Alicia Ault

Fourteen medical specialty societies have signed a voluntary pledge to be more transparent in dealings with pharmaceutical and medical device manufacturers and other for-profit companies in the health care field.

The pledge, issued by the Council of Medical Specialty Societies (CMSS), was the result of at least a year of negotiations, said Dr. Allen S. Lichter, who is chair of the CMSS Task Force on Professionalism and Conflict of Interest and the chief executive officer of the American Society of Clinical Oncology (ASCO).

“CMSS is committed to encouraging and supporting a culture of integrity, voluntary self-regulation, and transparency,” said Dr. James H. Scully Jr., CMSS president and chief executive officer of the American Psychiatric Association. “This code provides a clear benchmark for maintaining integrity and independence.”

The 14 societies adopting the CMSS Code for Interactions with Companies agree to establish and publish conflict of interest policies as well as policies and procedures to ensure separation of program development from sponsor influence. They also must disclose corporate contributions and board members' financial relationships with companies, and prohibit financial relationships for key association leaders.

The initial signers included the American College of Physicians (ACP), American Academy of Family Physicians (AAFP), American Academy of Neurology (AAN), American College of Cardiology (ACC), Accreditation Council for Continuing Medical Education (ACCME), American College of Emergency Physicians (ACEP), American College of Obstetricians and Gynecologists (ACOG), American College of Radiology (ACR), American Society for Radiation Oncology (ASTRO), and ASCO.

Dr. Daniel J. Ostergaard, the AAFP's vice president for professional activities, said that the CMSS code gives his organization a chance to see where it might improve its current policies on disclosure and ethical conflicts. He said that the AAFP has a long history of seeking to conduct itself ethically. “I feel very confident that my academy has always been addressing the issues pretty directly and with transparency,” Dr. Ostergaard said in an interview.

The AAFP's board members and counsel will spend the next few months determining how to bring its policies into compliance with the CMSS code, he added.

Adoption of the code will not impact the controversial alliance the AAFP struck with Coca-Cola in the fall of 2009 to conduct a consumer awareness campaign about beverages and sweeteners. Dr. Ostergaard said that the code related specifically to health-related companies and that Coca-Cola did not purport to be health related.

Dr. Lichter called the code a “very important milestone” because it will create consistency where there has been none. Many previous efforts to reduce conflicts have been done in private, but this effort is very much a public undertaking, designed to reassure the public and regulators that professional societies are acting ethically, Dr. Lichter said.

It is also, however, just a first step, he said. The code is not meant to be the last word; it represents a minimum set of guidelines. Some organizations may choose to be more restrictive, Dr. Lichter said.

According to the CMSS, the code was developed by a 30-member task force. More of the 32 CMSS members plan to adopt the code in the next few months.

The 25-page code is available on the CMSS Web site at www.cmss.org/codeforinteractions.aspx

Fourteen medical specialty societies have signed a voluntary pledge to be more transparent in dealings with pharmaceutical and medical device manufacturers and other for-profit companies in the health care field.

The pledge, issued by the Council of Medical Specialty Societies (CMSS), was the result of at least a year of negotiations, said Dr. Allen S. Lichter, who is chair of the CMSS Task Force on Professionalism and Conflict of Interest and the chief executive officer of the American Society of Clinical Oncology (ASCO).

“CMSS is committed to encouraging and supporting a culture of integrity, voluntary self-regulation, and transparency,” said Dr. James H. Scully Jr., CMSS president and chief executive officer of the American Psychiatric Association. “This code provides a clear benchmark for maintaining integrity and independence.”

The 14 societies adopting the CMSS Code for Interactions with Companies agree to establish and publish conflict of interest policies as well as policies and procedures to ensure separation of program development from sponsor influence. They also must disclose corporate contributions and board members' financial relationships with companies, and prohibit financial relationships for key association leaders.

The initial signers included the American College of Physicians (ACP), American Academy of Family Physicians (AAFP), American Academy of Neurology (AAN), American College of Cardiology (ACC), Accreditation Council for Continuing Medical Education (ACCME), American College of Emergency Physicians (ACEP), American College of Obstetricians and Gynecologists (ACOG), American College of Radiology (ACR), American Society for Radiation Oncology (ASTRO), and ASCO.

Dr. Daniel J. Ostergaard, the AAFP's vice president for professional activities, said that the CMSS code gives his organization a chance to see where it might improve its current policies on disclosure and ethical conflicts. He said that the AAFP has a long history of seeking to conduct itself ethically. “I feel very confident that my academy has always been addressing the issues pretty directly and with transparency,” Dr. Ostergaard said in an interview.

The AAFP's board members and counsel will spend the next few months determining how to bring its policies into compliance with the CMSS code, he added.

Adoption of the code will not impact the controversial alliance the AAFP struck with Coca-Cola in the fall of 2009 to conduct a consumer awareness campaign about beverages and sweeteners. Dr. Ostergaard said that the code related specifically to health-related companies and that Coca-Cola did not purport to be health related.

Dr. Lichter called the code a “very important milestone” because it will create consistency where there has been none. Many previous efforts to reduce conflicts have been done in private, but this effort is very much a public undertaking, designed to reassure the public and regulators that professional societies are acting ethically, Dr. Lichter said.

It is also, however, just a first step, he said. The code is not meant to be the last word; it represents a minimum set of guidelines. Some organizations may choose to be more restrictive, Dr. Lichter said.

According to the CMSS, the code was developed by a 30-member task force. More of the 32 CMSS members plan to adopt the code in the next few months.

The 25-page code is available on the CMSS Web site at www.cmss.org/codeforinteractions.aspx

Fourteen medical specialty societies have signed a voluntary pledge to be more transparent in dealings with pharmaceutical and medical device manufacturers and other for-profit companies in the health care field.

The pledge, issued by the Council of Medical Specialty Societies (CMSS), was the result of at least a year of negotiations, said Dr. Allen S. Lichter, who is chair of the CMSS Task Force on Professionalism and Conflict of Interest and the chief executive officer of the American Society of Clinical Oncology (ASCO).

“CMSS is committed to encouraging and supporting a culture of integrity, voluntary self-regulation, and transparency,” said Dr. James H. Scully Jr., CMSS president and chief executive officer of the American Psychiatric Association. “This code provides a clear benchmark for maintaining integrity and independence.”

The 14 societies adopting the CMSS Code for Interactions with Companies agree to establish and publish conflict of interest policies as well as policies and procedures to ensure separation of program development from sponsor influence. They also must disclose corporate contributions and board members' financial relationships with companies, and prohibit financial relationships for key association leaders.

The initial signers included the American College of Physicians (ACP), American Academy of Family Physicians (AAFP), American Academy of Neurology (AAN), American College of Cardiology (ACC), Accreditation Council for Continuing Medical Education (ACCME), American College of Emergency Physicians (ACEP), American College of Obstetricians and Gynecologists (ACOG), American College of Radiology (ACR), American Society for Radiation Oncology (ASTRO), and ASCO.

Dr. Daniel J. Ostergaard, the AAFP's vice president for professional activities, said that the CMSS code gives his organization a chance to see where it might improve its current policies on disclosure and ethical conflicts. He said that the AAFP has a long history of seeking to conduct itself ethically. “I feel very confident that my academy has always been addressing the issues pretty directly and with transparency,” Dr. Ostergaard said in an interview.

The AAFP's board members and counsel will spend the next few months determining how to bring its policies into compliance with the CMSS code, he added.

Adoption of the code will not impact the controversial alliance the AAFP struck with Coca-Cola in the fall of 2009 to conduct a consumer awareness campaign about beverages and sweeteners. Dr. Ostergaard said that the code related specifically to health-related companies and that Coca-Cola did not purport to be health related.

Dr. Lichter called the code a “very important milestone” because it will create consistency where there has been none. Many previous efforts to reduce conflicts have been done in private, but this effort is very much a public undertaking, designed to reassure the public and regulators that professional societies are acting ethically, Dr. Lichter said.

It is also, however, just a first step, he said. The code is not meant to be the last word; it represents a minimum set of guidelines. Some organizations may choose to be more restrictive, Dr. Lichter said.

According to the CMSS, the code was developed by a 30-member task force. More of the 32 CMSS members plan to adopt the code in the next few months.

The 25-page code is available on the CMSS Web site at www.cmss.org/codeforinteractions.aspx

A little-noticed provision of the new health reform law will let physicians use data collected and reported as part of the maintenance of certification process as an alternative to the Medicare Physician Quality Reporting Initiative.

The details have yet to be worked out, but it would mean that physicians likely would have at least one fewer process to report quality data, said Dr. Christine Cassel, president and CEO of the American Board of Internal Medicine.

The advantage of the maintenance of certification (MOC) process is that physicians are familiar with it, as more than 80% of all physicians participate, Dr. Cassel said in an interview.

Physicians have been eligible to receive bonuses for participation in the Medicare PQRI, but they have complained about it as a redundant, burdensome, and confusing process, and have bemoaned botched or missing payments. Even the Centers for Medicare and Medicaid Services has acknowledged problems with the program.

In a statement, Dr. Kevin B. Weiss, president and CEO of the American Board of Medical Specialties, said that “MOC reporting will give patients, health plans, and others the information they need to choose physicians based on performance and other key qualifications, including diagnostic acumen, clinical reasoning, and medical knowledge. This [law] is a significant step forward in recognizing the value of MOC in advancing health care quality for the benefit of patients.”

Under the Patient Protection and Affordable Care Act of 2010—one of the two major health reform laws—the Health and Human Services secretary will decide how MOC will fit into the PQRI process. The hope is that this will be clarified within the year, ABIM's Dr. Cassel said.

ABIM and other medical specialty boards seek to meet with CMS officials to help write the regulations for implementing the process, she said. “Our concept is that it would be kind of an alternative pathway, … that it would include all the same conditions and measures as PQRI, but be even more comprehensive,” said Dr. Cassel.

Family physicians already have some experience with using MOC as an alternative to PQRI. The American Board of Family Medicine received approval from Medicare to use its MOC registry for the PQRI process, according to Dr. Michael Hagen, ABFM's senior vice president. Instead of using Medicare “G” codes, physicians report actual patient data.

