July 12, 2006

Medicare Revises Guidance for National Coverage Determinations

The Centers for Medicare & Medicaid Services (CMS) today released revised guidance for national coverage determinations (NCDs) that include, as a condition of payment, the development and capture of additional patient data to supplement standard claims data and help ensure that patients receive appropriate care.

“Our goal is to speed access to valuable new technologies, and to promote the effective use of those technologies by providing patients and doctors with better medical evidence,” said CMS Administrator Mark B. McClellan, MD, PhD. “In the particular cases where this coverage approach is relevant, our new guidance provides for faster and more effective coverage coupled with more informed clinical decision making,” Dr. McClellan said. “We expect these steps to lead to more appropriate use of beneficial treatments with better health outcomes and fewer unnecessary medical costs and complications.”

The release follows the CMS announcement that it is reconsidering its NCD on how it covers clinical research, to better clarify how and when CMS can pay for both routine costs and investigational costs incurred in clinical trials.

Read the full press release at http://www.cms.hhs.gov/apps/media/press/release.asp?Counter=1897

The revision of the CED guidance document is available for review on the CMS Coverage Web site at:

www.cms.hhs.gov/coverage

MedPAC Starts Testing Doctor Efficiency

The Medicare Payment Advisory Commission has taken the first steps toward comparing physicians’ use of program resources in order to identify efficiency in doctors. In a June report, the Commission analyzed 5% of Medicare claims in 13 major metropolitan areas to determine how much the program spent on physician services and other medical care for specific types of conditions.

The numbers determined that the average cost to medicare for a single episode of care varied widely, depending on region. MEDPAC hopes that Medicare officials may eventually use these types of total dollar figures to determine how many resources can be linked to the one physician who is most responsible for directing or coordinating the care for the patient.

CMS administrator Mark McClellan, MD, PhD, said preliminary work by the commission shows promise amid recent trends of rising Medicare costs and growing evidence that more care isn’t necessarily better for the patient.

Subscribers can read more at AMNews.com

Medicaid Spending Projections Down Again

In a July 11 press release CMS released a fact sheet showing Medicaid cost projections are once again declining, reflecting slower Medicaid spending growth in recent years.  For the fiscal year (FY) 2006-2015 period, projected Federal Medicaid costs are $224 billion lower than had been projected just a year ago – a reduction of  8 percent. This reflects a slowdown in Federal Medicaid spending growth from over 12 percent per year in fiscal year 2000-2002 to 7.2 percent from 2002-2005, down further to 4.6 percent projected for fiscal year 2006-2007.  State Medicaid spending growth has simultaneously slowed significantly, with many states projecting lower costs in FY 2006 than FY 2005.  States are also paying much less than had been predicted for drug coverage for “dual eligible” beneficiaries who are now getting coverage through Medicare.

Read the CMS fact sheet http://www.cms.hhs.gov/apps/media/press/release.asp?Counter=1896

Also see Health Trends online article: U.S. Health Spending Projections for 2004-2014

CMS Says Medicare Part D Spending Projections Down

In a media release yesterday, CMS announced Medicare Part D expenditures are now projected to be $34 billion lower over 5 years (2006-2010) than in the President’s Budget, and $110 billion lower than in the Mid-Session Review one year ago. The average Part D premium is almost 40 percent lower than had been projected a year ago as a result of strong competition, and 90 percent of Medicare beneficiaries are receiving prescription drug coverage.

Medicare Part A and Part B expenditures are higher, primarily because of continuing rapid growth in the use of Medicare services. Part A projected expenditures over 5 years (2006-2010) are $17 billion higher and Part B projected expenditures over 5 years are $30 billion higher than in the President’s Budget.  Rapid growth in physician-related services and hospital outpatient services are the main factors responsible for a projected increase in the Medicare Part B premium of 11 percent for next year.

