Medical News, Medicare Reimbursement Cuts, Prescription Profiling, Electronic Medical Record Privacy

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Physicians representation continues to grow in congress based on the recent elections. We have 20 physicians in congress, a new record. Only two physicians were not re-elected. All but Jim McDermot and Vic Snyder are republicans. In the 2010 elections we have elected to the senate ophthalmologist Rand Paul MD (R, KY), and Ob-Gyn Tom Coburn (R, OK) was re-elected.

Elected to the house were Mike Fallon MD (R, CO, emergency medicine; Larry Bucshorn, MD (R, IN) thoracic surgery; Andy Harris MD (R Maryland) anesthesia; Joe Heck DO (R NV)emergency medicine; Nan Hayworth MD (R, NY) internal medicine, Scott DesJarlais MD ( R, TN) family medicine. Re-elected to the house were Charles Boustany Jr MD (R, LA) cardiovascular surgery; Paul Broun MD, (R, GA) family medicine; Michael Burgess MD, (R, TX) ob-gyn; Bill Cassidy MD, (R, LA) GI; John Fleming MD (R, LA) family medicine; Phil Gingrey, MD (R,GA) ob-gyn; Jm McDermott MD (D, WA) psychiatry; Ron Paul MD ( R, TX) ob-gyn; Tom Price (R, GA) orhopedics, Phil Roe (R, TN) ob-gyn; Vic Snyder MD (D, AR) family medicine

Physicians fared well in the 2008 US elections. We will have a total of 14 physicians in the new congress, the most we have ever had. The final Medicare fee schedule for 2009 will show a 1.1% pay increase. We originally were going to suffer a 5% pay cut in 2009 , on top of the 10.6 percent cut for 2008 which congress overturned. In addition to the pay increase there will be bonus payments of 2% for physicians who prescribe medications electronically for their Medicare patients, and another 2% bonus for doctors who participate in the Physician Quality Reporting Initiative. There is a major bipartisan congressional push to make electronic medical record systems mandatory. Its advocates cite cost savings to the government, the use of EMR data in implementing pay for performance, and reductions in medical errors. No one is saying how we are supposed to pay for the EMR systems, which average $15,000-$30,000 start up costs per physician, and about $3,000-$6,000 yearly maintenance. The potential for invasion of privacy of both patients and doctors by commercial EMR systems is huge and has been largely overlooked. Data mining companies have successfully argued in two state courts that they have a constitutional right to compile and sell confidential patient prescription information.

Top Stories 11/19/08

Federal Appeals Court Upholds Prescription Privacy Law 11/19/08
The federal district appeals court in Boston upheld a New Hampshire law that blocked the sale of doctor specific prescription information. This information was compiled by data mining companies and sold to pharmaceutical companies. The pharmaceutical companies were thus armed with precise current prescription information which they used to target physicians that weren't prescribing their product, or to increase market share. By increasing the use of expensive name drugs, the cost to the state Medicaid programs were increased. The purpose of the New Hampshire law, (and similar laws passed in Maine and Vermont), was to block this practice. This would save the states money and improve physician and patient privacy. According to the opinion written by United States Court of Appeals Judge Bruce Marshall Selya the buying and reselling of prescription information was “mind-boggling” . “The record contains substantial evidence that, in several instances, detailers armed with prescribing histories encourage the overzealous prescription of more costly brand-name drugs regardless of both the public health consequences and the probable outcome of a sensible cost/benefit analysis." It is expected that this ruling will also apply to Maine. In both Maine and New Hampshire prescription privacy laws were overturned by state federal courts. In Maine a decision issued 12/21/07 by Judge John Woodcock said the privacy law would prohibit "the transfer of truthful commercial information" and "violate the free speech guarantee of the First Amendment." Bangor Daily News. There is no constitutional guarantee of a right to privacy, it is an implied right. Thus in prior decisions the constitutionally guaranteed right to free speech of the Data Mining companies was considered more important than the implied right to privacy of patients and their physicians.

