Monthly Archives: June 2009

Alert: for physicians not opted out of Medicare

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CMS asks that you share this important information with all of your association members and State and local chapters. 

Scam Alert

CMS has become aware of a scam where perpetrators are sending faxes to physician offices posing as the Medicare carrier or Medicare Administrative Contractor (MAC).  The fax instructs physician staff to respond to a questionnaire to provide an account information update within 48 hours in order to prevent a gap in Medicare payments.  The fax may have  the CMS logo and/or the contractor logo to enhance the appearance of authenticity.

Medicare FFS providers, including physicians, non-physician practitioners, should be wary of this type of request.  If you receive a request for information in the manner described above, please check with your contractor before submitting any information.  Medicare providers should only send information to a Medicare contractor using the address found in the download section of the  CMS.gov website found at

http://www.cms.hhs.gov/MLNGenInfo/ or

http://www.cms.hhs.gov/MedicareProviderSupEnroll .

Mary Case for Valerie A. Haugen, Director
Division of Provider Information Planning & Development
Provider Communications Group, CMS
(410) 786-6690
Valerie.Haugen@cms.hhs.gov

Digital panacea is fiscally disastrous, clinically dangerous

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While advances in technology—eagerly adopted by doctors and hospitals—are often blamed for high medical costs, there is one type of technology that will supposedly save billions once we “invest” billions in it and force it on supposedly recalcitrant, technophobic doctors and hospitals: health information technology (HIT), including the electronic medical record (EMR) and computerized physician order entry (CPOE).

“Faith-based cost control” is the term used by Dr. Jon Oberlander in a “Perspective Roundtable: Health Care and the Recession,” offered by The New England Journal of Medicine in January, 2009.

The “stimulus” package provides between $44,000 and $64,000 for physicians who acquire an EMR and demonstrate “meaningful use.” However, “the price is dwarfed by the problems [an EMR] causes the office,” stated Evan Steele, CEO of SRS Soft, which provides a less complex alternative. If a specialist who bills $750,000 a year loses 5% of her productivity dealing with the computer system, she loses $162,000 over 5 years (Physicians Practice, April 2009).

Even the vaunted Veterans Administration system has major problems. An 8-year, $167 million project was not able to develop acceptable scheduling software. The military’s AHLTA system is so slow, unreliable, and cumbersome that clinicians spend 40% of their time inputting data, causing a “near mutiny” (CPR #172, 4/3/09).

For ₤12.7 billion the UK still does not have a national health information technology system, but rather an HIT quagmire, some of it caused by U.S. HIT vendors, writes Dr. Scot Silverstein to the Wall Street Journal.

The province of Ontario just created a new agency, eHealth Ontario, to replace Smart Systems for Health Agency, which spent $647 million without showing any noticeable results. The new agency is supposed to provide EMRs for all citizens by 2015. The province has just hired a consultant to examine whether eHealth Ontario is spending too much money on consultants (Canada Free Press 6/9/09).

In the U.S. also, “most big health IT projects have been clear disasters,” says Dr. David Kibbe, senior technology advisor to the American Academy of Family Physicians. And it’s not just the money.

One U.S. pharmaceutical data base found 43,372 medication mistakes, or about 25% of the total reported in 2006, that involved computer technology: flaws in data entry, inadequate software, and confusing screens. In 2006, Children’s National Medical Center in Washington, D.C., found an eightfold increase in dosage errors for high-risk medications (Terhune C, et al., Business Week 4/23/09).

A 2005 study by University of Pennsylvania sociologist Ross Koppel found 22 circumstances in which the software boosted the probability of error. Doctors also suffered from “alert fatigue” from endless false alarms about minor drug interactions.

“If drug companies sold products with this quality level,” states Dr. Scot Silverstein, “it would be a scandal” (Forbes 5/11/09).

HIT vendors shift liability to users and insert contract language that keeps them from learning of serious faults (Koppel R, Kreda D, JAMA 3/25/09).

“There is a dearth of data on the incidence of adverse events directly caused by HIT overall” (Joint Commission. Sentinel Events Alert, Issue 42, 12/11/08). Among many potential problems are “dangerous workarounds” necessitated by counterproductive technology.

Potential benefits have been greatly exaggerated. Large randomized controlled studies in both the U.S. and Britain have found that EMRs with computerized decision support “did not result in a single improvement in any measure of quality of care for patients with chronic conditions including heart disease and asthma” (Washington Post 3/17/09).

