMA spokesperson said. “It would be nearly impossible to do accurate direct observation or time/motion studies to collect time data on these low volume services. The survey methodology, followed by rigorous cross-specialty RUC review, is the best way to accomplish this data collection.”
The current GAO report is far from the first to criticize the RUC. The AAFP has long argued that the RUC should include more family physicians, health plans, consumers, employers, and health care economists on its panel. In 2012, the committee added another seat for geriatric medicine and another rotating primary care seat.
In an interview, Dr. Wergin said these additions helped, but that the AAFP would like to see at least one more primary care slot, as well as slots for other stakeholders. In a January 2014 letter, the AAFP called on the CMS to correct what the AAFP referred to as “a disturbing trend seen in the recommendations of RUC.” Specifically, the AAFP urged the CMS to address undervalued services, such as office-based evaluation and management (E/M) codes.
The Medicare Payment Advisory Commission (MedPAC), an independent advisory commission to Congress, has also issued several reports questioning the effectiveness of the RUC, including a 2011 white paper that expressed skepticism about the way in which data is collected by the panel. In 2013, MedPAC executive director Mark E. Miller, in testimony before the Senate Finance Committee, criticized how the RUC operated.
In the last Congress, Rep. Jim McDermott (D-Wash.), ranking member of the Ways and Means Committee’s Subcommittee on Health, introduced the Accuracy in Medicare Physician Payment Act of 2013, which would supplement the work of RUC by establishing an expert panel within Medicare to oversee the valuation of physician services and to help correct distortions in the physician fee schedule. The bill was not considered by the House.
On Twitter @legal_med
ED revisits twice as frequent as expected
The rate of adult revisits to emergency departments is more than twice as high as has been reported previously – 8% at 3 days and 20% at 30 days – in large part because until now researchers have failed to account for revisits to different hospitals, according to a report published online June 1 in Annals of Internal Medicine.
Little is known about returns to an emergency department following an index ED visit because most studies have assessed only visits to a single institution or to hospitals within a single state or insurance plan. Now researchers have performed a broader examination of the issue by analyzing newly available multistate longitudinal data from the Healthcare Cost and Utilization Project, which allowed them to identify returns to any ED or acute-care hospital. They focused on acute-care revisits after 57,530,239 initial ED visits by adults in six states (Arizona, California, Florida, Nebraska, Utah, and Hawaii) during 2006-2010.
At 3 days after an initial ED visit, the overall revisit rate was 8.2%, with one-third of these revisits occurring at a medical facility different from that of the initial visit. Previously, estimates of 3-day revisits have ranged from 2.7% to 3.4%. At 30 days, the revisit rate was 20%, and approximately one-third of these revisits involved a different facility. Revisits to different institutions “may have special clinical and financial implications because fragmentation of care increases the likelihood of duplication of services and problems with care transitions,” said Dr. Reena Duseja of the department of emergency medicine, University of California, San Francisco, and her associates.
“The scope of revisits to outside institutions is much greater than previously suspected, which suggests that improving communication infrastructure across institutions (such as health information exchanges) may improve care and allow individual institutions to get a more accurate picture of their revisit rates,” they noted (Ann. Intern. Med. 2015 June 1 [doi:10.7326/M14-1616]).
Revisit rates varied substantially according to diagnosis. “Skin and subcutaneous tissue infection”accounted for 23% of revisits. “Abdominal pain” was the diagnosis with the next highest revisit rate (10%). The most frequent diagnosis among patients who revisited a different hospital was back pain (2.6%), and nonspecific chest pain was the diagnosis with the highest rate of later admission to a different hospital (1.1%).
Financial data from the Florida facilities showed that revisits accounted for more of the total costs of ED care than initial visits did. This demonstrates that revisits are a major, and unaccounted for, component of emergency care costs, Dr. Duseja and her associates said.
Because of insufficient data, they could not determine whether these revisits reflected inadequate access to primary care, patient nonadherence to treatment recommendations, poor quality of care at the initial visit, or other factors, the researchers noted.
The findings of Duseja et al. highlight an underappreciated problem and also raise important questions.
