Health and Medical News and Resources

General interest items edited by Janice Flahiff

[Reblog] What’s Next For Physician Compare? | The Health Care Blog

What’s Next For Physician Compare? | The Health Care Blog.

From the 22 January 2015 post

Screen Shot 2015-01-23 at 9.33.17 PMOf the many hidden gems in the Affordable Care Act, one of my favorites is Physician Compare.  This website could end up being a game changer—holding doctors accountable for their care and giving consumers a new way to compare and choose doctors.  Or it could end up a dud.

The outcome depends on how brave and resolute the Centers for Medicare and Medicaid Services (CMS) is over the next few years.  That’s because the physician lobby has been less than thrilled with Physician Compare, and, for that matter, with every other effort to publically report measures of physician performance and quality.

I’d give CMS a C+ to date.   Not bad considering it’s the tough task.  The agency has been cautious and deliberate.  But after the many problems with Hospital Compare, Nursing Home Compare, Home Health Compare, and Dialysis Facility Compare—not to mention the shadow of healthcare.gov’s initial rollout—that’s understandable.  They want, I hope, to get this one right from the get-go.  And competition from the private sector looms.

Congress mandated that CMS establish Physician Compare by Jan. 1, 2011 and that an initial content plan be submitted by Jan. 1, 2013.  CMS met those deadlines, albeit with a rudimentary site that launched in late December 2010.  The agency updated its plans in 2013 and 2014, even as it added more content and functionality to the site.

The law requires the site to have “information on physician performance that provides comparable information on quality and patient experience measures.”  That’s to include measures collected under the Medicare Physician Quality Reporting System (PQRS), Medicare’s main quality reporting vehicle, and assessments of:

  • patient health outcomes and the functional status of patients
  • continuity and coordination of care and care transitions, including episodes of care and risk-adjusted resource use
  • the efficiency of care
  • patient experience and patient, caregiver, and family engagement
  • the safety, effectiveness, and timeliness of care

Notably, Congress set no deadline for the site to meet those specifications or be fully operational.

So what’s posted so far?   The centerpiece of the site is a searchable directory of some 850,000 Medicare providers.  That includes most of the practicing doctors in the U.S. with the exception of pediatricians and other physicians who don’t treat Medicare patients.  This database predates the ACA and Physician Compare but its functionality, reliability and accuracy (a big complaint from physician groups) is being gradually enhanced.

Each doctor has his or her own profile page—a significant foundation that could accommodate quality and patient experience data in the future.

Consumers can also search three additional databases on the site.  They identify doctors and other clinicians who participate in (a) PQRS; (b) the Electronic Prescribing Incentive Program; and (c) the electronic health record (EHR) incentive program (also called the meaningful-use program).  About 350,000 physicians and other clinicians participate in the latter.

The bad news: these databases are separate and their content is not integrated.  That makes searching for information on a particular group practice or individual doctor cumbersome and time consuming.  And the databases aren’t user-friendly.  On the plus side, for researchers and health administrators, the databases are downloadable.

January 26, 2015 Posted by | health care | , , , , , , | Leave a comment

The Most Powerful Health Care Group You’ve Never Heard Of

 

By BRIAN KLEPPER AND PAUL FISCHER in their 9 August 2012 post at The Health Care Blog

Excessive health care spending is overwhelming America’s economy, but the subtler truth is that this excess has been largely facilitated by subjugating primary care. A wealth of evidence shows that empowered primary care results in better outcomes at lower cost. Other developed nations have heeded this truth. But US payment policy has undervalued primary care while favoring specialists. The result has been spotty health quality, with costs that are double those in other industrialized countries. How did this happen, and what can we do about it.

American primary care physicians make about half what the average specialist takes home, so only the most idealistic medical students now choose primary care. Over a 30 year career, the average specialist will earn about $3.5 million more. Orthopedic surgeons will make $10 million more. Despite this pay difference, the volume, complexity and risk of primary care work has increased over time. Primary care office visits have, on average, shrunk from 20 minutes to 10 or less, and the next patient could have any disease, presenting in any way.

By contrast, specialists’ work most often has a narrower, repetitive focus, but with richer financial rewards. Ophthalmologists may line up 25 cataract operations at a time, earning 12.5 times a primary care doctor’s hourly rate for what may be less challenging or risky work.

 

These differences in physician worth and payment didn’t just happen. Instead, they have been driven by a 31 doctor – 26 specialists and 5 primary care physicians – American Medical Association panel, the Relative Value Scale Update Committee (RUC), which for 20 years has been Medicare’s sole advisor on the value of physician services. The Centers for Medicare and Medicaid Services (CMS), the federal agency overseeing the program, has historically accepted nearly 90 percent of the RUC’s recommendations with no further due diligence. So the RUC has huge financial impact throughout health care, not only for Medicare but for many commercial health plans that follow Medicare’s lead on payment…

t is clear that it will be impossible to get American health care under control unless we can recapture regulation and reconfigure it to act in the common rather than the special interest. Until that is accomplished, America’s and our children’s diminishing prospects will be directly tied to our failure to stop the health industry’s rapaciousness.

