tag:blogger.com,1999:blog-377097382024-03-07T02:44:42.329-06:00Gardner's GateThe healthcare landscape from the viewpoint of a worker.Unknownnoreply@blogger.comBlogger157125tag:blogger.com,1999:blog-37709738.post-45463140770815626332011-10-03T10:36:00.000-05:002011-10-03T10:37:53.119-05:00Physicians File Suit to Prevent Washington State Plan that Classifies more than 700 diagnoses as “non-emergent” for Medicaid Patients<br />
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<span class="Apple-style-span" style="font-family: 'Times New Roman', serif;"><span class="Apple-style-span" style="background-color: #274e13; font-size: 15px;">Emergency physicians in Washington State today filed suit in the Superior Court of Washington for Thurston County against a state plan that would limit payment for Medicaid visits to three "non-emergency" visits to emergency departments each year and classify more than 700 diagnoses as "non-emergent," including chest pain, abdominal pain, miscarriage and breathing problems.</span></span></div>
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<span class="Apple-style-span" style="font-family: 'Times New Roman', serif;"><span class="Apple-style-span" style="background-color: #274e13; font-size: 15px;">The Washington Chapter of the American College of Emergency Physicians said the basis for the suit is multi-factorial and includes:</span></span></div>
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<span class="Apple-style-span" style="font-family: 'Times New Roman', serif;"><span class="Apple-style-span" style="background-color: #274e13; font-size: 15px;">*The state has not implemented a rule making process that included stakeholder comments; yet the plan is being forced on hospitals and providers with no warning.</span></span></div>
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<span class="Apple-style-span" style="font-family: 'Times New Roman', serif;"><span class="Apple-style-span" style="background-color: #274e13; font-size: 15px;">*The state has violated requirements that this be a collaborative process as outlined by the legislature.</span></span></div>
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<span class="Apple-style-span" style="font-family: 'Times New Roman', serif;"><span class="Apple-style-span" style="background-color: #274e13; font-size: 15px;">*The state has violated the requirements that this be a collaborative process as outlined by the legislature.</span></span></div>
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<span class="Apple-style-span" style="font-family: 'Times New Roman', serif;"><span class="Apple-style-span" style="background-color: #274e13; font-size: 15px;">*The state has misconstrued the ability to bill patients for services. Federal law prevents physicians from meeting Medicaid requirements for billing patients through EMTALA, and state law blocks hospitals from billing under charity requirements.</span></span></div>
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<span class="Apple-style-span" style="font-family: 'Times New Roman', serif;"><span class="Apple-style-span" style="background-color: #274e13; font-size: 15px;">*The state is violating the federal Prudent Layperson standard by applying it to managed care patients.</span></span></div>
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Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-37709738.post-35794027682481647942011-10-02T02:15:00.000-05:002011-10-02T02:15:22.048-05:00ACEP Sues Washington State over Proposed Medicaid Rules<span class="Apple-style-span" style="color: #333333; font-family: Arial, Helvetica, Geneva, sans-serif; font-size: 14px; line-height: 22px;"></span><br />
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Proposed List of "Non-Emergency" Diagnoses Includes Those with Symptoms of Serious Medical Conditions</h3>
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The American College of Emergency Physicians (ACEP) this week urged the Centers for Medicare & Medicaid (CMS) to reject a list of more than 700 diagnoses that Washington State will treat as “non-emergent” for Medicaid patients, effective October 1. The list includes the symptoms of serious medical conditions, including chest pain, shortness of breath, miscarriage and abdominal pain. <br style="border-bottom-width: 0px; border-color: initial; border-left-width: 0px; border-right-width: 0px; border-style: initial; border-top-width: 0px; font-family: inherit; font-size: 13px; font-style: inherit; font-weight: inherit; margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px; outline-color: initial; outline-style: initial; outline-width: 0px; padding-bottom: 0px; padding-left: 0px; padding-right: 0px; padding-top: 0px; vertical-align: baseline;" /><br style="border-bottom-width: 0px; border-color: initial; border-left-width: 0px; border-right-width: 0px; border-style: initial; border-top-width: 0px; font-family: inherit; font-size: 13px; font-style: inherit; font-weight: inherit; margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px; outline-color: initial; outline-style: initial; outline-width: 0px; padding-bottom: 0px; padding-left: 0px; padding-right: 0px; padding-top: 0px; vertical-align: baseline;" />The state’s plan will limit Medicaid patients to three non-emergency visits to the emergency department each year, putting the most vulnerable members of society — including children — at risk of serious harm. Physicians in the state have offered to work with state officials to come up with a list of truly non-emergent conditions. <br style="border-bottom-width: 0px; border-color: initial; border-left-width: 0px; border-right-width: 0px; border-style: initial; border-top-width: 0px; font-family: inherit; font-size: 13px; font-style: inherit; font-weight: inherit; margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px; outline-color: initial; outline-style: initial; outline-width: 0px; padding-bottom: 0px; padding-left: 0px; padding-right: 0px; padding-top: 0px; vertical-align: baseline;" /><br style="border-bottom-width: 0px; border-color: initial; border-left-width: 0px; border-right-width: 0px; border-style: initial; border-top-width: 0px; font-family: inherit; font-size: 13px; font-style: inherit; font-weight: inherit; margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px; outline-color: initial; outline-style: initial; outline-width: 0px; padding-bottom: 0px; padding-left: 0px; padding-right: 0px; padding-top: 0px; vertical-align: baseline;" />“The list of conditions was generated solely by state Medicaid office over the objections of physician and hospital task force representatives,” said Dr. Sandra Schneider, president of ACEP. “The use of discharge diagnoses instead of presenting symptoms/conditions is a clear violation of the prudent lay person standard required for Medicaid managed care organizations. With Washington State having close to 60 percent of its Medicaid population enrolled in managed care, how will the state comply with the law? Also, what implications does this have for the millions of people who will be added as Medicaid beneficiaries as part of health care reform?” <br style="border-bottom-width: 0px; border-color: initial; border-left-width: 0px; border-right-width: 0px; border-style: initial; border-top-width: 0px; font-family: inherit; font-size: 13px; font-style: inherit; font-weight: inherit; margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px; outline-color: initial; outline-style: initial; outline-width: 0px; padding-bottom: 0px; padding-left: 0px; padding-right: 0px; padding-top: 0px; vertical-align: baseline;" /><br style="border-bottom-width: 0px; border-color: initial; border-left-width: 0px; border-right-width: 0px; border-style: initial; border-top-width: 0px; font-family: inherit; font-size: 13px; font-style: inherit; font-weight: inherit; margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px; outline-color: initial; outline-style: initial; outline-width: 0px; padding-bottom: 0px; padding-left: 0px; padding-right: 0px; padding-top: 0px; vertical-align: baseline;" />Specifically, ACEP asked CMS to ensure that the Washington’s State Plan Amendment:</div>
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<li style="border-bottom-width: 0px; border-color: initial; border-left-width: 0px; border-right-width: 0px; border-style: initial; border-top-width: 0px; font-family: inherit; font-size: 13px; font-style: inherit; font-weight: inherit; margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px; outline-color: initial; outline-style: initial; outline-width: 0px; padding-bottom: 0px; padding-left: 0px; padding-right: 0px; padding-top: 0px; vertical-align: baseline;">Requires the state to ensure that patients who reach this status have access to viable primary care services before imposing this policy, and</li>
<li style="border-bottom-width: 0px; border-color: initial; border-left-width: 0px; border-right-width: 0px; border-style: initial; border-top-width: 0px; font-family: inherit; font-size: 13px; font-style: inherit; font-weight: inherit; margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px; outline-color: initial; outline-style: initial; outline-width: 0px; padding-bottom: 0px; padding-left: 0px; padding-right: 0px; padding-top: 0px; vertical-align: baseline;">Ensures the state does not apply this policy to managed care patients in violation of federal law.</li>
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“The symptoms of many of these medical conditions indicate life-threatening emergencies, and people with these symptoms should seek emergency care,” said Stephen Anderson, MD, president of Washington ACEP. “Not doing so could lead to severe illness, disability, and even death. Including conditions such as congestive heart failure, kidney stones, miscarriage, chest pain, and asthma is outrageous and dangerous.” <br style="border-bottom-width: 0px; border-color: initial; border-left-width: 0px; border-right-width: 0px; border-style: initial; border-top-width: 0px; font-family: inherit; font-size: 13px; font-style: inherit; font-weight: inherit; margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px; outline-color: initial; outline-style: initial; outline-width: 0px; padding-bottom: 0px; padding-left: 0px; padding-right: 0px; padding-top: 0px; vertical-align: baseline;" /><br style="border-bottom-width: 0px; border-color: initial; border-left-width: 0px; border-right-width: 0px; border-style: initial; border-top-width: 0px; font-family: inherit; font-size: 13px; font-style: inherit; font-weight: inherit; margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px; outline-color: initial; outline-style: initial; outline-width: 0px; padding-bottom: 0px; padding-left: 0px; padding-right: 0px; padding-top: 0px; vertical-align: baseline;" />The prudent layperson standard requires health plans to cover visits to emergency departments based on an average person‘s belief that he or she may be suffering a medical emergency due to the symptoms he or she is experiencing, not a final diagnosis. It is designed to protect patients who experience the symptoms of a medical emergency but who, after a medical examination and testing by a trained professional, are diagnosed with an acute care or non-emergent medical condition. <br style="border-bottom-width: 0px; border-color: initial; border-left-width: 0px; border-right-width: 0px; border-style: initial; border-top-width: 0px; font-family: inherit; font-size: 13px; font-style: inherit; font-weight: inherit; margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px; outline-color: initial; outline-style: initial; outline-width: 0px; padding-bottom: 0px; padding-left: 0px; padding-right: 0px; padding-top: 0px; vertical-align: baseline;" /><br style="border-bottom-width: 0px; border-color: initial; border-left-width: 0px; border-right-width: 0px; border-style: initial; border-top-width: 0px; font-family: inherit; font-size: 13px; font-style: inherit; font-weight: inherit; margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px; outline-color: initial; outline-style: initial; outline-width: 0px; padding-bottom: 0px; padding-left: 0px; padding-right: 0px; padding-top: 0px; vertical-align: baseline;" />“We understand the financial stress that states are under and we support efforts at the state and national level to link Medicaid beneficiaries to primary care practitioners, but those resources have to be available and accessible,” said Dr. Schneider. <br style="border-bottom-width: 0px; border-color: initial; border-left-width: 0px; border-right-width: 0px; border-style: initial; border-top-width: 0px; font-family: inherit; font-size: 13px; font-style: inherit; font-weight: inherit; margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px; outline-color: initial; outline-style: initial; outline-width: 0px; padding-bottom: 0px; padding-left: 0px; padding-right: 0px; padding-top: 0px; vertical-align: baseline;" /><br style="border-bottom-width: 0px; border-color: initial; border-left-width: 0px; border-right-width: 0px; border-style: initial; border-top-width: 0px; font-family: inherit; font-size: 13px; font-style: inherit; font-weight: inherit; margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px; outline-color: initial; outline-style: initial; outline-width: 0px; padding-bottom: 0px; padding-left: 0px; padding-right: 0px; padding-top: 0px; vertical-align: baseline;" />Dr. Schneider also said that hospital emergency departments are required by law to see patients, but then this state plan is requiring the services not to be paid. </div>
Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-37709738.post-80830414610694742982011-07-15T22:59:00.017-05:002011-07-15T23:10:45.900-05:00<br />
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<span style="font-family: Georgia;"><span class="Apple-style-span" style="color: white;">The American College of
Emergency Physicians sent a comment letter to Dr. Donald Berwick, Administrator
of the Centers for Medicare and Medicaid Services in response to the draft
Accountable Care Organization regulations published Spring 2011. The ACEP comment
</span></span><a href="http://www.acep.org/regulatory/"><span style="font-family: Georgia;"><span class="Apple-style-span" style="color: white;">letter</span></span></a><b><span style="font-family: Georgia;"><span class="Apple-style-span" style="color: white;">
</span></span></b><span style="font-family: Georgia;"><span class="Apple-style-span" style="color: white;">lists a series
of concerns regarding structure, governance, start-up costs and risk sharing
that would make physician-based ACOs inaccessible except to large, well-capitalized
multi-specialty practices.
