Blended payment model initiative values primary care
Amidst the doom and gloom of the 27.4 percent fee cut called for in the 2012 Medicare Physician Fee Schedule and the all-too-familiar uncertainty about whether Congress will once again intervene at the 11th hour to patch the flawed formula that gives rise to this annual crisis, there is a hopeful sign, and we want to make sure you don’t miss it. A new demonstration project announced by the Center for Medicare and Medicaid Innovation (CMMI) last month will pay participating primary care physicians a care coordination fee in addition to fee-for-service – the blended payment model that has long been at the center of the AAFP’s payment reform advocacy efforts.
The fee, which will range from $8 to $40 ($20 on average) per patient per month for Medicare and Medicaid patients and for patients who are enrolled in participating private-sector plans, is designed to compensate physicians for the administrative costs associated with patient-centered medical home services. Practices must meet several criteria to qualify for the project, known as the Comprehensive Primary Care Initiative (CPCI), including use of an electronic health record system and other criteria characteristic of patient-centered medical homes. The blended payment model also includes the potential for physicians to share in savings resulting from the initiative.
The project will be rolled out in five to seven health care markets next summer, each with about 75 primary care practices participating. Physicians will apply to participate next spring, after the markets have been identified. If the project demonstrates improved quality and lower costs, the Centers for Medicare & Medicaid Services has the authority to expand the initiative across the country.
Look for more details about the CPCI in the January/February issue of FPM.
Well, that was fast! The first EHRs get CMS certification
More than 20 complete ambulatory electronic health record systems (EHR) and several EHR modules have now been certified as suitable under the Centers for Medicare & Medicaid Services program offering incentives for meaningful use of EHR technology.
The Drummond Group and the Certification Commission for Health Information Technology (CCHIT), two of the "authorized testing and certification bodies" recognized by the Office of the National Coordinator for Health Information Technology, announced the names of the EHR systems and modules they had certified for 2011 and 2012. Drummond has certified three systems, while CCHIT has certified 19 ambulatory systems and seven modules for ambulatory use.
For more information about the incentive program, see "A Physician's Guide to the Medicare and Medicaid EHR Incentive Programs: The Basics" in the September/October issue of Family Practice Managment -- either on the FPM web site (where it's currently available to AAFP members and FPM subscribers) or in the free digital edition.
Perspective on the EHR incentive program
If your head is spinning with all you've heard about the Centers for Medicare & Medicaid Services program offering incentives for "meaningful use" (whatever that means) of "certified EHR technology" (whatever that means), it's certainly understandable. The programs are huge and quite complex. Of course, Family Practice Management is trying to help, with articles and our brand new Health IT blog. But here's another resource you might find valuable for a quick overview: this week's "Health Policy Brief" from Health Affairs and the Robert Wood Johnson Foundation.
While the four-page brief focuses on standards for EHRs (the "certified EHR technology" part of the program), it contains a link to an August brief on meaningful use – the part of the program that affects family physicians directly. Together, the two briefs give a readable, plain-language picture of what's going on, what you can expect, and why. They certainly don't cover all you need to know about the subject, but they'll give you a good sense of the big picture.
What patient-centeredness looks like
Depending on who you believe, Donald Berwick, MD, the Harvard professor, Institute for Healthcare Improvement president, and pediatrician appointed by President Obama to head the Centers for Medicare & Medicaid Services (CMS), is a radical bent on transforming the U.S. health care system in the image of Great Britian’s or a genius capable of reinventing health care and saving the U.S. economy in the process. (Just search for “Donald Berwick” on Google to see what I mean.) Of course the truth lies somewhere in between, and time will reveal the extent to which he can effect real change in his latest role.
Back in May, Berwick was a proud father delivering the commencement address at his daughter’s Yale Medical School graduation, the prepared text of which is making the rounds via e-mail. In describing the first history and physical he performed as a medical student and also in telling the story of a woman who was prohibited from seeing her ailing husband in the intensive care unit during most of the last hours of his life, he touches on themes that should be familiar to any family physician – the biopsychosocial model, patient-centered care and family:
“Those who suffer need you to be something more than a doctor; they need you to be a healer. And, to become a healer, you must do something even more difficult than putting your white coat on. You must take your white coat off. You must recover, embrace, and treasure the memory of your shared, frail humanity – of the dignity in each and every soul.”
Download the entire speech from the Institute for Healthcare Improvement web site.
Time's up! You're making 21 percent less
The last grains have trickled out of the Senate's hour glass, and the Medicare patients you see starting tomorrow will bring you 21 percent less. Or they would, if you were being paid for them. Fortunately (?), CMS is directing its regional carriers to hold claims for 10 days, so (with luck and less sand in the gears of the Senate) you may eventually get paid for tomorrow's work at the same rate you earned yesterday.
Donald Berwick, MD, faces his biggest challenge yet
President Obama’s impending nomination of Donald Berwick, MD, MPP, to head the Centers for Medicare & Medicaid Services (CMS) is welcome news. Berwick, a pediatrician and professor at Harvard Medical School and Harvard School of Public Health, is president and CEO of the Institute for Health Care Improvement (IHI), a think tank whose impressive and ambitious work we at FPM have been following since it launched the Idealized Design of Clinical Office Practices (IDCOP) initiative in 1998 (read more about IDCOP in FPM). Our only beef with Berwick is that, following IDCOP, IHI hasn’t devoted more focused attention to office-based practice.
Washington Post blogger Ezra Klein calls Berwick "the most important health-care reformer you’ve (probably) never heard of” and Maggie Mahar’s two-part profile of Berwick introduces him (don’t miss the video clip that, near the end, features Berwick’s thoughts on primary care payment). Having heard several of Berwick’s rousing keynote addresses at IHI’s Annual National Forums, it’s hard to imagine him not making the most of the new tools and authority of the CMS position to improve health care for patients and providers. If only we will let him. Let’s hope his confirmation isn’t a casualty of the resentment bred by the passage of health care reform legislation. May it be quick and painless. This man has work to do.
CMS makes e-prescribing simple
When was the last time the Centers for Medicare & Medicaid Services (CMS) made anything simple? Good question. Well, now they have published a document called "2009 Electronic Prescribing (E-Prescribing) Incentive Program Made Simple." It's just four pages, three questions, two tables and three steps, two of which you have to repeat a few hundred times. Simple, huh?
All you have to do is bill one of 33 CPT and G codes plus one of another set of three G codes for at least 50 percent of your patients, hope that CMS corrects the problems associated with the Physician Quality Reporting Initiative (PQRI) last year and rake in the incentive payments.
OK. I recognize that, even as simple as that sounds, it may not tempt you. But that doesn't make e-prescribing a bad deal in itself, as Kenneth Adler's article in our current issue argues. If you're not already doing e-prescribing, it's at least worth a look. And once you're up and running with it, you can decide whether you want to simplify your life by going for the Medicare incentive.