Frances Correa

UPDATE: The House of Representatives passed the payroll tax extension/SGR fix bill Feb. 17 by a vote of 293-132. The bill now moves on to the Senate.

After weeks of debate, congressional negotiators at press time were poised to grant a 10-month reprieve from the looming 27% cut in Medicare physician fees called for by the Sustainable Growth Rate formula.

The House/Senate conference committee tasked to solve that problem – while finding a way to extend the payroll tax holiday and benefits for the long-term unemployed – reached an agreement in the wee hours of Feb. 16. Their compromise would hold Medicare fees steady through the end of 2012.

Officials at the American Medical Association expressed both relief and disappointment with the deal.

"Congress had an opportunity to permanently end this problem, which is the sound, fiscally prudent policy choice," Dr. Peter W. Carmel, AMA president, said in a statement. "We appreciate efforts by members of Congress on both sides of the aisle who publicly supported a framework for a permanent end to this perennial problem. We are deeply disappointed that Congress chose to just do another patch – kicking the can, growing the problem and missing a clear opportunity to protect access to care for patients."

The short-term SGR fix does not come as a surprise, however. At the AMA National Advocacy Conference this week, Sen. Jon Kyl (R-Ariz.) warned physicians that negotiators would not agree to repeal the SGR. He added that negotiators were wrestling between a 2-year and a 10-month update.

At press time, the compromise was not official and full details had not been reported.

Both houses of Congress were expected to vote on the measure before taking a weeklong recess for the Presidents’ Day holiday.

UPDATE: The House of Representatives passed the payroll tax extension/SGR fix bill Feb. 17 by a vote of 293-132. The bill now moves on to the Senate.

After weeks of debate, congressional negotiators at press time were poised to grant a 10-month reprieve from the looming 27% cut in Medicare physician fees called for by the Sustainable Growth Rate formula.

The House/Senate conference committee tasked to solve that problem – while finding a way to extend the payroll tax holiday and benefits for the long-term unemployed – reached an agreement in the wee hours of Feb. 16. Their compromise would hold Medicare fees steady through the end of 2012.

Officials at the American Medical Association expressed both relief and disappointment with the deal.

"Congress had an opportunity to permanently end this problem, which is the sound, fiscally prudent policy choice," Dr. Peter W. Carmel, AMA president, said in a statement. "We appreciate efforts by members of Congress on both sides of the aisle who publicly supported a framework for a permanent end to this perennial problem. We are deeply disappointed that Congress chose to just do another patch – kicking the can, growing the problem and missing a clear opportunity to protect access to care for patients."

The short-term SGR fix does not come as a surprise, however. At the AMA National Advocacy Conference this week, Sen. Jon Kyl (R-Ariz.) warned physicians that negotiators would not agree to repeal the SGR. He added that negotiators were wrestling between a 2-year and a 10-month update.

At press time, the compromise was not official and full details had not been reported.

Both houses of Congress were expected to vote on the measure before taking a weeklong recess for the Presidents’ Day holiday.

UPDATE: The House of Representatives passed the payroll tax extension/SGR fix bill Feb. 17 by a vote of 293-132. The bill now moves on to the Senate.

After weeks of debate, congressional negotiators at press time were poised to grant a 10-month reprieve from the looming 27% cut in Medicare physician fees called for by the Sustainable Growth Rate formula.

The House/Senate conference committee tasked to solve that problem – while finding a way to extend the payroll tax holiday and benefits for the long-term unemployed – reached an agreement in the wee hours of Feb. 16. Their compromise would hold Medicare fees steady through the end of 2012.

Officials at the American Medical Association expressed both relief and disappointment with the deal.

"Congress had an opportunity to permanently end this problem, which is the sound, fiscally prudent policy choice," Dr. Peter W. Carmel, AMA president, said in a statement. "We appreciate efforts by members of Congress on both sides of the aisle who publicly supported a framework for a permanent end to this perennial problem. We are deeply disappointed that Congress chose to just do another patch – kicking the can, growing the problem and missing a clear opportunity to protect access to care for patients."

The short-term SGR fix does not come as a surprise, however. At the AMA National Advocacy Conference this week, Sen. Jon Kyl (R-Ariz.) warned physicians that negotiators would not agree to repeal the SGR. He added that negotiators were wrestling between a 2-year and a 10-month update.

At press time, the compromise was not official and full details had not been reported.

Both houses of Congress were expected to vote on the measure before taking a weeklong recess for the Presidents’ Day holiday.

WASHINGTON – Stop focusing on replacing the Medicare Sustainable Growth Rate formula and instead look at getting the best possible Medicare physician fee update for the longest period of time.

That was the advice Sen. Jon Kyl (R-Ariz.) gave to physicians Feb. 14 at a national advocacy conference sponsored by the American Medical Association.

Sen. Kyl serves on the House/Senate conference committee charged with crafting a plan to extend the payroll tax holiday and benefits for the long-term unemployed. An SGR fix was tacked onto short-term legislation to extend those provisions in December; those fixes expire Feb. 29.

It is unlikely that the conference committee will agree to repeal the SGR this year, Sen. Kyl said. In fact, the panel is currently looking at "de-coupling" an SGR fix from the two other provisions.

"These issues are in play: How long will the [physician fee] update be and will it be on the positive side?" he said. "I urge you ... to focus your attention on those two issues."

He added that he supports using monies not spent on the wars in Iraq and Afghanistan (officially called Oversees Contingency Operations [OCO] funds) to eliminate debt that would be incurred by a permanent and full SGR replacement.

But that won’t be enough to solve the whole problem, he said.

[Want to keep up with SGR and health care reform news? Listen to our latest Policy & Practice Podcast]

"There is a good chance that we can eliminate the almost $200 billion of past debt with these ‘phony savings’ " from OCO, Sen Kyl said. "But you still have $100 billion of real payments to real doctors and that has to be real money; that can’t be phony."

The AMA has been advocating for full repeal of the Sustainable Growth Rate formula, and the use of OCO money to fund it. Dr. Robert Wah, chair of the AMA Board of Trustees, said the organization remains cautiously optimistic about whether Congress will take action this year.

"[I’m encouraged by] the fact that we’re hearing the word ‘OCO’ and we’re hearing the word ‘elimination’ and ‘permanent repeal of SGR,’ " Dr. Wah said in an interview. "But whether or not all those talking words result in action is yet to be determined."

According to Sen. Kyl, the conference committee could release a decision on any changes to the SGR shortly. He added that the committee will have to compromise between the 10-month update supported by its Democratic members and the 2-year update proposed by its Republican members.

WASHINGTON – Stop focusing on replacing the Medicare Sustainable Growth Rate formula and instead look at getting the best possible Medicare physician fee update for the longest period of time.

That was the advice Sen. Jon Kyl (R-Ariz.) gave to physicians Feb. 14 at a national advocacy conference sponsored by the American Medical Association.

Sen. Kyl serves on the House/Senate conference committee charged with crafting a plan to extend the payroll tax holiday and benefits for the long-term unemployed. An SGR fix was tacked onto short-term legislation to extend those provisions in December; those fixes expire Feb. 29.

It is unlikely that the conference committee will agree to repeal the SGR this year, Sen. Kyl said. In fact, the panel is currently looking at "de-coupling" an SGR fix from the two other provisions.

"These issues are in play: How long will the [physician fee] update be and will it be on the positive side?" he said. "I urge you ... to focus your attention on those two issues."

He added that he supports using monies not spent on the wars in Iraq and Afghanistan (officially called Oversees Contingency Operations [OCO] funds) to eliminate debt that would be incurred by a permanent and full SGR replacement.

But that won’t be enough to solve the whole problem, he said.

[Want to keep up with SGR and health care reform news? Listen to our latest Policy & Practice Podcast]

"There is a good chance that we can eliminate the almost $200 billion of past debt with these ‘phony savings’ " from OCO, Sen Kyl said. "But you still have $100 billion of real payments to real doctors and that has to be real money; that can’t be phony."