Further, EM practices that cover large geographic areas could possibly
trigger an expensive and resource consumptive Federal Trade Commission review
as a result of the anti-trust requirements created by the new regulations. If the final regulation is not changed
significantly, the pool of applicants may be quite small. </span><b><span class="Apple-style-span" style="color: white;"><o:p></o:p></span></b></span></div>
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The letter in its entirety is posted below:<br />
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<span class="Apple-style-span" style="font-size: small;">December 2, 2010</span></div>
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<span class="Apple-style-span" style="font-size: small;">Donald M. Berwick, MD, MPP, FRCP </span></div>
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<span class="Apple-style-span" style="font-size: small;">Administrator, Centers for Medicare & Medicaid Services Department of Health and Human Services 445-G, Hubert H. Humphrey Building 200 Independence Avenue, </span></div>
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<span class="Apple-style-span" style="font-size: small;">SW Washington, DC 20201</span></div>
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<b><span class="Apple-style-span" style="font-size: small;">Attention: CMS-1345-NC Re: Policies and Standards for ACOs Participating with the Medicare Program</span></b></div>
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<span class="Apple-style-span" style="font-size: small;">Dear Dr. Berwick:</span></div>
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<span class="Apple-style-span" style="font-size: small;">On behalf of the American College of Emergency Physicians’ (ACEP) more than 29,000 members and the Emergency Department Practice Management Association (EDPMA) and its 83 affiliated member organizations, we appreciate the opportunity to submit preliminary comments regarding aspects of policies and standards for Accountable Care Organization (ACO) design and development.</span></div>
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<span class="Apple-style-span" style="font-size: small;">CMS has provided various background documents and public forums over the past few months in preparation for implementing Sec. 3021 and 3022 of PPACA. The vision for primary care physicians and/or hospital-based systems developing ACOs has been well-outlined. However, any description of expectations of the roles for emergency care physicians (and other hospital- based specialists) has not been addressed. We are concerned that once ACOs, medical homes, and expanded coverage are implemented, many policy makers expect emergency visits to all but disappear. While the health reform law will greatly expand insurance coverage starting in 2014, the volume of emergency visits is showing no signs of diminishing. In states like Massachusetts where 97 percent of the population has coverage, emergency department visits continue to grow.</span></div>
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<span class="Apple-style-span" style="font-size: small;">According to the HHS’ Centers for Disease Control and Prevention, emergency visits in 2008 grew to 124 million, the highest level ever reported, and the number of uninsured recently reported by CDC has now reached 50 million, which will undoubtedly add to the volume of already crowded emergency departments. In addition, we predict that when the estimated 16 million individuals are added to Medicaid, the volume of emergency department visits will rise again as the supply and willingness of physicians in the community to add more low paying Medicaid patients to their practices falls short of demand.</span><span style="font: normal normal normal 12px/normal 'Times New Roman';"><span class="Apple-style-span" style="font-size: small;">ACEP/EDPMA Response to ACO Questions December 2, 2010 Page 2</span></span></div>
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<span class="Apple-style-span" style="font-size: small;">We believe there is a significant, and often overlooked, role for emergency physicians in new delivery system models that will greatly contribute to improvements in quality and coordination of patient care.</span></div>
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<span class="Apple-style-span" style="font-size: small;">We have selected three of the seven questions posed in the November 17</span><span style="font: normal normal normal 7px/normal 'Times New Roman';"><span class="Apple-style-span" style="font-size: small;">th </span></span><span class="Apple-style-span" style="font-size: small;">Federal Register notice for response today. We will have more extensive reactions and recommendations when the draft regulation is released for comment.</span></div>
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<span style="font: normal normal normal 12px/normal 'Times New Roman';"><span class="Apple-style-span" style="font-size: small;">•</span><span class="Apple-tab-span" style="white-space: pre;"><span class="Apple-style-span" style="font-size: small;"> </span></span></span><i><span class="Apple-style-span" style="font-size: small;">What policies or standards should we consider adopting to ensure that groups of solo and small practice providers have the opportunity to actively participate in the Medicare Shared Savings Program and the ACO models tested by CMMI</span></i><span style="font: normal normal normal 12px/normal 'Times New Roman';"><i><span class="Apple-style-span" style="font-size: small;">?</span></i></span></div>
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<span class="Apple-style-span" style="font-size: small;">We urge CMS, FTC, and OIG to strongly consider concerns on the structure and the need to remove certain legal barriers that have been articulated to CMS by the American Medical Association, American Hospital Association, the Federation, and other provider groups.</span></div>
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<span class="Apple-style-span" style="font-size: small;">With regard to the question above, we believe that practice size is not the only factor that CMS needs to consider in planning shared savings models. Approximately one-third of emergency physicians are hospital employees while the majority are members of practice groups of varying sizes that contract with hospitals to provide 24/7 coverage of their emergency departments.</span></div>
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<span class="Apple-style-span" style="font-size: small;">Fifty percent of Medicare admissions come through the emergency department and the majority of those have time-sensitive conditions. Our members play a critically important role coordinating care at the front end of an episode, i.e. they conduct a medical screening examination and assess the patient’s need to be either admitted, treated and discharged, or kept in observation for several hours before a final disposition decision is made. Approximately 25 percent of US hospitals have dedicated observation units and they are generally directed by emergency physicians.</span><span class="Apple-tab-span" style="white-space: pre;"><span class="Apple-style-span" style="font-size: small;"> </span></span><span class="Apple-style-span" style="font-size: small;">If the patient requires inpatient care, the emergency physician contacts the patient’s treating physician – primary care and/or specialty – who actually admits the patient. If the patient has no physician, the decision goes to the hospitalist or other hospital medical staff member. At the end of the inpatient stay, many patients are discharged into the community or to post acute care settings with little or no coordinated follow up. And, some of these individuals return to the emergency department when their conditions worsen and they don’t know where else to go.</span></div>
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<span class="Apple-style-span" style="font-size: small;">This is an area where emergency physicians can improve transitions between sites of care, particularly when a patient comes back to the emergency department and is re-admitted within 30 days of discharge. As electronic health records continue to expand to link community-based physicians with the emergency department and other health care providers, emergency physicians will be able to play a more integral and expanded role in care coordination. Payment policies for specialty groups like emergency physicians who have little control over who comes to the emergency department should evolve over time as the ACO infrastructure improves and participating physicians can undertake joint risk sharing.</span></div>
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<span class="Apple-style-span" style="font-size: small;">•</span><span class="Apple-tab-span" style="white-space: pre;"><span class="Apple-style-span" style="font-size: small;"> </span></span><i><span class="Apple-style-span" style="font-size: small;">The Affordable Care Act requires us to develop patient-centeredness criteria for assessment of ACOs participating in the Medicare Shared Savings Program. What aspects of patient-centeredness are particularly important for us to consider and how should we evaluate them?</span></i></div>
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<span class="Apple-style-span" style="font-size: small;">ACEP/EDPMA Response to ACO Questions December 2, 2010 Page 3</span></div>
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<span class="Apple-style-span" style="font-size: small;">We believe that collaborative patient education is the most effective tool to improving quality and patient satisfaction. ACEP has long provided public education regarding when an individual should come to the emergency department, based on the now universal ‘prudent lay person standard’ that is based on the individual’s belief that he/she may have a medical emergency. Appropriate use of the emergency department requires much more than communication between the emergency physician and the patient.</span><span class="Apple-tab-span" style="white-space: pre;"><span class="Apple-style-span" style="font-size: small;"> </span></span></div>
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<span class="Apple-tab-span" style="white-space: pre;"><span class="Apple-style-span" style="font-size: small;"></span></span><span class="Apple-style-span" style="font-size: small;">It starts with the patient’s primary care provider, who is often the one who tells the patient to go </span></div>
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<span class="Apple-style-span" style="font-size: small;">directly from home to the emergency department for tests, especially on nights and weekends.</span></div>
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<span class="Apple-style-span" style="font-size: small;">The ACO should provide a framework to engage all the physicians in coordinating the patient’s care and keeping the patient informed about what types of services are actually needed at the most appropriate site for that care. We envision that inclusion of collaborative clinical decisions can reduce the number of diagnostic images and foster greater consideration of alternatives to inpatient care. Patient understanding and satisfaction should improve along with the quality, safety and efficiency. A team approach is especially important for Medicare patients with chronic conditions.</span></div>
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<span class="Apple-style-span" style="font-size: small;">Again, real time exchange between providers will require extensive investments in health information technology (IT) infrastructure to facilitate coordination using EHRs and other technology. We urge CMS to reassess the EHR incentive program as policies and standards continue to be established and the current state of health IT adoption and functionality evolves. At the same time, HCAHPS and/or other instruments can be refined to measure patient understanding and satisfaction with their overall care.</span></div>
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<span class="Apple-style-span" style="font-size: small;">We also note that emphasis on physicians providing more extensive education, coordination, and collaboration through participation in ACOs may result in higher costs for physician services, while reducing costs of inpatient and post acute care. The current payment silos must be adjusted to recognize overall system savings so physicians are not penalized.</span></div>
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<span class="Apple-style-span" style="font-size: small;">•</span><span class="Apple-tab-span" style="white-space: pre;"><span class="Apple-style-span" style="font-size: small;"> </span></span><i><span class="Apple-style-span" style="font-size: small;">In order for an ACO to share in savings under the Medicare Shared Savings Program, it must meet a quality performance standard determined by the Secretary. What quality measures should the Secretary use to determine performance in the Shared Savings Program?</span></i></div>
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<span class="Apple-style-span" style="font-size: small;">The most important aspect of performance measurement for nascent ACOs is to begin with existing measures endorsed by a consensus based entity (e.g., National Quality Forum) and work with consensus groups and private payers to further standardize measures and metrics. Most physicians and other providers are responding to myriad “quality” measures, and new, ACO-specific measures make no sense at this point.</span></div>
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<span class="Apple-style-span" style="font-size: small;">The majority of physician groups are now participating in PQRI/PQRS including emergency physicians who were early adopters, so PQRI/PQRS measures are the best source of measures for the foreseeable future. As CMS and ACOs glean experience with these new delivery models, more outcome measures should be added, while some of the more process- oriented measures should be retired.</span></div>
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<span class="Apple-style-span" style="font-size: small;">We also recommend that as the experience is gained, measures that reduce emergency department overcrowding be considered, as well as measures encouraging communication</span></div>
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<span class="Apple-style-span" style="font-size: small;">ACEP/EDPMA Response to ACO Questions December 2, 2010 Page 4</span></div>
