Alicia Ault

WASHINGTON – The historic midterm election victory by Republicans does not signal the end of the Affordable Care Act, but now the law will likely undergo the scrutiny that many in the GOP say it did not get as it made its way through Congress.

At press time, the Republicans had gained 60 seats in the House (with 9 races still undecided) and 6 seats in the Senate (with 1 still undecided). Even without the final results, the GOP now holds a majority in the House, with 239 seats, compared with 187 for the Democrats. Republican members of the Senate are still in the minority, but the current 52-46 Democratic margin is much slimmer than before the election.

Earlier this year, House Republican leaders and Senate Minority Leader Mitch McConnell (R-Ky.) vowed to "repeal and replace" the ACA if they regained the majority. A Republican-led House will not be able to make that happen alone; the Democratic-led Senate is unlikely to pass repeal legislation, and President Obama would likely veto any bill sent to him.

But Rep. John Boehner (R-Ohio), expected to be elected speaker of the House when the 112th Congress convenes in January, has indicated that the health reform law will be challenged in his chamber.

At a postelection press briefing, President Obama said he welcomed GOP input. "If the Republicans have ideas for how to improve our health care system, if they want to suggest modifications that would deliver faster and more effective reform to a health care system that has been widely expensive for too many families, businesses, and certainly our federal government, I'm happy to consider some of those ideas," he said.

But he said that the White House would not entertain a repeal debate.

Speaking at a postelection forum, Jim Slattery, a former six-term Democratic congressman from Kansas, said that he expected to see a repeal proposal. "The new Tea Party congresspeople and the leadership in the House will probably have to introduce some kind of resolution that would call for the repeal of ACA, and I think they know it's going nowhere and it's not going to happen, but they're going to have to do that probably to satisfy political demand," said Mr. Slattery, now a lobbyist with Wiley Rein.

Mr. Slattery said that President Obama mainly has himself to blame for the Democrats' poor showing in the election and for polling data indicating that half of Americans want to repeal the ACA. The president "failed to connect the dots" with Americans on how the law would benefit them, he added.

At the same forum, Nancy Johnson, a former Republican House member from Connecticut, said that she expected to see a number of oversight and investigative hearings on the ACA.

"The one thing that has to be done [in the next Congress] is, people have to regain their confidence in government and that's not about policy, that's about process," said Ms. Johnson, a senior public policy adviser at Baker Donelson. "Half the bill is terrific. But the other half wasn't seen, and that created suspicion."

Rep. Boehner and other congressional Republicans have said they will keep some of the insurance market reforms – such as the prohibition on denying coverage for preexisting conditions – but will seek to throw out the mandate that individuals have health insurance coverage. That is a formula for disaster for the law – and for insurance companies, wrote Henry Aaron, a senior fellow at the Brookings Institution, in a perspective article published in the New England Journal of Medicine (2010;18:1685-7). Unless most Americans are covered, insurers might be bankrupted by the reforms, he said.

"In brief, the pledge to keep insurance-market reforms without both mandated coverage and subsidies is untenable," Mr. Aaron wrote.

Mr. Slattery agreed. "If you're going to really reform the insurance industry with the preexisting-condition reforms, we have to have a mandate of some kind," he said.

The requirement that individuals carry insurance or pay a penalty, however, is the central issue being challenged by 20 states that are involved in a lawsuit against the federal government in the U.S. District Court in Florida. Virginia has also filed its own suit, a case that Mr. Slattery said he expected to rise to the Supreme Court.

And governors and attorneys general elected in five states also campaigned on the promise that they, too, would support overturning the mandate.

With money tight and millions of potential new Medicaid enrollees, governors from all parties may revolt against the mandate, said Ms. Johnson. "If you look at the basis on which states are challenging the mandate, it's in part that it abrogates the federal-state partnership because it imposes burdens they can't fulfill."

Back on Capitol Hill, the GOP-led House will also likely take a close look at the ACA-created Independent Payment Advisory Board, said Ms. Johnson. The IPAB, charged with looking at how the federal government pays physicians, hospitals, pharmaceutical companies, and other health providers, would have broad powers that make many Republicans uncomfortable, she said.

In his perspective piece, Mr. Aaron wrote that that Republicans could also tinker with the ACA by cutting off funding for implementation via the appropriations process, or even try to prohibit the Health and Human Services department from writing regulations. Some of those regulations are due to come out in the next 2 months – before the start of the 112th Congress.

WASHINGTON – The historic midterm election victory by Republicans does not signal the end of the Affordable Care Act, but now the law will likely undergo the scrutiny that many in the GOP say it did not get as it made its way through Congress.

At press time, the Republicans had gained 60 seats in the House (with 9 races still undecided) and 6 seats in the Senate (with 1 still undecided). Even without the final results, the GOP now holds a majority in the House, with 239 seats, compared with 187 for the Democrats. Republican members of the Senate are still in the minority, but the current 52-46 Democratic margin is much slimmer than before the election.

Earlier this year, House Republican leaders and Senate Minority Leader Mitch McConnell (R-Ky.) vowed to "repeal and replace" the ACA if they regained the majority. A Republican-led House will not be able to make that happen alone; the Democratic-led Senate is unlikely to pass repeal legislation, and President Obama would likely veto any bill sent to him.

But Rep. John Boehner (R-Ohio), expected to be elected speaker of the House when the 112th Congress convenes in January, has indicated that the health reform law will be challenged in his chamber.

At a postelection press briefing, President Obama said he welcomed GOP input. "If the Republicans have ideas for how to improve our health care system, if they want to suggest modifications that would deliver faster and more effective reform to a health care system that has been widely expensive for too many families, businesses, and certainly our federal government, I'm happy to consider some of those ideas," he said.

But he said that the White House would not entertain a repeal debate.

Speaking at a postelection forum, Jim Slattery, a former six-term Democratic congressman from Kansas, said that he expected to see a repeal proposal. "The new Tea Party congresspeople and the leadership in the House will probably have to introduce some kind of resolution that would call for the repeal of ACA, and I think they know it's going nowhere and it's not going to happen, but they're going to have to do that probably to satisfy political demand," said Mr. Slattery, now a lobbyist with Wiley Rein.

Mr. Slattery said that President Obama mainly has himself to blame for the Democrats' poor showing in the election and for polling data indicating that half of Americans want to repeal the ACA. The president "failed to connect the dots" with Americans on how the law would benefit them, he added.

At the same forum, Nancy Johnson, a former Republican House member from Connecticut, said that she expected to see a number of oversight and investigative hearings on the ACA.

"The one thing that has to be done [in the next Congress] is, people have to regain their confidence in government and that's not about policy, that's about process," said Ms. Johnson, a senior public policy adviser at Baker Donelson. "Half the bill is terrific. But the other half wasn't seen, and that created suspicion."

Rep. Boehner and other congressional Republicans have said they will keep some of the insurance market reforms – such as the prohibition on denying coverage for preexisting conditions – but will seek to throw out the mandate that individuals have health insurance coverage. That is a formula for disaster for the law – and for insurance companies, wrote Henry Aaron, a senior fellow at the Brookings Institution, in a perspective article published in the New England Journal of Medicine (2010;18:1685-7). Unless most Americans are covered, insurers might be bankrupted by the reforms, he said.

"In brief, the pledge to keep insurance-market reforms without both mandated coverage and subsidies is untenable," Mr. Aaron wrote.

Mr. Slattery agreed. "If you're going to really reform the insurance industry with the preexisting-condition reforms, we have to have a mandate of some kind," he said.

The requirement that individuals carry insurance or pay a penalty, however, is the central issue being challenged by 20 states that are involved in a lawsuit against the federal government in the U.S. District Court in Florida. Virginia has also filed its own suit, a case that Mr. Slattery said he expected to rise to the Supreme Court.

And governors and attorneys general elected in five states also campaigned on the promise that they, too, would support overturning the mandate.

With money tight and millions of potential new Medicaid enrollees, governors from all parties may revolt against the mandate, said Ms. Johnson. "If you look at the basis on which states are challenging the mandate, it's in part that it abrogates the federal-state partnership because it imposes burdens they can't fulfill."

Back on Capitol Hill, the GOP-led House will also likely take a close look at the ACA-created Independent Payment Advisory Board, said Ms. Johnson. The IPAB, charged with looking at how the federal government pays physicians, hospitals, pharmaceutical companies, and other health providers, would have broad powers that make many Republicans uncomfortable, she said.

In his perspective piece, Mr. Aaron wrote that that Republicans could also tinker with the ACA by cutting off funding for implementation via the appropriations process, or even try to prohibit the Health and Human Services department from writing regulations. Some of those regulations are due to come out in the next 2 months – before the start of the 112th Congress.

WASHINGTON – The historic midterm election victory by Republicans does not signal the end of the Affordable Care Act, but now the law will likely undergo the scrutiny that many in the GOP say it did not get as it made its way through Congress.

At press time, the Republicans had gained 60 seats in the House (with 9 races still undecided) and 6 seats in the Senate (with 1 still undecided). Even without the final results, the GOP now holds a majority in the House, with 239 seats, compared with 187 for the Democrats. Republican members of the Senate are still in the minority, but the current 52-46 Democratic margin is much slimmer than before the election.

