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Physicians, industry continue to wait for Sunshine Act rules

Senators from both major parties sharply criticized the Centers for Medicare & Medicaid Services for the continued delay in regulations on publicizing the financial ties between physicians and pharmaceutical, medical device and biologics companies during a Sept. 12 hearing. The Senate Special Committee on Aging convened a roundtable discussion on the long-awaited implementation of the Sunshine Act, a bipartisan component to the 2010 health system reform law. Senators took the opportunity to voice their frustration with the agency tasked with running a program that is designed to allow public searches of databases to find information about individual physicians’ financial relationships. CMS published a proposed rule for the Sunshine Act on Dec. 14, 2011, more than two months after the rule was supposed to be finalized. The overdue rule now should be ready following a review and comment period during the past nine months, said Sen. Charles Grassley (R, Iowa). However, the regulat ...

Educational tool helps residents learn value-based care

Amid increasing emphasis on containing health expenditures while providing high-quality care, a new educational tool is intended to teach medical residents how to evaluate the benefits and cost-effectiveness of treatments for patients. The VALUE framework is designed to help guide teaching hospitals and residency programs in educating physicians-in-training about providing value-based care. The program is outlined in the September issue of the Journal of General Internal Medicine. “Our model can be used to train young physicians to assess the benefits of medical interventions, with the goal of selecting those that generate high value and reduce unnecessary costs,” said Mitesh Patel, MD, lead author and Robert Wood Johnson clinical scholar at the Perelman School of Medicine at the University of Pennsylvania. VALUE is an acronym representing the model’s core concepts of validation and variability, affordability and access, long-term benefits and less side effects, utility ...

Dual-eligibles market creates opportunities for physician practices

Physicians have new opportunities to partner with health plans to take advantage of the rapidly growing private market for beneficiaries who are eligible for both Medicare and Medicaid, according to a partner at a global management consulting firm. “There’s been a tremendous interest and appetite around the so-called dual-eligibles population,” said Sanjay Saxena, MD, a partner in the North American health practice at Booz & Co. and co-author of a new Booz report. Several years ago, discussions about changes in the private insurance market were all about health insurance exchanges, then about accountable care organizations, and “now it’s about the duals,” Dr. Saxena said. The Booz report discusses ways in which managed care companies could leverage both the Medicaid and dual-eligibles markets by identifying states that present the best growth opportunities and then defining their operating models or “choosing a way to play” in these markets. Managed care organi ...