In 2008 (the first year of the registry), 260 family physicians participated. Participants could report on 15 patients over a 6-month period to receive half of the bonus, or 30 patients over a year to receive the full bonus, Dr. Hagen said in an interview. Last year, about 720 family physicians participated.

Source Elsevier Global Medical News

A little-noticed provision of the new health reform law will let physicians use data collected and reported as part of the maintenance of certification process as an alternative to the Medicare Physician Quality Reporting Initiative.

The details have yet to be worked out, but it would mean that physicians likely would have at least one fewer process to report quality data, said Dr. Christine Cassel, president and CEO of the American Board of Internal Medicine.

The advantage of the maintenance of certification (MOC) process is that physicians are familiar with it, as more than 80% of all physicians participate, Dr. Cassel said in an interview.

Physicians have been eligible to receive bonuses for participation in the Medicare PQRI, but they have complained about it as a redundant, burdensome, and confusing process, and have bemoaned botched or missing payments. Even the Centers for Medicare and Medicaid Services has acknowledged problems with the program.

In a statement, Dr. Kevin B. Weiss, president and CEO of the American Board of Medical Specialties, said that “MOC reporting will give patients, health plans, and others the information they need to choose physicians based on performance and other key qualifications, including diagnostic acumen, clinical reasoning, and medical knowledge. This [law] is a significant step forward in recognizing the value of MOC in advancing health care quality for the benefit of patients.”

Under the Patient Protection and Affordable Care Act of 2010—one of the two major health reform laws—the Health and Human Services secretary will decide how MOC will fit into the PQRI process. The hope is that this will be clarified within the year, ABIM's Dr. Cassel said.

ABIM and other medical specialty boards seek to meet with CMS officials to help write the regulations for implementing the process, she said. “Our concept is that it would be kind of an alternative pathway, … that it would include all the same conditions and measures as PQRI, but be even more comprehensive,” said Dr. Cassel.

Family physicians already have some experience with using MOC as an alternative to PQRI. The American Board of Family Medicine received approval from Medicare to use its MOC registry for the PQRI process, according to Dr. Michael Hagen, ABFM's senior vice president. Instead of using Medicare “G” codes, physicians report actual patient data.

In 2008 (the first year of the registry), 260 family physicians participated. Participants could report on 15 patients over a 6-month period to receive half of the bonus, or 30 patients over a year to receive the full bonus, Dr. Hagen said in an interview. Last year, about 720 family physicians participated.

Source Elsevier Global Medical News

A little-noticed provision of the new health reform law will let physicians use data collected and reported as part of the maintenance of certification process as an alternative to the Medicare Physician Quality Reporting Initiative.

The details have yet to be worked out, but it would mean that physicians likely would have at least one fewer process to report quality data, said Dr. Christine Cassel, president and CEO of the American Board of Internal Medicine.

The advantage of the maintenance of certification (MOC) process is that physicians are familiar with it, as more than 80% of all physicians participate, Dr. Cassel said in an interview.

Physicians have been eligible to receive bonuses for participation in the Medicare PQRI, but they have complained about it as a redundant, burdensome, and confusing process, and have bemoaned botched or missing payments. Even the Centers for Medicare and Medicaid Services has acknowledged problems with the program.

In a statement, Dr. Kevin B. Weiss, president and CEO of the American Board of Medical Specialties, said that “MOC reporting will give patients, health plans, and others the information they need to choose physicians based on performance and other key qualifications, including diagnostic acumen, clinical reasoning, and medical knowledge. This [law] is a significant step forward in recognizing the value of MOC in advancing health care quality for the benefit of patients.”

Under the Patient Protection and Affordable Care Act of 2010—one of the two major health reform laws—the Health and Human Services secretary will decide how MOC will fit into the PQRI process. The hope is that this will be clarified within the year, ABIM's Dr. Cassel said.

ABIM and other medical specialty boards seek to meet with CMS officials to help write the regulations for implementing the process, she said. “Our concept is that it would be kind of an alternative pathway, … that it would include all the same conditions and measures as PQRI, but be even more comprehensive,” said Dr. Cassel.

Family physicians already have some experience with using MOC as an alternative to PQRI. The American Board of Family Medicine received approval from Medicare to use its MOC registry for the PQRI process, according to Dr. Michael Hagen, ABFM's senior vice president. Instead of using Medicare “G” codes, physicians report actual patient data.

In 2008 (the first year of the registry), 260 family physicians participated. Participants could report on 15 patients over a 6-month period to receive half of the bonus, or 30 patients over a year to receive the full bonus, Dr. Hagen said in an interview. Last year, about 720 family physicians participated.

Source Elsevier Global Medical News

A little-noticed provision of the health reform law will let physicians use data collected and reported as part of the maintenance of certification process as an alternative to the Medicare Physician Quality Reporting Initiative.

The details have yet to be worked out, but it would mean that physicians likely would have at least one fewer process to report quality data, said Dr. Christine Cassel, president and CEO of the American Board of Internal Medicine.

The advantage of the maintenance of certification (MOC) process is that physicians are familiar with it, as more than 80% of all physicians participate, Dr. Cassel said in an interview.

Physicians have been eligible to receive bonuses for participation in the Medicare PQRI, but they have complained about it as a redundant, burdensome, and confusing process, and have bemoaned botched or missing payments. Even the Centers for Medicare and Medicaid Services has acknowledged problems with the program.

In a statement, Dr. Kevin B. Weiss, president and CEO of the American Board of Medical Specialties, said that “MOC reporting will give patients, health plans, and others the information they need to choose physicians based on performance and other key qualifications, including diagnostic acumen, clinical reasoning, and medical knowledge. This [law] is a significant step forward in recognizing the value of MOC in advancing health care quality for the benefit of patients.”

Under the Patient Protection and Affordable Care Act of 2010—one of the two major health reform laws—the Health and Human Services secretary will decide how MOC will fit into the PQRI process. The hope is that this will be clarified within the year, ABIM's Dr. Cassel said.

ABIM and other medical specialty boards seek to meet with CMS officials to help write the regulations for implementing the process, she said. “Our concept is that it would be kind of an alternative pathway … that it would include all the same conditions and measures as PQRI, but be even more comprehensive,” said Dr. Cassel.

Family physicians already have some experience with using MOC as an alternative to PQRI. The American Board of Family Medicine received approval from Medicare to use its MOC registry for the PQRI process, according to Dr. Michael Hagen, ABFM's senior vice president. Instead of using Medicare “G” codes, physicians report actual patient data.

In 2008 (the first year of the registry), 260 family physicians participated. Participants could report on 15 patients over a 6-month period to receive half of the bonus, or 30 patients over a year to receive the full bonus, Dr. Hagen said in an interview. Last year, all participants were required to report on the full year; about 720 family physicians participated, he said.

Dr. Hagen said that he doesn't expect the ABFM process to change anytime soon. “Our PQRI process will continue as it is until we see the final rules and regulations” regarding implementation of the new law.

Dr. Hagen said that he envisions a future in which physicians can submit data for PQRI, for MOC, and for meaningful electronic health records in one fell swoop.

This Month's Talk Back Question

How confident are you that maintenance of certification data can be adapted to accommodate the PQRI process?

A little-noticed provision of the health reform law will let physicians use data collected and reported as part of the maintenance of certification process as an alternative to the Medicare Physician Quality Reporting Initiative.

The details have yet to be worked out, but it would mean that physicians likely would have at least one fewer process to report quality data, said Dr. Christine Cassel, president and CEO of the American Board of Internal Medicine.

The advantage of the maintenance of certification (MOC) process is that physicians are familiar with it, as more than 80% of all physicians participate, Dr. Cassel said in an interview.

Physicians have been eligible to receive bonuses for participation in the Medicare PQRI, but they have complained about it as a redundant, burdensome, and confusing process, and have bemoaned botched or missing payments. Even the Centers for Medicare and Medicaid Services has acknowledged problems with the program.

In a statement, Dr. Kevin B. Weiss, president and CEO of the American Board of Medical Specialties, said that “MOC reporting will give patients, health plans, and others the information they need to choose physicians based on performance and other key qualifications, including diagnostic acumen, clinical reasoning, and medical knowledge. This [law] is a significant step forward in recognizing the value of MOC in advancing health care quality for the benefit of patients.”

Under the Patient Protection and Affordable Care Act of 2010—one of the two major health reform laws—the Health and Human Services secretary will decide how MOC will fit into the PQRI process. The hope is that this will be clarified within the year, ABIM's Dr. Cassel said.

ABIM and other medical specialty boards seek to meet with CMS officials to help write the regulations for implementing the process, she said. “Our concept is that it would be kind of an alternative pathway … that it would include all the same conditions and measures as PQRI, but be even more comprehensive,” said Dr. Cassel.

Family physicians already have some experience with using MOC as an alternative to PQRI. The American Board of Family Medicine received approval from Medicare to use its MOC registry for the PQRI process, according to Dr. Michael Hagen, ABFM's senior vice president. Instead of using Medicare “G” codes, physicians report actual patient data.

In 2008 (the first year of the registry), 260 family physicians participated. Participants could report on 15 patients over a 6-month period to receive half of the bonus, or 30 patients over a year to receive the full bonus, Dr. Hagen said in an interview. Last year, all participants were required to report on the full year; about 720 family physicians participated, he said.

Dr. Hagen said that he doesn't expect the ABFM process to change anytime soon. “Our PQRI process will continue as it is until we see the final rules and regulations” regarding implementation of the new law.

Dr. Hagen said that he envisions a future in which physicians can submit data for PQRI, for MOC, and for meaningful electronic health records in one fell swoop.

This Month's Talk Back Question

How confident are you that maintenance of certification data can be adapted to accommodate the PQRI process?

A little-noticed provision of the health reform law will let physicians use data collected and reported as part of the maintenance of certification process as an alternative to the Medicare Physician Quality Reporting Initiative.

The details have yet to be worked out, but it would mean that physicians likely would have at least one fewer process to report quality data, said Dr. Christine Cassel, president and CEO of the American Board of Internal Medicine.

The advantage of the maintenance of certification (MOC) process is that physicians are familiar with it, as more than 80% of all physicians participate, Dr. Cassel said in an interview.