Earlier this year, House Republican leaders and Senate Minority Leader Mitch McConnell (R-Ky.) vowed to "repeal and replace" the ACA if they regained the majority. A Republican-led House will not be able to make that happen alone; the Democratic-led Senate is unlikely to pass repeal legislation, and President Obama would likely veto any bill sent to him.

But Rep. John Boehner (R-Ohio), expected to be elected speaker of the House when the 112th Congress convenes in January, has indicated that the health reform law will be challenged in his chamber.

At a postelection press briefing, President Obama said he welcomed GOP input. "If the Republicans have ideas for how to improve our health care system, if they want to suggest modifications that would deliver faster and more effective reform to a health care system that has been widely expensive for too many families, businesses, and certainly our federal government, I'm happy to consider some of those ideas," he said.

But he said that the White House would not entertain a repeal debate.

Speaking at a postelection forum, Jim Slattery, a former six-term Democratic congressman from Kansas, said that he expected to see a repeal proposal. "The new Tea Party congresspeople and the leadership in the House will probably have to introduce some kind of resolution that would call for the repeal of ACA, and I think they know it's going nowhere and it's not going to happen, but they're going to have to do that probably to satisfy political demand," said Mr. Slattery, now a lobbyist with Wiley Rein.

Mr. Slattery said that President Obama mainly has himself to blame for the Democrats' poor showing in the election and for polling data indicating that half of Americans want to repeal the ACA. The president "failed to connect the dots" with Americans on how the law would benefit them, he added.

At the same forum, Nancy Johnson, a former Republican House member from Connecticut, said that she expected to see a number of oversight and investigative hearings on the ACA.

"The one thing that has to be done [in the next Congress] is, people have to regain their confidence in government and that's not about policy, that's about process," said Ms. Johnson, a senior public policy adviser at Baker Donelson. "Half the bill is terrific. But the other half wasn't seen, and that created suspicion."

Rep. Boehner and other congressional Republicans have said they will keep some of the insurance market reforms – such as the prohibition on denying coverage for preexisting conditions – but will seek to throw out the mandate that individuals have health insurance coverage. That is a formula for disaster for the law – and for insurance companies, wrote Henry Aaron, a senior fellow at the Brookings Institution, in a perspective article published in the New England Journal of Medicine (2010;18:1685-7). Unless most Americans are covered, insurers might be bankrupted by the reforms, he said.

"In brief, the pledge to keep insurance-market reforms without both mandated coverage and subsidies is untenable," Mr. Aaron wrote.

Mr. Slattery agreed. "If you're going to really reform the insurance industry with the preexisting-condition reforms, we have to have a mandate of some kind," he said.

The requirement that individuals carry insurance or pay a penalty, however, is the central issue being challenged by 20 states that are involved in a lawsuit against the federal government in the U.S. District Court in Florida. Virginia has also filed its own suit, a case that Mr. Slattery said he expected to rise to the Supreme Court.

And governors and attorneys general elected in five states also campaigned on the promise that they, too, would support overturning the mandate.

With money tight and millions of potential new Medicaid enrollees, governors from all parties may revolt against the mandate, said Ms. Johnson. "If you look at the basis on which states are challenging the mandate, it's in part that it abrogates the federal-state partnership because it imposes burdens they can't fulfill."

Back on Capitol Hill, the GOP-led House will also likely take a close look at the ACA-created Independent Payment Advisory Board, said Ms. Johnson. The IPAB, charged with looking at how the federal government pays physicians, hospitals, pharmaceutical companies, and other health providers, would have broad powers that make many Republicans uncomfortable, she said.

In his perspective piece, Mr. Aaron wrote that that Republicans could also tinker with the ACA by cutting off funding for implementation via the appropriations process, or even try to prohibit the Health and Human Services department from writing regulations. Some of those regulations are due to come out in the next 2 months – before the start of the 112th Congress.

WASHINGTON – The historic midterm election victory by Republicans does not signal the end of the Affordable Care Act, but now the law will very likely undergo the scrutiny that many in the GOP say it did not get as it made its way through Congress.

At press time, the Republicans had gained 60 seats in the House (with 9 races still undecided) and 6 seats in the Senate (with 1 still undecided). Even without the final results, the GOP now holds a majority in the House, with 239 seats, compared with 187 for the Democrats. Republican members of the Senate are still in the minority, but the current 52-46 Democratic margin is much slimmer than before the election.

Earlier this year, House Republican leaders and Senate Minority Leader Mitch McConnell (R-Ky.) vowed to "repeal and replace" the ACA if they regained the majority. A Republican-led House will not be able to make that happen alone; the Democratic-led Senate is unlikely to pass repeal legislation, and President Obama would likely veto any bill sent to him.

But Rep. John Boehner (R-Ohio), expected to be elected speaker of the House when the 112th Congress convenes in January, has indicated that the health reform law will be challenged in his chamber.

At a postelection press briefing, President Obama said he welcomed GOP input. "If the Republicans have ideas for how to improve our health care system, if they want to suggest modifications that would deliver faster and more effective reform to a health care system that has been widely expensive for too many families, businesses, and certainly our federal government, I’m happy to consider some of those ideas," he said.

But he said that the White House would not entertain a repeal debate.

Speaking at a postelection forum, Jim Slattery, a former six-term Democratic congressman from Kansas, said that he expected to see a repeal proposal. "The new Tea Party congresspeople and the leadership in the House will probably have to introduce some kind of resolution that would call for the repeal of ACA, and I think they know it’s going nowhere and it’s not going to happen, but they’re going to have to do that probably to satisfy political demand," said Mr. Slattery, now a lobbyist with Wiley Rein.

Mr. Slattery said that President Obama mainly has himself to blame for the Democrats’ poor showing in the election and for polling data indicating that half of Americans want to repeal the ACA. The president "failed to connect the dots" with Americans on how the law would benefit them, he added.

At the same forum, Nancy Johnson, a former Republican House member from Connecticut, said that she expected to see a number of oversight and investigative hearings on the ACA.

"The one thing that has to be done [in the next Congress] is, people have to regain their confidence in government and that’s not about policy, that’s about process," said Ms. Johnson, a senior public policy adviser at Baker Donelson. "Half the bill is terrific. But the other half wasn’t seen, and that created suspicion."

Rep. Boehner and other congressional Republicans have said they will keep some of the insurance market reforms – such as the prohibition on denying coverage for preexisting conditions – but will seek to throw out the mandate that individuals have health insurance coverage. That is a formula for disaster for the law – and for insurance companies, wrote Henry Aaron, a senior fellow at the Brookings Institution, in a perspective article published in the New England Journal of Medicine (2010;18:1685-7). Unless most Americans are covered, insurers might be bankrupted by the reforms, he said.

"In brief, the pledge to keep insurance-market reforms without both mandated coverage and subsidies is untenable," Mr. Aaron wrote.

Mr. Slattery agreed. "If you’re going to really reform the insurance industry with the preexisting-condition reforms, we have to have a mandate of some kind," he said.

The requirement that individuals carry insurance or pay a penalty, however, is the central issue being challenged by 20 states that are involved in a lawsuit against the federal government in the U.S. District Court in Florida. Virginia has also filed its own suit, a case that Mr. Slattery said he expected to rise to the Supreme Court.

And governors and attorneys general elected in five states also campaigned on the promise that they, too, would support overturning the mandate.

With money tight and millions of potential new Medicaid enrollees, governors from all parties may revolt against the mandate, said Ms. Johnson. "If you look at the basis on which states are challenging the mandate, it’s in part that it abrogates the federal-state partnership because it imposes burdens they can’t fulfill."

Back on Capitol Hill, the GOP-led House will also likely take a close look at the ACA-created Independent Payment Advisory Board, said Ms. Johnson. The IPAB, charged with looking at how the federal government pays physicians, hospitals, pharmaceutical companies, and other health providers, would have broad powers that make many Republicans uncomfortable, she said.

In his perspective piece, Mr. Aaron wrote that that Republicans could also tinker with the ACA by cutting off funding for implementation via the appropriations process, or even try to prohibit the Health and Human Services department from writing regulations. Some of those regulations are due to come out in the next 2 months – before the start of the 112th Congress.

WASHINGTON – The historic midterm election victory by Republicans does not signal the end of the Affordable Care Act, but now the law will very likely undergo the scrutiny that many in the GOP say it did not get as it made its way through Congress.

At press time, the Republicans had gained 60 seats in the House (with 9 races still undecided) and 6 seats in the Senate (with 1 still undecided). Even without the final results, the GOP now holds a majority in the House, with 239 seats, compared with 187 for the Democrats. Republican members of the Senate are still in the minority, but the current 52-46 Democratic margin is much slimmer than before the election.

Earlier this year, House Republican leaders and Senate Minority Leader Mitch McConnell (R-Ky.) vowed to "repeal and replace" the ACA if they regained the majority. A Republican-led House will not be able to make that happen alone; the Democratic-led Senate is unlikely to pass repeal legislation, and President Obama would likely veto any bill sent to him.

