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Obama Gets Health Team in Place
President Obama has now filled several of the major positions on his health care team. They include former Kansas governor Kathleen Sebelius as Health and Human Services secretary, former New York City health commissioner Dr. Thomas Frieden as Centers for Disease Control and Prevention director, and another former New York City health commissioner, Dr. Margaret Hamburg, as Food and Drug Administration commissioner. Ms. Sebelius, a former insurance commissioner, was chosen in part for her health insurance expertise, while Dr. Frieden is well known as a crusader for various public health causes, such as decreasing the number of people who smoke and removing trans fats from restaurant food. Dr. Hamburg is respected for her work on a multidrug-resistant tuberculosis outbreak in New York.
AACE Issues Conflict Statement
The American Association of Clinical Endocrinologists has issued a position statement on conflicts of interest for association members. The statement asserts that “the appearance of conflict of interest can have damaging effects to the integrity of the association. In some situations, a relationship with industry or another organization may alter a board/council/committee/task force member's perspective without any awareness by that individual of any loss of objectivity.” However, the statement continues, “everyone who is in a position to control the content of an educational activity must disclose all relevant financial relationships. … The intent of this disclosure is not to prevent a speaker with commercial affiliations from presenting, but rather to provide learners with information from which they may make their own judgments. Informed learners are the final safeguards in [ensuring] that a continuing medical education activity is independent from commercial influence.” The full statement can be found online at
Diabetes Drug Costs Rise
Spending for diabetes drugs increased 10% in 2008, according to a report from Medco Health Solutions, a mail-order pharmacy company. The increase in diabetes drug costs was smaller than that for selected neurologic drugs (18%) but larger than for respiratory drugs (6%). The report notes that the diabetes epidemic continues to grow, as does the number of Americans with prediabetes, currently estimated at 57 million. “Fifty-seven million people with prediabetes represent an enormous future burden on our health care system,” the report says. It concluded that “obesity-related onset of diabetes is likely to be a major contributor to the rapid utilization growth of diabetes drugs over the next several years.”
Many Don't Have Glycemic Control
About 55% of American adults with diabetes had their blood sugar and cholesterol levels under control in 2006, according to data from the Agency for Healthcare Research and Quality. About 59% had their BP under control, with improvement in that category among certain ethnic groups—for instance, the percentage of blacks with diabetes who had their blood pressure under control increased from 39% in 2002 to 58% in 2006. An estimated 6 million Americans have undiagnosed diabetes, the report notes.
New Web Site Pushes Reform
Doctors for America, a grassroots physician organization, is launching a campaign to get physicians' voices heard on health care reform. The “Voices of Physicians” campaign has collected and published comments from doctors nationwide at
Obama Gets Health Team in Place
President Obama has now filled several of the major positions on his health care team. They include former Kansas governor Kathleen Sebelius as Health and Human Services secretary, former New York City health commissioner Dr. Thomas Frieden as Centers for Disease Control and Prevention director, and another former New York City health commissioner, Dr. Margaret Hamburg, as Food and Drug Administration commissioner. Ms. Sebelius, a former insurance commissioner, was chosen in part for her health insurance expertise, while Dr. Frieden is well known as a crusader for various public health causes, such as decreasing the number of people who smoke and removing trans fats from restaurant food. Dr. Hamburg is respected for her work on a multidrug-resistant tuberculosis outbreak in New York.
AACE Issues Conflict Statement
The American Association of Clinical Endocrinologists has issued a position statement on conflicts of interest for association members. The statement asserts that “the appearance of conflict of interest can have damaging effects to the integrity of the association. In some situations, a relationship with industry or another organization may alter a board/council/committee/task force member's perspective without any awareness by that individual of any loss of objectivity.” However, the statement continues, “everyone who is in a position to control the content of an educational activity must disclose all relevant financial relationships. … The intent of this disclosure is not to prevent a speaker with commercial affiliations from presenting, but rather to provide learners with information from which they may make their own judgments. Informed learners are the final safeguards in [ensuring] that a continuing medical education activity is independent from commercial influence.” The full statement can be found online at
Diabetes Drug Costs Rise
Spending for diabetes drugs increased 10% in 2008, according to a report from Medco Health Solutions, a mail-order pharmacy company. The increase in diabetes drug costs was smaller than that for selected neurologic drugs (18%) but larger than for respiratory drugs (6%). The report notes that the diabetes epidemic continues to grow, as does the number of Americans with prediabetes, currently estimated at 57 million. “Fifty-seven million people with prediabetes represent an enormous future burden on our health care system,” the report says. It concluded that “obesity-related onset of diabetes is likely to be a major contributor to the rapid utilization growth of diabetes drugs over the next several years.”
Many Don't Have Glycemic Control
About 55% of American adults with diabetes had their blood sugar and cholesterol levels under control in 2006, according to data from the Agency for Healthcare Research and Quality. About 59% had their BP under control, with improvement in that category among certain ethnic groups—for instance, the percentage of blacks with diabetes who had their blood pressure under control increased from 39% in 2002 to 58% in 2006. An estimated 6 million Americans have undiagnosed diabetes, the report notes.
New Web Site Pushes Reform
Doctors for America, a grassroots physician organization, is launching a campaign to get physicians' voices heard on health care reform. The “Voices of Physicians” campaign has collected and published comments from doctors nationwide at
Obama Gets Health Team in Place
President Obama has now filled several of the major positions on his health care team. They include former Kansas governor Kathleen Sebelius as Health and Human Services secretary, former New York City health commissioner Dr. Thomas Frieden as Centers for Disease Control and Prevention director, and another former New York City health commissioner, Dr. Margaret Hamburg, as Food and Drug Administration commissioner. Ms. Sebelius, a former insurance commissioner, was chosen in part for her health insurance expertise, while Dr. Frieden is well known as a crusader for various public health causes, such as decreasing the number of people who smoke and removing trans fats from restaurant food. Dr. Hamburg is respected for her work on a multidrug-resistant tuberculosis outbreak in New York.
AACE Issues Conflict Statement
The American Association of Clinical Endocrinologists has issued a position statement on conflicts of interest for association members. The statement asserts that “the appearance of conflict of interest can have damaging effects to the integrity of the association. In some situations, a relationship with industry or another organization may alter a board/council/committee/task force member's perspective without any awareness by that individual of any loss of objectivity.” However, the statement continues, “everyone who is in a position to control the content of an educational activity must disclose all relevant financial relationships. … The intent of this disclosure is not to prevent a speaker with commercial affiliations from presenting, but rather to provide learners with information from which they may make their own judgments. Informed learners are the final safeguards in [ensuring] that a continuing medical education activity is independent from commercial influence.” The full statement can be found online at
Diabetes Drug Costs Rise
Spending for diabetes drugs increased 10% in 2008, according to a report from Medco Health Solutions, a mail-order pharmacy company. The increase in diabetes drug costs was smaller than that for selected neurologic drugs (18%) but larger than for respiratory drugs (6%). The report notes that the diabetes epidemic continues to grow, as does the number of Americans with prediabetes, currently estimated at 57 million. “Fifty-seven million people with prediabetes represent an enormous future burden on our health care system,” the report says. It concluded that “obesity-related onset of diabetes is likely to be a major contributor to the rapid utilization growth of diabetes drugs over the next several years.”
Many Don't Have Glycemic Control
About 55% of American adults with diabetes had their blood sugar and cholesterol levels under control in 2006, according to data from the Agency for Healthcare Research and Quality. About 59% had their BP under control, with improvement in that category among certain ethnic groups—for instance, the percentage of blacks with diabetes who had their blood pressure under control increased from 39% in 2002 to 58% in 2006. An estimated 6 million Americans have undiagnosed diabetes, the report notes.
New Web Site Pushes Reform
Doctors for America, a grassroots physician organization, is launching a campaign to get physicians' voices heard on health care reform. The “Voices of Physicians” campaign has collected and published comments from doctors nationwide at
Consensus Document Defines 'Meaningful Use'
WASHINGTON — Just what exactly does “meaningful use” mean?
It sounds like a simple question, but there's a lot of money riding on the answer. The Recovery Act, formally known as the American Recovery and Reinvestment Act, stipulates that for a physician to receive up to $44,000 in financial incentives for purchasing an electronic health record, the record must be put to “meaningful use.” Now the government has to come up with a definition of the term.
At a subcommittee meeting of the National Committee on Vital and Health Statistics, which was convened to discuss meaningful use, several speakers explained why having more physicians adopt an electronic health record (EHR) was so valuable.
“The financial meltdown … has shown us how we as a nation need to totally transform the U.S. health care system,” said Helen Darling, president of the National Business Group on Health. “We have a fiscal crisis, not just a health crisis; we have to act urgently.”
Although everyone agreed that EHRs were valuable, speakers' definitions of “meaningful use” of them differed. “Meaningful use might vary by site of care as well as by type of care,” said Dr. David Classen of the Computer Sciences Corporation, whereas Dr. John Halamka of the Health Information Technology Standards Panel, a government-funded group that helps ensure EHR interoperability, said his definition of meaningful use was “processes and workflows that facilitate improved quality and increased efficiency.”
Several panelists agreed that EHRs had to allow for three things in order to be used meaningfully: electronic prescribing, interoperability with other computers, and reporting on health care quality measures. EHRs are particularly useful for reporting quality measures because they are a direct source of information and provide very timely data, said Dr. Michael Rapp of the Centers for Medicare and Medicaid Services.
Experts at the meeting also agreed in general that EHR systems need to be certified by a government-approved organization such as the Certification Commission for Healthcare Information Technology to meet the Recovery Act's requirements. However, certification alone is not sufficient, because many parts of a certified EHR are not necessarily implemented, said Dr. Floyd Eisenberg, senior vice-president for health information technology at the National Quality Forum, which sets goals for performance improvement.
The day after the subcommittee's 2-day meeting concluded, the Markle Foundation held a press conference to release a consensus document on the definition of meaningful use. The document was endorsed by a number of provider and advocacy groups, America's Health Insurance Plans, and the National Committee for Quality Assurance.
The consensus document provides a “simple” definition of patient-centered meaningful use: “The provider makes use of, and the patient has access to, clinically relevant electronic information about the patient to improve patient outcomes and health status, improve the delivery of care, and control the growth of costs.”
The document lists slightly different meaningful use requirements for the first 2 years, however; during that time period meaningful use would be when “the provider makes use of, and the patient has access to, clinically relevant electronic information about the patient to improve medication management and coordination of care.”
The consensus document is available at www.markle.org/downloadable_assets/20090430_meaningful_use.pdf
EHRs are useful for reporting quality measures because they are a direct source of information. DR. RAPP
WASHINGTON — Just what exactly does “meaningful use” mean?
It sounds like a simple question, but there's a lot of money riding on the answer. The Recovery Act, formally known as the American Recovery and Reinvestment Act, stipulates that for a physician to receive up to $44,000 in financial incentives for purchasing an electronic health record, the record must be put to “meaningful use.” Now the government has to come up with a definition of the term.
At a subcommittee meeting of the National Committee on Vital and Health Statistics, which was convened to discuss meaningful use, several speakers explained why having more physicians adopt an electronic health record (EHR) was so valuable.
“The financial meltdown … has shown us how we as a nation need to totally transform the U.S. health care system,” said Helen Darling, president of the National Business Group on Health. “We have a fiscal crisis, not just a health crisis; we have to act urgently.”
