Tag Archives: medicaid

Spurring Health IT Adoption

The Obama administration really, really wants doctors to start using electronic health records (EHRs). For the past few years, they have been out urging physicians to invest in the systems and offering a pretty big carrot for adoption. Under the 2009 HITECH (Health Information Technology for Economic and Clinical Health) Act, physicians who meet certain quality metrics through the use of certified health IT systems can qualify for incentive payments from Medicare and Medicaid. Under the Medicare program, the maximum incentive is $44,000 over 5 years. Under Medicaid, it’s nearly 64,000 over 6.

HHS officials want to make paper medical records a thing of the past. Courtesy Wikimedia Commons/U.S. Navy Photo by Rod Duren/ Public Domain.

Now officials at the Health and Human Services department are trying to drive up adoption by removing a potential barrier to early participation in the program. HHS recently announced that physicians can begin participating in the incentive program this year and not have to meet quality standards until 2014. Previously, if a provider reported to HHS that he or she was using health IT as part of the incentive program in 2011, they would have to meet the quality standards starting in 2013. But those that started sometime in 2012 wouldn’t have to meet the standards until 2014 and would still qualify for the maximum incentive payments. It can get a little complicated, but essentially HHS is trying to take away reasons for people to hold off on adopting EHRs.

It’s hard to tell if this latest policy change will make a big difference to physicians considering an EHR. But the incentive program as a whole does seem to have physicians interested. A new survey from the Centers for Disease Control and Prevention found that 52% of office-based physicians report that they plan to take advantage of the new incentive payments. As for doctors who have already adopted some type of “basic” EHR, that number has climbed from 17% in 2008 to 34% this year.

Tell us what’s driving your decision to adopt an EHR in your practice? Take our poll:

— Mary Ellen Schneider

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Here Comes the Super Committee

The Joint Select Committee on Deficit Reduction was created as a part of Congress’ debt deal in July. The 12-member bipartisan committee is charged with cutting $1.5 trillion in federal spending by Thanksgiving. Medicare and Medicaid benefits, doctor’s pay, and the Children’s Health Insurance Plan could be on the chopping block. As physicians advocate for a permanent fix to the Sustainable Growth Rate Formula and medical liability reform(among other things), here’s a look at what you can expect from committee members concerning the issues that matter to you.

Co-Chair: Senator Patty Murray (D-Wash.)

Courtesy Sen. Murray

As a supporter of the Affordable Care Act (ACA), Sen. Murray (@SenMurrayPress) advocates for expanding access to health care, including increasing mental health coverage and the use of health technology. She also supports decreasing long-term health costs through preventive care.

She has experience in handling budget and spending issues after serving on the Senate Budget Committee and the Appropriations Committee. She is currently the chair of the Appropriations Subcommittee on Transportation. Click here to learn more.

Health-related legislation: Sen. Murray has sponsored several health-related bills including legislation to increase awareness of emergency contraception, and a bill to improve mental health services for the military.

Co-chair: Rep. Jeb Hensarling (R-Tex.)

Courtesy Rep. Hensarling

Rep. Hensarling (@RepHensarling)  has a background in economics and previously served on the Congressional Oversight Panel for the Troubled Asset Relief Program (TARP) and on the President’s Debt Commission.

Rep. Hensarling has maintained a conservative voting record and opposed the ACA, calling it a “travesty.” He advocates for limited government, including arguing against the expansion of Medicare, Medicaid, and Social Security. He currently serves as the chairman of the House Republican Conference and as vice-chairman of the House Financial Services Committee. Click here to learn more.

Health-related legislation: Sen. Harling has cosponsored legislation to repeal the ACA (H.R. 4903, H.R.4919,  and H.R.4972). He has also cosponsored H.R. 3217, to allow Americans to purchase health insurance across state lines, and H.R. 1086 to enact medical liability reform.

Other members of the Joint Select Committee on Deficit Reduction include:

Sen. Max Baucus (D-Mont.)

Courtesy Sen. Baucus

A long-time supporter of the ACA, Sen. Baucus (@MaxedBaucus) supports expanding Medicaid and Medicare benefits, increasing preventive services, and closing the prescription drug coverage gap under Medicare Part D. He also supports programs to provide access to health care for displaced workers, farmers, and ranchers. He has advocated to increase funding for the Children’s Health Insurance Program (CHIP) and is the chairman of the Senate Finance Committee. Click here to learn more.

