21st Century Edge
Summer 2011
Pain Practice Management Conference!
June 10th-11th, 2011
Intercontinental Hotel
The Country Club Plaza
Kansas City, Missouri
Friday, May 27, 2011
Wednesday, May 25, 2011
Physician Association Members Offer Earful to Lawmakers Doctors Would Toss Out SGR, Take Time to Seek Alternatives
Physician association members testifying before a House Energy and Commerce committee hearing May 5 offered alternatives to the SGR formula, which mandates a 29.5% physician pay cut in 2012.
In the hearing, American Medical Association (AMA) members recommended that Congress repeal the Sustainable Growth Rate (SGR) formula immediately, establish five years of positive Medicare payment updates on practice costs, and use the borrowed time to test and evaluate various payment models to find a permanent fix.
Both the AMA and the American Academy of Family Physicians (AAFP) support a five-year transition. Reworking the payment system during the transition would ensure continued access to care for Medicare beneficiaries, said Michael Burgess, M.D. (R-Texas), a subcommittee member. Repealing SGR will be costly, he added, but the current payment system has to go.
A controversial option on the table is private contracting, which would allow patients and physicians to negotiate freely for most outpatient Medicare services without penalty. Medicare rates would apply for emergency medical services or urgent care.
Private contracting is in the Medicare Patient Empowerment Act, introduced by Rep. Tom Price, M.D. (R-Georgia). While some lawmakers like the idea, others cringe at the thought of its introduction in a system now restrained by the threat of civil and criminal charges. Removing that blanket, patient advocates argue, could unleash behaviors that drive up healthcare costs and impair availability of care.
“These proposals serve to fundamentally undermine the purpose of the Medicare program by unraveling the protections against high costs that prevent people from accessing the care they require," said Joe Baker, president of the New York-based Medicare Rights Center.
In the hearing, American Medical Association (AMA) members recommended that Congress repeal the Sustainable Growth Rate (SGR) formula immediately, establish five years of positive Medicare payment updates on practice costs, and use the borrowed time to test and evaluate various payment models to find a permanent fix.
Both the AMA and the American Academy of Family Physicians (AAFP) support a five-year transition. Reworking the payment system during the transition would ensure continued access to care for Medicare beneficiaries, said Michael Burgess, M.D. (R-Texas), a subcommittee member. Repealing SGR will be costly, he added, but the current payment system has to go.
A controversial option on the table is private contracting, which would allow patients and physicians to negotiate freely for most outpatient Medicare services without penalty. Medicare rates would apply for emergency medical services or urgent care.
Private contracting is in the Medicare Patient Empowerment Act, introduced by Rep. Tom Price, M.D. (R-Georgia). While some lawmakers like the idea, others cringe at the thought of its introduction in a system now restrained by the threat of civil and criminal charges. Removing that blanket, patient advocates argue, could unleash behaviors that drive up healthcare costs and impair availability of care.
“These proposals serve to fundamentally undermine the purpose of the Medicare program by unraveling the protections against high costs that prevent people from accessing the care they require," said Joe Baker, president of the New York-based Medicare Rights Center.
Wednesday, May 11, 2011
EHR: Exchange or Share? The Patient is the Key
It’s not about exchanging information – it is about sharing it. One of the biggest problems today in implementing electronic medical records is redundancy. Today, each provider that sees the patient records their version of the patient medical record. Often the record will differ between providers and sometimes it will even contain conflicting information. Not one provider has the complete medical record. This brings up the question of which record is most correct? And, what do we not know that could help us to provide a better outcome?
With today’s technology it is possible to create a virtual non-redundant database that contains the patient’s complete medical record, normalized to third normal form that can be shared by all authorized parties creating a more collaborative healthcare environment.
Sharing begins with recognition that the patient is the key that links all healthcare information. Once we embrace this paradigm shift we can begin to think about the solution from a totally different angle.
Vermont Pushes to Be First State with own Healthcare System
The Vermont senate voted April 26 to approve a bill (S.57) that would establish an exchange where the state’s citizens can shop for health insurance. Under a waiver provision in the federal healthcare reform law known as the Affordable Care Act (ACA), the insurance exchange could become a state-sponsored healthcare plan called Green Mountain Care, which would offer insurance to all Vermont citizens.
Under the ACA, states that want to create their own healthcare reform programs can begin doing so in 2017 if they obtain a federal waiver. To qualify for the waiver, states must show that their proposed healthcare programs can provide comprehensive and affordable coverage to just as many persons as the ACA without increasing the federal deficit. However, Vermont may not need to wait until 2017 to opt out of the federal healthcare reform program. A separate bill now awaiting consideration in Vermont’s senate would accelerate the opt-out year to 2014. Vermont also would need federal clearance to include Medicaid and Children’s Health Insurance Program (CHIP) patients in Green Mountain Care and to administer the Medicare program for Vermont seniors.
Passage of S.57 in the Vermont legislature now seems a distinct possibility. The bill made it through the House easily last month, but then was amended in the Senate. Because of the amendment, the bill now must pass through a legislative conference committee for rewording, and then go back to each chamber for a final vote possibly as early as next week. The Vermont governor then would sign the bill into law.
Green Mountain Care has been touted in the press as “something akin to a single-payer healthcare system” and as “universal coverage”. But those claims are not quite true. The private payers aren’t going away. Vermont residents who like their existing coverage would be able to keep it. Those who change to Green Mountain Care would be able to purchase supplemental coverage from the private insurers. Vermont also would contract with a private insurer to administer Green Mountain Care. However, Green Mountain Care could squeeze private health insurers out of the low-income and small-employer group insurance markets.
While legislators like Green Mountain Care, Physicians for a National Health Plan (PNHP) criticize it on grounds that multiple payers would lead to higher administrative costs that could be eliminated by a single-payer plan.
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