The AMA has been advocating for full repeal of the Sustainable Growth Rate formula, and the use of OCO money to fund it. Dr. Robert Wah, chair of the AMA Board of Trustees, said the organization remains cautiously optimistic about whether Congress will take action this year.

"[I’m encouraged by] the fact that we’re hearing the word ‘OCO’ and we’re hearing the word ‘elimination’ and ‘permanent repeal of SGR,’ " Dr. Wah said in an interview. "But whether or not all those talking words result in action is yet to be determined."

According to Sen. Kyl, the conference committee could release a decision on any changes to the SGR shortly. He added that the committee will have to compromise between the 10-month update supported by its Democratic members and the 2-year update proposed by its Republican members.

WASHINGTON – Stop focusing on replacing the Medicare Sustainable Growth Rate formula and instead look at getting the best possible Medicare physician fee update for the longest period of time.

That was the advice Sen. Jon Kyl (R-Ariz.) gave to physicians Feb. 14 at a national advocacy conference sponsored by the American Medical Association.

Sen. Kyl serves on the House/Senate conference committee charged with crafting a plan to extend the payroll tax holiday and benefits for the long-term unemployed. An SGR fix was tacked onto short-term legislation to extend those provisions in December; those fixes expire Feb. 29.

It is unlikely that the conference committee will agree to repeal the SGR this year, Sen. Kyl said. In fact, the panel is currently looking at "de-coupling" an SGR fix from the two other provisions.

"These issues are in play: How long will the [physician fee] update be and will it be on the positive side?" he said. "I urge you ... to focus your attention on those two issues."

He added that he supports using monies not spent on the wars in Iraq and Afghanistan (officially called Oversees Contingency Operations [OCO] funds) to eliminate debt that would be incurred by a permanent and full SGR replacement.

But that won’t be enough to solve the whole problem, he said.

[Want to keep up with SGR and health care reform news? Listen to our latest Policy & Practice Podcast]

"There is a good chance that we can eliminate the almost $200 billion of past debt with these ‘phony savings’ " from OCO, Sen Kyl said. "But you still have $100 billion of real payments to real doctors and that has to be real money; that can’t be phony."

The AMA has been advocating for full repeal of the Sustainable Growth Rate formula, and the use of OCO money to fund it. Dr. Robert Wah, chair of the AMA Board of Trustees, said the organization remains cautiously optimistic about whether Congress will take action this year.

"[I’m encouraged by] the fact that we’re hearing the word ‘OCO’ and we’re hearing the word ‘elimination’ and ‘permanent repeal of SGR,’ " Dr. Wah said in an interview. "But whether or not all those talking words result in action is yet to be determined."

According to Sen. Kyl, the conference committee could release a decision on any changes to the SGR shortly. He added that the committee will have to compromise between the 10-month update supported by its Democratic members and the 2-year update proposed by its Republican members.

The American College of Physicians is calling on Congress to do away with the automatic, across-the-board budget cuts called for by the Budget Control Act and to replace the Medicare Sustainable Growth Rate formula.

"While we are pleased there is progress being made to improve access, reduce costs, and address physician shortages, recent and proposed cuts in federal funding for many critical health programs threaten to turn back the clock," Dr. Virginia Hood, ACP president, said at a briefing to release the organization’s State of the Nation’s Health Care 2012 report.

Dr. Hood said that, while the Affordable Care Act has gone far to improve health care, the automatic cuts called for by the Budget Control Act would negate that progress, starting in 2013.

Included in the cuts is a 2% Medicare pay cut to physicians, hospitals, and other providers. That’s on top of the impending 27.5% cut to physician fees called for by the Sustainable Growth Rate (SGR) formula, set to go into effect March 1.

To solve the impending crisis in Medicare physician fees, ACP advocates an SGR replacement plan that includes a 2% pay increase for primary care physicians each year for 5 years. Specialist pay would be protected from any further reductions. ACP suggests using dedicated funds no longer needed for overseas military operations to fund this interim solution. The plan also calls on the Centers for Medicare and Medicaid Services to assess new value-based payment models.

After 5 years, physicians would be required to transition to the payment model found to be most effective.

ACP is also submitting a list of questions to Republican presidential candidates and President Obama about the future of the Affordable Care Act.

Questions to Republican hopefuls include what health reform provisions they would consider maintaining and what strategies they would have to increase access to health insurance. Questions to Mr. Obama include how he would address concerns that the health reform law gives the government too much power.

Bob Doherty, ACP Senior Vice President of Governmental Affairs and Public Policy, said at the briefing that political infighting surrounding health care is blocking progress and disheartening the American people.

"Regrettable though, a broken political culture that demands confrontation over compromise has made it impossible for congress to achieve agreements and some common sense, common ground bipartisan approaches," Mr. Doherty said. "The 2012 elections unfortunately will likely result in more inflammatory and misleading rhetorical attacks intended to fire up voters, causing even more cynicism, polarization and a lack of confidence in the ability of elected government to deal responsibly with healthcare."

Mr. Doherty said that it’s critical for Congress take immediate action to address the flawed SGR system this year.

"Congress has punted on this issue every year since 2002. It makes no sense to do that again, especially if the consequence of that is another round of deep cuts," Mr. Doherty said.

The ACP plan also outlines strategies for reducing defensive medicine costs by enacting caps on noneconomic damages and authorizing a pilot of no-fault health courts. Lastly, the plan lists strategies for promoting cost-effective, value-based care. Recommendations include creating a single deductible for Medicare Parts A and B, providing patients and clinicians with information on effectiveness of different procedures, and negotiating prescription drug prices under Medicare part D.

The American College of Physicians is calling on Congress to do away with the automatic, across-the-board budget cuts called for by the Budget Control Act and to replace the Medicare Sustainable Growth Rate formula.

"While we are pleased there is progress being made to improve access, reduce costs, and address physician shortages, recent and proposed cuts in federal funding for many critical health programs threaten to turn back the clock," Dr. Virginia Hood, ACP president, said at a briefing to release the organization’s State of the Nation’s Health Care 2012 report.

Dr. Hood said that, while the Affordable Care Act has gone far to improve health care, the automatic cuts called for by the Budget Control Act would negate that progress, starting in 2013.

Included in the cuts is a 2% Medicare pay cut to physicians, hospitals, and other providers. That’s on top of the impending 27.5% cut to physician fees called for by the Sustainable Growth Rate (SGR) formula, set to go into effect March 1.

To solve the impending crisis in Medicare physician fees, ACP advocates an SGR replacement plan that includes a 2% pay increase for primary care physicians each year for 5 years. Specialist pay would be protected from any further reductions. ACP suggests using dedicated funds no longer needed for overseas military operations to fund this interim solution. The plan also calls on the Centers for Medicare and Medicaid Services to assess new value-based payment models.

After 5 years, physicians would be required to transition to the payment model found to be most effective.

ACP is also submitting a list of questions to Republican presidential candidates and President Obama about the future of the Affordable Care Act.

Questions to Republican hopefuls include what health reform provisions they would consider maintaining and what strategies they would have to increase access to health insurance. Questions to Mr. Obama include how he would address concerns that the health reform law gives the government too much power.

Bob Doherty, ACP Senior Vice President of Governmental Affairs and Public Policy, said at the briefing that political infighting surrounding health care is blocking progress and disheartening the American people.

"Regrettable though, a broken political culture that demands confrontation over compromise has made it impossible for congress to achieve agreements and some common sense, common ground bipartisan approaches," Mr. Doherty said. "The 2012 elections unfortunately will likely result in more inflammatory and misleading rhetorical attacks intended to fire up voters, causing even more cynicism, polarization and a lack of confidence in the ability of elected government to deal responsibly with healthcare."

