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February 1, 2010 |
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IN THIS ISSUE
Editor's Column: Another Inconvenient Truth
Haiti: Call To Action
SGR Repeal Protected For Now, Action Still Needed
Dr. Bepler To Lead Karmanos
Joint Effort Produces Environmental Cancer Center
Karmanos Credits Pols For Image Center Funding
Medical Liability Rate Reductions Level Off
2010 Medicare Payment Schedule Summary Available
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Editor's Column: Another Inconvenient
Truth
By JOSEPH WEISS, MD
The December 9 issue of the Journal of the American Medical
Association (JAMA) included a 6-page article equal in importance to
the 2,073 page bill now before Congress.
The JAMA article carries the title: Relationship of
Primary Care Physicians’ Caseload With Measurement of Quality and
Cost Performance. (Nyweide David J. et al: JAMA, December 9,
2009; Vol 302, No.22, pp2444-2450). The authors asked if
practitioners caring for Medicare patients see sufficient numbers of
outpatients to assess individual physician performance in a
statistically valid manner. Nyweide et al found:
·
The majority of primary care physicians work in small or
solo practices with no one physician seeing sufficient Medicare
patients to permit performance evaluation
·
No practices of under six physicians had sufficient numbers
of patients to detect a 10 percent difference in cost or quality
with any other physician group
·
To make comparisons of cost or quality consistently required
a group of 50 or more primary care physicians. At present, groups
that size represent 0.2 percent of primary physician groups in
America
·
No primary care group, no matter what size, could generate
sufficient caseloads to detect a difference between physician groups
of preventable hospitalization or less than 30-day re-admission.
The authors point out that their findings cast doubt on the
validity of Pay-for- Performance and the Physician Quality Reporting
Measures as means of rewarding superior performance. The patients
that physicians report on, are too small in number to qualify for a
reward for superior care.
The implication for physicians is that at some point
insurance companies, and that includes Medicare, will put an end to
physicians working in solo or small group practice. The insurers
will mandate that physicians work in groups large enough to generate
performance comparison statistics.
Furthermore, those of us who now participate in Pay for
Performance or Quality Reporting should realize we are involved in
an undertaking that is both a sham and a scam. Nyweide et al reveals
that what we report is false as a measure of quality; that is the
sham. Once having read Nyweide et al, we know we are taking the
money under false pretenses; that is the scam.
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Haiti: Call To Action
Editor's note:
AMA President J. James Rohack, MD, sent this message to the nation’s
physicians on Jan. 26.
Physician
volunteers needed to support Haiti relief efforts—sign up today
Dear physicians:
While hospitals
in Haiti have reported a decrease in emergency patients and
hospitalizations since the middle of last week, the need for
continued medical assistance is still significant. As a result, the
need for all physicians—within the disciplines of primary care,
surgery and rehabilitation—will continue over the following months.
This news
surfaced when representatives from the AMA’s Center for Public
Health Preparedness and Disaster Response met with federal officials
and other private sector partners in Washington, D.C., last week. I
encourage you—as the AMA remains heavily engaged with the
international response community—to consider how you too can help
with this effort.
The AMA/NDLS™
Disaster Volunteer Physician Registry provides an easy and
convenient means to facilitate and coordinate the deployment of
physicians who are willing to volunteer with federal and private
sector response organizations. The information you provide will be
used specifically for disaster response deployment to Haiti, but it
may also be employed should future disasters occur around the world.
Visit
http://www.ama-assn.org/ama/pub/physician-resources/public-health/center-public-health-preparedness-disaster-response/haiti-earthquake/help/haiti-volunteer.shtml
to access the registry.
Remember, the
health care infrastructure in Port-au-Prince and other areas
affected by the Jan. 12 earthquake and subsequent aftershocks have
suffered significant damage. This environment isn’t one that many of
us have ever seen before. It’s physically challenging, austere and
resource-constrained. Therefore, we must be self-sufficient and able
to work independently.
