Frances Correa

More than a year after taking the test, the round of interviews, and much anticipation to be a contestant on "Who Wants to Be a Millionaire," Dr. James Perri finally got his chance this past November, competing on an episode that aired in late April. But even as he walked onto the stage, Dr. Perri didn’t want to be a millionaire – he wanted to make a difference. After all the final answers were in, Dr. Perri, an emergency physician at Presbyterian Hospital in Huntersville, N.C., pledged all of his winnings – $15,800 – to benefit brain tumor research.

The cause hits home for Dr. Perri, who at age 24 was diagnosed with oligodendroglioma, a rare brain tumor representing only 3% of primary brain tumors, according to the College of American Pathologists. After a successful round of chemotherapy and radiation, Dr. Perri was cancer free. He then moved with his job from Philadelphia to Huntersville, N.C.

Courtesy of Valleycrest Productions Ltd

In 2009, the cancer resurfaced, and Dr. Perri, then 36 years old, started another round of radiation and chemotherapy, forcing him to leave his position on the Relative Value Scale Update Committee (RUC). Again, however, the tumor was successfully removed, and Dr. Perri and his wife, Nancy – by then parents of Jack, 7, and Sofia, 5 – were inspired to use their experience to give a voice to this rare disease.

"[I was] just trying to take an active role in fighting a disease I have, which you have very little control over," Dr. Perri said in an interview. But he also took the next step and asked himself, "Okay, what can I do to fight not only what I have, but others have?" and bring attention to a disease that is "underrepresented," he said.

Very little funding is available to study oligodendroglioma, which means there is limited information about the condition itself, Nancy Perri said. She recalled contacting cancer researchers about oligodendroglioma, only to hear that while innovative ideas exist, the funding for studying them does not. So this past February, she completed steps necessary to establish a nonprofit – Operation Oligo Cure. The goal of the organization is to raise awareness and funding for clinical trials to test innovative treatments for oligodendroglioma. In April, they raised $1,000 during their Exercise for a Cure event featuring fitness instruction at a local gym where Nancy works part-time.

"This is my way of contributing, helping to try and make a change and regain some type of control in this situation," she said in an interview. "I can not only help my husband but [also] pay it forward to people who are in this type of situation."

To add to Dr. Perri’s game show winnings and donations from family and friends, the Perris are aiming to raise between $150,000 and $200,000 to fund trials testing strategies such as tumor vaccines or the role of genetics in preventing brain tumors, Dr. Perri said.

Although Dr. Perri didn’t walk away a millionaire, he did get the chance to share his story and shine a light on the struggle shared by others with oligodendroglioma.

"If you’re giving yourself more hope or [giving] others more hope, then that’s a good thing," Dr. Perri said.

To contribute to Operation Oligo Cure, go to www.oligocure.org.

More than a year after taking the test, the round of interviews, and much anticipation to be a contestant on "Who Wants to Be a Millionaire," Dr. James Perri finally got his chance this past November, competing on an episode that aired in late April. But even as he walked onto the stage, Dr. Perri didn’t want to be a millionaire – he wanted to make a difference. After all the final answers were in, Dr. Perri, an emergency physician at Presbyterian Hospital in Huntersville, N.C., pledged all of his winnings – $15,800 – to benefit brain tumor research.

The cause hits home for Dr. Perri, who at age 24 was diagnosed with oligodendroglioma, a rare brain tumor representing only 3% of primary brain tumors, according to the College of American Pathologists. After a successful round of chemotherapy and radiation, Dr. Perri was cancer free. He then moved with his job from Philadelphia to Huntersville, N.C.

Courtesy of Valleycrest Productions Ltd

In 2009, the cancer resurfaced, and Dr. Perri, then 36 years old, started another round of radiation and chemotherapy, forcing him to leave his position on the Relative Value Scale Update Committee (RUC). Again, however, the tumor was successfully removed, and Dr. Perri and his wife, Nancy – by then parents of Jack, 7, and Sofia, 5 – were inspired to use their experience to give a voice to this rare disease.

"[I was] just trying to take an active role in fighting a disease I have, which you have very little control over," Dr. Perri said in an interview. But he also took the next step and asked himself, "Okay, what can I do to fight not only what I have, but others have?" and bring attention to a disease that is "underrepresented," he said.

Very little funding is available to study oligodendroglioma, which means there is limited information about the condition itself, Nancy Perri said. She recalled contacting cancer researchers about oligodendroglioma, only to hear that while innovative ideas exist, the funding for studying them does not. So this past February, she completed steps necessary to establish a nonprofit – Operation Oligo Cure. The goal of the organization is to raise awareness and funding for clinical trials to test innovative treatments for oligodendroglioma. In April, they raised $1,000 during their Exercise for a Cure event featuring fitness instruction at a local gym where Nancy works part-time.

"This is my way of contributing, helping to try and make a change and regain some type of control in this situation," she said in an interview. "I can not only help my husband but [also] pay it forward to people who are in this type of situation."

To add to Dr. Perri’s game show winnings and donations from family and friends, the Perris are aiming to raise between $150,000 and $200,000 to fund trials testing strategies such as tumor vaccines or the role of genetics in preventing brain tumors, Dr. Perri said.

Although Dr. Perri didn’t walk away a millionaire, he did get the chance to share his story and shine a light on the struggle shared by others with oligodendroglioma.

"If you’re giving yourself more hope or [giving] others more hope, then that’s a good thing," Dr. Perri said.

To contribute to Operation Oligo Cure, go to www.oligocure.org.

More than a year after taking the test, the round of interviews, and much anticipation to be a contestant on "Who Wants to Be a Millionaire," Dr. James Perri finally got his chance this past November, competing on an episode that aired in late April. But even as he walked onto the stage, Dr. Perri didn’t want to be a millionaire – he wanted to make a difference. After all the final answers were in, Dr. Perri, an emergency physician at Presbyterian Hospital in Huntersville, N.C., pledged all of his winnings – $15,800 – to benefit brain tumor research.

The cause hits home for Dr. Perri, who at age 24 was diagnosed with oligodendroglioma, a rare brain tumor representing only 3% of primary brain tumors, according to the College of American Pathologists. After a successful round of chemotherapy and radiation, Dr. Perri was cancer free. He then moved with his job from Philadelphia to Huntersville, N.C.

Courtesy of Valleycrest Productions Ltd

In 2009, the cancer resurfaced, and Dr. Perri, then 36 years old, started another round of radiation and chemotherapy, forcing him to leave his position on the Relative Value Scale Update Committee (RUC). Again, however, the tumor was successfully removed, and Dr. Perri and his wife, Nancy – by then parents of Jack, 7, and Sofia, 5 – were inspired to use their experience to give a voice to this rare disease.

"[I was] just trying to take an active role in fighting a disease I have, which you have very little control over," Dr. Perri said in an interview. But he also took the next step and asked himself, "Okay, what can I do to fight not only what I have, but others have?" and bring attention to a disease that is "underrepresented," he said.

Very little funding is available to study oligodendroglioma, which means there is limited information about the condition itself, Nancy Perri said. She recalled contacting cancer researchers about oligodendroglioma, only to hear that while innovative ideas exist, the funding for studying them does not. So this past February, she completed steps necessary to establish a nonprofit – Operation Oligo Cure. The goal of the organization is to raise awareness and funding for clinical trials to test innovative treatments for oligodendroglioma. In April, they raised $1,000 during their Exercise for a Cure event featuring fitness instruction at a local gym where Nancy works part-time.

