Frances Correa

Despite a stagnant economy, young doctors in their final year of residency can look forward to being heavily recruited, according to a recent survey by Merritt Hawkins, a physician-consulting firm.

Among the just over 300 respondents to the survey, 78% had received 50 or more solicitations and 47% received 100 or more.

As the nation faces a shortage of physicians and an aging health care workforce, new doctors in nearly every specialty are in high demand, James Merritt, founder of Merritt Hawkins, said in a statement.

“For primary care, I think you pretty much can write your own ticket,” said Dr. Neil Skolnik of the family practice residency program at Abington (Pa.) Memorial Hospital. He added that today's residents look for the best package deal when considering a placement – which could include generous compensation, loan repayment, and regular hours.

“The days are over when doctors want to be on call every night or every other night; they won't do it,” Dr. Skolnik said. “They're not willing to make the sacrifices that many in the older generation will.”

When asked about practice locales, only 4% of respondents said they would prefer a practice in a small (25,000 people or less) or rural community.

Dr. Jennifer Thuener, a family medicine resident at Abington Memorial Hospital, said that she is among that 4%.

“I'm from Colorado so I know that I want to go back out West,” Dr. Thuener said. She added that the same is true for her colleagues. “Most people want to be around their family so they do end up going to where they're from.”

Despite the onslaught of interest most residents see, 28% of respondents to the Merritt Hawkins survey said they would choose a field other than medicine if they could redo their education – up from 18% in a similar survey in 2008.

Whatever is drawing new doctors to their positions after training, Dr. Skolnik said the high demand for residents may help to resolve the physician shortage and make way for a new generation of a health care workforce.

Merritt Hawkins e-mailed its survey to 10,000 final-year residents, with approximately 30% going to primary care residents and the remainder to specialty residents and fellows. The survey's response rate was 3%.

Despite a stagnant economy, young doctors in their final year of residency can look forward to being heavily recruited, according to a recent survey by Merritt Hawkins, a physician-consulting firm.

Among the just over 300 respondents to the survey, 78% had received 50 or more solicitations and 47% received 100 or more.

As the nation faces a shortage of physicians and an aging health care workforce, new doctors in nearly every specialty are in high demand, James Merritt, founder of Merritt Hawkins, said in a statement.

“For primary care, I think you pretty much can write your own ticket,” said Dr. Neil Skolnik of the family practice residency program at Abington (Pa.) Memorial Hospital. He added that today's residents look for the best package deal when considering a placement – which could include generous compensation, loan repayment, and regular hours.

“The days are over when doctors want to be on call every night or every other night; they won't do it,” Dr. Skolnik said. “They're not willing to make the sacrifices that many in the older generation will.”

When asked about practice locales, only 4% of respondents said they would prefer a practice in a small (25,000 people or less) or rural community.

Dr. Jennifer Thuener, a family medicine resident at Abington Memorial Hospital, said that she is among that 4%.

“I'm from Colorado so I know that I want to go back out West,” Dr. Thuener said. She added that the same is true for her colleagues. “Most people want to be around their family so they do end up going to where they're from.”

Despite the onslaught of interest most residents see, 28% of respondents to the Merritt Hawkins survey said they would choose a field other than medicine if they could redo their education – up from 18% in a similar survey in 2008.

Whatever is drawing new doctors to their positions after training, Dr. Skolnik said the high demand for residents may help to resolve the physician shortage and make way for a new generation of a health care workforce.

Merritt Hawkins e-mailed its survey to 10,000 final-year residents, with approximately 30% going to primary care residents and the remainder to specialty residents and fellows. The survey's response rate was 3%.

Despite a stagnant economy, young doctors in their final year of residency can look forward to being heavily recruited, according to a recent survey by Merritt Hawkins, a physician-consulting firm.

Among the just over 300 respondents to the survey, 78% had received 50 or more solicitations and 47% received 100 or more.

As the nation faces a shortage of physicians and an aging health care workforce, new doctors in nearly every specialty are in high demand, James Merritt, founder of Merritt Hawkins, said in a statement.

“For primary care, I think you pretty much can write your own ticket,” said Dr. Neil Skolnik of the family practice residency program at Abington (Pa.) Memorial Hospital. He added that today's residents look for the best package deal when considering a placement – which could include generous compensation, loan repayment, and regular hours.

“The days are over when doctors want to be on call every night or every other night; they won't do it,” Dr. Skolnik said. “They're not willing to make the sacrifices that many in the older generation will.”

When asked about practice locales, only 4% of respondents said they would prefer a practice in a small (25,000 people or less) or rural community.

Dr. Jennifer Thuener, a family medicine resident at Abington Memorial Hospital, said that she is among that 4%.

“I'm from Colorado so I know that I want to go back out West,” Dr. Thuener said. She added that the same is true for her colleagues. “Most people want to be around their family so they do end up going to where they're from.”

Despite the onslaught of interest most residents see, 28% of respondents to the Merritt Hawkins survey said they would choose a field other than medicine if they could redo their education – up from 18% in a similar survey in 2008.

Whatever is drawing new doctors to their positions after training, Dr. Skolnik said the high demand for residents may help to resolve the physician shortage and make way for a new generation of a health care workforce.

Merritt Hawkins e-mailed its survey to 10,000 final-year residents, with approximately 30% going to primary care residents and the remainder to specialty residents and fellows. The survey's response rate was 3%.

WASHINGTON – Expert members of the Medicare Payment Advisory Commission voted Oct. 6 to present their Medicare physician pay fix plan to Congress, despite the objections of primary care and specialist physician organizations.

First presented at the commission’s September meeting, the MedPAC recommendations aim to, among other things, avoid the looming almost-30% Medicare pay cut on Jan. 1 under the Sustainable Growth Rate (SGR) formula.

To do so, the commissioners advise 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. The recommendation passed by a vote of 15-2.

Physician organizations said the recommendations are a less-than-adequate alternative to the current system.

"The MedPAC proposal, we believe, will unintentionally undermine the goal of transitioning to new payment models aligned with value," said Shari Erickson, director of regulatory and insurer affairs for the American College of Physicians.

Ms. Erickson urged the committee to consider the SGR replacement proposal that ACP submitted in September to the Joint Select Committee on Deficit Reduction. Under the ACP proposal:

• The SGR would be repealed and physicians fees would be stabilized and set by statute in a 5-year transition period.

• A physician-led initiative would work to decrease use of low-value services.

• Potential savings of $500 billion to $886 billion could be achieved via measures such as reducing defensive medicine, rewarding physicians for high-quality coordinated care, and allowing the government to negotiate prices of drugs paid by Medicare.

The American College of Cardiology also registered its displeasure. "The proposal is not an acceptable or sustainable solution to the SGR and does nothing to promote quality or resource stewardship," Dr. Jack Lewin, CEO, said in a statement. "Looming primary care shortages require focused solutions, we agree. But this proposal somewhat misaligns the interests of primary and specialty doctors, rather than focusing on incentives to work together to improve quality, efficiency, coordination of care, and outcomes."

In advance of the MedPAC meeting, a coalition of physician groups, led by the American Medical Association, wrote to commission Chairman Glenn Hackbarth urging that the commission not adopt their proposed recommendations. Instead, the physicians urged the commissioners to look at previous proposals put forth by groups such as the Congressional Budget Office, the Simpson-Bowles Commission, and the Senate Gang of Six.

MedPAC commissioners also voiced their disapproval of the recommendation for pay cuts and freezes.

Dr. Ronald D. Castellanos, a commissioner and a Florida urologist, said he considered it "extremely disturbing" that a nurse practitioner that he may hire could make more money from treating the same patients, simply because of codes. He added that he believes the cuts would push some doctors into early retirement and discourage medical school students from becoming physicians.

Commission member Dr. Karen Borman, a Pennsylvania surgeon, agreed. She warned her fellow commissioners not to create even more adverse consequences than already exist with the SGR.

With a $200 billion price tag, the recommendations reduce the estimated cost of replacing the SGR by $100 billion, according to a MedPAC document. Outside of pay cuts and freezes, the proposal would result in a 2% annual increase in federal spending per Medicare beneficiary, but is budget neutral based on a number of possible savings identified.

WASHINGTON – Expert members of the Medicare Payment Advisory Commission voted Oct. 6 to present their Medicare physician pay fix plan to Congress, despite the objections of primary care and specialist physician organizations.

First presented at the commission’s September meeting, the MedPAC recommendations aim to, among other things, avoid the looming almost-30% Medicare pay cut on Jan. 1 under the Sustainable Growth Rate (SGR) formula.

To do so, the commissioners advise 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. The recommendation passed by a vote of 15-2.

Physician organizations said the recommendations are a less-than-adequate alternative to the current system.

"The MedPAC proposal, we believe, will unintentionally undermine the goal of transitioning to new payment models aligned with value," said Shari Erickson, director of regulatory and insurer affairs for the American College of Physicians.

Ms. Erickson urged the committee to consider the SGR replacement proposal that ACP submitted in September to the Joint Select Committee on Deficit Reduction. Under the ACP proposal:

• The SGR would be repealed and physicians fees would be stabilized and set by statute in a 5-year transition period.

• A physician-led initiative would work to decrease use of low-value services.

• Potential savings of $500 billion to $886 billion could be achieved via measures such as reducing defensive medicine, rewarding physicians for high-quality coordinated care, and allowing the government to negotiate prices of drugs paid by Medicare.

The American College of Cardiology also registered its displeasure. "The proposal is not an acceptable or sustainable solution to the SGR and does nothing to promote quality or resource stewardship," Dr. Jack Lewin, CEO, said in a statement. "Looming primary care shortages require focused solutions, we agree. But this proposal somewhat misaligns the interests of primary and specialty doctors, rather than focusing on incentives to work together to improve quality, efficiency, coordination of care, and outcomes."

In advance of the MedPAC meeting, a coalition of physician groups, led by the American Medical Association, wrote to commission Chairman Glenn Hackbarth urging that the commission not adopt their proposed recommendations. Instead, the physicians urged the commissioners to look at previous proposals put forth by groups such as the Congressional Budget Office, the Simpson-Bowles Commission, and the Senate Gang of Six.

