May 12, 2008

IN THIS ISSUE

Editor's Column: Paying A Price For Pay-For-Performance
WSU Chooses Doc, Public Health Expert As Next President
State Senate Passes Smoking Ban, Finally
Clock Ticking To Stop Medicare Physician Cuts
WSUSOM Department Chair Wins Fellowship
Acquiring NPI
AMA Works To Advance E-Prescribing
AMA: More Rx Drug Oversight Needed

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Editor's Column: Paying A Price For
Pay-For-Performance

 By JOSEPH WEISS, MD
The true pay-for-performance measures are not appearing on the spreadsheets of Medicare, United Health Care or the National Committee for Quality Assurance (NCQA). The real performance measures are two:

• Emergency Room Utilization
• Hospital Admissions

Independent Physician Associations (IPAs) keep track of these two quality indicators and reward physicians who exhibit superior performance. In the arena of emergency room utilization the typical primary care physician averages 320-340 emergency room visits per 1,000 individuals cared for. The better performing physicians are in the range of 200-215 emergency room visits per 1,000. Regarding hospital admissions, physicians average between 285-310 per 1,000 patients. The better performing physicians average 220-240 hospital admissions per 1,000 patients.

To meet superior numbers requires physicians who both make good judgments on their patients’ needs and are available to see them on short notice. Then an office visit or timely phone conversation or e-mail can substitute for an emergency room visit or hospital admission. IPAs recognize that superior numbers in these areas reflect superior performance and reward physicians appropriately.

The criteria for pay-for-performance used by Medicare and health insurance companies is completely different. The criteria for superior performance these institutions use include the percentage of women patients receiving bone density testing, the percentage of patients over age 65 receiving influenza vaccine and the percentage of adults with diabetes receiving foot examinations. These criteria represent standards of care that every physician should meet with each patient and are not evidence of superior care.

It makes more sense to dock physicians who don’t reach these standards as to pay more to physicians who practice medicine as it should be done.

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WSU Chooses Doc, Public Health Expert As Next President

University officials are not coming right out and saying it, but it seems their choice of a new university president to replace the departing Irvin Reid was made with direct concern about the ongoing dispute between the Wayne State University School of Medicine and the Detroit Medical Center.

The Detroit Free Press reported Friday that WSU chose Jay Noren, MD, dean of the College of Public Health at the University of Nebraska, as its new president. Dr. Noren has a medical degree from the University of Minnesota and a master’s degree in public health from Harvard University.

University officials acknowledge the WSU-DMC dispute was a factor in the hiring.

WSU Board Vice Chairman Richard Bernstein told the Free Press, “(Dr. Noren) has a very clear understanding of health-related issues. This is someone who will have a unique and true understanding of how to work with the medical school and the DMC.”

According to the Free Press, Dr. Noren agreed to a tentative contract that pays $330,000 and runs through 2013.

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State Senate Passes Smoking Ban, Finally

By PAUL NATINSKY
The dam finally broke. The Michigan Senate Thursday, after much delay, approved a more inclusive version of the House-Passed smoking ban in restaurants and bars less than a week after the MSMS House of Delegates ramped up its pressure on the upper chamber.

Senate Majority Leader Mike Bishop, who opposes the ban, responded to political pressure, extracting the bill from committee for consideration by the full Senate. The bill passed 25-12 and removed ban exclusions for casinos, bingo halls and cigar bars contained in the House-passed bills.

At the MSMS House of Delegates May 3, Republican Sen. Dr. Tom George, who chairs the Senate Health Policy Committee, pounded the drums for an increase in preventive behavior to help ebb the tide of terrible health status in Michigan. He spoke strongly for Senate passage of the smoking ban and criticized labor unions for negotiating for generous health insurance benefits, while also bargaining for the rights of workers to smoke.

House Commerce Committee Chair Andy Meisner (D-Huntington Woods) was a strong supporter of the ban legislation as it moved through the House. He also addressed the delegates May 3 and called for Michigan to take the steps to ban smoking taken by 33 other states and a growing number of developed countries including the Republic of Ireland.

While he is proud of the House’s support of the bills, Meisner said he found it hard to believe that there was debate on the House floor about whether second-hand smoke posed a health risk. “At the beginning of the 21^st century your legislature was actually debating about second-hand smoke,” he said.

Thank you notes and flowers are generally not warranted for state legislators, but a kind word might be in order for those who voted to approve the ban. The vote shook out this way:

Democrats for: Glenn Anderson, Raymond Basham, Liz Brater, Deborah Cherry, Irma Clark-Coleman, Hansen Clarke, John Gleason, Tupac Hunter, Gilda Jacobs, Dennis Olshove, Michael Prusi, Mark Schauer, Martha Scott, Michael Switalski, Samuel Buzz Thomas III, Gretchen Whitmer

Democrats against: Jim Barcia

Republicans for: Patricia Birkholz, Cameron Brown, Nancy Cassis, Thomas George, Ron Jelinek, Roger Kahn, Michelle McManus, John Pappageorge, Bruce Patterson

Republicans against: Jason Allen, Mike Bishop, Alan Cropsey, Valde Garcia, Judson Gilbert II, Mark Jansen, Wayne Kuipers, Randy Richardville, Alan Sanborn, Tony Stamas, Gerald VanWoerkom

Not voting: Bill Hardiman

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Clock Ticking To Stop Medicare Physician Cuts

The American Medical Association (AMA) urged Congress to take immediate action to avert looming Medicare physician payment cuts that will harm seniors' access to care in testimony May 8 to the House Small Business Committee. AMA Board Member Cecil Wilson, MD, highlighted the impact the cuts will have on the many physicians who are small business owners.