But Rep. John Boehner (R-Ohio), expected to be elected speaker of the House when the 112th Congress convenes in January, has indicated that the health reform law will be challenged in his chamber.

At a postelection press briefing, President Obama said he welcomed GOP input. "If the Republicans have ideas for how to improve our health care system, if they want to suggest modifications that would deliver faster and more effective reform to a health care system that has been widely expensive for too many families, businesses, and certainly our federal government, I’m happy to consider some of those ideas," he said.

But he said that the White House would not entertain a repeal debate.

Speaking at a postelection forum, Jim Slattery, a former six-term Democratic congressman from Kansas, said that he expected to see a repeal proposal. "The new Tea Party congresspeople and the leadership in the House will probably have to introduce some kind of resolution that would call for the repeal of ACA, and I think they know it’s going nowhere and it’s not going to happen, but they’re going to have to do that probably to satisfy political demand," said Mr. Slattery, now a lobbyist with Wiley Rein.

Mr. Slattery said that President Obama mainly has himself to blame for the Democrats’ poor showing in the election and for polling data indicating that half of Americans want to repeal the ACA. The president "failed to connect the dots" with Americans on how the law would benefit them, he added.

At the same forum, Nancy Johnson, a former Republican House member from Connecticut, said that she expected to see a number of oversight and investigative hearings on the ACA.

"The one thing that has to be done [in the next Congress] is, people have to regain their confidence in government and that’s not about policy, that’s about process," said Ms. Johnson, a senior public policy adviser at Baker Donelson. "Half the bill is terrific. But the other half wasn’t seen, and that created suspicion."

Rep. Boehner and other congressional Republicans have said they will keep some of the insurance market reforms – such as the prohibition on denying coverage for preexisting conditions – but will seek to throw out the mandate that individuals have health insurance coverage. That is a formula for disaster for the law – and for insurance companies, wrote Henry Aaron, a senior fellow at the Brookings Institution, in a perspective article published in the New England Journal of Medicine (2010;18:1685-7). Unless most Americans are covered, insurers might be bankrupted by the reforms, he said.

"In brief, the pledge to keep insurance-market reforms without both mandated coverage and subsidies is untenable," Mr. Aaron wrote.

Mr. Slattery agreed. "If you’re going to really reform the insurance industry with the preexisting-condition reforms, we have to have a mandate of some kind," he said.

The requirement that individuals carry insurance or pay a penalty, however, is the central issue being challenged by 20 states that are involved in a lawsuit against the federal government in the U.S. District Court in Florida. Virginia has also filed its own suit, a case that Mr. Slattery said he expected to rise to the Supreme Court.

And governors and attorneys general elected in five states also campaigned on the promise that they, too, would support overturning the mandate.

With money tight and millions of potential new Medicaid enrollees, governors from all parties may revolt against the mandate, said Ms. Johnson. "If you look at the basis on which states are challenging the mandate, it’s in part that it abrogates the federal-state partnership because it imposes burdens they can’t fulfill."

Back on Capitol Hill, the GOP-led House will also likely take a close look at the ACA-created Independent Payment Advisory Board, said Ms. Johnson. The IPAB, charged with looking at how the federal government pays physicians, hospitals, pharmaceutical companies, and other health providers, would have broad powers that make many Republicans uncomfortable, she said.

In his perspective piece, Mr. Aaron wrote that that Republicans could also tinker with the ACA by cutting off funding for implementation via the appropriations process, or even try to prohibit the Health and Human Services department from writing regulations. Some of those regulations are due to come out in the next 2 months – before the start of the 112th Congress.

WASHINGTON – The historic midterm election victory by Republicans does not signal the end of the Affordable Care Act, but now the law will very likely undergo the scrutiny that many in the GOP say it did not get as it made its way through Congress.

At press time, the Republicans had gained 60 seats in the House (with 9 races still undecided) and 6 seats in the Senate (with 1 still undecided). Even without the final results, the GOP now holds a majority in the House, with 239 seats, compared with 187 for the Democrats. Republican members of the Senate are still in the minority, but the current 52-46 Democratic margin is much slimmer than before the election.

Earlier this year, House Republican leaders and Senate Minority Leader Mitch McConnell (R-Ky.) vowed to "repeal and replace" the ACA if they regained the majority. A Republican-led House will not be able to make that happen alone; the Democratic-led Senate is unlikely to pass repeal legislation, and President Obama would likely veto any bill sent to him.

But Rep. John Boehner (R-Ohio), expected to be elected speaker of the House when the 112th Congress convenes in January, has indicated that the health reform law will be challenged in his chamber.

At a postelection press briefing, President Obama said he welcomed GOP input. "If the Republicans have ideas for how to improve our health care system, if they want to suggest modifications that would deliver faster and more effective reform to a health care system that has been widely expensive for too many families, businesses, and certainly our federal government, I’m happy to consider some of those ideas," he said.

But he said that the White House would not entertain a repeal debate.

Speaking at a postelection forum, Jim Slattery, a former six-term Democratic congressman from Kansas, said that he expected to see a repeal proposal. "The new Tea Party congresspeople and the leadership in the House will probably have to introduce some kind of resolution that would call for the repeal of ACA, and I think they know it’s going nowhere and it’s not going to happen, but they’re going to have to do that probably to satisfy political demand," said Mr. Slattery, now a lobbyist with Wiley Rein.

Mr. Slattery said that President Obama mainly has himself to blame for the Democrats’ poor showing in the election and for polling data indicating that half of Americans want to repeal the ACA. The president "failed to connect the dots" with Americans on how the law would benefit them, he added.

At the same forum, Nancy Johnson, a former Republican House member from Connecticut, said that she expected to see a number of oversight and investigative hearings on the ACA.

"The one thing that has to be done [in the next Congress] is, people have to regain their confidence in government and that’s not about policy, that’s about process," said Ms. Johnson, a senior public policy adviser at Baker Donelson. "Half the bill is terrific. But the other half wasn’t seen, and that created suspicion."

Rep. Boehner and other congressional Republicans have said they will keep some of the insurance market reforms – such as the prohibition on denying coverage for preexisting conditions – but will seek to throw out the mandate that individuals have health insurance coverage. That is a formula for disaster for the law – and for insurance companies, wrote Henry Aaron, a senior fellow at the Brookings Institution, in a perspective article published in the New England Journal of Medicine (2010;18:1685-7). Unless most Americans are covered, insurers might be bankrupted by the reforms, he said.

"In brief, the pledge to keep insurance-market reforms without both mandated coverage and subsidies is untenable," Mr. Aaron wrote.

Mr. Slattery agreed. "If you’re going to really reform the insurance industry with the preexisting-condition reforms, we have to have a mandate of some kind," he said.

The requirement that individuals carry insurance or pay a penalty, however, is the central issue being challenged by 20 states that are involved in a lawsuit against the federal government in the U.S. District Court in Florida. Virginia has also filed its own suit, a case that Mr. Slattery said he expected to rise to the Supreme Court.

And governors and attorneys general elected in five states also campaigned on the promise that they, too, would support overturning the mandate.

With money tight and millions of potential new Medicaid enrollees, governors from all parties may revolt against the mandate, said Ms. Johnson. "If you look at the basis on which states are challenging the mandate, it’s in part that it abrogates the federal-state partnership because it imposes burdens they can’t fulfill."

Back on Capitol Hill, the GOP-led House will also likely take a close look at the ACA-created Independent Payment Advisory Board, said Ms. Johnson. The IPAB, charged with looking at how the federal government pays physicians, hospitals, pharmaceutical companies, and other health providers, would have broad powers that make many Republicans uncomfortable, she said.

In his perspective piece, Mr. Aaron wrote that that Republicans could also tinker with the ACA by cutting off funding for implementation via the appropriations process, or even try to prohibit the Health and Human Services department from writing regulations. Some of those regulations are due to come out in the next 2 months – before the start of the 112th Congress.

Bristol-Myers Squibb reported on Nov. 2 that the Food and Drug Administration would need more time to review ipilimumab, its biologic drug for melanoma.

The agency was due to make an approval decision by Dec. 25, but now will have until March 26, 2011, according to a statement from Bristol-Myers.

The drug maker said that it submitted additional data to the FDA at the agency’s request.

Ipilimumab, to be marketed as Yervoy, was also due to be reviewed by the FDA’s Oncologic Drugs Advisory Committee on Dec. 2. That meeting is now in doubt, said Ira Loss of "Washington Analysis," a research and analysis company, in an interview.

"I've seen this happen enough times in the past where the product is scheduled on a panel, the company submits additional data, the PDUFA [user fee] date gets pushed out, and then they dropped the meeting," said Mr. Loss.

He still expects approval for ipilimumab, in part because he believes the data are strong, and because "there hasn't been any other product approved for melanoma in years," he said.

In its statement, the drug maker said, "Bristol-Myers Squibb continues to be very encouraged by its interactions with the FDA and remains confident in the overall development program for ipilimumab."