MedPAC commissioners also voiced their disapproval of the recommendation for pay cuts and freezes.

Dr. Ronald D. Castellanos, a commissioner and a Florida urologist, said he considered it "extremely disturbing" that a nurse practitioner that he may hire could make more money from treating the same patients, simply because of codes. He added that he believes the cuts would push some doctors into early retirement and discourage medical school students from becoming physicians.

Commission member Dr. Karen Borman, a Pennsylvania surgeon, agreed. She warned her fellow commissioners not to create even more adverse consequences than already exist with the SGR.

With a $200 billion price tag, the recommendations reduce the estimated cost of replacing the SGR by $100 billion, according to a MedPAC document. Outside of pay cuts and freezes, the proposal would result in a 2% annual increase in federal spending per Medicare beneficiary, but is budget neutral based on a number of possible savings identified.

WASHINGTON – Expert members of the Medicare Payment Advisory Commission voted Oct. 6 to present their Medicare physician pay fix plan to Congress, despite the objections of primary care and specialist physician organizations.

First presented at the commission’s September meeting, the MedPAC recommendations aim to, among other things, avoid the looming almost-30% Medicare pay cut on Jan. 1 under the Sustainable Growth Rate (SGR) formula.

To do so, the commissioners advise 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. The recommendation passed by a vote of 15-2.

Physician organizations said the recommendations are a less-than-adequate alternative to the current system.

"The MedPAC proposal, we believe, will unintentionally undermine the goal of transitioning to new payment models aligned with value," said Shari Erickson, director of regulatory and insurer affairs for the American College of Physicians.

Ms. Erickson urged the committee to consider the SGR replacement proposal that ACP submitted in September to the Joint Select Committee on Deficit Reduction. Under the ACP proposal:

• The SGR would be repealed and physicians fees would be stabilized and set by statute in a 5-year transition period.

• A physician-led initiative would work to decrease use of low-value services.

• Potential savings of $500 billion to $886 billion could be achieved via measures such as reducing defensive medicine, rewarding physicians for high-quality coordinated care, and allowing the government to negotiate prices of drugs paid by Medicare.

The American College of Cardiology also registered its displeasure. "The proposal is not an acceptable or sustainable solution to the SGR and does nothing to promote quality or resource stewardship," Dr. Jack Lewin, CEO, said in a statement. "Looming primary care shortages require focused solutions, we agree. But this proposal somewhat misaligns the interests of primary and specialty doctors, rather than focusing on incentives to work together to improve quality, efficiency, coordination of care, and outcomes."

In advance of the MedPAC meeting, a coalition of physician groups, led by the American Medical Association, wrote to commission Chairman Glenn Hackbarth urging that the commission not adopt their proposed recommendations. Instead, the physicians urged the commissioners to look at previous proposals put forth by groups such as the Congressional Budget Office, the Simpson-Bowles Commission, and the Senate Gang of Six.

MedPAC commissioners also voiced their disapproval of the recommendation for pay cuts and freezes.

Dr. Ronald D. Castellanos, a commissioner and a Florida urologist, said he considered it "extremely disturbing" that a nurse practitioner that he may hire could make more money from treating the same patients, simply because of codes. He added that he believes the cuts would push some doctors into early retirement and discourage medical school students from becoming physicians.

Commission member Dr. Karen Borman, a Pennsylvania surgeon, agreed. She warned her fellow commissioners not to create even more adverse consequences than already exist with the SGR.

With a $200 billion price tag, the recommendations reduce the estimated cost of replacing the SGR by $100 billion, according to a MedPAC document. Outside of pay cuts and freezes, the proposal would result in a 2% annual increase in federal spending per Medicare beneficiary, but is budget neutral based on a number of possible savings identified.

For the first time, doctors will have the opportunity for formal training and certification in the field of brain injury medicine as a result of the American Board of Medical Specialties’ decision in September to create a new subspecialty.

The brain injury medicine program arose out of growing interest from physicians who care for athletes and deployed soldiers with brain injuries, according to Dr. Larry Faulkner, president and CEO of the American Board of Psychiatry and Neurology, which is cosponsoring the certification program with the American Board of Physical Medicine and Rehabilitation.

A full training program is expected to be available within approximately 5 years, Dr. Faulkner said. He added, however, that physicians who can prove they have experience treating patients with brain injuries will be allowed to sit for the certification exam under the "grandfather provision."

The first certification exam will be held in approximately 2 years, but the committee still has to determine the training requirements, Dr. Faulkner said. Once the full program is developed, however, it will be open only to psychiatrists, neurologists, doctors in sports medicine, and doctors in physical medicine and rehabilitation.

Every year, 1.7 million people in the United States suffer from a traumatic brain injury, and 52,000 people die from them, according to the Centers for Disease Control and Prevention. Additionally, the CDC estimates the 5.3 million Americans are currently living with a TBI-related disability. Creating a subspecialty opens new doors for advancing care, said Dr. Jose Cardenas, a neurologist from North Platte, Neb., who spoke on behalf of the American Academy of Neurology.

"Having a formal subspecialty will create programs and fellowships that will focus on providing extra [education] for doctors who are interested in this subspecialty," said Dr. Cardenas, who is interested in becoming certified. "Having continuous education and having to have recertification is going to make us ... keep at least a minimum level of quality and level of knowledge that will then guarantee that patients get the best care possible."

According to the American Board of Medical Specialties, the program will have three main goals:

• Creating standards for evaluating and providing nonsurgical treatment for patients with brain injuries.

• Providing high-level care for patients with brain injuries, as well as their families, in both hospital and postacute care settings.

• Providing physicians with administrative skills, including program development, standards development, facilities planning, and quality assurance.

"The hope is that it will not only spur and improve the quality of patient care but also the quality of medical education for all medical students and residents, irrespective of whether or not they’re going into brain injury medicine," Dr. Faulkner said.

For the first time, doctors will have the opportunity for formal training and certification in the field of brain injury medicine as a result of the American Board of Medical Specialties’ decision in September to create a new subspecialty.

The brain injury medicine program arose out of growing interest from physicians who care for athletes and deployed soldiers with brain injuries, according to Dr. Larry Faulkner, president and CEO of the American Board of Psychiatry and Neurology, which is cosponsoring the certification program with the American Board of Physical Medicine and Rehabilitation.

A full training program is expected to be available within approximately 5 years, Dr. Faulkner said. He added, however, that physicians who can prove they have experience treating patients with brain injuries will be allowed to sit for the certification exam under the "grandfather provision."

The first certification exam will be held in approximately 2 years, but the committee still has to determine the training requirements, Dr. Faulkner said. Once the full program is developed, however, it will be open only to psychiatrists, neurologists, doctors in sports medicine, and doctors in physical medicine and rehabilitation.

Every year, 1.7 million people in the United States suffer from a traumatic brain injury, and 52,000 people die from them, according to the Centers for Disease Control and Prevention. Additionally, the CDC estimates the 5.3 million Americans are currently living with a TBI-related disability. Creating a subspecialty opens new doors for advancing care, said Dr. Jose Cardenas, a neurologist from North Platte, Neb., who spoke on behalf of the American Academy of Neurology.

"Having a formal subspecialty will create programs and fellowships that will focus on providing extra [education] for doctors who are interested in this subspecialty," said Dr. Cardenas, who is interested in becoming certified. "Having continuous education and having to have recertification is going to make us ... keep at least a minimum level of quality and level of knowledge that will then guarantee that patients get the best care possible."

According to the American Board of Medical Specialties, the program will have three main goals:

• Creating standards for evaluating and providing nonsurgical treatment for patients with brain injuries.

• Providing high-level care for patients with brain injuries, as well as their families, in both hospital and postacute care settings.

• Providing physicians with administrative skills, including program development, standards development, facilities planning, and quality assurance.

"The hope is that it will not only spur and improve the quality of patient care but also the quality of medical education for all medical students and residents, irrespective of whether or not they’re going into brain injury medicine," Dr. Faulkner said.

For the first time, doctors will have the opportunity for formal training and certification in the field of brain injury medicine as a result of the American Board of Medical Specialties’ decision in September to create a new subspecialty.

The brain injury medicine program arose out of growing interest from physicians who care for athletes and deployed soldiers with brain injuries, according to Dr. Larry Faulkner, president and CEO of the American Board of Psychiatry and Neurology, which is cosponsoring the certification program with the American Board of Physical Medicine and Rehabilitation.

A full training program is expected to be available within approximately 5 years, Dr. Faulkner said. He added, however, that physicians who can prove they have experience treating patients with brain injuries will be allowed to sit for the certification exam under the "grandfather provision."

The first certification exam will be held in approximately 2 years, but the committee still has to determine the training requirements, Dr. Faulkner said. Once the full program is developed, however, it will be open only to psychiatrists, neurologists, doctors in sports medicine, and doctors in physical medicine and rehabilitation.

Every year, 1.7 million people in the United States suffer from a traumatic brain injury, and 52,000 people die from them, according to the Centers for Disease Control and Prevention. Additionally, the CDC estimates the 5.3 million Americans are currently living with a TBI-related disability. Creating a subspecialty opens new doors for advancing care, said Dr. Jose Cardenas, a neurologist from North Platte, Neb., who spoke on behalf of the American Academy of Neurology.

"Having a formal subspecialty will create programs and fellowships that will focus on providing extra [education] for doctors who are interested in this subspecialty," said Dr. Cardenas, who is interested in becoming certified. "Having continuous education and having to have recertification is going to make us ... keep at least a minimum level of quality and level of knowledge that will then guarantee that patients get the best care possible."

According to the American Board of Medical Specialties, the program will have three main goals:

• Creating standards for evaluating and providing nonsurgical treatment for patients with brain injuries.

• Providing high-level care for patients with brain injuries, as well as their families, in both hospital and postacute care settings.

• Providing physicians with administrative skills, including program development, standards development, facilities planning, and quality assurance.

"The hope is that it will not only spur and improve the quality of patient care but also the quality of medical education for all medical students and residents, irrespective of whether or not they’re going into brain injury medicine," Dr. Faulkner said.

