Heart failure patients who are treated by noncardiologists are less likely to receive key medications including ACE inhibitors, ?-blockers, and aldosterone antagonists, according to a study published in the American Journal of Health-System Pharmacy (2005;62:168-72). For example, ACE inhibitors were prescribed for 61% of heart failure patients upon discharge from the hospital by cardiologists vs. 35% by noncardiologists. The study also found that cardiologists are more likely to admit a heart failure patient to the ICU and to order diagnostic tests without significantly increasing a patient's length of stay.
Revising Practice Expenses
Changing the way Medicare pays cardiothoracic surgeons is a complex issue that will require more data to solve, according to a recent analysis for the Medicare Payment Advisory Commission (MedPAC). Under the Medicare Modernization Act of 2003, Congress charged MedPAC with conducting a study of the practice expense relative values for physicians in thoracic and cardiac surgery to determine whether the values adequately account for physician costs in providing staff to hospitals. MedPAC analysts found that some physicians have their costs offset either because their staff can bill Medicare or because the hospital will pay to bring in the additional staff. However, some physicians are not reimbursed by either source. MedPAC concluded that the current system of excluding the costs of clinical staff brought to the hospital from the practice expense relative value units (RVUs) will need to be reviewed using new data being developed for an upcoming update of practice expense RVUs. “Data that enable the appropriate calculation of clinical staff expenses both in the physician's office and in the hospital … should be a priority,” the MedPAC's report to Congress said.
MedPAC: Give Doctors a 2.7% Hike
Medicare should increase physician payments by 2.7% in 2006 to keep pace with the cost of providing care, MedPAC has recommended. Such an increase will help physicians continue to treat Medicare patients, John C. Nelson, M.D., president of the American Medical Association, said in a statement. “Unless Medicare payments keep up with the cost of providing care, there is a real concern that some physicians will be forced to stop taking new Medicare patients,” he said. However, unless Congress fixes a flaw in Medicare's physician payment formula, doctors face a 5% cut next year and cumulative cuts of 30% thru 2012. Several MedPAC commissioners supported the idea of taking outpatient or Part B drugs from the formula, although the Government Accountability Office has warned that this solution would not prevent several years of declines in physician payments.
A Level Playing Field for Hospitals
The Bush administration plans to refine the inpatient hospital payment system “to ensure a more level playing field between specialty and nonspecialty hospitals,” the president announced in his fiscal year 2006 budget request for the Department of Health and Human Services. The Medicare Payment Advisory Commission has reported that specialty hospitals tend to treat relatively lower-severity patients within them, and lower shares of Medicaid patients. Yet, “it's unclear what the effect of these specialty hospitals will be,” Aaron Krupp, senior counsel with the Medical Group Management Association, said. “One thing MedPAC didn't look at was the quality of services for specialty versus regular hospitals. That angle would be informative,” said Mr. Krupp, whose organization supports a free market system. “We are going to have a lot more to say on specialty hospitals in the coming months,” when HHS releases its own report, Mark McClellan, M.D., administrator of the Centers for Medicare and Medicaid Services, recently informed reporters.
New HHS Chief and Medicaid
Medicaid reform will be high on the agenda for new HHS Secretary Mike Leavitt. “Medicaid is not meeting its potential,” Mr. Leavitt, former governor of Utah and former head of the Environmental Protection Agency, said at a health care congress sponsored by the Wall Street Journal and CNBC. “It's rigid; inflexible; inefficient; and, worse yet, not financially sustainable. We need to have a serious conversation about Medicaid.” Among the ideas he's considering are negotiating reductions in the prices Medicaid pays for prescription drugs, closing loopholes relating to coverage for long-term care, and stopping states from manipulating Medicaid rules to increase their federal matching funds. President Bush in the meantime focused on medical liability reform and health savings accounts in his State of the Union address, asking Congress to act on tax credits to help low-income workers buy insurance, and on establishing community health centers in impoverished counties.