The company noted that "ipilimumab is also currently under review with the European Medicines Agency and other health authorities worldwide."

Bristol-Myers Squibb reported on Nov. 2 that the Food and Drug Administration would need more time to review ipilimumab, its biologic drug for melanoma.

The agency was due to make an approval decision by Dec. 25, but now will have until March 26, 2011, according to a statement from Bristol-Myers.

The drug maker said that it submitted additional data to the FDA at the agency’s request.

Ipilimumab, to be marketed as Yervoy, was also due to be reviewed by the FDA’s Oncologic Drugs Advisory Committee on Dec. 2. That meeting is now in doubt, said Ira Loss of "Washington Analysis," a research and analysis company, in an interview.

"I've seen this happen enough times in the past where the product is scheduled on a panel, the company submits additional data, the PDUFA [user fee] date gets pushed out, and then they dropped the meeting," said Mr. Loss.

He still expects approval for ipilimumab, in part because he believes the data are strong, and because "there hasn't been any other product approved for melanoma in years," he said.

In its statement, the drug maker said, "Bristol-Myers Squibb continues to be very encouraged by its interactions with the FDA and remains confident in the overall development program for ipilimumab."

The company noted that "ipilimumab is also currently under review with the European Medicines Agency and other health authorities worldwide."

Bristol-Myers Squibb reported on Nov. 2 that the Food and Drug Administration would need more time to review ipilimumab, its biologic drug for melanoma.

The agency was due to make an approval decision by Dec. 25, but now will have until March 26, 2011, according to a statement from Bristol-Myers.

The drug maker said that it submitted additional data to the FDA at the agency’s request.

Ipilimumab, to be marketed as Yervoy, was also due to be reviewed by the FDA’s Oncologic Drugs Advisory Committee on Dec. 2. That meeting is now in doubt, said Ira Loss of "Washington Analysis," a research and analysis company, in an interview.

"I've seen this happen enough times in the past where the product is scheduled on a panel, the company submits additional data, the PDUFA [user fee] date gets pushed out, and then they dropped the meeting," said Mr. Loss.

He still expects approval for ipilimumab, in part because he believes the data are strong, and because "there hasn't been any other product approved for melanoma in years," he said.

In its statement, the drug maker said, "Bristol-Myers Squibb continues to be very encouraged by its interactions with the FDA and remains confident in the overall development program for ipilimumab."

The company noted that "ipilimumab is also currently under review with the European Medicines Agency and other health authorities worldwide."

Bristol-Myers Squibb reported on Nov. 2 that the Food and Drug Administration would need more time to review ipilimumab, its biologic drug for melanoma.

The agency was due to make an approval decision by Dec. 25, but now will have until March 26, 2011, according to a statement from Bristol-Myers.

The drug maker said that it submitted additional data to the FDA at the agency’s request.

Ipilimumab, to be marketed as Yervoy, was also due to be reviewed by the FDA’s Oncologic Drugs Advisory Committee on Dec. 2. That meeting is now in doubt, said Ira Loss of "Washington Analysis,"a research and analysis company, in an interview.

"I’ve seen this happen enough times in the past where the product is scheduled on a panel, the company submits additional data, the PDUFA [user fee] date gets pushed out, and then they dropped the meeting," said Mr. Loss.

He still expects approval for ipilimumab, in part because he believes the data are strong, and because "there hasn’t been any other product approved for melanoma in years," he said.

In its statement, the drug maker said, "Bristol-Myers Squibb continues to be very encouraged by its interactions with the FDA and remains confident in the overall development program for ipilimumab."

The company noted that "ipilimumab is also currently under review with the European Medicines Agency and other health authorities worldwide."

Bristol-Myers Squibb reported on Nov. 2 that the Food and Drug Administration would need more time to review ipilimumab, its biologic drug for melanoma.

The agency was due to make an approval decision by Dec. 25, but now will have until March 26, 2011, according to a statement from Bristol-Myers.

The drug maker said that it submitted additional data to the FDA at the agency’s request.

Ipilimumab, to be marketed as Yervoy, was also due to be reviewed by the FDA’s Oncologic Drugs Advisory Committee on Dec. 2. That meeting is now in doubt, said Ira Loss of "Washington Analysis,"a research and analysis company, in an interview.

"I’ve seen this happen enough times in the past where the product is scheduled on a panel, the company submits additional data, the PDUFA [user fee] date gets pushed out, and then they dropped the meeting," said Mr. Loss.

He still expects approval for ipilimumab, in part because he believes the data are strong, and because "there hasn’t been any other product approved for melanoma in years," he said.

In its statement, the drug maker said, "Bristol-Myers Squibb continues to be very encouraged by its interactions with the FDA and remains confident in the overall development program for ipilimumab."

The company noted that "ipilimumab is also currently under review with the European Medicines Agency and other health authorities worldwide."

Bristol-Myers Squibb reported on Nov. 2 that the Food and Drug Administration would need more time to review ipilimumab, its biologic drug for melanoma.

The agency was due to make an approval decision by Dec. 25, but now will have until March 26, 2011, according to a statement from Bristol-Myers.

The drug maker said that it submitted additional data to the FDA at the agency’s request.

Ipilimumab, to be marketed as Yervoy, was also due to be reviewed by the FDA’s Oncologic Drugs Advisory Committee on Dec. 2. That meeting is now in doubt, said Ira Loss of "Washington Analysis,"a research and analysis company, in an interview.

"I’ve seen this happen enough times in the past where the product is scheduled on a panel, the company submits additional data, the PDUFA [user fee] date gets pushed out, and then they dropped the meeting," said Mr. Loss.

He still expects approval for ipilimumab, in part because he believes the data are strong, and because "there hasn’t been any other product approved for melanoma in years," he said.

In its statement, the drug maker said, "Bristol-Myers Squibb continues to be very encouraged by its interactions with the FDA and remains confident in the overall development program for ipilimumab."

The company noted that "ipilimumab is also currently under review with the European Medicines Agency and other health authorities worldwide."

The Centers for Medicare and Medicaid Services issued its final rule governing physician fees for 2011 on Nov. 3, offering a 10% incentive payment to primary care physicians, but taking away an additional 2% across the board as a result of the statutory requirements of the sustainable growth rate formula.

Unless Congress acts, physician fees under Medicare will be cut by 23% on Dec. 1 as mandated by the SGR; just about 2% more will be cut Jan. 1, brining the total cut for 2011 to 25%.

Although CMS Administrator Don Berwick has called for a permanent overhaul of the SGR, it was not mentioned in the materials that went out with the new rule. Instead, Dr. Berwick touted the new preventive care benefits that will be covered, and thus reimbursed, as a result of the Affordable Care Act.

Under the final rule, which implements certain ACA provisions, Medicare will pay for an annual wellness visit, "that will allow a physician and patient to develop a closer partnership to improve the patient’s long term health," said Dr. Berwick in a statement. "The rule will also eliminate out-of-pocket costs for most preventive services beginning Jan. 1, 2011, reducing barriers to access for many beneficiaries," he added.

The wellness visit will be paid at the rate of a level 4 office visit for a new patient.

The ACA also provided the primary care bonus, which is separate from the fee cuts. The payment is available to family physicians, general internists, geriatricians, pediatricians, nurse practitioners, clinical nurse specialists, and physician assistants who can show that 60% or more of their Medicare allowable charges were for primary care.

The incentive payments will be made quarterly, based on the services provided in the previous quarter.

A similar 10% quarterly incentive payment will be made in 2011 to general surgeons in Health Professional Shortage Areas.

The fee schedule also implements a provision of the ACA that increases payment for two codes for dual energy x-ray absorptiometry (DXA) for both 2010 and 2011.

The ACA also dictated new requirements for physicians who refer patients to MRI, CT, and PET facilities in which they have an ownership interest. Now, the physician will have to disclose in writing to patients that they can receive the service elsewhere. Referring physicians will also have to provide a list of five alternatives within 25 miles of the physician’s office.

Payment for imaging procedures will also be reduced. Previously, the CMS reimbursed based on the assumption that equipment was used 100% of the time. That assumption has been changed to 75%.

The ACA also reduced incentives for the Physician Quality Reporting System (formerly known as the Physician Quality Reporting Initiative). In 2011, physicians will be eligible for an incentive payment equal to 1% of the total Medicare charges during the reporting period. For 2012 through 2014, the payment drops to 0.5% of charges. After 2014, physicians who do not report data could see a 1.5% cut in Medicare fees; the penalty increases each year.

There is a carrot, though. Physicians who use a Maintenance of Certification program to report PQRS data will get an additional 0.5%.

The incentive payment for e-prescribing in 2011 will be 1% of charges during the calendar year. But in 2012, payments will be reduced if physicians are "not successful e-prescribers," according to the CMS.

The final fee schedule rule will be published Nov. 29 in the Federal Register.

The Centers for Medicare and Medicaid Services issued its final rule governing physician fees for 2011 on Nov. 3, offering a 10% incentive payment to primary care physicians, but taking away an additional 2% across the board as a result of the statutory requirements of the sustainable growth rate formula.