Physicians have been eligible to receive bonuses for participation in the Medicare PQRI, but they have complained about it as a redundant, burdensome, and confusing process, and have bemoaned botched or missing payments. Even the Centers for Medicare and Medicaid Services has acknowledged problems with the program.

In a statement, Dr. Kevin B. Weiss, president and CEO of the American Board of Medical Specialties, said that “MOC reporting will give patients, health plans, and others the information they need to choose physicians based on performance and other key qualifications, including diagnostic acumen, clinical reasoning, and medical knowledge. This [law] is a significant step forward in recognizing the value of MOC in advancing health care quality for the benefit of patients.”

Under the Patient Protection and Affordable Care Act of 2010—one of the two major health reform laws—the Health and Human Services secretary will decide how MOC will fit into the PQRI process. The hope is that this will be clarified within the year, ABIM's Dr. Cassel said.

ABIM and other medical specialty boards seek to meet with CMS officials to help write the regulations for implementing the process, she said. “Our concept is that it would be kind of an alternative pathway … that it would include all the same conditions and measures as PQRI, but be even more comprehensive,” said Dr. Cassel.

Family physicians already have some experience with using MOC as an alternative to PQRI. The American Board of Family Medicine received approval from Medicare to use its MOC registry for the PQRI process, according to Dr. Michael Hagen, ABFM's senior vice president. Instead of using Medicare “G” codes, physicians report actual patient data.

In 2008 (the first year of the registry), 260 family physicians participated. Participants could report on 15 patients over a 6-month period to receive half of the bonus, or 30 patients over a year to receive the full bonus, Dr. Hagen said in an interview. Last year, all participants were required to report on the full year; about 720 family physicians participated, he said.

Dr. Hagen said that he doesn't expect the ABFM process to change anytime soon. “Our PQRI process will continue as it is until we see the final rules and regulations” regarding implementation of the new law.

Dr. Hagen said that he envisions a future in which physicians can submit data for PQRI, for MOC, and for meaningful electronic health records in one fell swoop.

This Month's Talk Back Question

How confident are you that maintenance of certification data can be adapted to accommodate the PQRI process?

That physicians have received another brief reprieve from the looming 21% cut to Medicare reimbursement is not the point, according to Dr. Karen S. Kolba.

The real issue is why physicians are being asked to bear the entire burden of higher-than-expected Medicare costs, she said in an interview. “I understand there are budget implications [to rising Medicare costs], but the responsibility to provide this benefit to seniors and the disabled is the duty of all citizens, not just physicians,” said Dr. Kolba, who is chair of the American College of Rheumatology's Committee on Rheumatologic Care.

President Obama signed legislation late on April 15 giving physicians another temporary reprieve from the 21% Medicare pay cut until June 1.

Dr. Kolba expects the cuts will not go through in this election year. The question is whether Congress will have the “guts” to fix the Sustainable Growth Rate (SGR) formula, said Dr. Kolba, who practices in Santa Maria, Calif.

The fate of Medicare's physician fees was in doubt as late as the afternoon of the 15th. The Senate spent most of the week debating a bill (H.R. 4851) that would delay the cuts mandated by the SGR formula as well as extend unemployment benefits and federal subsidies for COBRA benefits.

The Senate finally approved the bill, with the House doing so in quick succession. The president signed it shortly thereafter. The Congressional Budget Office estimated the cost of this brief delay in the pay cuts at $2.1 billion, the second most costly aspect of the bill after unemployment benefits extension, at almost $12 billion.

The pay cut technically went into effect on April 1, but the Centers for Medicare and Medicaid Services held all claims submitted from that date until April 15, in anticipation that Congress would reverse the cuts retroactively. But on the afternoon of the 15th, CMS officials noted in a statement that claims with dates of service on or after April 1 would be processed at the lower rate “as soon as systems are fully tested to ensure proper claims payment.”

Physician groups were not pleased and began chiding members of Congress for their inaction. J. James Rohack, president of the American Medical Association, said in a statement, “Congress must now turn toward solving this problem once and for all through repeal of the broken payment formula that will hurt seniors, military families, and the physicians who care for them.” Dr. Rohack warned—again—that physicians are starting to limit new Medicare patients. “It is impossible for physicians to continue to care for all seniors when Medicare payments fall so far below the cost of providing care,” he said.

That physicians have received another brief reprieve from the looming 21% cut to Medicare reimbursement is not the point, according to Dr. Karen S. Kolba.

The real issue is why physicians are being asked to bear the entire burden of higher-than-expected Medicare costs, she said in an interview. “I understand there are budget implications [to rising Medicare costs], but the responsibility to provide this benefit to seniors and the disabled is the duty of all citizens, not just physicians,” said Dr. Kolba, who is chair of the American College of Rheumatology's Committee on Rheumatologic Care.

President Obama signed legislation late on April 15 giving physicians another temporary reprieve from the 21% Medicare pay cut until June 1.

Dr. Kolba expects the cuts will not go through in this election year. The question is whether Congress will have the “guts” to fix the Sustainable Growth Rate (SGR) formula, said Dr. Kolba, who practices in Santa Maria, Calif.

The fate of Medicare's physician fees was in doubt as late as the afternoon of the 15th. The Senate spent most of the week debating a bill (H.R. 4851) that would delay the cuts mandated by the SGR formula as well as extend unemployment benefits and federal subsidies for COBRA benefits.

The Senate finally approved the bill, with the House doing so in quick succession. The president signed it shortly thereafter. The Congressional Budget Office estimated the cost of this brief delay in the pay cuts at $2.1 billion, the second most costly aspect of the bill after unemployment benefits extension, at almost $12 billion.

The pay cut technically went into effect on April 1, but the Centers for Medicare and Medicaid Services held all claims submitted from that date until April 15, in anticipation that Congress would reverse the cuts retroactively. But on the afternoon of the 15th, CMS officials noted in a statement that claims with dates of service on or after April 1 would be processed at the lower rate “as soon as systems are fully tested to ensure proper claims payment.”

Physician groups were not pleased and began chiding members of Congress for their inaction. J. James Rohack, president of the American Medical Association, said in a statement, “Congress must now turn toward solving this problem once and for all through repeal of the broken payment formula that will hurt seniors, military families, and the physicians who care for them.” Dr. Rohack warned—again—that physicians are starting to limit new Medicare patients. “It is impossible for physicians to continue to care for all seniors when Medicare payments fall so far below the cost of providing care,” he said.

That physicians have received another brief reprieve from the looming 21% cut to Medicare reimbursement is not the point, according to Dr. Karen S. Kolba.

The real issue is why physicians are being asked to bear the entire burden of higher-than-expected Medicare costs, she said in an interview. “I understand there are budget implications [to rising Medicare costs], but the responsibility to provide this benefit to seniors and the disabled is the duty of all citizens, not just physicians,” said Dr. Kolba, who is chair of the American College of Rheumatology's Committee on Rheumatologic Care.

President Obama signed legislation late on April 15 giving physicians another temporary reprieve from the 21% Medicare pay cut until June 1.

Dr. Kolba expects the cuts will not go through in this election year. The question is whether Congress will have the “guts” to fix the Sustainable Growth Rate (SGR) formula, said Dr. Kolba, who practices in Santa Maria, Calif.

The fate of Medicare's physician fees was in doubt as late as the afternoon of the 15th. The Senate spent most of the week debating a bill (H.R. 4851) that would delay the cuts mandated by the SGR formula as well as extend unemployment benefits and federal subsidies for COBRA benefits.

The Senate finally approved the bill, with the House doing so in quick succession. The president signed it shortly thereafter. The Congressional Budget Office estimated the cost of this brief delay in the pay cuts at $2.1 billion, the second most costly aspect of the bill after unemployment benefits extension, at almost $12 billion.

The pay cut technically went into effect on April 1, but the Centers for Medicare and Medicaid Services held all claims submitted from that date until April 15, in anticipation that Congress would reverse the cuts retroactively. But on the afternoon of the 15th, CMS officials noted in a statement that claims with dates of service on or after April 1 would be processed at the lower rate “as soon as systems are fully tested to ensure proper claims payment.”

Physician groups were not pleased and began chiding members of Congress for their inaction. J. James Rohack, president of the American Medical Association, said in a statement, “Congress must now turn toward solving this problem once and for all through repeal of the broken payment formula that will hurt seniors, military families, and the physicians who care for them.” Dr. Rohack warned—again—that physicians are starting to limit new Medicare patients. “It is impossible for physicians to continue to care for all seniors when Medicare payments fall so far below the cost of providing care,” he said.

The White House announced on April 19 that it has nominated Dr. Donald Berwick to lead the Centers for Medicare and Medicaid Services.

The nomination of Dr. Berwick, a pediatrician who is president and chief executive officer of the Institute for Healthcare Improvement, had been rumored for weeks.

In a statement released by the White House, President Obama said, “Dr. Berwick has dedicated his career to improving outcomes for patients and providing better care at lower cost. That's one of the core missions facing our next CMS Administrator.”

Physicians' organizations began to express enthusiasm for Dr. Berwick's nomination even before it was made official. The American Medical Association praised Dr. Berwick's “visionary leadership efforts” in quality and patient safety in a statement by Dr. Nancy H. Nielsen, the AMA's immediate -past president.

With the passage of health reform and the continuing lack of a permanent solution for the fee cuts threatened by Medicare's sustainable growth rate (SGR) formula, Dr. Berwick will have a full plate if he is confirmed by the Senate.

Physicians, hospitals, insurers, consumers, and pharmaceutical and medical device manufacturers all are hoping to influence how the law is implemented.

The medical device industry lobby, AdvaMed, issued a statement praising Dr. Berwick's “compelling vision,” but reminded him also of what he will be taking on. “There is perhaps no more important job in health care,” said Stephen J. Ubl, president and CEO of AdvaMed. “The decisions made by Dr. Berwick will affect the lives of America's seniors and every health care provider, and CMS will play a pivotal role in implementing the comprehensive health reform program recently enacted by Congress.”

For his part, Dr. Berwick said in a statement that he felt “flattered and humbled” at his nomination. He added, “If confirmed by the U.S. Senate, I would welcome the opportunity to lead CMS because it offers the chance to help extend the effort to improve America's health care system—the very vision that led to the founding of the Institute for Healthcare Improvement.”