WASHINGTON – Now that the Community Living Assistance Services and Supports program has been suspended, supporters warn that without some kind of long-term care program, Medicaid costs could steadily increase as the U.S. population continues to grow older.

The CLASS program was enacted in 2010 as a part of the Affordable Care Act and was controversial from the start, due in part to concerns over whether or not it would save federal health care dollars.

After conducting several internal analyses, the Health and Human Services department decided in October to delay implementation of the program, calling it fiscally unsustainable.

According to the Kaiser Family Foundation, Medicaid currently pays for 40% of long-term care services in the United States. Rep. Kathy Castor (D-Fla.) of the Oversight and Investigations subcommittee said that, with the growing elderly population, those numbers will only increase.

"Here comes the Baby Boom generation and if we don’t get in front of this ... we’re going to be paying on the back end in Medicaid," she said.

"We must continue to encourage middle-class Americans to plan."

Kathy Greenlee, assistant secretary for aging at HHS Health, testified that while CLASS was determined to be fiscally unsustainable, the administration considers it a priority to find an alternative that offers similar coverage.

"The opportunity that CLASS presents is a way for people to take responsibility for some of their own long-term care financing," she testified. She added that many Americans who need long-term care can’t afford the high premiums of private insurance or are excluded based on preexisting conditions.

Rep. Ted Deutch (D-Fla.) testified that without a long-term care program that’s affordable, Americans are doing whatever necessary to qualify for Medicaid.

"The current system ‘incentivizes’ poverty. It forces seniors to blow through their life savings and spend down in order to qualify for Medicaid," Rep. Deutch said. "Sadly, Medicaid steers [long-term care patients] into institutional care, despite their preference for less-costly, in-home care and other community-based options."

Republican lawmakers continue to call for a full repeal of the CLASS program.

There are more fiscally responsible options for long-term care than CLASS, according to Rep. Michael Burgess (R-Tex.), vice chair of the Health subcommittee. Congress should allow American to pay for long-term care insurance with pretax dollars, or out of their Health Savings Account, he said.

Rep. Charles Boustany (R-La.) testified that Congress should try to motivate Americans to think ahead.

"Beyond CLASS, we must continue to encourage middle-class Americans to plan. The fundamental issue here is planning, staring at an early age and planning for these kinds of things," he said.

WASHINGTON – Now that the Community Living Assistance Services and Supports program has been suspended, supporters warn that without some kind of long-term care program, Medicaid costs could steadily increase as the U.S. population continues to grow older.

The CLASS program was enacted in 2010 as a part of the Affordable Care Act and was controversial from the start, due in part to concerns over whether or not it would save federal health care dollars.

After conducting several internal analyses, the Health and Human Services department decided in October to delay implementation of the program, calling it fiscally unsustainable.

According to the Kaiser Family Foundation, Medicaid currently pays for 40% of long-term care services in the United States. Rep. Kathy Castor (D-Fla.) of the Oversight and Investigations subcommittee said that, with the growing elderly population, those numbers will only increase.

"Here comes the Baby Boom generation and if we don’t get in front of this ... we’re going to be paying on the back end in Medicaid," she said.

"We must continue to encourage middle-class Americans to plan."

Kathy Greenlee, assistant secretary for aging at HHS Health, testified that while CLASS was determined to be fiscally unsustainable, the administration considers it a priority to find an alternative that offers similar coverage.

"The opportunity that CLASS presents is a way for people to take responsibility for some of their own long-term care financing," she testified. She added that many Americans who need long-term care can’t afford the high premiums of private insurance or are excluded based on preexisting conditions.

Rep. Ted Deutch (D-Fla.) testified that without a long-term care program that’s affordable, Americans are doing whatever necessary to qualify for Medicaid.

"The current system ‘incentivizes’ poverty. It forces seniors to blow through their life savings and spend down in order to qualify for Medicaid," Rep. Deutch said. "Sadly, Medicaid steers [long-term care patients] into institutional care, despite their preference for less-costly, in-home care and other community-based options."

Republican lawmakers continue to call for a full repeal of the CLASS program.

There are more fiscally responsible options for long-term care than CLASS, according to Rep. Michael Burgess (R-Tex.), vice chair of the Health subcommittee. Congress should allow American to pay for long-term care insurance with pretax dollars, or out of their Health Savings Account, he said.

Rep. Charles Boustany (R-La.) testified that Congress should try to motivate Americans to think ahead.

"Beyond CLASS, we must continue to encourage middle-class Americans to plan. The fundamental issue here is planning, staring at an early age and planning for these kinds of things," he said.

WASHINGTON – Now that the Community Living Assistance Services and Supports program has been suspended, supporters warn that without some kind of long-term care program, Medicaid costs could steadily increase as the U.S. population continues to grow older.

The CLASS program was enacted in 2010 as a part of the Affordable Care Act and was controversial from the start, due in part to concerns over whether or not it would save federal health care dollars.

After conducting several internal analyses, the Health and Human Services department decided in October to delay implementation of the program, calling it fiscally unsustainable.

According to the Kaiser Family Foundation, Medicaid currently pays for 40% of long-term care services in the United States. Rep. Kathy Castor (D-Fla.) of the Oversight and Investigations subcommittee said that, with the growing elderly population, those numbers will only increase.

"Here comes the Baby Boom generation and if we don’t get in front of this ... we’re going to be paying on the back end in Medicaid," she said.

"We must continue to encourage middle-class Americans to plan."

Kathy Greenlee, assistant secretary for aging at HHS Health, testified that while CLASS was determined to be fiscally unsustainable, the administration considers it a priority to find an alternative that offers similar coverage.

"The opportunity that CLASS presents is a way for people to take responsibility for some of their own long-term care financing," she testified. She added that many Americans who need long-term care can’t afford the high premiums of private insurance or are excluded based on preexisting conditions.

Rep. Ted Deutch (D-Fla.) testified that without a long-term care program that’s affordable, Americans are doing whatever necessary to qualify for Medicaid.

"The current system ‘incentivizes’ poverty. It forces seniors to blow through their life savings and spend down in order to qualify for Medicaid," Rep. Deutch said. "Sadly, Medicaid steers [long-term care patients] into institutional care, despite their preference for less-costly, in-home care and other community-based options."

Republican lawmakers continue to call for a full repeal of the CLASS program.

There are more fiscally responsible options for long-term care than CLASS, according to Rep. Michael Burgess (R-Tex.), vice chair of the Health subcommittee. Congress should allow American to pay for long-term care insurance with pretax dollars, or out of their Health Savings Account, he said.

Rep. Charles Boustany (R-La.) testified that Congress should try to motivate Americans to think ahead.

"Beyond CLASS, we must continue to encourage middle-class Americans to plan. The fundamental issue here is planning, staring at an early age and planning for these kinds of things," he said.

WASHINGTON – Expert members of the Medicare Payment Advisory Commission voted last month to present their Medicare physician pay fix plan to Congress, despite the objections of primary care and specialist physician organizations.

First presented at the commission's September meeting, the MedPAC recommendations aim to, among other things, avoid the looming almost-30% Medicare pay cut on Jan. 1 under the Sustainable Growth Rate (SGR) formula.

To do so, the commissioners advise 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.

The recommendation passed by a vote of 15-2.

Physician organizations said the recommendations are a less-than-adequate alternative to the current system.

“The MedPAC proposal, we believe, will unintentionally undermine the goal of transitioning to new payment models aligned with value,” said Shari Erickson, who is director of regulatory and insurer affairs for the American College of Physicians.

Ms. Erickson urged the committee to consider the SGR replacement proposal that ACP submitted in September to the Joint Select Committee on Deficit Reduction. Under the ACP proposal:

▸ The SGR would be repealed and physicians fees would be stabilized and set by statute during a 5-year transition period.

▸ A physician-led initiative would work to decrease use of low-value services.

▸ Potential savings of $500 billion to $886 billion could be achieved via measures such as reducing defensive medicine, rewarding physicians for high-quality coordinated care, and allowing the government to negotiate prices of drugs paid by Medicare.

The American College of Cardiology also registered its displeasure.

“The proposal is not an acceptable or sustainable solution to the SGR and does nothing to promote quality or resource stewardship,” Dr. Jack Lewin, CEO, said in a statement. “Looming primary care shortages require focused solutions, we agree. But this proposal somewhat misaligns the interests of primary and specialty doctors, rather than focusing on incentives to work together to improve quality, efficiency, coordination of care, and outcomes.”

Several specialty organizations argued that the plan fails to recognize their own primary care roles. According to a statement from The Endocrine Society, “this recommendation will unfairly punish endocrinologists, and other cognitive specialists, who largely bill evaluation and management services and often serve as the primary care provider to patients with chronic and complex diseases.”

In advance of the MedPAC meeting, a coalition of physician groups, led by the American Medical Association, wrote to commission Chairman Glenn Hackbarth urging that the commission not adopt their proposed recommendations.

Instead, the physicians urged the commissioners to look at previous proposals put forth by groups such as the Congressional Budget Office, the Simpson-Bowles Commission, and the Senate Gang of Six.

MedPAC commissioners also voiced their disapproval of the recommendation for pay cuts and freezes.

Dr. Ronald D. Castellanos, a commissioner and a Florida urologist, said he considered it “extremely disturbing” that a nurse practitioner that he may hire could make more money from treating the same patients, simply because of codes. He added that he believes the cuts would push some doctors into early retirement and discourage medical school students from becoming physicians.

“I think [there are] going to be a lot of doctors, like myself, who are going to say, it's just not worth it any more,” Dr. Castellanos said.

Commission member Dr. Karen Borman, a Pennsylvania surgeon, agreed. She warned her fellow commissioners not to create even more adverse consequences than already exist with the SGR.

Despite opposition from fellow members and physician groups, MedPAC chairman Glenn Hackbarth said an imperfect plan is better then nothing.

“If we have accomplished nothing else through this exercise other than to systematically work through it and make it clear to the Congress what the implications of that policy choice are, that's an important thing in its own right,” Mr. Hackbarth said.