Mr. Doherty said that it’s critical for Congress take immediate action to address the flawed SGR system this year.

"Congress has punted on this issue every year since 2002. It makes no sense to do that again, especially if the consequence of that is another round of deep cuts," Mr. Doherty said.

The ACP plan also outlines strategies for reducing defensive medicine costs by enacting caps on noneconomic damages and authorizing a pilot of no-fault health courts. Lastly, the plan lists strategies for promoting cost-effective, value-based care. Recommendations include creating a single deductible for Medicare Parts A and B, providing patients and clinicians with information on effectiveness of different procedures, and negotiating prescription drug prices under Medicare part D.

The American College of Physicians is calling on Congress to do away with the automatic, across-the-board budget cuts called for by the Budget Control Act and to replace the Medicare Sustainable Growth Rate formula.

"While we are pleased there is progress being made to improve access, reduce costs, and address physician shortages, recent and proposed cuts in federal funding for many critical health programs threaten to turn back the clock," Dr. Virginia Hood, ACP president, said at a briefing to release the organization’s State of the Nation’s Health Care 2012 report.

Dr. Hood said that, while the Affordable Care Act has gone far to improve health care, the automatic cuts called for by the Budget Control Act would negate that progress, starting in 2013.

Included in the cuts is a 2% Medicare pay cut to physicians, hospitals, and other providers. That’s on top of the impending 27.5% cut to physician fees called for by the Sustainable Growth Rate (SGR) formula, set to go into effect March 1.

To solve the impending crisis in Medicare physician fees, ACP advocates an SGR replacement plan that includes a 2% pay increase for primary care physicians each year for 5 years. Specialist pay would be protected from any further reductions. ACP suggests using dedicated funds no longer needed for overseas military operations to fund this interim solution. The plan also calls on the Centers for Medicare and Medicaid Services to assess new value-based payment models.

After 5 years, physicians would be required to transition to the payment model found to be most effective.

ACP is also submitting a list of questions to Republican presidential candidates and President Obama about the future of the Affordable Care Act.

Questions to Republican hopefuls include what health reform provisions they would consider maintaining and what strategies they would have to increase access to health insurance. Questions to Mr. Obama include how he would address concerns that the health reform law gives the government too much power.

Bob Doherty, ACP Senior Vice President of Governmental Affairs and Public Policy, said at the briefing that political infighting surrounding health care is blocking progress and disheartening the American people.

"Regrettable though, a broken political culture that demands confrontation over compromise has made it impossible for congress to achieve agreements and some common sense, common ground bipartisan approaches," Mr. Doherty said. "The 2012 elections unfortunately will likely result in more inflammatory and misleading rhetorical attacks intended to fire up voters, causing even more cynicism, polarization and a lack of confidence in the ability of elected government to deal responsibly with healthcare."

Mr. Doherty said that it’s critical for Congress take immediate action to address the flawed SGR system this year.

"Congress has punted on this issue every year since 2002. It makes no sense to do that again, especially if the consequence of that is another round of deep cuts," Mr. Doherty said.

The ACP plan also outlines strategies for reducing defensive medicine costs by enacting caps on noneconomic damages and authorizing a pilot of no-fault health courts. Lastly, the plan lists strategies for promoting cost-effective, value-based care. Recommendations include creating a single deductible for Medicare Parts A and B, providing patients and clinicians with information on effectiveness of different procedures, and negotiating prescription drug prices under Medicare part D.

A new subspecialty certification in complex general surgical oncology aims to provide surgeons with training in the diagnosis, treatment, and rehabilitation of patients with complex cancers such as sarcoma, melanoma, and esophageal malignancies – and hopefully will attract surgeons who want to focus on research.

"The idea is to build leaders in cancer research," said Christine Shiffer, spokesperson for the American Board of Surgery (ABS). The certification program was created by the ABS and approved by the Accreditation Council for Graduate Medical Education (ACGME) in March.

Ms. Shiffer noted that the majority of oncology cases are – and will continue to be – treated by general surgeons trained in surgical oncology.

Some surgeons say the certification simply solidifies the training qualifications that surgical oncologists already have.

"Trained surgical oncologists are already available to provide care for complex general surgical oncology," said Dr. Stephen Edge, chair of the Commission on Cancer for the American College of Surgeons (ACS). "The SSO is taking it to the next level for the future. That’s good for surgeons. That’s good for the American College of Surgeons and, most importantly, that’s good for the American public."

Dr. Edge added that the public will benefit from the assurance that their doctor has the training and credentials to provide the best care possible.

The certification will have minimal impact on general surgeons currently treating the same conditions, said Dr. Fabrizio Michelassi, chair of the ABS Surgical Oncology Advisory Council.

"As current [Society for Surgical Oncology]–approved fellowships graduate only 50 surgical oncologists each year, the number of surgeons who will be eligible for this certificate is relatively small," Dr. Michelassi said in a statement.

The ABS decided against grandfathering surgeons who have already completed a fellowship in surgical oncology or general surgeons who perform oncologic surgery.

Newly trained surgeons should see the new certification program as an opportunity but not a necessity, said Dr. Patricia L. Turner, a general surgeon and director of member services at ACS. However, she added that the certification could eventually carry a greater marketing advantage for new surgical oncologists. When this process is rolled out, among trainees who finish the same fellowship 1 year apart (and have identical training), one would carry the certificate and the other wouldn’t, she explained.

While program development is underway, there is still work to be done. First, the ACGME will have to approve their training requirements, which the ABS expects to see by June. Once requirements are approved, the written and oral examinations can be finalized.

Existing surgical oncology training programs can become ACGME accredited to provide the training that will lead to ABS certification.* The first examinations are expected to start in the fall of 2012, at the earliest, according to the ABS.

*CLARIFICATION 1/23/12 Additional information was added to clarifiy the role of ACGME accredited training in ABS certification.

A new subspecialty certification in complex general surgical oncology aims to provide surgeons with training in the diagnosis, treatment, and rehabilitation of patients with complex cancers such as sarcoma, melanoma, and esophageal malignancies – and hopefully will attract surgeons who want to focus on research.

"The idea is to build leaders in cancer research," said Christine Shiffer, spokesperson for the American Board of Surgery (ABS). The certification program was created by the ABS and approved by the Accreditation Council for Graduate Medical Education (ACGME) in March.

Ms. Shiffer noted that the majority of oncology cases are – and will continue to be – treated by general surgeons trained in surgical oncology.

Some surgeons say the certification simply solidifies the training qualifications that surgical oncologists already have.

"Trained surgical oncologists are already available to provide care for complex general surgical oncology," said Dr. Stephen Edge, chair of the Commission on Cancer for the American College of Surgeons (ACS). "The SSO is taking it to the next level for the future. That’s good for surgeons. That’s good for the American College of Surgeons and, most importantly, that’s good for the American public."

Dr. Edge added that the public will benefit from the assurance that their doctor has the training and credentials to provide the best care possible.

The certification will have minimal impact on general surgeons currently treating the same conditions, said Dr. Fabrizio Michelassi, chair of the ABS Surgical Oncology Advisory Council.

"As current [Society for Surgical Oncology]–approved fellowships graduate only 50 surgical oncologists each year, the number of surgeons who will be eligible for this certificate is relatively small," Dr. Michelassi said in a statement.

The ABS decided against grandfathering surgeons who have already completed a fellowship in surgical oncology or general surgeons who perform oncologic surgery.

Newly trained surgeons should see the new certification program as an opportunity but not a necessity, said Dr. Patricia L. Turner, a general surgeon and director of member services at ACS. However, she added that the certification could eventually carry a greater marketing advantage for new surgical oncologists. When this process is rolled out, among trainees who finish the same fellowship 1 year apart (and have identical training), one would carry the certificate and the other wouldn’t, she explained.