"There's no doubt that the Medicare cuts will hurt seniors as physicians are forced to make practice changes to keep their medical practice doors open," said Dr. Wilson. "Half of the physician practices in the nation have less than five physicians, yet they account for 80 percent of all patient visits to the doctor's office."

An AMA survey found that 60 percent of physicians would be forced to limit the number of new Medicare patients they can treat if this year's 10.6 percent cut goes into effect this July as planned. Over a year and half the cut grows to over 15 percent, and the future for seniors' access to care is dire - unless Congress acts.

"The Medicare cuts also have a ripple effect on quality of care for all patients, as more than two-thirds of physicians say they will defer purchases this year of information technology used to improve patient care," said Dr. Wilson.

"There are only 53 calendar days, and substantially fewer legislative days remaining for Congress to fix this problem," testified Dr. Wilson. "We urge Congress to take immediate action to replace 18 months of cuts that begin this summer with payment updates that reflect medical practice cost increases."

Dr. Wilson pointed out that an 18 month update will inject stability into the system for seniors and their physicians, and provide time for lawmakers to begin work on a long-term solution to the Medicare cuts problem.

"In three years, the first wave of baby boomers will begin aging into the Medicare program," said Dr. Wilson. "Couple that with a predicted physician shortage, and the Medicare physician payment cuts will have a devastating effect on access to care for seniors and baby boomers."

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WSUSOM Department Chair Wins Fellowship

Wayne State University School of Medicine Department of Neurology Chair Robert Lisak, MD, was recently elected to the prestigious Fellowship of the Royal College of Physicians.

Founded in London in 1518, the Royal College of Physicians was the first medical institution in England to receive a Royal Charter. Since its creation, the college has offered a wide array of resources and services to its 20,000 members, fellows and other medical professionals. These include providing continuing medical education opportunities and advising the British government and other decision-makers on behalf of its members.

Dr. Lisak’s election is one of the highest honors the organization will bestow. The Honorary Fellowship is awarded to no more than 20 people per year. Dr Lisak is among only 13 physicians selected this year and one of only five Americans.

“This award is special to me because it acknowledges that the work I’ve done is recognized by a historic and prominent body,” he said. “It is a great honor.”

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Acquiring NPI

National Provider Identifier numbers are now available for application by all physicians who conduct electronic transactions, as well as by other HIPAA “covered entities.” After May 23, 2008, all healthcare providers and plans will be required to use and accept only NPIs in standard transactions (small health plans will have one extra year). The compliance date was May 23, 2007 however the Centers for Medicare and Medicaid Services (CMS) extended this timeframe one year through a "contingency plan" in order to give the healthcare industry needed more time to prepare. By replacing the various unique identifiers currently used by physicians when dealing with different payers, the NPI works toward fulfilling HIPAA’s administrative simplification goals.

NPIs will be used to identify health care providers in the following standard transactions: claims, eligibly inquires and responses, claim status inquiries and responses, referrals and remittance advices. Even providers who employ third party business associates to conduct standard electronic transactions on their behalf will need to obtain an NPI.

Additional information on NPIs from CMS.
This link will take you off the AMA Web site. The AMA is not responsible for content of other Web sites.

Application for an NPI can be accomplished in three ways:
1) online application (individually, by group practice or organization. This link will take you off the AMA Web site.)
2) by requesting a paper application from the same Web site; or
3) by calling (800) 465-3203.

Group practices should decide ahead of time whether physicians will file for NPIs individually or as a group. Physicians who are unincorporated need one NPI. Incorporated physicians need an NPI for themselves and one for their group.  More information can be found on the CMS website. (This link will take you off the AMA Web site.)

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AMA Works To Advance E-Prescribing

The American Medical Association highlighted its support for electronic prescribing May 8, and outlined key steps to move forward with broader adoption of e-prescribing at a meeting with stakeholders held at the Brookings Institution in Washington, D.C. AMA board member and emergency physician Steven Stack, MD discussed the AMA's work to address adoption barriers among physicians, and the important role e-prescribing will play in transforming health care.

"The AMA supports efforts to advance e-prescribing adoption among physicians," said Dr. Stack. "E-prescribing can serve as a means to improve patient safety, enhance care coordination among health care providers, and reduce administrative burdens that take physicians away from patients."

The AMA has reached out to physicians across the country to better understand the challenges that must be addressed to facilitate rapid, widespread adoption of e-prescribing by physicians.

"Every day more physicians across the country are using e-prescribing or are in the process of implementing the technology," said Dr. Stack. "To help more physicians take advantage of e-prescribing, financial incentives are needed to offset the costs of implementation."

The AMA supports a national framework that includes a uniform set of e-prescribing standards and a transitional period for physicians to adopt the technology.

"Any e-prescribing requirement that triggers potential penalties should be deferred until two years after final standards are in place," said Dr. Stack. "This will allow physicians to acquire and implement e-prescribing tools and train their staff."

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AMA: More Rx Drug Oversight Needed

American Medical Association (AMA) May 8 called for better government oversight of prescription drug advertisements directed at consumers to protect patients from misleading information. AMA President-elect Nancy Nielsen, MD, shared the AMA's concerns with some direct-to-consumer advertisements (DTCA) in testimony to the House Energy and Commerce Committee Subcommittee on Oversight and Investigations.

"Direct-to-consumer ads often portray drugs through rose-colored glasses by including more information about a drug's benefits than risks," said Dr. Nielsen. "Imbalances in these ads can diminish patient understanding of certain drug risks, and increase the need for an ongoing dialogue between patients and physicians about the benefits and risks of prescription drugs."

At the hearing, the AMA discussed the need for FDA regulation over DTCA and shared guidelines for DTCA that address advertising content, disclosures, and audiences targeted.

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