Physicians Win New Seats In US Congress 11/18/08
There will be a total of 14 physicians in the new US congress, 12 in the House of Representatives, and two in the Senate. There will be five Ob-gyn specialists serving in congress. Senator Tom Coburn, MD (R, Okla.), ob-gyn was not up for relection. Newly elected physician members of congress are: Rep. Bill Cassidy, MD (R, La.), family medicine; Rep. Parker Griffith, MD (D, Ala.), medical oncology; and Rep. Phil Roe, MD (R, Tenn.), ob-gyn. Reelected were Sen. John Barrasso, MD (R, Wyo.), orthopedic surgery; Rep. Charles Boustany, MD (R, La.), cardiovascular surgery; Rep. Paul Broun, MD (R, Ga.), family medicine; Rep. Michael Burgess, MD (R, Texas), ob-gyn; Rep. Phil Gingrey, MD (R, Ga.), ob-gyn; Rep. Steve Kagen, MD (D, Wis.), internal medicine; Rep. Jim McDermott, MD (D, Wash.), psychiatry; Rep. Ron Paul, MD (R, Texas), ob-gyn; Rep. Tom Price, MD (R, Ga.), orthopedic surgery; and Rep. Vic Snyder, MD (D, Ark.), family medicine. Retiring is Rep. Dave Weldon, MD (R, Fla.), internal medicine.
Unfortunately our physician representatives don't vote the same way on health care issues, which dilutes our voice. For example democrat Jim McDermott has been an outspoken proponent of a single payer universal healthcare system, whereas many of his republican colleagues have been outspoken critics of such a system. Hopefully they can all agree on the need for malpractice reform, especially with five ob-gyns serving in congress.

Michigan Voters Legalize Growth, Distribution, Sale, and Use of Medical Marijuana 11.16.08
Michigan voters passed a measure legalizing the growth, distribution, and possession of up to 2.5 ounces of marijuana by registered patients. Patients must have a written certification from a physician certifying that they have a debilitating condition which can be alleviated by marijuana use. Patients may then designate a primary caregiver who is allowed to grow and distribute the marijuana. The caregiver is allowed to assist up to five patients, and each caregiver may posses up to 2.5 ounces of marijuana and 12 plants per patient they are assisting. The caregivers are allowed to sell the marijuana to registered patients. The caregivers must not have been convicted of prior drug offenses, and must register with the state. Michigan joins 14 other states which have decriminalized marijuana. These state laws are in conflict with federal law which bans the sale, distribution, possession, or use of the drug. The Controlled Substances Act of 1970 classifies marijuana as a Schedule I drug, ie, it has a high potential for abuse and no acceptable medical use. mlive.com

Health Insurers To Launch Medical Tourism Programs 11/12/08
An article in Business Week stated that Health insurer WellPoint is setting up a pilot program that send patients to India for elective surgeries. The program can save the insurer thousands of dollars per procedure and give WellPoint extra clout at the bargaining table with U.S. physicians and hospitals. About 750,000 Americans headed abroad last year for major health care. Aetna Inc. launched a medical tourism pilot program earlier this year. Medical tourism involves traveling to another country for elective care that can include dental procedures, hip replacements, cosmetic surgery, bariatric surgery, and even heart bypasses or heart valve replacements.

Insurance Companies Know What In Your Patients' Medicine Cabinets 8/04/08
An article in Business Week and a similar article in the Washington Post detailed how insurance companies such as Aetna, Humana, United Healthcare, Blue Cross, and others routinely use prescription profiling services. The information is used to deny insurance to people who are considered high risk of incurring medical expenses. Prescriptions for hypertension, diabetes, and mental health medications are red flags for insurers. The companies that sell this information include Intelliscript , and MedPoint,.
Congress Overrides Presidents Veto, Blocks Medicare pay cut 7/15/08
On July 15 Both houses of congress overrode President Bushes veto, enacting an 18 month patch on Physician Medicare payments. The money will come from Medicare Advantage programs, which charge the federal government a premium over medicare rates, and which are a major source of profits for the HMO industry. Instead of a 10.6% pay cut, we will get a 0.5% pay increase for the next 18 months, then face even larger cuts. Also in the "Medicare Improvements For Patients And Physicians Act of 2008" was a mandate for e-prescribing, with both a carrot for early adapters, and a stick for late adapters. Starting in 2009, physicians will receive incentives of up to 2% of their Medicare payments for using electronic prescribing to place medication orders on Medicare approved drugs. The bonus will decrease to 0.5% in 2013. Starting in 2011, doctors will be required to use e-prescribing in Medicare and there will be a 2% penalty against Medicare payments for those physicians that don't use e-prescribing. AMA News