While program development is underway, there is still work to be done. First, the ACGME will have to approve their training requirements, which the ABS expects to see by June. Once requirements are approved, the written and oral examinations can be finalized.

Existing surgical oncology training programs can become ACGME accredited to provide the training that will lead to ABS certification.* The first examinations are expected to start in the fall of 2012, at the earliest, according to the ABS.

*CLARIFICATION 1/23/12 Additional information was added to clarifiy the role of ACGME accredited training in ABS certification.

A new subspecialty certification in complex general surgical oncology aims to provide surgeons with training in the diagnosis, treatment, and rehabilitation of patients with complex cancers such as sarcoma, melanoma, and esophageal malignancies – and hopefully will attract surgeons who want to focus on research.

"The idea is to build leaders in cancer research," said Christine Shiffer, spokesperson for the American Board of Surgery (ABS). The certification program was created by the ABS and approved by the Accreditation Council for Graduate Medical Education (ACGME) in March.

Ms. Shiffer noted that the majority of oncology cases are – and will continue to be – treated by general surgeons trained in surgical oncology.

Some surgeons say the certification simply solidifies the training qualifications that surgical oncologists already have.

"Trained surgical oncologists are already available to provide care for complex general surgical oncology," said Dr. Stephen Edge, chair of the Commission on Cancer for the American College of Surgeons (ACS). "The SSO is taking it to the next level for the future. That’s good for surgeons. That’s good for the American College of Surgeons and, most importantly, that’s good for the American public."

Dr. Edge added that the public will benefit from the assurance that their doctor has the training and credentials to provide the best care possible.

The certification will have minimal impact on general surgeons currently treating the same conditions, said Dr. Fabrizio Michelassi, chair of the ABS Surgical Oncology Advisory Council.

"As current [Society for Surgical Oncology]–approved fellowships graduate only 50 surgical oncologists each year, the number of surgeons who will be eligible for this certificate is relatively small," Dr. Michelassi said in a statement.

The ABS decided against grandfathering surgeons who have already completed a fellowship in surgical oncology or general surgeons who perform oncologic surgery.

Newly trained surgeons should see the new certification program as an opportunity but not a necessity, said Dr. Patricia L. Turner, a general surgeon and director of member services at ACS. However, she added that the certification could eventually carry a greater marketing advantage for new surgical oncologists. When this process is rolled out, among trainees who finish the same fellowship 1 year apart (and have identical training), one would carry the certificate and the other wouldn’t, she explained.

While program development is underway, there is still work to be done. First, the ACGME will have to approve their training requirements, which the ABS expects to see by June. Once requirements are approved, the written and oral examinations can be finalized.

Existing surgical oncology training programs can become ACGME accredited to provide the training that will lead to ABS certification.* The first examinations are expected to start in the fall of 2012, at the earliest, according to the ABS.

*CLARIFICATION 1/23/12 Additional information was added to clarifiy the role of ACGME accredited training in ABS certification.

WASHINGTON – The Medicare Payment Advisory Commission voiced its disappointment with Congress’ failure to find a permanent fix for Medicare’s sustainable growth rate formula (SGR) at its Jan. 12 meeting.

MedPAC Chairman Glenn Hackbarth said the opportunity to pay for an SGR solution is fading. "Repeal of SGR will only get more expensive." He added that the likelihood that Congress would forgive any debt incurred by the SGR also is fading, as are the Medicare savings that could fund the repeal.

"To say that we can’t repeal SGR without it being offset and then take Medicare savings for other purposes leaves this destabilizing element at the heart of the Medicare program," Mr. Hackbarth said.

At its October meeting, the commission voted to submit its recommendations to Congress for using Medicare savings to fund an SGR replacement. Key among the recommendations are:

• Repealing the SGR.

• Freezing payments to primary care physicians for 10 years.

• Cutting reimbursements to specialist physicians by 17% over 3 years, followed by a 7-year freeze.

Dr. Ron Castellanos, MedPAC commissioner and a Florida urologist, called on MedPAC to increase their pressure on Congress to find a permanent solution.

"I don’t know how to say more passionately that there needs to be a message from MedPAC that this is just totally unacceptable," Dr. Castellanos said. He added that if the 27.4% pay cut goes through, it could force Congress to come up with a permanent fix.

"I don’t like the idea of letting the cut go through but certainly if that happens I think we could get an answer," Mr. Castellanos said.

The commission’s next meeting is March 8.

WASHINGTON – The Medicare Payment Advisory Commission voiced its disappointment with Congress’ failure to find a permanent fix for Medicare’s sustainable growth rate formula (SGR) at its Jan. 12 meeting.

MedPAC Chairman Glenn Hackbarth said the opportunity to pay for an SGR solution is fading. "Repeal of SGR will only get more expensive." He added that the likelihood that Congress would forgive any debt incurred by the SGR also is fading, as are the Medicare savings that could fund the repeal.

"To say that we can’t repeal SGR without it being offset and then take Medicare savings for other purposes leaves this destabilizing element at the heart of the Medicare program," Mr. Hackbarth said.

At its October meeting, the commission voted to submit its recommendations to Congress for using Medicare savings to fund an SGR replacement. Key among the recommendations are:

• Repealing the SGR.

• Freezing payments to primary care physicians for 10 years.

• Cutting reimbursements to specialist physicians by 17% over 3 years, followed by a 7-year freeze.

Dr. Ron Castellanos, MedPAC commissioner and a Florida urologist, called on MedPAC to increase their pressure on Congress to find a permanent solution.

"I don’t know how to say more passionately that there needs to be a message from MedPAC that this is just totally unacceptable," Dr. Castellanos said. He added that if the 27.4% pay cut goes through, it could force Congress to come up with a permanent fix.

"I don’t like the idea of letting the cut go through but certainly if that happens I think we could get an answer," Mr. Castellanos said.

The commission’s next meeting is March 8.

WASHINGTON – The Medicare Payment Advisory Commission voiced its disappointment with Congress’ failure to find a permanent fix for Medicare’s sustainable growth rate formula (SGR) at its Jan. 12 meeting.

MedPAC Chairman Glenn Hackbarth said the opportunity to pay for an SGR solution is fading. "Repeal of SGR will only get more expensive." He added that the likelihood that Congress would forgive any debt incurred by the SGR also is fading, as are the Medicare savings that could fund the repeal.

"To say that we can’t repeal SGR without it being offset and then take Medicare savings for other purposes leaves this destabilizing element at the heart of the Medicare program," Mr. Hackbarth said.

At its October meeting, the commission voted to submit its recommendations to Congress for using Medicare savings to fund an SGR replacement. Key among the recommendations are:

• Repealing the SGR.

• Freezing payments to primary care physicians for 10 years.

• Cutting reimbursements to specialist physicians by 17% over 3 years, followed by a 7-year freeze.

Dr. Ron Castellanos, MedPAC commissioner and a Florida urologist, called on MedPAC to increase their pressure on Congress to find a permanent solution.

"I don’t know how to say more passionately that there needs to be a message from MedPAC that this is just totally unacceptable," Dr. Castellanos said. He added that if the 27.4% pay cut goes through, it could force Congress to come up with a permanent fix.

"I don’t like the idea of letting the cut go through but certainly if that happens I think we could get an answer," Mr. Castellanos said.

The commission’s next meeting is March 8.

Dr. Dan Garza is on the leading edge of research designed to improve our insight into the mechanics of mild traumatic brain injuries, or concussions. As the medical director of the San Francisco 49ers, Dr. Garza has firsthand experience with sports-related injuries.

He also treats college-level athletes at Stanford University in California, where he teaches and works in the sports medicine clinic. Since June, Dr. Garza and his team have been collecting real-time data on sports-related impacts using a modified accelerometer to calculate the force of an impact on the brain.

In an interview, Dr. Garza discussed how the tool works and his findings thus far.

Question: How did you use the accelerometer in your research?