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<span class="Apple-style-span" style="font-size: small;">between hospital physicians and primary care physicians and coordination of emergency department transitions so that a loop of continuous care is created to diminish morbidity and mortality at critical transition point</span><span class="Apple-style-span" style="font-size: small;">s.</span></div>
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<span class="Apple-style-span" style="font-size: small;">We look forward to working with CMS and other physician and hospital groups to share research and clinical guidelines that can be integrated into larger bundles of care. If you have any questions about our comments, please contact Barbara Tomar, ACEP’s Federal Affairs Director at (202) 728-0610, ext. 3017.</span></div>
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<span class="Apple-style-span" style="font-size: small;">Sincerely,</span></div>
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<span class="Apple-style-span" style="font-size: small;">Sandra H. Schneider, MD, FACEP</span><span class="Apple-tab-span" style="white-space: pre;"><span class="Apple-style-span" style="font-size: small;"> </span></span><span class="Apple-style-span" style="font-size: small;">Randy Pilgrim, MD, FACEP President, ACEP</span><span class="Apple-tab-span" style="white-space: pre;"><span class="Apple-style-span" style="font-size: small;"> </span></span><span class="Apple-style-span" style="font-size: small;">Chairman, Board of Directors, EDPMA</span></div>
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Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-37709738.post-89118494309641389712011-04-07T11:24:00.000-05:002011-04-07T11:24:57.708-05:00American College of Emergency Physicians Announces Leadership Nominations<!--StartFragment--> <br />
<div class="MsoNormal">Today the Board of Directors of the American College of Emergency Physicians released the slate of candidates seeking elected leadership positions in 2012.</div><div class="MsoNormal"><br />
</div><div class="MsoNormal"><b style="mso-bidi-font-weight: normal;"><u>President-elect<o:p></o:p></u></b></div><div class="MsoNormal"><br />
</div><div class="MsoNormal">Dr. Alexander Rosenau</div><div class="MsoNormal">Dr. Andrew Sama</div><div class="MsoNormal">Dr. Robert Solomon</div><div class="MsoNormal"><br />
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</div><div class="MsoNormal">Dr. Marco Coppola</div><div class="MsoNormal"><br />
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</div><div class="MsoNormal">Dr. James Cusick</div><div class="MsoNormal">Dr. Kevin Klauer</div><div class="MsoNormal">Dr. William Meeks</div><div class="MsoNormal"><br />
</div><div class="MsoNormal"><b style="mso-bidi-font-weight: normal;"><u>Board of Directors<o:p></o:p></u></b></div><div class="MsoNormal"><br />
</div><div class="MsoNormal">Dr. Michael Gerardi (Incumbent)</div><div class="MsoNormal">Dr. Hans House</div><div class="MsoNormal">Dr. William Jaquis</div><div class="MsoNormal">Dr. David John</div><div class="MsoNormal">Dr. Mark Mackey</div><div class="MsoNormal">Dr. David Mendelson</div><div class="MsoNormal">Dr. John Rogers</div><div class="MsoNormal"><br />
</div><div class="MsoNormal">Elections will be held during the annual Council Meeting in San Francisco in October. </div><!--EndFragment-->Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-37709738.post-36171866982412835992011-03-20T21:57:00.000-05:002011-03-20T21:57:34.950-05:00Off The GridI'll be off the grid for the next ten days. See on April Fool's Day!Unknownnoreply@blogger.com1tag:blogger.com,1999:blog-37709738.post-57622188231199446782011-03-17T23:07:00.002-05:002011-03-17T23:09:30.748-05:00Americans Living Longer<span class="Apple-style-span" style="font-family: Arial, sans-serif; font-size: 13px;"><span class="Apple-style-span" style="background-color: #38761d;"><span class="Apple-style-span" style="color: white;">Life expectancy in the United States has reached an all-time high. An individual born in 2009 has a life expectancy of 78 years, according to a preliminary CDC report. The death rate has declined for the 10th year in a row and infant mortality is expected to reach a new low, as well. Deaths from all causes declined proportionately, making it difficulty to distinguish a single explanation for decrease. The gender difference in lifespan persists, with the overall male life expectancy at around 75.5 and the overall female life expectancy at about 80.5.</span></span></span><br />
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</span></span>Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-37709738.post-88247366983577249562011-02-16T09:50:00.000-06:002011-02-16T09:50:33.904-06:00President Obama Launches Medical Malpractice Reform Proposal<!--StartFragment--> <br />
<div class="MsoNormal"><span style="font-family: Georgia;">President Obama’s budget, discussed at a press conference yesterday, launches a new presidential focus on professional liability laws as they apply to medicine.<span style="mso-spacerun: yes;"> </span>He intends to revamp state medical malpractice laws and curb the practice of so-called “defensive medicine.”<span style="mso-spacerun: yes;"> </span>The budget specifically calls for $250 million in Justice Department grants to help states rewrite malpractice laws that are consistent with the recommendations made by the bipartisan debt reduction commission last year.<span style="mso-spacerun: yes;"> </span>Health and Human Services Secretary Kathleen Sebelius told the Senate Finance Committee yesterday that her agency would advise the Justice Department on grant awards.<span style="mso-spacerun: yes;"> </span><o:p></o:p></span></div><div class="MsoNormal"><br />
</div><div class="MsoNormal"><span style="font-family: Georgia;">The president’s proposals for professional liability reform include:<o:p></o:p></span></div><div class="MsoNormal"><br />
</div><div class="MsoNormal"></div><ul><li><span class="Apple-style-span" style="font-family: Georgia;">Establishing health courts to deal with medical liability cases.</span><span class="Apple-style-span" style="font-family: Georgia;"><span style="mso-spacerun: yes;"> </span></span><span class="Apple-style-span" style="font-family: Georgia;">Health courts would use specially trained judges instead of juries to decide medical malpractice cases.</span><span class="Apple-style-span" style="font-family: Georgia;"><span style="mso-spacerun: yes;"> </span></span><span class="Apple-style-span" style="font-family: Georgia;">Awards would be made according to a set schedule.</span></li>
<li><span class="Apple-style-span" style="font-family: Georgia;">Creating a “safe harbor” for physicians who adhere to guidelines for best clinical practices.</span><span class="Apple-style-span" style="font-family: Georgia;"> </span></li>
<li><span class="Apple-style-span" style="font-family: Georgia;">Creating some protections for physicians who demonstrate acceptable use of an electronic medical record.</span><span class="Apple-style-span" style="font-family: Georgia;"> </span></li>
<li><span class="Apple-style-span" style="font-family: Georgia;">Providing protections for hospitals and physicians that employ early apology and compensation for medical errors.</span></li>
<li><span class="Apple-style-span" style="font-family: Georgia;">Changing proportionate share laws such that instead of each defendant being held liable for the entire amount of an award in a malpractice suit, each defendant is liable for a percentage proportionate to the responsibility for the harm.</span><span class="Apple-style-span" style="font-family: Georgia;"><span style="mso-spacerun: yes;"> </span></span><span class="Apple-style-span" style="font-family: Georgia;"> </span></li>
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<div class="MsoNormal"><span style="font-family: Georgia;">NOT covered in the president’s proposal is a cap on jury awards.<span style="mso-spacerun: yes;"> </span>President Obama has long said that he would not entertain caps as a solution to the professional liability insurance crisis, but has said that he would entertain other options as outlined in his proposal.<o:p></o:p></span></div><div class="MsoNormal"><br />
</div><div class="MsoNormal"><span style="font-family: Georgia;">President Obama’s debt reduction commission estimates that implementation of the recommendations could save government programs $17 billion by 2020.<span style="mso-spacerun: yes;"> </span>Although the cost of defensive medicine is widely debated, conservative estimates start at around $50 billion per year.<span style="mso-spacerun: yes;"> </span>The president’s budget does not include any actual savings from the new proposal.<span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span><o:p></o:p></span></div><div class="MsoNormal"><br />
</div><!--EndFragment-->Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-37709738.post-72126601834102585262011-01-27T11:31:00.000-06:002011-01-27T11:31:07.558-06:00The Future of Emergency Medicine SummitLeaders from the major organizations in emergency medicine are meeting to discuss the needs of emergency patients both now and in the future. Major areas of discussion include workforce, access to care, the daily practice of emergency medicine, and the value of emergency medicine in the emerging era of healthcare reform, with discussion of emergency medicine's role in the formation of accountable care organizations. <br />
<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiwFIXCACqF-e252M2ufFMe-hyi0eugPEP0AP0mGoVANXIEXhyphenhyphenhG8QLjfBrWygSYF9PDtxH8ClkwbZte9CBG_KKopgz3kEP2zQr7tpQabDsSJt8QdUrWtOjg5-1YdRhamx79zBj/s1600/ACEP_EM_Summit_01+27+11.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="145" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiwFIXCACqF-e252M2ufFMe-hyi0eugPEP0AP0mGoVANXIEXhyphenhyphenhG8QLjfBrWygSYF9PDtxH8ClkwbZte9CBG_KKopgz3kEP2zQr7tpQabDsSJt8QdUrWtOjg5-1YdRhamx79zBj/s320/ACEP_EM_Summit_01+27+11.jpg" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Future of EM Summit 2011</td></tr>
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Participants in the conference include:<br />
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</span></div><div class="MsoNormal"><span class="Apple-style-span" style="font-family: 'Courier New', Courier, monospace;">James G. Adams, MD, FACEP (AACEM)<o:p></o:p></span></div><div class="MsoNormal"><span class="Apple-style-span" style="font-family: 'Courier New', Courier, monospace;">Dennis M. Beck, MD, FACEP (ACEP)<o:p></o:p></span></div><div class="MsoNormal"><span class="Apple-style-span" style="font-family: 'Courier New', Courier, monospace;">Howard Blumstein, MD (AAEM)<o:p></o:p></span></div><div class="MsoNormal"><span class="Apple-style-span" style="font-family: 'Courier New', Courier, monospace;">Marilyn Bromley, RN (ACEP)<o:p></o:p></span></div><div class="MsoNormal"><span class="Apple-style-span" style="font-family: 'Courier New', Courier, monospace;">Michele Byers, CAE (EMRA)<o:p></o:p></span></div><div class="MsoNormal"><span class="Apple-style-span" style="font-family: 'Courier New', Courier, monospace;">Steven H. Bowman, MD, FACEP (CORD)<o:p></o:p></span></div><div class="MsoNormal"><span class="Apple-style-span" style="font-family: 'Courier New', Courier, monospace;">Thomas Brabson, DO, FACOEP (ACOEP)<o:p></o:p></span></div><div class="MsoNormal"><span class="Apple-style-span" style="font-family: 'Courier New', Courier, monospace;">Gregory Christiansen, DO (ACOEP)<o:p></o:p></span></div><div class="MsoNormal"><span class="Apple-style-span" style="font-family: 'Courier New', Courier, monospace;">Theodore A. Christopher, MD, FACEP (AACEM)<o:p></o:p></span></div><div class="MsoNormal"><span class="Apple-style-span" style="font-family: 'Courier New', Courier, monospace;">Tammy Crowley (ACEP)<o:p></o:p></span></div><div class="MsoNormal"><span class="Apple-style-span" style="font-family: 'Courier New', Courier, monospace;">Nathan Deal, MD (EMRA)<o:p></o:p></span></div><div class="MsoNormal"><span class="Apple-style-span" style="font-family: 'Courier New', Courier, monospace;">Angela F. Gardner, MD, FACEP (ACEP)<o:p></o:p></span></div><div class="MsoNormal"><span class="Apple-style-span" style="font-family: 'Courier New', Courier, monospace;">Marjorie Geist, RN, PhD, CAE (ACEP)<o:p></o:p></span></div><div class="MsoNormal"><span class="Apple-style-span" style="font-family: 'Courier New', Courier, monospace;">John Graykoski, PA-C, MPAS (SEMPA)<o:p></o:p></span></div><div class="MsoNormal"><span class="Apple-style-span" style="font-family: 'Courier New', Courier, monospace;">Robert Heard, MBA, CAE (ACEP)<o:p></o:p></span></div><div class="MsoNormal"><span class="Apple-style-span" style="font-family: 'Courier New', Courier, monospace;">Cherri D. Hobgood, MD, FACEP (SAEM)</span><o:p></o:p></div><div class="MsoNormal"><span class="Apple-style-span" style="font-family: 'Courier New', Courier, monospace;">Michelle Hoppes, RN, MS, AHRMQR, DFASHRM (ASHRM)<o:p></o:p></span></div><div class="MsoNormal"><span class="Apple-style-span" style="font-family: 'Courier New', Courier, monospace;">Hans R. House, MD, FACEP (ACEP)<o:p></o:p></span></div><div class="MsoNormal"><span class="Apple-style-span" style="font-family: 'Courier New', Courier, monospace;">Nicholas J. Jouriles, MD, FACEP (ACEP)<o:p></o:p></span></div><div class="MsoNormal"><span class="Apple-style-span" style="font-family: 'Courier New', Courier, monospace;">Douglas F. Kupas, MD, FACEP (SAEM)<o:p></o:p></span></div><div class="MsoNormal"><span class="Apple-style-span" style="font-family: 'Courier New', Courier, monospace;">Douglas L. McGee, DO, FACEP (CORD)<o:p></o:p></span></div><div class="MsoNormal"><span class="Apple-style-span" style="font-family: 'Courier New', Courier, monospace;">Robert McCurren, MD, FACEP (EDPMA)<o:p></o:p></span></div><div class="MsoNormal"><span class="Apple-style-span" style="font-family: 'Courier New', Courier, monospace;">Mark Mitchell, DO, FACOEP (ACOEP)<o:p></o:p></span></div><div class="MsoNormal"><span class="Apple-style-span" style="font-family: 'Courier New', Courier, monospace;">Dighton Packard, MD, FACEP (EDPMA)<o:p></o:p></span></div><div class="MsoNormal"><span class="Apple-style-span" style="font-family: 'Courier New', Courier, monospace;">AnnMarie Papa, DNP, RN, CEN, NE-BC, FAEN (ENA)<o:p></o:p></span></div><div class="MsoNormal"><span class="Apple-style-span" style="font-family: 'Courier New', Courier, monospace;">Michelle Parker (SEMPA)<o:p></o:p></span></div><div class="MsoNormal"><span class="Apple-style-span" style="font-family: 'Courier New', Courier, monospace;">Randy Pilgrim, MD, FACEP (EDPMA)<o:p></o:p></span></div><div class="MsoNormal"><span class="Apple-style-span" style="font-family: 'Courier New', Courier, monospace;">John J. Rogers, MD, FACEP (ACEP)<o:p></o:p></span></div><div class="MsoNormal"><span class="Apple-style-span" style="font-family: 'Courier New', Courier, monospace;">Sandra Schneider, MD, FACEP (Chair of Summit, ACEP)<o:p></o:p></span></div><div class="MsoNormal"><span class="Apple-style-span" style="font-family: 'Courier New', Courier, monospace;">Donald Stader, MD (EMRA)<o:p></o:p></span></div><div class="MsoNormal"><span class="Apple-style-span" style="font-family: 'Courier New', Courier, monospace;">Cary J. Stratford, PA-C, DFAAPA (SEMPA)<o:p></o:p></span></div><div class="MsoNormal"><span class="Apple-style-span" style="font-family: 'Courier New', Courier, monospace;">Jim Tarrant, CAE (SAEM)</span><o:p></o:p></div><div class="MsoNormal"><span class="Apple-style-span" style="font-family: 'Courier New', Courier, monospace;">Harold A. Thomas, MD, FACEP (Observer only)<o:p></o:p></span></div><div class="MsoNormal"><span class="Apple-style-span" style="font-family: 'Courier New', Courier, monospace;">Jill Walsh, DNP, RN, CEN (ENA)<o:p></o:p></span></div><div class="MsoNormal"><span class="Apple-style-span" style="font-family: 'Courier New', Courier, monospace;">Dean Wilkerson, JD, MBA, CAE (ACEP)<o:p></o:p></span></div><div class="MsoNormal"><span class="Apple-style-span" style="font-family: 'Courier New', Courier, monospace;">Joseph Wood, MD, FACEP (AAEM)<o:p></o:p></span></div><div class="MsoNormal"><span class="Apple-style-span" style="font-family: 'Courier New', Courier, monospace;"><br />
