CBO Releases Two Reports on Health Care

The Congressional Budget Office (CBO) on Dec. 17 released two new reports examining issues within the U.S. health care system. The first report, “Key Issues in Analyzing Major Health Insurance Proposals,” examines background information, as well as large-scale reform proposals. The report finds that the rising costs of health care and health insurance will be a significant problem to the country’s financial stability. Meanwhile, the number of nonelderly residents without health insurance is likely to increase substantially, from at least 45 million in 2009 to about 54 million in 2019. According to the report, the “problems cannot be solved without making major changes in the financing or provision of health insurance and health care.”

The second report, “Budget Options, Volume 1: Health Care,” discusses the projected effects of 115 discrete options for the financing and delivery of health care. The options range in topic and include: the private health insurance market; tax treatment of insurance; quality and efficiency of health care; health behavior and health promotion, among others. The report provides cost or savings estimates on a year-by-year basis for five years and a 10-year total. ACC staff is currently reviewing the reports. The College applauds CBO's efforts to address these critical issues related to health care reform. For more information, visit: http://qualityfirst.acc.org.

E-Prescribing Program Begins

Under new federal law, beginning on Jan. 1, 2009, physicians who successfully e-prescribe will be eligible to participate in a new incentive program. Physicians who successfully e-prescribe under the program requirements will receive incentive payments of 2 percent in 2009. The size of the payment will decrease to 1 percent in 2011 – 2012 and 0.5 percent in 2013. Those who have not adopted e-prescribing by 2012 will be penalized by 1 percent of Medicare-allowed charges, with the penalties size growing in 2013 and beyond. CMS has released the technical specifications for e-prescribing systems that must be present to qualify for the program.

The ACC highly encourages members to adopt e-prescribing, and offers tools and resources to members to assist in the adoption and use of health information technology, including a “how-to” guide to help clinicians make informed decisions about how and when to transition from paper to e-prescribing systems. Visit ACC’s Web site at http://www.acc.org/HealthIT for more information.

CMS Releases 2007 PQRI Report

The Centers for Medicare & Medicaid Services (CMS) released its 2007 Reporting Experience report on the Physician Quality Reporting Initiative (PQRI) on Dec. 3, and held a conference call on Dec. 16 to discuss the report and field questions. CMS acknowledged in the report that many eligible professionals had difficulties with various aspects of the 2007 PQRI program and the reports. Data showed that about 16 percent of eligible professionals participated in 2007 PQRI, and just over half submitted valid quality data codes (QDCs) and received a bonus payment. CMS also acknowledged that 48.4 percent of the QDCs reported were submitted invalidly.

CMS continues to review the 2007 data and is reassessing whether some professionals who did not receive a bonus payment during the 2007 period may actually qualify for payment. However, this may impact physician payments for the 2008 PQRI reporting period, with eligible professionals receiving payments and feedback reports as late as October 2009. The agency also is addressing questions and problems related to the feedback reports, and may make changes to improve the program, feedback reports, and the quality of CMS education and outreach related to PQRI. The College is engaged with CMS to resolve issues related to the 2007 reporting period, as well as the finalization of 2008 reporting and preparations for the 2009 program. To view the report, click here.

CMS Releases 2009 PQRI Technical Specifications

The Centers for Medicare & Medicaid Services (CMS) has released the 2009 technical specifications for the Physician Quality Reporting Initiative (PQRI). As part of these specifications, CMS has included a new measure for cardiology, measure #152: CAD: Lipid Profile in Patients with CAD. In addition, CMS has determined that some of the PQRI measures used during 2008 are not conducive to claims-based reporting and, in 2009, will only be accepted via registry-based reporting. The measure that impacts cardiology is measure #7: “CAD: Beta-Blocker Therapy for CAD patients with Prior Myocardial Infarction.” Practices should plan to discontinue submitting this measure via their claims process effective Jan. 1, 2009. For a list of 2009 measures and reporting options per measure, click here. The ACC will update its PQRI toolkit in early January. Please check for updates.

ACC Comments on Proposed Imaging Efficiency Measures

The ACC has submitted comment letters to the Centers for Medicare & Medicaid Services regarding a set of imaging efficiency measures for outpatient hospital imaging centers that were developed by The Lewin Group, National Imaging Associates, and Dobson & DaVanzo. Two of the proposed measures would impact cardiovascular imaging: inappropriate stress imaging prior to low-risk surgery and inappropriate stress imaging within five years of CABG. The submitted comments reflect concerns around the potential inclusion of patients with chest pain or the equivalent being captured by these measures, which would change the testing from inappropriate to appropriate. The ACC also emphasized the need to validate these measures through testing prior to using for public reporting or measurement. The two comment letters can be found on the Imaging Services & Referral Resource Center.

Health IT Funding Must Encourage Interoperability, Leavitt Says

In an opinion piece in the Washington Post on Monday, Department of Health and Human Services Secretary Mike Leavitt wrote that including health information technology (IT) funds in an economic stimulus package “could spur a critical mass of the nation’s doctors to finally enter the information age.” However, “unless the funds are tied to standards for the interoperability of health IT systems, the expenditure could do more harm than good,” he continues. This is because if “stimulus money supports a proliferation of systems that can’t exchange information, we will only be replacing paper-based silos of medical information with more expensive, computer-based silos that are barely more useful” because information will be “trapped in proprietary systems, unable to get where it’s needed,” Leavitt writes. Leavitt’s opinion piece is available in full online.

Hospital Spending on CV Disease Nearly $60B, Study Finds

Spending on cardiovascular disease by U.S. hospitals increased to $57.9 billion in 2006, up 40 percent from 1997, according to the latest News and Numbers report from the Agency for Healthcare Research and Quality (AHRQ). According to the report, which is based on data in HCUP Facts and Figures, 2006, the majority of the growth occurred between 1997 and 2003, at which point, annual growth dropped to less than 2 percent. This slowing is a result of a decrease in the number of heart disease patients and slower growth in cost per patient, the report suggests. In addition, the report found that cardiovascular disease accounted for 17.6 percent of the $329 billion of total hospital spending on patient care in 2006, a decrease from the 18.7 percent of $216 billion spent by hospitals in 1997. More information is available about the study online.