The continued rising costs in Medicare Part A and Part B highlight the need for reform of the original Medicare program to pay more accurately and especially to pay more for better care, not simply more services. The President’s Budget proposed building on MedPAC’s recommendations for more accurate payments to health care providers, and the adoption of performance-based payment systems.

Read the full CMS fact sheet release: http://www.cms.hhs.gov/apps/media/press/release.asp?Counter=1895

Employee Drug Testing Dropping

The percentage of businesses that require their employees to submit to drug testing is dropping. And a major laboratory testing company reported recently that the percentage of American workers who tested positive for illegal drugs last year was the lowest ever. Drug testing "is an effective deterrent," said Dr. Barry Sample, director of science and technology for the employers solutions division of Quest Diagnostics, a major drug testing company.

Companies began to test primarily because the federal government drafted them into the war on drugs in 1986 when the President's Commission on Organized Crime called on private employers "to support unequivocally" that "all use of drugs is unacceptable." But over time that testing rate has decreased significantly. Perhaps due in part to the rising costs of drug testing.

Read more on the subject at Time.com

For more information on drug use in the workplace go to the Office of National Drug Control Policy

2.4 Million Started Using Pain Relievers in Past Year

More persons initiated non-medical use of narcotic pain relievers in the past year than initiated use of marijuana or cocaine. This is the finding of a new report from the Substance Abuse and Mental Health Services Administration (SAMHSA) that extracted data from the 2004 National Survey on Drug Use and Health and reported in a June 19 press release.

The new report, “Non-medical Users of Pain Relievers: Characteristics of Recent Initiates”, shows that 2.4 million persons ages 12 or older initiated non-medical use of prescription pain relievers in the 12 months prior to the survey, 2.1 million initiated use of marijuana, and 1 million initiated use of cocaine.

“While overall illicit drug use continues to decline among our young people we are always paying close attention to the data to identify any potential areas of concern,” said SAMHSA Administrator Charles Curie. “Abuse of prescription pain medication is dangerous and can lead to the destructive path of addiction. The initiation rates show we must continue our efforts help the public confront and reduce all drug abuse.”

The new report shows that 48 percent of new initiates used Vicodin®, Lortab® or Lorcet®; 34.3 percent used Darvocet®, Darvon®, or Tylenol® with codeine; 20 percent used Percocet®, Percodan® or Tylox®; 18.4 percent used generic hydrocodone; 14.3 percent used generic codeine; 8.4 percent used Oxycontin®; and 4.3 percent used morphine. Over half of persons who initiated non-medical use of pain medications (54.9 percent) in 2004 were female.

Further, the report found that only 26.2 percent of the new initiates to pain medications started using pain relievers as their first illicit drug of abuse. Marijuana was used by 66.2 percent prior to starting narcotic pain medications; hallucinogens were used by 24.9 percent; and inhalants were used by 21.3 percent.

The report is available on the web at www.oas.samhsa.gov.

CMS Reminder for Providers and Physicians Billing Medicare Contractors

CMS sent out a reminder today that a brief hold will be placed on Medicare payments for all claims during the last 9 days of the Federal fiscal year (September 22 through September 30, 2006). These payment delays are mandated by section 5203 of the Deficit Reduction Act of 2005. No interest will be accrued and no late penalties will be paid to an entity or individual by reason of this one-time hold on payments.  All claims held during this time will be paid on October 2, 2006.

This policy only applies to claims subject to payment. It does not apply to full denials, no-pay claims, and other non-claim payments such as periodic interim payments, home health requests for anticipated payments, and cost report settlements.

Please note that payments will not be staggered and no advance payments will be allowed during this 9-day hold.

For more information, please view the MLN Matters Article at

http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM5047.pdf

Rhode Island Makes Move Toward Statewide Health Information Network

On June 24The Rhode Island General Assembly approved a new state budget under which the state agreed to contribute $6 million to help finance the cost of building a regional health information organization, subject to certain conditions.