Dr. Berwick is a affiliated with Children's Hospital Boston, and is a consultant in pediatrics at Massachusetts General Hospital. He is an elected member of the Institute of Medicine, and previously chaired the National Advisory Council for the federal Agency for Healthcare Research and Quality. He also served on President Clinton's Advisory Commission on Consumer Protection and Quality in the Healthcare Industry in 1997 and 1998.

The White House announced on April 19 that it has nominated Dr. Donald Berwick to lead the Centers for Medicare and Medicaid Services.

The nomination of Dr. Berwick, a pediatrician who is president and chief executive officer of the Institute for Healthcare Improvement, had been rumored for weeks.

In a statement released by the White House, President Obama said, “Dr. Berwick has dedicated his career to improving outcomes for patients and providing better care at lower cost. That's one of the core missions facing our next CMS Administrator.”

Physicians' organizations began to express enthusiasm for Dr. Berwick's nomination even before it was made official. The American Medical Association praised Dr. Berwick's “visionary leadership efforts” in quality and patient safety in a statement by Dr. Nancy H. Nielsen, the AMA's immediate -past president.

With the passage of health reform and the continuing lack of a permanent solution for the fee cuts threatened by Medicare's sustainable growth rate (SGR) formula, Dr. Berwick will have a full plate if he is confirmed by the Senate.

Physicians, hospitals, insurers, consumers, and pharmaceutical and medical device manufacturers all are hoping to influence how the law is implemented.

The medical device industry lobby, AdvaMed, issued a statement praising Dr. Berwick's “compelling vision,” but reminded him also of what he will be taking on. “There is perhaps no more important job in health care,” said Stephen J. Ubl, president and CEO of AdvaMed. “The decisions made by Dr. Berwick will affect the lives of America's seniors and every health care provider, and CMS will play a pivotal role in implementing the comprehensive health reform program recently enacted by Congress.”

For his part, Dr. Berwick said in a statement that he felt “flattered and humbled” at his nomination. He added, “If confirmed by the U.S. Senate, I would welcome the opportunity to lead CMS because it offers the chance to help extend the effort to improve America's health care system—the very vision that led to the founding of the Institute for Healthcare Improvement.”

Dr. Berwick is a affiliated with Children's Hospital Boston, and is a consultant in pediatrics at Massachusetts General Hospital. He is an elected member of the Institute of Medicine, and previously chaired the National Advisory Council for the federal Agency for Healthcare Research and Quality. He also served on President Clinton's Advisory Commission on Consumer Protection and Quality in the Healthcare Industry in 1997 and 1998.

The White House announced on April 19 that it has nominated Dr. Donald Berwick to lead the Centers for Medicare and Medicaid Services.

The nomination of Dr. Berwick, a pediatrician who is president and chief executive officer of the Institute for Healthcare Improvement, had been rumored for weeks.

In a statement released by the White House, President Obama said, “Dr. Berwick has dedicated his career to improving outcomes for patients and providing better care at lower cost. That's one of the core missions facing our next CMS Administrator.”

Physicians' organizations began to express enthusiasm for Dr. Berwick's nomination even before it was made official. The American Medical Association praised Dr. Berwick's “visionary leadership efforts” in quality and patient safety in a statement by Dr. Nancy H. Nielsen, the AMA's immediate -past president.

With the passage of health reform and the continuing lack of a permanent solution for the fee cuts threatened by Medicare's sustainable growth rate (SGR) formula, Dr. Berwick will have a full plate if he is confirmed by the Senate.

Physicians, hospitals, insurers, consumers, and pharmaceutical and medical device manufacturers all are hoping to influence how the law is implemented.

The medical device industry lobby, AdvaMed, issued a statement praising Dr. Berwick's “compelling vision,” but reminded him also of what he will be taking on. “There is perhaps no more important job in health care,” said Stephen J. Ubl, president and CEO of AdvaMed. “The decisions made by Dr. Berwick will affect the lives of America's seniors and every health care provider, and CMS will play a pivotal role in implementing the comprehensive health reform program recently enacted by Congress.”

For his part, Dr. Berwick said in a statement that he felt “flattered and humbled” at his nomination. He added, “If confirmed by the U.S. Senate, I would welcome the opportunity to lead CMS because it offers the chance to help extend the effort to improve America's health care system—the very vision that led to the founding of the Institute for Healthcare Improvement.”

Dr. Berwick is a affiliated with Children's Hospital Boston, and is a consultant in pediatrics at Massachusetts General Hospital. He is an elected member of the Institute of Medicine, and previously chaired the National Advisory Council for the federal Agency for Healthcare Research and Quality. He also served on President Clinton's Advisory Commission on Consumer Protection and Quality in the Healthcare Industry in 1997 and 1998.

ICD Maker Pleads Guilty

Boston Scientific has pleaded guilty to failing to report problems with a subsidiary's implantable cardioverter defibrillators (ICDs) to the Food and Drug Administration. Previously, the company paid $296 million in criminal penalties for making false statements to the FDA and failing to notify the agency about material changes to an ICD. Now, however, a federal judge in Minnesota has rejected the plea deal, saying that the government should have insisted on probation in addition to the fine to hold the company more accountable for its actions. It is not clear where the case will go from here. The devices in question were from subsidiary Guidant, which recalled them in 2005. But this March, Boston Scientific recalled eight of its own ICDs. The company said that it had neglected to notify the FDA about manufacturing changes, seemingly a repeat of the Guidant situation. In mid-April, the company said the FDA had approved a resumption of sales for two ICDs: the Cognis and the Telegen. Boston Scientific is still working with the FDA on five other models and hopes to resume sales soon, the company said.

Company Warned on Rings

Showing that it will continue to pursue paperwork and reporting violations, the FDA warned Irvine, Calif.–based Edwards Lifesciences that it failed to properly and promptly notify the agency about problems with several models of its annuloplasty rings. In the letter, the FDA said that six complaints “were not reported within 30 calendar days and are adverse events that resulted in a death or serious injury.” The letter said that the warning related to inspections conducted in September 2009.

Cardiologists Are Reform Skeptics

A small survey showed that a majority of cardiologists are skeptical that health care reform will help them or their patients. The survey of 225 cardiologists was conducted in late March by MedAxiom, an information and networking resource for cardiologists based in Neptune, Fla. Eighty-one percent of those surveyed said they thought the law would hurt their practices, and 83% said their revenue would decrease; 71% said that the law would hurt their ability to serve patients.

Few Complaints to Device Office

The FDA's Center for Devices and Radiological Health (CDRH) has issued its ninth annual ombudsman's report on complaints, disputes, and inquiries from the industry, health care providers, and consumers. Of the 250 contacts to CDRH in 2009, 53% were complaints, 21% were to dispute an agency action, and 26% were inquiries. Source of contacts were 70% from industry, 17% from consumers, and 9% from health providers. Most of the complaints and disputes were about the agency's policies or procedures, followed by the agency's data or testing requirements. Safety or adverse events were the subject of only 4% of the contacts.

CV Admissions High for Women

The Agency for Health Research and Quality (AHRQ) reported that there were 2 million cardiovascular disease–related hospital stays for women in 2007, making it the second biggest reason for admission after pregnancy and childbirth. The reasons for admission included treatment of coronary artery disease, congestive heart failure, heart attacks, atrial fibrillation and other arrhythmias, and chest pain with no determined cause. Other top reasons for admission included pneumonia, osteoarthritis, depression and bipolar disorder, urinary tract infections, blood infections, and skin infections. The data is from the AHRQ's Healthcare Cost and Utilization Project report for 2007.

Generics 75% of Dispensed Drugs

More introductions of lower-cost generics dampened sales of brand name prescription drugs last year, but overall sales were still up 5%, according to IMS Health. U.S. sales grew to $300 billion, with 3.9 billion prescriptions dispensed in 2009. Generics made up 75% of dispensed prescriptions, an increase of almost 6% since 2008. Prescriptions dispensed as branded products decreased by almost 8%. There were 32 novel drugs introduced in 2009, but those “drove a limited increase in drug spending,” IMS Senior Vice President Murray Aitken said in a statement. The top-selling class was antipsychotics, whose $14 billion in sales equaled the 2008 total. Proton pump inhibitors were second, hitting $13.6 billion in sales last year. Lipid regulators accounted for $13 billion in sales, a figure held down by generics, and antidepressants were fourth-largest in sales at $9.9 billion.

Pfizer Details Pay to Physicians

As part of a settlement with the federal government, Pfizer has posted its first report detailing how much it pays health care professionals for consulting and other duties, including clinical trial participation. No other company has detailed trial payments. The data, posted at

www.pfizer.com/responsibility

ICD Maker Pleads Guilty

Boston Scientific has pleaded guilty to failing to report problems with a subsidiary's implantable cardioverter defibrillators (ICDs) to the Food and Drug Administration. Previously, the company paid $296 million in criminal penalties for making false statements to the FDA and failing to notify the agency about material changes to an ICD. Now, however, a federal judge in Minnesota has rejected the plea deal, saying that the government should have insisted on probation in addition to the fine to hold the company more accountable for its actions. It is not clear where the case will go from here. The devices in question were from subsidiary Guidant, which recalled them in 2005. But this March, Boston Scientific recalled eight of its own ICDs. The company said that it had neglected to notify the FDA about manufacturing changes, seemingly a repeat of the Guidant situation. In mid-April, the company said the FDA had approved a resumption of sales for two ICDs: the Cognis and the Telegen. Boston Scientific is still working with the FDA on five other models and hopes to resume sales soon, the company said.

Company Warned on Rings

Showing that it will continue to pursue paperwork and reporting violations, the FDA warned Irvine, Calif.–based Edwards Lifesciences that it failed to properly and promptly notify the agency about problems with several models of its annuloplasty rings. In the letter, the FDA said that six complaints “were not reported within 30 calendar days and are adverse events that resulted in a death or serious injury.” The letter said that the warning related to inspections conducted in September 2009.