With a $200 billion price tag, the MedPAC recommendations reduce the estimated cost of replacing the SGR by $100 billion, according to a MedPAC staff document. Outside of pay cuts and freezes, the proposal would result in a 2% annual increase in federal spending per Medicare beneficiary, but is budget neutral based on a number of possible savings sources that were identified.

For example, the proposal outlines $235 billion in possible savings from pharmaceuticals ($75 billion), postacute care ($49 billion), beneficiaries ($33 billion), hospitals ($26 billion), labs ($21 billion), Medicare Advantage ($12 billion), and durable medical equipment ($14 billion).

MedPAC will present its recommendations to Congress this month.

“The MedPAC proposal, we believe, will unintentionally undermine” efforts to build new payment models, saidShari Erickson of the American College of Physicians.

Source Frances Correa/Elsevier Global Medical News

WASHINGTON – Expert members of the Medicare Payment Advisory Commission voted last month to present their Medicare physician pay fix plan to Congress, despite the objections of primary care and specialist physician organizations.

First presented at the commission's September meeting, the MedPAC recommendations aim to, among other things, avoid the looming almost-30% Medicare pay cut on Jan. 1 under the Sustainable Growth Rate (SGR) formula.

To do so, the commissioners advise 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.

The recommendation passed by a vote of 15-2.

Physician organizations said the recommendations are a less-than-adequate alternative to the current system.

“The MedPAC proposal, we believe, will unintentionally undermine the goal of transitioning to new payment models aligned with value,” said Shari Erickson, who is director of regulatory and insurer affairs for the American College of Physicians.

Ms. Erickson urged the committee to consider the SGR replacement proposal that ACP submitted in September to the Joint Select Committee on Deficit Reduction. Under the ACP proposal:

▸ The SGR would be repealed and physicians fees would be stabilized and set by statute during a 5-year transition period.

▸ A physician-led initiative would work to decrease use of low-value services.

▸ Potential savings of $500 billion to $886 billion could be achieved via measures such as reducing defensive medicine, rewarding physicians for high-quality coordinated care, and allowing the government to negotiate prices of drugs paid by Medicare.

The American College of Cardiology also registered its displeasure.

“The proposal is not an acceptable or sustainable solution to the SGR and does nothing to promote quality or resource stewardship,” Dr. Jack Lewin, CEO, said in a statement. “Looming primary care shortages require focused solutions, we agree. But this proposal somewhat misaligns the interests of primary and specialty doctors, rather than focusing on incentives to work together to improve quality, efficiency, coordination of care, and outcomes.”

Several specialty organizations argued that the plan fails to recognize their own primary care roles. According to a statement from The Endocrine Society, “this recommendation will unfairly punish endocrinologists, and other cognitive specialists, who largely bill evaluation and management services and often serve as the primary care provider to patients with chronic and complex diseases.”

In advance of the MedPAC meeting, a coalition of physician groups, led by the American Medical Association, wrote to commission Chairman Glenn Hackbarth urging that the commission not adopt their proposed recommendations.

Instead, the physicians urged the commissioners to look at previous proposals put forth by groups such as the Congressional Budget Office, the Simpson-Bowles Commission, and the Senate Gang of Six.

MedPAC commissioners also voiced their disapproval of the recommendation for pay cuts and freezes.

Dr. Ronald D. Castellanos, a commissioner and a Florida urologist, said he considered it “extremely disturbing” that a nurse practitioner that he may hire could make more money from treating the same patients, simply because of codes. He added that he believes the cuts would push some doctors into early retirement and discourage medical school students from becoming physicians.

“I think [there are] going to be a lot of doctors, like myself, who are going to say, it's just not worth it any more,” Dr. Castellanos said.

Commission member Dr. Karen Borman, a Pennsylvania surgeon, agreed. She warned her fellow commissioners not to create even more adverse consequences than already exist with the SGR.

Despite opposition from fellow members and physician groups, MedPAC chairman Glenn Hackbarth said an imperfect plan is better then nothing.

“If we have accomplished nothing else through this exercise other than to systematically work through it and make it clear to the Congress what the implications of that policy choice are, that's an important thing in its own right,” Mr. Hackbarth said.

With a $200 billion price tag, the MedPAC recommendations reduce the estimated cost of replacing the SGR by $100 billion, according to a MedPAC staff document. Outside of pay cuts and freezes, the proposal would result in a 2% annual increase in federal spending per Medicare beneficiary, but is budget neutral based on a number of possible savings sources that were identified.

For example, the proposal outlines $235 billion in possible savings from pharmaceuticals ($75 billion), postacute care ($49 billion), beneficiaries ($33 billion), hospitals ($26 billion), labs ($21 billion), Medicare Advantage ($12 billion), and durable medical equipment ($14 billion).

MedPAC will present its recommendations to Congress this month.

“The MedPAC proposal, we believe, will unintentionally undermine” efforts to build new payment models, saidShari Erickson of the American College of Physicians.

Source Frances Correa/Elsevier Global Medical News

WASHINGTON – Expert members of the Medicare Payment Advisory Commission voted last month to present their Medicare physician pay fix plan to Congress, despite the objections of primary care and specialist physician organizations.

First presented at the commission's September meeting, the MedPAC recommendations aim to, among other things, avoid the looming almost-30% Medicare pay cut on Jan. 1 under the Sustainable Growth Rate (SGR) formula.

To do so, the commissioners advise 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.

The recommendation passed by a vote of 15-2.

Physician organizations said the recommendations are a less-than-adequate alternative to the current system.

“The MedPAC proposal, we believe, will unintentionally undermine the goal of transitioning to new payment models aligned with value,” said Shari Erickson, who is director of regulatory and insurer affairs for the American College of Physicians.

Ms. Erickson urged the committee to consider the SGR replacement proposal that ACP submitted in September to the Joint Select Committee on Deficit Reduction. Under the ACP proposal:

▸ The SGR would be repealed and physicians fees would be stabilized and set by statute during a 5-year transition period.

▸ A physician-led initiative would work to decrease use of low-value services.

▸ Potential savings of $500 billion to $886 billion could be achieved via measures such as reducing defensive medicine, rewarding physicians for high-quality coordinated care, and allowing the government to negotiate prices of drugs paid by Medicare.

The American College of Cardiology also registered its displeasure.

“The proposal is not an acceptable or sustainable solution to the SGR and does nothing to promote quality or resource stewardship,” Dr. Jack Lewin, CEO, said in a statement. “Looming primary care shortages require focused solutions, we agree. But this proposal somewhat misaligns the interests of primary and specialty doctors, rather than focusing on incentives to work together to improve quality, efficiency, coordination of care, and outcomes.”

Several specialty organizations argued that the plan fails to recognize their own primary care roles. According to a statement from The Endocrine Society, “this recommendation will unfairly punish endocrinologists, and other cognitive specialists, who largely bill evaluation and management services and often serve as the primary care provider to patients with chronic and complex diseases.”

In advance of the MedPAC meeting, a coalition of physician groups, led by the American Medical Association, wrote to commission Chairman Glenn Hackbarth urging that the commission not adopt their proposed recommendations.

Instead, the physicians urged the commissioners to look at previous proposals put forth by groups such as the Congressional Budget Office, the Simpson-Bowles Commission, and the Senate Gang of Six.

MedPAC commissioners also voiced their disapproval of the recommendation for pay cuts and freezes.

Dr. Ronald D. Castellanos, a commissioner and a Florida urologist, said he considered it “extremely disturbing” that a nurse practitioner that he may hire could make more money from treating the same patients, simply because of codes. He added that he believes the cuts would push some doctors into early retirement and discourage medical school students from becoming physicians.

“I think [there are] going to be a lot of doctors, like myself, who are going to say, it's just not worth it any more,” Dr. Castellanos said.

Commission member Dr. Karen Borman, a Pennsylvania surgeon, agreed. She warned her fellow commissioners not to create even more adverse consequences than already exist with the SGR.

Despite opposition from fellow members and physician groups, MedPAC chairman Glenn Hackbarth said an imperfect plan is better then nothing.

“If we have accomplished nothing else through this exercise other than to systematically work through it and make it clear to the Congress what the implications of that policy choice are, that's an important thing in its own right,” Mr. Hackbarth said.

With a $200 billion price tag, the MedPAC recommendations reduce the estimated cost of replacing the SGR by $100 billion, according to a MedPAC staff document. Outside of pay cuts and freezes, the proposal would result in a 2% annual increase in federal spending per Medicare beneficiary, but is budget neutral based on a number of possible savings sources that were identified.

For example, the proposal outlines $235 billion in possible savings from pharmaceuticals ($75 billion), postacute care ($49 billion), beneficiaries ($33 billion), hospitals ($26 billion), labs ($21 billion), Medicare Advantage ($12 billion), and durable medical equipment ($14 billion).

MedPAC will present its recommendations to Congress this month.

“The MedPAC proposal, we believe, will unintentionally undermine” efforts to build new payment models, saidShari Erickson of the American College of Physicians.

Source Frances Correa/Elsevier Global Medical News

WASHINGTON – Expert members of the Medicare Payment Advisory Commission voted last month to present their Medicare physician pay fix plan to Congress, despite the objections of primary care and specialist physician organizations.

First presented at the commission's September meeting, the MedPAC recommendations aim to, among other things, avoid the looming almost-30% Medicare pay cut on Jan. 1 under the Sustainable Growth Rate (SGR) formula.

To do so, the commissioners advise 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.

The recommendation passed by a vote of 15-2.

Physician organizations said the recommendations are a less-than-adequate alternative to the current system.

“The MedPAC proposal, we believe, will unintentionally undermine the goal of transitioning to new payment models aligned with value,” said Shari Erickson, director of regulatory and insurer affairs for the American College of Physicians.

Ms. Erickson urged the committee to consider the SGR replacement proposal that ACP submitted in September to the Joint Select Committee on Deficit Reduction. Under the ACP proposal:

▸ The SGR would be repealed and physicians fees would be stabilized and set by statute during a 5-year transition period.

▸ A physician led initiative would work to decrease use of low-value services.