To what extent do ED revisits represent gaps in quality as opposed to reasonable strategies that prevent admissions? How often are revisits due to failures of transitional care, suboptimal patient education, or lack of timely follow-up? And why do patients so often seek care at different institutions? Are they dissatisfied with their initial encounter, exercising greater discretion in choosing a facility the second time around, or doing something else?
Dr. Kumar Dharmarajan and Dr. Harlan M. Krumholz are at the Center for Outcomes Research and Evaluation, Yale University, New Haven Conn. Dr. Dharmarajan reported receiving grant support from the National Institute on Aging and the American Federation for Aging Research. Dr. Krumholz reported receiving grant support from the National Heart, Lung, and Blood Institute and the Center for Cardiovascular Outcomes Research at Yale. The investigators made these remarks in an editorial accompanying Dr. Duseja’s report (Ann. Intern. Med. 2015 June 1 [doi:10.7326/M15-0878]).
The findings of Duseja et al. highlight an underappreciated problem and also raise important questions.
To what extent do ED revisits represent gaps in quality as opposed to reasonable strategies that prevent admissions? How often are revisits due to failures of transitional care, suboptimal patient education, or lack of timely follow-up? And why do patients so often seek care at different institutions? Are they dissatisfied with their initial encounter, exercising greater discretion in choosing a facility the second time around, or doing something else?
Dr. Kumar Dharmarajan and Dr. Harlan M. Krumholz are at the Center for Outcomes Research and Evaluation, Yale University, New Haven Conn. Dr. Dharmarajan reported receiving grant support from the National Institute on Aging and the American Federation for Aging Research. Dr. Krumholz reported receiving grant support from the National Heart, Lung, and Blood Institute and the Center for Cardiovascular Outcomes Research at Yale. The investigators made these remarks in an editorial accompanying Dr. Duseja’s report (Ann. Intern. Med. 2015 June 1 [doi:10.7326/M15-0878]).
The findings of Duseja et al. highlight an underappreciated problem and also raise important questions.
To what extent do ED revisits represent gaps in quality as opposed to reasonable strategies that prevent admissions? How often are revisits due to failures of transitional care, suboptimal patient education, or lack of timely follow-up? And why do patients so often seek care at different institutions? Are they dissatisfied with their initial encounter, exercising greater discretion in choosing a facility the second time around, or doing something else?
Dr. Kumar Dharmarajan and Dr. Harlan M. Krumholz are at the Center for Outcomes Research and Evaluation, Yale University, New Haven Conn. Dr. Dharmarajan reported receiving grant support from the National Institute on Aging and the American Federation for Aging Research. Dr. Krumholz reported receiving grant support from the National Heart, Lung, and Blood Institute and the Center for Cardiovascular Outcomes Research at Yale. The investigators made these remarks in an editorial accompanying Dr. Duseja’s report (Ann. Intern. Med. 2015 June 1 [doi:10.7326/M15-0878]).
The rate of adult revisits to emergency departments is more than twice as high as has been reported previously – 8% at 3 days and 20% at 30 days – in large part because until now researchers have failed to account for revisits to different hospitals, according to a report published online June 1 in Annals of Internal Medicine.
Little is known about returns to an emergency department following an index ED visit because most studies have assessed only visits to a single institution or to hospitals within a single state or insurance plan. Now researchers have performed a broader examination of the issue by analyzing newly available multistate longitudinal data from the Healthcare Cost and Utilization Project, which allowed them to identify returns to any ED or acute-care hospital. They focused on acute-care revisits after 57,530,239 initial ED visits by adults in six states (Arizona, California, Florida, Nebraska, Utah, and Hawaii) during 2006-2010.
At 3 days after an initial ED visit, the overall revisit rate was 8.2%, with one-third of these revisits occurring at a medical facility different from that of the initial visit. Previously, estimates of 3-day revisits have ranged from 2.7% to 3.4%. At 30 days, the revisit rate was 20%, and approximately one-third of these revisits involved a different facility. Revisits to different institutions “may have special clinical and financial implications because fragmentation of care increases the likelihood of duplication of services and problems with care transitions,” said Dr. Reena Duseja of the department of emergency medicine, University of California, San Francisco, and her associates.