E-Prescribing: Following The Money Path From Ex Officials 5-28-08
An excellent article in

Proposed Law Will Hold Data Mining Companies Accountable To HIPAA 5-28-08

Dingell Proposed Law Memorandum

New Study On Relationship Between Outcome and Surgical Volume 5-02-08
Surgical volume is being increasingly used as a marker of physician quality. A recent Swedish study published in the British Medical Journal questions this practice. For physicians who perform less than five inguinal hernia repair surgeries per year, the risk of recurrence was increased. However, beyond five procedures per year, there was no relationship between recurrence rates and volume. Thus there appears to be a threshold effect, and not a proportional relation between surgical volume and quality.
CMS to Implement 10.6% Cut Unless Congress Acts
The Centers for Medicare and Medicaid Services (CMS) announced in Transmittal 312 (February 1, 2008) that if Congress does not pass legislation regarding the sustainable growth rate (SGR) formula on which Medicare physician payments are based, the current conversion factor (CF) in the Medicare Physician Fee Schedule (MFS) of $38.0870 will be reduced to $34.0682 (a 10.6 reduction) effective on July 1, 2008.
Senate Finance Committee Chair Max Baucus (D-MO) is working on legislation to address the scheduled Medicare physician pay cut , as well as the additional 10.1% cut that would take place January 1, 2009. In a Medicare package he plans to introduce directly on the Senate floor by mid-May, Senator Baucus has stated he favors applying an 18-month fix to the Medicare payment system and possibly providing a 1.1% rate increase during that period. Additional priorities Senator Baucus has outlined for his proposed legislation include: Extra incentives to get health care providers to work in rural areas. An electronic prescribing provision that would provide incentives for physicians to use e-prescribing tools and electronic medical records. An expansion of the Physician Quality Reporting Initiative program.
Bill Delaying Medicare Physician Fee Reductions Progresses In Senate 4-07-08
Senate Finance Committee Chair Max Baucus (D-Mont.) on Thursday said he intends to send a bill correcting the scheduled reduction in Medicare physician fees straight to the Senate floor. The American Medical Association is lobbying for a bill sponsored by Sen. Debbie Stabenow (D-Mich.) that would increase physician fees by 1.8% for 18 months. Kaiser Daily Health Reports

CMS Announces 3.6 Percent Rate Increase For Medicare Advantage 4-03-08
The HMO controlled Medicare advantage plans already cost the government significantly more than traditional Medicare NY Times. They are also the main source of profits for companies such as Humana, and United. Today the Centers For Medicare Services announced a 3.6% fee increase for these already highly profitable plans. CMS

Neuroleptics Worsen Alzheimers 4-01-08
A common practice is to give nursing home patients antipsychotic medications to reduce aggressive behavior and make them more manageable. A British study has found that antipsychotic drugs worsen the cognitive decline of nursing home patients with Alzheimers. The neuroleptics analyzed were thioridazine (Melleril), chlorpromazine (Largactil), haloperidol (Serenace), trifluoperazine (Stelazine) and risperidone (Risperdal). The death rates were also higher for nursing home patients on antipsychotics. In the US, federal rules that took effect October 2007 require nursing homes,to use antipsychotic drugs only when medically necessary, to document the medical necessity and to make every effort to reduce the dose of the drugs. NY Times

CMS Releases Hospital Report Cards For Consumers 3/31/08
The Centers for Medicare & Medicaid Services (CMS) has added consumer survey information to its Hospital Compare website for Medicare beneficiaries. The site now includes the results of patient care surveys, as well as information on pricing and elective procedure volumes at hospitals. The website already offered 26 measures to assess the quality of care in acute care hospitals. There is also information on the average medicare payment made for a range of procedures. The information is available at http://www.hospitalcompare.hhs.gov/

