|
December 15,
2008 |
|
IN THIS ISSUE
Editor's Column: P4P & PQRI: What Do They Really
Mean?
Recovery Audit Contractor (RAC) Put On Hold
Ron Davis, MD, Tribute Video From AMA
$35 Million Henry Ford Project To Open
Dr. Santucci Selected 'Germany Traveling Fellow'
WSUSOM News
Flu Vaccination: It's Not Too Late
Dachle To Have Dual Health Care Roles |
|
Click Here To Contact Us
|
Editor's Column: P4P & PQRI: What Do
They Really Mean?
BY JOSEPH WEISS, MD
Pay-for-performance (P4P) and the Physician Quality Reporting
Initiative (PQRI) are strategies by Medicare and the health
insurance companies to induce doctors to “do the right thing” by
paying them to do it.
The “right thing” usually represents a consensus from a
group of experts who cull the literature, review their lecture notes
and discuss among themselves what they think makes good medical
practice. The result is a guideline that Medicare and insurers use
as PQRI measures.
One result of this process is the Osteoporosis PQRI measures
that state that for a physician to qualify for a bonus in
osteoporosis care the physician must have documentation that answers
the following:
-
Have 80 percent or more of his/her woman patients ages 60-65
years had at least one DEXA evaluation (a bone-density measurement)
of the spine and femur?
-
Have all patients with a diagnosis of osteoporosis had a
DEXA at least once?
-
Are all patients with a diagnosis of osteoporosis under
therapy within 12 months of diagnosis?
-
Are 80 percent of patients using steroid therapy for more
than three months or who have a fracture history, dx of hypogonadism,
or are on Arimidex or similar anti-estrogen drug for breast cancer,
receiving pharmacologic therapy for osteoporosis?
-
Have 80 percent or more of patients with osteoporosis and
their caregivers received education on Vitamin D exercise and
calcium?
-
Have all patients age 50 years of age or older who suffered
a fracture received a DEXA examination and/or started on therapy to
prevent or treat osteoporosis?
-
Have all patients with a fracture received counseling on
smoking, drinking , risk fall and safety education?
It is not yet clear what fields a coder must fill in to flag
to Medicare or the gain an insurer’s attention that the physician
has carried through to qualify for the payment.
It is unclear how the physician will be able to remember all
his activities in each patient case to satisfy the demands of an
Osteoporosis PQRI.
What is clear from past experience is that payment by
insurers is erratic and that tracking by a physician’s office is
impossible. Furthermore, while each measure is reasonable, taken
together the groupings are impossible to record. Estimates are that
approximately 38 percent of physicians who submit for the 2 percent
bonuses will receive some payment; while most physicians believe
that they received less then they had coming.
Physicians can only conclude that that the financial rewards
are not worth the time and cost the reporting requires.
Not only is PQRI an administrative nightmare, but worse, it
is demeaning. We are asked to report in baby steps what we would do
and should do as physicians. We do not need a lecture nor an
incentive to know that any person, man or woman, who suffers a
fracture after a trivial fall, needs the status of their bone
structure assessed. We don’t need a bonus as an incentive to do what
the profession expects us to do.
Furthermore, we don’t need PQRI to improve our work habits.
In almost all of the specialty re-certifications, the process
requires that the physician undertake a project involving his or her
patients to improve their care. This is the best way: Physicians
working from their practice to advance patient care with monitoring
from colleagues.
Nevertheless, the government, demented and determined,
continues its PQRI initiatives. We can only hope that the federal
fiscal crisis that the sub-prime mess brings, will take money away
from marginal projects such as PQRI. Continuous improvement is best
left with us.
Managing Editor’s Note: The following is a link to the CMS
PQRI website, which contains background information and news about
the program:
http://www.cms.hhs.gov/pqri/
Share Your
Thoughts on this Article
Back
to top
|
Recovery Audit
Contractor (RAC) Put On Hold
The Centers
for Medicare & Medicaid Services (CMS) is required to impose an
automatic stay in the contract work of the four Recovery Audit
Contractor (RAC) program. This action is the result of protests
filed by two unsuccessful bidders for the RAC program with the
Government Accountability office (GAO).
According
the website for The Journal of Oncology Practice, “The
purpose of an RAC is to identify overpayments and
underpayments made by the Medicare program under Part A
and Part B. The RACs are also responsible for the
recoupment of overpayments made to providers.”
An automatic
stay will stop work for all four RAC regional awards until a
determination is made by GAO, as required under provisions of the
Competition and Contracting Act of 1984 (CICA).
Under the CICA,
GAO has 100 days to issue its decision, which means a decision would
be due for these protests in early February. The four RAC contracts
– and any work under those contracts – are on hold pending the
outcomes of the protests.