Unless Congress acts, physician fees under Medicare will be cut by 23% on Dec. 1 as mandated by the SGR; just about 2% more will be cut Jan. 1, brining the total cut for 2011 to 25%.

Although CMS Administrator Don Berwick has called for a permanent overhaul of the SGR, it was not mentioned in the materials that went out with the new rule. Instead, Dr. Berwick touted the new preventive care benefits that will be covered, and thus reimbursed, as a result of the Affordable Care Act.

Under the final rule, which implements certain ACA provisions, Medicare will pay for an annual wellness visit, "that will allow a physician and patient to develop a closer partnership to improve the patient’s long term health," said Dr. Berwick in a statement. "The rule will also eliminate out-of-pocket costs for most preventive services beginning Jan. 1, 2011, reducing barriers to access for many beneficiaries," he added.

The wellness visit will be paid at the rate of a level 4 office visit for a new patient.

The ACA also provided the primary care bonus, which is separate from the fee cuts. The payment is available to family physicians, general internists, geriatricians, pediatricians, nurse practitioners, clinical nurse specialists, and physician assistants who can show that 60% or more of their Medicare allowable charges were for primary care.

The incentive payments will be made quarterly, based on the services provided in the previous quarter.

A similar 10% quarterly incentive payment will be made in 2011 to general surgeons in Health Professional Shortage Areas.

The fee schedule also implements a provision of the ACA that increases payment for two codes for dual energy x-ray absorptiometry (DXA) for both 2010 and 2011.

The ACA also dictated new requirements for physicians who refer patients to MRI, CT, and PET facilities in which they have an ownership interest. Now, the physician will have to disclose in writing to patients that they can receive the service elsewhere. Referring physicians will also have to provide a list of five alternatives within 25 miles of the physician’s office.

Payment for imaging procedures will also be reduced. Previously, the CMS reimbursed based on the assumption that equipment was used 100% of the time. That assumption has been changed to 75%.

The ACA also reduced incentives for the Physician Quality Reporting System (formerly known as the Physician Quality Reporting Initiative). In 2011, physicians will be eligible for an incentive payment equal to 1% of the total Medicare charges during the reporting period. For 2012 through 2014, the payment drops to 0.5% of charges. After 2014, physicians who do not report data could see a 1.5% cut in Medicare fees; the penalty increases each year.

There is a carrot, though. Physicians who use a Maintenance of Certification program to report PQRS data will get an additional 0.5%.

The incentive payment for e-prescribing in 2011 will be 1% of charges during the calendar year. But in 2012, payments will be reduced if physicians are "not successful e-prescribers," according to the CMS.

The final fee schedule rule will be published Nov. 29 in the Federal Register.

The Centers for Medicare and Medicaid Services issued its final rule governing physician fees for 2011 on Nov. 3, offering a 10% incentive payment to primary care physicians, but taking away an additional 2% across the board as a result of the statutory requirements of the sustainable growth rate formula.

Unless Congress acts, physician fees under Medicare will be cut by 23% on Dec. 1 as mandated by the SGR; just about 2% more will be cut Jan. 1, brining the total cut for 2011 to 25%.

Although CMS Administrator Don Berwick has called for a permanent overhaul of the SGR, it was not mentioned in the materials that went out with the new rule. Instead, Dr. Berwick touted the new preventive care benefits that will be covered, and thus reimbursed, as a result of the Affordable Care Act.

Under the final rule, which implements certain ACA provisions, Medicare will pay for an annual wellness visit, "that will allow a physician and patient to develop a closer partnership to improve the patient’s long term health," said Dr. Berwick in a statement. "The rule will also eliminate out-of-pocket costs for most preventive services beginning Jan. 1, 2011, reducing barriers to access for many beneficiaries," he added.

The wellness visit will be paid at the rate of a level 4 office visit for a new patient.

The ACA also provided the primary care bonus, which is separate from the fee cuts. The payment is available to family physicians, general internists, geriatricians, pediatricians, nurse practitioners, clinical nurse specialists, and physician assistants who can show that 60% or more of their Medicare allowable charges were for primary care.

The incentive payments will be made quarterly, based on the services provided in the previous quarter.

A similar 10% quarterly incentive payment will be made in 2011 to general surgeons in Health Professional Shortage Areas.

The fee schedule also implements a provision of the ACA that increases payment for two codes for dual energy x-ray absorptiometry (DXA) for both 2010 and 2011.

The ACA also dictated new requirements for physicians who refer patients to MRI, CT, and PET facilities in which they have an ownership interest. Now, the physician will have to disclose in writing to patients that they can receive the service elsewhere. Referring physicians will also have to provide a list of five alternatives within 25 miles of the physician’s office.

Payment for imaging procedures will also be reduced. Previously, the CMS reimbursed based on the assumption that equipment was used 100% of the time. That assumption has been changed to 75%.

The ACA also reduced incentives for the Physician Quality Reporting System (formerly known as the Physician Quality Reporting Initiative). In 2011, physicians will be eligible for an incentive payment equal to 1% of the total Medicare charges during the reporting period. For 2012 through 2014, the payment drops to 0.5% of charges. After 2014, physicians who do not report data could see a 1.5% cut in Medicare fees; the penalty increases each year.

There is a carrot, though. Physicians who use a Maintenance of Certification program to report PQRS data will get an additional 0.5%.

The incentive payment for e-prescribing in 2011 will be 1% of charges during the calendar year. But in 2012, payments will be reduced if physicians are "not successful e-prescribers," according to the CMS.

The final fee schedule rule will be published Nov. 29 in the Federal Register.

The Centers for Medicare and Medicaid Services issued its final rule governing physician fees for 2011 on Nov. 3, offering a 10% incentive payment to primary care physicians, but taking away an additional 2% across the board as a result of the statutory requirements of the sustainable growth rate formula.

Unless Congress acts, physician fees under Medicare will be cut by 23% on Dec. 1 as mandated by the SGR; just about 2% more will be cut Jan. 1, brining the total cut for 2011 to 25%.

Although CMS Administrator Don Berwick has called for a permanent overhaul of the SGR, it was not mentioned in the materials that went out with the new rule. Instead, Dr. Berwick touted the new preventive care benefits that will be covered, and thus reimbursed, as a result of the Affordable Care Act.

Under the final rule, which implements certain ACA provisions, Medicare will pay for an annual wellness visit, "that will allow a physician and patient to develop a closer partnership to improve the patient’s long term health," said Dr. Berwick in a statement. "The rule will also eliminate out-of-pocket costs for most preventive services beginning Jan. 1, 2011, reducing barriers to access for many beneficiaries," he added.

The wellness visit will be paid at the rate of a level 4 office visit for a new patient.

The ACA also provided the primary care bonus, which is separate from the fee cuts. The payment is available to family physicians, general internists, geriatricians, pediatricians, nurse practitioners, clinical nurse specialists, and physician assistants who can show that 60% or more of their Medicare allowable charges were for primary care.

The incentive payments will be made quarterly, based on the services provided in the previous quarter.

A similar 10% quarterly incentive payment will be made in 2011 to general surgeons in Health Professional Shortage Areas.

The fee schedule also implements a provision of the ACA that increases payment for two codes for dual energy x-ray absorptiometry (DXA) for both 2010 and 2011.

The ACA also dictated new requirements for physicians who refer patients to MRI, CT, and PET facilities in which they have an ownership interest. Now, the physician will have to disclose in writing to patients that they can receive the service elsewhere. Referring physicians will also have to provide a list of five alternatives within 25 miles of the physician’s office.

Payment for imaging procedures will also be reduced. Previously, the CMS reimbursed based on the assumption that equipment was used 100% of the time. That assumption has been changed to 75%.

The ACA also reduced incentives for the Physician Quality Reporting System (formerly known as the Physician Quality Reporting Initiative). In 2011, physicians will be eligible for an incentive payment equal to 1% of the total Medicare charges during the reporting period. For 2012 through 2014, the payment drops to 0.5% of charges. After 2014, physicians who do not report data could see a 1.5% cut in Medicare fees; the penalty increases each year.

There is a carrot, though. Physicians who use a Maintenance of Certification program to report PQRS data will get an additional 0.5%.

The incentive payment for e-prescribing in 2011 will be 1% of charges during the calendar year. But in 2012, payments will be reduced if physicians are "not successful e-prescribers," according to the CMS.

The final fee schedule rule will be published Nov. 29 in the Federal Register.

The Centers for Medicare and Medicaid Services issued its final rule governing physician fees for 2011 on Nov. 3, offering a 10% incentive payment to primary care physicians, but taking away an additional 2% across the board as a result of the statutory requirements of the sustainable growth rate formula.

Unless Congress acts, physician fees under Medicare will be cut by 23% on Dec. 1 as mandated by the SGR; just about 2% more will be cut Jan. 1, brining the total cut for 2011 to 25%.

Although CMS Administrator Don Berwick has called for a permanent overhaul of the SGR, it was not mentioned in the materials that went out with the new rule. Instead, Dr. Berwick touted the new preventive care benefits that will be covered, and thus reimbursed, as a result of the Affordable Care Act.