▸ Potential savings of $500 billion to $886 billion could be achieved via measures such as reducing defensive medicine, rewarding physicians for high-quality coordinated care, and allowing the government to negotiate prices of drugs paid by Medicare.

Neurologists argued against the plan's preferential treatment towards primary care.

“We object strenuously to recommendation number one that splits primary care from all other specialties without recognizing all of the actual treatment that physicians provide to patients,” Michael Amery, legislative counsel to the American Academy of Neurology, said at the meeting. “Neurologists [that] treat people with Alzheimer's, ALS, Parkinson's, [and] epilepsy, often times become the primary care providers to those patients.”

The American College of Cardiology also registered its displeasure.

“The proposal is not an acceptable or sustainable solution to the SGR and does nothing to promote quality or resource stewardship,” Dr. Jack Lewin, CEO of the, said in a statement. “Looming primary care shortages require focused solutions, we agree. But this proposal somewhat misaligns the interests of primary and specialty doctors, rather than focusing on incentives to work together to improve quality, efficiency, coordination of care, and outcomes.”

In advance of the MedPAC meeting, a coalition of physician groups, led by the American Medical Association, wrote to commission Chairman Glenn Hackbarth urging that the commission not adopt their proposed recommendations.

Instead, the physicians urged the commissioners to look at previous proposals put forth by groups such as the Congressional Budget Office, the Simpson-Bowles Commission, and the Senate Gang of Six.

Dr. Ronald D. Castellanos, a MedPAC commissioner and a Florida urologist, said he considered it “extremely disturbing” that a nurse practitioner that he may hire could make more money from treating the same patients, simply because of codes. He added that he believes the cuts would push some doctors into early retirement and discourage medical school students from becoming physicians.

Commission member Dr. Karen Borman, a Pennsylvania surgeon, agreed. She warned her fellow commissioners not to create even more adverse consequences than already exist with the SGR.

Despite opposition from fellow members and physician groups, MedPAC chairman Glenn Hackbarth said an imperfect plan is better than nothing.

“If we have accomplished nothing else through this exercise other than to systematically work through it and make it clear to the Congress what the implications of that policy choice are, that's an important thing in its own right,” Mr. Hackbarth said.

With a $200 billion price tag, the MedPAC recommendations reduce the estimated cost of replacing the SGR by $100 billion, according to a MedPAC staff document. Outside of pay cuts and freezes, the proposal would result in a 2% annual increase in federal spending per Medicare beneficiary, but is budget neutral based on a number of possible savings identified.

For example, the proposal outlines $235 billion in possible savings from pharmaceuticals ($75 billion), postacute care ($49 billion), beneficiaries ($33 billion), hospitals ($26 billion), labs ($21 billion), Medicare Advantage ($12 billion), and durable medical equipment ($14 billion).

WASHINGTON – Expert members of the Medicare Payment Advisory Commission voted last month to present their Medicare physician pay fix plan to Congress, despite the objections of primary care and specialist physician organizations.

First presented at the commission's September meeting, the MedPAC recommendations aim to, among other things, avoid the looming almost-30% Medicare pay cut on Jan. 1 under the Sustainable Growth Rate (SGR) formula.

To do so, the commissioners advise 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.

The recommendation passed by a vote of 15-2.

Physician organizations said the recommendations are a less-than-adequate alternative to the current system.

“The MedPAC proposal, we believe, will unintentionally undermine the goal of transitioning to new payment models aligned with value,” said Shari Erickson, director of regulatory and insurer affairs for the American College of Physicians.

Ms. Erickson urged the committee to consider the SGR replacement proposal that ACP submitted in September to the Joint Select Committee on Deficit Reduction. Under the ACP proposal:

▸ The SGR would be repealed and physicians fees would be stabilized and set by statute during a 5-year transition period.

▸ A physician led initiative would work to decrease use of low-value services.

▸ Potential savings of $500 billion to $886 billion could be achieved via measures such as reducing defensive medicine, rewarding physicians for high-quality coordinated care, and allowing the government to negotiate prices of drugs paid by Medicare.

Neurologists argued against the plan's preferential treatment towards primary care.

“We object strenuously to recommendation number one that splits primary care from all other specialties without recognizing all of the actual treatment that physicians provide to patients,” Michael Amery, legislative counsel to the American Academy of Neurology, said at the meeting. “Neurologists [that] treat people with Alzheimer's, ALS, Parkinson's, [and] epilepsy, often times become the primary care providers to those patients.”

The American College of Cardiology also registered its displeasure.

“The proposal is not an acceptable or sustainable solution to the SGR and does nothing to promote quality or resource stewardship,” Dr. Jack Lewin, CEO of the, said in a statement. “Looming primary care shortages require focused solutions, we agree. But this proposal somewhat misaligns the interests of primary and specialty doctors, rather than focusing on incentives to work together to improve quality, efficiency, coordination of care, and outcomes.”

In advance of the MedPAC meeting, a coalition of physician groups, led by the American Medical Association, wrote to commission Chairman Glenn Hackbarth urging that the commission not adopt their proposed recommendations.

Instead, the physicians urged the commissioners to look at previous proposals put forth by groups such as the Congressional Budget Office, the Simpson-Bowles Commission, and the Senate Gang of Six.

Dr. Ronald D. Castellanos, a MedPAC commissioner and a Florida urologist, said he considered it “extremely disturbing” that a nurse practitioner that he may hire could make more money from treating the same patients, simply because of codes. He added that he believes the cuts would push some doctors into early retirement and discourage medical school students from becoming physicians.

Commission member Dr. Karen Borman, a Pennsylvania surgeon, agreed. She warned her fellow commissioners not to create even more adverse consequences than already exist with the SGR.

Despite opposition from fellow members and physician groups, MedPAC chairman Glenn Hackbarth said an imperfect plan is better than nothing.

“If we have accomplished nothing else through this exercise other than to systematically work through it and make it clear to the Congress what the implications of that policy choice are, that's an important thing in its own right,” Mr. Hackbarth said.

With a $200 billion price tag, the MedPAC recommendations reduce the estimated cost of replacing the SGR by $100 billion, according to a MedPAC staff document. Outside of pay cuts and freezes, the proposal would result in a 2% annual increase in federal spending per Medicare beneficiary, but is budget neutral based on a number of possible savings identified.

For example, the proposal outlines $235 billion in possible savings from pharmaceuticals ($75 billion), postacute care ($49 billion), beneficiaries ($33 billion), hospitals ($26 billion), labs ($21 billion), Medicare Advantage ($12 billion), and durable medical equipment ($14 billion).

WASHINGTON – Expert members of the Medicare Payment Advisory Commission voted last month to present their Medicare physician pay fix plan to Congress, despite the objections of primary care and specialist physician organizations.

First presented at the commission's September meeting, the MedPAC recommendations aim to, among other things, avoid the looming almost-30% Medicare pay cut on Jan. 1 under the Sustainable Growth Rate (SGR) formula.

To do so, the commissioners advise 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.

The recommendation passed by a vote of 15-2.

Physician organizations said the recommendations are a less-than-adequate alternative to the current system.

“The MedPAC proposal, we believe, will unintentionally undermine the goal of transitioning to new payment models aligned with value,” said Shari Erickson, director of regulatory and insurer affairs for the American College of Physicians.

Ms. Erickson urged the committee to consider the SGR replacement proposal that ACP submitted in September to the Joint Select Committee on Deficit Reduction. Under the ACP proposal:

▸ The SGR would be repealed and physicians fees would be stabilized and set by statute during a 5-year transition period.

▸ A physician led initiative would work to decrease use of low-value services.

▸ Potential savings of $500 billion to $886 billion could be achieved via measures such as reducing defensive medicine, rewarding physicians for high-quality coordinated care, and allowing the government to negotiate prices of drugs paid by Medicare.

Neurologists argued against the plan's preferential treatment towards primary care.

“We object strenuously to recommendation number one that splits primary care from all other specialties without recognizing all of the actual treatment that physicians provide to patients,” Michael Amery, legislative counsel to the American Academy of Neurology, said at the meeting. “Neurologists [that] treat people with Alzheimer's, ALS, Parkinson's, [and] epilepsy, often times become the primary care providers to those patients.”

The American College of Cardiology also registered its displeasure.

“The proposal is not an acceptable or sustainable solution to the SGR and does nothing to promote quality or resource stewardship,” Dr. Jack Lewin, CEO of the, said in a statement. “Looming primary care shortages require focused solutions, we agree. But this proposal somewhat misaligns the interests of primary and specialty doctors, rather than focusing on incentives to work together to improve quality, efficiency, coordination of care, and outcomes.”

In advance of the MedPAC meeting, a coalition of physician groups, led by the American Medical Association, wrote to commission Chairman Glenn Hackbarth urging that the commission not adopt their proposed recommendations.

Instead, the physicians urged the commissioners to look at previous proposals put forth by groups such as the Congressional Budget Office, the Simpson-Bowles Commission, and the Senate Gang of Six.

Dr. Ronald D. Castellanos, a MedPAC commissioner and a Florida urologist, said he considered it “extremely disturbing” that a nurse practitioner that he may hire could make more money from treating the same patients, simply because of codes. He added that he believes the cuts would push some doctors into early retirement and discourage medical school students from becoming physicians.

Commission member Dr. Karen Borman, a Pennsylvania surgeon, agreed. She warned her fellow commissioners not to create even more adverse consequences than already exist with the SGR.

Despite opposition from fellow members and physician groups, MedPAC chairman Glenn Hackbarth said an imperfect plan is better than nothing.

“If we have accomplished nothing else through this exercise other than to systematically work through it and make it clear to the Congress what the implications of that policy choice are, that's an important thing in its own right,” Mr. Hackbarth said.

With a $200 billion price tag, the MedPAC recommendations reduce the estimated cost of replacing the SGR by $100 billion, according to a MedPAC staff document. Outside of pay cuts and freezes, the proposal would result in a 2% annual increase in federal spending per Medicare beneficiary, but is budget neutral based on a number of possible savings identified.

