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CMS innovation center faulted for wasteful duplication
Government investigators report that there appears to be overlap between agencies overseeing health programs and the relatively new Center for Medicare & Medicaid Innovation. The Government Accountability Office found instances in which similar multimillion-dollar programs exist in the Obama administration and urged in a report published on Dec. 21, 2012, that they be coordinated better. The Dept. of Health and Human Services, which oversees the innovation center, has championed the testing of new health care payment and delivery models that could lower federal health spending in the Medicare and Medicaid programs. GAO reviewed the innovation center’s funding and organization as of March 31, 2012. The report detailed the center’s plans for evaluating new models and examined whether there is overlap with activities by the Centers for Medicare & Medicaid Services. The innovation center had hired 184 employees to work in four groups overseeing the testing of 17 models designe [Read more]
Medicaid primary care pay at risk in lame-duck talks
Organized medicine reacted with strong opposition to indications that Congress might eliminate a temporary Medicaid pay increase to primary care physicians as lawmakers deliberate in year-end negotiations on outstanding fiscal issues. In a series of letters to House and Senate leaders on Dec. 5, more than 250 physician associations and state medical societies urged lawmakers to oppose any proposals to eliminate the Affordable Care Act provision that boosts Medicaid primary care rates to Medicare levels in 2013 and 2014. Doing away with the primary care parity policy “further burdens the already challenged Medicaid system of today,” the physician organizations wrote. The letters don’t specify the rationale behind the possible elimination of the pay bump. But some of the signatories said Republican lawmakers were eyeing the move as a way to help pay for preventing a 26.5% Medicare doctor pay cut under the sustainable growth rate formula, or as a general offset for avoiding el [Read more]
Incentive pay prevalence echoes boom in employed physicians
As more physicians opt for employment, annual incentive plans have been on the rise for the last five years, and employment contracts are increasing, according to the Hay Group, a global management consulting firm in Philadelphia. The number of hospitals that use incentive plans increased 23% since 2008, and integrated health care systems jumped from 43% to 61% in the same period. Physician practices went up from 70% to 80%, according to Hay’s 2012 Physician Compensation Survey, which was released in December. The boost in incentive plans is related to more doctors selecting employment with hospitals and groups, said C.J. Bolster, vice president of specialized industry for the Hay Group. Ninety-five percent of the largest health systems use incentive plans, he said. Growth in employment contracts also reflected physicians’ move away from independent practice. Seventy percent of hospital-based physicians had employment contracts in 2012, compared with 64% in 2011, while 67% [Read more]
Scope-of-practice challenge from chiropractors heads back to trial
Texas physicians will have to convince a trial court that a diagnostic procedure called Technological Instrumented Vestibular-Ocular-Nystagmus Testing — or VONT — is beyond chiropractors’ scope of practice. A district court, through summary judgment, earlier had ruled that chiropractors could not perform VONT because it expands their practice beyond what Texas law allows. But the Texas Court of Appeals, 3rd District in Austin reversed that decision in late November, saying it was unclear how VONT is defined. The court said that without that clarity, a trial needs to be held to determine those facts in the case that the Texas Medical Assn. filed against the Texas Board of Chiropractic Examiners. “What procedures are covered by the term, what are the purposes for performing those procedures and what do those procedures reveal about the patient, specifically about the biomechanical condition of the spine or musculoskeletal system?” the court asked in its opinion. The TM [Read more]
Universal EHR to streamline care for active military and vets
The Dept. of Defense and the Dept. of Veterans Affairs are accelerating efforts to link their health information technology systems to coordinate care better for service members as they transition out of the military and into civilian life. Leaders of the departments announced that they are moving toward using a single electronic health record system, for which the technology will be open-sourced and made available for use by other software developers. The integrated EHR will streamline administrative processes and encourage information sharing between the two departments, said VA Secretary Eric Shinseki during a Dec. 6 news conference. “The new program provides a warm handoff from service member to veteran status to ensure all who served are prepared to transition into civilian life and that they have access to VA benefits and services they’ve earned,” Shinseki said. Sharing between the departments with budgets the size of those for some small countries has not been eas [Read more]
Doctor not liable for physician assistant’s misconduct, court rules
If a physician has supervised a physician’s assistant properly, the state medical board shouldn’t discipline the supervising physician for the PA’s improper conduct, the Vermont Supreme Court has ruled. The ruling upheld a 2012 decision by the Vermont Board of Medical Practice, which found that the physician wasn’t answerable for a PA who prescribed opiates improperly. The state argued that Jon Porter, MD, should be held accountable for the PA’s actions because physicians are vicariously liable for those that they supervise. “With the court’s decision, physicians may be less likely to supervise PAs to a certain degree,” said Vermont Assistant Attorney General Kurt A. Kuehl. An attorney for Dr. Porter and an executive for the Vermont Medical Society each said the court got the ruling right. If it had ruled the other way, it likely would have made it difficult to find physicians willing to supervise PAs, they said. “Physicians’ licenses would have been at [Read more]
E-prescribing soars among doctors with EHRs
Government incentives and better education on the benefits of e-prescribing are being credited for a dramatic increase in the number of physicians who use electronic health record systems to e-prescribe. The Office of the National Coordinator for Health Information Technology in the Dept. of Health and Human Services published a report in November that looked at e-prescribing trends in the U.S. As of June, 48% of physicians are e-prescribing with an EHR. That is up from 7% in December 2008. Physicians sending prescriptions electronically can do so using stand-alone systems or EHRs with an e-prescribing component. Although e-prescribing adoption rates among states vary, each state has seen growth since 2008. In 23 states, more than half of physicians e-prescribe through an EHR. The highest growth rates are in New Hampshire, which saw an increase of 70 percentage points from 2008, and North Dakota, which had an increase of 65 percentage points. “What we are really seeing is [Read more]
Preventable birth injuries cut after proven interventions are bundled
Harm to mothers and their infants is significantly reduced when physicians, nurses and others follow protocols in the perinatal setting, a new study shows. Between January 2008 and December 2010, 14 hospitals participating in the Premier Perinatal Safety Initiative, a collaborative of facilities from 12 states, reduced by 25% birth hypoxia and asphyxia that can cause infant brain damage. Neonatal birth trauma — from minor bruising to nerve or brain damage — was reduced 22%, according to results from the initiative published in December. Mothers saw a 15% decrease in complications associated with anesthesia during labor and delivery, including events such as cardiac arrest and other complications. They also saw postpartum hemorrhaging, the most common cause of perinatal maternal death in the developed world, drop by 5.4%. To achieve those numbers, the initiative used “care bundles,” groups of evidence-based interventions that are more effective when used together rather [Read more]
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