"This is my way of contributing, helping to try and make a change and regain some type of control in this situation," she said in an interview. "I can not only help my husband but [also] pay it forward to people who are in this type of situation."

To add to Dr. Perri’s game show winnings and donations from family and friends, the Perris are aiming to raise between $150,000 and $200,000 to fund trials testing strategies such as tumor vaccines or the role of genetics in preventing brain tumors, Dr. Perri said.

Although Dr. Perri didn’t walk away a millionaire, he did get the chance to share his story and shine a light on the struggle shared by others with oligodendroglioma.

"If you’re giving yourself more hope or [giving] others more hope, then that’s a good thing," Dr. Perri said.

To contribute to Operation Oligo Cure, go to www.oligocure.org.

WASHINGTON – The major expansions in health care coverage in 2014 called for by the Affordable Care Act will cause health care spending to grow by 7.4% that year alone – a rate two percentage points higher than would have occurred without the law, according to an analysis by economists from the Centers for Medicare & Medicaid Services.

Much of that growth will be driven by increased use of physician services (projected to grow by 8.5%) and prescription drugs (projected to grow by 8.8%) as an estimated additional 30 million Americans gain health coverage under the law, Sean P. Keehan and his colleagues from the CMS Office of the Actuary said at a press briefing today sponsored by the journal Health Affairs. Their analysis was published online in that journal (Health Aff. 2012 June [doi:10.1377/hlthaff.2012.0404]).

The coming growth in health spending is tempered by the current economic climate, according to the analysis. Estimated spending growth for 2011 is 3.9% – the same rate seen in 2010 and just above the historically slow growth rate of 3.8% in 2009.

"The recent recession and the modest economic recovery have played a role in our projection of near historic lows in health spending growth through 2013," Mr. Keehan said.

The economists noted, however, that once the health care system absorbs those newly insured via the state health insurance exchanges and Medicaid expansion in 2014, growth in spending is projected to stabilize.

"Once you have [the population from the coverage expansion] in, the growth rate of national health spending is projected to be fairly similar with or without the Affordable Care Act," Mr. Keehan said.

Their analysis is based on a fairly uncertain future, however, as the Supreme Court deliberates on the constitutionality of the ACA.

The projections also assume the approximate 30% cut in Medicare physician payment under the Sustainable Growth Rate formula will go into effect Jan. 1, 2013, and will remain in effect. This would bring the growth in Medicare spending down to 1.3%, from 5.9% in 2012.

Medicare costs are projected to grow every year, as more baby boomers qualify for benefits. Those costs will be offset partially by cost-saving provisions under the ACA, said CMS economist Gigi Cuckler.

"The growth rate in 2014 is largely influenced by the coverage expansions, but once you go into 2015 through 2021, you still have continuing effects of the coverage expansions," she said. "However, you have a lot of Medicare cost-savings provisions also in play here that are bringing down the costs at this time."

The analysis is similar to that released last July by CMS.

The projections are based on economic and demographic assumptions from the 2012 Medicare Trustees Report.

WASHINGTON – The major expansions in health care coverage in 2014 called for by the Affordable Care Act will cause health care spending to grow by 7.4% that year alone – a rate two percentage points higher than would have occurred without the law, according to an analysis by economists from the Centers for Medicare & Medicaid Services.

Much of that growth will be driven by increased use of physician services (projected to grow by 8.5%) and prescription drugs (projected to grow by 8.8%) as an estimated additional 30 million Americans gain health coverage under the law, Sean P. Keehan and his colleagues from the CMS Office of the Actuary said at a press briefing today sponsored by the journal Health Affairs. Their analysis was published online in that journal (Health Aff. 2012 June [doi:10.1377/hlthaff.2012.0404]).

The coming growth in health spending is tempered by the current economic climate, according to the analysis. Estimated spending growth for 2011 is 3.9% – the same rate seen in 2010 and just above the historically slow growth rate of 3.8% in 2009.

"The recent recession and the modest economic recovery have played a role in our projection of near historic lows in health spending growth through 2013," Mr. Keehan said.

The economists noted, however, that once the health care system absorbs those newly insured via the state health insurance exchanges and Medicaid expansion in 2014, growth in spending is projected to stabilize.

"Once you have [the population from the coverage expansion] in, the growth rate of national health spending is projected to be fairly similar with or without the Affordable Care Act," Mr. Keehan said.

Their analysis is based on a fairly uncertain future, however, as the Supreme Court deliberates on the constitutionality of the ACA.

The projections also assume the approximate 30% cut in Medicare physician payment under the Sustainable Growth Rate formula will go into effect Jan. 1, 2013, and will remain in effect. This would bring the growth in Medicare spending down to 1.3%, from 5.9% in 2012.

Medicare costs are projected to grow every year, as more baby boomers qualify for benefits. Those costs will be offset partially by cost-saving provisions under the ACA, said CMS economist Gigi Cuckler.

"The growth rate in 2014 is largely influenced by the coverage expansions, but once you go into 2015 through 2021, you still have continuing effects of the coverage expansions," she said. "However, you have a lot of Medicare cost-savings provisions also in play here that are bringing down the costs at this time."

The analysis is similar to that released last July by CMS.

The projections are based on economic and demographic assumptions from the 2012 Medicare Trustees Report.

WASHINGTON – The major expansions in health care coverage in 2014 called for by the Affordable Care Act will cause health care spending to grow by 7.4% that year alone – a rate two percentage points higher than would have occurred without the law, according to an analysis by economists from the Centers for Medicare & Medicaid Services.

Much of that growth will be driven by increased use of physician services (projected to grow by 8.5%) and prescription drugs (projected to grow by 8.8%) as an estimated additional 30 million Americans gain health coverage under the law, Sean P. Keehan and his colleagues from the CMS Office of the Actuary said at a press briefing today sponsored by the journal Health Affairs. Their analysis was published online in that journal (Health Aff. 2012 June [doi:10.1377/hlthaff.2012.0404]).

The coming growth in health spending is tempered by the current economic climate, according to the analysis. Estimated spending growth for 2011 is 3.9% – the same rate seen in 2010 and just above the historically slow growth rate of 3.8% in 2009.

"The recent recession and the modest economic recovery have played a role in our projection of near historic lows in health spending growth through 2013," Mr. Keehan said.

The economists noted, however, that once the health care system absorbs those newly insured via the state health insurance exchanges and Medicaid expansion in 2014, growth in spending is projected to stabilize.

"Once you have [the population from the coverage expansion] in, the growth rate of national health spending is projected to be fairly similar with or without the Affordable Care Act," Mr. Keehan said.

Their analysis is based on a fairly uncertain future, however, as the Supreme Court deliberates on the constitutionality of the ACA.

The projections also assume the approximate 30% cut in Medicare physician payment under the Sustainable Growth Rate formula will go into effect Jan. 1, 2013, and will remain in effect. This would bring the growth in Medicare spending down to 1.3%, from 5.9% in 2012.