Sen. John Kerry (D-Mass.)

Courtesy Sen. Kerry

Sen. Kerry (@JohnKerry) has been a steady advocate for expanding health coverage for children. He has also been behind legislation to improve funding for hospitals as well as consumer protection in the Medigap marketplace. A supporter of the ACA, Sen. Kerry also has worked to improve and expand access to health care in his own state, which functions under a single-payer system. In 2010, Sen. Kerry worked to provide incentives for small businesses to offer health insurance for their workers. He is chairman of the Senate Foreign Relations Committee. Click here to learn more.

Sen. Jon Kyl (R-Ariz.)

Courtesy Sen. Kyl

Sen. Kyl (@SenJonKyl) supports repealing the ACA, maintaining the belief that the law takes decision-making away from physicians and patients and puts it in the hands of the government. He also advocates for medical liability reform, the purchase of health insurance across state lines, and expanding coverage through improving the system of health spending and flexible spending accounts. He currently serves on the Senate Finance Committee. Click here for more on his preferred approach to health care reform.

Sen. Pat Toomey (R-Pa.)

Courtesy Sen. Toomey

Sen. Toomey (@SenToomey) cosponsored the bill the repeal the ACA. In an op-ed piece, Sen. Toomey voiced support for individuals purchasing health insurance, as opposed to an employer-based system, as well as purchasing coverage across state lines. He also supports the need for medial liability reform and federal regulations to allow small businesses and organizations to purchase health insurance on behalf of their members. He sees this as a path to decreasing costs and increasing competition. Click here to learn more.

Sen. Rob Portman (R-Ohio)

Courtesy of Sen. Portman

Sen. Portman (@robportman) does not support the ACA. He argues that the health care law increases costs for employers, making it more difficult for them to hire workers. Sen. Portman has voiced his support for expanding health savings accounts, purchasing health insurance across state lines, implementing tort reform, and encouraging medical innovation. Click here to learn more.

Rep. Xavier Becerra (D-Calif.)

Courtesy Rep. Becerra

Rep. Becerra (@RepBecerra) has spoken out in ardent support of the ACA, calling it “transformative.” He has advocated for the expansion of Medicare, Medicaid, and CHIP. In 2010, Rep. Becerra was recognized by the California Hospital Association as  a “health care champion” for his work to preserve $3 billion in Medicare funds  for hospitals in California.  Click here to learn more.

Rep. Dave Camp (R-Mich.)

Courtesy Rep. Camp

Rep. Camp (@RepDaveCamp) is the chairman of the House Ways and Means Committee. He was the first to introduce a bill to repeal the ACA, although he has supported certain aspects of the law including providing affordable coverage for individuals with pre-existing conditions.   Rep. Camp submitted his own alternative to the health care law, which he says will lower to cost of care without raising taxes or cutting Medicare. Click here to learn more.

Rep. Jim Clyburn (D-S.C.)

Courtesy Rep. Clyburn

Rep. Clyburn (@Clyburn) was one of the main advocates for the passage of the ACA. He previously voted against capping damages in medical liability suits. Rep. Clyburn  also supports the expansion of Medicare, Medicaid, and CHIP, as well as negotiating prices for prescription drugs covered under Medicare Part D. Click here to learn more.

Rep. Fred Upton (R-Mich.)

Courtesy Rep. Upton

Rep. Upton (@RepFredUpton) advocates for repealing the ACA, expanding health savings accounts, allowing the purchase of coverage across state lines, and implementing medical liability reform. He has also spoken out against the Independent Payment Advisory Board (IPAB), an 15-person appointed board that will be tasked with reducing costs to Medicare, without affecting quality or coverage. IPAB opponents say it could take aim at reimbursements to health professionals, who already face a 30% pay cut in January. Rep. Upton serves as chairman of the House Committee on Energy and Commerce.

Rep. Chris Van Hollen (D-Md.)