Cardiologists Are Reform Skeptics

A small survey showed that a majority of cardiologists are skeptical that health care reform will help them or their patients. The survey of 225 cardiologists was conducted in late March by MedAxiom, an information and networking resource for cardiologists based in Neptune, Fla. Eighty-one percent of those surveyed said they thought the law would hurt their practices, and 83% said their revenue would decrease; 71% said that the law would hurt their ability to serve patients.

Few Complaints to Device Office

The FDA's Center for Devices and Radiological Health (CDRH) has issued its ninth annual ombudsman's report on complaints, disputes, and inquiries from the industry, health care providers, and consumers. Of the 250 contacts to CDRH in 2009, 53% were complaints, 21% were to dispute an agency action, and 26% were inquiries. Source of contacts were 70% from industry, 17% from consumers, and 9% from health providers. Most of the complaints and disputes were about the agency's policies or procedures, followed by the agency's data or testing requirements. Safety or adverse events were the subject of only 4% of the contacts.

CV Admissions High for Women

The Agency for Health Research and Quality (AHRQ) reported that there were 2 million cardiovascular disease–related hospital stays for women in 2007, making it the second biggest reason for admission after pregnancy and childbirth. The reasons for admission included treatment of coronary artery disease, congestive heart failure, heart attacks, atrial fibrillation and other arrhythmias, and chest pain with no determined cause. Other top reasons for admission included pneumonia, osteoarthritis, depression and bipolar disorder, urinary tract infections, blood infections, and skin infections. The data is from the AHRQ's Healthcare Cost and Utilization Project report for 2007.

Generics 75% of Dispensed Drugs

More introductions of lower-cost generics dampened sales of brand name prescription drugs last year, but overall sales were still up 5%, according to IMS Health. U.S. sales grew to $300 billion, with 3.9 billion prescriptions dispensed in 2009. Generics made up 75% of dispensed prescriptions, an increase of almost 6% since 2008. Prescriptions dispensed as branded products decreased by almost 8%. There were 32 novel drugs introduced in 2009, but those “drove a limited increase in drug spending,” IMS Senior Vice President Murray Aitken said in a statement. The top-selling class was antipsychotics, whose $14 billion in sales equaled the 2008 total. Proton pump inhibitors were second, hitting $13.6 billion in sales last year. Lipid regulators accounted for $13 billion in sales, a figure held down by generics, and antidepressants were fourth-largest in sales at $9.9 billion.

Pfizer Details Pay to Physicians

As part of a settlement with the federal government, Pfizer has posted its first report detailing how much it pays health care professionals for consulting and other duties, including clinical trial participation. No other company has detailed trial payments. The data, posted at

www.pfizer.com/responsibility

ICD Maker Pleads Guilty

Boston Scientific has pleaded guilty to failing to report problems with a subsidiary's implantable cardioverter defibrillators (ICDs) to the Food and Drug Administration. Previously, the company paid $296 million in criminal penalties for making false statements to the FDA and failing to notify the agency about material changes to an ICD. Now, however, a federal judge in Minnesota has rejected the plea deal, saying that the government should have insisted on probation in addition to the fine to hold the company more accountable for its actions. It is not clear where the case will go from here. The devices in question were from subsidiary Guidant, which recalled them in 2005. But this March, Boston Scientific recalled eight of its own ICDs. The company said that it had neglected to notify the FDA about manufacturing changes, seemingly a repeat of the Guidant situation. In mid-April, the company said the FDA had approved a resumption of sales for two ICDs: the Cognis and the Telegen. Boston Scientific is still working with the FDA on five other models and hopes to resume sales soon, the company said.

Company Warned on Rings

Showing that it will continue to pursue paperwork and reporting violations, the FDA warned Irvine, Calif.–based Edwards Lifesciences that it failed to properly and promptly notify the agency about problems with several models of its annuloplasty rings. In the letter, the FDA said that six complaints “were not reported within 30 calendar days and are adverse events that resulted in a death or serious injury.” The letter said that the warning related to inspections conducted in September 2009.

Cardiologists Are Reform Skeptics

A small survey showed that a majority of cardiologists are skeptical that health care reform will help them or their patients. The survey of 225 cardiologists was conducted in late March by MedAxiom, an information and networking resource for cardiologists based in Neptune, Fla. Eighty-one percent of those surveyed said they thought the law would hurt their practices, and 83% said their revenue would decrease; 71% said that the law would hurt their ability to serve patients.

Few Complaints to Device Office

The FDA's Center for Devices and Radiological Health (CDRH) has issued its ninth annual ombudsman's report on complaints, disputes, and inquiries from the industry, health care providers, and consumers. Of the 250 contacts to CDRH in 2009, 53% were complaints, 21% were to dispute an agency action, and 26% were inquiries. Source of contacts were 70% from industry, 17% from consumers, and 9% from health providers. Most of the complaints and disputes were about the agency's policies or procedures, followed by the agency's data or testing requirements. Safety or adverse events were the subject of only 4% of the contacts.

CV Admissions High for Women

The Agency for Health Research and Quality (AHRQ) reported that there were 2 million cardiovascular disease–related hospital stays for women in 2007, making it the second biggest reason for admission after pregnancy and childbirth. The reasons for admission included treatment of coronary artery disease, congestive heart failure, heart attacks, atrial fibrillation and other arrhythmias, and chest pain with no determined cause. Other top reasons for admission included pneumonia, osteoarthritis, depression and bipolar disorder, urinary tract infections, blood infections, and skin infections. The data is from the AHRQ's Healthcare Cost and Utilization Project report for 2007.

Generics 75% of Dispensed Drugs

More introductions of lower-cost generics dampened sales of brand name prescription drugs last year, but overall sales were still up 5%, according to IMS Health. U.S. sales grew to $300 billion, with 3.9 billion prescriptions dispensed in 2009. Generics made up 75% of dispensed prescriptions, an increase of almost 6% since 2008. Prescriptions dispensed as branded products decreased by almost 8%. There were 32 novel drugs introduced in 2009, but those “drove a limited increase in drug spending,” IMS Senior Vice President Murray Aitken said in a statement. The top-selling class was antipsychotics, whose $14 billion in sales equaled the 2008 total. Proton pump inhibitors were second, hitting $13.6 billion in sales last year. Lipid regulators accounted for $13 billion in sales, a figure held down by generics, and antidepressants were fourth-largest in sales at $9.9 billion.

Pfizer Details Pay to Physicians

As part of a settlement with the federal government, Pfizer has posted its first report detailing how much it pays health care professionals for consulting and other duties, including clinical trial participation. No other company has detailed trial payments. The data, posted at

www.pfizer.com/responsibility

NATIONAL HARBOR, MD. — After an 8-year development effort, the Society of Hospital Medicine has published core competencies for pediatric hospitalists.

The competencies define the expected standards for all pediatric hospitalists, regardless of their practice setting or location, said Dr. Mary C. Ottolini of the SHM's pediatric committee. They are also a means of differentiating hospitalists from primary care pediatricians or other pediatric specialists, she said.

Although the competencies are viewed as the first step in gaining recognition as a new specialty through the American Board of Pediatrics, it is not guaranteed that a certification process will be forthcoming soon, Dr. Ottolini said at the annual meeting of the Society of Hospital Medicine.

Coauthor Dr. Erin R. Stucky of Rady Children's Hospital and the University of California, San Diego, said that negotiations with the ABP are ongoing.

The American Board of Pediatrics, however, has not been petitioned to consider a new pediatric hospitalist subspecialty, according to Dr. James A. Stockman III, president and CEO of the board. In the absence of a petition, the board will not formally weigh the pros and cons of introducing such certification, he noted in an interview.

The American Board of Internal Medicine and the American Board of Family Practice have chosen to offer Recognition of Focused Practice in Hospital Medicine, a credential available for the first time in 2010. The new certification requirements will be met through an exam, along with self-evaluation and practice improvement modules to be completed as part of the maintenance of certification process. But the ABP is not certain that such a mechanism would be appropriate for pediatrics, Dr. Stockman said.

Many hospitalists thought that the competencies had already been published because a development framework was published in 2006, noted Dr. Ottolini of Children's National Medical Center and George Washington University, both in Washington. In the years since the SHM's pediatric core competencies task force was created, there have been many iterations, corrections, and reviews, she said.

The final publication contains 54 chapters covering 22 common clinical diagnoses, 6 specialized clinical services, 13 core skills, and 13 health care systems for supporting and advancing child health (J. Hosp. Med. 2010 April 9 [doi:10.1002/jhm.776

The common clinical conditions were taken from nonsurgical data collected by the Joint Commission and publications on common pediatric hospitalizations. The specialized services include care that is not based on diagnosis-related group data. The core skills come from the Healthcare Cost and Utilization Project Factbook and randomly selected hospitalist billing data.

The competencies are not meant to be all inclusive, rigid, or easily achieved during residency training, Dr. Ottolini said.

They may even be difficult to achieve during a fellowship, Dr. Stucky added.

In an extensive collaborative process, the competencies were reviewed by 9 section editors, 50-plus authors and contributors, 3 senior editors, 33 internal reviewers, and dozens of external reviewers, including all the major academic and certifying societies, “stakeholder” agencies such as the American Hospital Association and the American College of Emergency Physicians, and pediatric hospital medicine fellowship directors at major children's hospitals around the country.

Dr. Ottolini said that she thought the competencies would be used in a variety of ways, including by educators to help develop curricula, by those new to the specialty to increase their knowledge, by physicians as a marketing tool, and by physician groups as a means of recruiting new partners.

Disclosures: None was reported.

The core competencies are not meant to be all inclusive, rigid, or easily achieved during residency.

Source DR. OTTOLINI

NATIONAL HARBOR, MD. — After an 8-year development effort, the Society of Hospital Medicine has published core competencies for pediatric hospitalists.

The competencies define the expected standards for all pediatric hospitalists, regardless of their practice setting or location, said Dr. Mary C. Ottolini of the SHM's pediatric committee. They are also a means of differentiating hospitalists from primary care pediatricians or other pediatric specialists, she said.

Although the competencies are viewed as the first step in gaining recognition as a new specialty through the American Board of Pediatrics, it is not guaranteed that a certification process will be forthcoming soon, Dr. Ottolini said at the annual meeting of the Society of Hospital Medicine.