</span></div><div class="MsoNormal"><span class="Apple-style-span" style="font-family: inherit;">Led by Dr. Sandra Schneider, ACEP President, the group will produce a document detailing both the discussions and recommendations in the near future. </span></div><div class="MsoNormal"><span style="font-family: Ayuthaya;"><br />
</span></div><div class="MsoNormal"><span class="Apple-style-span" style="font-family: Ayuthaya;"><br />
</span></div><!--EndFragment-->Unknownnoreply@blogger.com2tag:blogger.com,1999:blog-37709738.post-44633468568716431612010-12-24T15:18:00.000-06:002010-12-24T15:18:27.532-06:00Top 10 Doctor MoviesOne of my social media buddies recently challenged me to share my "Top 10 Emergency Doctor Movies." Although I could not rattle off ten movies that have an emergency doc as the main character, I did come up with 10 of my favorite doctor movies. My favorite "doctor movie" is based on the true story of an emergency doc in a busy urban ED who could not get a specialist to take care of a critical patient. (Sound familiar? It's a way of life for many of my colleagues.) The movie stars Joe Mantagne, and depicts the choices that face emergency physicians every day - choices made without enough information and without a crystal ball. <br />
<br />
Here is my list:<br />
<br />
<!--StartFragment--> <br />
<div class="MsoNormal"><span style="font-family: "Apple Casual";">1.<span style="mso-spacerun: yes;"> </span>State of Emergency<o:p></o:p></span></div><div class="MsoNormal"><span style="font-family: "Apple Casual";"><span style="mso-tab-count: 1;"> </span>1994 (Joe Mantegna)<o:p></o:p></span></div><div class="MsoNormal"><br />
</div><div class="MsoNormal"><span style="font-family: "Apple Casual";">2.<span style="mso-spacerun: yes;"> </span>M*A*S*H*<o:p></o:p></span></div><div class="MsoNormal"><span style="font-family: "Apple Casual";"><span style="mso-tab-count: 1;"> </span>1970<o:p></o:p></span></div><div class="MsoNormal"><br />
</div><div class="MsoNormal"><span style="font-family: "Apple Casual";">3.<span style="mso-spacerun: yes;"> </span>The Elephant Man<o:p></o:p></span></div><div class="MsoNormal"><span style="font-family: "Apple Casual";"><span style="mso-tab-count: 1;"> </span>1980<o:p></o:p></span></div><div class="MsoNormal"><br />
</div><div class="MsoNormal"><span style="font-family: "Apple Casual";">4.<span style="mso-spacerun: yes;"> </span>Beyond Borders<o:p></o:p></span></div><div class="MsoNormal"><span style="font-family: "Apple Casual";"><span style="mso-tab-count: 1;"> </span>2003<o:p></o:p></span></div><div class="MsoNormal"><br />
</div><div class="MsoNormal"><span style="font-family: "Apple Casual";">5.<span style="mso-spacerun: yes;"> </span>Guess Who’s Coming to Dinner<o:p></o:p></span></div><div class="MsoNormal"><span style="font-family: "Apple Casual";"><span style="mso-tab-count: 1;"> </span>1967<o:p></o:p></span></div><div class="MsoNormal"><br />
</div><div class="MsoNormal"><span style="font-family: "Apple Casual";">6.<span style="mso-spacerun: yes;"> </span>And The Band Played On<o:p></o:p></span></div><div class="MsoNormal"><span style="font-family: "Apple Casual";"><span style="mso-tab-count: 1;"> </span>1993 <o:p></o:p></span></div><div class="MsoNormal"><br />
</div><div class="MsoNormal"><span style="font-family: "Apple Casual";">7.<span style="mso-spacerun: yes;"> </span>Spellbound<o:p></o:p></span></div><div class="MsoNormal"><span style="font-family: "Apple Casual";"><span style="mso-tab-count: 1;"> </span>1945<o:p></o:p></span></div><div class="MsoNormal"><br />
</div><div class="MsoNormal"><span style="font-family: "Apple Casual";">8.<span style="mso-spacerun: yes;"> </span>Miss Evers’ Boys<o:p></o:p></span></div><div class="MsoNormal"><span style="font-family: "Apple Casual";"><span style="mso-tab-count: 1;"> </span>1997<o:p></o:p></span></div><div class="MsoNormal"><br />
</div><div class="MsoNormal"><span style="font-family: "Apple Casual";">9.<span style="mso-spacerun: yes;"> </span>Flatliners<o:p></o:p></span></div><div class="MsoNormal"><span style="font-family: "Apple Casual";"><span style="mso-tab-count: 1;"> </span>1990<o:p></o:p></span></div><div class="MsoNormal"><br />
</div><div class="MsoNormal"><span style="font-family: "Apple Casual";">10.<span style="mso-spacerun: yes;"> </span>The Hospital <o:p></o:p></span></div><div class="MsoNormal"><span style="font-family: "Apple Casual";"><span style="mso-tab-count: 1;"> </span>1971<o:p></o:p></span></div><div class="MsoNormal"><br />
</div><div class="MsoNormal"><span style="font-family: "Apple Casual";"><span style="mso-spacerun: yes;"><br />
</span></span></div><div class="MsoNormal"><span style="font-family: "Apple Casual";"><span style="mso-spacerun: yes;">Honorable mention: </span>What About Bob? (1991)</span></div><div class="MsoNormal"><span style="font-family: "Apple Casual";"><br />
</span></div><div class="MsoNormal"><span class="Apple-style-span" style="font-family: 'Apple Casual';">A parting thought: As one of a generation of emergency doctors who grew up with Hawkeye Pierce for a hero, let me say that he COULD have been an ER doc, but was created one war too early.</span></div><div class="MsoNormal"><span class="Apple-style-span" style="font-family: 'Apple Casual';"><br />
</span></div><div class="MsoNormal"><span class="Apple-style-span" style="font-family: 'Apple Casual';">Happy Holidays to all!</span></div><div class="MsoNormal"><span style="font-family: "Apple Casual";"><br />
</span></div><div class="MsoNormal"><br />
</div><!--EndFragment-->Unknownnoreply@blogger.com1tag:blogger.com,1999:blog-37709738.post-17240175839220112612010-12-09T06:50:00.000-06:002010-12-09T06:50:42.334-06:00Independent Contractor Status At Risk For Emergency Physicians<span class="Apple-style-span" style="font-family: Arial; font-size: 13px;"></span><br />
As Congress tries to complete work for the year, several bills are being considered and funding must be found to offset their costs. The Senate is considering a menu of funding mechanisms that could be used to pay for the legislation under consideration. One source of offset funding under consideration is The Fair Playing Field Act of 2010. Currently, the law allows businesses a safe harbor to treat workers as independent contractors for employment tax purposes if the company has had a reasonable basis for such treatment and has consistently treated such employees as independent contractors by reporting their compensation on Form 1099s. <br />
<br />
As proposed, The Fair Playing Field Act would require the Treasury Secretary to issue regulations or other prospective guidance clarifying the employment status of individuals for federal employment tax purposes. It specifically allow the Internal Revenue Service the ability to individually question independent contractor status. <br />
<br />
<b>How would this impact the delivery of Emergency Care?</b><br />
<b><br />
</b><br />
If enacted, this provision could have a negative impact on the delivery of emergency care by harming the ability of independent contractor emergency physicians to provide much-needed staffing of emergency departments throughout the country. Restricting the ability of hospitals to staff their emergency departments using emergency physician independent contractors could have dire results for patients' access to lifesaving emergency care. <br />
<br />
<br />
<strong>ACEP's Message:</strong><br />
<strong>Please contact your U.S. Senators and urge them not to attach The Fair Playing Field Act to any other bill during the lame duck period and/or use its provisions as an offset to legislation under consideration.</strong><br />
<br />
Thank you for your prompt action.<br />
<br />
Questions: Contact Brad Gruehn in the ACEP Washington DC office.Unknownnoreply@blogger.com1tag:blogger.com,1999:blog-37709738.post-4923171527313051852010-12-07T05:32:00.000-06:002010-12-07T05:32:14.731-06:00The Joint Commission Reveals New Areas of Field Review and More...<div style="font: normal normal normal 9px/normal 'Arial Black'; margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px;"><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;">The Joint Commission has several areas that are currently in the process of field review:</span><br />
<br />
<ul><li><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;">Proposed National Patient Safety Goals addressing ventilator-associated pneumonia (VAP) and catheter-associated urinary tract infections (CAUTI).</span></li>
<ul><li><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;">Start Date: December 2, 2010</span></li>
<li><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;">End Date: January 27, 2011</span></li>
</ul><li><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;">Proposed revisions to credentialing and privileging requirements for the Long Term Care accreditation program</span></li>
<ul><li><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;">Start Date: December 2, 2010</span></li>
<li><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;">End Date: January 17, 2011</span></li>
</ul><li><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;">Proposed requirements for advanced heart failure certification</span></li>
<ul><li><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;">Start Date: November 3, 2010</span></li>
<li><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif; font-size: 9.25926px;">End Date: December 15, 2011</span></li>
</ul></ul><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;">To participate in any current field reviews, visit the Joint Commission Web site at <a href="http://www.jointcommission.org/Standards/FieldReviews.">http://www.jointcommission.org/Standards/FieldReviews.</a></span></div><div style="font: normal normal normal 9px/normal 'Arial Black'; margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px;"><br />
</div><div style="font: normal normal normal 9px/normal 'Arial Black'; margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px;"><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;">The Joint Commission also has the following areas currently in development:</span></div><div style="font: normal normal normal 9px/normal 'Arial Black'; margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px;"><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;"><br />
</span></div><div style="font: normal normal normal 9px/normal 'Arial Black'; margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px;"><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;">STANDARDS AND GOALS</span></div><div style="font: normal normal normal 9px/normal 'Arial Black'; margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px;"><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;"><br />
</span></div><div style="font: normal normal normal 9px/normal 'Arial Black'; margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px;"><ul><li><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;">Proposed revision to the National Patient Safety Goal on medication reconciliation for the ambulatory care, behavioral health care, critical access hospital, home care, hospital, long term care, Medicare/Medicaid certification-based long term care, and office-based surgery programs.</span></li>
<li><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;">Proposed applicability changes to urgent care requirements in the ambulatory care program.</span></li>
<li><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;">Proposed 2012 National Patient Safety Goals pertaining to health-care associated infections for the hospital and long term care programs.</span></li>
<li><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;">Proposed standards for the "Primary Care Home" initiative in the ambulatory care program.</span></li>
<li><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;">Proposed clarifications and applicability changes to the home health standards in the home care program.</span></li>
<li><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;">Proposed standards to encompass the continuum of care provided to heart failure patients in a variety of health care delivery settings in the disease-specific care program for Heart Failure Advanced Certification.</span></li>
<li><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;">Development of a model to integrate performance expectations on accountability measures into a standards requirement for the hospital accreditation program. The tentative implementation date for a new requirement is January 2012.</span></li>
</ul><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;"><br />
</span></div><div style="font: normal normal normal 9px/normal 'Arial Black'; margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px;"><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;">POLICIES AND PROCEDURES</span></div><div style="font: normal normal normal 9px/normal 'Arial Black'; margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px;"><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;"><br />
</span></div><div style="font: normal normal normal 9px/normal 'Arial Black'; margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px;"><ul><li><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;">Proposed revisions to the Sentinel Event Policy for all programs. </span></li>