Medicare costs are projected to grow every year, as more baby boomers qualify for benefits. Those costs will be offset partially by cost-saving provisions under the ACA, said CMS economist Gigi Cuckler.

"The growth rate in 2014 is largely influenced by the coverage expansions, but once you go into 2015 through 2021, you still have continuing effects of the coverage expansions," she said. "However, you have a lot of Medicare cost-savings provisions also in play here that are bringing down the costs at this time."

The analysis is similar to that released last July by CMS.

The projections are based on economic and demographic assumptions from the 2012 Medicare Trustees Report.

PHILADELPHIA – High doses of the anesthetic ketamine hydrochloride injected into the anterior thigh are the first line of defense when treating a patient with excited delirium syndrome, Dr. James R. Roberts reported at the meeting.

Excited delirium syndrome (ExDS) is characterized by delirium, agitation, acidosis, and hyper adrenergic autonomic dysfunction, according to the Journal of Emergency Medicine (J. Emerg. Med. 2011 March 24 [doi: 10.1016/j.jemermed.2011.02.017]). It is often comorbid with serious mental illness, drug abuse, or a combination of the two, said Dr. Roberts, who serves as director of emergency medicine at Mercy Philadelphia Hospital and Mercy Fitzgerald Hospital, and has more than 40 years of experience working in emergency departments.

Dr. Roberts said ExDS patients often have symptoms that include severe hypothermia, high levels of testosterone, elevated temperature, extreme paranoia, and tolerance to pain, and sweating. These patients also often display super-human strength and are non-compliant with police. Some ExDS patients have an attraction to glass or mirrors. After an episode, patients also tend to have no memory of the event.

According to the American College of Emergency Physicians (ACEP), which published a white paper on ExDS and formally recognized the illness as a unique syndrome in 2009, more than 95% of published fatal cases of ExDS involve males with a mean age of 36. After the cohort of people who abuse stimulants, those with psychiatric illness make up the second-largest and "distinctly smaller cohort of ExDS cases and deaths," according to the white paper.

Death from ExDS is often sudden and can result from several conditions, including cardiac arrest, renal failure, or hypothermia. The mortality is nearly 75%, yet ExDS is neither well recognized nor understood within the medical community, Dr. Roberts said. He also noted an absence of coding that can be used to classify the syndrome.

Diagnosis and research of ExDS is tricky, the report noted, because of a lack of well-defined and consistent case definitions, as well as shared characteristics with other diseases. For example, ExDS can be confused with heat stroke, alcohol withdrawal, and post-seizures.

To help decrease mortality and complications, Dr. Roberts encouraged physicians and law enforcement to raise their awareness of the condition.

"In the heat of the battle [between the patient and law enforcement], the patient stops struggling. The [police are] happy, but what really happens is the patient is dying and they’re not aware of it," Dr. Roberts said.

He added that police often mistake ExDS for another psychiatric disease, such as schizophrenia, and they often feel compelled to use physical force to encourage compliance. Tasers, he added, should only be used to remove any weapons the patient might have. Tasers increase the patient’s physiological stress and increase likelihood of death, he said.

Medical treatment should be used as soon as possible to improve outcomes.

"The cooler heads have to prevail," Dr. Roberts said. "Doctors have to set the example."

PHILADELPHIA – High doses of the anesthetic ketamine hydrochloride injected into the anterior thigh are the first line of defense when treating a patient with excited delirium syndrome, Dr. James R. Roberts reported at the meeting.

Excited delirium syndrome (ExDS) is characterized by delirium, agitation, acidosis, and hyper adrenergic autonomic dysfunction, according to the Journal of Emergency Medicine (J. Emerg. Med. 2011 March 24 [doi: 10.1016/j.jemermed.2011.02.017]). It is often comorbid with serious mental illness, drug abuse, or a combination of the two, said Dr. Roberts, who serves as director of emergency medicine at Mercy Philadelphia Hospital and Mercy Fitzgerald Hospital, and has more than 40 years of experience working in emergency departments.

Dr. Roberts said ExDS patients often have symptoms that include severe hypothermia, high levels of testosterone, elevated temperature, extreme paranoia, and tolerance to pain, and sweating. These patients also often display super-human strength and are non-compliant with police. Some ExDS patients have an attraction to glass or mirrors. After an episode, patients also tend to have no memory of the event.

According to the American College of Emergency Physicians (ACEP), which published a white paper on ExDS and formally recognized the illness as a unique syndrome in 2009, more than 95% of published fatal cases of ExDS involve males with a mean age of 36. After the cohort of people who abuse stimulants, those with psychiatric illness make up the second-largest and "distinctly smaller cohort of ExDS cases and deaths," according to the white paper.

Death from ExDS is often sudden and can result from several conditions, including cardiac arrest, renal failure, or hypothermia. The mortality is nearly 75%, yet ExDS is neither well recognized nor understood within the medical community, Dr. Roberts said. He also noted an absence of coding that can be used to classify the syndrome.

Diagnosis and research of ExDS is tricky, the report noted, because of a lack of well-defined and consistent case definitions, as well as shared characteristics with other diseases. For example, ExDS can be confused with heat stroke, alcohol withdrawal, and post-seizures.

To help decrease mortality and complications, Dr. Roberts encouraged physicians and law enforcement to raise their awareness of the condition.

"In the heat of the battle [between the patient and law enforcement], the patient stops struggling. The [police are] happy, but what really happens is the patient is dying and they’re not aware of it," Dr. Roberts said.

He added that police often mistake ExDS for another psychiatric disease, such as schizophrenia, and they often feel compelled to use physical force to encourage compliance. Tasers, he added, should only be used to remove any weapons the patient might have. Tasers increase the patient’s physiological stress and increase likelihood of death, he said.

Medical treatment should be used as soon as possible to improve outcomes.

"The cooler heads have to prevail," Dr. Roberts said. "Doctors have to set the example."

PHILADELPHIA – High doses of the anesthetic ketamine hydrochloride injected into the anterior thigh are the first line of defense when treating a patient with excited delirium syndrome, Dr. James R. Roberts reported at the meeting.

Excited delirium syndrome (ExDS) is characterized by delirium, agitation, acidosis, and hyper adrenergic autonomic dysfunction, according to the Journal of Emergency Medicine (J. Emerg. Med. 2011 March 24 [doi: 10.1016/j.jemermed.2011.02.017]). It is often comorbid with serious mental illness, drug abuse, or a combination of the two, said Dr. Roberts, who serves as director of emergency medicine at Mercy Philadelphia Hospital and Mercy Fitzgerald Hospital, and has more than 40 years of experience working in emergency departments.

Dr. Roberts said ExDS patients often have symptoms that include severe hypothermia, high levels of testosterone, elevated temperature, extreme paranoia, and tolerance to pain, and sweating. These patients also often display super-human strength and are non-compliant with police. Some ExDS patients have an attraction to glass or mirrors. After an episode, patients also tend to have no memory of the event.

According to the American College of Emergency Physicians (ACEP), which published a white paper on ExDS and formally recognized the illness as a unique syndrome in 2009, more than 95% of published fatal cases of ExDS involve males with a mean age of 36. After the cohort of people who abuse stimulants, those with psychiatric illness make up the second-largest and "distinctly smaller cohort of ExDS cases and deaths," according to the white paper.