Coauthor Dr. Erin R. Stucky of Rady Children's Hospital and the University of California, San Diego, said that negotiations with the ABP are ongoing.

The American Board of Pediatrics, however, has not been petitioned to consider a new pediatric hospitalist subspecialty, according to Dr. James A. Stockman III, president and CEO of the board. In the absence of a petition, the board will not formally weigh the pros and cons of introducing such certification, he noted in an interview.

The American Board of Internal Medicine and the American Board of Family Practice have chosen to offer Recognition of Focused Practice in Hospital Medicine, a credential available for the first time in 2010. The new certification requirements will be met through an exam, along with self-evaluation and practice improvement modules to be completed as part of the maintenance of certification process. But the ABP is not certain that such a mechanism would be appropriate for pediatrics, Dr. Stockman said.

Many hospitalists thought that the competencies had already been published because a development framework was published in 2006, noted Dr. Ottolini of Children's National Medical Center and George Washington University, both in Washington. In the years since the SHM's pediatric core competencies task force was created, there have been many iterations, corrections, and reviews, she said.

The final publication contains 54 chapters covering 22 common clinical diagnoses, 6 specialized clinical services, 13 core skills, and 13 health care systems for supporting and advancing child health (J. Hosp. Med. 2010 April 9 [doi:10.1002/jhm.776

The common clinical conditions were taken from nonsurgical data collected by the Joint Commission and publications on common pediatric hospitalizations. The specialized services include care that is not based on diagnosis-related group data. The core skills come from the Healthcare Cost and Utilization Project Factbook and randomly selected hospitalist billing data.

The competencies are not meant to be all inclusive, rigid, or easily achieved during residency training, Dr. Ottolini said.

They may even be difficult to achieve during a fellowship, Dr. Stucky added.

In an extensive collaborative process, the competencies were reviewed by 9 section editors, 50-plus authors and contributors, 3 senior editors, 33 internal reviewers, and dozens of external reviewers, including all the major academic and certifying societies, “stakeholder” agencies such as the American Hospital Association and the American College of Emergency Physicians, and pediatric hospital medicine fellowship directors at major children's hospitals around the country.

Dr. Ottolini said that she thought the competencies would be used in a variety of ways, including by educators to help develop curricula, by those new to the specialty to increase their knowledge, by physicians as a marketing tool, and by physician groups as a means of recruiting new partners.

Disclosures: None was reported.

The core competencies are not meant to be all inclusive, rigid, or easily achieved during residency.

Source DR. OTTOLINI

NATIONAL HARBOR, MD. — After an 8-year development effort, the Society of Hospital Medicine has published core competencies for pediatric hospitalists.

The competencies define the expected standards for all pediatric hospitalists, regardless of their practice setting or location, said Dr. Mary C. Ottolini of the SHM's pediatric committee. They are also a means of differentiating hospitalists from primary care pediatricians or other pediatric specialists, she said.

Although the competencies are viewed as the first step in gaining recognition as a new specialty through the American Board of Pediatrics, it is not guaranteed that a certification process will be forthcoming soon, Dr. Ottolini said at the annual meeting of the Society of Hospital Medicine.

Coauthor Dr. Erin R. Stucky of Rady Children's Hospital and the University of California, San Diego, said that negotiations with the ABP are ongoing.

The American Board of Pediatrics, however, has not been petitioned to consider a new pediatric hospitalist subspecialty, according to Dr. James A. Stockman III, president and CEO of the board. In the absence of a petition, the board will not formally weigh the pros and cons of introducing such certification, he noted in an interview.

The American Board of Internal Medicine and the American Board of Family Practice have chosen to offer Recognition of Focused Practice in Hospital Medicine, a credential available for the first time in 2010. The new certification requirements will be met through an exam, along with self-evaluation and practice improvement modules to be completed as part of the maintenance of certification process. But the ABP is not certain that such a mechanism would be appropriate for pediatrics, Dr. Stockman said.

Many hospitalists thought that the competencies had already been published because a development framework was published in 2006, noted Dr. Ottolini of Children's National Medical Center and George Washington University, both in Washington. In the years since the SHM's pediatric core competencies task force was created, there have been many iterations, corrections, and reviews, she said.

The final publication contains 54 chapters covering 22 common clinical diagnoses, 6 specialized clinical services, 13 core skills, and 13 health care systems for supporting and advancing child health (J. Hosp. Med. 2010 April 9 [doi:10.1002/jhm.776

The common clinical conditions were taken from nonsurgical data collected by the Joint Commission and publications on common pediatric hospitalizations. The specialized services include care that is not based on diagnosis-related group data. The core skills come from the Healthcare Cost and Utilization Project Factbook and randomly selected hospitalist billing data.

The competencies are not meant to be all inclusive, rigid, or easily achieved during residency training, Dr. Ottolini said.

They may even be difficult to achieve during a fellowship, Dr. Stucky added.

In an extensive collaborative process, the competencies were reviewed by 9 section editors, 50-plus authors and contributors, 3 senior editors, 33 internal reviewers, and dozens of external reviewers, including all the major academic and certifying societies, “stakeholder” agencies such as the American Hospital Association and the American College of Emergency Physicians, and pediatric hospital medicine fellowship directors at major children's hospitals around the country.

Dr. Ottolini said that she thought the competencies would be used in a variety of ways, including by educators to help develop curricula, by those new to the specialty to increase their knowledge, by physicians as a marketing tool, and by physician groups as a means of recruiting new partners.

Disclosures: None was reported.

The core competencies are not meant to be all inclusive, rigid, or easily achieved during residency.

Source DR. OTTOLINI

Already struggling from California's diversion of funds meant to pay for uninsured patients, the state's emergency departments may be facing an even grimmer financial scenario when fiscal 2011 begins in July, say California emergency department directors.

Physicians have already been coping with either no pay since last July or with a huge reduction in how much they are paid from county funds for care of uninsured patients. Now, with the state's ongoing budget crisis, some counties have decided to slash reimbursement rates even further. And that scenario could be repeated again in a few months, Dr. Robert Rosenbloom, president of the California chapter of the American College of Emergency Physicians (CAL/ACEP), said in an interview.

Uncompensated care in the state's private emergency departments has been reimbursed primarily through a combination of tobacco taxes and the Maddy Fund, which was created in 1987. The Maddy Fund law allows counties to collect a portion of fines from traffic violations and criminal offenses and dedicate them to emergency medical services. Fifty-eight percent of the fund's revenues must go to reimburse physicians, 25% to hospitals, and 17% to other emergency medical services.

However, physicians can be reimbursed only up to 50% of the losses incurred from uncompensated care.

So far, 50 California counties have established Maddy Funds. Some of those counties have been aggressive about collections, accounting, and distribution. But others have done a poor job of collections or accounting, which means that not all the monies are properly distributed—or distributed at all, said Dr. Rosenbloom.

CAL/ACEP is supporting a bill before the state legislature that would require counties with Maddy Funds to be transparent in their accounting so that proper amounts go to emergency services.

Budget Crisis Drains Maddy Funds

The California budget crisis has clouded the already uncertain Maddy Fund picture. In 2009, Gov. Arnold Schwarzenegger (R) used statutory discretion to redirect $25 million of emergency services money into the state's general coffers. That was out of a total $60 million, said Dr. Rosenbloom.

The move had immediate repercussions. Los Angeles County lost $9 million, and as of July 1, 2009, it halted all uncompensated-care payments to the county's private facilities and their physicians. Emergency physicians in the county were already receiving only 27% of their costs of caring for the uninsured.

In February, the Los Angeles County Board of Supervisors voted to give physicians and hospitals back pay, but at a further reduced rate: 18% of the cost of care.

Despite the low reimbursement, CAL/ACEP has fought to keep the system in place, said Dr. Rosenbloom. It ensures that the uninsured get some kind of care and reduces the pressure on public emergency departments, he said.

However, the low to nonexistent pay rates are exacerbating the difficulties in finding physicians who will take emergency department call, Dr. Rosenbloom said. Many specialists find the pay “insulting,” he said.

The latest reductions in funding have had “a huge effect on the willingness of private physicians to back up emergency departments,” said Dr. B. Thomas Hafkenschiel, an emergency physician at Santa Clara Valley Medical Center.

When the county's Maddy Fund is working, it at least ensures a minimal payment, which is better than nothing, said Dr. Hafkenschiel. But now the pay appears even more uncertain. Although he works at a county facility, he is monitoring—and feeling—the effects of the reimbursement cuts for private facilities.

Dr. Hafkenschiel has been working with a group of ED directors in the south San Francisco Bay area to get a better accounting of the criminal penalties being collected by the Maddy Fund and their distribution. As other funding sources have shrunk, including tobacco tax collections, “we have to make sure this is being done properly, or we're going to be in deep trouble,” Dr. Hafkenschiel said.

Uninsured Patient Visits Rising

The lack of funds for uncompensated care is a growing problem because of the increasing numbers of uninsured patients in California. Dr. Hafkenschiel said that the patient volume at his ED has grown from 82,000 visits in 2007 to 128,000 in 2009, largely due to people losing their health insurance. That trend may be accelerating in 2010—ED visits in the first 2 months of 2010 exceeded the volume seen in the same period of 2009.

Other ED directors in the county have noticed the same rise in uninsured patients, he added. In Los Angeles County, the percentage of uninsured patients in the ED has risen from 16% to 19% in the past year, said Dr. Rosenbloom.

At Arrowhead Regional Medical Center, a county facility in San Bernadino County, volume has gone up 6% in the past year, said Dr. Rodney Borger, medical director of the ED at Arrowhead. The number of physician claims to the county's Maddy Fund has gone up 15% over the past 2 years, but the revenues have been flat or decreasing, said Dr. Borger, a member of the fund's oversight board.

When Gov. Schwarzenegger diverted the $25 million, San Bernadino lost $900,000, Dr. Borger said. In October, the county coped by cutting reimbursement by 24% to physicians at private EDs for uninsured care. Another 25% cut may be around the corner in July, said Dr. Borger, who added that he was hopeful that it could be averted.

Already struggling from California's diversion of funds meant to pay for uninsured patients, the state's emergency departments may be facing an even grimmer financial scenario when fiscal 2011 begins in July, say California emergency department directors.