Germany To Introduce Centralized Electronic Health Records Despite Doctor Opposition 3-27-08
Germany will introduce an Electronic Health Card system in April, despite doctor opposition. According to the British Medical Journal, the German Medical Association issued a press release earlier this month that claimed that patient data stored on central servers would not be secure and would be open for commercial exploitation. "Patients are not commercial products," the press release declared. The German physicians don't oppose Electronic Health Records, rather they oppose the storage of health information on centralized servers. German physicians have proposed an alternative whereby patient information is stored on encrypted USB drives given to each patient, and not on centralized servers. E-Health Insider Security breeches of centrally secured electronic health records have been a recurring problem in Great Britain. A recent security breech of 25 million people in the children's benefit database has an estimated street value of $3 Billion US dollars. BBC News. In the US, HIPAA privacy laws apply to doctors and hospitals, but not commercial entities, thus Health information can be freely sold even without a security breech. HIPAA: Intent Versus Reality

Were Doctors Being Bribed By Orthopedic Device Manufacturers? 3-22-08
A long-running federal investigation into the orthopedic device industry’s suspected kickback payments to hip and knee surgeons now has the doctors in the crosshairs. The investigation by Newark US attorney General Christie resulted in a 311 million dollar settlement against five manufacturers of orthopedic devices. The manufacturers are required to publicly list all payments to consulting physicians. The settlement sets a $500 per hour cap on physician consulting agreements. NY Times The settlement has proven to be a bonanza for attorney general Christie's ex boss, US attorney General Ashcroft. His firm is being paid to monitor the settlement. In order to insure that doctors aren't being paid more than $500 an hour as consultants, Ashcroft's firm will get a multimillion dollar monthly retainer and bill time at $895 per hour. Ashcroft's D.C.-based firm is poised to collect more than $52 million in 18 months, among the biggest payouts reported for a federal monitor. Disclosed in SEC filings, the arrangement pays Ashcroft Group Consulting Services an average monthly fee between $1.5 million and $2.9 million. The figure includes a flat payment of $750,000 to the firm's "senior leadership group," individual legal and consulting services billed at up to $895 an hour, and as much as $250,000 a month for expenses including private airfare, lodging and meals. Newark Star Ledger

US Senator Introduces Bill To Eliminate Medicare Physician Fee Schedule Cuts 3-13-08
A bill has been introduced into the Senate that would eliminate the nearly 11 percent Medicare physician reimbursement cuts scheduled for July 1. Sen. Debbie Stabenow, D, Mich., introduced the "Save Medicare Act of 2008" on March 13. The bill (S. 2785) proposes to replace the scheduled 10.6 percent cut with a 0.5 percent update for the second half of 2008 and a 1.8 percent update for 2009. Stabenow's bill has been submitted to the senate finance committee. Health Imaging News

New Hampshire Defeats Medical Privacy Bill 3-13-08
The New Hampshire state senate defeated a bill which would have extended federal HIPAA privacy requirements to businesses such as software vendors, drug companies, and data mining firms. The bill also would have allowed patients to place additional restrictions on their records, and would have required that the hospital produce an audit trail, at the patient’s expense, detailing who had access to a patient’s medical information. Hospitals opposed the bill saying that it would establish another costly layer of bureaucracy. New Hampshire Business Review

Insurer Finds That EMR is Not Worth The Cost To Doctors 3-10-08
Blue Cross of Massachusetts has concluded that the financial benefits of an Electronic Medical Record system are not worth the cost to doctors. Thus they will not require EMR for physicians to participate in its bonus program. They have reached a different conclusion for hospitals, and concluded that an electronic order entry system for doctors orders would prevent enough medication errors to make the system economically viable in 26 months. The AMA has taken the position that physicians need financial subsidies in order to encourage widespread adoption of EMR systems. AMA News
Proposed Massachusetts Law Would Fine Doctors $5,000 for Accepting Drug Company Pens 3-04-08
Massachusetts state senate president Therese Murray has proposed a law that would ban all gifts to doctors from drug companies, including pens. Drug samples could still be given. The new law calls for a $5,000 fine for violations. State senator Mark Montigny (D), castigated drug companies for hiring "former beauty queens and cheerleaders" as sales reps to wine and dine doctors and induce them to prescribe brand name drugs that may not be cost effective. The law also mandates physician implementation of electronic health records. Boston Globe