</ul></div><div style="font: normal normal normal 9px/normal 'Arial Black'; margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px;"><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;"><br />
</span></div><div style="font: normal normal normal 9px/normal 'Arial Black'; margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px;"><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;">For more information on any or all of the forthcoming changes, please visit the The Joint Commission site at <a href="http://www.jointcommission.org./">http://www.jointcommission.org.</a></span></div>Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-37709738.post-40076794334605263402010-12-03T16:11:00.001-06:002010-12-03T16:12:58.107-06:00Policies and Standards for ACOs Participating with the Medicare Program<span class="Apple-style-span" style="font-family: Arial; font-size: 13px;"><span style="font-family: Calibri; font-size: small;"><span style="font-family: Calibri; font-size: small;">In response to pre-ACO regulations, CMS posed questions to physicians concerning their possible participation in soon to be developed accountable care organizations. ACOs are a product of the new Patient Protection and Affordable Care Act (PPPAC) and will serve a minimum of 5000 Medicare beneficiaries. It is assumed that most ACOs will enroll private patients as well as Medicare once they are up and running. ACEP's</span></span><a href="http://click.acepinfo.org/?qs=9d8a3f9b007b0e3f1084baa79ac8f16b6d83db7e54ee622add58adf788c05709"><u><span style="color: blue; font-size: small;"><span style="color: blue; font-size: small;"> comments</span></span></u><span style="color: blue; font-size: small;"><span style="color: blue; font-size: small;"></span></span></a><span style="font-family: Calibri; font-size: small;"> <span style="font-family: Calibri; font-size: small;">to CMS Administrator Donald Berwick regarding aspects of policies and standards for ACOs' design and development include the need to recognize the potential role that emergency physicians can play in coordinating care across sites of service.</span></span></span><br />
<span class="Apple-style-span" style="font-family: Arial; font-size: 13px;"><span style="font-family: Calibri; font-size: small;"><span style="font-family: Calibri; font-size: small;"><br />
</span></span></span><br />
<span class="Apple-style-span" style="font-family: Arial; font-size: 13px;"><span style="font-family: Calibri; font-size: small;"><span style="font-family: Calibri; font-size: small;">Below is the text of the letter sent to Dr. Berwick by ACEP President Dr. Sandra Schneider and EDPMA Board Chairman Dr. Randy Pilgrim.</span></span></span><br />
<span class="Apple-style-span" style="font-family: Calibri;"> </span><span class="Apple-style-span" style="font-family: Calibri;"> </span><span class="Apple-style-span" style="font-family: Calibri;"> </span><span class="Apple-style-span" style="font-family: Calibri;"> </span><br />
<span style="font-family: Calibri; font-size: small;"><span style="font-family: Calibri; font-size: small;"><div class="MsoNormal"><br />
</div><div class="MsoNormal"><br />
</div><div class="MsoNormal"><span style="font-size: 11pt;">December 2, 2010<o:p></o:p></span></div><div class="MsoNormal"><br />
</div><div class="MsoNormal"><br />
</div><div class="MsoNormal"><span style="font-size: 11pt;">Donald M. Berwick, MD, MPP, FRCP <o:p></o:p></span></div><div class="MsoNormal"><span style="font-size: 11pt;">Administrator, Centers for Medicare & Medicaid Services <o:p></o:p></span></div><div class="MsoNormal"><span style="font-size: 11pt;">Department of Health and Human Services<o:p></o:p></span></div><div class="MsoNormal"><span style="font-size: 11pt;">445-G, Hubert H. Humphrey Building<o:p></o:p></span></div><div class="MsoNormal"><span style="font-size: 11pt;">200 Independence Avenue, SW<o:p></o:p></span></div><div class="MsoNormal"><span style="font-size: 11pt;">Washington, DC 20201<o:p></o:p></span></div><div class="MsoNormal" style="text-autospace: none;"><span style="font-size: 11pt;"> <b style="mso-bidi-font-weight: normal;">Attention: CMS-1345-NC<o:p></o:p></b></span></div><div class="MsoNormal" style="text-autospace: none;"><br />
</div><div class="MsoNormal"><br />
</div><div class="MsoNormal"><b style="mso-bidi-font-weight: normal;"><span style="font-size: 11pt;">Re: Policies and Standards for ACOs Participating with the Medicare Program <o:p></o:p></span></b></div><div class="MsoNormal"><br />
</div><div class="MsoNormal"><br />
</div><div class="MsoNormal"><span style="font-size: 11pt;">Dear Dr. Berwick:<o:p></o:p></span></div><div class="MsoNormal"><br />
</div><div class="MsoNormal"><span style="font-size: 11pt;">On behalf of the American College of Emergency Physicians’ (ACEP) more than 29,000 members and the Emergency Department Practice Management Association (EDPMA) and its 83 affiliated member organizations, we appreciate the opportunity to submit preliminary comments regarding aspects of policies and standards for Accountable Care Organization (ACO) design and development. <o:p></o:p></span></div><div class="MsoNormal"><br />
</div><div class="MsoNormal" style="text-autospace: none;"><span style="font-size: 11pt;">CMS has provided various background documents and public forums over the past few months in preparation for implementing Sec. 3021 and 3022 of PPACA. The vision for primary care physicians and/or hospital-based systems developing ACOs has been well-outlined. However, any description of expectations of the roles for emergency care physicians (and other hospital-based specialists) has not been addressed. We are concerned that once ACOs, medical homes, and expanded coverage are implemented, many policy makers expect emergency visits to all but disappear. While the health reform law will greatly expand insurance coverage starting in 2014, the volume of emergency visits is showing no signs of diminishing. In states like Massachusetts where 97 percent of the population has coverage, emergency department visits continue to grow. <o:p></o:p></span></div><div class="MsoNormal" style="text-align: justify;"><br />
</div><div class="MsoNormal" style="text-autospace: none;"><span style="font-size: 11pt;">According to the HHS’ Centers for Disease Control and Prevention, emergency visits in 2008 grew to 124 million, the highest level ever reported, and the number of uninsured recently reported by CDC has now reached 50 million, which will undoubtedly add to the volume of already crowded emergency departments. In addition, we predict that when the estimated 16 million individuals are added to Medicaid, the volume of emergency department visits will rise again as the supply and willingness of physicians in the community to add more low paying Medicaid patients to their practices falls short of demand. <o:p></o:p></span></div><div class="MsoNormal" style="text-autospace: none;"><br />
</div><div class="MsoNormal" style="text-autospace: none;"><span style="font-size: 11pt;">We believe there is a significant, and often overlooked, role for emergency physicians in new delivery system models that will greatly contribute to improvements in quality and coordination of patient care. <o:p></o:p></span></div><div class="MsoNormal" style="text-autospace: none;"><br />
</div><div class="MsoNormal" style="text-autospace: none;"><span style="font-size: 11pt;">We have selected three of the seven questions posed in the November 17<sup>th</sup> Federal Register notice for response today. We will have more extensive reactions and recommendations when the draft regulation is released for comment. <o:p></o:p></span></div><div class="MsoNormal" style="text-autospace: none;"><br />
</div><div class="MsoNormal" style="margin-left: .5in; mso-list: l1 level1 lfo1; text-align: justify; text-indent: -.25in;">•<span style="font: normal normal normal 7pt/normal 'Times New Roman';"> </span><i style="mso-bidi-font-style: normal;"><span style="font-size: 11pt;">What policies or standards should we consider adopting to ensure that groups of solo and small practice providers have the opportunity to actively participate in the Medicare Shared Savings Program and the ACO models tested by CMMI</span>?<o:p></o:p></i></div><div class="MsoNormal" style="text-align: justify;"><br />
</div><div class="MsoNormal" style="margin-right: .25in;"><span style="font-size: 11pt;">We urge CMS, FTC, and OIG to strongly consider concerns on the structure and the need to remove certain legal barriers that have been articulated to CMS by the American Medical Association, American Hospital Association, the Federation, and other provider groups. <o:p></o:p></span></div><div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in; margin-left: -139.5pt; margin-right: .25in; margin-top: 0in;"><br />
</div><div class="MsoNormal" style="margin-right: .25in;"><span style="font-size: 11pt;">With regard to the question above, we believe that practice size is not the only factor that CMS needs to consider in planning shared savings models. Approximately one-third of emergency physicians are hospital employees while the majority are members of practice groups of varying sizes that contract with hospitals to provide 24/7 coverage of their emergency departments. <o:p></o:p></span></div><div class="MsoNormal" style="text-align: justify;"><br />
</div><div class="MsoNormal" style="margin-right: .25in;"><span style="font-size: 11pt;">Fifty percent of Medicare admissions come through the emergency department and the majority of those have time-sensitive conditions. Our members play a critically important role coordinating care at the front end of an episode, i.e. they conduct a medical screening examination and assess the patient’s need to be either admitted, treated and discharged, or kept in observation for several hours before a final disposition decision is made. Approximately 25 percent of US hospitals have dedicated observation units and they are generally directed by emergency physicians. If the patient requires inpatient care, the emergency physician contacts the patient’s treating physician – primary care and/or specialty – who actually admits the patient. If the patient has no physician, the decision goes to the hospitalist or other hospital medical staff member. At the end of the inpatient stay, many patients are discharged into the community or to post acute care settings with little or no coordinated follow up. And, some of these individuals return to the emergency department when their conditions worsen and they don’t know where else to go. <o:p></o:p></span></div><div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in; margin-left: -139.5pt; margin-right: .25in; margin-top: 0in;"><br />
</div><div class="MsoNormal" style="margin-right: .25in;"><span style="font-size: 11pt;">This is an area where emergency physicians can improve transitions between sites of care, particularly when a patient comes back to the emergency department and is re-admitted within 30 days of discharge. As electronic health records continue to expand to link community-based physicians with the emergency department and other health care providers, emergency physicians will be able to play a more integral and expanded role in care coordination. Payment policies for specialty groups like emergency physicians who have little control over who comes to the emergency department should evolve over time as the ACO infrastructure improves and participating physicians can undertake joint risk sharing. <o:p></o:p></span></div><div class="MsoNormal" style="margin-right: .25in;"><br />
</div><div class="MsoNormalCxSpMiddle" style="margin-bottom: .0001pt; margin-bottom: 0in; margin-left: .5in; margin-right: .25in; margin-top: 0in; mso-add-space: auto; mso-layout-grid-align: none; mso-list: l0 level1 lfo2; text-autospace: none; text-indent: -.25in;"><span style="font-size: 11pt;">•<span style="font: normal normal normal 7pt/normal 'Times New Roman';"> </span></span><i style="mso-bidi-font-style: normal;"><span style="font-size: 11pt;">The Affordable Care Act requires us to develop patient-centeredness criteria for assessment of ACOs participating in the Medicare Shared Savings Program. What aspects of patient-centeredness are particularly important for us to consider and how should we evaluate them?<o:p></o:p></span></i></div><div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 22.5pt; margin-right: .25in; margin-top: 0in; mso-layout-grid-align: none; text-autospace: none;"><br />
</div><div class="MsoNormal"><span style="font-size: 11pt;">We believe that collaborative patient education is the most effective tool to improving quality and patient satisfaction. ACEP has long provided public education regarding when an individual should come to the emergency department, based on the now universal ‘prudent lay person standard’ that is based on the individual’s belief that he/she may have a medical emergency. Appropriate use of the emergency department requires much more than communication between the emergency physician and the patient. It starts with the patient’s primary care provider, who is often the one who tells the patient to go directly from home to the emergency department for tests, especially on nights and weekends. <o:p></o:p></span></div><div class="MsoNormal"><br />
</div><div class="MsoNormal"><span style="font-size: 11pt;">The ACO should provide a framework to engage all the physicians in coordinating the patient’s care and keeping the patient informed about what types of services are actually needed at the most appropriate site for that care. We envision that inclusion of collaborative clinical decisions can reduce the number of diagnostic images and foster greater consideration of alternatives to inpatient care. Patient understanding and satisfaction should improve along with the quality, safety and efficiency. A team approach is especially important for Medicare patients with chronic conditions.<o:p></o:p></span></div><div class="MsoNormal" style="text-align: justify;"><br />
</div><div class="MsoNormal" style="margin-right: .25in;"><span style="font-size: 11pt;">Again, real time exchange between providers will require extensive investments in health information technology (IT) infrastructure to facilitate coordination using EHRs and other technology. We<span style="color: black;"> urge </span></span><span style="color: black; font-size: 11pt;">CMS to reassess the EHR incentive program </span><span style="color: black; font-size: 11pt;">as </span><span style="font-size: 11pt;">policies and standards continue to be established and <span style="color: black;">the</span></span><span style="color: black; font-size: 11pt;"> current state of health IT adoption and functionality evolves. </span><span style="font-size: 11pt;"> At the same time, HCAHPS and/or other instruments can be refined to measure patient understanding and satisfaction with their overall care. <o:p></o:p></span></div><div class="MsoNormal" style="margin-right: .25in;"><br />