For example, the proposal outlines $235 billion in possible savings from pharmaceuticals ($75 billion), postacute care ($49 billion), beneficiaries ($33 billion), hospitals ($26 billion), labs ($21 billion), Medicare Advantage ($12 billion), and durable medical equipment ($14 billion).

Multiple shift changes and patient handovers are leading to a decrease in the amount and quality of information conveyed between residents, according to a study of 89 internal medicine residents at the University of Virginia, Charlottesville. The study analyzed the current process of patient handovers, as well as resident opinions about the process.

Residents surveyed said information about laboratory test results (87%) and patient medications (84%) was frequently inaccurate when passed on to the next resident on shift. Only 24% of the time did residents report no major errors or omissions on a sign-out form. In addition, even less information was conveyed during the night shift.

For example, lab test results were discussed 24% less often than during the day shift, as well as treatment plans (21% less often), and active problems (10% less often). In addition, 40% of residents said they didn’t expect to have to make any decisions about patient care during a handoff period (J. Gen. Intern. Med. 2011 [doi:10.1007/s11606-011-1885-4]).

In the study, led by Dr. Adam Helms, the authors wrote that the degradation of information passed between residents leaves the patient to suffer the consequences.

"Inadequate handoff of care, or sign-out, leads to interns and residents feeling unprepared for events that happen during crossover periods and has been associated with adverse events," wrote Dr. Helms and his colleagues.

Residents felt there was no consensus on how patient handovers should be carried out and that the lack of consensus is a result of a lack of direction, the authors observed.

The researchers found great value in using an appreciative-inquiry approach, identifying common attributes to improve the efficiency and organization of sign-out. They defined appreciative inquiry as "a highly effective change methodology that focuses on finding what is working in a system and using that as a basis for improvement."

"A key finding of the appreciative-inquiry group was that both written and verbal sign-out should be concise and organized in a systematic way by all residents," the authors wrote.

"Most residency programs do not have curriculum devoted to the sign-out process, and there is currently little prospective evidence supporting specific sign-out content or process," the authors wrote.

Residency programs have been increasingly faced with handling patient handoffs since the Accreditation Council for Graduate Medical Education first instituted program requirements limiting residents to an 80-hour work week in 2003. While Dr. Helms offered few details, researchers wrote that as a result of their analysis, they’ve developed an educational curriculum, as well as an electronic database to support the sign-out process at the university. The authors also encouraged other teaching institutions to do the same.

"Initiating an educational curriculum for sign-out at teaching hospitals is critical not only for establishing a standardized process for sign-out, but for creating a culture of patients’ ownership among cross-covering physicians," they wrote.

The study was sponsored in part by a grant from the National Library of Medicine, the University of Virginia’s Graduate Medical Education Office, and the University of Virginia’s Institute of Quality and Patient Safety. One of the study authors is an investigator on a Bristol-Myers Squibb–sponsored diabetes study.

Multiple shift changes and patient handovers are leading to a decrease in the amount and quality of information conveyed between residents, according to a study of 89 internal medicine residents at the University of Virginia, Charlottesville. The study analyzed the current process of patient handovers, as well as resident opinions about the process.

Residents surveyed said information about laboratory test results (87%) and patient medications (84%) was frequently inaccurate when passed on to the next resident on shift. Only 24% of the time did residents report no major errors or omissions on a sign-out form. In addition, even less information was conveyed during the night shift.

For example, lab test results were discussed 24% less often than during the day shift, as well as treatment plans (21% less often), and active problems (10% less often). In addition, 40% of residents said they didn’t expect to have to make any decisions about patient care during a handoff period (J. Gen. Intern. Med. 2011 [doi:10.1007/s11606-011-1885-4]).

In the study, led by Dr. Adam Helms, the authors wrote that the degradation of information passed between residents leaves the patient to suffer the consequences.

"Inadequate handoff of care, or sign-out, leads to interns and residents feeling unprepared for events that happen during crossover periods and has been associated with adverse events," wrote Dr. Helms and his colleagues.

Residents felt there was no consensus on how patient handovers should be carried out and that the lack of consensus is a result of a lack of direction, the authors observed.

The researchers found great value in using an appreciative-inquiry approach, identifying common attributes to improve the efficiency and organization of sign-out. They defined appreciative inquiry as "a highly effective change methodology that focuses on finding what is working in a system and using that as a basis for improvement."

"A key finding of the appreciative-inquiry group was that both written and verbal sign-out should be concise and organized in a systematic way by all residents," the authors wrote.

"Most residency programs do not have curriculum devoted to the sign-out process, and there is currently little prospective evidence supporting specific sign-out content or process," the authors wrote.

Residency programs have been increasingly faced with handling patient handoffs since the Accreditation Council for Graduate Medical Education first instituted program requirements limiting residents to an 80-hour work week in 2003. While Dr. Helms offered few details, researchers wrote that as a result of their analysis, they’ve developed an educational curriculum, as well as an electronic database to support the sign-out process at the university. The authors also encouraged other teaching institutions to do the same.

"Initiating an educational curriculum for sign-out at teaching hospitals is critical not only for establishing a standardized process for sign-out, but for creating a culture of patients’ ownership among cross-covering physicians," they wrote.

The study was sponsored in part by a grant from the National Library of Medicine, the University of Virginia’s Graduate Medical Education Office, and the University of Virginia’s Institute of Quality and Patient Safety. One of the study authors is an investigator on a Bristol-Myers Squibb–sponsored diabetes study.

Multiple shift changes and patient handovers are leading to a decrease in the amount and quality of information conveyed between residents, according to a study of 89 internal medicine residents at the University of Virginia, Charlottesville. The study analyzed the current process of patient handovers, as well as resident opinions about the process.

Residents surveyed said information about laboratory test results (87%) and patient medications (84%) was frequently inaccurate when passed on to the next resident on shift. Only 24% of the time did residents report no major errors or omissions on a sign-out form. In addition, even less information was conveyed during the night shift.

For example, lab test results were discussed 24% less often than during the day shift, as well as treatment plans (21% less often), and active problems (10% less often). In addition, 40% of residents said they didn’t expect to have to make any decisions about patient care during a handoff period (J. Gen. Intern. Med. 2011 [doi:10.1007/s11606-011-1885-4]).

In the study, led by Dr. Adam Helms, the authors wrote that the degradation of information passed between residents leaves the patient to suffer the consequences.

"Inadequate handoff of care, or sign-out, leads to interns and residents feeling unprepared for events that happen during crossover periods and has been associated with adverse events," wrote Dr. Helms and his colleagues.

Residents felt there was no consensus on how patient handovers should be carried out and that the lack of consensus is a result of a lack of direction, the authors observed.

The researchers found great value in using an appreciative-inquiry approach, identifying common attributes to improve the efficiency and organization of sign-out. They defined appreciative inquiry as "a highly effective change methodology that focuses on finding what is working in a system and using that as a basis for improvement."

"A key finding of the appreciative-inquiry group was that both written and verbal sign-out should be concise and organized in a systematic way by all residents," the authors wrote.

"Most residency programs do not have curriculum devoted to the sign-out process, and there is currently little prospective evidence supporting specific sign-out content or process," the authors wrote.

Residency programs have been increasingly faced with handling patient handoffs since the Accreditation Council for Graduate Medical Education first instituted program requirements limiting residents to an 80-hour work week in 2003. While Dr. Helms offered few details, researchers wrote that as a result of their analysis, they’ve developed an educational curriculum, as well as an electronic database to support the sign-out process at the university. The authors also encouraged other teaching institutions to do the same.

"Initiating an educational curriculum for sign-out at teaching hospitals is critical not only for establishing a standardized process for sign-out, but for creating a culture of patients’ ownership among cross-covering physicians," they wrote.

The study was sponsored in part by a grant from the National Library of Medicine, the University of Virginia’s Graduate Medical Education Office, and the University of Virginia’s Institute of Quality and Patient Safety. One of the study authors is an investigator on a Bristol-Myers Squibb–sponsored diabetes study.

Based on feedback from physicians and health care providers, the final federal e-prescribing regulations released Aug. 31 are more flexible and contain more exemptions, the Centers for Medicare and Medicaid Services announced.

The changes come after concern that the program criteria should be more aligned with the Medicaid incentive program for electronic health records, according to CMS officials.

"[The changes] will encourage more doctors and other health care professionals to adopt this technology and give them the added flexibility to help them succeed," Dr. Patrick Conway, chief medical officer at CMS and director of the agency’s Office of Clinical Standards and Quality, wrote in a blog post announcing the change. "With electronic prescribing, providers can better manage patient prescriptions, reducing drug interactions or other preventable prescription errors."Under the Medicare Electronic Prescribing Incentive Program, eligible prescribers who meet the e-prescribing criteria will get a 1% bonus payment for 2011 and 2012 and a 0.5% bonus in 2013. Those who do not meet the criteria in 2012 will be penalized 1% of Medicare payments; the penalty will escalate in 2013 and 2014.

Under the final rule, prescribers who use certified electronic health records can claim this as a "qualified" e-prescribing system. This move was designed to more closely align the e-prescribing program with the program that offers incentives for meaningful use of electronic health records, CMS officials said.

The final rule, which goes into effect 30 days after its official publication in the Federal Register, contains hardship exemptions for those who live in a rural area without high-speed Internet access and those who work where there are not enough pharmacies that can take electronic prescriptions.

In addition, the final rule creates additional hardship exemption categories. Eligible professionals have to demonstrate that they have:

• registered to participate in the Medicare or Medicaid EHR incentive program and have adopted certified EHR technology,

• an inability to electronically prescribe due to local, state, or federal law (this primarily applies to prescribing of narcotics),

• very limited prescribing activity, or

• insufficient opportunities to report the e-prescribing measure.

The deadline to apply for a hardship exemption has been extended until Nov. 1, 2011, according to CMS officials.

Even with the changes, however, some physicians still have concerns. The American Medical Association said it is worried about the amount of time physicians will have to apply for the exemptions.

"We remain concerned that physicians will be hit with a penalty and are not being given enough time to comply with the e-prescribing program criteria to avoid this penalty," Dr. Cecil Wilson, AMA immediate past president, said in a statement.