Although everyone agreed that EHRs were valuable, speakers' definitions of “meaningful use” of them differed. “Meaningful use might vary by site of care as well as by type of care,” said Dr. David Classen of the Computer Sciences Corporation, whereas Dr. John Halamka of the Health Information Technology Standards Panel, a government-funded group that helps ensure EHR interoperability, said his definition of meaningful use was “processes and workflows that facilitate improved quality and increased efficiency.”
Several panelists agreed that EHRs had to allow for three things in order to be used meaningfully: electronic prescribing, interoperability with other computers, and reporting on health care quality measures. EHRs are particularly useful for reporting quality measures because they are a direct source of information and provide very timely data, said Dr. Michael Rapp of the Centers for Medicare and Medicaid Services.
Experts at the meeting also agreed in general that EHR systems need to be certified by a government-approved organization such as the Certification Commission for Healthcare Information Technology to meet the Recovery Act's requirements. However, certification alone is not sufficient, because many parts of a certified EHR are not necessarily implemented, said Dr. Floyd Eisenberg, senior vice-president for health information technology at the National Quality Forum, which sets goals for performance improvement.
The day after the subcommittee's 2-day meeting concluded, the Markle Foundation held a press conference to release a consensus document on the definition of meaningful use. The document was endorsed by a number of provider and advocacy groups, America's Health Insurance Plans, and the National Committee for Quality Assurance.
The consensus document provides a “simple” definition of patient-centered meaningful use: “The provider makes use of, and the patient has access to, clinically relevant electronic information about the patient to improve patient outcomes and health status, improve the delivery of care, and control the growth of costs.”
The document lists slightly different meaningful use requirements for the first 2 years, however; during that time period meaningful use would be when “the provider makes use of, and the patient has access to, clinically relevant electronic information about the patient to improve medication management and coordination of care.”
The consensus document is available at www.markle.org/downloadable_assets/20090430_meaningful_use.pdf
EHRs are useful for reporting quality measures because they are a direct source of information. DR. RAPP
WASHINGTON — Just what exactly does “meaningful use” mean?
It sounds like a simple question, but there's a lot of money riding on the answer. The Recovery Act, formally known as the American Recovery and Reinvestment Act, stipulates that for a physician to receive up to $44,000 in financial incentives for purchasing an electronic health record, the record must be put to “meaningful use.” Now the government has to come up with a definition of the term.
At a subcommittee meeting of the National Committee on Vital and Health Statistics, which was convened to discuss meaningful use, several speakers explained why having more physicians adopt an electronic health record (EHR) was so valuable.
“The financial meltdown … has shown us how we as a nation need to totally transform the U.S. health care system,” said Helen Darling, president of the National Business Group on Health. “We have a fiscal crisis, not just a health crisis; we have to act urgently.”
Although everyone agreed that EHRs were valuable, speakers' definitions of “meaningful use” of them differed. “Meaningful use might vary by site of care as well as by type of care,” said Dr. David Classen of the Computer Sciences Corporation, whereas Dr. John Halamka of the Health Information Technology Standards Panel, a government-funded group that helps ensure EHR interoperability, said his definition of meaningful use was “processes and workflows that facilitate improved quality and increased efficiency.”
Several panelists agreed that EHRs had to allow for three things in order to be used meaningfully: electronic prescribing, interoperability with other computers, and reporting on health care quality measures. EHRs are particularly useful for reporting quality measures because they are a direct source of information and provide very timely data, said Dr. Michael Rapp of the Centers for Medicare and Medicaid Services.
Experts at the meeting also agreed in general that EHR systems need to be certified by a government-approved organization such as the Certification Commission for Healthcare Information Technology to meet the Recovery Act's requirements. However, certification alone is not sufficient, because many parts of a certified EHR are not necessarily implemented, said Dr. Floyd Eisenberg, senior vice-president for health information technology at the National Quality Forum, which sets goals for performance improvement.
The day after the subcommittee's 2-day meeting concluded, the Markle Foundation held a press conference to release a consensus document on the definition of meaningful use. The document was endorsed by a number of provider and advocacy groups, America's Health Insurance Plans, and the National Committee for Quality Assurance.
The consensus document provides a “simple” definition of patient-centered meaningful use: “The provider makes use of, and the patient has access to, clinically relevant electronic information about the patient to improve patient outcomes and health status, improve the delivery of care, and control the growth of costs.”
The document lists slightly different meaningful use requirements for the first 2 years, however; during that time period meaningful use would be when “the provider makes use of, and the patient has access to, clinically relevant electronic information about the patient to improve medication management and coordination of care.”
The consensus document is available at www.markle.org/downloadable_assets/20090430_meaningful_use.pdf
EHRs are useful for reporting quality measures because they are a direct source of information. DR. RAPP
Medical Groups Pledge Cost Cuts to Obama
Leaders of several health care and labor organizations met with President Barack Obama at the White House on May 11 and proposed ideas to reduce the growth in health care costs by up to $2 trillion over the next decade.
In a letter sent to the president, the six organizations—the American Medical Association, the American Hospital Association, the Pharmaceutical Research and Manufacturers of America, the Advanced Medical Technology Association, America's Health Insurance Plans, and the Service Employees International Union—vowed to work as a group to help achieve the cost reduction. Among their proposals:
▸ Cutting costs by focusing on administrative simplification, standardization, and transparency.
▸ Reducing overuse and underuse of health care by aligning incentives so that physicians, hospitals, and other providers are encouraged to work together toward the highest standards of quality and efficiency.
▸ Encouraging coordinated care and adhering to evidence-based best practices and therapies that reduce hospitalization and manage chronic disease more effectively.
▸ Implementing proven prevention strategies.
▸ Making common-sense improvements in care delivery, health information technology, workforce development, and regulatory reforms.
The American Medical Association told the president that although evidence-based guidelines will be helpful in reducing costs, the reductions could be enhanced if physicians had more liability protection.
“For example, if everyone who walks into the emergency room gets an MRI for a headache, it's a costly procedure,” Dr. J. James Rohack, AMA president-elect, said in an interview. “We know that in some areas of the country [that test has] been done because people sued when they didn't get the test. If we create scientifically based guidelines that say not everyone needs to have the MRI for a headache, physicians have got to have liability protection so they don't get sued if they follow that guideline.”
Dr. Rohack said he felt the president heard what the AMA was conveying. “Clearly the message of defensive medicine costing dollars in the health care system was received, as was the recognition that prior attempts at tort liability by just creating global caps hasn't been successful. We are going to have to work at other creative ways of achieving the goal.”
The president called the White House meeting historic. “[This is] a watershed event in the long and elusive quest for health care reform,” he said after the gathering. “And as these groups take the steps they are outlining, and as we work with Congress on health care reform legislation, my administration will continue working to reduce health care costs to achieve similar savings.”
Reaction to the meeting varied.
“If the savings described today truly occur, this may be one of the most significant developments in promoting meaningful health care reform,” Ron Pollack, executive director of Families USA, a liberal consumer health organization, said in a statement.
“These savings would cut projected health care costs for families and businesses, and they would enable adequate subsidies to be offered so that everyone has access to high-quality, affordable health care.”
Others were less impressed. “We are very cautious about the particulars of the voluntary effort that groups proposed to the White House,” said a statement from the National Coalition on Health Care, a progressive advocacy group. “Most of the measures that they cited would help to make the health care system more efficient over time, but, as the Congressional Budget Office has indicated, should not be counted on to produce substantial savings soon. … We are heartened by the sector's growing acceptance of responsibility to engage constructively in a search for solutions, but we believe that those solutions will need to be embodied in law,” the group said in its statement.
Further, Rep. Michael Burgess (R-Tex.) noted that although he was glad the groups were trying to work together, they weren't taking the correct approach.
“From what I can tell, the announcement by the health industry leaders misses the mark in several areas,” he said in a statement. “It promises no protections against a Washington takeover of health care, no guarantees that Washington bureaucrats won't stand in the way of Americans getting the treatment they need when they need it, no promises that patients will be able to control their health care decisions, and no assurances that Americans will have their choice of doctors or hospitals. Until more details are revealed, I would encourage Americans to be circumspect about today's announcement.”
President Obama (left) called the White house meeting “a watershed event in the long and elusive quest for health care reform.” OFFICIAL WHITE HOUSE PHOTO BY PETE SOUZA
Leaders of several health care and labor organizations met with President Barack Obama at the White House on May 11 and proposed ideas to reduce the growth in health care costs by up to $2 trillion over the next decade.
In a letter sent to the president, the six organizations—the American Medical Association, the American Hospital Association, the Pharmaceutical Research and Manufacturers of America, the Advanced Medical Technology Association, America's Health Insurance Plans, and the Service Employees International Union—vowed to work as a group to help achieve the cost reduction. Among their proposals:
▸ Cutting costs by focusing on administrative simplification, standardization, and transparency.
▸ Reducing overuse and underuse of health care by aligning incentives so that physicians, hospitals, and other providers are encouraged to work together toward the highest standards of quality and efficiency.
▸ Encouraging coordinated care and adhering to evidence-based best practices and therapies that reduce hospitalization and manage chronic disease more effectively.
▸ Implementing proven prevention strategies.
▸ Making common-sense improvements in care delivery, health information technology, workforce development, and regulatory reforms.
The American Medical Association told the president that although evidence-based guidelines will be helpful in reducing costs, the reductions could be enhanced if physicians had more liability protection.
“For example, if everyone who walks into the emergency room gets an MRI for a headache, it's a costly procedure,” Dr. J. James Rohack, AMA president-elect, said in an interview. “We know that in some areas of the country [that test has] been done because people sued when they didn't get the test. If we create scientifically based guidelines that say not everyone needs to have the MRI for a headache, physicians have got to have liability protection so they don't get sued if they follow that guideline.”
Dr. Rohack said he felt the president heard what the AMA was conveying. “Clearly the message of defensive medicine costing dollars in the health care system was received, as was the recognition that prior attempts at tort liability by just creating global caps hasn't been successful. We are going to have to work at other creative ways of achieving the goal.”
The president called the White House meeting historic. “[This is] a watershed event in the long and elusive quest for health care reform,” he said after the gathering. “And as these groups take the steps they are outlining, and as we work with Congress on health care reform legislation, my administration will continue working to reduce health care costs to achieve similar savings.”
Reaction to the meeting varied.
“If the savings described today truly occur, this may be one of the most significant developments in promoting meaningful health care reform,” Ron Pollack, executive director of Families USA, a liberal consumer health organization, said in a statement.
“These savings would cut projected health care costs for families and businesses, and they would enable adequate subsidies to be offered so that everyone has access to high-quality, affordable health care.”
Others were less impressed. “We are very cautious about the particulars of the voluntary effort that groups proposed to the White House,” said a statement from the National Coalition on Health Care, a progressive advocacy group. “Most of the measures that they cited would help to make the health care system more efficient over time, but, as the Congressional Budget Office has indicated, should not be counted on to produce substantial savings soon. … We are heartened by the sector's growing acceptance of responsibility to engage constructively in a search for solutions, but we believe that those solutions will need to be embodied in law,” the group said in its statement.
Further, Rep. Michael Burgess (R-Tex.) noted that although he was glad the groups were trying to work together, they weren't taking the correct approach.
“From what I can tell, the announcement by the health industry leaders misses the mark in several areas,” he said in a statement. “It promises no protections against a Washington takeover of health care, no guarantees that Washington bureaucrats won't stand in the way of Americans getting the treatment they need when they need it, no promises that patients will be able to control their health care decisions, and no assurances that Americans will have their choice of doctors or hospitals. Until more details are revealed, I would encourage Americans to be circumspect about today's announcement.”