Under the final rule, which implements certain ACA provisions, Medicare will pay for an annual wellness visit, "that will allow a physician and patient to develop a closer partnership to improve the patient’s long term health," said Dr. Berwick in a statement. "The rule will also eliminate out-of-pocket costs for most preventive services beginning Jan. 1, 2011, reducing barriers to access for many beneficiaries," he added.

The wellness visit will be paid at the rate of a level 4 office visit for a new patient.

The ACA also provided the primary care bonus, which is separate from the fee cuts. The payment is available to family physicians, general internists, geriatricians, pediatricians, nurse practitioners, clinical nurse specialists, and physician assistants who can show that 60% or more of their Medicare allowable charges were for primary care.

The incentive payments will be made quarterly, based on the services provided in the previous quarter.

A similar 10% quarterly incentive payment will be made in 2011 to general surgeons in Health Professional Shortage Areas.

The fee schedule also implements a provision of the ACA that increases payment for two codes for dual energy x-ray absorptiometry (DXA) for both 2010 and 2011.

The ACA also dictated new requirements for physicians who refer patients to MRI, CT, and PET facilities in which they have an ownership interest. Now, the physician will have to disclose in writing to patients that they can receive the service elsewhere. Referring physicians will also have to provide a list of five alternatives within 25 miles of the physician’s office.

Payment for imaging procedures will also be reduced. Previously, the CMS reimbursed based on the assumption that equipment was used 100% of the time. That assumption has been changed to 75%.

The ACA also reduced incentives for the Physician Quality Reporting System (formerly known as the Physician Quality Reporting Initiative). In 2011, physicians will be eligible for an incentive payment equal to 1% of the total Medicare charges during the reporting period. For 2012 through 2014, the payment drops to 0.5% of charges. After 2014, physicians who do not report data could see a 1.5% cut in Medicare fees; the penalty increases each year.

There is a carrot, though. Physicians who use a Maintenance of Certification program to report PQRS data will get an additional 0.5%.

The incentive payment for e-prescribing in 2011 will be 1% of charges during the calendar year. But in 2012, payments will be reduced if physicians are "not successful e-prescribers," according to the CMS.

The final fee schedule rule will be published Nov. 29 in the Federal Register.

The Centers for Medicare and Medicaid Services issued its final rule governing physician fees for 2011 on Nov. 3, offering a 10% incentive payment to primary care physicians, but taking away an additional 2% across the board as a result of the statutory requirements of the sustainable growth rate formula.

Unless Congress acts, physician fees under Medicare will be cut by 23% on Dec. 1 as mandated by the SGR; just about 2% more will be cut Jan. 1, brining the total cut for 2011 to 25%.

Although CMS Administrator Don Berwick has called for a permanent overhaul of the SGR, it was not mentioned in the materials that went out with the new rule. Instead, Dr. Berwick touted the new preventive care benefits that will be covered, and thus reimbursed, as a result of the Affordable Care Act.

Under the final rule, which implements certain ACA provisions, Medicare will pay for an annual wellness visit, "that will allow a physician and patient to develop a closer partnership to improve the patient’s long term health," said Dr. Berwick in a statement. "The rule will also eliminate out-of-pocket costs for most preventive services beginning Jan. 1, 2011, reducing barriers to access for many beneficiaries," he added.

The wellness visit will be paid at the rate of a level 4 office visit for a new patient.

The ACA also provided the primary care bonus, which is separate from the fee cuts. The payment is available to family physicians, general internists, geriatricians, pediatricians, nurse practitioners, clinical nurse specialists, and physician assistants who can show that 60% or more of their Medicare allowable charges were for primary care.

The incentive payments will be made quarterly, based on the services provided in the previous quarter.

A similar 10% quarterly incentive payment will be made in 2011 to general surgeons in Health Professional Shortage Areas.

The fee schedule also implements a provision of the ACA that increases payment for two codes for dual energy x-ray absorptiometry (DXA) for both 2010 and 2011.

The ACA also dictated new requirements for physicians who refer patients to MRI, CT, and PET facilities in which they have an ownership interest. Now, the physician will have to disclose in writing to patients that they can receive the service elsewhere. Referring physicians will also have to provide a list of five alternatives within 25 miles of the physician’s office.

Payment for imaging procedures will also be reduced. Previously, the CMS reimbursed based on the assumption that equipment was used 100% of the time. That assumption has been changed to 75%.

The ACA also reduced incentives for the Physician Quality Reporting System (formerly known as the Physician Quality Reporting Initiative). In 2011, physicians will be eligible for an incentive payment equal to 1% of the total Medicare charges during the reporting period. For 2012 through 2014, the payment drops to 0.5% of charges. After 2014, physicians who do not report data could see a 1.5% cut in Medicare fees; the penalty increases each year.

There is a carrot, though. Physicians who use a Maintenance of Certification program to report PQRS data will get an additional 0.5%.

The incentive payment for e-prescribing in 2011 will be 1% of charges during the calendar year. But in 2012, payments will be reduced if physicians are "not successful e-prescribers," according to the CMS.

The final fee schedule rule will be published Nov. 29 in the Federal Register.

The Centers for Medicare and Medicaid Services issued its final rule governing physician fees for 2011 on Nov. 3, offering a 10% incentive payment to primary care physicians, but taking away an additional 2% across the board as a result of the statutory requirements of the sustainable growth rate formula.

Unless Congress acts, physician fees under Medicare will be cut by 23% on Dec. 1 as mandated by the SGR; just about 2% more will be cut Jan. 1, bring the total cut for 2011 to 25%.

Although CMS Administrator Don Berwick has called for a permanent overhaul of the SGR, it was not mentioned in the materials that went out with the new rule. Instead, Dr. Berwick touted the new preventive care benefits that will be covered, and thus reimbursed, as a result of the Affordable Care Act.

Under the final rule, which implements certain ACA provisions, Medicare will pay for an annual wellness visit, "that will allow a physician and patient to develop a closer partnership to improve the patient's long term health," said Dr. Berwick in a statement. "The rule will also eliminate out-of-pocket costs for most preventive services beginning Jan. 1, 2011, reducing barriers to access for many beneficiaries," he added.

The wellness visit will be paid at the rate of a level 4 office visit for a new patient.

The ACA also provided the primary care bonus, which is separate from the fee cuts. The payment is available to family physicians, general internists, geriatricians, pediatricians, nurse practitioners, clinical nurse specialists, and physician assistants who can show that 60% or more of their Medicare allowable charges were for primary care.

The incentive payments will be made quarterly, based on the services provided in the previous quarter.

A similar 10% quarterly incentive payment will be made in 2011 to general surgeons in Health Professional Shortage Areas.

The fee schedule also implements a provision of the ACA that increases payment for two codes for dual energy x-ray absorptiometry (DXA) for both 2010 and 2011.

The ACA also dictated new requirements for physicians who refer patients to MRI, CT, and PET facilities in which they have an ownership interest. Now, the physician will have to disclose in writing to patients that they can receive the service elsewhere. Referring physicians will also have to provide a list of five alternatives within 25 miles of the physician's office.

Payment for imaging procedures will also be reduced. Previously, the CMS reimbursed based on the assumption that equipment was used 100% of the time. That assumption has been changed to 75%.

The ACA also reduced incentives for the Physician Quality Reporting System (formerly known as the Physician Quality Reporting Initiative). In 2011, physicians will be eligible for an incentive payment equal to 1% of the total Medicare charges during the reporting period. For 2012 through 2014, the payment drops to 0.5% of charges. After 2014, physicians who do not report data could see a 1.5% cut in Medicare fees; the penalty increases each year.

There is a carrot, though. Physicians who use a Maintenance of Certification program to report PQRS data will get an additional 0.5%.

The incentive payment for e-prescribing in 2011 will be 1% of charges during the calendar year. But in 2012, payments will be reduced if physicians are "not successful e-prescribers," according to the CMS.

The final fee schedule rule will be published Nov. 29 in the Federal Register.

The Centers for Medicare and Medicaid Services issued its final rule governing physician fees for 2011 on Nov. 3, offering a 10% incentive payment to primary care physicians, but taking away an additional 2% across the board as a result of the statutory requirements of the sustainable growth rate formula.

Unless Congress acts, physician fees under Medicare will be cut by 23% on Dec. 1 as mandated by the SGR; just about 2% more will be cut Jan. 1, bring the total cut for 2011 to 25%.

Although CMS Administrator Don Berwick has called for a permanent overhaul of the SGR, it was not mentioned in the materials that went out with the new rule. Instead, Dr. Berwick touted the new preventive care benefits that will be covered, and thus reimbursed, as a result of the Affordable Care Act.

Under the final rule, which implements certain ACA provisions, Medicare will pay for an annual wellness visit, "that will allow a physician and patient to develop a closer partnership to improve the patient's long term health," said Dr. Berwick in a statement. "The rule will also eliminate out-of-pocket costs for most preventive services beginning Jan. 1, 2011, reducing barriers to access for many beneficiaries," he added.