NY Attorney General Issues Subpoenas Against Aetna, Cigna, Empire Blue Cross, United Healthcare 2-13-08

NY Attorney General

Hillary Clinton Healthcare Taskforce Records Still Secret 2-10-08
Hillary Clinton has made healthcare reform a keystone of her campaign. However the records from her first healthcare taskforce under Bill Clinton's administration still remain secret. Judicial Watch has filed a Freedom Of Information Act lawsuit to get the government to release these records, which have become a major issue for anyone wanting to objectively evaluate Hillary's health plan. There are over 3 million records from her secret taskforce which remain unreleased. The initial records which have emerged have been cause for concern. “These documents paint a disturbing picture of how Hillary Clinton and the Clinton administration approached health care reform – secrecy, smears, and the misuse of government computers to track private and political information on citizens,” said Judicial Watch President Tom Fitton. “There are millions more documents that the Library has yet to release. The Clintons continue to play games and pretend they have nothing to do with this delay. The Clintons should get out of the way and authorize the release of these records now.” In a recent editorial the Washington Post has argued against the release of the Task force documents before the November election.
Clinton, Obama, and McCain Healthcare Proposals Compared at Forum 2-04-08
In a recent Washington DC forum representatives for Clinton, Obama, and McCain discussed and compared their healthcare policies. Each one tries to improve coverage. McCain's proposal relies on tax credit incentives and the free market. Obama would mandate coverage for children, but not adults. Clinton mandates coverage for everyone and requires every adult to purchase health insurance which would have income based subsidies. The Wall Street Journal criticized the Clinton approach as heavy handed, stating that it is "really a government mandate that requires brute force plus huge subsidies to get anywhere near its goal of universal coverage." Kaiser Health Reports. A comparison of different candidates healthcare platforms is at WebMD.
Insurers To Stop Paying For Hospital Errors 1-15-08
Aetna and Wellpoint will ban payments to hospitals for serious medical errors. A list of 28 conditions for which insurers may ban payments includes items such as surgery on the wrong body part or wrong patient, and death or disability due to incorrect medication or blood products as listed by the National Quality Forum. Last October the federal Medicare program announced that they will no longer pay for six preventable conditions that arise as a result of hospitalization, such as bed sores, falls, hospital-acquired blood infections, blood clots in legs and lungs, and pneumonia contracted from a ventilator. Wall Street Journal
No Survival Benefit To Zetia 1-14-08
In a recently released study, Merck and Schering jointly reported that the cholesterol lowering drug Zetia did not improve survival. Atheromatous plaques actually grew faster in patients taking Zetia along with Zocor than in those taking Zocor alone. Patients on Vytorin (Zocor and Zetia combination) actually had more heart attacks, cardiovascular deaths, and heart procedures than those who got Zocor. Those differences were not statistically significant. Dr. Steven Nissen, the chairman of cardiology at the Cleveland Clinic, said patients should not be prescribed Zetia unless all other cholesterol drugs have failed. Analysts estimate that 70% of Schering's earnings depend on these drugs. NY Times
Doctors Get Six Month Reprieve From Pay Cut
Physicians will get a six-month reprieve from a 10 percent rate cut when treating Medicare patients under legislation that passed the Senate on 12/18/07. The pay cut for doctors had been scheduled to take effect Jan. 1. Doctors had warned that a cut in reimbursement rates would lead to physicians taking on fewer new Medicare patients. Instead, they'll get a 0.5 percent raise. AMA News

Federal Judge Rules That Data Mining Firms Have Constitutional Right To Compile And Sell Prescription Info 12-22-07
A federal district court judge in Bangor ruled against a new Maine law that would have made it easier for doctors to keep their prescription writing confidential. The law would have attempted to restrict access to prescription information by companies that collect, analyze and sell medical data. Pharmaceutical firms buy the data to help them develop marketing strategies. Data mining companies said the law was unconstitutional and filed suit against the state in August. In a decision issued 12/21/07 Judge John Woodcock said the law would prohibit "the transfer of truthful commercial information" and "violate the free speech guarantee of the First Amendment." There is no constitutional guarantee of a right to privacy. Bangor Daily News. In Washington, D.C., the local government is trying to restrict access to physicians' prescribing information, but pharmaceutical companies are arguing that banning the practice is unconstitutional and could hinder research and efforts to monitor drug safety.

