07.31.07
Horseback Riding a Major Cause of Recreational Brain Trauma
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07.30.07
P4P demo pays off for Medicare, but not for most doctors involved
Washington -- Ten large physician practices participating in one of the first Medicare pay-for-performance projects have proven that such programs lead to better performance, according to government officials. But only two practices were able to reduce costs enough to receive any additional pay.Last month, the Centers for Medicare & Medicaid Services released first-year results from the Medicare Physician Group Practice Demonstration, which launched in April 2005. CMS asked 10 practices to implement care management improvements that would lead to higher quality of care. In return, the practices were eligible to receive as a bonus a portion of the money that they saved Medicare by improving patient care in a targeted group of Medicare enrollees.
CMS found that all of the participants were able to hit or exceed standards on at least seven out of the 10 clinical quality measures for the treatment of diabetes, the only condition targeted in the project's first year. For the pilot's second and third years, the agency is adding congestive heart failure, coronary artery disease and preventive care measures.
Two of the participants, Forsyth Medical Group in Winston-Salem, N.C., and St. John's Health System in Springfield, Mo., were able to make the grade on all diabetes measures.
The physicians and other health professionals involved in the pilot saved Medicare money, in part, by reducing repeat office visits, hospitalizations and trips to emergency departments, federal officials said.
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Medicaid measures performance: The push to improve care and save money
Private health plans' push for pay-for-performance and Medicare's first steps in that direction have garnered much attention. But the trend isn't confined to these two sectors. State Medicaid agencies have quietly entered the game in an effort to try to improve enrollees' care.As of mid-2006, at least 28 states had 35 Medicaid pay-for-performance programs. Two were specifically designed for primary care physicians, although others involve doctors.
Physicians can expect to see more initiatives. In the next two years, at least 34 states are planning 47 new programs, including nine directly involving primary care doctors, according to a recent report by the Commonwealth Fund.
However, doctors shouldn't expect to see a tidal wave of comprehensive changes because most programs have tailored goals, such as improving childhood immunization rates and care of patients with chronic diseases, or controlling costs.
That narrow focus is partly due to a lack of evidence-based standards for children, said E. Susan Hodgson, MD, chair of the American Academy of Pediatrics' Steering Committee on Quality Improvement and Management. About half of Medicaid enrollees are children.
Many states are using or customizing the National Committee for Quality Assurance's Healthcare Effectiveness Data and Information Set measures. HEDIS standards mostly focus on adult care.
The Alliance for Pediatric Quality, formed in 2006 by four pediatric organizations, is working to fill the standards gap. The alliance, which includes the AAP, is developing evidence-based standards for children and electronic medical records compatible with children's care.
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Senate panel OKs SCHIP funding bill; Bush threatens to veto it
Washington -- Add the State Children's Health Insurance Program to the list of issues on which Congress and President Bush fundamentally disagree.On July 17, Bush promised to veto a bipartisan Senate SCHIP reauthorization bill to increase the program's five-year funding by $35 billion, from $25 billion to $60 billion. The measure, approved 17-4 by the Senate Finance Committee on July 19, with six Republicans voting in favor, would allow another 3.3 million uninsured children to gain coverage. SCHIP now covers 6 million children.
The veto threat cast a shadow over the Senate bill, a compromise carefully negotiated over several weeks. The measure backed away from the $50 billion boost, for total five-year funding of $75 billion, approved by House and Senate lawmakers May 7 in their budget resolution.
House leaders were expected to stick with the $50 billion funding increase in their SCHIP reauthorization legislation, said a House Energy and Commerce Committee aide. At press time, that measure was scheduled for a committee vote on July 25.
Bush said he views the Senate bill as an attempt to federalize health care. He also objected to lawmakers' plan to raise the extra $35 billion by increasing the national cigarette tax by 61 cents to $1. "If Congress continues to insist upon expanding health care through the SCHIP program -- which, by the way, would entail a huge tax increase for the American people -- I'll veto the bill," Bush said.
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Oregon adopts plan for universal health access
Washington -- Oregon will offer health insurance to all uninsured residents by 2010 if the state can carry out a recently adopted plan and if voters approve a cigarette tax.In late June, Oregon Gov. Ted Kulongoski signed the Healthy Oregon Act, a 14-page road map for reforming the state's health care system and covering all of the state's roughly 615,000 uninsured residents -- about 17% of the population. The law calls for a health insurance pool for the uninsured and suggests an individual insurance mandate.
One of the measure's sponsors, Sen. Alan Bates, DO, compared the task at hand -- providing universal insurance access while improving health care quality and reducing costs -- to climbing Mount Everest. "We've just established base camp," said Dr. Bates, a family physician.
The measure creates the seven-member Oregon Health Fund Board to design a plan for the insurance pool and overall reforms. On July 9, Kulongoski appointed as the board's executive director Barney Speight, his deputy chief of staff and former deputy administrator for the Washington State Health Care Authority. The Oregon board will issue an interim report in February 2008 and final reform recommendations that October.
Democratic lawmakers also are asking voters to approve a constitutional amendment boosting the cigarette tax by 84.5 cents to provide health insurance for children up to age 19. The tax, part of Kulongoski's Healthy Kids Plan, would increase the cigarette levy to $2.025 and raise $152.7 million by 2009 to cover 117,000 uninsured kids. The vote split along party lines, so House Democrats didn't reach the 60% majority required for tax increase passage.
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