The wellness visit will be paid at the rate of a level 4 office visit for a new patient.

The ACA also provided the primary care bonus, which is separate from the fee cuts. The payment is available to family physicians, general internists, geriatricians, pediatricians, nurse practitioners, clinical nurse specialists, and physician assistants who can show that 60% or more of their Medicare allowable charges were for primary care.

The incentive payments will be made quarterly, based on the services provided in the previous quarter.

A similar 10% quarterly incentive payment will be made in 2011 to general surgeons in Health Professional Shortage Areas.

The fee schedule also implements a provision of the ACA that increases payment for two codes for dual energy x-ray absorptiometry (DXA) for both 2010 and 2011.

The ACA also dictated new requirements for physicians who refer patients to MRI, CT, and PET facilities in which they have an ownership interest. Now, the physician will have to disclose in writing to patients that they can receive the service elsewhere. Referring physicians will also have to provide a list of five alternatives within 25 miles of the physician's office.

Payment for imaging procedures will also be reduced. Previously, the CMS reimbursed based on the assumption that equipment was used 100% of the time. That assumption has been changed to 75%.

The ACA also reduced incentives for the Physician Quality Reporting System (formerly known as the Physician Quality Reporting Initiative). In 2011, physicians will be eligible for an incentive payment equal to 1% of the total Medicare charges during the reporting period. For 2012 through 2014, the payment drops to 0.5% of charges. After 2014, physicians who do not report data could see a 1.5% cut in Medicare fees; the penalty increases each year.

There is a carrot, though. Physicians who use a Maintenance of Certification program to report PQRS data will get an additional 0.5%.

The incentive payment for e-prescribing in 2011 will be 1% of charges during the calendar year. But in 2012, payments will be reduced if physicians are "not successful e-prescribers," according to the CMS.

The final fee schedule rule will be published Nov. 29 in the Federal Register.

The Centers for Medicare and Medicaid Services issued its final rule governing physician fees for 2011 on Nov. 3, offering a 10% incentive payment to primary care physicians, but taking away an additional 2% across the board as a result of the statutory requirements of the sustainable growth rate formula.

Unless Congress acts, physician fees under Medicare will be cut by 23% on Dec. 1 as mandated by the SGR; just about 2% more will be cut Jan. 1, bring the total cut for 2011 to 25%.

Although CMS Administrator Don Berwick has called for a permanent overhaul of the SGR, it was not mentioned in the materials that went out with the new rule. Instead, Dr. Berwick touted the new preventive care benefits that will be covered, and thus reimbursed, as a result of the Affordable Care Act.

Under the final rule, which implements certain ACA provisions, Medicare will pay for an annual wellness visit, "that will allow a physician and patient to develop a closer partnership to improve the patient's long term health," said Dr. Berwick in a statement. "The rule will also eliminate out-of-pocket costs for most preventive services beginning Jan. 1, 2011, reducing barriers to access for many beneficiaries," he added.

The wellness visit will be paid at the rate of a level 4 office visit for a new patient.

The ACA also provided the primary care bonus, which is separate from the fee cuts. The payment is available to family physicians, general internists, geriatricians, pediatricians, nurse practitioners, clinical nurse specialists, and physician assistants who can show that 60% or more of their Medicare allowable charges were for primary care.

The incentive payments will be made quarterly, based on the services provided in the previous quarter.

A similar 10% quarterly incentive payment will be made in 2011 to general surgeons in Health Professional Shortage Areas.

The fee schedule also implements a provision of the ACA that increases payment for two codes for dual energy x-ray absorptiometry (DXA) for both 2010 and 2011.

The ACA also dictated new requirements for physicians who refer patients to MRI, CT, and PET facilities in which they have an ownership interest. Now, the physician will have to disclose in writing to patients that they can receive the service elsewhere. Referring physicians will also have to provide a list of five alternatives within 25 miles of the physician's office.

Payment for imaging procedures will also be reduced. Previously, the CMS reimbursed based on the assumption that equipment was used 100% of the time. That assumption has been changed to 75%.

The ACA also reduced incentives for the Physician Quality Reporting System (formerly known as the Physician Quality Reporting Initiative). In 2011, physicians will be eligible for an incentive payment equal to 1% of the total Medicare charges during the reporting period. For 2012 through 2014, the payment drops to 0.5% of charges. After 2014, physicians who do not report data could see a 1.5% cut in Medicare fees; the penalty increases each year.

There is a carrot, though. Physicians who use a Maintenance of Certification program to report PQRS data will get an additional 0.5%.

The incentive payment for e-prescribing in 2011 will be 1% of charges during the calendar year. But in 2012, payments will be reduced if physicians are "not successful e-prescribers," according to the CMS.

The final fee schedule rule will be published Nov. 29 in the Federal Register.

The use of comparative effectiveness research would give Medicare a sophisticated tool for making coverage decisions on the basis of quality, but the federal health program's ability to use such data is hamstrung by political interests and the health reform law, according to two researchers.

“We believe that the time is ripe for Medicare to use comparative effectiveness research to reach a new paradigm of paying equally for services that provide equivalent results,” the authors wrote.

Dr. Steven D. Pearson, president of the Institute for Clinical and Economic Review in Boston, and Dr. Peter B. Bach, an attending physician at Memorial Sloan-Kettering Cancer Center in New York, say that Medicare can take advantage of the burgeoning comparative effectiveness movement to change its ways (Health Affairs 2010;29:1796–804).

The Obama administration is helping create a larger comparative effectiveness enterprise through some $1.1 billion that was set aside as part of the American Recovery and Reinvestment Act of 2009. In March 2009, the Department of Health and Human Services announced that 15 experts would guide investments and coordinate research through the Federal Coordinating Council for Comparative Effectiveness Research.

However, the council's role is limited in that it will not set clinical guidelines, or establish payment rates or tell Medicare what to cover. The Affordable Care Act further spelled out restrictions on how comparative effectiveness findings could be used by the federal government.

Currently, Medicare covers a drug, device, product, or service if evidence supports its effectiveness. No comparisons are made to other products. Payment is set separately, based on arcane formulas that cover cost and maybe a small profit.

Dr. Pearson and Dr. Bach propose that Medicare instead link coverage and payment decisions at the outset. The program could still use the “reasonable and necessary” threshold in deciding when to cover a product or service. But regulators could adopt a three-tiered effectiveness scale that would let them assign differing reimbursement to each level.

For instance, a superior rating would garner the highest payment. Such a product would have the fewest side effects or offer the most effective treatment when compared with similar treatments.

Next down would be the “comparable” product or service. Payment would be slightly less than that for the superior product, as in the difference between what is paid for a brand name and a generic pharmaceutical, for example.

The lowest rating, “insufficient evidence,” would be covered and reimbursed at the conventional cost plus a small profit, but the payment level would be reevaluated every 3 years.

The authors said a 3-year time frame can act as both a carrot and a stick. Having coverage – at current Medicare rates – is better than not having coverage, so innovation will not be stifled. Limiting that rate to only 3 years gives manufacturers and clinicians greater incentives to conduct comparative effectiveness studies.

Dr. Pearson reported no conflicts. He is a member of the National Institutes of Health's Comparative Effectiveness Research Steering Committee and was a previous vice chair of the Medicare Evidence Development and Coverage Advisory Committee. Dr. Bach made no disclosures. He serves on the Committee on Performance Management of the National Committee for Quality Assurance and the Institute of Medicine's National Cancer Policy Forum.

The use of comparative effectiveness research would give Medicare a sophisticated tool for making coverage decisions on the basis of quality, but the federal health program's ability to use such data is hamstrung by political interests and the health reform law, according to two researchers.

“We believe that the time is ripe for Medicare to use comparative effectiveness research to reach a new paradigm of paying equally for services that provide equivalent results,” the authors wrote.

Dr. Steven D. Pearson, president of the Institute for Clinical and Economic Review in Boston, and Dr. Peter B. Bach, an attending physician at Memorial Sloan-Kettering Cancer Center in New York, say that Medicare can take advantage of the burgeoning comparative effectiveness movement to change its ways (Health Affairs 2010;29:1796–804).

The Obama administration is helping create a larger comparative effectiveness enterprise through some $1.1 billion that was set aside as part of the American Recovery and Reinvestment Act of 2009. In March 2009, the Department of Health and Human Services announced that 15 experts would guide investments and coordinate research through the Federal Coordinating Council for Comparative Effectiveness Research.

However, the council's role is limited in that it will not set clinical guidelines, or establish payment rates or tell Medicare what to cover. The Affordable Care Act further spelled out restrictions on how comparative effectiveness findings could be used by the federal government.

Currently, Medicare covers a drug, device, product, or service if evidence supports its effectiveness. No comparisons are made to other products. Payment is set separately, based on arcane formulas that cover cost and maybe a small profit.

Dr. Pearson and Dr. Bach propose that Medicare instead link coverage and payment decisions at the outset. The program could still use the “reasonable and necessary” threshold in deciding when to cover a product or service. But regulators could adopt a three-tiered effectiveness scale that would let them assign differing reimbursement to each level.