Death from ExDS is often sudden and can result from several conditions, including cardiac arrest, renal failure, or hypothermia. The mortality is nearly 75%, yet ExDS is neither well recognized nor understood within the medical community, Dr. Roberts said. He also noted an absence of coding that can be used to classify the syndrome.

Diagnosis and research of ExDS is tricky, the report noted, because of a lack of well-defined and consistent case definitions, as well as shared characteristics with other diseases. For example, ExDS can be confused with heat stroke, alcohol withdrawal, and post-seizures.

To help decrease mortality and complications, Dr. Roberts encouraged physicians and law enforcement to raise their awareness of the condition.

"In the heat of the battle [between the patient and law enforcement], the patient stops struggling. The [police are] happy, but what really happens is the patient is dying and they’re not aware of it," Dr. Roberts said.

He added that police often mistake ExDS for another psychiatric disease, such as schizophrenia, and they often feel compelled to use physical force to encourage compliance. Tasers, he added, should only be used to remove any weapons the patient might have. Tasers increase the patient’s physiological stress and increase likelihood of death, he said.

Medical treatment should be used as soon as possible to improve outcomes.

"The cooler heads have to prevail," Dr. Roberts said. "Doctors have to set the example."

Cancer patients deserve to receive aggressive treatment for comorbid depression. Dr. David Spiegel and his team of researchers at Stanford University found that patients with depression may exhibit faster rates of cancer progression. The team found that depression was as dangerous a risk factor for mortality in cancer as it is in cardiovascular disease.

               While depression is often underdiagnosed in cancer patients, Dr. Spiegel said his findings suggests that psychiatrists should view treatment for depression as part of overall cancer treatment. Dr. Spiegel presented his findings at the annual meeting of the American Psychiatric Association. 

Cancer patients deserve to receive aggressive treatment for comorbid depression. Dr. David Spiegel and his team of researchers at Stanford University found that patients with depression may exhibit faster rates of cancer progression. The team found that depression was as dangerous a risk factor for mortality in cancer as it is in cardiovascular disease.

               While depression is often underdiagnosed in cancer patients, Dr. Spiegel said his findings suggests that psychiatrists should view treatment for depression as part of overall cancer treatment. Dr. Spiegel presented his findings at the annual meeting of the American Psychiatric Association. 

Cancer patients deserve to receive aggressive treatment for comorbid depression. Dr. David Spiegel and his team of researchers at Stanford University found that patients with depression may exhibit faster rates of cancer progression. The team found that depression was as dangerous a risk factor for mortality in cancer as it is in cardiovascular disease.

               While depression is often underdiagnosed in cancer patients, Dr. Spiegel said his findings suggests that psychiatrists should view treatment for depression as part of overall cancer treatment. Dr. Spiegel presented his findings at the annual meeting of the American Psychiatric Association. 

The mentally ill in the prison system are in dire need of resources and improved standards of diagnosis. That's according to researchers at the annual meeting of the American Psychiatric Association.

Dr. Rodrigo Munoz, a private practice psychiatrist in San Diego, said prisoners with mental illness are often given only one diagnosis, even when they present with several accessory illnesses. Dr. Marcia Goin, a private practice psychiatrist in Los Angeles and past president of the American Psychiatric Association, added that mentally ill inmates also need additional protection from manipulation by other inmates. Dr. Goin and Dr. Munoz urged their colleagues and the APA to push for improved standards of diagnosis, protection, and more resources for the mentally ill in prisons.

The mentally ill in the prison system are in dire need of resources and improved standards of diagnosis. That's according to researchers at the annual meeting of the American Psychiatric Association.

Dr. Rodrigo Munoz, a private practice psychiatrist in San Diego, said prisoners with mental illness are often given only one diagnosis, even when they present with several accessory illnesses. Dr. Marcia Goin, a private practice psychiatrist in Los Angeles and past president of the American Psychiatric Association, added that mentally ill inmates also need additional protection from manipulation by other inmates. Dr. Goin and Dr. Munoz urged their colleagues and the APA to push for improved standards of diagnosis, protection, and more resources for the mentally ill in prisons.

The mentally ill in the prison system are in dire need of resources and improved standards of diagnosis. That's according to researchers at the annual meeting of the American Psychiatric Association.

Dr. Rodrigo Munoz, a private practice psychiatrist in San Diego, said prisoners with mental illness are often given only one diagnosis, even when they present with several accessory illnesses. Dr. Marcia Goin, a private practice psychiatrist in Los Angeles and past president of the American Psychiatric Association, added that mentally ill inmates also need additional protection from manipulation by other inmates. Dr. Goin and Dr. Munoz urged their colleagues and the APA to push for improved standards of diagnosis, protection, and more resources for the mentally ill in prisons.

WASHINGTON – By implementing a series of payment reforms now – and adopting MedPAC’s recommendations on replacing the SGR – Congress can fix the Medicare physician pay problem and come closer to paying for it, too.

That’s the bottom line of the March 2012 Report to Congress from the Medicare Payment Advisory Commission (MedPAC), released March 15.

While the recommended cuts may cause some physicians to wince, according to Mark Miller, the blow would be much harder if Congress allows the nearly 30% physician pay cut called for by the Medicare SGR Growth Rate formula to go through, Mr. Miller, MedPAC executive director, said at a press conference.

Key among those recommendations was freezing most Medicare payments to primary care physicians for 10 years and cutting specialists’ payments by 17% over 3 years, followed by a freeze for 7 years more.

"That’s hard medicine," Mr. Miller said. "But one of the things that it does is it reduces the cost of the fix."

MedPAC estimates their recommendations will bring the price tag of repealing the SGR to approximately $200 billion. To pick up another $60 billion to $65 billion in savings, the MedPAC March report lists 29 recommended program and policy changes.

Key among the changes:

• Freeze payments to skilled nursing facilities in 2013, then cut them by 4% in 2014.
• Equalize payments for office-based and hospital outpatient services.
• Modify Medicare Part D low-income subsidies to favor more generic drugs.

"The biggest reason that Congress doesn’t move forward on this issue is that it costs $300 billion. ... It’s a big cost."

WASHINGTON – By implementing a series of payment reforms now – and adopting MedPAC’s recommendations on replacing the SGR – Congress can fix the Medicare physician pay problem and come closer to paying for it, too.

That’s the bottom line of the March 2012 Report to Congress from the Medicare Payment Advisory Commission (MedPAC), released March 15.

While the recommended cuts may cause some physicians to wince, according to Mark Miller, the blow would be much harder if Congress allows the nearly 30% physician pay cut called for by the Medicare SGR Growth Rate formula to go through, Mr. Miller, MedPAC executive director, said at a press conference.

Key among those recommendations was freezing most Medicare payments to primary care physicians for 10 years and cutting specialists’ payments by 17% over 3 years, followed by a freeze for 7 years more.

"That’s hard medicine," Mr. Miller said. "But one of the things that it does is it reduces the cost of the fix."

MedPAC estimates their recommendations will bring the price tag of repealing the SGR to approximately $200 billion. To pick up another $60 billion to $65 billion in savings, the MedPAC March report lists 29 recommended program and policy changes.