Dr. Garza: It is a mouthpiece equipped with accelerometers, which measure XYZ acceleration forces on the brain; and gyrometers, which measure rotational acceleration. It’s held in the mouth, so we first had to make sure it was reliable in translating the readings it was getting from the mouth to tell us the true acceleration of the brain. To validate its efficacy, we first tested the device on a crash test dummy head. With the mouthpiece in place, we dropped the head about 4,000 times from different heights and positions. We wanted to make sure we were getting reliable readings in comparison to the gold standard of a crash test dummy. We certainly did.

Dr. Garza and his team of researchers spent 3 months validating the device. Then, they tested the device on Stanford’s football team.

Question: What was the methodology for testing the accelerometer?

Dr. Garza: We had about 70 players wear the mouthpiece during practices and games throughout the season. We had dentists take impressions and mold the pieces to fit each individual player. The mouthpiece was also equipped with three accelerometers and three gyrometers, and it collected real-time data about how many hits these kids were getting. The mouthpiece recorded the force and direction of the hits. We are now reviewing the data, and what we’re hoping to find is an introduction to the biomechanics of concussions.

Question: Have any of the findings so far surprised you?

Dr. Garza: One of the more surprising findings was that there are two blows that actually occur if a player hits the ground. The first blow is when the player actually hits, but as the player lands and hits the ground, there’s a second significant acceleration that occurs. As the torso hits the ground, the head whips again. It makes sense in hindsight, but it turns out that these secondary hits are actually very significant. They’re not small accelerations.

Question: How do you hope your research will improve the field of emergency medicine?

Dr. Garza: There are a lot of physicians who have experience with concussions, but there are also those who don’t. I think that emergency physicians are excellent at ruling out initial, potentially catastrophic brain trauma, but we probably aren’t so familiar with feeling comfortable not getting brain imaging in someone who is altered after a blow to the head in soccer.

The research that’s ongoing is to better characterize for our field the nature of concussions and what we should and should not expect to see. That will only happen if we understand the forces that are involved and the types of blows that really are consistent with concussions that may or may not need to be imaged.

Dr. Garza said he eventually hopes to use his findings to improve imaging techniques and to recommend improvements in concussion regulations.

Dr. Dan Garza is on the leading edge of research designed to improve our insight into the mechanics of mild traumatic brain injuries, or concussions. As the medical director of the San Francisco 49ers, Dr. Garza has firsthand experience with sports-related injuries.

He also treats college-level athletes at Stanford University in California, where he teaches and works in the sports medicine clinic. Since June, Dr. Garza and his team have been collecting real-time data on sports-related impacts using a modified accelerometer to calculate the force of an impact on the brain.

In an interview, Dr. Garza discussed how the tool works and his findings thus far.

Question: How did you use the accelerometer in your research?

Dr. Garza: It is a mouthpiece equipped with accelerometers, which measure XYZ acceleration forces on the brain; and gyrometers, which measure rotational acceleration. It’s held in the mouth, so we first had to make sure it was reliable in translating the readings it was getting from the mouth to tell us the true acceleration of the brain. To validate its efficacy, we first tested the device on a crash test dummy head. With the mouthpiece in place, we dropped the head about 4,000 times from different heights and positions. We wanted to make sure we were getting reliable readings in comparison to the gold standard of a crash test dummy. We certainly did.

Dr. Garza and his team of researchers spent 3 months validating the device. Then, they tested the device on Stanford’s football team.

Question: What was the methodology for testing the accelerometer?

Dr. Garza: We had about 70 players wear the mouthpiece during practices and games throughout the season. We had dentists take impressions and mold the pieces to fit each individual player. The mouthpiece was also equipped with three accelerometers and three gyrometers, and it collected real-time data about how many hits these kids were getting. The mouthpiece recorded the force and direction of the hits. We are now reviewing the data, and what we’re hoping to find is an introduction to the biomechanics of concussions.

Question: Have any of the findings so far surprised you?

Dr. Garza: One of the more surprising findings was that there are two blows that actually occur if a player hits the ground. The first blow is when the player actually hits, but as the player lands and hits the ground, there’s a second significant acceleration that occurs. As the torso hits the ground, the head whips again. It makes sense in hindsight, but it turns out that these secondary hits are actually very significant. They’re not small accelerations.

Question: How do you hope your research will improve the field of emergency medicine?

Dr. Garza: There are a lot of physicians who have experience with concussions, but there are also those who don’t. I think that emergency physicians are excellent at ruling out initial, potentially catastrophic brain trauma, but we probably aren’t so familiar with feeling comfortable not getting brain imaging in someone who is altered after a blow to the head in soccer.

The research that’s ongoing is to better characterize for our field the nature of concussions and what we should and should not expect to see. That will only happen if we understand the forces that are involved and the types of blows that really are consistent with concussions that may or may not need to be imaged.

Dr. Garza said he eventually hopes to use his findings to improve imaging techniques and to recommend improvements in concussion regulations.

Dr. Dan Garza is on the leading edge of research designed to improve our insight into the mechanics of mild traumatic brain injuries, or concussions. As the medical director of the San Francisco 49ers, Dr. Garza has firsthand experience with sports-related injuries.

He also treats college-level athletes at Stanford University in California, where he teaches and works in the sports medicine clinic. Since June, Dr. Garza and his team have been collecting real-time data on sports-related impacts using a modified accelerometer to calculate the force of an impact on the brain.

In an interview, Dr. Garza discussed how the tool works and his findings thus far.

Question: How did you use the accelerometer in your research?

Dr. Garza: It is a mouthpiece equipped with accelerometers, which measure XYZ acceleration forces on the brain; and gyrometers, which measure rotational acceleration. It’s held in the mouth, so we first had to make sure it was reliable in translating the readings it was getting from the mouth to tell us the true acceleration of the brain. To validate its efficacy, we first tested the device on a crash test dummy head. With the mouthpiece in place, we dropped the head about 4,000 times from different heights and positions. We wanted to make sure we were getting reliable readings in comparison to the gold standard of a crash test dummy. We certainly did.

Dr. Garza and his team of researchers spent 3 months validating the device. Then, they tested the device on Stanford’s football team.

Question: What was the methodology for testing the accelerometer?

Dr. Garza: We had about 70 players wear the mouthpiece during practices and games throughout the season. We had dentists take impressions and mold the pieces to fit each individual player. The mouthpiece was also equipped with three accelerometers and three gyrometers, and it collected real-time data about how many hits these kids were getting. The mouthpiece recorded the force and direction of the hits. We are now reviewing the data, and what we’re hoping to find is an introduction to the biomechanics of concussions.

Question: Have any of the findings so far surprised you?

Dr. Garza: One of the more surprising findings was that there are two blows that actually occur if a player hits the ground. The first blow is when the player actually hits, but as the player lands and hits the ground, there’s a second significant acceleration that occurs. As the torso hits the ground, the head whips again. It makes sense in hindsight, but it turns out that these secondary hits are actually very significant. They’re not small accelerations.

Question: How do you hope your research will improve the field of emergency medicine?

Dr. Garza: There are a lot of physicians who have experience with concussions, but there are also those who don’t. I think that emergency physicians are excellent at ruling out initial, potentially catastrophic brain trauma, but we probably aren’t so familiar with feeling comfortable not getting brain imaging in someone who is altered after a blow to the head in soccer.

The research that’s ongoing is to better characterize for our field the nature of concussions and what we should and should not expect to see. That will only happen if we understand the forces that are involved and the types of blows that really are consistent with concussions that may or may not need to be imaged.

Dr. Garza said he eventually hopes to use his findings to improve imaging techniques and to recommend improvements in concussion regulations.

Electronic prescribing is getting better, but challenges remain related to e-renewals, mail-order pharmacy connectivity, and pharmacy processing of e-prescriptions, based on survey results from 114 individuals involved in e-prescribing in 97 health care organizations.