President Obama (left) called the White house meeting “a watershed event in the long and elusive quest for health care reform.” OFFICIAL WHITE HOUSE PHOTO BY PETE SOUZA
Leaders of several health care and labor organizations met with President Barack Obama at the White House on May 11 and proposed ideas to reduce the growth in health care costs by up to $2 trillion over the next decade.
In a letter sent to the president, the six organizations—the American Medical Association, the American Hospital Association, the Pharmaceutical Research and Manufacturers of America, the Advanced Medical Technology Association, America's Health Insurance Plans, and the Service Employees International Union—vowed to work as a group to help achieve the cost reduction. Among their proposals:
▸ Cutting costs by focusing on administrative simplification, standardization, and transparency.
▸ Reducing overuse and underuse of health care by aligning incentives so that physicians, hospitals, and other providers are encouraged to work together toward the highest standards of quality and efficiency.
▸ Encouraging coordinated care and adhering to evidence-based best practices and therapies that reduce hospitalization and manage chronic disease more effectively.
▸ Implementing proven prevention strategies.
▸ Making common-sense improvements in care delivery, health information technology, workforce development, and regulatory reforms.
The American Medical Association told the president that although evidence-based guidelines will be helpful in reducing costs, the reductions could be enhanced if physicians had more liability protection.
“For example, if everyone who walks into the emergency room gets an MRI for a headache, it's a costly procedure,” Dr. J. James Rohack, AMA president-elect, said in an interview. “We know that in some areas of the country [that test has] been done because people sued when they didn't get the test. If we create scientifically based guidelines that say not everyone needs to have the MRI for a headache, physicians have got to have liability protection so they don't get sued if they follow that guideline.”
Dr. Rohack said he felt the president heard what the AMA was conveying. “Clearly the message of defensive medicine costing dollars in the health care system was received, as was the recognition that prior attempts at tort liability by just creating global caps hasn't been successful. We are going to have to work at other creative ways of achieving the goal.”
The president called the White House meeting historic. “[This is] a watershed event in the long and elusive quest for health care reform,” he said after the gathering. “And as these groups take the steps they are outlining, and as we work with Congress on health care reform legislation, my administration will continue working to reduce health care costs to achieve similar savings.”
Reaction to the meeting varied.
“If the savings described today truly occur, this may be one of the most significant developments in promoting meaningful health care reform,” Ron Pollack, executive director of Families USA, a liberal consumer health organization, said in a statement.
“These savings would cut projected health care costs for families and businesses, and they would enable adequate subsidies to be offered so that everyone has access to high-quality, affordable health care.”
Others were less impressed. “We are very cautious about the particulars of the voluntary effort that groups proposed to the White House,” said a statement from the National Coalition on Health Care, a progressive advocacy group. “Most of the measures that they cited would help to make the health care system more efficient over time, but, as the Congressional Budget Office has indicated, should not be counted on to produce substantial savings soon. … We are heartened by the sector's growing acceptance of responsibility to engage constructively in a search for solutions, but we believe that those solutions will need to be embodied in law,” the group said in its statement.
Further, Rep. Michael Burgess (R-Tex.) noted that although he was glad the groups were trying to work together, they weren't taking the correct approach.
“From what I can tell, the announcement by the health industry leaders misses the mark in several areas,” he said in a statement. “It promises no protections against a Washington takeover of health care, no guarantees that Washington bureaucrats won't stand in the way of Americans getting the treatment they need when they need it, no promises that patients will be able to control their health care decisions, and no assurances that Americans will have their choice of doctors or hospitals. Until more details are revealed, I would encourage Americans to be circumspect about today's announcement.”
President Obama (left) called the White house meeting “a watershed event in the long and elusive quest for health care reform.” OFFICIAL WHITE HOUSE PHOTO BY PETE SOUZA
Medicare Panel Debates Genetic Test Coverage
BALTIMORE — If Medicare pays for genetic tests, what criteria should it use to decide which to cover?
That was one of the questions tackled by a Medicare Evidence Development and Coverage Advisory Committee panel at a May meeting. The 17-member panel included an ethicist, a patient advocate, representatives from the insurance and genetic-testing industries, and experts in cancer, ophthalmology, and cardiology.
Panel members heard presentations on various aspects of genetic testing. Dr. W. Gregory Feero, senior adviser to the director of genomic medicine at the National Human Genome Research Institute, argued that a good family history was vital to deciding which patients should receive particular genetic tests. “Family history is still the cheapest, most time-tested way to get an idea of disease risk,” he said. “It also helps you understand family relationships and understand patients' concerns.”
Although several new practice guidelines call on physicians to collect family histories, “family history collection by primary care clinicians is actually quite poor,” said Dr. Feero, a board-certified family physician. “I would argue that it's going to get worse with [the advent of] electronic health records, as most systems are not well set up to enable clinicians to collect family health information.”
The Centers for Medicare and Medicaid Services seems to be conflicted on the genetic-testing issue, including its relationship to family history, he continued. On the one hand, at a meeting of the Secretary's Advisory Committee on Genetics, Health, and Society in March, Dr. Barry Straube, director of CMS's Office of Clinical Standards and Quality, said that Medicare does not cover genetic tests based on family history alone. “In the year 2009, [Medicare] may need to rethink this,” Dr. Feero said.
On the other hand, the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA) allows Medicare to consider covering diagnostic tests, as long as the test is reasonable and necessary and has been given a grade A or B recommendation from the U.S. Preventive Services Task Force, Dr. Feero noted. Currently, the only genetic test addressed by the USPSTF is the test for the BRCA1 or BRCA2 genetic mutations that increase the risk of breast cancer; however, the task force's guidance recommends only counseling about the test, and does not address how to decide whether the test should be given.
A panel member asked Dr. Feero if using family history to determine whether a beneficiary needs a genetic test would mean that the family history itself becomes the screening test. “That is why I [support] the idea of having a [procedure] code for family history,” Dr. Feero replied, adding that family history can mean different things in different contexts.
Panel members also heard from fellow panelist Dr. Steven Teutsch, chief science officer of the Los Angeles County Public Health Department. Dr. Teutsch is a member of the EGAPP (Evaluation of Genomic Applications in Practice and Prevention) working group, an independent body organized in 2004 by the Centers for Disease Control and Prevention to provide guidance on the appropriate use of genetic tests in clinical practice.
“At the end of the day, the question is whether genetic tests can modify outcomes,” he said. Dr. Teutsch also urged panel members to consider the potential harm caused by some of these tests, including labeling, anxiety, additional testing, and false reassurance from negative tests.
“For preventive applications for genomic tests, the bar should be high” for their use, he said. “We want to screen for something important [and] common, and [something] that you can do something about.”
During the public participation section of the meeting, Dr. Richard Wenstrup, chief medical officer of Myriad Genetics Inc., noted that guidelines on hereditary breast and ovarian cancer from the National Comprehensive Cancer Network recommend performing genetic testing on high-risk individuals.
He also said that an analysis of his company's own data for 2000-2009 showed that 5.6% of patients with deleterious mutations developed cancer after age 65. “It's presumable that if they had been identified and tested before developing the cancer, they could have taken preventive measures to reduce their risk,” he said.
Panel member Dr. Neil Holtzman, professor of public health at Johns Hopkins University in Baltimore, said that there had been confusion among some speakers about the definition of screening. He noted that a panel convened by the National Academy of Sciences during the 1970s had defined genetic screening as “a search in the population.”
“A number of speakers have concluded that [in] individuals who have been identified through family history but who are asymptomatic, availability or use of [genetic] tests is defined as screening,” Dr. Holtzman said. “I don't think that kind of testing is screening. It would save a lot of confusion if we defined screening as a search in the population … and not in a high-risk situation where there's a family history.”
Dr. Marcel Salive, director of the division of medical and surgical services within CMS's coverage and analysis group, said he agreed with Dr. Holtzman. “If we want to discuss how can we cover genetic tests for other than diagnostic purposes, we're going to have to discuss it here as a preventive service,” he said. “Can we change things in the future and recognize things differently? Sure. Congress just gave us this authority last year, and they may change it in the future, but currently the only way to cover this type of testing is as a preventive service.”
BALTIMORE — If Medicare pays for genetic tests, what criteria should it use to decide which to cover?
That was one of the questions tackled by a Medicare Evidence Development and Coverage Advisory Committee panel at a May meeting. The 17-member panel included an ethicist, a patient advocate, representatives from the insurance and genetic-testing industries, and experts in cancer, ophthalmology, and cardiology.
Panel members heard presentations on various aspects of genetic testing. Dr. W. Gregory Feero, senior adviser to the director of genomic medicine at the National Human Genome Research Institute, argued that a good family history was vital to deciding which patients should receive particular genetic tests. “Family history is still the cheapest, most time-tested way to get an idea of disease risk,” he said. “It also helps you understand family relationships and understand patients' concerns.”
Although several new practice guidelines call on physicians to collect family histories, “family history collection by primary care clinicians is actually quite poor,” said Dr. Feero, a board-certified family physician. “I would argue that it's going to get worse with [the advent of] electronic health records, as most systems are not well set up to enable clinicians to collect family health information.”
The Centers for Medicare and Medicaid Services seems to be conflicted on the genetic-testing issue, including its relationship to family history, he continued. On the one hand, at a meeting of the Secretary's Advisory Committee on Genetics, Health, and Society in March, Dr. Barry Straube, director of CMS's Office of Clinical Standards and Quality, said that Medicare does not cover genetic tests based on family history alone. “In the year 2009, [Medicare] may need to rethink this,” Dr. Feero said.
On the other hand, the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA) allows Medicare to consider covering diagnostic tests, as long as the test is reasonable and necessary and has been given a grade A or B recommendation from the U.S. Preventive Services Task Force, Dr. Feero noted. Currently, the only genetic test addressed by the USPSTF is the test for the BRCA1 or BRCA2 genetic mutations that increase the risk of breast cancer; however, the task force's guidance recommends only counseling about the test, and does not address how to decide whether the test should be given.
A panel member asked Dr. Feero if using family history to determine whether a beneficiary needs a genetic test would mean that the family history itself becomes the screening test. “That is why I [support] the idea of having a [procedure] code for family history,” Dr. Feero replied, adding that family history can mean different things in different contexts.
Panel members also heard from fellow panelist Dr. Steven Teutsch, chief science officer of the Los Angeles County Public Health Department. Dr. Teutsch is a member of the EGAPP (Evaluation of Genomic Applications in Practice and Prevention) working group, an independent body organized in 2004 by the Centers for Disease Control and Prevention to provide guidance on the appropriate use of genetic tests in clinical practice.
“At the end of the day, the question is whether genetic tests can modify outcomes,” he said. Dr. Teutsch also urged panel members to consider the potential harm caused by some of these tests, including labeling, anxiety, additional testing, and false reassurance from negative tests.
“For preventive applications for genomic tests, the bar should be high” for their use, he said. “We want to screen for something important [and] common, and [something] that you can do something about.”
During the public participation section of the meeting, Dr. Richard Wenstrup, chief medical officer of Myriad Genetics Inc., noted that guidelines on hereditary breast and ovarian cancer from the National Comprehensive Cancer Network recommend performing genetic testing on high-risk individuals.