Key among the changes:

• Freeze payments to skilled nursing facilities in 2013, then cut them by 4% in 2014.
• Equalize payments for office-based and hospital outpatient services.
• Modify Medicare Part D low-income subsidies to favor more generic drugs.

"The biggest reason that Congress doesn’t move forward on this issue is that it costs $300 billion. ... It’s a big cost."

WASHINGTON – By implementing a series of payment reforms now – and adopting MedPAC’s recommendations on replacing the SGR – Congress can fix the Medicare physician pay problem and come closer to paying for it, too.

That’s the bottom line of the March 2012 Report to Congress from the Medicare Payment Advisory Commission (MedPAC), released March 15.

While the recommended cuts may cause some physicians to wince, according to Mark Miller, the blow would be much harder if Congress allows the nearly 30% physician pay cut called for by the Medicare SGR Growth Rate formula to go through, Mr. Miller, MedPAC executive director, said at a press conference.

Key among those recommendations was freezing most Medicare payments to primary care physicians for 10 years and cutting specialists’ payments by 17% over 3 years, followed by a freeze for 7 years more.

"That’s hard medicine," Mr. Miller said. "But one of the things that it does is it reduces the cost of the fix."

MedPAC estimates their recommendations will bring the price tag of repealing the SGR to approximately $200 billion. To pick up another $60 billion to $65 billion in savings, the MedPAC March report lists 29 recommended program and policy changes.

Key among the changes:

• Freeze payments to skilled nursing facilities in 2013, then cut them by 4% in 2014.
• Equalize payments for office-based and hospital outpatient services.
• Modify Medicare Part D low-income subsidies to favor more generic drugs.

"The biggest reason that Congress doesn’t move forward on this issue is that it costs $300 billion. ... It’s a big cost."

At a recent briefing, researchers cited their studies as examples of the advantages of comparative effectiveness research. One study, for example, questioned the effectiveness of proton therapy for the treatment of prostate cancer. Another found that using the monoclonal antibody bevacizumab (Avastin) as a first-line chemotherapy treatment did not improve outcomes for elderly patients with advanced lung cancer.

At a recent briefing, researchers cited their studies as examples of the advantages of comparative effectiveness research. One study, for example, questioned the effectiveness of proton therapy for the treatment of prostate cancer. Another found that using the monoclonal antibody bevacizumab (Avastin) as a first-line chemotherapy treatment did not improve outcomes for elderly patients with advanced lung cancer.

At a recent briefing, researchers cited their studies as examples of the advantages of comparative effectiveness research. One study, for example, questioned the effectiveness of proton therapy for the treatment of prostate cancer. Another found that using the monoclonal antibody bevacizumab (Avastin) as a first-line chemotherapy treatment did not improve outcomes for elderly patients with advanced lung cancer.

Few hospitals are prepared to handle a mass casualty event that overwhelms available resources, even though most have a disaster response plan, according to a report from the Institute of Medicine.

The report provides a guide to help hospitals and acute care centers respond during and after a catastrophic disaster like a flu pandemic or tsunami, while making optimal use of limited resources.

"At the time the disaster strikes is the wrong time to start thinking about crisis standards of care," said Dr. Stephen V. Cantrill, director of emergency medicine at Denver Health Medical Center and a member of the IOM’s Committee for Establishing Standards of Care for Use in Disaster Situations. He added that statewide and regional coordination on disaster preparedness for hospitals is rare and often depends on funding, time, and the interest of legislators.

"If you have a statewide emergency preparedness group that is very gung ho in this area and has reached out to the medical community, then you’re better off" than if your institution tries to do it all alone, he said.

The report emphasizes the need for a coordinated response among emergency management, public health, and public safety departments; emergency medical services; and health care providers.

"Regional coordination allows the maximum use of available resources ... and provides a mechanism for policy development and situational awareness that is critical to avoid crisis situations and, when a crisis does occur, ensuring fair and consistent use of resources to provide a uniform level of care across the region," the report said.

A regional preparedness plan should specify where to focus the often-limited funding to meet the unique needs of the community, according to Margaret VanAmringe, vice president for public policy and government relations at the Joint Commission.

"You look at what you believe are your highest risks, and you prepare for those risks. There’s no preparing for a flood in the middle of the mountains of Utah," she said.

When creating a disaster response plan, the report recommended that hospitals address the following:

• Resource shortfalls. Make sure you anticipate shortfalls in resources and can implement adaptive strategies as needed. Identify which devices and medications are functionally equivalent. Conserve therapies for only those who really need it. For example, reserve your oxygen supply for patients with documented hypoxia. Know which devices can be reused with proper sterilization. Reallocate treatment time and supplies to the patients who are most likely to benefit.

• Communication. Maintain communication directly with the emergency medical services, public safety officers, hospital partners, the state’s Department of Public Health, the National Weather Service, community members who can offer clinical care, and technical experts in areas such as blood banking, burn surgery, and mental health. Make sure staff and administration know how to receive and share information with the state disaster medical advisory committee. Coordinate with other geographic areas to provide telemedicine or hotline specialist support. Offer regular updates through a hotline, Twitter, or Facebook. The public information officer should also coordinate with the media to inform the public about where to seek care.

• Triage. Develop criteria for triage into levels of care, including the chronically ill. Prioritize care based on societal need and achieving the greatest good for the most people. However, make sure it’s possible to also reverse triage decisions based on changes in conditions and resource availability. Decide what to do with patients expected to die imminently.

• Palliative care. Determine what resources are needed to provide palliative care. Long-term care providers should shelter the elderly and disabled who can’t stay in their homes. Determine what care can be delivered and who is responsible to deliver that care. Keep a stock of pain medications such as opioids, acetaminophen, and steroids.

• Space flexibility. To make optimal use of space, consider using operative space for inpatient care, placing patient cots in open areas such as lobbies, and sending patients to alternative care sites. Adjust admission criteria to accommodate as many people as possible.

• Staff flexibility. Extend operating hours, and adjust regular staffing hours and documentation requirements. Delegate nonclinical duties to volunteers or administrative staff. Perform clinical assessments like vital signs less frequently, based on clinical changes. Provide immediate training to staff so they can provide basic patient care.

The report also encourages hospitals and physicians to fully evaluate the existing legal protections and liabilities regarding emergency care.

The Joint Commission applauded the IOM report for its recommendations and has already begun reevaluating its own standards in response, Ms. VanAmringe said.

 

The IOM "tried to set these crisis standards of care [by] thinking about what happens when the infrastructure changes so dramatically that you have to move your focus from patients to populations," she said. "It’s going to take a lot more than just one report to get there, but this is a very nice step."

Few hospitals are prepared to handle a mass casualty event that overwhelms available resources, even though most have a disaster response plan, according to a report from the Institute of Medicine.

The report provides a guide to help hospitals and acute care centers respond during and after a catastrophic disaster like a flu pandemic or tsunami, while making optimal use of limited resources.

"At the time the disaster strikes is the wrong time to start thinking about crisis standards of care," said Dr. Stephen V. Cantrill, director of emergency medicine at Denver Health Medical Center and a member of the IOM’s Committee for Establishing Standards of Care for Use in Disaster Situations. He added that statewide and regional coordination on disaster preparedness for hospitals is rare and often depends on funding, time, and the interest of legislators.