MSMS will
continue to monitor this development and communicate the results of
the protests when the GAO has made their decision.
The Medicare Prescription Drug Improvement and
Modernization Act of 2003, commonly referred to as the
Medicare Modernization Act (MMA), included a provision
that required the Centers for Medicare & Medicaid
Services (CMS) to demonstrate the applicability of audit
contractors to identify overpayments and underpayments,
and recoup overpayments made by the Medicare program. The following
questions and answers are provided to illustrate the CMS
initiative of audit contractors.
According to
The Journal of Oncology Practice, the RAC came about when, “Section
306 of the MMA specifically directed CMS to use audit
contractors to investigate Medicare claims. In response to the
legislative directive, CMS developed a three-year
demonstration project for the RAC initiative, which began
in March 2005. CMS is required to evaluate the
effectiveness of the initiative and provide a report to
Congress at the end of the demonstration project.”
For more
information about reimbursement issues, contact Stacie Saylor, CPC,
at MSMS at 517-336-5722 or
ssaylor@msms.org
For a full
frequently asked questions list on the RAC, visit the following link
to The Journal of Oncology Practice website:
http://jop.ascopubs.org/cgi/content/full/3/5/255
Share Your
Thoughts on this Article
Back
to top
|
Ron Davis, MD,
Tribute Video From The AMA
The following is
a link to a three-minute remembrance of Ron Davis, MD.
http://www.bigshouldersdubs.com/clients/AMA/23-AMA-Ron_Davis.htm
Share Your Thoughts on this
Article
Back to top
|
$35 Million Henry
Ford Project To Open
The first phase of the two-story, $35-million Henry Ford II (West)
Pavilion expansion project is set to open. The 40 new private rooms
have wireless Internet access, patient-controlled lighting and room
temperature, and space for family members to stay overnight.
The expansion is part of the $310 million investment in the Henry
Ford Hospital Campus. It will house 80 private rooms including 20
intensive care rooms on two floors once complete, bringing the total
number of ICU beds at Henry Ford to 162 - the largest ICU in
Detroit. Phase two of the project is slated to open in the spring of
2009.
In all, nearly $90 million has been spent in the past two years,
including the expansion and renovation of the Emergency Department
in 2006.
Other expansion projects include:
-
Clinical
Skill Simulation Center - $5 million: This 12,000-square-foot
facility, the largest in the Midwest, has opened at Henry Ford
Hospital allowing health care professionals to practice and
augment their skills using simulations including computers and
mannequins that can simulate hundreds of different medical
conditions. The facility houses two operating theaters, (one
with a $1.6 million da Vinci robot system), six clinical rooms,
a minimally invasive procedure lab with more than 30 stations,
and two classrooms. Fully-equipped, reconfigurable rooms
simulate surgery, labor and delivery, intensive care, emergency
and routine hospital scenarios.
-
Expansion
of existing operating rooms - $10 million: Three new operating
rooms will be added that are designed to accommodate new
technology, including robotics and additional pre-surgery and
recover room capacity.
-
Outpatient
tower redevelopment - $33 million: Major redevelopment and
redesign for Oncology, Gastroenterology and
Nephrology/Transplant, Urology and Orthopedics.
-
Research &
Education development - $13 million: Expansion and relocation of
a number of labs including Neurology and Neurosurgery,
Hypertension-Vascular, Genetics, Urology, Epidemiology.
-
Infrastructure - $50 million: Redevelopment of the core heating,
cooling along with electrical and emergency power distribution
systems.
-
Ongoing
imaging and medical equipment replacement - $120 million
-
Routine
renovation and replacement capital - $100 million
Demand for services downtown has significantly increased in recent
years and is anticipated to grow faster over the next decade. From
2003 to 2005, Henry Ford Hospital had the highest admission growth
in southeast Michigan, with an increase of 13.4 percent.
Share Your
Thoughts on this Article
Back
to top |
Dr. Santucci Selected 'Germany
Traveling Fellow'
WCMSSM member
Richard Santucci, MD, has been selected to travel to Germany as a
fellow and will attend a meeting of the German Surgical Society
April 28-May 1, 2009, visit two German medical centers, he told the
Detroit Medical News. He will give a talk at the meeting he attends.
He will be a visiting professor at health the medical centers, which
are in Heidelberg and Bremen.
Dr. Santucci is
Chief of Urology at Detroit Receiving Hospital, Specialist-in-Chief
at the Detroit Medical Center. He is also a clinical professor at
the Michigan State College of Medicine.
According to the
Bulletin of the American College of Surgeons, “Dr. Santucci has
researched and written extensively on genitourinary trauma and
reconstruction as well as on more customary urological topics.”