“The scope of revisits to outside institutions is much greater than previously suspected, which suggests that improving communication infrastructure across institutions (such as health information exchanges) may improve care and allow individual institutions to get a more accurate picture of their revisit rates,” they noted (Ann. Intern. Med. 2015 June 1 [doi:10.7326/M14-1616]).
Revisit rates varied substantially according to diagnosis. “Skin and subcutaneous tissue infection”accounted for 23% of revisits. “Abdominal pain” was the diagnosis with the next highest revisit rate (10%). The most frequent diagnosis among patients who revisited a different hospital was back pain (2.6%), and nonspecific chest pain was the diagnosis with the highest rate of later admission to a different hospital (1.1%).
Financial data from the Florida facilities showed that revisits accounted for more of the total costs of ED care than initial visits did. This demonstrates that revisits are a major, and unaccounted for, component of emergency care costs, Dr. Duseja and her associates said.
Because of insufficient data, they could not determine whether these revisits reflected inadequate access to primary care, patient nonadherence to treatment recommendations, poor quality of care at the initial visit, or other factors, the researchers noted.
The rate of adult revisits to emergency departments is more than twice as high as has been reported previously – 8% at 3 days and 20% at 30 days – in large part because until now researchers have failed to account for revisits to different hospitals, according to a report published online June 1 in Annals of Internal Medicine.
Little is known about returns to an emergency department following an index ED visit because most studies have assessed only visits to a single institution or to hospitals within a single state or insurance plan. Now researchers have performed a broader examination of the issue by analyzing newly available multistate longitudinal data from the Healthcare Cost and Utilization Project, which allowed them to identify returns to any ED or acute-care hospital. They focused on acute-care revisits after 57,530,239 initial ED visits by adults in six states (Arizona, California, Florida, Nebraska, Utah, and Hawaii) during 2006-2010.
At 3 days after an initial ED visit, the overall revisit rate was 8.2%, with one-third of these revisits occurring at a medical facility different from that of the initial visit. Previously, estimates of 3-day revisits have ranged from 2.7% to 3.4%. At 30 days, the revisit rate was 20%, and approximately one-third of these revisits involved a different facility. Revisits to different institutions “may have special clinical and financial implications because fragmentation of care increases the likelihood of duplication of services and problems with care transitions,” said Dr. Reena Duseja of the department of emergency medicine, University of California, San Francisco, and her associates.
“The scope of revisits to outside institutions is much greater than previously suspected, which suggests that improving communication infrastructure across institutions (such as health information exchanges) may improve care and allow individual institutions to get a more accurate picture of their revisit rates,” they noted (Ann. Intern. Med. 2015 June 1 [doi:10.7326/M14-1616]).
Revisit rates varied substantially according to diagnosis. “Skin and subcutaneous tissue infection”accounted for 23% of revisits. “Abdominal pain” was the diagnosis with the next highest revisit rate (10%). The most frequent diagnosis among patients who revisited a different hospital was back pain (2.6%), and nonspecific chest pain was the diagnosis with the highest rate of later admission to a different hospital (1.1%).
Financial data from the Florida facilities showed that revisits accounted for more of the total costs of ED care than initial visits did. This demonstrates that revisits are a major, and unaccounted for, component of emergency care costs, Dr. Duseja and her associates said.
Because of insufficient data, they could not determine whether these revisits reflected inadequate access to primary care, patient nonadherence to treatment recommendations, poor quality of care at the initial visit, or other factors, the researchers noted.
Key clinical point: Revisits to the emergency department were twice as frequent as previously reported: 8% at 3 days and 20% at 30 days.
Major finding: At 3 days after an initial ED visit, the overall revisit rate was 8.2%, and at 30 days it was 20%, with one-third of these revisits occurring at a medical facility different from that of the initial visit.
Data source: A longitudinal, population-based study of adult revisits to the ED after 57,530,239 initial visits in six states during 2006-2010.
Disclosures: This study was supported by the U.S. Agency for Healthcare Research and Quality. The researchers’ financial disclosures are available at www.acponline.org