"If you have a statewide emergency preparedness group that is very gung ho in this area and has reached out to the medical community, then you’re better off" than if your institution tries to do it all alone, he said.

The report emphasizes the need for a coordinated response among emergency management, public health, and public safety departments; emergency medical services; and health care providers.

"Regional coordination allows the maximum use of available resources ... and provides a mechanism for policy development and situational awareness that is critical to avoid crisis situations and, when a crisis does occur, ensuring fair and consistent use of resources to provide a uniform level of care across the region," the report said.

A regional preparedness plan should specify where to focus the often-limited funding to meet the unique needs of the community, according to Margaret VanAmringe, vice president for public policy and government relations at the Joint Commission.

"You look at what you believe are your highest risks, and you prepare for those risks. There’s no preparing for a flood in the middle of the mountains of Utah," she said.

When creating a disaster response plan, the report recommended that hospitals address the following:

• Resource shortfalls. Make sure you anticipate shortfalls in resources and can implement adaptive strategies as needed. Identify which devices and medications are functionally equivalent. Conserve therapies for only those who really need it. For example, reserve your oxygen supply for patients with documented hypoxia. Know which devices can be reused with proper sterilization. Reallocate treatment time and supplies to the patients who are most likely to benefit.

• Communication. Maintain communication directly with the emergency medical services, public safety officers, hospital partners, the state’s Department of Public Health, the National Weather Service, community members who can offer clinical care, and technical experts in areas such as blood banking, burn surgery, and mental health. Make sure staff and administration know how to receive and share information with the state disaster medical advisory committee. Coordinate with other geographic areas to provide telemedicine or hotline specialist support. Offer regular updates through a hotline, Twitter, or Facebook. The public information officer should also coordinate with the media to inform the public about where to seek care.

• Triage. Develop criteria for triage into levels of care, including the chronically ill. Prioritize care based on societal need and achieving the greatest good for the most people. However, make sure it’s possible to also reverse triage decisions based on changes in conditions and resource availability. Decide what to do with patients expected to die imminently.

• Palliative care. Determine what resources are needed to provide palliative care. Long-term care providers should shelter the elderly and disabled who can’t stay in their homes. Determine what care can be delivered and who is responsible to deliver that care. Keep a stock of pain medications such as opioids, acetaminophen, and steroids.

• Space flexibility. To make optimal use of space, consider using operative space for inpatient care, placing patient cots in open areas such as lobbies, and sending patients to alternative care sites. Adjust admission criteria to accommodate as many people as possible.

• Staff flexibility. Extend operating hours, and adjust regular staffing hours and documentation requirements. Delegate nonclinical duties to volunteers or administrative staff. Perform clinical assessments like vital signs less frequently, based on clinical changes. Provide immediate training to staff so they can provide basic patient care.

The report also encourages hospitals and physicians to fully evaluate the existing legal protections and liabilities regarding emergency care.

The Joint Commission applauded the IOM report for its recommendations and has already begun reevaluating its own standards in response, Ms. VanAmringe said.

 

The IOM "tried to set these crisis standards of care [by] thinking about what happens when the infrastructure changes so dramatically that you have to move your focus from patients to populations," she said. "It’s going to take a lot more than just one report to get there, but this is a very nice step."

Few hospitals are prepared to handle a mass casualty event that overwhelms available resources, even though most have a disaster response plan, according to a report from the Institute of Medicine.

The report provides a guide to help hospitals and acute care centers respond during and after a catastrophic disaster like a flu pandemic or tsunami, while making optimal use of limited resources.

"At the time the disaster strikes is the wrong time to start thinking about crisis standards of care," said Dr. Stephen V. Cantrill, director of emergency medicine at Denver Health Medical Center and a member of the IOM’s Committee for Establishing Standards of Care for Use in Disaster Situations. He added that statewide and regional coordination on disaster preparedness for hospitals is rare and often depends on funding, time, and the interest of legislators.

"If you have a statewide emergency preparedness group that is very gung ho in this area and has reached out to the medical community, then you’re better off" than if your institution tries to do it all alone, he said.

The report emphasizes the need for a coordinated response among emergency management, public health, and public safety departments; emergency medical services; and health care providers.

"Regional coordination allows the maximum use of available resources ... and provides a mechanism for policy development and situational awareness that is critical to avoid crisis situations and, when a crisis does occur, ensuring fair and consistent use of resources to provide a uniform level of care across the region," the report said.

A regional preparedness plan should specify where to focus the often-limited funding to meet the unique needs of the community, according to Margaret VanAmringe, vice president for public policy and government relations at the Joint Commission.

"You look at what you believe are your highest risks, and you prepare for those risks. There’s no preparing for a flood in the middle of the mountains of Utah," she said.

When creating a disaster response plan, the report recommended that hospitals address the following:

• Resource shortfalls. Make sure you anticipate shortfalls in resources and can implement adaptive strategies as needed. Identify which devices and medications are functionally equivalent. Conserve therapies for only those who really need it. For example, reserve your oxygen supply for patients with documented hypoxia. Know which devices can be reused with proper sterilization. Reallocate treatment time and supplies to the patients who are most likely to benefit.

• Communication. Maintain communication directly with the emergency medical services, public safety officers, hospital partners, the state’s Department of Public Health, the National Weather Service, community members who can offer clinical care, and technical experts in areas such as blood banking, burn surgery, and mental health. Make sure staff and administration know how to receive and share information with the state disaster medical advisory committee. Coordinate with other geographic areas to provide telemedicine or hotline specialist support. Offer regular updates through a hotline, Twitter, or Facebook. The public information officer should also coordinate with the media to inform the public about where to seek care.

• Triage. Develop criteria for triage into levels of care, including the chronically ill. Prioritize care based on societal need and achieving the greatest good for the most people. However, make sure it’s possible to also reverse triage decisions based on changes in conditions and resource availability. Decide what to do with patients expected to die imminently.

• Palliative care. Determine what resources are needed to provide palliative care. Long-term care providers should shelter the elderly and disabled who can’t stay in their homes. Determine what care can be delivered and who is responsible to deliver that care. Keep a stock of pain medications such as opioids, acetaminophen, and steroids.

• Space flexibility. To make optimal use of space, consider using operative space for inpatient care, placing patient cots in open areas such as lobbies, and sending patients to alternative care sites. Adjust admission criteria to accommodate as many people as possible.

• Staff flexibility. Extend operating hours, and adjust regular staffing hours and documentation requirements. Delegate nonclinical duties to volunteers or administrative staff. Perform clinical assessments like vital signs less frequently, based on clinical changes. Provide immediate training to staff so they can provide basic patient care.

The report also encourages hospitals and physicians to fully evaluate the existing legal protections and liabilities regarding emergency care.

The Joint Commission applauded the IOM report for its recommendations and has already begun reevaluating its own standards in response, Ms. VanAmringe said.

 

The IOM "tried to set these crisis standards of care [by] thinking about what happens when the infrastructure changes so dramatically that you have to move your focus from patients to populations," she said. "It’s going to take a lot more than just one report to get there, but this is a very nice step."

The first 27 Accountable Care Organizations are now participating in the Medicare Shared Savings Program. This first class of ACOs hail from from 18 states and serve 375,000 beneficiaries. Nearly half of the ACOs are physician-led, according to the Center for Medicare and Medicaid Innovation (CMMI).