Courtesy Rep. Van Hollen

Rep. Van Hollen (@ChrisVanHollen)  supports the IPAB, saying it is a tool that ensures the solvency of Medicare. He has also argued against raising the age Medicare eligibility. In a recent interview with National Public Radio, Rep. Van Hollen said the government should improve incentives for doctors and hospitals to provide quality care. Rep. Van Hollen serves as ranking member of the House Budget Committee. Click here to learn more.

–Frances Correa (@FMCReporting on Twitter)

Research for this article was gathered from the following sources: govtrack.com, PRNewswire, Senate websites, House websites, politifact.com, ohiogop.com, ontheissues.org, politico.com, and npr.org

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Docs Brace for Cuts: The Policy & Practice Podcast

image courtesy of iStock

The ink may be dry on the debt ceiling and deficit reduction agreement, but there are still plenty of questions about what it will mean for doctors. The plan to cut trillions in federal spending did not address the Sustainable Growth Rate formula (SGR), the loathed payment formula used to set Medicare physician fees. On Jan. 1, 2012, physician payments are slated to be cut by 30% because of the SGR. Some physicians say that without congressional action to avert the scheduled cut, access to health care could be in jeopardy.

Meanwhile, the debt agreement set up a bipartisan committee that will recommend additional spending cuts. This committee could take aim at Medicare, Medicaid, and the Affordable Care Act.

In other bad news for physicians, a new study in the journal Health Affairs shows that American doctors spend nearly $83,000 per year to deal with health plans and paperwork. That’s four times what their counterparts in Canada spend. For details on this and more, check out the Aug. 8 edition of the Policy & Practice Podcast.

Take a listen and share your thoughts.


The Policy & Practice team will be taking a short summer break, but check back on Aug. 22 for all the latest news on health reform and what it means for you.

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Lawmakers Agree on Debt Plan: The Policy & Practice Podcast

After weeks of contentious debate, lawmakers have finally reached an agreement to raise the nation’s borrowing limit. The plan includes cuts to lower the deficit by about $1 trillion over 10 years and creation of a committee to determine future cuts. The plan did not address the Sustainable Growth Rate formula and the committee could potentially reduce physician pay under Medicare and Medicaid. Congress is expected to vote on the plan today or tomorrow.

Photo courtesy of iStock

While the details of further cuts remains unclear, federal economists released their predictions on the growth of U.S. health care spending. Not surprisingly, health spending growth was low last year, due to the impact of the recession. And even in 2014, when many Affordable Care Act provisions kick in, the rate of spending growth is predicted to be just 2%  over the average annual growth rate for the rest of the decade.

In related news, a repeal to the unpopular Independent Payment Advisory board has gained bipartisan support. For details on that and more, listen to this week’s Policy & Practice podcast.


Check back next week for more on the fallout from the debt agreement and health reform implementation.

—Frances Correa (@FMCReporting on Twitter)

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Fixing the SGR: The Policy & Practice Podcast

Doctors know that the Medicare physician payment system is broken. Lawmakers know it. Maybe even some patients know it, too.

The problem is how to fix it so that it doesn’t bust the federal budget. And if lawmakers choose to replace the Sustainable Growth Rate (SGR) formula, which is currently used to determine physician payments under Medicare, they will face another challenge: choosing a new formula that won’t create the same problems in a few years.

Medicare payments could fall off a cliff if Congress doesn't act this year. Image via Wikimedia from User Urban.

The Medicare Payment Advisory Commission, which advises Congress on all things Medicare, has come out with a new report that outlines several alternatives to the SGR. In its report, MedPAC tells lawmakers that by replacing the SGR with a structure that doesn’t have scheduled payment cuts to doctors, they would have the chance to adopt other payment changes that could save the system money.

For example, in exchange for across-the-board pay increases to physicians, Medicare officials could reduce payments for specific services that are overpriced, they wrote. Or they could shift payments away from procedures and toward services that promote care coordination and population health.

Get all the details on the SGR, Medicaid reform options, and the 2012 GOP presidential field in this week’s Policy & Practice podcast.

Take a listen:


And check back throughout the week for all the policy news out of the American Medical Association’s House of Delegates meeting.