The survey included physician practices, community pharmacies, and mail-order pharmacies using the Surescripts e-prescribing network (J. Am. Med. Inform. Assoc. [doi:10.1136/amiajnl-2011-000515]).

Respondents reported overall satisfaction with the system, but noted the need for improvements in technical standards, in network connectivity on the mail-order side, and in system and database design, lead author Joy Grossman said in an interview.

From the physician’s perspective, the system often creates either duplicate prescriptions or faulty formatting, Dr. Yul Ejnes said in an interview. Dr. Ejnes, chair of the Board of Regents for the American College of Physicians and an internist based in Cranston, R.I., has been using e-prescribing systems since 2003.

"One thinks of electronic prescribing as [a] totally seamless, no-extra-effort-needed process but there does need to be some human intervention," he said.

The most notable problem, mentioned by 75% of the physicians responding to the survey, is unreliable transmission of prescriptions to mail-order pharmacies. Dr. Ejnes said resolving such inefficiencies takes up extra time for physician and pharmacists.

Another inefficiency noted in the survey is that 94% of retail pharmacies nationwide are registered users of the Surescripts system, yet nearly half of participating local pharmacies and three national pharmacies do not send renewal requests electronically.

According to the survey, pharmacies said they didn’t use the electronic systems because they either lacked the functionality or wanted to avoid Surescript transaction fees. Instead they relied on phone or fax systems.

Pharmacies using electronic systems reported challenges with inconsistent data fields for physician and pharmaceutical e-prescription programs, requiring editing and manual data entry.

As use of electronic systems increases in response to federal incentives, Ms. Grossman said stakeholders, including vendors and the federal government, will have to work together to address the challenges.

Surescripts spokesman Ron Cronin acknowledged in an interview that the technology related to the transmission of prescriptions between practices and pharmacies is a common concern that stakeholders will need to address.

With increasing financial incentives, e-prescribing has continued its expansion among office-based physicians, increasing from fewer than 10% in 2008 to 52% in 2011.

Today, one in three prescriptions is routed electronically, according to Mr. Cronin, who attributed the increase to a greater comfort level with the technology.

In Dr. Ejnes’ state of Rhode Island, every retail pharmacy had e-prescribing systems in place by 2009, according to the Rhode Island Department of Health.

And, despite the inefficiencies, e-prescribing helps more than it hurts, Dr. Ejnes said. His electronic system has saved him several hours per week that he previously devoted to handling prescription renewals.

"Even with all these problem areas that are identified I think overall [providers] are going to find their lives to be less complicated with e-prescribing," Dr. Ejnes said. The problems noted by the survey respondents "aren’t minor issues but they don’t justify not going there."

Electronic prescribing is getting better, but challenges remain related to e-renewals, mail-order pharmacy connectivity, and pharmacy processing of e-prescriptions, based on survey results from 114 individuals involved in e-prescribing in 97 health care organizations.

The survey included physician practices, community pharmacies, and mail-order pharmacies using the Surescripts e-prescribing network (J. Am. Med. Inform. Assoc. [doi:10.1136/amiajnl-2011-000515]).

Respondents reported overall satisfaction with the system, but noted the need for improvements in technical standards, in network connectivity on the mail-order side, and in system and database design, lead author Joy Grossman said in an interview.

From the physician’s perspective, the system often creates either duplicate prescriptions or faulty formatting, Dr. Yul Ejnes said in an interview. Dr. Ejnes, chair of the Board of Regents for the American College of Physicians and an internist based in Cranston, R.I., has been using e-prescribing systems since 2003.

"One thinks of electronic prescribing as [a] totally seamless, no-extra-effort-needed process but there does need to be some human intervention," he said.

The most notable problem, mentioned by 75% of the physicians responding to the survey, is unreliable transmission of prescriptions to mail-order pharmacies. Dr. Ejnes said resolving such inefficiencies takes up extra time for physician and pharmacists.

Another inefficiency noted in the survey is that 94% of retail pharmacies nationwide are registered users of the Surescripts system, yet nearly half of participating local pharmacies and three national pharmacies do not send renewal requests electronically.

According to the survey, pharmacies said they didn’t use the electronic systems because they either lacked the functionality or wanted to avoid Surescript transaction fees. Instead they relied on phone or fax systems.

Pharmacies using electronic systems reported challenges with inconsistent data fields for physician and pharmaceutical e-prescription programs, requiring editing and manual data entry.

As use of electronic systems increases in response to federal incentives, Ms. Grossman said stakeholders, including vendors and the federal government, will have to work together to address the challenges.

Surescripts spokesman Ron Cronin acknowledged in an interview that the technology related to the transmission of prescriptions between practices and pharmacies is a common concern that stakeholders will need to address.

With increasing financial incentives, e-prescribing has continued its expansion among office-based physicians, increasing from fewer than 10% in 2008 to 52% in 2011.

Today, one in three prescriptions is routed electronically, according to Mr. Cronin, who attributed the increase to a greater comfort level with the technology.

In Dr. Ejnes’ state of Rhode Island, every retail pharmacy had e-prescribing systems in place by 2009, according to the Rhode Island Department of Health.

And, despite the inefficiencies, e-prescribing helps more than it hurts, Dr. Ejnes said. His electronic system has saved him several hours per week that he previously devoted to handling prescription renewals.

"Even with all these problem areas that are identified I think overall [providers] are going to find their lives to be less complicated with e-prescribing," Dr. Ejnes said. The problems noted by the survey respondents "aren’t minor issues but they don’t justify not going there."

Electronic prescribing is getting better, but challenges remain related to e-renewals, mail-order pharmacy connectivity, and pharmacy processing of e-prescriptions, based on survey results from 114 individuals involved in e-prescribing in 97 health care organizations.

The survey included physician practices, community pharmacies, and mail-order pharmacies using the Surescripts e-prescribing network (J. Am. Med. Inform. Assoc. [doi:10.1136/amiajnl-2011-000515]).

Respondents reported overall satisfaction with the system, but noted the need for improvements in technical standards, in network connectivity on the mail-order side, and in system and database design, lead author Joy Grossman said in an interview.

From the physician’s perspective, the system often creates either duplicate prescriptions or faulty formatting, Dr. Yul Ejnes said in an interview. Dr. Ejnes, chair of the Board of Regents for the American College of Physicians and an internist based in Cranston, R.I., has been using e-prescribing systems since 2003.

"One thinks of electronic prescribing as [a] totally seamless, no-extra-effort-needed process but there does need to be some human intervention," he said.

The most notable problem, mentioned by 75% of the physicians responding to the survey, is unreliable transmission of prescriptions to mail-order pharmacies. Dr. Ejnes said resolving such inefficiencies takes up extra time for physician and pharmacists.

Another inefficiency noted in the survey is that 94% of retail pharmacies nationwide are registered users of the Surescripts system, yet nearly half of participating local pharmacies and three national pharmacies do not send renewal requests electronically.

According to the survey, pharmacies said they didn’t use the electronic systems because they either lacked the functionality or wanted to avoid Surescript transaction fees. Instead they relied on phone or fax systems.

Pharmacies using electronic systems reported challenges with inconsistent data fields for physician and pharmaceutical e-prescription programs, requiring editing and manual data entry.

As use of electronic systems increases in response to federal incentives, Ms. Grossman said stakeholders, including vendors and the federal government, will have to work together to address the challenges.

Surescripts spokesman Ron Cronin acknowledged in an interview that the technology related to the transmission of prescriptions between practices and pharmacies is a common concern that stakeholders will need to address.

With increasing financial incentives, e-prescribing has continued its expansion among office-based physicians, increasing from fewer than 10% in 2008 to 52% in 2011.

Today, one in three prescriptions is routed electronically, according to Mr. Cronin, who attributed the increase to a greater comfort level with the technology.