He also said that an analysis of his company's own data for 2000-2009 showed that 5.6% of patients with deleterious mutations developed cancer after age 65. “It's presumable that if they had been identified and tested before developing the cancer, they could have taken preventive measures to reduce their risk,” he said.
Panel member Dr. Neil Holtzman, professor of public health at Johns Hopkins University in Baltimore, said that there had been confusion among some speakers about the definition of screening. He noted that a panel convened by the National Academy of Sciences during the 1970s had defined genetic screening as “a search in the population.”
“A number of speakers have concluded that [in] individuals who have been identified through family history but who are asymptomatic, availability or use of [genetic] tests is defined as screening,” Dr. Holtzman said. “I don't think that kind of testing is screening. It would save a lot of confusion if we defined screening as a search in the population … and not in a high-risk situation where there's a family history.”
Dr. Marcel Salive, director of the division of medical and surgical services within CMS's coverage and analysis group, said he agreed with Dr. Holtzman. “If we want to discuss how can we cover genetic tests for other than diagnostic purposes, we're going to have to discuss it here as a preventive service,” he said. “Can we change things in the future and recognize things differently? Sure. Congress just gave us this authority last year, and they may change it in the future, but currently the only way to cover this type of testing is as a preventive service.”
BALTIMORE — If Medicare pays for genetic tests, what criteria should it use to decide which to cover?
That was one of the questions tackled by a Medicare Evidence Development and Coverage Advisory Committee panel at a May meeting. The 17-member panel included an ethicist, a patient advocate, representatives from the insurance and genetic-testing industries, and experts in cancer, ophthalmology, and cardiology.
Panel members heard presentations on various aspects of genetic testing. Dr. W. Gregory Feero, senior adviser to the director of genomic medicine at the National Human Genome Research Institute, argued that a good family history was vital to deciding which patients should receive particular genetic tests. “Family history is still the cheapest, most time-tested way to get an idea of disease risk,” he said. “It also helps you understand family relationships and understand patients' concerns.”
Although several new practice guidelines call on physicians to collect family histories, “family history collection by primary care clinicians is actually quite poor,” said Dr. Feero, a board-certified family physician. “I would argue that it's going to get worse with [the advent of] electronic health records, as most systems are not well set up to enable clinicians to collect family health information.”
The Centers for Medicare and Medicaid Services seems to be conflicted on the genetic-testing issue, including its relationship to family history, he continued. On the one hand, at a meeting of the Secretary's Advisory Committee on Genetics, Health, and Society in March, Dr. Barry Straube, director of CMS's Office of Clinical Standards and Quality, said that Medicare does not cover genetic tests based on family history alone. “In the year 2009, [Medicare] may need to rethink this,” Dr. Feero said.
On the other hand, the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA) allows Medicare to consider covering diagnostic tests, as long as the test is reasonable and necessary and has been given a grade A or B recommendation from the U.S. Preventive Services Task Force, Dr. Feero noted. Currently, the only genetic test addressed by the USPSTF is the test for the BRCA1 or BRCA2 genetic mutations that increase the risk of breast cancer; however, the task force's guidance recommends only counseling about the test, and does not address how to decide whether the test should be given.
A panel member asked Dr. Feero if using family history to determine whether a beneficiary needs a genetic test would mean that the family history itself becomes the screening test. “That is why I [support] the idea of having a [procedure] code for family history,” Dr. Feero replied, adding that family history can mean different things in different contexts.
Panel members also heard from fellow panelist Dr. Steven Teutsch, chief science officer of the Los Angeles County Public Health Department. Dr. Teutsch is a member of the EGAPP (Evaluation of Genomic Applications in Practice and Prevention) working group, an independent body organized in 2004 by the Centers for Disease Control and Prevention to provide guidance on the appropriate use of genetic tests in clinical practice.
“At the end of the day, the question is whether genetic tests can modify outcomes,” he said. Dr. Teutsch also urged panel members to consider the potential harm caused by some of these tests, including labeling, anxiety, additional testing, and false reassurance from negative tests.
“For preventive applications for genomic tests, the bar should be high” for their use, he said. “We want to screen for something important [and] common, and [something] that you can do something about.”
During the public participation section of the meeting, Dr. Richard Wenstrup, chief medical officer of Myriad Genetics Inc., noted that guidelines on hereditary breast and ovarian cancer from the National Comprehensive Cancer Network recommend performing genetic testing on high-risk individuals.
He also said that an analysis of his company's own data for 2000-2009 showed that 5.6% of patients with deleterious mutations developed cancer after age 65. “It's presumable that if they had been identified and tested before developing the cancer, they could have taken preventive measures to reduce their risk,” he said.
Panel member Dr. Neil Holtzman, professor of public health at Johns Hopkins University in Baltimore, said that there had been confusion among some speakers about the definition of screening. He noted that a panel convened by the National Academy of Sciences during the 1970s had defined genetic screening as “a search in the population.”
“A number of speakers have concluded that [in] individuals who have been identified through family history but who are asymptomatic, availability or use of [genetic] tests is defined as screening,” Dr. Holtzman said. “I don't think that kind of testing is screening. It would save a lot of confusion if we defined screening as a search in the population … and not in a high-risk situation where there's a family history.”
Dr. Marcel Salive, director of the division of medical and surgical services within CMS's coverage and analysis group, said he agreed with Dr. Holtzman. “If we want to discuss how can we cover genetic tests for other than diagnostic purposes, we're going to have to discuss it here as a preventive service,” he said. “Can we change things in the future and recognize things differently? Sure. Congress just gave us this authority last year, and they may change it in the future, but currently the only way to cover this type of testing is as a preventive service.”
ICD-10 More Complicated Than ICD-9—but More Useful
WASHINGTON — The upcoming ICD-10 diagnosis and procedure coding system is more complicated than was its predecessor, ICD-9, but it will allow for a greater level of clinical detail and will be better able to keep up with advances in technology, according to several speakers at a meeting sponsored by the American Health Information Management Association.
“ICD-9 badly needs to be replaced,” said Nelly Leon-Chisen, director of coding and classification at the American Hospital Association. “It's 30 years old, and the terminology and classification of some conditions are obsolete.”
There are two parts to ICD-10, formally known as the International Classification of Diseases, 10th revision, which goes into effect in the United States on Oct. 1, 2013: ICD-10-CM, which is the clinical modification of the World Health Organization's ICD-10 diagnostic coding system; and ICD-10-PCS, an inpatient procedural coding system developed under contract to the Centers for Medicare and Medicaid Services.
ICD-10 “will have better data for evaluating and improving quality of care. It will provide codes for a more complete picture,” she added, noting that the new code set will allow health officials to be “better able to track and respond to global health threats.”
Because ICD-10 can more precisely document diagnoses and procedures, it will bring better justification of medical necessity for billing purposes, “but not from day 1,” said Ms. Leon-Chisen. “It will take a little while” for people to adjust to the new codes. The new system also may reduce opportunities for fraud, she added.
Ms. Leon-Chisen outlined a few basic differences between ICD-9 and ICD-10 diagnosis codes:
▸ ICD-9 codes contain three to five characters, whereas ICD-10 contains three to seven characters.
▸ In ICD-9 codes, the first character can be alphabetic or numeric, but in ICD-10, the first character is always alphabetic.
▸ ICD-10 codes can include the use of a placeholder “x,” whereas ICD-9 codes cannot.
Ms. Leon-Chisen gave an example to illustrate the differences between the two revisions. Under the ICD-9 coding system, a patient with a pressure ulcer on the right buttock might receive a diagnosis code of 707.05, “pressure ulcer, buttock.” Under ICD-10, the same patient would get L89.111, “decubitus ulcer of right buttock limited to breakdown of the skin.” A pressure ulcer on the left buttock or a more severe one including necrosis of the bone would get a different ICD-10 code.
Sue Bowman, director of coding policy and compliance for the American Health Information Management Association, noted that ICD-10-PCS can have even more complexities. For example, under ICD-9, there is only one code for artery repair; under ICD-10-PCS, there are 276 codes.
However, “once you work with it, you're struck by the logic of the system,” she said. “It's really not that difficult.” Under the ICD-10 code structure, each character has a specific meaning. (See box.)
Ms. Bowman pointed out some of the differences between procedure codes under the two revisions. For example, ICD-9 procedure codes have three to four characters, whereas ICD-10-PCS codes always have seven characters. Also, all ICD-9 procedure code characters are numeric, whereas ICD-10-PCS code characters can each be alphabetic or numeric; alphabetic characters are not case sensitive.
As an example of the difference in procedure codes, she cited the ICD-9 code 17.43 for “percutaneous robotic assisted procedure” vs. 8E093CZ, the ICD-10-PCS code for “robotic assisted procedure of head and neck region, percutaneous approach.”
One issue with which Medicare officials and others dealing with ICD-10 are wrangling, according to Ms. Bowman, is when—or even whether—both ICD-9 and ICD-10 should be “frozen” (that is, when no more new entries should be added to either code set so that they will be stable while people are making the changeover from ICD-9 to ICD-10).
Both code sets are currently updated annually, according to Ms. Bowman.
With ICD-10 in hand, health officials will be better able to track and respond to global health threats. MS. LEON-CHISEN
ICD-10 Resources
Sue Bowman recommended the following resources for more information on ICD-10 coding:
National Center for Health Statistics/Centers for Disease Control and Prevention
www.cdc.gov/nchs/about/otheract/icd9/abticd10.htm
Centers for Medicare and Medicaid Services
The American Hospital Association's ICD-10 Resource Center
www.ahacentraloffice.com/ahacentraloffice_app/ICD-10/ICD-10.jsp
American Health Information Management Association
WASHINGTON — The upcoming ICD-10 diagnosis and procedure coding system is more complicated than was its predecessor, ICD-9, but it will allow for a greater level of clinical detail and will be better able to keep up with advances in technology, according to several speakers at a meeting sponsored by the American Health Information Management Association.
“ICD-9 badly needs to be replaced,” said Nelly Leon-Chisen, director of coding and classification at the American Hospital Association. “It's 30 years old, and the terminology and classification of some conditions are obsolete.”
There are two parts to ICD-10, formally known as the International Classification of Diseases, 10th revision, which goes into effect in the United States on Oct. 1, 2013: ICD-10-CM, which is the clinical modification of the World Health Organization's ICD-10 diagnostic coding system; and ICD-10-PCS, an inpatient procedural coding system developed under contract to the Centers for Medicare and Medicaid Services.
ICD-10 “will have better data for evaluating and improving quality of care. It will provide codes for a more complete picture,” she added, noting that the new code set will allow health officials to be “better able to track and respond to global health threats.”
Because ICD-10 can more precisely document diagnoses and procedures, it will bring better justification of medical necessity for billing purposes, “but not from day 1,” said Ms. Leon-Chisen. “It will take a little while” for people to adjust to the new codes. The new system also may reduce opportunities for fraud, she added.
Ms. Leon-Chisen outlined a few basic differences between ICD-9 and ICD-10 diagnosis codes:
▸ ICD-9 codes contain three to five characters, whereas ICD-10 contains three to seven characters.
▸ In ICD-9 codes, the first character can be alphabetic or numeric, but in ICD-10, the first character is always alphabetic.
▸ ICD-10 codes can include the use of a placeholder “x,” whereas ICD-9 codes cannot.
Ms. Leon-Chisen gave an example to illustrate the differences between the two revisions. Under the ICD-9 coding system, a patient with a pressure ulcer on the right buttock might receive a diagnosis code of 707.05, “pressure ulcer, buttock.” Under ICD-10, the same patient would get L89.111, “decubitus ulcer of right buttock limited to breakdown of the skin.” A pressure ulcer on the left buttock or a more severe one including necrosis of the bone would get a different ICD-10 code.