Share
Your Thoughts on this Article
Back to top
|
WSUSOM News
Neurology Leader Helps Draft New Guidelines
The
associate chair of the Wayne State University School of Medicine’s
Department of Neurology played a key role in creating new guidelines
developed to assist in the evaluation of patients who may suffer
from neuropathy.
Richard A. Lewis MD, professor and associate chair of Neurology for
the School of Medicine, said the guidelines, adopted by the American
Academy of Neurology (AAN), will aid clinicians in evaluating
patients, and provide a more efficient and complete evaluation.
The
guidelines were published in the Dec. 3, 2008, online issue of
Neurology, the medical journal of the American Academy of Neurology.
“The
group of clinicians involved in this study represents some of the
most outstanding investigators in clinical peripheral nerve
disease,” Dr. Lewis said. “As the lead author on the skin biopsy
section, I was honored to work with three outstanding investigators
who lead the field in the use of skin biopsy for clinical and
research purposes.”
The new guidelines, according to the AAN, indicate a combination of
blood tests and other assessments appear to be “most helpful” for
tracing the cause of neuropathy, also known as neuritis or distal
symmetric polyneuropathy. The nerve disorder affects one in 50
people in the general population and one in 12 over the age of 55,
according to the AAN. Symptoms include numbness, tingling or pain,
often starting in the feet and moving to the hands. The most common
cause is diabetes, although heredity, alcohol abuse, poor nutrition
and autoimmune processes can have an effect.
WSUSOM Prof To Oversee Anti-Seizure Medication Trial
The
Wayne State University School of Medicine will participate in a
trial comparing the effectiveness of two FDA-approved anti-seizure
medications and how they are administered to patients before they
arrive at hospitals.
The Rapid Anticonvulsant Medication Prior to Arrival Trial, or
RAMPART, is sponsored by the National Institutes of Health. The
purpose of the study is to determine whether Midazolam or Lorazepam
are safer and more effective at stopping seizures when paramedics
are called to treat a patient whose seizures aren’t stopping.
The study will be conducted on patients transported to and treated
at Detroit Receiving and Sinai-Grace hospitals. Robert Welch, MD,
associate professor of the Department of Emergency Medicine, will
oversee the study. Dr. Welch also serves as associate director of
Clinical Research for the department, as well as principal
investigator of the Wayne State University hub of the Neurological
Emergencies Treatment Trials Network (NETT).
The
network, funded by the National Institutes of Health, includes more
than 100 emergency departments and Emergency Medical Services
agencies in 17 major metropolitan areas. The organization was formed
to conduct large trials to reduce the burden of injuries and
illnesses affecting the brain, spinal cord and peripheral nervous
system. The network, said Dr. Welch, explores the narrow window of
opportunity that seems to exist in treating neurologic damage from a
variety of conditions, ranging from stroke and traumatic brain
injury to seizures and meningitis. The study of rapid interventions
under study by NETT requires the assistance of paramedics treating
patients in the field.
The
seizures, called status epilepticus, create an emergency situation,
Dr. Welch said. Estimates indicate that between 120,000 and 200,000
cases take place each year in the United States. As many as 55,000
people die from such seizures.
Complications of prolonged seizures, Dr. Welch explained, include
impaired ventilation and aspiration into the lungs, which can result
in pneumonia. Other problems include heart rhythm problems and
direct injury to the nervous system.
“Optimal outcomes in patients, therefore depends on treatments that
lead to rapid cessation of seizure,” Dr. Welch said. “In the
pre-hospital setting, it can be difficult to treat this group of
patients, particularly since starting an IV to administer
medications can be very difficult.”
Dr.
Welch said the study should begin by March 2009 and may continue for
two years. Nationwide, the study may involve as many as patients,
and Dr. Welch expects to oversee “one of the top enrolling sites.”
Area
residents who suffer a seizure and are treated by Detroit EMS
personnel may be enrolled in the RAMPART trial. Since the study will
involve patients who are severely injured or severely affected and
can’t make decisions for themselves, the research has been given
exception from informed consent parameters.
For questions regarding the study,
call the RAMPART trial hotline at 1-866-929-6388.
Researcher Publishes New
Autism/Schizophrenia Findings At WSU
A
Wayne State University School of Medicine professor has published
research that could open the gateway for the exploration of new
treatments for autism, schizophrenia and a host of other
neurodegenerative diseases.
Alexander Gow, PhD, associate professor of the Center for Molecular
Medicine and Genetics, the Carman and Ann Adams Department of
Pediatrics and the Department of Neurology, published the paper,
“Claudin 11 Stops the Leaks,” in the Dec. 1 issue of the Journal of
Cell Biology.