Bush Administration Blocks Last Minute Reprieve of 10.1% Medicare Pay Cut
Medicare part B expenditures, which includes physician payments, have increased faster than inflation. In order to achieve budget neutrality, OMB initially sought cuts in payments to physicians. A 10.1% cut in physician Medicare fees was approved, scheduled to take effect January 2008. The senate finance committee, headed by Max Baucus (D, Montana)decided to suspend these pay cuts for a year, and find alternative places to cut. Predictably, every alternative source of cuts has lobbied congress to protect their turf. For example, the home oxygen industry mounted a massive lobbying campaign to block cuts. The Senate finance committee ultimately recommended cutting the Medicare Advantage program. This is a notorious boondoggle for the insurance industry. The Medicare Advantage program pays on average a 19% bonus to insurance companies over the Medicare rates. The Bush administration has threatened to veto any bill that fixes the physician pay cuts if it comes at the expense of the Medicare Advantage program. Furthermore the Bush administration has said that any fix for physician payments should include a mandate for "adoption of certified electronic health information technology". Physicians who don't use electronic health records or E-prescribing should be paid less, according to Health and Human Services secretary, Mike Leavitt. MedPageToday Kaiser Daily Health Reports

Zagat To Rate Doctors.
Wellpoint and Zagat are teaming up to rate doctors based on Zagat's well known 30 point rating system. WellPoint will begin to offer an online survey using the Zagat approach to members in its Blue Cross/Blue Shield subsidiaries in January 2008. The Zagat restaurant rating system is based on food, service, decor, and cost. Doctors will be rated based on availability, office environment, communication, and trust.

NJ Ruling Threatens Ambulatory Surgery Centers 12-13-07
Physician owned ambulatory surgical centers have been shown to provide higher patient satisfaction and comparable outcomes to surgery performed in hospital. A recent NJ ruling has concluded that these centers violate the NJ State Codey law against self referral. The Codey law prohibits physician referral to facilities in which they have a financial self interest. It exempts facilities that are part of a physicians office practice, radiation oncology, kidney stone centers, and dialysis centers. Hospitals have long sought to close down the ambulatory surgical centers which they feel siphon off the best insured patients, and thus compromise hospitals financially. Philadelphia Inquirer . Previously New Jersey's hospitals persuaded the state Legislature to boost charity-care funding by 53%, but the bounty came at least in part by a tax on ambulatory surgical centers. Modern Healthcare

Pilot Program Offers Incentives For EMR Implementation
Is Medicare tossing us a bone or a brick?
The Centers for Medicare and Medicaid Services announced a pilot project to give higher Medicare payments to doctors who adopt electronic medical record systems, starting next summer. They want 1200 practices to participate. The magnitude of the bonus hasn't been decided. The project will be revenue neutral, so ultimately those of us who don't adapt EMR will be penalized. Implementation will be the first step, the next step will be preparing reports on clinical quality measures, and the third step will be requiring us to show how we are improving on clinical quality measures. From American Medical News

Bipartisan Call For Electronic Prescriptions
The last time Kerry and Gingrich agreed was back in Sept 2002, in support of the invasion of Iraq.
In a joint editorial in the Wall Street Journal 11/16/07, John Kerry and Newt Gingrich lay out the case for E-Prescriptions. They state that "If a majority of doctors don't e-prescribe a few years down the road, the government should require all doctors to adopt e-prescribing or face financial penalties. Their argument was undercut a few days later by Karl Williams, an associate professor of pharmacy administration, who pointed out in an 11/21/07 letter to the editor that by law many prescriptions, such as controlled substances, may not be transmitted electronically. As of 12/5/07 a senate bill has already been introduced to mandate electronic prescriptions. Senators have also called on the DEA to allow electronic prescribing of controlled substances. iHealthBeat AMA News

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Top Stories 11/19/08

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