Sue Bowman, director of coding policy and compliance for the American Health Information Management Association, noted that ICD-10-PCS can have even more complexities. For example, under ICD-9, there is only one code for artery repair; under ICD-10-PCS, there are 276 codes.
However, “once you work with it, you're struck by the logic of the system,” she said. “It's really not that difficult.” Under the ICD-10 code structure, each character has a specific meaning. (See box.)
Ms. Bowman pointed out some of the differences between procedure codes under the two revisions. For example, ICD-9 procedure codes have three to four characters, whereas ICD-10-PCS codes always have seven characters. Also, all ICD-9 procedure code characters are numeric, whereas ICD-10-PCS code characters can each be alphabetic or numeric; alphabetic characters are not case sensitive.
As an example of the difference in procedure codes, she cited the ICD-9 code 17.43 for “percutaneous robotic assisted procedure” vs. 8E093CZ, the ICD-10-PCS code for “robotic assisted procedure of head and neck region, percutaneous approach.”
One issue with which Medicare officials and others dealing with ICD-10 are wrangling, according to Ms. Bowman, is when—or even whether—both ICD-9 and ICD-10 should be “frozen” (that is, when no more new entries should be added to either code set so that they will be stable while people are making the changeover from ICD-9 to ICD-10).
Both code sets are currently updated annually, according to Ms. Bowman.
With ICD-10 in hand, health officials will be better able to track and respond to global health threats. MS. LEON-CHISEN
ICD-10 Resources
Sue Bowman recommended the following resources for more information on ICD-10 coding:
National Center for Health Statistics/Centers for Disease Control and Prevention
www.cdc.gov/nchs/about/otheract/icd9/abticd10.htm
Centers for Medicare and Medicaid Services
The American Hospital Association's ICD-10 Resource Center
www.ahacentraloffice.com/ahacentraloffice_app/ICD-10/ICD-10.jsp
American Health Information Management Association
WASHINGTON — The upcoming ICD-10 diagnosis and procedure coding system is more complicated than was its predecessor, ICD-9, but it will allow for a greater level of clinical detail and will be better able to keep up with advances in technology, according to several speakers at a meeting sponsored by the American Health Information Management Association.
“ICD-9 badly needs to be replaced,” said Nelly Leon-Chisen, director of coding and classification at the American Hospital Association. “It's 30 years old, and the terminology and classification of some conditions are obsolete.”
There are two parts to ICD-10, formally known as the International Classification of Diseases, 10th revision, which goes into effect in the United States on Oct. 1, 2013: ICD-10-CM, which is the clinical modification of the World Health Organization's ICD-10 diagnostic coding system; and ICD-10-PCS, an inpatient procedural coding system developed under contract to the Centers for Medicare and Medicaid Services.
ICD-10 “will have better data for evaluating and improving quality of care. It will provide codes for a more complete picture,” she added, noting that the new code set will allow health officials to be “better able to track and respond to global health threats.”
Because ICD-10 can more precisely document diagnoses and procedures, it will bring better justification of medical necessity for billing purposes, “but not from day 1,” said Ms. Leon-Chisen. “It will take a little while” for people to adjust to the new codes. The new system also may reduce opportunities for fraud, she added.
Ms. Leon-Chisen outlined a few basic differences between ICD-9 and ICD-10 diagnosis codes:
▸ ICD-9 codes contain three to five characters, whereas ICD-10 contains three to seven characters.
▸ In ICD-9 codes, the first character can be alphabetic or numeric, but in ICD-10, the first character is always alphabetic.
▸ ICD-10 codes can include the use of a placeholder “x,” whereas ICD-9 codes cannot.
Ms. Leon-Chisen gave an example to illustrate the differences between the two revisions. Under the ICD-9 coding system, a patient with a pressure ulcer on the right buttock might receive a diagnosis code of 707.05, “pressure ulcer, buttock.” Under ICD-10, the same patient would get L89.111, “decubitus ulcer of right buttock limited to breakdown of the skin.” A pressure ulcer on the left buttock or a more severe one including necrosis of the bone would get a different ICD-10 code.
Sue Bowman, director of coding policy and compliance for the American Health Information Management Association, noted that ICD-10-PCS can have even more complexities. For example, under ICD-9, there is only one code for artery repair; under ICD-10-PCS, there are 276 codes.
However, “once you work with it, you're struck by the logic of the system,” she said. “It's really not that difficult.” Under the ICD-10 code structure, each character has a specific meaning. (See box.)
Ms. Bowman pointed out some of the differences between procedure codes under the two revisions. For example, ICD-9 procedure codes have three to four characters, whereas ICD-10-PCS codes always have seven characters. Also, all ICD-9 procedure code characters are numeric, whereas ICD-10-PCS code characters can each be alphabetic or numeric; alphabetic characters are not case sensitive.
As an example of the difference in procedure codes, she cited the ICD-9 code 17.43 for “percutaneous robotic assisted procedure” vs. 8E093CZ, the ICD-10-PCS code for “robotic assisted procedure of head and neck region, percutaneous approach.”
One issue with which Medicare officials and others dealing with ICD-10 are wrangling, according to Ms. Bowman, is when—or even whether—both ICD-9 and ICD-10 should be “frozen” (that is, when no more new entries should be added to either code set so that they will be stable while people are making the changeover from ICD-9 to ICD-10).
Both code sets are currently updated annually, according to Ms. Bowman.
With ICD-10 in hand, health officials will be better able to track and respond to global health threats. MS. LEON-CHISEN
ICD-10 Resources
Sue Bowman recommended the following resources for more information on ICD-10 coding:
National Center for Health Statistics/Centers for Disease Control and Prevention
www.cdc.gov/nchs/about/otheract/icd9/abticd10.htm
Centers for Medicare and Medicaid Services
The American Hospital Association's ICD-10 Resource Center
www.ahacentraloffice.com/ahacentraloffice_app/ICD-10/ICD-10.jsp
American Health Information Management Association
Definition of 'Meaningful Use' Elusive for EHRs
WASHINGTON — Just what exactly does “meaningful use” mean?
It sounds like a simple question, but there's a lot of money riding on the answer. The Recovery Act, formally known as the American Recovery and Reinvestment Act, stipulates that for a physician to receive up to $44,000 in financial incentives for purchasing an electronic health record, the record must be put to “meaningful use.” Now the government has to come up with a definition of the term.
At a subcommittee meeting of the National Committee on Vital and Health Statistics, which was convened to discuss meaningful use, several speakers explained why having more physicians adopt an electronic health record (EHR) was so valuable.
“The financial meltdown … has shown us how we as a nation need to totally transform the U.S. health care system,” said Helen Darling, president of the National Business Group on Health. “We have a fiscal crisis, not just a health crisis; we have to act urgently.”
Dr. Elliott Fisher, professor of medicine at Dartmouth University, Hanover, N.H., started explaining the benefits of EHRs by noting that more health care is not always better care. “Gray area” discretionary decisions about when to refer to a specialist explain most of the regional differences in health care spending and are responsible for most of the health care overuse, he said.
The only way to reduce that overuse is to feed the information—gathered through EHRs—back to the physician “and start to have a conversation” about when certain tests or referrals are necessary, Dr. Fisher said.
Although everyone agreed that EHRs were valuable, speakers' definitions of their “meaningful use” differed. “Meaningful use might vary by site of care as well as by type of care,” said Dr. David Classen of Computer Sciences Corp., whereas Dr. John Halamka of the Health Information Technology Standards Panel, a government-funded group that helps ensure EHR interoperability, said his definition of meaningful use was “processes and work flows that facilitate improved quality and increased efficiency.”
Several panelists agreed that EHRs had to allow for three things in order to be used meaningfully: electronic prescribing, interoperability with other computers, and reporting on health care quality measures. EHRs are particularly useful for reporting quality measures because they are a direct source of information and provide very timely data, said Dr. Michael Rapp of the Centers for Medicare and Medicaid Services.
Experts at the meeting also agreed in general that EHR systems need to be certified by a government-approved organization such as the Certification Commission for Healthcare Information Technology to meet the Recovery Act's requirements. However, certification alone is not sufficient, because many parts of a certified EHR are not necessarily implemented, said Dr. Floyd Eisenberg, senior vice-president for health information technology at the National Quality Forum, which sets goals for performance improvement.
The day after the subcommittee's 2-day meeting concluded, the Markle Foundation held a press conference to release a consensus document on the definition of meaningful use. The document was endorsed by a number of provider and advocacy groups, including the AARP, the American Academy of Family Physicians, the Joint Commission, Surescripts, America's Health Insurance Plans, and the National Committee for Quality Assurance.
The consensus document provides a “simple” definition of patient-centered meaningful use: “The provider makes use of, and the patient has access to, clinically relevant electronic information about the patient to improve patient outcomes and health status, improve the delivery of care, and control the growth of costs.” The document lists slightly different meaningful use requirements for the first 2 years, however; during that time period, meaningful use would be when “the provider makes use of, and the patient has access to, clinically relevant electronic information about the patient to improve medication management and coordination of care.”
With their ability to provide timely data, EHRs are particularly useful for reporting quality measures. DR. RAPP
The consensus document is available at http://www.markle.org/downloadable_assets/20090430_meaningful_use.pdf
WASHINGTON — Just what exactly does “meaningful use” mean?
It sounds like a simple question, but there's a lot of money riding on the answer. The Recovery Act, formally known as the American Recovery and Reinvestment Act, stipulates that for a physician to receive up to $44,000 in financial incentives for purchasing an electronic health record, the record must be put to “meaningful use.” Now the government has to come up with a definition of the term.
At a subcommittee meeting of the National Committee on Vital and Health Statistics, which was convened to discuss meaningful use, several speakers explained why having more physicians adopt an electronic health record (EHR) was so valuable.
“The financial meltdown … has shown us how we as a nation need to totally transform the U.S. health care system,” said Helen Darling, president of the National Business Group on Health. “We have a fiscal crisis, not just a health crisis; we have to act urgently.”
Dr. Elliott Fisher, professor of medicine at Dartmouth University, Hanover, N.H., started explaining the benefits of EHRs by noting that more health care is not always better care. “Gray area” discretionary decisions about when to refer to a specialist explain most of the regional differences in health care spending and are responsible for most of the health care overuse, he said.
The only way to reduce that overuse is to feed the information—gathered through EHRs—back to the physician “and start to have a conversation” about when certain tests or referrals are necessary, Dr. Fisher said.
Although everyone agreed that EHRs were valuable, speakers' definitions of their “meaningful use” differed. “Meaningful use might vary by site of care as well as by type of care,” said Dr. David Classen of Computer Sciences Corp., whereas Dr. John Halamka of the Health Information Technology Standards Panel, a government-funded group that helps ensure EHR interoperability, said his definition of meaningful use was “processes and work flows that facilitate improved quality and increased efficiency.”
Several panelists agreed that EHRs had to allow for three things in order to be used meaningfully: electronic prescribing, interoperability with other computers, and reporting on health care quality measures. EHRs are particularly useful for reporting quality measures because they are a direct source of information and provide very timely data, said Dr. Michael Rapp of the Centers for Medicare and Medicaid Services.