The ACO model was created by the Affordable Care Act and is being administered through CMMI. ACOs are groups of doctors, hospitals, and other health care providers, that band together to coordinate patient care and lower costs through avoiding duplicative services and medical errors. While there was some initial wariness « http://www.familypracticenews.com/index.php?id=2633&cHash=071010&tx_ttnews[tt_news]=58801»about ACO requirements, physician feedback helped shape changes in the final rule.  « http://www.familypracticenews.com/views/commentaries/single-article/the-aco-final-rule-game-changer-for-primary-care/01f6caec47.html?tx_ttnews[sViewPointer]=1»

Jordan Community ACO is one of the 27 that just joined the program. Dr. James Fanale, vice president of operations at Jordan Hospital, helped form the ACO through a merging of Jordan Hospital and a primary care group in Plymouth, Mass.

In a recent interview, Dr. Falane discussed the advantages and challenges the group has encountered so far. 

The first 27 Accountable Care Organizations are now participating in the Medicare Shared Savings Program. This first class of ACOs hail from from 18 states and serve 375,000 beneficiaries. Nearly half of the ACOs are physician-led, according to the Center for Medicare and Medicaid Innovation (CMMI).

The ACO model was created by the Affordable Care Act and is being administered through CMMI. ACOs are groups of doctors, hospitals, and other health care providers, that band together to coordinate patient care and lower costs through avoiding duplicative services and medical errors. While there was some initial wariness « http://www.familypracticenews.com/index.php?id=2633&cHash=071010&tx_ttnews[tt_news]=58801»about ACO requirements, physician feedback helped shape changes in the final rule.  « http://www.familypracticenews.com/views/commentaries/single-article/the-aco-final-rule-game-changer-for-primary-care/01f6caec47.html?tx_ttnews[sViewPointer]=1»

Jordan Community ACO is one of the 27 that just joined the program. Dr. James Fanale, vice president of operations at Jordan Hospital, helped form the ACO through a merging of Jordan Hospital and a primary care group in Plymouth, Mass.

In a recent interview, Dr. Falane discussed the advantages and challenges the group has encountered so far. 

The first 27 Accountable Care Organizations are now participating in the Medicare Shared Savings Program. This first class of ACOs hail from from 18 states and serve 375,000 beneficiaries. Nearly half of the ACOs are physician-led, according to the Center for Medicare and Medicaid Innovation (CMMI).

The ACO model was created by the Affordable Care Act and is being administered through CMMI. ACOs are groups of doctors, hospitals, and other health care providers, that band together to coordinate patient care and lower costs through avoiding duplicative services and medical errors. While there was some initial wariness « http://www.familypracticenews.com/index.php?id=2633&cHash=071010&tx_ttnews[tt_news]=58801»about ACO requirements, physician feedback helped shape changes in the final rule.  « http://www.familypracticenews.com/views/commentaries/single-article/the-aco-final-rule-game-changer-for-primary-care/01f6caec47.html?tx_ttnews[sViewPointer]=1»

Jordan Community ACO is one of the 27 that just joined the program. Dr. James Fanale, vice president of operations at Jordan Hospital, helped form the ACO through a merging of Jordan Hospital and a primary care group in Plymouth, Mass.

In a recent interview, Dr. Falane discussed the advantages and challenges the group has encountered so far. 

WASHINGTON – Federal technology incentives may not cover the true cost of implementing an electronic health record, according to members of the Medicare Payment Advisory Commission.

At MedPAC’s April 5 meeting, several commissioners expressed concern about the burden placed on smaller practices by the requirements of the Health Information Technology for Economic and Clinical Health (HITECH) Act.

Physicians who meet requirements for the meaningful use of an electronic health record (EHR) can earn incentive payments of up to $44,000 under HITECH. Beginning in 2015, physicians who do not participate will be penalized.

Dr. Ronald D. Castellanos, a MedPAC commissioner, noted that between the cost of purchasing, and the hassle of implementing, an EHR, many physicians are feeling forced to abandon their private practices and are joining hospital groups.

"People are going into the hospital or employed market because of the hassle factor, and it’s a hassle to this learning curve, and it’s a cost," said Dr. Castellanos, a urologist.

One thing the incentive pay does not cover, according to Commissioner Peter Butler, is the time necessary to manage all the additional data requirements.

"What [incentives] do not do is provide dollars for decision support, for data repositories, data warehouses, which are really the heart of managing in an [accountable care organization] capitated world. It kind of ignores some of the real tools that ultimately you need to kind of make a difference," said Mr. Butler, president and chief operating officer at Rush University Medical Center, Chicago.

Dr. Karen Borman, a MedPAC commissioner, added that the additional data requirements are also forcing physicians to spend more time in front of the computer instead of interacting with the patient.

As data requirements increase, the commission should consider how to address that concern in terms of patient satisfaction, noted Dr. Borman, a surgeon at Abington (Pa.) Memorial Hospital.

Despite the flaws in the EHR incentive program, commissioners agreed that, if it’s done right, EHRs would benefit both physicians and patients.

MedPAC Commissioner Dr. William Hall noted that EHR systems support a higher level of coding, which would mean higher payments to physicians than even incentive payments could offer.

"If you’re able to do it and willing to go through what’s a painful transition process, it pays for itself," said Dr. Hall, professor of medicine at the University of Rochester (N.Y.).

Joanna Kim, senior associate director of the American Hospital Association, Washington, testified to the commission that EHR requirements are too challenging, even for hospitals.

"[Incentive payments] are slow to come because the stage one requirements were set entirely too high," Ms. Kim said. She added that certain elements, like the patient portal are too expensive to implement, cause major security concerns, and carry uncertain benefits.

In addition, she said, CMS penalties for failing to meet meaningful use requirements will not hit until 2015, but they’ll be based on 2013 performances. Ms. Kim said this offers less time for physicians to adapt to requirements and increases the possibility that they’ll get a penalty payment along with any incentive payment.

MedPAC June Report to Congress

In addition to examining the EHR incentive program, the commission unanimously recommended changes to Medicare fee-for-service benefit design, including:

• Establishing a limit for out-of-pocket expenses to protect beneficiaries who reach catastrophic levels of Medicare costs. Although the commission recognized that a small group of beneficiaries would reach the out-of-pocket cap in any given year, they said many more would benefit from the cap.*

• Replacing coinsurance (where the beneficiary pays a percentage of the fee) with copayments (where the beneficiary pays a proscribed fee per service) that vary according to the type of service and provider. According to MedPAC staffers, copayments are more predictable, easier to budget for, and easier to understand than is coinsurance.

• Placing an additional charge on private supplemental insurance, or Medigap, that pays for services not covered under Medicare. The commission said the charge would help recoup some of the added costs of Medicare.

• Allowing the HHS secretary to determine cost sharing based on evidence of the value of services.*

• Maintaining a deductible for Part A and Part B services.

The recommendations were included in the commission’s June report to Congress.*

* UPDATE: Additional information was added to this story on 6/25/2012.

WASHINGTON – Federal technology incentives may not cover the true cost of implementing an electronic health record, according to members of the Medicare Payment Advisory Commission.