Based on feedback from physicians and health care providers, the final federal e-prescribing regulations released Aug. 31 are more flexible and contain more exemptions, the Centers for Medicare and Medicaid Services announced.

The changes come after concern that the program criteria should be more aligned with the Medicaid incentive program for electronic health records, according to CMS officials.

"[The changes] will encourage more doctors and other health care professionals to adopt this technology and give them the added flexibility to help them succeed," Dr. Patrick Conway, chief medical officer at CMS and director of the agency’s Office of Clinical Standards and Quality, wrote in a blog post announcing the change. "With electronic prescribing, providers can better manage patient prescriptions, reducing drug interactions or other preventable prescription errors."Under the Medicare Electronic Prescribing Incentive Program, eligible prescribers who meet the e-prescribing criteria will get a 1% bonus payment for 2011 and 2012 and a 0.5% bonus in 2013. Those who do not meet the criteria in 2012 will be penalized 1% of Medicare payments; the penalty will escalate in 2013 and 2014.

Under the final rule, prescribers who use certified electronic health records can claim this as a "qualified" e-prescribing system. This move was designed to more closely align the e-prescribing program with the program that offers incentives for meaningful use of electronic health records, CMS officials said.

The final rule, which goes into effect 30 days after its official publication in the Federal Register, contains hardship exemptions for those who live in a rural area without high-speed Internet access and those who work where there are not enough pharmacies that can take electronic prescriptions.

In addition, the final rule creates additional hardship exemption categories. Eligible professionals have to demonstrate that they have:

• registered to participate in the Medicare or Medicaid EHR incentive program and have adopted certified EHR technology,

• an inability to electronically prescribe due to local, state, or federal law (this primarily applies to prescribing of narcotics),

• very limited prescribing activity, or

• insufficient opportunities to report the e-prescribing measure.

The deadline to apply for a hardship exemption has been extended until Nov. 1, 2011, according to CMS officials.

Even with the changes, however, some physicians still have concerns. The American Medical Association said it is worried about the amount of time physicians will have to apply for the exemptions.

"We remain concerned that physicians will be hit with a penalty and are not being given enough time to comply with the e-prescribing program criteria to avoid this penalty," Dr. Cecil Wilson, AMA immediate past president, said in a statement.

Based on feedback from physicians and health care providers, the final federal e-prescribing regulations released Aug. 31 are more flexible and contain more exemptions, the Centers for Medicare and Medicaid Services announced.

The changes come after concern that the program criteria should be more aligned with the Medicaid incentive program for electronic health records, according to CMS officials.

"[The changes] will encourage more doctors and other health care professionals to adopt this technology and give them the added flexibility to help them succeed," Dr. Patrick Conway, chief medical officer at CMS and director of the agency’s Office of Clinical Standards and Quality, wrote in a blog post announcing the change. "With electronic prescribing, providers can better manage patient prescriptions, reducing drug interactions or other preventable prescription errors."Under the Medicare Electronic Prescribing Incentive Program, eligible prescribers who meet the e-prescribing criteria will get a 1% bonus payment for 2011 and 2012 and a 0.5% bonus in 2013. Those who do not meet the criteria in 2012 will be penalized 1% of Medicare payments; the penalty will escalate in 2013 and 2014.

Under the final rule, prescribers who use certified electronic health records can claim this as a "qualified" e-prescribing system. This move was designed to more closely align the e-prescribing program with the program that offers incentives for meaningful use of electronic health records, CMS officials said.

The final rule, which goes into effect 30 days after its official publication in the Federal Register, contains hardship exemptions for those who live in a rural area without high-speed Internet access and those who work where there are not enough pharmacies that can take electronic prescriptions.

In addition, the final rule creates additional hardship exemption categories. Eligible professionals have to demonstrate that they have:

• registered to participate in the Medicare or Medicaid EHR incentive program and have adopted certified EHR technology,

• an inability to electronically prescribe due to local, state, or federal law (this primarily applies to prescribing of narcotics),

• very limited prescribing activity, or

• insufficient opportunities to report the e-prescribing measure.

The deadline to apply for a hardship exemption has been extended until Nov. 1, 2011, according to CMS officials.

Even with the changes, however, some physicians still have concerns. The American Medical Association said it is worried about the amount of time physicians will have to apply for the exemptions.

"We remain concerned that physicians will be hit with a penalty and are not being given enough time to comply with the e-prescribing program criteria to avoid this penalty," Dr. Cecil Wilson, AMA immediate past president, said in a statement.

WASHINGTON – Expert members of the Medicare Payment Advisory Commission voted Oct. 6 to present their Medicare physician pay fix plan to Congress, despite the objections of primary care and specialist physician organizations.

First presented at the commission’s September meeting, the MedPAC recommendations aim to, among other things, avoid the looming almost-30% Medicare pay cut on Jan. 1 under the Sustainable Growth Rate (SGR) formula.

To do so, the commissioners advise 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.

The recommendation passed by a vote of 15-2.

Physician organizations said the recommendations are a less than adequate alternative to the current system.

"The MedPAC proposal, we believe, will unintentionally undermine the goal of transitioning to new payment models aligned with value," said Shari Erickson, director of regulatory and insurer affairs for the American College of Physicians.

"The proposal is not an acceptable or sustainable solution to the SGR and does nothing to promote quality or resource stewardship," said Dr. Jack Lewin, CEO of the American College of Cardiology, in a statement. "Looming primary care shortages require focused solutions, we agree. But this proposal somewhat misaligns the interests of primary and specialty doctors, rather than focusing on incentives to work together to improve quality, efficiency, coordination of care, and outcomes."

Prior to the meeting, a coalition of physician groups, led by the American Medical Association, wrote to MedPAC Chairman Glenn Hackbarth urging that the commission not adopt their proposed recommendations.

Instead, the physicians urged the commissioners to look at previous proposals put forth by groups such as the Congressional Budget Office, the Simpson-Bowles Commission, and the Senate Gang of Six.

MedPAC commissioners also voiced their disapproval of the recommendation for pay cuts and freezes.

Dr. Ronald D. Castellanos, a commissioner and a Florida urologist, said he considered it "extremely disturbing" that a nurse practitioner that he may hire could make more money from treating the same patients, simply because of codes. He added that he believes the cuts would push some doctors into early retirement and discourage medical school students from becoming physicians.

"I think [there are] going to be a lot of doctors, like myself, who are going to say, it’s just not worth any more," Dr. Castellanos said.

With a $200 billion price tag, the MedPAC recommendations reduce the estimated cost of replacing the SGR by $100 billion, according to a MedPAC staff document. Outside of pay cuts and freezes, the proposal would result in a 2% annual increase in federal spending per Medicare beneficiary, but is budget neutral based on a number of possible savings identified.

For example, the proposal outlines $235 billion in possible savings from pharmaceuticals ($75 billion), postacute care ($49 billion), beneficiaries ($33 billion), hospitals ($26 billion), labs ($21 billion), Medicare Advantage ($12 billion), and durable medical equipment ($14 billion).

WASHINGTON – Expert members of the Medicare Payment Advisory Commission voted Oct. 6 to present their Medicare physician pay fix plan to Congress, despite the objections of primary care and specialist physician organizations.

First presented at the commission’s September meeting, the MedPAC recommendations aim to, among other things, avoid the looming almost-30% Medicare pay cut on Jan. 1 under the Sustainable Growth Rate (SGR) formula.

To do so, the commissioners advise 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.

The recommendation passed by a vote of 15-2.

Physician organizations said the recommendations are a less than adequate alternative to the current system.

"The MedPAC proposal, we believe, will unintentionally undermine the goal of transitioning to new payment models aligned with value," said Shari Erickson, director of regulatory and insurer affairs for the American College of Physicians.

"The proposal is not an acceptable or sustainable solution to the SGR and does nothing to promote quality or resource stewardship," said Dr. Jack Lewin, CEO of the American College of Cardiology, in a statement. "Looming primary care shortages require focused solutions, we agree. But this proposal somewhat misaligns the interests of primary and specialty doctors, rather than focusing on incentives to work together to improve quality, efficiency, coordination of care, and outcomes."

Prior to the meeting, a coalition of physician groups, led by the American Medical Association, wrote to MedPAC Chairman Glenn Hackbarth urging that the commission not adopt their proposed recommendations.

Instead, the physicians urged the commissioners to look at previous proposals put forth by groups such as the Congressional Budget Office, the Simpson-Bowles Commission, and the Senate Gang of Six.

MedPAC commissioners also voiced their disapproval of the recommendation for pay cuts and freezes.

Dr. Ronald D. Castellanos, a commissioner and a Florida urologist, said he considered it "extremely disturbing" that a nurse practitioner that he may hire could make more money from treating the same patients, simply because of codes. He added that he believes the cuts would push some doctors into early retirement and discourage medical school students from becoming physicians.

"I think [there are] going to be a lot of doctors, like myself, who are going to say, it’s just not worth any more," Dr. Castellanos said.

With a $200 billion price tag, the MedPAC recommendations reduce the estimated cost of replacing the SGR by $100 billion, according to a MedPAC staff document. Outside of pay cuts and freezes, the proposal would result in a 2% annual increase in federal spending per Medicare beneficiary, but is budget neutral based on a number of possible savings identified.

For example, the proposal outlines $235 billion in possible savings from pharmaceuticals ($75 billion), postacute care ($49 billion), beneficiaries ($33 billion), hospitals ($26 billion), labs ($21 billion), Medicare Advantage ($12 billion), and durable medical equipment ($14 billion).

WASHINGTON – Expert members of the Medicare Payment Advisory Commission voted Oct. 6 to present their Medicare physician pay fix plan to Congress, despite the objections of primary care and specialist physician organizations.

First presented at the commission’s September meeting, the MedPAC recommendations aim to, among other things, avoid the looming almost-30% Medicare pay cut on Jan. 1 under the Sustainable Growth Rate (SGR) formula.

To do so, the commissioners advise 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.

The recommendation passed by a vote of 15-2.

Physician organizations said the recommendations are a less than adequate alternative to the current system.