</div><div class="MsoNormal" style="margin-right: .25in;"><span style="font-size: 11pt;">We also note that emphasis on physicians providing more extensive education, coordination, and collaboration through participation in ACOs may result in higher costs for physician services, while reducing costs of inpatient and post acute care. The current payment silos must be adjusted to recognize overall system savings so physicians are not penalized. <o:p></o:p></span></div><div class="MsoNormal" style="margin-right: .25in;"><br />
</div><div class="MsoNormalCxSpMiddle" style="margin-bottom: .0001pt; margin-bottom: 0in; margin-left: .5in; margin-right: .25in; margin-top: 0in; mso-add-space: auto; mso-layout-grid-align: none; mso-list: l2 level1 lfo3; text-autospace: none; text-indent: -.25in;"><span style="font-size: 11pt;">•<span style="font: normal normal normal 7pt/normal 'Times New Roman';"> </span></span><i style="mso-bidi-font-style: normal;"><span style="font-size: 11pt;">In order for an ACO to share in savings under the Medicare Shared Savings Program, it must meet a quality performance standard determined by the Secretary. What quality measures should the Secretary use to determine performance in the Shared Savings Program?<o:p></o:p></span></i></div><div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in; margin-left: -139.5pt; margin-right: .25in; margin-top: 0in; mso-layout-grid-align: none; text-autospace: none;"><br />
</div><div class="MsoNormal" style="margin-right: .25in; mso-layout-grid-align: none; text-autospace: none;"><span style="font-size: 11pt;">The most important aspect of performance measurement for nascent ACOs is to begin with existing measures endorsed by a consensus based entity (e.g., National Quality Forum) and work with consensus groups and private payers to further standardize measures and metrics. Most physicians and other providers are responding to myriad “quality” measures, and new, ACO-specific measures make no sense at this point. <o:p></o:p></span></div><div class="MsoNormal" style="margin-right: .25in; mso-layout-grid-align: none; text-autospace: none;"><br />
</div><div class="MsoNormal" style="margin-right: .25in; mso-layout-grid-align: none; text-autospace: none;"><span style="font-size: 11pt;">The majority of physician groups are now participating in PQRI/PQRS including emergency physicians who were early adopters, so PQRI/PQRS measures are the best source of measures for the foreseeable future. As CMS and ACOs glean experience with these new delivery models, more outcome measures should be added, while some of the more process-oriented measures should be retired. <o:p></o:p></span></div><div class="MsoNormal" style="margin-right: .25in; mso-layout-grid-align: none; text-autospace: none;"><br />
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</div><div class="MsoNormal" style="margin-right: .25in; mso-layout-grid-align: none; text-autospace: none;"><br />
</div><div class="MsoNormal" style="margin-right: .25in; mso-layout-grid-align: none; text-autospace: none;"><span style="font-size: 11pt;">We also recommend that as the experience is gained, measures that reduce emergency department overcrowding be considered, as well as measures encouraging communication between hospital physicians and primary care physicians and coordination of emergency department transitions so that a loop of continuous care is created to diminish morbidity and mortality at critical transition points. <o:p></o:p></span></div><div class="MsoNormal" style="margin-right: .25in; mso-layout-grid-align: none; text-autospace: none;"><br />
</div><div class="MsoNormal" style="margin-right: .25in; mso-layout-grid-align: none; text-autospace: none;"><span style="font-size: 11pt;">We look forward to working with CMS and other physician and hospital groups to share research and clinical guidelines that can be integrated into larger bundles of care. If you have any questions about our comments, please contact Barbara Tomar, ACEP’s Federal Affairs Director at (202) 728-0610, ext. 3017.<o:p></o:p></span></div><div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 0in; margin-right: .25in; margin-top: 6.0pt;"><br />
</div><div class="MsoNormal"><span style="font-size: 11pt;">Sincerely, </span> <span style="font-size: 11pt;"> </span></div><div class="MsoNormal"><span style="font-size: 11pt;">Sandra H. Schneider, MD, FACEP Randy Pilgrim, MD <o:p></o:p></span></div><span style="font-family: 'Times New Roman'; font-size: 11pt;">President, ACEP Chairman, Board of Directors, EDPMA</span> </span></span>Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-37709738.post-65425100150199347222010-11-23T22:32:00.002-06:002010-11-23T22:32:54.513-06:00Voters Favor Health Care Reform Bill, Polls Show<!--StartFragment--> <br />
<div class="MsoNormal">Steven Thomma reports this morning in the Miami Herald that voters actually favor the new healthcare reform law, as determined by a new McClatchy Newspapers-Marist poll.<span style="mso-spacerun: yes;"> </span>The post-election survey reportedly states that 51 percent of registered voters want to keep the law or change it to do more, while 44 percent want to repeal it or change it to do less.<span style="mso-spacerun: yes;"> </span>Despite the Republican rhetoric that the recent mid-term elections represent a mandate to repeal the controversial law, many Americans actually favor many aspects of the bill.<span style="mso-spacerun: yes;"> </span></div><div class="MsoNormal"><br />
</div><div class="MsoNormal">Not surprisingly, voters favor aspects of the bill that benefit patients.<span style="mso-spacerun: yes;"> </span>The requirement that insurance companies provide coverage to people with pre-existing conditions is favored by 59% of respondents, with 36% opposed.<span style="mso-spacerun: yes;"> </span>Allowing children to remain on a parent’s insurance policy until the age of 26 is also popular, with 68% of respondents favoring and 29% against.<span style="mso-spacerun: yes;"> </span>Additionally, closing the “doughnut hole” in Medicare prescription drug coverage was favored by 57% of the respondents, compared to 32% against.<span style="mso-spacerun: yes;"> </span></div><div class="MsoNormal"><br />
</div><div class="MsoNormal">The results of the poll portend a more complex and challenging political landscape ahead for the Republicans in Congress than perhaps anticipated.<span style="mso-spacerun: yes;"> </span>It will be difficult to repeal bill in its entirety when significant portions are so popular.<span style="mso-spacerun: yes;"> </span>Instead, this may represent the opportunity to create a truly bipartisan solution to America’s healthcare system problems. <span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span></div><!--EndFragment-->Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-37709738.post-45470551259136102792010-11-18T22:23:00.000-06:002010-11-18T22:23:01.601-06:00Senate Passes Doc Fix Bill<!--StartFragment--> <br />
<div class="MsoNormal">The U.S. Senate tonight passed a bill entitled the “Physician Payment and Therapy Relief Act” that will postpone a 23% cut in Medicare reimbursement to physicians from December 1<sup>st </sup>to January 1<sup>st</sup>.<span style="mso-spacerun: yes;"> </span>The bill was constructed by Senator Max Baucus (D-MT), chair of the Senate Finance Committee, and Senator Chuck Grassley (R-IA).<span style="mso-spacerun: yes;"> </span>Senators Baucus and Grassley also announced that they would seek a second “doc fix” that would further delay the scheduled December 1<sup>st</sup> pay cut as well as the 2% pay cut scheduled for January 1, 2011.<span style="mso-spacerun: yes;"> </span>The second bill would postpone all pending physician reimbursement cuts until January 1, 2012.<span style="mso-spacerun: yes;"> </span></div><div class="MsoNormal"><br />
</div><div class="MsoNormal">Unfortunately for physicians facing the 23% pay cut in 12 days, the House has already adjourned for the Thanksgiving holiday, meaning that they cannot take up consideration of the Senate bill before November 29<sup>th</sup>.<span style="mso-spacerun: yes;"> </span>There is currently a bill proposed by Representative John Dingell (D-MI) that would extend the effective date of Medicare cuts until January 1, 2012.<span style="mso-spacerun: yes;"> </span>Whether the House pursues Dingell’s bill or takes up the Senate bill on the 29<sup>th</sup> is unclear, but spokespersons for House Speaker Nancy Pelosi (D-CA) have indicated that the House would consider “doc fix” legislation prior to the December 1<sup>st</sup> deadline.</div><div class="MsoNormal"><br />
</div><!--EndFragment-->Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-37709738.post-60433811759835186652010-09-24T13:37:00.000-05:002010-09-24T13:37:23.547-05:00It's official. EMS is now a subspecialty of Emergency MedicineThe American Board of Medical Specialties (ABMS) approved the American Board of Emergency Medicine (ABEM) application for subspecialty certification in Emergency Medical Services (EMS) yesterday at their meeting in Chicago. This effort was led by Dr. Debra Perina, Immediate Past President of ABEM.<br />
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</span><span class="Apple-style-span" style="font-family: Georgia;"></span><span class="Apple-style-span" style="font-family: Georgia;"></span><span class="Apple-style-span" style="font-family: Georgia;">Unofficial reports are that the first exam will be scheduled for 2013.</span><br />
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<span class="Apple-style-span" style="font-family: Georgia;">The American College of Emergency Physicians kicks off it's Scientific Assembly tomorrow in Las Vegas, Nevada. As part of the week-long conference members of the ABEM Board will attend the EMS committee meeting on Tuesday, September 28th in the Las Vegas Convention Center.</span><br />
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<span class="Apple-style-span" style="font-family: Georgia;">It is especially fitting that EMS gain recognition as a subspecialty on the 50-year anniversary of the publication of the first scientific research in cardiopulmonary resuscitation (CPR), a basic skill for all involved in pre-hospital care.</span><br />
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</span>Unknownnoreply@blogger.com2tag:blogger.com,1999:blog-37709738.post-8461862044703087162010-08-10T22:45:00.001-05:002010-08-10T22:46:47.177-05:00Emergency visits up 23% according to the CDC<div style="margin-bottom: .0001pt; margin: 0in;"><span style="font-size: 11pt;"><span class="Apple-style-span" style="color: white;">A new report from the Centers for Disease Control and Prevention once again debunks the myth that emergency departments are crowded with non-urgent patients, a finding noted by the American College of Emergency Physicians (ACEP). <o:p></o:p></span></span></div><div style="margin-bottom: .0001pt; margin: 0in;"><span class="Apple-style-span" style="color: white;"><br />
</span></div><div style="margin-bottom: .0001pt; margin: 0in;"><span style="font-size: 11pt;"><span class="Apple-style-span" style="color: white;">The percentage of non-urgent patients dropped to only 7.9 percent in 2007 [from 12.1 percent in 2006]. The report also makes the excellent point that non-urgent does not imply unnecessary. As ACEP has said repeatedly, our patients are in the ER because that’s where they need to be.<o:p></o:p></span></span></div><div style="margin-bottom: .0001pt; margin: 0in;"><span class="Apple-style-span" style="color: white;"><br />
</span></div><div style="margin-bottom: .0001pt; margin: 0in;"><span style="font-size: 11pt;"><span class="Apple-style-span" style="color: white;">There were approximately 222 visits to U.S. emergency departments every minute in 2007 (</span></span><span class="entry-content"><span style="font-size: 11pt;"><span class="MsoHyperlink"><span class="Apple-style-span" style="color: white;">http://bit.ly/9B5kHJ</span></span><span class="Apple-style-span" style="color: white;">) and </span></span></span><span style="font-size: 11pt;"><span class="Apple-style-span" style="color: white;">the number of visits increased by 23 percent between 1997 and 2007</span></span><span class="entry-content"><span style="font-size: 11pt;"><span class="Apple-style-span" style="color: white;">, according to the report.</span></span></span></div><div style="margin-bottom: .0001pt; margin: 0in;"><span style="font-size: 11pt;"><span class="Apple-style-span" style="color: white;"><br />
</span> </span></div><div style="margin-bottom: .0001pt; margin: 0in;"><span class="entry-content"><span class="Apple-style-span" style="color: white;"><span style="font-size: 11pt;"></span></span></span><span style="font-size: 11pt;"><span class="Apple-style-span" style="color: white;">Preliminary data for 2008 indicate that emergency visits will increase to a record high of more than 123 million</span></span><span style="color: black; font-size: 11pt;"> (<a href="http://bit.ly/ak6oRx">http://bit.ly/ak6oRx</a>).</span></div><div style="margin-bottom: .0001pt; margin: 0in;"><span style="color: black; font-size: 11pt;"><br />
</span></div><div style="margin-bottom: .0001pt; margin: 0in;"><span class="Apple-style-span" style="font-size: 15px;"><span class="Apple-style-span" style="color: white;">Babies under 12 months old had the highest visit rate at 88.5 visits per 100 infants. The second highest visit rate was by adults age 75 and older, with 62 visits per 100 people. </span></span></div><div class="MsoNormal" style="margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px;"><span class="Apple-style-span" style="color: white;"><br />
</span></div><div class="MsoNormal" style="margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px;"><span style="font-size: 11pt;"><span class="Apple-style-span" style="color: white;">Approximately one-quarter of all visits were by patients insured by either Medicaid or the State Children’s Health Insurance Program. The uninsured represented about 15 percent of all visits.</span></span></div><div class="MsoNormal" style="margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px;"><span style="font-size: 11pt;"><span class="Apple-style-span" style="color: white;"><br />
</span> </span></div><div style="margin-bottom: .0001pt; margin: 0in;"><span style="font-size: 11pt;"><span class="Apple-style-span" style="color: white;">The report, “National Hospital Ambulatory Medical Care Survey: 2007 Emergency Department Summary” offers far more detail than the data brief released by the Centers for Disease Control and Prevention (CDC) in May. </span></span><span class="entry-content"><span style="font-size: 11pt;"><span class="Apple-style-span" style="color: white;">The U.S. Department of Health and Human Services, of which the CDC is a part, has indicated that this is the last fully detailed report of its kind to be issued about emergency department visits.</span></span></span><span style="font-size: 11pt;"><span class="Apple-style-span" style="color: white;"><o:p></o:p></span></span></div><div style="margin-bottom: .0001pt; margin: 0in;"><span class="Apple-style-span" style="color: white;"><br />