In Dr. Ejnes’ state of Rhode Island, every retail pharmacy had e-prescribing systems in place by 2009, according to the Rhode Island Department of Health.

And, despite the inefficiencies, e-prescribing helps more than it hurts, Dr. Ejnes said. His electronic system has saved him several hours per week that he previously devoted to handling prescription renewals.

"Even with all these problem areas that are identified I think overall [providers] are going to find their lives to be less complicated with e-prescribing," Dr. Ejnes said. The problems noted by the survey respondents "aren’t minor issues but they don’t justify not going there."

Medical practices equipped to provide at-home care services for chronically-ill patients may be eligible for incentive payments under a new demonstration project created by the Affordable Care Act.

Starting this month, the Independence at Home Demonstration is calling for applications to test whether providing coordinated home-care services for patients with multiple chronic conditions will keep them out of the hospital, improve patient satisfaction and outcomes, and lower Medicare costs.

Up to 10,000 eligible beneficiaries, as well as up to 50 providers may participate during the study’s 3-year period. Applications from medical practices to the program are being accepted until Feb. 6.

"When critically-ill patients can remain in familiar surroundings, the benefits are many: the person retains greater control over their lives, families and caregivers report greater satisfaction with the care, and unnecessary hospitalizations are avoided," CMS acting administrator Marilyn Tavenner said in a statement.

In order for beneficiaries to participate, they must have multiple chronic conditions, have received rehabilitation treatment in the last year, be covered under fee-for-service Medicare, have been admitted to the hospital in the last year, and need assistance with at least two daily activities (such as walking or bathing). CMS will track beneficiaries’ experiences through a variety of quality measurements.

To qualify for the program, medical practices must have experience providing at-home care, they must serve at least 200 eligible beneficiaries, they must use electronic health information systems, and they must provide at-home visits and have available 24/7 coverage. They must also report required quality measures. Practices may apply separately, or multiple primary care practices within a geographic area may form a consortium in order to participate.

Practices that demonstrate a specific savings target as a result of participation in the project will receive an incentive payment if they also meet at least three of six quality measures. The amount of the incentive payment will be commensurate with the savings achieved. Saving targets will be determined on a per capita basis.

Medical practices equipped to provide at-home care services for chronically-ill patients may be eligible for incentive payments under a new demonstration project created by the Affordable Care Act.

Starting this month, the Independence at Home Demonstration is calling for applications to test whether providing coordinated home-care services for patients with multiple chronic conditions will keep them out of the hospital, improve patient satisfaction and outcomes, and lower Medicare costs.

Up to 10,000 eligible beneficiaries, as well as up to 50 providers may participate during the study’s 3-year period. Applications from medical practices to the program are being accepted until Feb. 6.

"When critically-ill patients can remain in familiar surroundings, the benefits are many: the person retains greater control over their lives, families and caregivers report greater satisfaction with the care, and unnecessary hospitalizations are avoided," CMS acting administrator Marilyn Tavenner said in a statement.

In order for beneficiaries to participate, they must have multiple chronic conditions, have received rehabilitation treatment in the last year, be covered under fee-for-service Medicare, have been admitted to the hospital in the last year, and need assistance with at least two daily activities (such as walking or bathing). CMS will track beneficiaries’ experiences through a variety of quality measurements.

To qualify for the program, medical practices must have experience providing at-home care, they must serve at least 200 eligible beneficiaries, they must use electronic health information systems, and they must provide at-home visits and have available 24/7 coverage. They must also report required quality measures. Practices may apply separately, or multiple primary care practices within a geographic area may form a consortium in order to participate.

Practices that demonstrate a specific savings target as a result of participation in the project will receive an incentive payment if they also meet at least three of six quality measures. The amount of the incentive payment will be commensurate with the savings achieved. Saving targets will be determined on a per capita basis.

Medical practices equipped to provide at-home care services for chronically-ill patients may be eligible for incentive payments under a new demonstration project created by the Affordable Care Act.

Starting this month, the Independence at Home Demonstration is calling for applications to test whether providing coordinated home-care services for patients with multiple chronic conditions will keep them out of the hospital, improve patient satisfaction and outcomes, and lower Medicare costs.

Up to 10,000 eligible beneficiaries, as well as up to 50 providers may participate during the study’s 3-year period. Applications from medical practices to the program are being accepted until Feb. 6.

"When critically-ill patients can remain in familiar surroundings, the benefits are many: the person retains greater control over their lives, families and caregivers report greater satisfaction with the care, and unnecessary hospitalizations are avoided," CMS acting administrator Marilyn Tavenner said in a statement.

In order for beneficiaries to participate, they must have multiple chronic conditions, have received rehabilitation treatment in the last year, be covered under fee-for-service Medicare, have been admitted to the hospital in the last year, and need assistance with at least two daily activities (such as walking or bathing). CMS will track beneficiaries’ experiences through a variety of quality measurements.

To qualify for the program, medical practices must have experience providing at-home care, they must serve at least 200 eligible beneficiaries, they must use electronic health information systems, and they must provide at-home visits and have available 24/7 coverage. They must also report required quality measures. Practices may apply separately, or multiple primary care practices within a geographic area may form a consortium in order to participate.

Practices that demonstrate a specific savings target as a result of participation in the project will receive an incentive payment if they also meet at least three of six quality measures. The amount of the incentive payment will be commensurate with the savings achieved. Saving targets will be determined on a per capita basis.

Electronic prescribing is getting better, but challenges remain related to e-renewals, mail-order pharmacy connectivity, and pharmacy processing of e-prescriptions, based on survey results from 114 individuals involved in e-prescribing in 97 health care organizations.

The survey included physician practices, community pharmacies, and mail-order pharmacies using the Surescripts e-prescribing network (J. Am. Med. Inform. Assoc. [doi:10.1136/amiajnl-2011-000515]).

Respondents reported overall satisfaction with the system, but noted the need for improvements in technical standards, in network connectivity on the mail-order side, and in system and database design, lead author Joy Grossman said in an interview.

From the physician's perspective, the system often creates either duplicate prescriptions or faulty formatting, Dr. Yul Ejnes said in an interview. Dr. Ejnes, chair of the Board of Regents for the American College of Physicians and an internist based in Cranston, R.I., has been using e-prescribing systems since 2003.

“One thinks of electronic prescribing as [a] totally seamless, no-extra-effort-needed process but there does need to be some human intervention,” he said.

The most notable problem, mentioned by 75% of the physicians responding to the survey, is unreliable transmission of prescriptions to mail-order pharmacies. Dr. Ejnes said resolving such inefficiencies takes up extra time for physician and pharmacists.

Another inefficiency noted in the survey is that 94% of retail pharmacies nationwide are registered users of the Surescripts system, yet nearly half of participating local pharmacies and three national pharmacies do not send renewal requests electronically.

According to the survey, pharmacies said they didn't use the electronic systems because they either lacked the functionality or wanted to avoid Surescript transaction fees. Instead they relied on phone or fax systems.

Pharmacies using electronic systems reported challenges with inconsistent data fields for physician and pharmaceutical e-prescription programs, requiring editing and manual data entry.

As use of electronic systems increases in response to federal incentives, Ms. Grossman said stakeholders, including vendors and the federal government, will have to work together to address the challenges.

Surescripts spokesman Ron Cronin acknowledged in an interview that the technology related to the transmission of prescriptions between practices and pharmacies is a common concern that stakeholders will need to address.

With increasing financial incentives, e-prescribing has continued its expansion among office-based physicians, increasing from fewer than 10% in 2008 to 52% in 2011. Today, one in three prescriptions is routed electronically, according to Mr. Cronin, who attributed the increase to a greater comfort level with the technology.

In Dr. Ejnes' state of Rhode Island, every retail pharmacy had e-prescribing systems in place by 2009, according to the Rhode Island Department of Health.