Patients with schizophrenia and other affective disorders are
thought to suffer from brain disconnect –- the different parts of
the brain don’t communicate with each other. Dr. Gow said this can
be interpreted as neurons not sending signals to different parts of
the brain or signals being sent but arriving too late.
While Dr. Gow said the significance of the research in terms of
immediately combating disease and disorders is speculative at this
point, the findings may explain some of the symptoms for a number of
neurological diseases, including autism, schizophrenia and other
disorders.
“While our study doesn’t suggest any treatments at this stage, it
does suggest new directions of research that should be looked at in
schizophrenia and other neurodegenerative diseases,” Dr. Gow said.
Share
Your Thoughts on this Article
Back
to top |
Flu Vaccination:
It's Not Too Late
It is not too late to get a flu shot. Although flu cases have
already been confirmed in Michigan, flu activity often does not peak
until January or later and influenza can continue to circulate
through spring.
More than 84 percent of the United States population is recommended
to get an annual flu vaccine - that's more than 4 out of 5 people.
However, anyone who wants to reduce their chances of getting flu or
of spreading it to a loved one should be vaccinated. The Centers for
Disease Control and Prevention, along with Families Fighting Flu,
have developed a video, entitled Why Flu Vaccination Matters, to
spread the message that flu is a serious disease - one that can lead
to death in otherwise healthy children.
In February, the Advisory Committee on Immunization Practices (ACIP)
voted to expand the recommended ages for annual flu vaccination to
include all children 6 months through 18 years of age.
Another group at heightened risk for the negative complications from
influenza is pregnant women. Expecting mothers have historically low
rates of influenza vaccination. According to a recent study, a
two-for-one protection against the flu develops when an expecting
mother is vaccinated. When a pregnant woman is vaccinated, the
unborn child is protected. Emphasizing the importance of vaccination
among pregnant women, the National Women's Health Resource Center
launched the campaign, Flu Free and a Mom-To-Be.
Pregnant women can receive the flu shot during any trimester of
pregnancy. All new parents, grandparents, siblings, babysitters, and
contacts of infants should be vaccinated against influenza, as well
as pertussis (whooping cough).
The flu vaccine is the single best way to protect against influenza.
Anyone who wants to reduce their chances of getting the flu can get
vaccinated. Visit
www.michigan.gov/flu
for the most up-to-date flu information.
Courtnay McFeters, MA
Adolescent Immunization Coordinator
MDCH Division of Immunization
Share
Your Thoughts on this Article
Back
to top |
Daschle To Have
Dual Health Care Roles
Los Angeles Times
Examines HHS Secretary-Nominee Daschle's Approach to U.S. Health
Care System Overhaul
[Dec 15, 2008]
President-elect Barack Obama's
HHS secretary nominee -- former Senate Majority Leader Tom
Daschle (D-S.D.), who Obama also named as director of a new White
House Office of Health Reform -- "has put a premium on cooperation
between the White House, Congress and major health care interest
groups" in the overhaul of the U.S. health care system, the
Los Angeles Times
reports. The Times
examines
Daschle's book on health care called "Critical," and his
specific and "potentially controversial" plans for health care
reform.
Daschle has proposed to establish a Federal Health Board modeled
after the Federal Reserve to determine the medications, medical
devices and other treatments that federal health care programs
should cover based on cost-effectiveness. According to the Times,
Daschle also has proposed a requirement that all U.S. residents
obtain health insurance and the establishment of a public health
plan to provide coverage for those who do not obtain private
coverage. The Times
also looks at Daschle's "virtual road map for the kind of campaign
the Obama White House and its allies will probably pursue in their
effort to avoid the pitfalls that doomed" health care reform efforts
by former President Bill Clinton in the 1990s (Levey,
Los Angeles Times,
12/15).
Health Care 'Czar'
According to the
Wall Street Journal,
as director of the White House Office of Health Reform, Daschle will
serve as a "health czar of sorts" -- one of a number of czars whom
Obama has appointed to address various issues. Obama seeks to "have
someone in the White House with the president's ear to coordinate
policy and give the topic the weight it deserves," and the
appointment of a czar "gives an issue prominence, allows for
coordination among agencies and streamlines decision making," the
Journal
reports (Meckler, Wall
Street Journal, 12/15).
Daschle will have a role on health care reform that "truly does
represent a czar role," Phil Blando of the health care consulting
group
AB+M Partners said, adding, "He's the go-to guy across the
board. People will try to end run around him, and they're going to
have nowhere to go" (Frates,
The Politico,
12/13).
Share
Your Thoughts on this Article
Back
to top |
|
This publication brought to you by
Natinsky Publishing Network.
Problems seeing this email? You may view it online at
http://www.wcmssm.org
To subscribe or unsubscribe to this newsletter contact
info@wcmssm.org |
|