Under the terms of the measure, Rhode Island will kick in the money if other parties who stand to benefit from the electronic exchange of patient data also pony up. The state estimates the start-up cost for the network at $20 million. Because studies have shown that insurers reap most of the benefit from physicians' using information technology, Rhode Island is looking primarily to insurers to pay their "fair share" not only of the cost of building the network but also of the $2 million to $4 million it estimates it will cost for annual operations, director of the state's Dept. of Health, Dr. Gifford, said. The state estimates its fair share of the network's start-up capital cost at 30%, which is how it came up with $6 million.

http://www.ama-assn.org/amednews/2006/07/17/bisc0717.htm

Doctors vote to fight Medicare imaging cuts and audit project

Physician delegates from the American Medical Association last month voted to actively oppose two elements of the Medicare system that so far have unfairly impacted only a minority of doctors.

The AMA will work with Congress to rescind Medicare's recovery audit contractor program, under which private firms comb through physician claims data to find instances in which the federal government overpaid doctors and to recoup those dollars. In a separate action at the Annual Meeting, the House of Delegates also decided to support the repeal or delay of medical imaging cuts that are due to start in January 2007.

http://www.ama-assn.org/amednews/2006/07/03/gvsb0703.htm

CMS Announces contingency plan for HIPPA

The Centers for Medicare & Medicaid Services (CMS) has announced that its contingency plan for the HIPPA compliant transaction 835, or Electronic Remittance Advice, will expire on October 1, 2006. A special edition MLN Matters article has been developed to help the Medicare fee-for-service provider community prepare for this change. You can access the article on the CMS Web site.

More Doctors Using IT

Physicians are making more use of information technology in their clinical practices, but in some cases that use may be fairly basic, such as looking up information on the Web as opposed to using a printed reference source, the Center for Studying Health System Change says in a report. The report compared the survey responses of more than 6,600 physicians in 2004-05 with the responses of about 12,000 physicians in 2000-01. The results show that the number of doctors using IT for any important clinical functions is going up. For example, 64.8% of doctors in the most recent survey said they had access to IT to obtain treatment guidelines, up from 52.9% in 2000-01. In the case of electronic prescribing, the rate rose to 21.9% from 11.4%.

State Society News

If your state society would like to announce meetings or share news stories with our readers, send your new items to Melinda Martin - mmartin@asipp.org

Florida Society of Interventional Pain Physicians to host dinner

On July 15th at 7:30 p.m., FSIPP is hosting a dinner event at Charley’s Crabs, 456 South Ocean Blvd., Palm Beach, Florida. The dinner is in conjunction with the Florida Academy of Pain Medicine’s annual meeting. All FSIPP members and spouses are welcome. To RSVP or to obtain more information, contact Lorrie Brown, MD @ 727-512-4621 by Friday July 14.

Please…Save the Date!!!

The New Hampshire Society of Interventional Pain Physicians Annual Meeting

The New Hampshire Society of Interventional Pain Physicians Annual Meeting will take place on Wednesday, September 27, 2006 at 6:00 p.m.CR Sparks, Bedford, NH

Your nursing and management staff are encouraged to attend as well. Guest speaker to be announced.

To register or for more information, contact:

Kacey Guay 603-577-3003 x31

kguay@painsolutionsusa.com

Second Annual GSIPP Summer Meeting - July 21-23

The second annual summer meeting for the Georgia Society of Interventional Pain Physicians "Pain Summit At Lake Oconee” will be held on July 21-23 at Lake Oconee in Greensboro, GA.

It is strongly suggested that all physicians attending the meeting should stay at the Ritz Carlton (800-241-3333) in the reserved GSIPP block of rooms. If this becomes full, or if you’re seeking an alternate to the Ritz, there are two nearby hotels: Jameson Inn, Greensboro, 706-453-9135; and The Lodge, Greensboro, 706-485-7785. Both are about six miles from the meeting facility.

See the GSIPP brochure for registration and meeting information. Please mail your registration form and check early – we anticipate this meeting WILL fill up!