We also must be
prepared. If you want to help, start by viewing a free online
training program from the AMA and the National Disaster Life Support
(NDLS) Education Consortium™ entitled “Medical and public health
responders: Prepare for the Haitian earthquake disaster relief
efforts.” It will help you gain a better understanding of the
essential clinical and public health skills needed to manage
individuals and populations affected by the earthquake. Visit
http://www.ama-assn.org/ama/pub/news/news/haiti-earthquake-response.shtml
to view the program.
Visit
http://www.ama-assn.org/ama/pub/physician-resources/public-health/center-public-health-preparedness-disaster-response/national-disaster-life-support/ndlsec.shtml
to learn more about the NDLS Education Consortium™.
It truly is an
amazing thing how we as a nation and the entire world have quickly
come together to help our fellow members of mankind. Practicing
physicians, we need your help. Visit
www.ama-assn.org/go/haiti-volunteer to learn more about
the AMA/NDLS™ Disaster Volunteer Physician Registry, or to register,
today. And thank you—your efforts are deeply appreciated.
- J. James Rohack,
MD, AMA president
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SGR Repeal
Protected For Now, Action Still Needed
Editor's note:
The following is from an AMA Advocacy Update. To view the full
update, click here.
On January 28,
the Senate passed H.J. Res. 45, a resolution to raise the federal
debt limit. Included in the resolution was a provision that
reinstitutes pay-as-you-go, or PAYGO, rules for new federal
spending. Under PAYGO terms, any new spending or tax cuts passed by
Congress would have to be offset by corresponding spending cuts or
tax increases. Importantly, several limited exemptions were made to
the PAYGO rule, including one for addressing the Medicare physician
payment cuts being produced by the sustainable growth rate (SGR)
formula.
Some have
characterized the SGR exemption as a five-year freeze. While the
exemption reflects the amount that could be used to fund a five-year
freeze with larger cuts and a higher cost for repealing the formula
in the out years, the actual exemption does not implement new
Medicare physician payment policy. Instead, this action means that
up to $82 billion spent for an SGR fix would not have to be offset
by other revenue or cuts. The House is expected to take up H.J. Res.
45 this week.
The House of
Representative is expected to pass H.J. Res. 45 with the PAYGO and
SGR provisions. Congress must still enact separate legislation to
stop the SGR cuts prior to March 1. To obtain permanent repeal of
the flawed payment formula, the PAYGO exception must be accompanied
by an additional $130 billion in budget offsets.
AMA position: The
AMA continues to insist that Congress pass legislation to
permanently repeal the SGR.
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Dr. Bepler To Lead
Karmanos
Dr. Gerold Bepler
has been named president and ceo of the Barbara Ann Karmanos Cancer
Institute.
The
selection follows a 10-month search. Dr. Bepler will also chair the
soon-to-be-created Wayne State University Department of Oncology at
WSU's School of Medicine.
A thoracic
oncologist, Bepler most was director of the Comprehensive Lung
Cancer Research Center, department chair of Thoracic Oncology and
program leader of the Lung Cancer Program at the Moffitt Cancer
Center in Tampa, Fla.
"Dr. Bepler comes
to us with exceptional experience in oncology, both in the clinical
and research settings," said Alan S. Schwartz, chair of the
institute board of directors in a press release. "His expertise,
leadership and knowledge will help us achieve our mission as one of
the top cancer centers in the nation. We are excited to enter this
new chapter under his leadership."
Bepler has
received nearly $24 million in research funding over the past 13
years from the National Cancer Institute and has published more than
100 articles, according to a press release.
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Joint Effort Produces Environmental
Cancer Center
Editor’s note:
the following is a letter to physicians from Dr. Michael Harbut
regarding a new cancer initiative.
In conjunction
with Michigan Blue Cross/Blue Shield and the US Centers for Disease
Control’s Agency for Toxic Substances and Disease Registry (ATSDR),
it is our hope that working together we can help stop cancers caused
by environmental exposures in their earliest stages or before they
begin.
The most recent data suggests that over 30% of lung cancers are
caused by environmental agents AFTER controlling for smoking.
