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 Medicare services. 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 melanoma- and radiology-related measures, as well as measures dealing with cataracts and age-related macular degeneration. CMS said it encourages providers to submit data for these test measures on Part B claims from July 1 through Sept. 30, 2008, but providers will not receive financial incentives for reporting the measures.
AMA Launches Insurer Report Card
The American Medical Association has 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. Analysis of a random sample pulled from more than 5 million services billed electronically to Medicare and seven health insurers showed that insurers reported to physicians the correct contracted payment rate only 62%-87% of the time. Also, payers varied widely as to how often they applied 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.
ACP Helps Members Choose EHRs
The American College of Physicians has launched a program designed to help members purchase and install electronic health record systems that match the needs of their practices. The EHR Partners Program is a collaboration between the college and participating EHR companies that have achieved 2006 and/or 2007 certification by the Certification Commission for Healthcare Information Technology (CCHIT). The ACP said it strongly recommends that physicians entering the EHR arena for the first time, or who are seeking to upgrade older systems, consider certified EHRs.
Areas Chosen for EHR Demo
Twelve areas across the country, ranging from entire states to smaller cities, will participate in a Medicare demonstration project that provides incentive payments to physicians for using certified EHRs to improve quality of care. The 5-year project is designed to help increase use of the technology in practices where adoption has been the slowest—at the individual physician and small practice level, CMS said. The areas selected to participate include Alabama; Delaware; Jacksonville, Fla.; Georgia; Maine; Louisiana; Maryland/Washington; Oklahoma; Pittsburgh; South Dakota; Virginia; and Madison, Wis. 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 performance on clinical quality measures. Total payments for all 5 years may be up to $58,000 per physician or $290,000 per practice, CMS said.
Drug Lobby Spending Up 32%
The pharmaceutical and medical device industries had another banner year for spending on lobbying in 2007, according to a report by the Washington-based Center for Public Integrity. Last year, the pharmaceutical industry alone spent at least $168 million on lobbying 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 supporting 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.
Insurers Back Medical Home
The board of directors of America's Health Insurance Plans has endorsed the concept of a medical home. The board voted to approve the principles for achieving coordinated, comprehensive care at the organization's Institute 2008 meeting. “The patient-centered medical home is a promising concept that would replace episodic care with a sustained relationship between patient and physician,” the board said in a statement. The board suggested that “many clinical settings can potentially constitute a patient-centered medical home,” but that all should follow eight broad principles: Care should be comprehensive and individualized to suit each patient; coordination should include strategies to engage the patient; health information technology should be used; clinicians should commit to being accountable for quality and to report on outcomes and cost-effectiveness; and payments should reflect the level of management involved and help support the cost of developing a medical home infrastructure.