E-DMN - June 11, 2007

June 11, 2007

Study Finds P4P Gains Not Significant
Blues Offers Electronic Payment
Medicare Cuts Could Leave 180,000 Without Coverage
Coalition Aims Push Technology Into Docs' Offices
Medical Boards Take Fewer Actions Against Physicians
House Group Presses Medical Liability Reform
AMA Consortium Releases New Quality Measures

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Study Finds P4P Gains Not Significant

A program offering financial incentives to hospitals did improve outcomes for heart attack patients, but those outcomes weren’t significantly better than for patients at hospitals that did not participate in the program, according to a recent study published in the Journal of the American Medical Association.

Researchers at Duke University Medical Center, Durham, NC, studied whether some of the hospitals participating in a CMS pilot project launched in 2003 showed more improvement in certain process measures and outcomes for treatment of heart attack than hospitals not in the program. The study analyzed data for 105,383 patients treated between July 2003 and June 2006 at 54 hospitals in the CMS program and 446 control hospitals. The researchers found significant improvement at both pay-for-performance and control hospitals with no significant difference in the rate of improvement between the two hospital groups.

The researchers concluded that although they did not find significantly stronger improvement in hospitals participating in the voluntary pay-for-performance program, they also did not find evidence that pay-for-performance had an adverse impact on processes that were not subject to financial incentives. The researchers also noted that the study is one of the first to evaluate the CMS pay-for-performance pilot, and additional studies are needed to determine the optimal role of pay-for-performance initiatives.

Blues Offers Electronic Payment

Blue Cross Blue Shield of Michigan has made electronic payments and online vouchers available to all Michigan professional providers, including billers of routine vision and hearing services. There is no cost to participate in this program, but you must have a BCBSM Provider Identification Number to enroll online.

Some of the advantages, according to the Blues:

Elimination of problems associated with multiple BCBSM mailings of checks and paper payment vouchers
No more worries about lost checks
Searchable and printable online vouchers
Access to 36 months of voucher history
Notice of rejected services available online

To register, visit www.bcbsm.com (click "I Am a Provider"). After you log in with your user ID and password, you will see a section for electronic funds transfer. Click on the link to "Register Provider(s)," complete all of the required information, and submit. It will take three to five weeks for your registration form to be processed before you begin to receive payments via electronic funds transfer (EFT). Until you are successfully enrolled, you will continue to receive payments and vouchers by mail.

It takes approximately 15 calendar days for your banking information to be verified after signing up. A one-cent deposit will be made to your bank account during the verification process. You will then receive a letter from BCBSM, confirming that the EFT registration is complete. Dental and facility providers, as well as payments for FEP and Medicare Advantage members, are not included in this new program at this time.

For more information about reimbursement issues, contact Stacie Saylor at MSMS at 517-336-5722 or ssaylor@msms.org. Get additional news and information from MSMS publications, such as Medigram, Michigan Medicine and the Monthly Top 10, online at www.msms.org.

Medicare Cuts Could Leave 180,000 Without Coverage

A new study conducted by health policy researchers from Emory University estimates that funding cuts to the Medicare Advantage program would cause more than 180,000 people in Michigan with Medicare Advantage plans to lose their coverage.

According to researchers Kenneth Thorpe and Adam Atherly, 24 states including Michigan would lose 50,000 or more enrollees if Congress adopted funding cuts recommended by the Medicare Payment Advisory Commission. Overall, more than 3 million beneficiaries would no longer have Medicare Advantage coverage. The study was commissioned by the Chicago-based Blue Cross and Blue Shield Association.

"This study shows the recommended funding cuts would be devastating to the Medicare Advantage program in Michigan," said Cathy Schmitt, vice president of federal programs for Blue Cross Blue Shield of Michigan. "Total Medicare Advantage enrollment in Michigan would plummet from 196,075 to an estimated 15,644 in 2008 — a 92 percent drop. Members would lose all the benefits they now enjoy under Medicare Advantage: coordinated care, lower cost sharing, benefits not offered under traditional Medicare and enhanced drug coverage."