And, despite the inefficiencies, e-prescribing helps more than it hurts, Dr. Ejnes said. His electronic system has saved him several hours per week that he previously devoted to handling prescription renewals.

Electronic prescribing is getting better, but challenges remain related to e-renewals, mail-order pharmacy connectivity, and pharmacy processing of e-prescriptions, based on survey results from 114 individuals involved in e-prescribing in 97 health care organizations.

The survey included physician practices, community pharmacies, and mail-order pharmacies using the Surescripts e-prescribing network (J. Am. Med. Inform. Assoc. [doi:10.1136/amiajnl-2011-000515]).

Respondents reported overall satisfaction with the system, but noted the need for improvements in technical standards, in network connectivity on the mail-order side, and in system and database design, lead author Joy Grossman said in an interview.

From the physician's perspective, the system often creates either duplicate prescriptions or faulty formatting, Dr. Yul Ejnes said in an interview. Dr. Ejnes, chair of the Board of Regents for the American College of Physicians and an internist based in Cranston, R.I., has been using e-prescribing systems since 2003.

“One thinks of electronic prescribing as [a] totally seamless, no-extra-effort-needed process but there does need to be some human intervention,” he said.

The most notable problem, mentioned by 75% of the physicians responding to the survey, is unreliable transmission of prescriptions to mail-order pharmacies. Dr. Ejnes said resolving such inefficiencies takes up extra time for physician and pharmacists.

Another inefficiency noted in the survey is that 94% of retail pharmacies nationwide are registered users of the Surescripts system, yet nearly half of participating local pharmacies and three national pharmacies do not send renewal requests electronically.

According to the survey, pharmacies said they didn't use the electronic systems because they either lacked the functionality or wanted to avoid Surescript transaction fees. Instead they relied on phone or fax systems.

Pharmacies using electronic systems reported challenges with inconsistent data fields for physician and pharmaceutical e-prescription programs, requiring editing and manual data entry.

As use of electronic systems increases in response to federal incentives, Ms. Grossman said stakeholders, including vendors and the federal government, will have to work together to address the challenges.

Surescripts spokesman Ron Cronin acknowledged in an interview that the technology related to the transmission of prescriptions between practices and pharmacies is a common concern that stakeholders will need to address.

With increasing financial incentives, e-prescribing has continued its expansion among office-based physicians, increasing from fewer than 10% in 2008 to 52% in 2011. Today, one in three prescriptions is routed electronically, according to Mr. Cronin, who attributed the increase to a greater comfort level with the technology.

In Dr. Ejnes' state of Rhode Island, every retail pharmacy had e-prescribing systems in place by 2009, according to the Rhode Island Department of Health.

And, despite the inefficiencies, e-prescribing helps more than it hurts, Dr. Ejnes said. His electronic system has saved him several hours per week that he previously devoted to handling prescription renewals.

Electronic prescribing is getting better, but challenges remain related to e-renewals, mail-order pharmacy connectivity, and pharmacy processing of e-prescriptions, based on survey results from 114 individuals involved in e-prescribing in 97 health care organizations.

The survey included physician practices, community pharmacies, and mail-order pharmacies using the Surescripts e-prescribing network (J. Am. Med. Inform. Assoc. [doi:10.1136/amiajnl-2011-000515]).

Respondents reported overall satisfaction with the system, but noted the need for improvements in technical standards, in network connectivity on the mail-order side, and in system and database design, lead author Joy Grossman said in an interview.

From the physician's perspective, the system often creates either duplicate prescriptions or faulty formatting, Dr. Yul Ejnes said in an interview. Dr. Ejnes, chair of the Board of Regents for the American College of Physicians and an internist based in Cranston, R.I., has been using e-prescribing systems since 2003.

“One thinks of electronic prescribing as [a] totally seamless, no-extra-effort-needed process but there does need to be some human intervention,” he said.

The most notable problem, mentioned by 75% of the physicians responding to the survey, is unreliable transmission of prescriptions to mail-order pharmacies. Dr. Ejnes said resolving such inefficiencies takes up extra time for physician and pharmacists.

Another inefficiency noted in the survey is that 94% of retail pharmacies nationwide are registered users of the Surescripts system, yet nearly half of participating local pharmacies and three national pharmacies do not send renewal requests electronically.

According to the survey, pharmacies said they didn't use the electronic systems because they either lacked the functionality or wanted to avoid Surescript transaction fees. Instead they relied on phone or fax systems.

Pharmacies using electronic systems reported challenges with inconsistent data fields for physician and pharmaceutical e-prescription programs, requiring editing and manual data entry.

As use of electronic systems increases in response to federal incentives, Ms. Grossman said stakeholders, including vendors and the federal government, will have to work together to address the challenges.

Surescripts spokesman Ron Cronin acknowledged in an interview that the technology related to the transmission of prescriptions between practices and pharmacies is a common concern that stakeholders will need to address.

With increasing financial incentives, e-prescribing has continued its expansion among office-based physicians, increasing from fewer than 10% in 2008 to 52% in 2011. Today, one in three prescriptions is routed electronically, according to Mr. Cronin, who attributed the increase to a greater comfort level with the technology.

In Dr. Ejnes' state of Rhode Island, every retail pharmacy had e-prescribing systems in place by 2009, according to the Rhode Island Department of Health.

And, despite the inefficiencies, e-prescribing helps more than it hurts, Dr. Ejnes said. His electronic system has saved him several hours per week that he previously devoted to handling prescription renewals.

Nearly $300 million in Children’s Health Insurance Program performance bonuses have been awarded to 23 states for 2011, according to a statement from the Department of Health and Human Services.

The bonuses are tied to increases of 10% or more within each state in health insurance coverage for children via Medicaid and the Children’s Health Insurance Program (CHIP). States also must meet criteria for cutting red tape and streamlining procedures so families can more easily enroll their children in health coverage. Of the 23 states receiving awards, 16 states exceeded the 10% goal.

The awards are intended to offset the costs of boosting Medicaid enrollment, according to the HHS statement.

The bonuses come 1 week after new data from the Centers for Disease Control and Prevention showed that the number of children with health insurance has increased by 1.2 million since CHIP was reauthorized in 2009. An HHS issue brief noted that this increase has been entirely due to greater enrollment in public programs such as Medicaid and CHIP.

Nearly $300 million in Children’s Health Insurance Program performance bonuses have been awarded to 23 states for 2011, according to a statement from the Department of Health and Human Services.

The bonuses are tied to increases of 10% or more within each state in health insurance coverage for children via Medicaid and the Children’s Health Insurance Program (CHIP). States also must meet criteria for cutting red tape and streamlining procedures so families can more easily enroll their children in health coverage. Of the 23 states receiving awards, 16 states exceeded the 10% goal.

The awards are intended to offset the costs of boosting Medicaid enrollment, according to the HHS statement.

The bonuses come 1 week after new data from the Centers for Disease Control and Prevention showed that the number of children with health insurance has increased by 1.2 million since CHIP was reauthorized in 2009. An HHS issue brief noted that this increase has been entirely due to greater enrollment in public programs such as Medicaid and CHIP.

Nearly $300 million in Children’s Health Insurance Program performance bonuses have been awarded to 23 states for 2011, according to a statement from the Department of Health and Human Services.

The bonuses are tied to increases of 10% or more within each state in health insurance coverage for children via Medicaid and the Children’s Health Insurance Program (CHIP). States also must meet criteria for cutting red tape and streamlining procedures so families can more easily enroll their children in health coverage. Of the 23 states receiving awards, 16 states exceeded the 10% goal.

The awards are intended to offset the costs of boosting Medicaid enrollment, according to the HHS statement.

The bonuses come 1 week after new data from the Centers for Disease Control and Prevention showed that the number of children with health insurance has increased by 1.2 million since CHIP was reauthorized in 2009. An HHS issue brief noted that this increase has been entirely due to greater enrollment in public programs such as Medicaid and CHIP.