As a direct consequence of the EMR and pay for performance (P4P), the veracity of the clinical record is compromised, write David J. Gibson, M.D., and Jennifer Shaw Gibson (“The Case Against the Electronic Medical Record,” MedicalTuesday.net). Reported data may be “dry-labbed,” and, once entered, data are rarely checked for accuracy.

There are good reasons why only 1.5% of U.S. acute-care hospitals have a comprehensive EMR (Jha AK, et al. N Engl J Med 4/16/09).

Obama’s estimate of savings is an $80 billion exaggeration,” write Jerome Groopman and Pamela Hartzband (Wall Street Journal 5/12/09).

Additional information:

Kennedy plan estimated to cost $4 trillion, four times CBO estimate; legislation pushed at frantic pace

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The Congressional Budget Office (CBO) released a cost estimate of $1 trillion over 10 years for the Democrats’ Senate bill, scheduled to be marked up in the Health, Education, Labor and Pensions (HELP) Committee on July 18. This draft did not include provisions to increase Medicaid eligibility to 150% of poverty, or subsidies to persons earning up to 500% of poverty. It would leave 30 million uninsured (American Spectator, AmSpecBlog 6/16/09).

Adding in these provisions, which would lower the uninsured to less than 1% of the population, would raise costs to $4 trillion, according to calculations by Health Systems Innovations Network (HSI). About 79 million Americans would shift from private to government insurance. There is no mention of removing the tax exclusion for health insurance (worth some $300 billion per year) or of changes to Medicare or Medicaid, except for the need to reduce fraud.

The CBO’s estimate of crowd-out (loss of private coverage) was 23 million. The CBO noted that if enacted the bill would break a key Obama promise that those with private insurance would not be harmed.

Leading Democrats such as Christopher Dodd (D-CT) complained that CBO did not take into account receipts or savings from increased tax revenues as people moved from employment-based to other coverage, payments of penalties by uninsured persons, and reductions in outlays for Medicaid and SCHIP—including reduced payments to physicians. Also the CBO refused to take Congress at its word on savings assumptions, as from prevention.

Dodd told reporters that “reform” would affect 100% of the population. He could not, however, answer questions about the cost. “Contentious issues like a public plan” had been intentionally omitted from the draft submitted to CBO (CNS News 6/17/09).

The New England Journal of Medicine continues to weigh in with frequent articles.

“Some of the most prominent shortcomings of the U.S. health insurance market are rooted in the fact that the system is a voluntary one,” write Linda J. Blumberg and John Holohan in the issue slated for publication on July 2. They favor an individual mandate as the most politically feasible route to universal coverage.

In an update on congressional action dated June 18, John Iglehart notes the accelerated timetable for passing a bill through the House of Representatives by July 31. Neither Republicans nor the 50 Democrats in the House Blue Dog Coalition have participated in the secretive process.

A major issue is whether to eliminate the tax exclusion for employer-sponsored insurance—“the government’s third-largest health insurance expenditure (after Medicare and Medicaid).”

Iglehart also writes that the committees have yet to grapple seriously with the issue of what to do about the 21% reduction in physician Medicare fees scheduled for next January.

After the table-setting, the congressional posturing, and the Long Tease (the current stage) comes the scrum, writes New York Times columnist David Brooks. “You want the scrum to be quick before some of the interest groups realize they’ve been decapitated.”

Additional information:

Obama disses doctors; gets standing O at AMA

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At the annual meeting of the AMA House of Delegates in Chicago, President Obama made an appearance to court physician support for his ideas for a comprehensive, government-directed “overhaul” of American medicine. Reportedly, he got a standing ovation from polite delegates, though there was a smattering of “boos” when he expressed opposition to limits on malpractice awards.

“Now, just hold on to your horses here, guys,” he told doctors when they applauded him for sympathizing with their worries about lawsuits. “I want to be honest with you. I’m not advocating caps on malpractice awards—which I personally believe can be unfair to people who’ve been wrongfully harmed.”

Obama called opponents of his plan “naysayers,” “fear-mongers,” and “peddlers of ‘Trojan horse’ falsehoods.” One such opponent is Representative Tom Price, M.D., of Georgia, an orthopedic surgeon, who calls the Obama proposal a “government takeover” that will set up a rationing board.