Physicians have already been coping with either no pay since last July or with a huge reduction in how much they are paid from county funds for care of uninsured patients. Now, with the state's ongoing budget crisis, some counties have decided to slash reimbursement rates even further. And that scenario could be repeated again in a few months, Dr. Robert Rosenbloom, president of the California chapter of the American College of Emergency Physicians (CAL/ACEP), said in an interview.

Uncompensated care in the state's private emergency departments has been reimbursed primarily through a combination of tobacco taxes and the Maddy Fund, which was created in 1987. The Maddy Fund law allows counties to collect a portion of fines from traffic violations and criminal offenses and dedicate them to emergency medical services. Fifty-eight percent of the fund's revenues must go to reimburse physicians, 25% to hospitals, and 17% to other emergency medical services.

However, physicians can be reimbursed only up to 50% of the losses incurred from uncompensated care.

So far, 50 California counties have established Maddy Funds. Some of those counties have been aggressive about collections, accounting, and distribution. But others have done a poor job of collections or accounting, which means that not all the monies are properly distributed—or distributed at all, said Dr. Rosenbloom.

CAL/ACEP is supporting a bill before the state legislature that would require counties with Maddy Funds to be transparent in their accounting so that proper amounts go to emergency services.

Budget Crisis Drains Maddy Funds

The California budget crisis has clouded the already uncertain Maddy Fund picture. In 2009, Gov. Arnold Schwarzenegger (R) used statutory discretion to redirect $25 million of emergency services money into the state's general coffers. That was out of a total $60 million, said Dr. Rosenbloom.

The move had immediate repercussions. Los Angeles County lost $9 million, and as of July 1, 2009, it halted all uncompensated-care payments to the county's private facilities and their physicians. Emergency physicians in the county were already receiving only 27% of their costs of caring for the uninsured.

In February, the Los Angeles County Board of Supervisors voted to give physicians and hospitals back pay, but at a further reduced rate: 18% of the cost of care.

Despite the low reimbursement, CAL/ACEP has fought to keep the system in place, said Dr. Rosenbloom. It ensures that the uninsured get some kind of care and reduces the pressure on public emergency departments, he said.

However, the low to nonexistent pay rates are exacerbating the difficulties in finding physicians who will take emergency department call, Dr. Rosenbloom said. Many specialists find the pay “insulting,” he said.

The latest reductions in funding have had “a huge effect on the willingness of private physicians to back up emergency departments,” said Dr. B. Thomas Hafkenschiel, an emergency physician at Santa Clara Valley Medical Center.

When the county's Maddy Fund is working, it at least ensures a minimal payment, which is better than nothing, said Dr. Hafkenschiel. But now the pay appears even more uncertain. Although he works at a county facility, he is monitoring—and feeling—the effects of the reimbursement cuts for private facilities.

Dr. Hafkenschiel has been working with a group of ED directors in the south San Francisco Bay area to get a better accounting of the criminal penalties being collected by the Maddy Fund and their distribution. As other funding sources have shrunk, including tobacco tax collections, “we have to make sure this is being done properly, or we're going to be in deep trouble,” Dr. Hafkenschiel said.

Uninsured Patient Visits Rising

The lack of funds for uncompensated care is a growing problem because of the increasing numbers of uninsured patients in California. Dr. Hafkenschiel said that the patient volume at his ED has grown from 82,000 visits in 2007 to 128,000 in 2009, largely due to people losing their health insurance. That trend may be accelerating in 2010—ED visits in the first 2 months of 2010 exceeded the volume seen in the same period of 2009.

Other ED directors in the county have noticed the same rise in uninsured patients, he added. In Los Angeles County, the percentage of uninsured patients in the ED has risen from 16% to 19% in the past year, said Dr. Rosenbloom.

At Arrowhead Regional Medical Center, a county facility in San Bernadino County, volume has gone up 6% in the past year, said Dr. Rodney Borger, medical director of the ED at Arrowhead. The number of physician claims to the county's Maddy Fund has gone up 15% over the past 2 years, but the revenues have been flat or decreasing, said Dr. Borger, a member of the fund's oversight board.

When Gov. Schwarzenegger diverted the $25 million, San Bernadino lost $900,000, Dr. Borger said. In October, the county coped by cutting reimbursement by 24% to physicians at private EDs for uninsured care. Another 25% cut may be around the corner in July, said Dr. Borger, who added that he was hopeful that it could be averted.

Already struggling from California's diversion of funds meant to pay for uninsured patients, the state's emergency departments may be facing an even grimmer financial scenario when fiscal 2011 begins in July, say California emergency department directors.

Physicians have already been coping with either no pay since last July or with a huge reduction in how much they are paid from county funds for care of uninsured patients. Now, with the state's ongoing budget crisis, some counties have decided to slash reimbursement rates even further. And that scenario could be repeated again in a few months, Dr. Robert Rosenbloom, president of the California chapter of the American College of Emergency Physicians (CAL/ACEP), said in an interview.

Uncompensated care in the state's private emergency departments has been reimbursed primarily through a combination of tobacco taxes and the Maddy Fund, which was created in 1987. The Maddy Fund law allows counties to collect a portion of fines from traffic violations and criminal offenses and dedicate them to emergency medical services. Fifty-eight percent of the fund's revenues must go to reimburse physicians, 25% to hospitals, and 17% to other emergency medical services.

However, physicians can be reimbursed only up to 50% of the losses incurred from uncompensated care.

So far, 50 California counties have established Maddy Funds. Some of those counties have been aggressive about collections, accounting, and distribution. But others have done a poor job of collections or accounting, which means that not all the monies are properly distributed—or distributed at all, said Dr. Rosenbloom.

CAL/ACEP is supporting a bill before the state legislature that would require counties with Maddy Funds to be transparent in their accounting so that proper amounts go to emergency services.

Budget Crisis Drains Maddy Funds

The California budget crisis has clouded the already uncertain Maddy Fund picture. In 2009, Gov. Arnold Schwarzenegger (R) used statutory discretion to redirect $25 million of emergency services money into the state's general coffers. That was out of a total $60 million, said Dr. Rosenbloom.

The move had immediate repercussions. Los Angeles County lost $9 million, and as of July 1, 2009, it halted all uncompensated-care payments to the county's private facilities and their physicians. Emergency physicians in the county were already receiving only 27% of their costs of caring for the uninsured.

In February, the Los Angeles County Board of Supervisors voted to give physicians and hospitals back pay, but at a further reduced rate: 18% of the cost of care.

Despite the low reimbursement, CAL/ACEP has fought to keep the system in place, said Dr. Rosenbloom. It ensures that the uninsured get some kind of care and reduces the pressure on public emergency departments, he said.

However, the low to nonexistent pay rates are exacerbating the difficulties in finding physicians who will take emergency department call, Dr. Rosenbloom said. Many specialists find the pay “insulting,” he said.

The latest reductions in funding have had “a huge effect on the willingness of private physicians to back up emergency departments,” said Dr. B. Thomas Hafkenschiel, an emergency physician at Santa Clara Valley Medical Center.

When the county's Maddy Fund is working, it at least ensures a minimal payment, which is better than nothing, said Dr. Hafkenschiel. But now the pay appears even more uncertain. Although he works at a county facility, he is monitoring—and feeling—the effects of the reimbursement cuts for private facilities.

Dr. Hafkenschiel has been working with a group of ED directors in the south San Francisco Bay area to get a better accounting of the criminal penalties being collected by the Maddy Fund and their distribution. As other funding sources have shrunk, including tobacco tax collections, “we have to make sure this is being done properly, or we're going to be in deep trouble,” Dr. Hafkenschiel said.

Uninsured Patient Visits Rising

The lack of funds for uncompensated care is a growing problem because of the increasing numbers of uninsured patients in California. Dr. Hafkenschiel said that the patient volume at his ED has grown from 82,000 visits in 2007 to 128,000 in 2009, largely due to people losing their health insurance. That trend may be accelerating in 2010—ED visits in the first 2 months of 2010 exceeded the volume seen in the same period of 2009.

Other ED directors in the county have noticed the same rise in uninsured patients, he added. In Los Angeles County, the percentage of uninsured patients in the ED has risen from 16% to 19% in the past year, said Dr. Rosenbloom.

At Arrowhead Regional Medical Center, a county facility in San Bernadino County, volume has gone up 6% in the past year, said Dr. Rodney Borger, medical director of the ED at Arrowhead. The number of physician claims to the county's Maddy Fund has gone up 15% over the past 2 years, but the revenues have been flat or decreasing, said Dr. Borger, a member of the fund's oversight board.

When Gov. Schwarzenegger diverted the $25 million, San Bernadino lost $900,000, Dr. Borger said. In October, the county coped by cutting reimbursement by 24% to physicians at private EDs for uninsured care. Another 25% cut may be around the corner in July, said Dr. Borger, who added that he was hopeful that it could be averted.

The White House announced last month that it has nominated Dr. Donald Berwick to lead the Centers for Medicare and Medicaid Services.

Dr. Berwick, a pediatrician, is president and chief executive officer of the Institute for Healthcare Improvement.

In a statement, President Obama said, “Dr. Berwick has dedicated his career to improving outcomes for patients and providing better care at lower cost. That's one of the core missions facing our next CMS Administrator, and I'm confident that Don will be an outstanding leader for the agency and the millions of Americans it serves.”

The American Medical Association praised Dr. Berwick's “visionary leadership efforts” in quality and patient safety in a statement given by Dr. Nancy H. Nielsen, the AMA's immediate-past president. “Upon confirmation, we look forward to working with Dr. Berwick at CMS on implementation of the new health reform law and on ensuring that physicians can continue to care for seniors who rely on Medicare.”

With the passage of health reform and the continuing lack of a permanent solution for the fee cuts threatened by Medicare's sustainable growth rate (SGR) formula, Dr. Berwick will have a full plate if he is confirmed by the Senate.

The medical device industry lobby, AdvaMed, issued a statement praising Dr. Berwick's “compelling vision,” but reminded him also of what he will be taking on. “There is perhaps no more important job in health care,” said Stephen J. Ubl, president and CEO of AdvaMed. “The decisions made by Dr. Berwick will affect the lives of America's seniors and every health care provider, and CMS will play a pivotal role in implementing the comprehensive health reform program recently enacted by Congress.”