"The MedPAC proposal, we believe, will unintentionally undermine the goal of transitioning to new payment models aligned with value," said Shari Erickson, director of regulatory and insurer affairs for the American College of Physicians.

"The proposal is not an acceptable or sustainable solution to the SGR and does nothing to promote quality or resource stewardship," said Dr. Jack Lewin, CEO of the American College of Cardiology, in a statement. "Looming primary care shortages require focused solutions, we agree. But this proposal somewhat misaligns the interests of primary and specialty doctors, rather than focusing on incentives to work together to improve quality, efficiency, coordination of care, and outcomes."

Prior to the meeting, a coalition of physician groups, led by the American Medical Association, wrote to MedPAC Chairman Glenn Hackbarth urging that the commission not adopt their proposed recommendations.

Instead, the physicians urged the commissioners to look at previous proposals put forth by groups such as the Congressional Budget Office, the Simpson-Bowles Commission, and the Senate Gang of Six.

MedPAC commissioners also voiced their disapproval of the recommendation for pay cuts and freezes.

Dr. Ronald D. Castellanos, a commissioner and a Florida urologist, said he considered it "extremely disturbing" that a nurse practitioner that he may hire could make more money from treating the same patients, simply because of codes. He added that he believes the cuts would push some doctors into early retirement and discourage medical school students from becoming physicians.

"I think [there are] going to be a lot of doctors, like myself, who are going to say, it’s just not worth any more," Dr. Castellanos said.

With a $200 billion price tag, the MedPAC recommendations reduce the estimated cost of replacing the SGR by $100 billion, according to a MedPAC staff document. Outside of pay cuts and freezes, the proposal would result in a 2% annual increase in federal spending per Medicare beneficiary, but is budget neutral based on a number of possible savings identified.

For example, the proposal outlines $235 billion in possible savings from pharmaceuticals ($75 billion), postacute care ($49 billion), beneficiaries ($33 billion), hospitals ($26 billion), labs ($21 billion), Medicare Advantage ($12 billion), and durable medical equipment ($14 billion).

Hospitals with the highest cost but lowest quality scores care for twice as many minority and low-income patients as do hospitals with the lowest cost and the highest quality scores, according to an analysis of Medicare and hospital databases.

Harvard-based researchers, lead by Dr. Ashish K. Jha, examined quality performance data on more than 3,200 hospitals from Medicare’s Hospital Compare program and several other databases maintained by Medicare and American Hospital Association; they also examined cost information and patient demographics.

Their findings have implications as Medicare prepares to base some hospital compensation on quality, according to Dr. Jha.

The researchers stratified hospitals into quartiles, terming the highest cost/lowest quality facilities "worst" and the lowest cost/highest quality ones "best." The worst hospitals were typically smaller, public, or for-profit, and located in the South, according to the study published in the October issue of the journal Health Affairs.

The 178 worst hospitals cared for more elderly black patients than did the 122 best hospitals (15% vs. 7% respectively); the pattern was similar for elderly Hispanic patients (4% and 1% respectively).

Hospitals with the lowest quality/highest costs also served more Medicaid recipients – 22% vs. 15% for hospitals with the highest quality/lowest costs.

Dr. Jha and his associates also examined each hospital’s health outcomes for acute myocardial infarction, congestive heart failure, and pneumonia. They found that patients with acute myocardial infarction or pneumonia admitted to the worst hospitals were 7%-10% more likely to die than were their peers admitted to the best hospitals (Health Affairs 2011 [doi:10.1377/hlthaff.2011.0027]).

As policy makers seek to lower health care spending while improving quality, Dr. Jha and his associates urged caution in implementing the Medicare value-based purchasing program.

Starting in October 2012, the program will reimburse hospitals based on a series of quality performance measures including mortality rates and hospital-acquired conditions.

"While value-based purchasing is well-intended, many hospitals that disproportionately care for minorities and the poor will fare poorly," Dr. Jha said in a statement. "We will have to track closely to make sure we don’t inadvertently worsen health care disparities in the process of promoting quality and efficiency."

While the researchers point out that only 1% of Medicare reimbursement is at risk through the value-based purchasing program, "even losing a portion of that 1% may put some hospitals at risk of financial failure."

CMS officials noted that hospitals will be monitored through a variety of quality improvement programs, and minorities will be protected.

"The CMS Value-Based Purchasing program isn’t just about meeting a certain one-size-fits-all benchmark on the quality of care hospitals provide – it’s about improving the quality for every patient relative to where a hospital begins," according to an agency spokesman. "Our program takes into account patient traits such as gender, age, and health status when patients enter the hospital because we recognize that less-affluent populations may have particular needs, and we want to help hospitals treat those patients well and be successful."

The study was funded by the Commonwealth Fund. The authors reported no relevant financial conflicts of interest.

Hospitals with the highest cost but lowest quality scores care for twice as many minority and low-income patients as do hospitals with the lowest cost and the highest quality scores, according to an analysis of Medicare and hospital databases.

Harvard-based researchers, lead by Dr. Ashish K. Jha, examined quality performance data on more than 3,200 hospitals from Medicare’s Hospital Compare program and several other databases maintained by Medicare and American Hospital Association; they also examined cost information and patient demographics.

Their findings have implications as Medicare prepares to base some hospital compensation on quality, according to Dr. Jha.

The researchers stratified hospitals into quartiles, terming the highest cost/lowest quality facilities "worst" and the lowest cost/highest quality ones "best." The worst hospitals were typically smaller, public, or for-profit, and located in the South, according to the study published in the October issue of the journal Health Affairs.

The 178 worst hospitals cared for more elderly black patients than did the 122 best hospitals (15% vs. 7% respectively); the pattern was similar for elderly Hispanic patients (4% and 1% respectively).

Hospitals with the lowest quality/highest costs also served more Medicaid recipients – 22% vs. 15% for hospitals with the highest quality/lowest costs.

Dr. Jha and his associates also examined each hospital’s health outcomes for acute myocardial infarction, congestive heart failure, and pneumonia. They found that patients with acute myocardial infarction or pneumonia admitted to the worst hospitals were 7%-10% more likely to die than were their peers admitted to the best hospitals (Health Affairs 2011 [doi:10.1377/hlthaff.2011.0027]).

As policy makers seek to lower health care spending while improving quality, Dr. Jha and his associates urged caution in implementing the Medicare value-based purchasing program.

Starting in October 2012, the program will reimburse hospitals based on a series of quality performance measures including mortality rates and hospital-acquired conditions.

"While value-based purchasing is well-intended, many hospitals that disproportionately care for minorities and the poor will fare poorly," Dr. Jha said in a statement. "We will have to track closely to make sure we don’t inadvertently worsen health care disparities in the process of promoting quality and efficiency."

While the researchers point out that only 1% of Medicare reimbursement is at risk through the value-based purchasing program, "even losing a portion of that 1% may put some hospitals at risk of financial failure."

CMS officials noted that hospitals will be monitored through a variety of quality improvement programs, and minorities will be protected.

"The CMS Value-Based Purchasing program isn’t just about meeting a certain one-size-fits-all benchmark on the quality of care hospitals provide – it’s about improving the quality for every patient relative to where a hospital begins," according to an agency spokesman. "Our program takes into account patient traits such as gender, age, and health status when patients enter the hospital because we recognize that less-affluent populations may have particular needs, and we want to help hospitals treat those patients well and be successful."

The study was funded by the Commonwealth Fund. The authors reported no relevant financial conflicts of interest.

Hospitals with the highest cost but lowest quality scores care for twice as many minority and low-income patients as do hospitals with the lowest cost and the highest quality scores, according to an analysis of Medicare and hospital databases.

Harvard-based researchers, lead by Dr. Ashish K. Jha, examined quality performance data on more than 3,200 hospitals from Medicare’s Hospital Compare program and several other databases maintained by Medicare and American Hospital Association; they also examined cost information and patient demographics.

Their findings have implications as Medicare prepares to base some hospital compensation on quality, according to Dr. Jha.

The researchers stratified hospitals into quartiles, terming the highest cost/lowest quality facilities "worst" and the lowest cost/highest quality ones "best." The worst hospitals were typically smaller, public, or for-profit, and located in the South, according to the study published in the October issue of the journal Health Affairs.

The 178 worst hospitals cared for more elderly black patients than did the 122 best hospitals (15% vs. 7% respectively); the pattern was similar for elderly Hispanic patients (4% and 1% respectively).

Hospitals with the lowest quality/highest costs also served more Medicaid recipients – 22% vs. 15% for hospitals with the highest quality/lowest costs.

Dr. Jha and his associates also examined each hospital’s health outcomes for acute myocardial infarction, congestive heart failure, and pneumonia. They found that patients with acute myocardial infarction or pneumonia admitted to the worst hospitals were 7%-10% more likely to die than were their peers admitted to the best hospitals (Health Affairs 2011 [doi:10.1377/hlthaff.2011.0027]).

As policy makers seek to lower health care spending while improving quality, Dr. Jha and his associates urged caution in implementing the Medicare value-based purchasing program.

Starting in October 2012, the program will reimburse hospitals based on a series of quality performance measures including mortality rates and hospital-acquired conditions.

"While value-based purchasing is well-intended, many hospitals that disproportionately care for minorities and the poor will fare poorly," Dr. Jha said in a statement. "We will have to track closely to make sure we don’t inadvertently worsen health care disparities in the process of promoting quality and efficiency."

While the researchers point out that only 1% of Medicare reimbursement is at risk through the value-based purchasing program, "even losing a portion of that 1% may put some hospitals at risk of financial failure."

CMS officials noted that hospitals will be monitored through a variety of quality improvement programs, and minorities will be protected.

"The CMS Value-Based Purchasing program isn’t just about meeting a certain one-size-fits-all benchmark on the quality of care hospitals provide – it’s about improving the quality for every patient relative to where a hospital begins," according to an agency spokesman. "Our program takes into account patient traits such as gender, age, and health status when patients enter the hospital because we recognize that less-affluent populations may have particular needs, and we want to help hospitals treat those patients well and be successful."

The study was funded by the Commonwealth Fund. The authors reported no relevant financial conflicts of interest.