Experts at the meeting also agreed in general that EHR systems need to be certified by a government-approved organization such as the Certification Commission for Healthcare Information Technology to meet the Recovery Act's requirements. However, certification alone is not sufficient, because many parts of a certified EHR are not necessarily implemented, said Dr. Floyd Eisenberg, senior vice-president for health information technology at the National Quality Forum, which sets goals for performance improvement.
The day after the subcommittee's 2-day meeting concluded, the Markle Foundation held a press conference to release a consensus document on the definition of meaningful use. The document was endorsed by a number of provider and advocacy groups, including the AARP, the American Academy of Family Physicians, the Joint Commission, Surescripts, America's Health Insurance Plans, and the National Committee for Quality Assurance.
The consensus document provides a “simple” definition of patient-centered meaningful use: “The provider makes use of, and the patient has access to, clinically relevant electronic information about the patient to improve patient outcomes and health status, improve the delivery of care, and control the growth of costs.” The document lists slightly different meaningful use requirements for the first 2 years, however; during that time period, meaningful use would be when “the provider makes use of, and the patient has access to, clinically relevant electronic information about the patient to improve medication management and coordination of care.”
With their ability to provide timely data, EHRs are particularly useful for reporting quality measures. DR. RAPP
The consensus document is available at http://www.markle.org/downloadable_assets/20090430_meaningful_use.pdf
WASHINGTON — Just what exactly does “meaningful use” mean?
It sounds like a simple question, but there's a lot of money riding on the answer. The Recovery Act, formally known as the American Recovery and Reinvestment Act, stipulates that for a physician to receive up to $44,000 in financial incentives for purchasing an electronic health record, the record must be put to “meaningful use.” Now the government has to come up with a definition of the term.
At a subcommittee meeting of the National Committee on Vital and Health Statistics, which was convened to discuss meaningful use, several speakers explained why having more physicians adopt an electronic health record (EHR) was so valuable.
“The financial meltdown … has shown us how we as a nation need to totally transform the U.S. health care system,” said Helen Darling, president of the National Business Group on Health. “We have a fiscal crisis, not just a health crisis; we have to act urgently.”
Dr. Elliott Fisher, professor of medicine at Dartmouth University, Hanover, N.H., started explaining the benefits of EHRs by noting that more health care is not always better care. “Gray area” discretionary decisions about when to refer to a specialist explain most of the regional differences in health care spending and are responsible for most of the health care overuse, he said.
The only way to reduce that overuse is to feed the information—gathered through EHRs—back to the physician “and start to have a conversation” about when certain tests or referrals are necessary, Dr. Fisher said.
Although everyone agreed that EHRs were valuable, speakers' definitions of their “meaningful use” differed. “Meaningful use might vary by site of care as well as by type of care,” said Dr. David Classen of Computer Sciences Corp., whereas Dr. John Halamka of the Health Information Technology Standards Panel, a government-funded group that helps ensure EHR interoperability, said his definition of meaningful use was “processes and work flows that facilitate improved quality and increased efficiency.”
Several panelists agreed that EHRs had to allow for three things in order to be used meaningfully: electronic prescribing, interoperability with other computers, and reporting on health care quality measures. EHRs are particularly useful for reporting quality measures because they are a direct source of information and provide very timely data, said Dr. Michael Rapp of the Centers for Medicare and Medicaid Services.
Experts at the meeting also agreed in general that EHR systems need to be certified by a government-approved organization such as the Certification Commission for Healthcare Information Technology to meet the Recovery Act's requirements. However, certification alone is not sufficient, because many parts of a certified EHR are not necessarily implemented, said Dr. Floyd Eisenberg, senior vice-president for health information technology at the National Quality Forum, which sets goals for performance improvement.
The day after the subcommittee's 2-day meeting concluded, the Markle Foundation held a press conference to release a consensus document on the definition of meaningful use. The document was endorsed by a number of provider and advocacy groups, including the AARP, the American Academy of Family Physicians, the Joint Commission, Surescripts, America's Health Insurance Plans, and the National Committee for Quality Assurance.
The consensus document provides a “simple” definition of patient-centered meaningful use: “The provider makes use of, and the patient has access to, clinically relevant electronic information about the patient to improve patient outcomes and health status, improve the delivery of care, and control the growth of costs.” The document lists slightly different meaningful use requirements for the first 2 years, however; during that time period, meaningful use would be when “the provider makes use of, and the patient has access to, clinically relevant electronic information about the patient to improve medication management and coordination of care.”
With their ability to provide timely data, EHRs are particularly useful for reporting quality measures. DR. RAPP
The consensus document is available at http://www.markle.org/downloadable_assets/20090430_meaningful_use.pdf
Coalition Pledges to Reduce Health Care Costs
Leaders of several health care and labor organizations met with President Obama at the White House on May 11 and proposed ideas to reduce the growth in health care costs by as much as $2 trillion over the next decade.
In a letter sent to the president, the American Medical Association, American Hospital Association, Pharmaceutical Research and Manufacturers of America, Advanced Medical Technology Association, America's Health Insurance Plans, and Service Employees International Union vowed to work as a group to help achieve the cost reduction.
Among their proposals were to cut costs by focusing on administrative simplification, standardization, and transparency; reduce overuse and underuse of health care by aligning incentives for physicians, hospitals, and other providers to work together; encourage coordinated care and adhere to evidence-based best practices and therapies that reduce hospitalization and manage chronic disease more effectively; implement proven prevention strategies; and make common-sense improvements in care delivery, health information technology, workforce development, and regulatory reforms.
The AMA told the president that although evidence-based guidelines will be helpful in lowering costs, the reductions could be enhanced if physicians had more liability protection. “For example, if everyone who walks into the emergency room gets an MRI for a headache, it's a costly procedure,” AMA President-Elect J. James Rohack said in an interview. “If we create scientifically based guidelines that say not everyone needs to have the MRI for a headache, physicians have got to have liability protection so they don't get sued if they follow that guideline.”
Dr. Rohack said he felt the president understood the message that defensive medicine is costly, and “that prior attempts at tort liability by just creating global caps haven't been successful.”
The president called the meeting “a watershed event in the long and elusive quest for health care reform. … As these groups take the steps they are outlining, and as we work with Congress on health care reform legislation, my administration will continue working to reduce health care costs to achieve similar savings.”
Reaction to the meeting varied.
“If the savings described today truly occur, this may be one of the most significant developments in promoting meaningful health care reform,” Ron Pollack, executive director of Families USA, a liberal consumer health organization, said in a statement. “These savings would cut projected health care costs for families and businesses, and they would enable adequate subsidies to be offered so that everyone has access to high-quality, affordable health care.”
Others were less impressed. “We are very cautious about the particulars of the voluntary effort that groups proposed to the White House,” said a statement from the National Coalition on Health Care, a progressive advocacy group. “Most of the measures that they cited would help to make the health care system more efficient over time, but … should not be counted on to produce substantial savings soon.”
Rep. Michael Burgess (R-Tex.) said in a statement that the announcement by the health industry leaders “misses the mark in several areas,” offering “no protections against a Washington takeover of health care,” and no guarantees that Americans will be able to control their health care decisions.
President Obama vowed that his administration would do its part to reduce health care costs. Official White House Photo by Pete Souza
Leaders of several health care and labor organizations met with President Obama at the White House on May 11 and proposed ideas to reduce the growth in health care costs by as much as $2 trillion over the next decade.
In a letter sent to the president, the American Medical Association, American Hospital Association, Pharmaceutical Research and Manufacturers of America, Advanced Medical Technology Association, America's Health Insurance Plans, and Service Employees International Union vowed to work as a group to help achieve the cost reduction.
Among their proposals were to cut costs by focusing on administrative simplification, standardization, and transparency; reduce overuse and underuse of health care by aligning incentives for physicians, hospitals, and other providers to work together; encourage coordinated care and adhere to evidence-based best practices and therapies that reduce hospitalization and manage chronic disease more effectively; implement proven prevention strategies; and make common-sense improvements in care delivery, health information technology, workforce development, and regulatory reforms.
The AMA told the president that although evidence-based guidelines will be helpful in lowering costs, the reductions could be enhanced if physicians had more liability protection. “For example, if everyone who walks into the emergency room gets an MRI for a headache, it's a costly procedure,” AMA President-Elect J. James Rohack said in an interview. “If we create scientifically based guidelines that say not everyone needs to have the MRI for a headache, physicians have got to have liability protection so they don't get sued if they follow that guideline.”
Dr. Rohack said he felt the president understood the message that defensive medicine is costly, and “that prior attempts at tort liability by just creating global caps haven't been successful.”
The president called the meeting “a watershed event in the long and elusive quest for health care reform. … As these groups take the steps they are outlining, and as we work with Congress on health care reform legislation, my administration will continue working to reduce health care costs to achieve similar savings.”
Reaction to the meeting varied.
“If the savings described today truly occur, this may be one of the most significant developments in promoting meaningful health care reform,” Ron Pollack, executive director of Families USA, a liberal consumer health organization, said in a statement. “These savings would cut projected health care costs for families and businesses, and they would enable adequate subsidies to be offered so that everyone has access to high-quality, affordable health care.”
Others were less impressed. “We are very cautious about the particulars of the voluntary effort that groups proposed to the White House,” said a statement from the National Coalition on Health Care, a progressive advocacy group. “Most of the measures that they cited would help to make the health care system more efficient over time, but … should not be counted on to produce substantial savings soon.”
Rep. Michael Burgess (R-Tex.) said in a statement that the announcement by the health industry leaders “misses the mark in several areas,” offering “no protections against a Washington takeover of health care,” and no guarantees that Americans will be able to control their health care decisions.
President Obama vowed that his administration would do its part to reduce health care costs. Official White House Photo by Pete Souza
Leaders of several health care and labor organizations met with President Obama at the White House on May 11 and proposed ideas to reduce the growth in health care costs by as much as $2 trillion over the next decade.
In a letter sent to the president, the American Medical Association, American Hospital Association, Pharmaceutical Research and Manufacturers of America, Advanced Medical Technology Association, America's Health Insurance Plans, and Service Employees International Union vowed to work as a group to help achieve the cost reduction.
Among their proposals were to cut costs by focusing on administrative simplification, standardization, and transparency; reduce overuse and underuse of health care by aligning incentives for physicians, hospitals, and other providers to work together; encourage coordinated care and adhere to evidence-based best practices and therapies that reduce hospitalization and manage chronic disease more effectively; implement proven prevention strategies; and make common-sense improvements in care delivery, health information technology, workforce development, and regulatory reforms.
The AMA told the president that although evidence-based guidelines will be helpful in lowering costs, the reductions could be enhanced if physicians had more liability protection. “For example, if everyone who walks into the emergency room gets an MRI for a headache, it's a costly procedure,” AMA President-Elect J. James Rohack said in an interview. “If we create scientifically based guidelines that say not everyone needs to have the MRI for a headache, physicians have got to have liability protection so they don't get sued if they follow that guideline.”
Dr. Rohack said he felt the president understood the message that defensive medicine is costly, and “that prior attempts at tort liability by just creating global caps haven't been successful.”
The president called the meeting “a watershed event in the long and elusive quest for health care reform. … As these groups take the steps they are outlining, and as we work with Congress on health care reform legislation, my administration will continue working to reduce health care costs to achieve similar savings.”
Reaction to the meeting varied.
“If the savings described today truly occur, this may be one of the most significant developments in promoting meaningful health care reform,” Ron Pollack, executive director of Families USA, a liberal consumer health organization, said in a statement. “These savings would cut projected health care costs for families and businesses, and they would enable adequate subsidies to be offered so that everyone has access to high-quality, affordable health care.”