Obama stated publicly, for the first time, that his proposed “reshaping” would cost “about $1 trillion over 10 years.” That would include covering almost 50 million Americans who don’t have insurance. But not to worry: he ticked off $950 billion in hypothetical savings. These include cutting payments to hospitals for care of the uninsured, cuts in overpayments to Medicare Advantage plans, “adjusting” Medicare payments to reflect new advances, introducing generic biologic drugs, and reducing preventable hospital readmissions. This doesn’t count savings from computerization, prevention, and other things that the Congressional Budget Office can’t score.

There would also be revenue increases, as by “modestly limiting” the tax deductions of the “wealthiest Americans.” That should bring in $300 billion over 10 years for the $635 billion Health Reserve Fund.

Obama is for the “public option” and individual and employer mandates (“bearing a responsibility to own health insurance”). Not mentioned in the speech is his new “openness” to the idea of taxing some people’s health insurance benefits for the express purpose of subsidizing insurance for others. John Goodman notes that the Obama campaign spent hundreds of millions of dollars attacking John McCain for proposing to tax insurance benefits. Goodman explains the differences in proposed changes to the tax treatment of health insurance.

The huge cost of workers’ health care was “a big part of what led General Motors and Chrysler into trouble,” Obama said. Thus, the cost of not enacting his plan is higher than the cost of passing it, he asserts.

Obama promises to help doctors by seeing to it that “doctors can pull up on a computer all the medical information and latest research they’ll ever need to know to meet patients’ needs.” (No need for patients to tell every doctor they see their medical history.) Instead of “piecework” payments, and yearly negotiations over the Sustained Growth Rate, he proposes to pay for patients’ overall health status. He’ll get rid of cost disparities, like those in McAllen, Texas, detailed by Atul Gawande in a much quoted article in The New Yorker.

In return, he needs the doctors’ help. “The fact is, Americans—and I include myself, Michelle, and our kids in this—we just do what you tell us to do.”

Obama promised that “if you like your health care plan, you’ll be able to keep your health care plan, period. No one will take it away, no matter what.” Same for “your doctor.”

He did not promise, however, that the price would not become unaffordable because of new regulations, such as guaranteed issue or community rating, or that the plan would still be available. Or that the doctor would still be in practice.

Congressmen, including Charles Rangel (D-NY), say the “overhaul” will definitely cost more than $1 trillion. Sen Orrin Hatch (R-UT), estimates that costs will exceed $1.5 trillion. Legislation being drafted by House Democrats will include $600 billion in tax increases and $400 billion in cuts to Medicare and Medicaid.(Bloomberg.com 6/12/09).

Additional information:

Responding to President Obama’s doomsday predictions

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The President has kicked off the health care reform charge in the past week. Last Saturday, he used his weekly radio address to call for
a quick solution to the crisis, while his Town Meetings swung into high care, with him speaking today.

One of the best and most influential policy analysts and patient advocates, Betsy McCaughey, PhD, sent us a note that is one of the clearest rebuttals to most of the doomsday claims made by the President in his radio address, and again today at the town meeting. It also includes a link to her new article in American Spectator that blows the roof on many more of the claims – -titled “Downgrading American Medical Care.”

After you finish the articles, we recommend that you watch the video of Dr. McCaughey from our AAPS Congressional briefing held on April 16. Some of the data she is sharing cannot be found anywhere else.

READ “Downgrading American Medical Care”

WATCH THE VIDEO & COMMENT

FROM BETSY MCCAUGHEY:

New York, NY – June 9, 2009. In his Saturday weekly radio address, President Obama referred to the dangers of “skyrocketing costs” of healthcare. This doomsday scenario is untrue.

The truth is that healthcare spending is increasing at more moderate rates than in previous decades. Spending increased by 10% in 1970 and 13% in 1980. But over the last five years, spending increased less than 7% each year and reached a low of 6% in 2007. For more of the truth, backed up by government data, see “Downgrading American Medical Care,” at http://spectator.org/archives/2009/06/08/downgrading-american-medical-c

The evidence shows that Americans can afford their current standard of healthcare. They do not have to settle for the skimpier standards of care imposed by most Europeans governments. What Americans cannot afford is a healthcare overhaul based on misinformation.

“The President and his advisors owe the American people the truth, not misleading economics to back up their political agenda,” states Betsy McCaughey, Ph.D., a patient advocate and author of “Downgrading American Medical Care.”

“Slowing the flow of dollars into healthcare, as the President requests, will mean cuts in hospital budgets, nurses spread even thinner, fewer diagnostic machines, and waits for treatment,” McCaughey warns. “It’s an outrage that Americans coping with serious illnesses will have to make do with less.”