The impact of the cuts would be most severe in rural and urban areas where Congress improved payments to ensure Medicare beneficiaries have access to Medicare Advantage plans.

Due to explicit policy decisions by Congress, national enrollment in Medicare Advantage is at an all-time high of more than 8 million people. According to Thorpe and Atherly, Medicare Advantage plans provided more than $5 billion in supplemental benefits in 2006, up from $3 billion in 2005.

The study examines two scenarios: reducing Medicare Advantage benchmarks to county-level fee-for-service claims costs, and freezing Medicare Advantage payments for multiple years. Overall, the study predicts reductions in Medicare Advantage enrollment even larger than those experienced under the Medicare+Choice program. Nearly 2 million people lost coverage following the enactment of the Balanced Budget Act of 1997, which held Medicare+Choice payment increases to 2 percent at a time when medical costs were growing at double-digit rates annually.

Low income and minority populations would be among the hardest-hit groups if funding for Medicare Advantage is cut. According to a 2005 Medicare Current Beneficiary Survey from the Centers for Medicare and Medicaid Services, minorities make up 27 percent of Medicare Advantage enrollment but only 20 percent of traditional Medicare. Therefore, of the 3 million members nationwide that would likely lose Medicare Advantage coverage, about 811,000 would be minority beneficiaries.

The study, entitled "The Impact of Reductions in Medicare Advantage Funding on Beneficiaries," is available online at bcbs.com/medicare.

Coalition Aims To Push Technology Into Docs' Offices

Two former lawmakers plan to lead a nationwide effort to get electronic health records, e-prescribing tools and a host of other health information technology components into doctors’ offices, hospitals and in front of patients in short order, according to a published report.

Former Rep. Nancy Johnson and former Sen. John Breaux are set to head Health IT Now!, a coalition of patient, clinical and business groups that plans to push for federal legislation that would pave the way to an interconnected health IT system.

The coalition wants to sway lawmakers this year to agree on a bill that codifies the government’s commitment to health IT; offers federal grants and loans to providers; resolves privacy and professional licensure issues between state and federal laws; and focuses on consumer empowerment through patient education.

On Capitol Hill today, Breaux compared the promise of health IT to a wonder drug that could instantly save hundreds of thousands of lives. If it were a pill, he said, “People would say, ‘Don’t delay, give it to us immediately. Bring this to market just as soon as you can.’ ”

Former Michigan Gov. John Engler, president of the National Association of Manufacturers—also a coalition member—called health IT a nonpartisan issue. “Improving the healthcare system is something everyone can agree on,” he said.

Johnson, former chairwoman of the Ways and Mean health subcommittee, could not attend the news briefing because of a congressional rule that bans for one year former lawmakers from lobbying in the Capitol building itself. Joel White, who was the staff director of the subcommittee under Johnson, is the coalition’s executive director.

Medical Boards Take Fewer Actions Against Physicians

Serious disciplinary actions taken against physicians by state medical boards in 2006 decreased by 10 percent nationwide, an indication that the boards require additional resources and legislative oversight, according to a report released recently by Public Citizen, the Virginian-Pilot reports (Young, Virginian-Pilot, 6/7). For the report, Public Citizen analyzed data from the Federation of State Medical Boards for 2004 through 2006 and ranked states based on the number of serious disciplinary actions taken by medical boards per 1,000 physicians. Serious disciplinary actions included medical license revocations, surrenders, suspensions and restrictions.

According to the report, serious disciplinary actions taken against physicians by state medical boards nationwide decreased to 2,916 in 2006 from 3,255 in 2005. The Alaska medical board took the highest rate of serious disciplinary actions at 7.3 per 1,000 physicians, followed by the boards in Kentucky, Wyoming, Ohio and Oklahoma, the report found. The Mississippi medical board took the lowest rate of serious disciplinary actions at 1.41 per 1,000 physicians, followed by the boards in South Carolina, Minnesota, South Dakota and Nevada, according to the report (Dorschner, Miami Herald, 6/7).