 

August 9, 2012 Posted by | health care | , , , , | Leave a comment

GMOs should be safety tested before they hit the market says AMA

OGM - ADN

OGM – ADN (Photo credit: Wikipedia)

From a 19 June 2012 article at the Chicago Tribune

The American Medical Association called for mandatory pre-market safety testing of genetically engineered foods as part of a revised policy voted on at the AMA’s meeting in Chicago Tuesday.

Currently biotech companies are simply encouraged to engage in a voluntary safety consultation with theFood and Drug Administration before releasing a product onto the market.

Some activists concerned about foods made with genetically modified organisms, or GMOs, had hoped the association would have gone so far as to support mandatory labeling of genetically engineered foods. But some still view the policy change as a major breakthrough.

“We applaud the AMA for taking the lead to help ensure a safe and adequate food supply,” said Anne Dietrich of the Truth In Labeling Campaign, which advocates labeling of genetically engineered foods. When Monsanto Co., the world’s largest biotech seed company, testified Sunday at the AMA committee hearing on the policy, its representative did not raise any objections to the mandatory safety assessment provision.

On Tuesday, however, Monsanto spokesman Tom Helscher would not say whether or not the company supports mandatory pre-market testing, only that the current voluntary consultation process “is working,” he wrote to the Tribune. “All of Monsanto’s biotech products, and to our knowledge all those of other companies, go through the FDA consultation process, which provides a stringent safety assessment of biotech crops before they are placed on the market.”

The AMA’s Dr. Patrice Harris said the testing provision was aimed at addressing public interests and ensuring public health….

June 20, 2012 Posted by | Nutrition, Public Health | , , , , , | 1 Comment

American Medical Association (AMA) news: Appealing denied claims seems to work, GAO report says :: April 11, 2011 … American Medical News

amednews: Appealing denied claims seems to work, GAO report says :: April 11, 2011 … American Medical News

Yes, this is old news, but thought it would be worth posting…

The government is looking for a way to track and report denial rates to consumers as part of health insurance exchanges.

By EMILY BERRY, amednews staff. Posted April 11, 2011.

  • A government review of the rates at which insurers decline to write policies and reject claims for payment found that when physicians and patients appealed denied claims, those appeals were “frequently” successful, with 39% to 59% resulting in a reversal.

The Government Accountability Office report, released March 16, also found that many health insurance claims denials stem from miscodings, incomplete information or other paperwork errors, pointing to the need for further automation of claims processing.

The report examined what the GAO called “application denials” — declining to write a policy for someone — as well as “coverage denials” — deciding not to pay a claim. The Patient Protection and Affordable Care Act called on the GAO to examine both. The Dept. of Health and Human Services, which has started tracking application denials, plans to track and publish rates of coverage denials as part of the health insurance exchanges that will be part of the health reform law, according to the report.

Until HHS tracks application and coverage denials in a comprehensive way, there is limited information available about both. The GAO noted that the American Medical Association helped the authors interpret and understand the limitations of denial data available.

Rejected applications, denied claims

The GAO examined application denial data in the individual insurance market, collected by the HHS during the first quarter of 2010 and from six states that already track denials.

Researchers found that the rate at which insurers declined to offer an applicant coverage averaged 19%, but rates varied widely……

February 13, 2012 Posted by | health care | , , , , , , | Leave a comment

AMA: New policies that will impact the future of medicine

AMA

 

From the 14 December article at KevinMD.com by 

The AMA adopted new policy that, among other things, supports legislation that would require manufacturers of all drugs and biologics to notify the FDA of any discontinuance, interruption or adjustment in the manufacture of a drug that may result in a shortage. The AMA will also advocate for the FDA and/or Congress to require drug manufacturers to establish a plan for continuity of the supply of vital and life-sustaining medications and vaccines to avoid production shortages whenever possible.

With the implementation of the Affordable Care Act underway, health insurance exchanges have received significant attention as a new way for millions of Americans to obtain health insurance coverage from private insurers. New AMA policy supports using the open marketplace model for exchanges to increase competition and maximize patient choice. The policy also asks the AMA to advocate for the inclusion of actively practicing physicians and patients in health insurance exchange governing structures and for developing systems that allow for real-time patient eligibility information.

In addition to promoting the open marketplace model for health insurance exchanges, the AMA continued to endorse giving Medicare patients greater choice in seeing the physicians they want and need to see. The AMA reaffirmed support for the Medicare Patient Empowerment Act, which would eliminate current restrictions on private contracting with Medicare patients. New policy calls on the AMA to initiate and sustain a well-funded grassroots campaign to secure passage of the bill in Congress. This legislation ensures that if patients choose to see a physician that is not in the Medicare system they can still receive the benefits they have earned.

AMA delegates also recognized that onerous administrative burdens can divert a physician’s attention away from patient care. New policy calls on the AMA to work vigorously to stop implementation of ICD-10, a new code set for medical diagnoses. Currently, physicians use 14,000 diagnosis codes under ICD-9, but under ICD-10 the number of codes would grow by about 55,000.

Physicians are already working to integrate electronic health records into their offices, and the implementation of ICD-10 will place significant and costly burdens on the practice of medicine with no direct benefit to patients. At a time when we are working to get the best possible value for our health care dollars, this massive and expensive undertaking will add administrative expense and create unnecessary workflow disruptions….

 

 

Items included

 

December 15, 2011 Posted by | Health News Items | , , , , , , | Leave a comment

   

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