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CMS Tests PQRI Measures

The Centers for Medicare and Medicaid Services said it will begin testing 11 new quality measures for future adoption into the Physician Quality Reporting Initiative. PQRI provides incentive payments to providers who satisfactorily report data on covered services furnished to Medicare beneficiaries. Through the new measures, The CMS said it intends to track quality of care in influenza immunization in chronic kidney disease, assessment for use of anti-inflammatory or analgesic over-the-counter medications in osteoarthritis, and care plans for pain in medical and radiation oncology. CMS also will test several melanoma- and radiology-related measures, in addition to measures dealing with cataracts and age-related macular degeneration. The CMS said that it encourages providers to submit data for these test measures on Part B claims from July 1 through Sept. 30, 2008. Providers will not receive financial incentive for reporting these test measures, CMS said.

AMA Launches Report Card

The American Medical Association in June launched a campaign to cut waste from the insurance claims process with a new health insurer report card. “To diagnose the areas of greatest concern within the claims processing system, the AMA has developed its first online rating of health insurers,” said Dr. William Dolan, an AMA board member. The report card, based on a random sample pulled from more than 5 million services billed electronically to Medicare and seven health insurers, found that insurers reported to physicians the correct contracted payment rate only 62%–87% of the time. In addition, it found that there is extremely wide variation among payers as to how often they apply computer-generated edits to reduce payments—from a low of less than 0.5% to a high of more than 9%. Physicians spend as much as 14% of their total revenue to ensure accurate insurance payments for their services, according to the AMA.

Areas Chosen for EHR Demo

Twelve areas across the country, ranging from entire states to smaller cities, will participate in a national Medicare demonstration project that provides incentive payments to physicians for using certified electronic health records to improve the quality of patient care. The 5-year project has been designed to demonstrate the benefits of EHRs and help increase use of the technology in practices where adoption has been the slowest—at the individual physician and small practice level, the CMS said. The areas selected to participate include: Alabama; Delaware; Jacksonville, Fla.; Georgia; Maine; Louisiana; Maryland/ Washington; Oklahoma; Pittsburgh, Pa.; South Dakota; Virginia; and Madison, Wis. Over the course of the project, financial incentives and bonus payments will be provided to as many as 1,200 primary care practices that use EHRs to improve quality, as measured by their performance on specific clinical quality measures. Total payments under the demonstration for all 5 years may be up to $58,000 per physician or $290,000 per practice, CMS said.

“Smart” IDs Given the Nod in Colo.

Colorado has become one of the first states to approve legislation mandating that all insurers in the state issue “smart” identification cards with standard, legible information about the patient, insurance product, and insurer. The cards, which must be issued by July 1, 2010, also must include machine-readable information encoded on a magnetic strip. The legislation, signed last month by Gov. Bill Ritter (D), helps reduce the potential for human errors and the data-entry burden posed by nonstandardized cards, according to the Medical Group Management Association, which is headquartered in Colorado. Dr. William Jessee, MGMA president, said in a statement that most insurance-claim rejections stem from incorrectly entered information about the patient or the insurance product, and the practice of photocopying patient ID cards and then typing the information into a database invites errors. A card with a magnetic strip on it costs about 50 cents to make, MGMA stated. Similar laws have been approved in Kansas, North Carolina, and Texas, the group said, and other states are considering legislation on the issue.

Drug Lobby Spending Up 32%

The pharmaceutical and medical device industries had yet another banner year for spending on lobbying in 2007, according to a new report by the Washington-based Center for Public Integrity. Last year, the pharmaceutical industry alone spent at least $168 million on lobbying members of Congress, a 32% increase from 2006, according to the report. Forty companies and three trade organizations—the Pharmaceutical Research and Manufacturers of America, the Biotechnology Industry Organization, and the Advanced Medical Technology Association—accounted for 90% of the spending. PhRMA led the way, spending $23 million in 2007. Amgen Inc. and Pfizer Inc. were the two biggest individual spenders, at $16 million and $13 million, respectively. Most efforts went into blocking drug reimportation, protecting patents, and on free-trade agreements. The industry also went to bat for reauthorization of the State Children's Health Insurance Program and extensions of the Prescription Drug User Fee and Best Pharmaceuticals for Children acts, according to the center's analysis of lobbying records submitted to the Senate Office of Public Records.

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