Nationwide, state medical boards took an average of 3.18 serious disciplinary actions per 1,000 physicians, the report found (Lerner, Minneapolis Star Tribune, 6/6). "There is considerable evidence that most boards are under-disciplining physicians," the report said (Miami Herald, 6/7).

Reaction
James Thompson, CEO of the Federation of State Medical Boards, said that the rankings in the report are a misrepresentation because of the "extraordinary variability of the autonomy, funding and authority to make disciplinary actions between state boards." He added that annual increases and decreases in the number of serious disciplinary actions taken by state medical boards are not uncommon and that the report highlights the need for additional autonomy, funds and staff for the boards (Phillips, CQ HealthBeat, 6/7).

The report is available at http://www.citizen.org/publications/release.cfm?ID=7525

House Group Presses Medical Liability Reform

A bipartisan group in the House of Representatives is trying once again to get a bill through Congress that seeks to reform the medical liability system by placing caps on pain-and-suffering damages, according to a published report.

“This is the fifth time in less than five years” that the House has voted to approve the Help Efficient, Accessible, Low-cost, Timely Healthcare, or HEALTH, Act, said Rep. Phil Gingrey (R-Ga.), chief sponsor of the bill, at a news conference.

The legislation sets a $250,000 cap on noneconomic damages and limits the number of years a plaintiff has to file a healthcare liability action to ensure that claims are brought while witnesses are still available and before evidence is destroyed. The provisions are modeled after a tort reform law in California, which has benefited from stable medical malpractice premiums, Gingrey said. Texas, which approved a similar law, “has seen an increase in subspecialists and a reduction in the cost of medical malpractice premiums,” affirming that “tort reform does work,” he added.

The bill has the support of 51 physician groups. Bipartisan bills introduced in the House and Senate several weeks ago took another approach to resolving the medical liability crisis: awarding grants to states to pilot “health courts” and other solutions. “I wouldn’t be opposed to this option,” Gingrey said.

AMA Consortium Releases New Quality Measures

10 new quality measures to help physicians provide high quality care to patients were approved June 1 by the American Medical Association (AMA)-convened Physician Consortium for Performance Improvement (Consortium). The measures bring the total number of Consortium physician quality measures to 184.

“Through the Consortium, physicians representing many medical specialties come together to continually improve patient care based on the best available scientific and clinical evidence," said Consortium Chair Bernard Rosof, MD. "The latest measures developed through this collaborative process will help physicians assess and treat prostate cancer, prevent infections in the hospital environment and provide standardized breast and colorectal cancer pathology reports."

All Consortium measures are available on the AMA Web site for physicians to easily access at http://www.ama-assn.org/ama/pub/category/2946.html . The Consortium was founded in the year 2000 to bring physicians together to create measures to implement best care practices, and with more than 100 national medical specialty and state medical societies, government and medical board members, the Consortium has already developed quality measures for conditions like hypertension, asthma and heart failure. The Consortium has developed performance measures that cover conditions that represent 80 percent of Medicare spending.

The June 1 meeting, held in Washington, DC, marks the second time this year the Consortium has met in Washington. In addition to voting on the measures, the group received an update on the Medicare's new quality reporting program, the Physician Quality Reporting Initiative (PQRI) that begins July 1. The PQRI relies mainly on Consortium measures, with 80 percent of the measures developed by the Consortium.

"The AMA is developing coding worksheets to help physicians and other health care professionals who choose to participate in Medicare's new quality reporting program," said AMA Speaker Nancy Nielsen, MD. The worksheets will soon be available to physicians on both the CMS and AMA Web site.

This publication brought to you by Natinsky Publishing Network.

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