Others were less impressed. “We are very cautious about the particulars of the voluntary effort that groups proposed to the White House,” said a statement from the National Coalition on Health Care, a progressive advocacy group. “Most of the measures that they cited would help to make the health care system more efficient over time, but … should not be counted on to produce substantial savings soon.”
Rep. Michael Burgess (R-Tex.) said in a statement that the announcement by the health industry leaders “misses the mark in several areas,” offering “no protections against a Washington takeover of health care,” and no guarantees that Americans will be able to control their health care decisions.
President Obama vowed that his administration would do its part to reduce health care costs. Official White House Photo by Pete Souza
Nearly 3 Weeks/Year Spent on Insurer Paperwork
Physicians and their staffs spend the equivalent of weeks—and $31 billion—each year processing health insurance paperwork, according to a study funded by the Commonwealth Fund and the Robert Wood Johnson Foundation.
The survey of 895 physicians and practice administrators nationwide asked respondents about the amount of time their practice's staff spent on various administrative activities, including prior authorization, drug formularies, claims and billing, credentialing, contracting, and collecting and reporting quality data.
The researchers found that physicians spent an average of 3 hours a week—or nearly 3 weeks a year—on administrative activities. Nursing staff spent more than 23 weeks per physician per year, and clerical staff spent 44 weeks per physician per year, interacting with health plans. More than three in four respondents said the costs of interacting with health plans have increased over the past 2 years (Health Affairs 2009 May 14 [doi:10.1377/hlthaff.28.4.w533
Overall, the cost of these interactions amounts to $31 billion annually.
“While there are benefits to physician offices' interactions with health plans—which may, for example, help to reduce unnecessary care or the inappropriate use of medication—it would be useful to explore the extent to which these benefits are large enough to justify spending 3 weeks annually of physician time … on physician practice-health plan interaction,” the study's lead author, Dr. Lawrence P. Casalino of Cornell University said in a statement. “It would also be useful to explore ways to make the interactions more efficient, both on the health plan side and in physician offices.”
Physicians in solo or two-person practices spent many more hours interacting with health plans than did those in practices with 10 or more physicians; this was especially true in primary care, the researchers found. And all physicians and staff members spent much more time on authorization, formularies, claims and billing, and credentialing than they did on submitting quality data or on reviewing quality data provided by health plans.
“To get to a health care system that is high-quality and delivers better value for everyone, we have to address the skyrocketing price of health care's administrative costs,” Dr. Risa Lavizzo-Mourey, president and CEO of the Robert Wood Johnson Foundation, said in a statement. “Administrative costs will never be zero, but we need to make sure that administrative interactions improve the quality of care by working to make care safer and more efficient, and rewarding health care providers who successfully reduce excessive care and provide the right treatment at the right time.”
Physicians and their staffs spend the equivalent of weeks—and $31 billion—each year processing health insurance paperwork, according to a study funded by the Commonwealth Fund and the Robert Wood Johnson Foundation.
The survey of 895 physicians and practice administrators nationwide asked respondents about the amount of time their practice's staff spent on various administrative activities, including prior authorization, drug formularies, claims and billing, credentialing, contracting, and collecting and reporting quality data.
The researchers found that physicians spent an average of 3 hours a week—or nearly 3 weeks a year—on administrative activities. Nursing staff spent more than 23 weeks per physician per year, and clerical staff spent 44 weeks per physician per year, interacting with health plans. More than three in four respondents said the costs of interacting with health plans have increased over the past 2 years (Health Affairs 2009 May 14 [doi:10.1377/hlthaff.28.4.w533
Overall, the cost of these interactions amounts to $31 billion annually.
“While there are benefits to physician offices' interactions with health plans—which may, for example, help to reduce unnecessary care or the inappropriate use of medication—it would be useful to explore the extent to which these benefits are large enough to justify spending 3 weeks annually of physician time … on physician practice-health plan interaction,” the study's lead author, Dr. Lawrence P. Casalino of Cornell University said in a statement. “It would also be useful to explore ways to make the interactions more efficient, both on the health plan side and in physician offices.”
Physicians in solo or two-person practices spent many more hours interacting with health plans than did those in practices with 10 or more physicians; this was especially true in primary care, the researchers found. And all physicians and staff members spent much more time on authorization, formularies, claims and billing, and credentialing than they did on submitting quality data or on reviewing quality data provided by health plans.
“To get to a health care system that is high-quality and delivers better value for everyone, we have to address the skyrocketing price of health care's administrative costs,” Dr. Risa Lavizzo-Mourey, president and CEO of the Robert Wood Johnson Foundation, said in a statement. “Administrative costs will never be zero, but we need to make sure that administrative interactions improve the quality of care by working to make care safer and more efficient, and rewarding health care providers who successfully reduce excessive care and provide the right treatment at the right time.”
Physicians and their staffs spend the equivalent of weeks—and $31 billion—each year processing health insurance paperwork, according to a study funded by the Commonwealth Fund and the Robert Wood Johnson Foundation.
The survey of 895 physicians and practice administrators nationwide asked respondents about the amount of time their practice's staff spent on various administrative activities, including prior authorization, drug formularies, claims and billing, credentialing, contracting, and collecting and reporting quality data.
The researchers found that physicians spent an average of 3 hours a week—or nearly 3 weeks a year—on administrative activities. Nursing staff spent more than 23 weeks per physician per year, and clerical staff spent 44 weeks per physician per year, interacting with health plans. More than three in four respondents said the costs of interacting with health plans have increased over the past 2 years (Health Affairs 2009 May 14 [doi:10.1377/hlthaff.28.4.w533
Overall, the cost of these interactions amounts to $31 billion annually.
“While there are benefits to physician offices' interactions with health plans—which may, for example, help to reduce unnecessary care or the inappropriate use of medication—it would be useful to explore the extent to which these benefits are large enough to justify spending 3 weeks annually of physician time … on physician practice-health plan interaction,” the study's lead author, Dr. Lawrence P. Casalino of Cornell University said in a statement. “It would also be useful to explore ways to make the interactions more efficient, both on the health plan side and in physician offices.”
Physicians in solo or two-person practices spent many more hours interacting with health plans than did those in practices with 10 or more physicians; this was especially true in primary care, the researchers found. And all physicians and staff members spent much more time on authorization, formularies, claims and billing, and credentialing than they did on submitting quality data or on reviewing quality data provided by health plans.
“To get to a health care system that is high-quality and delivers better value for everyone, we have to address the skyrocketing price of health care's administrative costs,” Dr. Risa Lavizzo-Mourey, president and CEO of the Robert Wood Johnson Foundation, said in a statement. “Administrative costs will never be zero, but we need to make sure that administrative interactions improve the quality of care by working to make care safer and more efficient, and rewarding health care providers who successfully reduce excessive care and provide the right treatment at the right time.”
Coalition Pledges to Reduce Rise in Health Care Costs by $2 Trillion Over Next Decade
Leaders of several health care and labor organizations met with President Obama at the White House last month and proposed ideas to reduce the growth in health care costs by as much as $2 trillion over the next decade.
In a letter sent to the president, the six organizations—the American Medical Association, the American Hospital Association, the Pharmaceutical Research and Manufacturers of America, the Advanced Medical Technology Association, America's Health Insurance Plans, and the Service Employees International Union—vowed to help achieve the cost reduction. Among their proposals:
▸ Cutting costs by focusing on administrative simplification, standardization, and transparency.
▸ Reducing overuse and underuse of health care by aligning incentives so that physicians, hospitals, and other providers are encouraged to work together toward the highest standards of quality and efficiency.
▸ Encouraging coordinated care and adhering to evidence-based best practices and therapies that reduce hospitalization and manage chronic disease more effectively.
▸ Implementing proven prevention strategies.
▸ Making common-sense improvements in care delivery, health information technology, workforce development, and regulatory reforms.
The AMA told the president that although evidence-based guidelines will be helpful in reducing costs, the reductions could be enhanced if physicians had more liability protection. “For example, if everyone who walks into the emergency room gets an MRI for a headache, it's a costly procedure,” AMA President-Elect J. James Rohack said in an interview. “We know that in some areas of the country [that test has] been done because people sued when they didn't get the test. If we create scientifically based guidelines that say not everyone needs to have the MRI for a headache, physicians have got to have liability protection so they don't get sued if they follow that guideline.”
Dr. Rohack said he felt the president heard what the AMA was conveying. “Clearly the message of defensive medicine costing dollars in the health care system was received, as was the recognition that prior attempts at tort liability by just creating global caps hasn't been successful. We are going to have to work at other creative ways of achieving the goal.”
The president called the White House meeting historic. “As these groups take the steps they are outlining, and as we work with Congress on health care reform legislation, my administration will continue working to reduce health care costs to achieve similar savings.”
In reaction to the meeting, Rep. Michael Burgess (R-Texas) noted that while he was glad the groups were trying to work together, they weren't taking the correct approach. “From what I can tell, the announcement by the health industry leaders misses the mark in several areas,” he said in a statement. “It promises no protections against a Washington takeover of health care, no guarantees that Washington bureaucrats won't stand in the way of Americans getting the treatment they need when they need it, and no promises that patients will be able to control their health care decisions. … Until more details are revealed, I would encourage Americans to be circumspect about today's announcement.”
President Obama called the meeting of health care reform stakeholders last month 'historic.' Official White House Photo by Pete Souza
Leaders of several health care and labor organizations met with President Obama at the White House last month and proposed ideas to reduce the growth in health care costs by as much as $2 trillion over the next decade.
In a letter sent to the president, the six organizations—the American Medical Association, the American Hospital Association, the Pharmaceutical Research and Manufacturers of America, the Advanced Medical Technology Association, America's Health Insurance Plans, and the Service Employees International Union—vowed to help achieve the cost reduction. Among their proposals:
▸ Cutting costs by focusing on administrative simplification, standardization, and transparency.
▸ Reducing overuse and underuse of health care by aligning incentives so that physicians, hospitals, and other providers are encouraged to work together toward the highest standards of quality and efficiency.
▸ Encouraging coordinated care and adhering to evidence-based best practices and therapies that reduce hospitalization and manage chronic disease more effectively.
▸ Implementing proven prevention strategies.
▸ Making common-sense improvements in care delivery, health information technology, workforce development, and regulatory reforms.
The AMA told the president that although evidence-based guidelines will be helpful in reducing costs, the reductions could be enhanced if physicians had more liability protection. “For example, if everyone who walks into the emergency room gets an MRI for a headache, it's a costly procedure,” AMA President-Elect J. James Rohack said in an interview. “We know that in some areas of the country [that test has] been done because people sued when they didn't get the test. If we create scientifically based guidelines that say not everyone needs to have the MRI for a headache, physicians have got to have liability protection so they don't get sued if they follow that guideline.”
Dr. Rohack said he felt the president heard what the AMA was conveying. “Clearly the message of defensive medicine costing dollars in the health care system was received, as was the recognition that prior attempts at tort liability by just creating global caps hasn't been successful. We are going to have to work at other creative ways of achieving the goal.”
The president called the White House meeting historic. “As these groups take the steps they are outlining, and as we work with Congress on health care reform legislation, my administration will continue working to reduce health care costs to achieve similar savings.”