At MedPAC’s April 5 meeting, several commissioners expressed concern about the burden placed on smaller practices by the requirements of the Health Information Technology for Economic and Clinical Health (HITECH) Act.

Physicians who meet requirements for the meaningful use of an electronic health record (EHR) can earn incentive payments of up to $44,000 under HITECH. Beginning in 2015, physicians who do not participate will be penalized.

Dr. Ronald D. Castellanos, a MedPAC commissioner, noted that between the cost of purchasing, and the hassle of implementing, an EHR, many physicians are feeling forced to abandon their private practices and are joining hospital groups.

"People are going into the hospital or employed market because of the hassle factor, and it’s a hassle to this learning curve, and it’s a cost," said Dr. Castellanos, a urologist.

One thing the incentive pay does not cover, according to Commissioner Peter Butler, is the time necessary to manage all the additional data requirements.

"What [incentives] do not do is provide dollars for decision support, for data repositories, data warehouses, which are really the heart of managing in an [accountable care organization] capitated world. It kind of ignores some of the real tools that ultimately you need to kind of make a difference," said Mr. Butler, president and chief operating officer at Rush University Medical Center, Chicago.

Dr. Karen Borman, a MedPAC commissioner, added that the additional data requirements are also forcing physicians to spend more time in front of the computer instead of interacting with the patient.

As data requirements increase, the commission should consider how to address that concern in terms of patient satisfaction, noted Dr. Borman, a surgeon at Abington (Pa.) Memorial Hospital.

Despite the flaws in the EHR incentive program, commissioners agreed that, if it’s done right, EHRs would benefit both physicians and patients.

MedPAC Commissioner Dr. William Hall noted that EHR systems support a higher level of coding, which would mean higher payments to physicians than even incentive payments could offer.

"If you’re able to do it and willing to go through what’s a painful transition process, it pays for itself," said Dr. Hall, professor of medicine at the University of Rochester (N.Y.).

Joanna Kim, senior associate director of the American Hospital Association, Washington, testified to the commission that EHR requirements are too challenging, even for hospitals.

"[Incentive payments] are slow to come because the stage one requirements were set entirely too high," Ms. Kim said. She added that certain elements, like the patient portal are too expensive to implement, cause major security concerns, and carry uncertain benefits.

In addition, she said, CMS penalties for failing to meet meaningful use requirements will not hit until 2015, but they’ll be based on 2013 performances. Ms. Kim said this offers less time for physicians to adapt to requirements and increases the possibility that they’ll get a penalty payment along with any incentive payment.

MedPAC June Report to Congress

In addition to examining the EHR incentive program, the commission unanimously recommended changes to Medicare fee-for-service benefit design, including:

• Establishing a limit for out-of-pocket expenses to protect beneficiaries who reach catastrophic levels of Medicare costs. Although the commission recognized that a small group of beneficiaries would reach the out-of-pocket cap in any given year, they said many more would benefit from the cap.*

• Replacing coinsurance (where the beneficiary pays a percentage of the fee) with copayments (where the beneficiary pays a proscribed fee per service) that vary according to the type of service and provider. According to MedPAC staffers, copayments are more predictable, easier to budget for, and easier to understand than is coinsurance.

• Placing an additional charge on private supplemental insurance, or Medigap, that pays for services not covered under Medicare. The commission said the charge would help recoup some of the added costs of Medicare.

• Allowing the HHS secretary to determine cost sharing based on evidence of the value of services.*

• Maintaining a deductible for Part A and Part B services.

The recommendations were included in the commission’s June report to Congress.*

* UPDATE: Additional information was added to this story on 6/25/2012.

WASHINGTON – Federal technology incentives may not cover the true cost of implementing an electronic health record, according to members of the Medicare Payment Advisory Commission.

At MedPAC’s April 5 meeting, several commissioners expressed concern about the burden placed on smaller practices by the requirements of the Health Information Technology for Economic and Clinical Health (HITECH) Act.

Physicians who meet requirements for the meaningful use of an electronic health record (EHR) can earn incentive payments of up to $44,000 under HITECH. Beginning in 2015, physicians who do not participate will be penalized.

Dr. Ronald D. Castellanos, a MedPAC commissioner, noted that between the cost of purchasing, and the hassle of implementing, an EHR, many physicians are feeling forced to abandon their private practices and are joining hospital groups.

"People are going into the hospital or employed market because of the hassle factor, and it’s a hassle to this learning curve, and it’s a cost," said Dr. Castellanos, a urologist.

One thing the incentive pay does not cover, according to Commissioner Peter Butler, is the time necessary to manage all the additional data requirements.

"What [incentives] do not do is provide dollars for decision support, for data repositories, data warehouses, which are really the heart of managing in an [accountable care organization] capitated world. It kind of ignores some of the real tools that ultimately you need to kind of make a difference," said Mr. Butler, president and chief operating officer at Rush University Medical Center, Chicago.

Dr. Karen Borman, a MedPAC commissioner, added that the additional data requirements are also forcing physicians to spend more time in front of the computer instead of interacting with the patient.

As data requirements increase, the commission should consider how to address that concern in terms of patient satisfaction, noted Dr. Borman, a surgeon at Abington (Pa.) Memorial Hospital.

Despite the flaws in the EHR incentive program, commissioners agreed that, if it’s done right, EHRs would benefit both physicians and patients.

MedPAC Commissioner Dr. William Hall noted that EHR systems support a higher level of coding, which would mean higher payments to physicians than even incentive payments could offer.

"If you’re able to do it and willing to go through what’s a painful transition process, it pays for itself," said Dr. Hall, professor of medicine at the University of Rochester (N.Y.).

Joanna Kim, senior associate director of the American Hospital Association, Washington, testified to the commission that EHR requirements are too challenging, even for hospitals.

"[Incentive payments] are slow to come because the stage one requirements were set entirely too high," Ms. Kim said. She added that certain elements, like the patient portal are too expensive to implement, cause major security concerns, and carry uncertain benefits.

In addition, she said, CMS penalties for failing to meet meaningful use requirements will not hit until 2015, but they’ll be based on 2013 performances. Ms. Kim said this offers less time for physicians to adapt to requirements and increases the possibility that they’ll get a penalty payment along with any incentive payment.

MedPAC June Report to Congress

In addition to examining the EHR incentive program, the commission unanimously recommended changes to Medicare fee-for-service benefit design, including:

• Establishing a limit for out-of-pocket expenses to protect beneficiaries who reach catastrophic levels of Medicare costs. Although the commission recognized that a small group of beneficiaries would reach the out-of-pocket cap in any given year, they said many more would benefit from the cap.*

• Replacing coinsurance (where the beneficiary pays a percentage of the fee) with copayments (where the beneficiary pays a proscribed fee per service) that vary according to the type of service and provider. According to MedPAC staffers, copayments are more predictable, easier to budget for, and easier to understand than is coinsurance.

• Placing an additional charge on private supplemental insurance, or Medigap, that pays for services not covered under Medicare. The commission said the charge would help recoup some of the added costs of Medicare.

• Allowing the HHS secretary to determine cost sharing based on evidence of the value of services.*

• Maintaining a deductible for Part A and Part B services.

The recommendations were included in the commission’s June report to Congress.*

* UPDATE: Additional information was added to this story on 6/25/2012.