Because Michigan has a high rate of lung and bronchus cancers and
because three environmental carcinogens – asbestos, arsenic and
radon, which can have an additive, synergistic or independent effect
on tobacco-caused lung cancer - are common in Michigan, we’ve
developed a program to help you identify patients at risk.
Details are included in this site, but the basic approach involves
on-line CME’s developed by the ATSDR, identification of patients,
appropriate diagnostics and treatment in addition to referrals to
appropriate specialty centers if needed.
If you are a member of a Blue Cross “PGIP PO”, and are a primary
care physician, a pulmonologist or oncologist as defined by BCBS,
Blue Cross will pay you a $500 honorarium on completion of the CME
part of the program.
I want to stress to you that this is a new program, never having
been attempted before in the United States. There will be learning
as we’re going, so I hope you’ll bear with us.
We are phasing in the initiative over six months, with January and
February at Providence Hospital in Southfield; March through June at
the St. John’s System and then in July, we’ll be statewide.
Sincerely,
Michael R. Harbut, MD, MPH
Director, Environmental Cancer Initiative,
Karmanos Cancer Center
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Karmanos Credits
Pols For Imaging Center Funding
The Wayne State
University School of Medicine’s oncology affiliate, the Barbara Ann
Karmanos Cancer Institute, has announced that $4.76 million for its
National Oncogenomics and Molecular Imaging Center has been secured
in the Department of Defense Appropriations budget.
Karmanos
administrators credited U.S. Rep. Carolyn Cheeks Kilpatrick, along
with U.S. Sens. Carl Levin and Debbie Stabenow, with securing the
funding.
The appropriation
will help School of Medicine and Karmanos researchers continue their
work to develop technology that will allow for the diagnosis of
human cancer by defining oncogene signatures that characterize
cancers in individual patients. Oncogenes are the mutated forms of
genes that cause normal cells to grow out of control and become
cancer cells. The center provides imaging technology capable of
greatly improving the detection of genes that cause cancer, as well
as measure the treatment response.
Launched in 2008,
the Karmanos Cancer Institute’s NOMIC is led by project director
Stephen Ethier, PhD, professor of the WSU Department of Pathology
and deputy director of the Karmanos Cancer Institute. Anthony
Shields, MD, PhD, professor of Medicine and Oncology at the School
of Medicine, is the co-investigator. A member of the Wayne State
University Physician Group, Dr. Shields also serves as associate
center director for Clinical Research and program leader for
Developmental Therapeutics at the Karmanos Cancer Institute.
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Medical Liability
Rate Reductions Level Off
The AMA has
completed a new analysis of medical professional liability insurance
premiums from the 2009 Medical Liability Monitor survey. Medical
Professional Liability Insurance Premiums: Changes and Levels,
2004-2009, concludes, while the medical liability climate has
improved compared to the liability crisis in the early part of the
decade, decreases in premiums of recent years are starting to level
off. Most premium levels reported in 2009 did not change and of
those that fell, the majority of the decreases were relatively
small. Thus, given the magnitude of increases from earlier in the
decade, premiums remain high in many states—some more than three
times larger then they were prior to the liability crisis. The
report is available online at
http://www.ama-assn.org/ama1/x-ama/upload/mm/363/prp-200905-mlm-summary.pdf.
For the entire AMA Advocacy Update,
click here.
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2010 Medicare
Payment Schedule Summary Now Available
Every year the
2010 Medicare physician payment schedule contains numerous policy
changes that will affect different practices in different ways. Some
of the major changes this year include revised practice expense
relative values, elimination of Medicare payment for consultation
codes, new quality reporting options and simpler reporting
requirements for the e-prescribing incentive program. To learn more
about these changes, including projected payment impacts for each
specialty, go to
www.ama-assn.org/go/medicarepaymentkit and click on “2010
Medicare Physician Payment Schedule.” An updated version of the
AMA’s “Medicare Participation Options for Physicians” document is
also available at this site, including information on a recent
extension of the deadline for participation decisions to March 17,
2010.
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