In reaction to the meeting, Rep. Michael Burgess (R-Texas) noted that while he was glad the groups were trying to work together, they weren't taking the correct approach. “From what I can tell, the announcement by the health industry leaders misses the mark in several areas,” he said in a statement. “It promises no protections against a Washington takeover of health care, no guarantees that Washington bureaucrats won't stand in the way of Americans getting the treatment they need when they need it, and no promises that patients will be able to control their health care decisions. … Until more details are revealed, I would encourage Americans to be circumspect about today's announcement.”
President Obama called the meeting of health care reform stakeholders last month 'historic.' Official White House Photo by Pete Souza
Leaders of several health care and labor organizations met with President Obama at the White House last month and proposed ideas to reduce the growth in health care costs by as much as $2 trillion over the next decade.
In a letter sent to the president, the six organizations—the American Medical Association, the American Hospital Association, the Pharmaceutical Research and Manufacturers of America, the Advanced Medical Technology Association, America's Health Insurance Plans, and the Service Employees International Union—vowed to help achieve the cost reduction. Among their proposals:
▸ Cutting costs by focusing on administrative simplification, standardization, and transparency.
▸ Reducing overuse and underuse of health care by aligning incentives so that physicians, hospitals, and other providers are encouraged to work together toward the highest standards of quality and efficiency.
▸ Encouraging coordinated care and adhering to evidence-based best practices and therapies that reduce hospitalization and manage chronic disease more effectively.
▸ Implementing proven prevention strategies.
▸ Making common-sense improvements in care delivery, health information technology, workforce development, and regulatory reforms.
The AMA told the president that although evidence-based guidelines will be helpful in reducing costs, the reductions could be enhanced if physicians had more liability protection. “For example, if everyone who walks into the emergency room gets an MRI for a headache, it's a costly procedure,” AMA President-Elect J. James Rohack said in an interview. “We know that in some areas of the country [that test has] been done because people sued when they didn't get the test. If we create scientifically based guidelines that say not everyone needs to have the MRI for a headache, physicians have got to have liability protection so they don't get sued if they follow that guideline.”
Dr. Rohack said he felt the president heard what the AMA was conveying. “Clearly the message of defensive medicine costing dollars in the health care system was received, as was the recognition that prior attempts at tort liability by just creating global caps hasn't been successful. We are going to have to work at other creative ways of achieving the goal.”
The president called the White House meeting historic. “As these groups take the steps they are outlining, and as we work with Congress on health care reform legislation, my administration will continue working to reduce health care costs to achieve similar savings.”
In reaction to the meeting, Rep. Michael Burgess (R-Texas) noted that while he was glad the groups were trying to work together, they weren't taking the correct approach. “From what I can tell, the announcement by the health industry leaders misses the mark in several areas,” he said in a statement. “It promises no protections against a Washington takeover of health care, no guarantees that Washington bureaucrats won't stand in the way of Americans getting the treatment they need when they need it, and no promises that patients will be able to control their health care decisions. … Until more details are revealed, I would encourage Americans to be circumspect about today's announcement.”
President Obama called the meeting of health care reform stakeholders last month 'historic.' Official White House Photo by Pete Souza
EHR Financial Incentives Tied to 'Meaningful Use'
WASHINGTON — Just what exactly does “meaningful use” mean?
It sounds like a simple question, but there's a lot of money riding on the answer. The Recovery Act, formally known as the American Recovery and Reinvestment Act, stipulates that for a physician to receive up to $44,000 in financial incentives for purchasing an electronic health record, the record must be put to “meaningful use.” Now the government has to come up with a definition of the term.
At a subcommittee meeting of the National Committee on Vital and Health Statistics, which was convened to discuss meaningful use, several speakers explained why having more physicians adopt an electronic health record (EHR) was so valuable.
Dr. Elliott Fisher, professor of medicine at Dartmouth University, Hanover, N.H., started explaining the benefits of EHRs by noting that more health care is not always better care. “Gray area” discretionary decisions about when to refer to a specialist explain most of the regional differences in health care spending and are responsible for most of the health care overuse. The only way to reduce that overuse is to feed the information—gathered through EHRs—back to the physician “and start to have a conversation” about when certain tests or referrals are necessary.
Although everyone agreed that EHRs were valuable, speakers' definitions of “meaningful use” of them differed. “Meaningful use might vary by site of care as well as by type of care,” said Dr. David Classen of the Computer Sciences Corporation, whereas Dr. John Halamka of the Health Information Technology Standards Panel, a government-funded group that helps ensure EHR interoperability, said his definition of meaningful use was “processes and workflows that facilitate improved quality and increased efficiency.”
Several panelists agreed that EHRs had to allow for three things in order to be used meaningfully: electronic prescribing, interoperability with other computers, and reporting on health care quality measures. EHRs are particularly useful for reporting quality measures because they are a direct source of information and provide very timely data, said Dr. Michael Rapp of the Centers for Medicare and Medicaid Services.
Experts at the meeting also agreed in general that EHR systems need to be certified by a government-approved organization such as the Certification Commission for Healthcare Information Technology to meet the Recovery Act's requirements. However, certification alone is not sufficient, because many parts of a certified EHR are not necessarily implemented, said Dr. Floyd Eisenberg, senior vice president for health information technology at the National Quality Forum, which sets goals for performance improvement.
The day after the subcommittee's 2-day meeting concluded, the Markle Foundation held a press conference to release a consensus document on the definition of meaningful use. The document was endorsed by a number of provider and advocacy groups, including the AARP, the American Academy of Family Physicians, the Joint Commission, Surescripts, America's Health Insurance Plans, and the National Committee for Quality Assurance.
The consensus document provides a “simple” definition of patient-centered meaningful use: “The provider makes use of, and the patient has access to, clinically relevant electronic information about the patient to improve patient outcomes and health status, improve the delivery of care, and control the growth of costs.”
The consensus document is available at http://www.markle.org/downloadable_assets/20090430_meaningful_use.pdf
EHRs are useful for reporting quality measures because they offer direct information and timely data. DR. RAPP
WASHINGTON — Just what exactly does “meaningful use” mean?
It sounds like a simple question, but there's a lot of money riding on the answer. The Recovery Act, formally known as the American Recovery and Reinvestment Act, stipulates that for a physician to receive up to $44,000 in financial incentives for purchasing an electronic health record, the record must be put to “meaningful use.” Now the government has to come up with a definition of the term.
At a subcommittee meeting of the National Committee on Vital and Health Statistics, which was convened to discuss meaningful use, several speakers explained why having more physicians adopt an electronic health record (EHR) was so valuable.
Dr. Elliott Fisher, professor of medicine at Dartmouth University, Hanover, N.H., started explaining the benefits of EHRs by noting that more health care is not always better care. “Gray area” discretionary decisions about when to refer to a specialist explain most of the regional differences in health care spending and are responsible for most of the health care overuse. The only way to reduce that overuse is to feed the information—gathered through EHRs—back to the physician “and start to have a conversation” about when certain tests or referrals are necessary.
Although everyone agreed that EHRs were valuable, speakers' definitions of “meaningful use” of them differed. “Meaningful use might vary by site of care as well as by type of care,” said Dr. David Classen of the Computer Sciences Corporation, whereas Dr. John Halamka of the Health Information Technology Standards Panel, a government-funded group that helps ensure EHR interoperability, said his definition of meaningful use was “processes and workflows that facilitate improved quality and increased efficiency.”
Several panelists agreed that EHRs had to allow for three things in order to be used meaningfully: electronic prescribing, interoperability with other computers, and reporting on health care quality measures. EHRs are particularly useful for reporting quality measures because they are a direct source of information and provide very timely data, said Dr. Michael Rapp of the Centers for Medicare and Medicaid Services.
Experts at the meeting also agreed in general that EHR systems need to be certified by a government-approved organization such as the Certification Commission for Healthcare Information Technology to meet the Recovery Act's requirements. However, certification alone is not sufficient, because many parts of a certified EHR are not necessarily implemented, said Dr. Floyd Eisenberg, senior vice president for health information technology at the National Quality Forum, which sets goals for performance improvement.
The day after the subcommittee's 2-day meeting concluded, the Markle Foundation held a press conference to release a consensus document on the definition of meaningful use. The document was endorsed by a number of provider and advocacy groups, including the AARP, the American Academy of Family Physicians, the Joint Commission, Surescripts, America's Health Insurance Plans, and the National Committee for Quality Assurance.
The consensus document provides a “simple” definition of patient-centered meaningful use: “The provider makes use of, and the patient has access to, clinically relevant electronic information about the patient to improve patient outcomes and health status, improve the delivery of care, and control the growth of costs.”
The consensus document is available at http://www.markle.org/downloadable_assets/20090430_meaningful_use.pdf
EHRs are useful for reporting quality measures because they offer direct information and timely data. DR. RAPP
WASHINGTON — Just what exactly does “meaningful use” mean?
It sounds like a simple question, but there's a lot of money riding on the answer. The Recovery Act, formally known as the American Recovery and Reinvestment Act, stipulates that for a physician to receive up to $44,000 in financial incentives for purchasing an electronic health record, the record must be put to “meaningful use.” Now the government has to come up with a definition of the term.
At a subcommittee meeting of the National Committee on Vital and Health Statistics, which was convened to discuss meaningful use, several speakers explained why having more physicians adopt an electronic health record (EHR) was so valuable.
Dr. Elliott Fisher, professor of medicine at Dartmouth University, Hanover, N.H., started explaining the benefits of EHRs by noting that more health care is not always better care. “Gray area” discretionary decisions about when to refer to a specialist explain most of the regional differences in health care spending and are responsible for most of the health care overuse. The only way to reduce that overuse is to feed the information—gathered through EHRs—back to the physician “and start to have a conversation” about when certain tests or referrals are necessary.
Although everyone agreed that EHRs were valuable, speakers' definitions of “meaningful use” of them differed. “Meaningful use might vary by site of care as well as by type of care,” said Dr. David Classen of the Computer Sciences Corporation, whereas Dr. John Halamka of the Health Information Technology Standards Panel, a government-funded group that helps ensure EHR interoperability, said his definition of meaningful use was “processes and workflows that facilitate improved quality and increased efficiency.”
Several panelists agreed that EHRs had to allow for three things in order to be used meaningfully: electronic prescribing, interoperability with other computers, and reporting on health care quality measures. EHRs are particularly useful for reporting quality measures because they are a direct source of information and provide very timely data, said Dr. Michael Rapp of the Centers for Medicare and Medicaid Services.
Experts at the meeting also agreed in general that EHR systems need to be certified by a government-approved organization such as the Certification Commission for Healthcare Information Technology to meet the Recovery Act's requirements. However, certification alone is not sufficient, because many parts of a certified EHR are not necessarily implemented, said Dr. Floyd Eisenberg, senior vice president for health information technology at the National Quality Forum, which sets goals for performance improvement.
The day after the subcommittee's 2-day meeting concluded, the Markle Foundation held a press conference to release a consensus document on the definition of meaningful use. The document was endorsed by a number of provider and advocacy groups, including the AARP, the American Academy of Family Physicians, the Joint Commission, Surescripts, America's Health Insurance Plans, and the National Committee for Quality Assurance.
The consensus document provides a “simple” definition of patient-centered meaningful use: “The provider makes use of, and the patient has access to, clinically relevant electronic information about the patient to improve patient outcomes and health status, improve the delivery of care, and control the growth of costs.”
The consensus document is available at http://www.markle.org/downloadable_assets/20090430_meaningful_use.pdf
EHRs are useful for reporting quality measures because they offer direct information and timely data. DR. RAPP