Dr. Berwick said in a statement that he felt “flattered and humbled” at his nomination. He added, “If confirmed by the U.S. Senate, I would welcome the opportunity to lead CMS because it offers the chance to help extend the effort to improve America's health care system—the very vision that led to the founding of the Institute for Healthcare Improvement.”

Dr. Berwick is a member of the adjunct staff in the department of medicine at Children's Hospital, Boston, and is a consultant in pediatrics at Massachusetts General Hospital. He is an elected member of the Institute of Medicine, and previously chaired the National Advisory Council for the federal Agency for Healthcare Research and Quality. He also served on President Clinton's Advisory Commission on Consumer Protection and Quality in the Healthcare Industry in 1997 and 1998.

The White House announced last month that it has nominated Dr. Donald Berwick to lead the Centers for Medicare and Medicaid Services.

Dr. Berwick, a pediatrician, is president and chief executive officer of the Institute for Healthcare Improvement.

In a statement, President Obama said, “Dr. Berwick has dedicated his career to improving outcomes for patients and providing better care at lower cost. That's one of the core missions facing our next CMS Administrator, and I'm confident that Don will be an outstanding leader for the agency and the millions of Americans it serves.”

The American Medical Association praised Dr. Berwick's “visionary leadership efforts” in quality and patient safety in a statement given by Dr. Nancy H. Nielsen, the AMA's immediate-past president. “Upon confirmation, we look forward to working with Dr. Berwick at CMS on implementation of the new health reform law and on ensuring that physicians can continue to care for seniors who rely on Medicare.”

With the passage of health reform and the continuing lack of a permanent solution for the fee cuts threatened by Medicare's sustainable growth rate (SGR) formula, Dr. Berwick will have a full plate if he is confirmed by the Senate.

The medical device industry lobby, AdvaMed, issued a statement praising Dr. Berwick's “compelling vision,” but reminded him also of what he will be taking on. “There is perhaps no more important job in health care,” said Stephen J. Ubl, president and CEO of AdvaMed. “The decisions made by Dr. Berwick will affect the lives of America's seniors and every health care provider, and CMS will play a pivotal role in implementing the comprehensive health reform program recently enacted by Congress.”

Dr. Berwick said in a statement that he felt “flattered and humbled” at his nomination. He added, “If confirmed by the U.S. Senate, I would welcome the opportunity to lead CMS because it offers the chance to help extend the effort to improve America's health care system—the very vision that led to the founding of the Institute for Healthcare Improvement.”

Dr. Berwick is a member of the adjunct staff in the department of medicine at Children's Hospital, Boston, and is a consultant in pediatrics at Massachusetts General Hospital. He is an elected member of the Institute of Medicine, and previously chaired the National Advisory Council for the federal Agency for Healthcare Research and Quality. He also served on President Clinton's Advisory Commission on Consumer Protection and Quality in the Healthcare Industry in 1997 and 1998.

The White House announced last month that it has nominated Dr. Donald Berwick to lead the Centers for Medicare and Medicaid Services.

Dr. Berwick, a pediatrician, is president and chief executive officer of the Institute for Healthcare Improvement.

In a statement, President Obama said, “Dr. Berwick has dedicated his career to improving outcomes for patients and providing better care at lower cost. That's one of the core missions facing our next CMS Administrator, and I'm confident that Don will be an outstanding leader for the agency and the millions of Americans it serves.”

The American Medical Association praised Dr. Berwick's “visionary leadership efforts” in quality and patient safety in a statement given by Dr. Nancy H. Nielsen, the AMA's immediate-past president. “Upon confirmation, we look forward to working with Dr. Berwick at CMS on implementation of the new health reform law and on ensuring that physicians can continue to care for seniors who rely on Medicare.”

With the passage of health reform and the continuing lack of a permanent solution for the fee cuts threatened by Medicare's sustainable growth rate (SGR) formula, Dr. Berwick will have a full plate if he is confirmed by the Senate.

The medical device industry lobby, AdvaMed, issued a statement praising Dr. Berwick's “compelling vision,” but reminded him also of what he will be taking on. “There is perhaps no more important job in health care,” said Stephen J. Ubl, president and CEO of AdvaMed. “The decisions made by Dr. Berwick will affect the lives of America's seniors and every health care provider, and CMS will play a pivotal role in implementing the comprehensive health reform program recently enacted by Congress.”

Dr. Berwick said in a statement that he felt “flattered and humbled” at his nomination. He added, “If confirmed by the U.S. Senate, I would welcome the opportunity to lead CMS because it offers the chance to help extend the effort to improve America's health care system—the very vision that led to the founding of the Institute for Healthcare Improvement.”

Dr. Berwick is a member of the adjunct staff in the department of medicine at Children's Hospital, Boston, and is a consultant in pediatrics at Massachusetts General Hospital. He is an elected member of the Institute of Medicine, and previously chaired the National Advisory Council for the federal Agency for Healthcare Research and Quality. He also served on President Clinton's Advisory Commission on Consumer Protection and Quality in the Healthcare Industry in 1997 and 1998.

President Obama signed legislation late on April 15 giving physicians another temporary reprieve from the 21% Medicare pay cut that, for all intents and purposes, was scheduled to go into effect at midnight.

The reduction in pay has now been deferred until June 1.

The fate of Medicare's physician fees was in doubt as late as the afternoon of the 15th. The Senate spent most of the week debating a bill (H.R. 4851) that would delay the cuts mandated by the Medicare Sustainable Growth Rate (SGR) formula as well as extend unemployment benefits and federal subsidies for COBRA benefits.

The Senate finally approved the bill, with the House doing so in quick succession. The President signed it shortly thereafter.

The Congressional Budget Office estimated the cost of this brief delay in the pay cuts at $2.1 billion, the second most costly aspect of the bill after unemployment benefits extension, at almost $12 billion.

The pay cut technically went into effect on April 1, but the Centers for Medicare and Medicaid Services (CMS) held all claims submitted from that date until April 15, in anticipation that Congress would reverse the cuts retroactively. But on the afternoon of the 15th, CMS officials noted in a statement that claims with dates of service on or after April 1 would be processed at the lower rate “as soon as systems are fully tested to ensure proper claims payment.”

Physician groups were not pleased and began chiding members of Congress for their lack of action.

After the cut was delayed again, Dr. J. James Rohack, president of the American Medical Association, said in a statement, “Congress must now turn toward solving this problem once and for all through repeal of the broken payment formula that will hurt seniors, military families, and the physicians who care for them.”

Dr. Rohack also warned—again—that physicians are starting to limit new Medicare patients.

“It is impossible for physicians to continue to care for all seniors when Medicare payments fall so far below the cost of providing care,” he said, adding, “If the formula is not repealed, the problem will continue to grow.”

President Obama signed legislation late on April 15 giving physicians another temporary reprieve from the 21% Medicare pay cut that, for all intents and purposes, was scheduled to go into effect at midnight.

The reduction in pay has now been deferred until June 1.

The fate of Medicare's physician fees was in doubt as late as the afternoon of the 15th. The Senate spent most of the week debating a bill (H.R. 4851) that would delay the cuts mandated by the Medicare Sustainable Growth Rate (SGR) formula as well as extend unemployment benefits and federal subsidies for COBRA benefits.

The Senate finally approved the bill, with the House doing so in quick succession. The President signed it shortly thereafter.

The Congressional Budget Office estimated the cost of this brief delay in the pay cuts at $2.1 billion, the second most costly aspect of the bill after unemployment benefits extension, at almost $12 billion.

The pay cut technically went into effect on April 1, but the Centers for Medicare and Medicaid Services (CMS) held all claims submitted from that date until April 15, in anticipation that Congress would reverse the cuts retroactively. But on the afternoon of the 15th, CMS officials noted in a statement that claims with dates of service on or after April 1 would be processed at the lower rate “as soon as systems are fully tested to ensure proper claims payment.”

Physician groups were not pleased and began chiding members of Congress for their lack of action.

After the cut was delayed again, Dr. J. James Rohack, president of the American Medical Association, said in a statement, “Congress must now turn toward solving this problem once and for all through repeal of the broken payment formula that will hurt seniors, military families, and the physicians who care for them.”

Dr. Rohack also warned—again—that physicians are starting to limit new Medicare patients.

“It is impossible for physicians to continue to care for all seniors when Medicare payments fall so far below the cost of providing care,” he said, adding, “If the formula is not repealed, the problem will continue to grow.”

President Obama signed legislation late on April 15 giving physicians another temporary reprieve from the 21% Medicare pay cut that, for all intents and purposes, was scheduled to go into effect at midnight.

The reduction in pay has now been deferred until June 1.

The fate of Medicare's physician fees was in doubt as late as the afternoon of the 15th. The Senate spent most of the week debating a bill (H.R. 4851) that would delay the cuts mandated by the Medicare Sustainable Growth Rate (SGR) formula as well as extend unemployment benefits and federal subsidies for COBRA benefits.

The Senate finally approved the bill, with the House doing so in quick succession. The President signed it shortly thereafter.

The Congressional Budget Office estimated the cost of this brief delay in the pay cuts at $2.1 billion, the second most costly aspect of the bill after unemployment benefits extension, at almost $12 billion.

The pay cut technically went into effect on April 1, but the Centers for Medicare and Medicaid Services (CMS) held all claims submitted from that date until April 15, in anticipation that Congress would reverse the cuts retroactively. But on the afternoon of the 15th, CMS officials noted in a statement that claims with dates of service on or after April 1 would be processed at the lower rate “as soon as systems are fully tested to ensure proper claims payment.”

Physician groups were not pleased and began chiding members of Congress for their lack of action.

After the cut was delayed again, Dr. J. James Rohack, president of the American Medical Association, said in a statement, “Congress must now turn toward solving this problem once and for all through repeal of the broken payment formula that will hurt seniors, military families, and the physicians who care for them.”

Dr. Rohack also warned—again—that physicians are starting to limit new Medicare patients.

“It is impossible for physicians to continue to care for all seniors when Medicare payments fall so far below the cost of providing care,” he said, adding, “If the formula is not repealed, the problem will continue to grow.”