</span></div><div style="margin-bottom: .0001pt; margin: 0in;"><span style="font-size: 11pt;"><span class="Apple-style-span" style="color: white;">I am urging the CDC to reconsider: <o:p></o:p></span></span></div><div class="MsoNormal"><span class="Apple-style-span" style="color: white;"><br />
</span></div><div class="MsoNormal" style="margin-left: .5in;"><span style="font-size: 11pt;"><span class="Apple-style-span" style="color: white;">“It is essential to know what is happening in our emergency departments as we implement health care reform. This report is rich in data about who our patients are, how old they are and why they are seeking care in the ER. From a planning perspective, this information is invaluable. It would be a mistake for the CDC to discontinue tracking what is happening on the front lines of healthcare, the nation’s emergency departments.”<o:p></o:p></span></span></div><div class="MsoNormal"><span class="Apple-style-span" style="color: white;"><br />
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</span></div><div class="MsoNormal"><span style="font-size: 11pt;"><span class="Apple-style-span" style="color: white;">The report also notes that only 0.1 percent of patients die in the emergency department.<o:p></o:p></span></span></div><div class="MsoNormal"><span class="Apple-style-span" style="color: white;"><br />
</span></div><div class="MsoNormal"><span style="font-size: 11pt;"><span class="Apple-style-span" style="color: white;">The report says the main issue contributing to overcrowding has been delays in moving the sickest patients to inpatient beds. Admitted patients have often been boarded in the emergency departments or hospital hallways for hours to days, resulting in overcrowding and diversion of incoming ambulances to other hospitals.<o:p></o:p></span></span></div><div class="MsoNormal"><br />
</div>Unknownnoreply@blogger.com1tag:blogger.com,1999:blog-37709738.post-54739828323649078122010-08-09T23:53:00.001-05:002010-08-09T23:55:30.070-05:00Congressional Update<span class="Apple-style-span" style="font-family: Arial; font-size: 13px;"></span><br />
<strong>S</strong><i>enate Approves Additional Medicaid Funding for States</i><br />
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The House will return next week to vote on the measure.<br />
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The Senate on Thursday passed a $26.1 billion state-aid package that the House is poised to consider next week, when it will return briefly from its August recess. The bill would provide $10 billion to save education jobs and six more months of increased federal Medicaid payments to states at a cost of $16.1 billion. The vote was 61-39 with Maine Republican Senators Olympia Snowe and Susan Collins joining all 59 members of the Senate Democratic Caucus. The Congressional Budget Office (CBO) says the bill is budget-neutral over 10 years and will reduce future deficits by $1.37 billion. Offsets include the end to a tax loophole for multinational corporations and reductions starting in 2014 in extra food stamp benefits provided under the 2009 economic stimulus law.<br />
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On Thursday House Speaker Nancy Pelosi (D-CA) announced on Twitter that she would call House members back to Washington, D.C. next week to take up the measure. The House adjourned for the August recess last Friday and the chamber was not scheduled to return until September 14.<br />
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<b>Senate Schedule in the Fall</b><br />
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The Senate now heads home for their August recess with Senate Democrats working on scheduling post-Labor Day votes that will make up the first portion of what appears a daunting fall agenda.<br />
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Even before the recess, the Senate's focus was shifting to Democratic plans to push what could be a massive tax policy package extending trillions of dollars in tax cuts passed in 2001 and 2003. Senate Finance Chairman Max Baucus (D-MT) wants to mark up the package after Labor Day and Democratic leadership aides said Senate Majority Leader Reid (D-NV) hopes to bring it to the floor before October.<br />
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In the face of the November midterm elections, that effort could be politically explosive. The bill could pit traditional Republican backing for tax reduction against pressure for deficit reduction that many GOP members are pushing on the campaign trail. A small-business jobs bill is expected to be the first measure on the Senate floor after Labor Day.<br />
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With time running short for legislating this year, Sen. Reid on Thursday announced the Senate will convene for a lame-duck session after the election. The Senate will be in session the week of Nov. 15, then off the following week for Thanksgiving. The chamber will return Nov. 29 and remain for an undetermined period. The Senate is scheduled to be in session from Sept. 13 to Oct. 8, then out until Nov. 12 in preparation for the elections.<br />
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</div>Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-37709738.post-85567381188995077912010-07-27T23:35:00.000-05:002010-07-27T23:35:55.614-05:00NAIC will set medical-loss ratios by mid-August<span class="Apple-style-span" style="font-family: Arial; font-size: 13px;"></span><br />
Officials with the National Association of Insurance Commissioners (NAIC) last week said that they may be able to complete guidelines to define administrative and medical spending under medical-loss ratio (MLR) rules by mid-August. Under the overhaul bill, large health plans will be required to spend at least 85% of premiums on medical services and quality improvement, rather than administrative costs or profits,beginning on Jan. 1, 2011. MLR for individual and small-group health plans must be at least 80%. Although the new law requires the recommendations to be made by year's end, federal health officials had urged the group to submit the draft guidelines by the end of May to give insurance companies ample time to adjust to the new regulations.<br />
Earlier this week, Sen. John Rockefeller (D-WV) sent a letter to NAIC urging the group to resist lobbying efforts by insurers to ease the MLR standards. Following this letter, Sen. Al Franken (D-MN) and Rep. Bill Pascrell (D-NJ) held an event Thursday with "Health Care for America Now" to highlight the liberal group's report on industry lobbying efforts to influence medical loss ratio provisions in the health care reform overhaul law.Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-37709738.post-54054421675634083502010-07-26T19:28:00.004-05:002010-07-26T19:39:56.115-05:00Save the Everest - 2011<span class="Apple-style-span"><span class="Apple-style-span" style="font-family: inherit;"> I had the opportunity to meet one of the world's leading climbers, Wongchu Sherpa, during this week's meeting of the Wilderness Medical Society in Snowmass, Colorado. Wongchu Sherpa has summited Everest and many other peaks in the Himalayas. He was immortalized in the 1996 David Brashears IMAX film </span></span><span class="Apple-style-span" style="font-family: inherit;">EVEREST </span><span class="Apple-style-span" style="font-family: inherit;"> and has continued his work as the chairman and managing director of Peak Promotion Pvt. Ltd. The company specializes in trekking, mountaineering, filming and expedition logistics. </span><br />
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<span class="Apple-style-span" style="font-family: inherit;"> Wongchu came to Kathmandu in search of his future at the age of 16, leaving his home village of Chyangba, about 500 km north of Kathmandu in the Solu Khumbu District. Through Sherpa friends he eventually found a job as a kitchen assistant with a trekking company, and went on to eventually found his own enterprise, Peak Promotions, in 1992.</span><br />
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<span class="Apple-style-span" style="font-family: inherit;"> He is a man who believes in giving back to the community. He built Wongchu Biswa Darshan Junior High School, bringing higher education to his community. With the help of David Brashears and Broughton Coburn, he brought electricity and clean drinking water to the village as well. He repaired the Chyangba Gompa (monastery) and helped to establish a health post at this school.</span><br />
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<div style="text-align: center;"> "There is only one life. We don't have a life after this and whatever we earn we must leave here. We cannot take with us. And this is how I will leave what I have earned," says Wongchu Sherpa.</div><span class="Apple-style-span" style="font-family: Verdana; font-size: small;"><span class="Apple-style-span" style="font-size: 11px;"><span class="Apple-style-span" style="font-family: 'American Typewriter';"><span class="Apple-style-span" style="font-size: medium;"><br />
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<tr><td class="tr-caption" style="text-align: center;">In Photo: Dr. Angela Gardner, Wongchu Sherpa</td></tr>
</tbody></table><span class="Apple-style-span" style="font-family: Verdana;"><span class="Apple-style-span"><span class="Apple-style-span" style="font-family: 'American Typewriter';"> Wongchu Sherpa is in the United States to promote the "Save the Everest - 2011" campaign. Since May 29, 1953 when Sir Edmund Hillary and Tenjing Norgay Sherpa reached the peak of Everest for the first time, more than 4500 climbers from eighty countries have climbed Everest, leaving behind a junk yard of oxygen cylinders, abandoned camping equipment, and food packaging debris. Wongchu Sherpa and the Everest Summiteers Association, in conjunction with the government of Nepal, want to change that.</span></span></span><br />
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<span class="Apple-style-span" style="font-family: Verdana;"><span class="Apple-style-span"><span class="Apple-style-span" style="font-family: 'American Typewriter';"> The goal of "Save the Everest - 2011" is to remove 8 tons of garbage from base camp and high camp by the end of the 2011 Spring Season. Following the cleanup effort, the campaign hopes to establish Everest as a garbage-free zone from base camp to summit, preserving the beauty of the world's most enigmatic mountain for generations to come. The garbage will be brought down by participating national and international expedition teams.</span></span></span><br />
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To learn more about "Save the Everest - 2011" or to support the effort physically or financially, go to <a href="http://www.everestsummiteersassociation.org/">www.everestsummiteersassociation.org</a> or send an email to esa@wlink.com.np<br />
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</div><div style="font: 11.0px 'Times New Roman'; margin: 0.0px 0.0px 0.0px 0.0px;"> July 19, 2010</div><div style="font: 11.0px 'Times New Roman'; margin: 0.0px 0.0px 0.0px 0.0px;"><br />
</div><div style="font: 11.0px 'Times New Roman'; margin: 0.0px 0.0px 0.0px 0.0px;">Donald M. Berwick, MD, MPP, FRCP </div><div style="font: 11.0px 'Times New Roman'; margin: 0.0px 0.0px 0.0px 0.0px;">Administrator Centers for Medicare & Medicaid Services</div><div style="font: 11.0px 'Times New Roman'; margin: 0.0px 0.0px 0.0px 0.0px;">200 Independence Avenue, SW </div><div style="font: 11.0px 'Times New Roman'; margin: 0.0px 0.0px 0.0px 0.0px;">Washington, DC 20201</div><div style="font: 11.0px 'Times New Roman'; margin: 0.0px 0.0px 0.0px 0.0px;"><br />
</div><div style="font: 11.0px 'Times New Roman'; margin: 0.0px 0.0px 0.0px 0.0px;">Dear Dr. Berwick:</div><div style="font: 11.0px 'Times New Roman'; margin: 0.0px 0.0px 0.0px 0.0px;"><br />
</div><div style="font: 11.0px 'Times New Roman'; margin: 0.0px 0.0px 0.0px 0.0px;">On behalf of the American College of Emergency Physicians (ACEP) and our 28,000 members, I want to congratulate you on your appointment as Administrator of the Centers for Medicare & Medicaid Services (CMS). We look forward to working with you and your staff during this critical time that the new health care reform law regulations are being promulgated and we believe your clinical and health care policy experience give you a unique perspective on how these rules may impact the delivery of health care in America.</div><div style="font: 11.0px 'Times New Roman'; margin: 0.0px 0.0px 0.0px 0.0px;">As an elected member of the Institute of Medicine (IOM), we're sure you are familiar with the 2006 IOM reports on the "Future of Emergency Care in the United States Health System," which detailed the challenges and concerns this nation faces in maintaining access to emergency medical care. As articulated in the IOM reports, America's emergency medical system as a whole is overburdened, underfunded and highly fragmented. As a result, ambulances are diverted from emergency departments once every minute on average and patients in many areas may wait hours, or even days, for hospital beds causing admitted patients to be boarded in the emergency department and redirecting precious emergency care resources away from incoming patients.</div><div style="font: 11.0px 'Times New Roman'; margin: 0.0px 0.0px 0.0px 0.0px;"><br />
</div><div style="font: 11.0px 'Times New Roman'; margin: 0.0px 0.0px 0.0px 0.0px;">Emergency departments in this country handle more than 120 million patient visits per year and utilization of our services continues to steadily increase. As we have learned from observing the evolution of the Massachusetts medical care system, and its near universal coverage, emergency department utilization has actually increased in that state, rather than decreased, as many projected. We believe this is the result of a number of factors, including the federal mandate applied by the Emergency Medical Treatment and Labor Act (EMTALA), the lack of internal medicine physicians and general practitioners in the state, injuries and illnesses that occur after normal physician office business hours, and the fact that emergency departments continue to be the sole source of access to the health care system for many in that state, despite their insurance status. The one true lesson from Massachusetts is that coverage does not equal access.</div><div style="font: 11.0px 'Times New Roman'; margin: 0.0px 0.0px 0.0px 0.0px;"><br />
