Bill Aims to Delay Imaging Cuts
Rep. Michael Burgess (R-Tex.), an ob.gyn., has introduced legislation to improve physician reimbursement under Medicare and delay cuts in payments for imaging services. The bill also would establish a system of quality measures to give patients more information about Medicare providers. The American Medical Association called the Medicare Physician Payment Reform Bill and Quality Improvement Act of 2006 an “important step toward replacing the flawed Medicare physician payment formula.” The legislation would change formulas to end the “negative feedback loop that constantly creates a deficit in healthcare funding,” Rep. Burgess said in a statement. It also includes a 1-year delay for planned cuts in Medicare payments for imaging services and requires the Institute of Medicine to perform a study on the question of whether imaging saves money. The quality measures would help beneficiaries decide whether a particular physician was worth paying a higher copayment to see. “If a patient sees that short waiting times equate to perhaps a $10 increase in their bill, they may decide that the money is worth it,” the congressman added.
PAs Eye Specialty Recognition
Physician assistants are considering voluntary recognition for those practicing in specialties to denote their advanced knowledge. A task force organized by the National Commission on Certification of Physician Assistants is studying options after receiving comments on the issue during a forum it held on the topic earlier this summer. PAs find their supervising doctors often lack time to train them, forum participants said. The task force does not have a deadline, and it is only considering recognition—not certification—for specialties, Tiffany Flick, communications manager for NCCPA, said in an interview.
P4P Raises Pay in U.K.
A 3-year experiment in pay for performance boosted gross income for family physicians in the United Kingdom but may have made it too easy for the physicians to earn that extra money, according to a study by Tim Doran of the National Primary Care Research and Development Centre, University of Manchester (England) and colleagues. The $3 billion program was designed to boost family physicians' pay an average of 25% depending on how well they performed on certain quality indicators for 10 chronic diseases, including asthma, coronary heart disease, diabetes, and epilepsy. The physicians attained a median of 97% of the available points for clinical indicators—greatly exceeding predictions of 75%—and boosted their gross income by an average of $40,000. However, “the high levels of achievement might suggest that the targets were too easy to achieve,” the authors said, adding that the monetary gains may have been offset by the money physicians spent getting ready for the program, including expenses such as hiring extra staff and installing electronic health records. The article appeared in the July 27, 2006, issue of the New England Journal of Medicine. An accompanying editorial agreed that the targets may have been set too low and raised the possibility that some physicians may have “gamed the system” by excluding patients whose care did not meet the performance criteria.
Paying Community Pharmacies
Independent pharmacies are seeking legislative help as they struggle with the increased workload from Medicare Part D. Many are racking up debt under the strain—an average of just under $70,000 per pharmacy, according to a survey of 5,000 members of the National Community Pharmacists Association. The Fair and Speedy Treatment of Claims Act of 2006 would require pharmacy claims submitted electronically to be paid within 14 days. The measure aims “to ensure that pharmacists are not forced out of business by inadequate, slow reimbursement and unclear claims processing,” according to its sponsors, Rep. Marion Berry (D-Ark.), and Rep. Walter Jones (R-N.C.). Mark Merritt, president of the Pharmaceutical Care Management Association, responded in a teleconference by noting that pharmacy benefit management companies pay most claims from pharmacies within 30 days—standard in American business. The legislation also includes a $14 payment for filling a generic prescription and sets guidelines for medication therapy management programs offered by drug plans. Such programs aim to promote proper medication use in high-risk seniors. PCMA's analysis found that overall, the bill would cost the Medicare program at least $55 billion over 10 years and beneficiaries $30 billion. The measure had 144 cosponsors as of mid-July.
Poll: Live Unhealthy, Pay the Price
More than half of respondents to a Wall Street Journal/Harris Interactive poll say that people who smoke or choose not to wear seat belts should pay a higher health insurance premium than people who don't engage in those behaviors, but most people did not feel the same way about people who were overweight or didn't exercise enough. Only 27% of the poll's 2,200 respondents thought that overweight people should pay more for insurance than slimmer people; the same percentage favored having people who did not exercise regularly pay more. The amount of education the respondent had affected the responses he or she gave: Those with some college education were more likely to agree that those with unhealthy lifestyles should pay higher premiums, compared with respondents with a high school education or less. The poll had a 3.3% margin of error.