— Mary Ellen Schneider (on Twitter @MaryEllenNY)

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AMA Delegates Talk Mandate: The Policy & Practice Podcast

Physicians at the AMA House of Delegates meeting on Sunday spent almost 3 hours debating whether the AMA should continue to support the so-called individual mandate. That mandate, which is part of the Affordable Care Act, would require Americans to purchase health insurance coverage.

Delegates in line to talk mandates. Photo by Alicia Ault

On the pro side, physicians argued that having health insurance had been shown to equate with longer and healthier lives. On the con side, many doctors said that the mandate would take away individual freedom and possibly result in the collapse of the insurance market.

Elsewhere at the meeting, physicians talked about gay marriage and civil unions, whether Medicaid should be converted to a block grant program.  They also discussed a physician’s right to counsel patients about gun use.

For more, take a listen to this special edition of the Policy & Practice Podcast.


– Alicia Ault (on Twitter @aliciaault)

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Docs Boo ACO Regs: The Policy & Practice Podcast

As the comment period wraps up for the proposed regulations on Affordable Care Organizations, health providers don’t seem to be biting. They’ve characterized the regulations as being too restrictive, discouraging to small physician groups, and lacking enough financial incentives.

CMS administrator Dr. Don Berwick said provider input will help to improve the final ACO regulations. Photo by Frances Correa

Meanwhile, the Centers for Medicare and Medicaid Services is working to add enrollees to the joint state and federal Pre-existing Condition Insurance Plan. Only 18,313 people have signed up so far, compared to the about 100,000 people with pre-existing conditions who lack health care coverage. Now, the government is cutting premiums by 40% and easing enrollment requirements.

For more on that and legal challenges facing the health reform law, check out this week’s Policy & Practice Podcast.


— Frances Correa (on Twitter @FMCReporting)

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House Talks Medicaid, Malpractice, and More: The Policy and Practice Podcast

House Republicans and Democrats debated legislation concerning Medicaid, malpractice suits, and alternatives to the Sustainable Growth Rate (SGR) this week.

Despite repeated attempts by the Democrats to exempt certain groups, the Health subcommittee of the House Energy and Commerce Committee passed a bill, H.R. 1683, that would repeal the Maintenance of Effort Provisions of the Affordable Care Act. The bill would give governors the power to change Medicaid eligibility requirements.

From Wikimedia Commons User: Nino Barbieri

The full committee also voted to back a bill, H.R. 5, that would set limitations on filing, damages awarded, and fees related to malpractice suits.

The House Ways and Means Committee looked at alternatives to the SGR, discussing alternative payment models and the elimination of the Independent Payment Advisory Board.

For more on that, and on the Fourth Circuit Court of Appeals  consideration of the health reform law’s constitutionality, listen to this week’s installment of the Policy & Practice Podcast.


Let us know what you think.

— Frances Correa (on Twitter @FMCReporting)

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GOP Budget Passes the House: The Policy & Practice Podcast

The House passed the controversial GOP budget plan Friday. The plan,  proposed by Rep. Paul Ryan (R-Wis.), delegates Medicaid to the states in the form of block grants. It also would basically privatize Medicare for everyone who is younger than 55 today.  President Obama said the plan will end Medicare as we know it.  He brought forward his own deficit-reduction plan, which he said would get the country back on track within 12 years.

Gov. Haley Barbour said Republican governors will present their recommendation on health care reform to Congress in May. Photo by Alicia Ault

Meanwhile, Republican governors are working up their own recommendations on health reform, which, according to Mississippi Governor Haley Barbour, would include a repeal of the Affordable Care Act.

Listen to this week’s Policy & Practice podcast to hear more. Stay tuned for more updates on May 2, after Congress returns from its two-week break.


–Frances Correa

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Medicare Takes on Fraud: The Policy & Practice Podcast

Hey, loyal listeners! Your Policy & Practice Podcast this week features Dr. Don Berwick talking about the beefed up fraud-fighting tools provided by the Affordable Care Act. Instead of reacting to fraudulent efforts, the new tools will help his agency prevent fraud, according to the good doctor.  Listen to his comments here:


Also, in this installment: The election and a looming SGR cut have doctors concerned as well. Do you think Congress will do anything to prevent your Medicare pay from being cut on Dec. 1? Add your thoughts to the comments section.

—Denise Fulton (@denisefulton on Twitter)

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