</div><div style="font: 11.0px 'Times New Roman'; margin: 0.0px 0.0px 0.0px 0.0px;">Frankly, we are concerned that the combination of health care law reforms and the general delay in producing more primary care physicians could potentially overwhelm America's emergency departments, many of which currently operate at or above capacity on a regular basis. In particular, we would like to focus your attention of the followingprovisions of the "Patient Protection and Affordable Care Act" and the "Health Care and Education Reconciliation Act:"</div><div style="font: 11.0px 'Times New Roman'; margin: 0.0px 0.0px 0.0px 0.0px;"><br />
</div><div style="font: 11.0px 'Times New Roman'; margin: 0.0px 0.0px 0.0px 0.0px;">Patient Protections (§10101) - This measure extends the "prudent layperson standard" to group health plans, or issuers of group or individual health plans, which offer hospital emergency department services, as well as eliminates the need for prior authorization and provides parity in coverage and patient co-payments for in- and out-of-network providers. We urge you to consider expanding these important patient protections to grandfathered health plans as well.</div><div style="font: 11.0px 'Times New Roman'; margin: 0.0px 0.0px 0.0px 0.0px;"><br />
</div><div style="font: 11.0px 'Times New Roman'; margin: 0.0px 0.0px 0.0px 0.0px;">Hospital Value-Based Purchasing Program (§3001) – As this program advances, we want to ensure measures that will improve emergency department efficiencies are considered an essential component of this plan.</div><div style="font: 11.0px 'Times New Roman'; margin: 0.0px 0.0px 0.0px 0.0px;"><br />
</div><div style="font: 11.0px 'Times New Roman'; margin: 0.0px 0.0px 0.0px 0.0px;">Improvements to PQRI System (§3002) – Please assure emergency physician measures continue to be available in the PQRI program and that these measures promote integration of clinical reporting using electronic health records, as well as demonstrate both meaningful use of electronic health records and quality of care furnished to the patient.</div><div style="font: 11.0px 'Times New Roman'; margin: 0.0px 0.0px 0.0px 0.0px;"><br />
</div><div style="font: 11.0px 'Times New Roman'; margin: 0.0px 0.0px 0.0px 0.0px;">Value-Based Payment Modifier (Physician Fee Schedule) (§3007) – As CMS develops its own transparent episode grouper software; it must account for the unique delivery aspects of emergency services. In addition, it is critical that future risk-based measures developed by HHS ensure emergency physician measures are applied only to services that are within the control of the physicians.</div><div style="font: 11.0px 'Times New Roman'; margin: 0.0px 0.0px 0.0px 0.0px;"><br />
</div><div style="font: 11.0px 'Times New Roman'; margin: 0.0px 0.0px 0.0px 0.0px;">Medicare Shared Savings Program (§3022) and Payment Bundling (§3023) – We urge you to recognize the important role emergency physicians play in providing the full continuum of care to Medicare beneficiaries. There must be commensurate recognition of these distinctive services as an integral part of any Accountable Care Organization (ACO) and through the coordination of bundled payments for an episode of care.</div><div style="font: 11.0px 'Times New Roman'; margin: 0.0px 0.0px 0.0px 0.0px;"><br />
</div><div style="font: 11.0px 'Times New Roman'; margin: 0.0px 0.0px 0.0px 0.0px;">Distribution of Additional Residency Positions (§5503) – Due to the statutory obligation to provide at least 75% of the redistributed residency positions to primary care or general surgery, it is even more imperative that CMS provide as many of the remaining slots to emergency medicine residency programs. The expected immediate increase in emergency department visits demands that we accelerate the availability of residency-trained emergency physicians in our communities.</div><div style="font: 11.0px 'Times New Roman'; margin: 0.0px 0.0px 0.0px 0.0px;"><br />
</div><div style="font: 11.0px 'Times New Roman'; margin: 0.0px 0.0px 0.0px 0.0px;">National Health Care Workforce Commission (§5101) – The growing disparity between the increasing number of emergency department visits each year and the decreasing number of emergency departments is alarming and of great concern to us and our constituents. We strongly encourage you to highlight the education and training needs of emergency medicine as the commission proceeds.</div><div style="font: 11.0px 'Times New Roman'; margin: 0.0px 0.0px 0.0px 0.0px;"><br />
</div><div style="font: 11.0px 'Times New Roman'; margin: 0.0px 0.0px 0.0px 0.0px;">Patient-Centered Outcomes Research (§6301) – Due to the integral role of emergency physicians in providing all types of care for elderly patients, we ask that the emergency medicine perspective be represented in the identification of research priorities and the establishment and implementation of the research project agenda.</div><div style="font: 11.0px 'Times New Roman'; margin: 0.0px 0.0px 0.0px 0.0px;"><br />
</div><div style="font: 11.0px 'Times New Roman'; margin: 0.0px 0.0px 0.0px 0.0px;">Extension of Medical Malpractice Coverage (§10608) – The law extends Federal Tort Claims Act liability protections to an officer, governing board member, employee or contactor of a free clinic. This is an important recognition of the unique role of those individuals who provide medical services without requiring compensation from the patient. As you know, the federal mandate of the Emergency Medical Treatment and Labor Act (EMTALA) requires emergency department physicians and many on-call specialists to provide similar, and in fact more comprehensive, services as those provided at free clinics with a substantial burden of uncompensated care. We urge you to review the unique requirements on physicians who provide EMTALA- related services and consider how the Federal Tort Claims Act may be applied to ensure the availability of these emergency and on-call physicians.</div><div style="font: 11.0px 'Times New Roman'; margin: 0.0px 0.0px 0.0px 0.0px;"><br />
</div><div style="font: 11.0px 'Times New Roman'; margin: 0.0px 0.0px 0.0px 0.0px;">In addition, we are writing to request your assistance with another matter of significant importance to the coordination and delivery of high-quality medical care in America's emergency departments. Senator Debbie Stabenow (D-MI) has requested a formal response from HHS on her proposal to create a CMS working group that would be responsible for reviewing issues affecting access to emergency care and for developing standards and measures to reduce emergency department boarding and crowding, as well as ambulance diversion. Both of these issues can have dire consequences for patient care and we urge you to develop your response to her request as soon as possible.</div><div style="font: 11.0px 'Times New Roman'; margin: 0.0px 0.0px 0.0px 0.0px;"><br />
</div><div style="font: 11.0px 'Times New Roman'; margin: 0.0px 0.0px 0.0px 0.0px;">Thank you for your consideration of these important issues. As you know, enactment of health care reform was only the first step. We look forward to working with you to ensure the implementation of these laws help our patients receive the best medical care possible, including maintaining access to lifesaving emergency medical services that are so vital to our communities.</div><div style="font: 11.0px 'Times New Roman'; margin: 0.0px 0.0px 0.0px 0.0px;"><br />
</div><div style="font: 11.0px 'Times New Roman'; margin: 0.0px 0.0px 0.0px 0.0px;">Sincerely,</div><div style="font: 11.0px 'Times New Roman'; margin: 0.0px 0.0px 0.0px 0.0px;"><br />
</div><div style="font: 11.0px 'Times New Roman'; margin: 0.0px 0.0px 0.0px 0.0px;">Angela Gardner, MD, FACEP</div><div style="font: 11.0px 'Times New Roman'; margin: 0.0px 0.0px 0.0px 0.0px;">President</div>Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-37709738.post-77212556547084441972010-07-21T21:27:00.000-05:002010-07-21T21:27:44.366-05:00New Medicare Economic Index Changes<span class="Apple-style-span" style="font-family: Arial; font-size: 13px;"></span><br />
<ul><li>The Medicare Economic Index (MEI) is used in conjunction with the SGR formula to update the physician fee schedule. For 2011, CMS will "rebase" the MEI, i.e. update the base year to 2006 (the most recent year with complete information) to reflect changes in physician expenses and "revise" some of the components or categories that comprise the MEI.</li>
</ul><dir><dir><ul><li>The impact of the proposed MEI changes varies by specialty. Data from the PCPI survey (that ACEP supported and participated in) showed that practice expense (PE) and medical liability costs grew at a faster rate than physician work. Therefore, CMS increased the PE RVUs used in the MEI to 47.44%, malpractice RVUs from 3 to 4%, and reduced work from 52.46%-48.27% of total RVUs.</li>
<li>Because these changes must be budget neutral in overall impact, CMS proposes to reduce the Conversion Factor by 7.9%, rather than reduce work values. Therefore, the proposed payment levels for high practice expense specialties will increase, while payment to low practice cost specialties, such as emergency medicine may decrease slightly.<br />
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<li><b>Primary Care Incentive Program: </b>The health reform law passed in March 2010 created a 10% bonus payment for primary care services performed by specific specialties of family practice, internal medicine, pediatrics, or geriatrics (but not emergency medicine). General surgeons are also eligible for a 10% bonus if they practice in designated shortage areas. Bonus funds are not budget neutral so money will not be taken from other specialties to pay for the bonuses.<br />
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<li><b>Physician Quality Reporting Initiative: </b>CMS is proposing to add 20 new measures to the physician quality reporting initiative (PQRI) and will make 12 additional measures reportable through electronic health records. A list of measures will be provided in the web update. The new law extends the PQRI program through 2014. Payments to eligible professionals will equal 1% of estimated total allowed fee schedule services for 2011 and .05% for 2012-2014. In 2015 the payment is replaced by a penalty of 1.5% for non-reporting. This increases to 2% for 2016 and thereafter.<br />
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<li><b>Imaging</b>: Last year, CMS increased amount of time that complex diagnostic imaging machines (valued at > $1m) are used in practices from 50% of the time to 90% using a 4-year phase-in. The Affordable Care Act changed the amount to 75%. This will affect the technical component only but will reduce practice expenses for many physicians who perform complex imaging services in their offices. The policy will not be phased in and is not budget neutral, meaning that savings will not be redistributed within the fee schedule.</li><br />
</dir>Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-37709738.post-66118783674759911162010-06-26T10:20:00.001-05:002010-06-26T10:26:22.480-05:00Congress Passes Delay of Scheduled Medicare Cut<table bgcolor="" border="0" bordercolor="" cellpadding="0" cellspacing="0" style="font-family: Georgia;"><tbody>
<tr><td>On Thursday, the U.S. House of Representatives approved the legislation (H.R. 3962) that passed in the Senate last week, which postpones cuts to Medicare physicians' reimbursement until November 2010, effectively postponing this issue until after the mid-term elections. The $6.5 billion bill reverses the 21% payment cut that took effect June 18th and affected all Medicare claims dated June 1, 2010 or later, and passed in a 417-1 vote. The measure increases payments by 2.2% for six months, applying retroactively to June 1st. President Obama signed the bill into law this morning, and CMS promises to quickly process retroactive payment claims. <br />
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http://well.blogs.nytimes.com/2010/05/21/buying-a-bike-helmet/Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-37709738.post-80034689276153878022010-05-20T12:50:00.001-05:002010-05-20T12:51:33.279-05:00Ohio Senate passes limited tort reform<span class="Apple-style-span" style="font-family: Verdana, Arial, Helvetica, sans-serif;"></span><br />
<div style="margin-left: 0in; margin-right: 0in;"><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;"><span class="Apple-style-span" style="font-size: x-large;">On May 19th the Ohio Senate passed S.B. 86, a limited tort reform bill, with a bipartisan floor vote of 22-10. Many chapter leaders were involved in the passage of this bill, including Dr. Gary Katz, Ohio ACEP President, and Dr. Catherine Marco, Ohio ACEP Government Affairs Committee Chair. The Chapter conducted a State Senator contact campaign on May 18th to encourage legislators to pass the bill. Ohio Senator Steve Buehrer sponsored this important legislation.</span></span></div><div style="margin-left: 0in; margin-right: 0in;"><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;"><span class="Apple-style-span" style="font-size: x-large;"><br />
</span></span></div><div style="margin-left: 0in; margin-right: 0in;"><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;"><span class="Apple-style-span" style="font-size: x-large;">The bill extends limited liability protections for physicians providing emergency care under EMTALA, changing the standard of negligence to that of "reckless disregard" instead of the simple negligence standard used for medical malpractice cases. This support for emergency physicians and on call specialists will improve access to emergency care for patients in Ohio and enhance the practice environment for emergency physicians. The Ohio chapter of ACEP looks forward to introducing the bill in the Ohio House of Representatives in the fall.</span></span></div><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjrT7ET5K4oc65irvozvkoDpO5GBJCWnK4jLCsPSR2mtS1oYBuzZQ21eXIAwpjmeWbPV4QQjPl8JBa-nL_fo3ya1JfpLhC_JibeupsmaXWKPpVlTS226YQLzjkq8w1QLS6lyFGY/s1600/DSCN0437.JPG" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjrT7ET5K4oc65irvozvkoDpO5GBJCWnK4jLCsPSR2mtS1oYBuzZQ21eXIAwpjmeWbPV4QQjPl8JBa-nL_fo3ya1JfpLhC_JibeupsmaXWKPpVlTS226YQLzjkq8w1QLS6lyFGY/s320/DSCN0437.JPG" /></a></div><div style="font-family: 'Times New Roman', serif; font-size: 12pt; margin-left: 0in; margin-right: 0in;"><span class="Apple-style-span" style="font-family: Verdana, sans-serif; font-size: x-small;"><span class="Apple-style-span" style="font-size: 10px;"><br />
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</div>Unknownnoreply@blogger.com0