For instance, a superior rating would garner the highest payment. Such a product would have the fewest side effects or offer the most effective treatment when compared with similar treatments.

Next down would be the “comparable” product or service. Payment would be slightly less than that for the superior product, as in the difference between what is paid for a brand name and a generic pharmaceutical, for example.

The lowest rating, “insufficient evidence,” would be covered and reimbursed at the conventional cost plus a small profit, but the payment level would be reevaluated every 3 years.

The authors said a 3-year time frame can act as both a carrot and a stick. Having coverage – at current Medicare rates – is better than not having coverage, so innovation will not be stifled. Limiting that rate to only 3 years gives manufacturers and clinicians greater incentives to conduct comparative effectiveness studies.

Dr. Pearson reported no conflicts. He is a member of the National Institutes of Health's Comparative Effectiveness Research Steering Committee and was a previous vice chair of the Medicare Evidence Development and Coverage Advisory Committee. Dr. Bach made no disclosures. He serves on the Committee on Performance Management of the National Committee for Quality Assurance and the Institute of Medicine's National Cancer Policy Forum.

The use of comparative effectiveness research would give Medicare a sophisticated tool for making coverage decisions on the basis of quality, but the federal health program's ability to use such data is hamstrung by political interests and the health reform law, according to two researchers.

“We believe that the time is ripe for Medicare to use comparative effectiveness research to reach a new paradigm of paying equally for services that provide equivalent results,” the authors wrote.

Dr. Steven D. Pearson, president of the Institute for Clinical and Economic Review in Boston, and Dr. Peter B. Bach, an attending physician at Memorial Sloan-Kettering Cancer Center in New York, say that Medicare can take advantage of the burgeoning comparative effectiveness movement to change its ways (Health Affairs 2010;29:1796–804).

The Obama administration is helping create a larger comparative effectiveness enterprise through some $1.1 billion that was set aside as part of the American Recovery and Reinvestment Act of 2009. In March 2009, the Department of Health and Human Services announced that 15 experts would guide investments and coordinate research through the Federal Coordinating Council for Comparative Effectiveness Research.

However, the council's role is limited in that it will not set clinical guidelines, or establish payment rates or tell Medicare what to cover. The Affordable Care Act further spelled out restrictions on how comparative effectiveness findings could be used by the federal government.

Currently, Medicare covers a drug, device, product, or service if evidence supports its effectiveness. No comparisons are made to other products. Payment is set separately, based on arcane formulas that cover cost and maybe a small profit.

Dr. Pearson and Dr. Bach propose that Medicare instead link coverage and payment decisions at the outset. The program could still use the “reasonable and necessary” threshold in deciding when to cover a product or service. But regulators could adopt a three-tiered effectiveness scale that would let them assign differing reimbursement to each level.

For instance, a superior rating would garner the highest payment. Such a product would have the fewest side effects or offer the most effective treatment when compared with similar treatments.

Next down would be the “comparable” product or service. Payment would be slightly less than that for the superior product, as in the difference between what is paid for a brand name and a generic pharmaceutical, for example.

The lowest rating, “insufficient evidence,” would be covered and reimbursed at the conventional cost plus a small profit, but the payment level would be reevaluated every 3 years.

The authors said a 3-year time frame can act as both a carrot and a stick. Having coverage – at current Medicare rates – is better than not having coverage, so innovation will not be stifled. Limiting that rate to only 3 years gives manufacturers and clinicians greater incentives to conduct comparative effectiveness studies.

Dr. Pearson reported no conflicts. He is a member of the National Institutes of Health's Comparative Effectiveness Research Steering Committee and was a previous vice chair of the Medicare Evidence Development and Coverage Advisory Committee. Dr. Bach made no disclosures. He serves on the Committee on Performance Management of the National Committee for Quality Assurance and the Institute of Medicine's National Cancer Policy Forum.

California Limits CT Radiation

California Gov. Arnold Schwarzenegger (R) has signed a bill that limits the radiation dose provided in computed tomography scans. The new law comes in the wake of patients at at least six California hospitals having received up to eight times the normal radiation from their CT scans. Beginning in 2012, technicians must record the radiation dose from every scan, and radiology reports must include that information. Each year, a medical physicist will be required to confirm each CT machine's readings. Beginning in 2013, medical imaging facilities need to report to the state any medical injury from CT radiation and any instance in which certain doses have been exceeded.

Off-Label Promotion Targeted

The Food and Drug Administration is warning that it will pursue disciplinary action against physicians, other practitioners, and manufacturers that promote medical devices for off-label uses, according to the Gray Sheet. The newsletter (published by Elsevier, as is this newspaper) reported that Deborah Wolf, a regulatory counsel in the Center for Devices and Radiological Health's Office of Compliance, said that the agency has been sending warning letters to physicians and others. An FDA staff member gave an example of a violation: a laser that is FDA approved for osteoarthritis treatment being promoted for killing toe fungus. “FDA doesn't regulate the practice of medicine but does in fact regulate promotion,” Ms. Wolf said. She spoke to the industry group called the Food and Drug Law Institute.

Stop-Smoking Coverage Expanded

Physicians will be reimbursed for counseling any Medicare patient about smoking cessation, not just those with tobacco-related illness, under new guidelines approved by the CMS. Previously, a patient needed to at least show signs of illness related to smoking before Medicare would pay. Now, any smoker covered by Medicare can have up to eight smoking cessation sessions per year from a physician or another Medicare-recognized health practitioner, CMS said. American Medical Association President Cecil Wilson applauded the coverage expansion. “More than 400,000 Americans die needlessly every year as a direct result of tobacco use,” Dr. Wilson said in a statement. “This expansion of coverage takes an important step toward helping Medicare patients lead healthier, tobacco-free lives.”

Productivity, Ownership Linked

Billable work per patient appears to be increasing only at physician groups under the “private practice model,” but expenses have also grown, according to a Medical Group Management Association study. Over the past 5 years, relative value units per patient rose by 13% at private medical practices, but declined nearly 18% at practices owned by hospitals or integrated delivery systems, analysts found. Meanwhile, operating costs for private practices increased by nearly 2% last year, in contrast to a slight decline for practices owned by the larger entities. MGMA attributed part of the increase in expenses for private practices to the cost of implementing electronic health record systems. “In the private practice model, EHR incentives have provided a catalyst for practices to purchase systems and deploy electronic health records, therefore increasing the practice's information technology expenditures,” said Kenneth Hertz, a principal with MGMA Health Care Consulting Group, in a statement.

Outcomes Research Funded

HHS will provide grants totaling nearly $17 million for “patient-centered outcomes research” (PCOR), which focuses on treatments and strategies that might improve health outcomes from the patient's point of view. Most of the announced grants will support outcomes research in primary care, HHS said. As part of the grant program, five health organizations will attempt to show that providers and academic institutions can partner on PCOR. Each organization – in California, Illinois, Massachusetts, New York, and Oregon – will receive about $2 million over 3 years to create a national network for evaluating the patient-centered approach in patient populations that are not always adequately represented in other studies, according to HHS. “Patient-centered outcomes research can improve health outcomes by developing and disseminating evidence-based information to patients, providers and decision-makers about the effectiveness of different treatments,” said HHS Secretary Kathleen Sebelius in a statement.

Claims Processors Deemed So-So

About 70% of physicians reported they were satisfied with the contractors who process their Medicare claims, in the annual Centers for Medicare and Medicaid Services survey on contractor performance. Meanwhile, 14% of physicians said they were neither satisfied nor dissatisfied, and more than 15% said they were dissatisfied with contractor performance. Hospitals were slightly happier, with three-quarters saying they were satisfied with contractor performance. Improvements in several areas would increase provider satisfaction, according to the CMS. For example, providers said they don't like having to make multiple inquires of claims processors to resolve problems. They also want better information through an automated telephone system, promptly returned calls, and consistently correct information.

California Limits CT Radiation

California Gov. Arnold Schwarzenegger (R) has signed a bill that limits the radiation dose provided in computed tomography scans. The new law comes in the wake of patients at at least six California hospitals having received up to eight times the normal radiation from their CT scans. Beginning in 2012, technicians must record the radiation dose from every scan, and radiology reports must include that information. Each year, a medical physicist will be required to confirm each CT machine's readings. Beginning in 2013, medical imaging facilities need to report to the state any medical injury from CT radiation and any instance in which certain doses have been exceeded.

Off-Label Promotion Targeted

The Food and Drug Administration is warning that it will pursue disciplinary action against physicians, other practitioners, and manufacturers that promote medical devices for off-label uses, according to the Gray Sheet. The newsletter (published by Elsevier, as is this newspaper) reported that Deborah Wolf, a regulatory counsel in the Center for Devices and Radiological Health's Office of Compliance, said that the agency has been sending warning letters to physicians and others. An FDA staff member gave an example of a violation: a laser that is FDA approved for osteoarthritis treatment being promoted for killing toe fungus. “FDA doesn't regulate the practice of medicine but does in fact regulate promotion,” Ms. Wolf said. She spoke to the industry group called the Food and Drug Law Institute.

Stop-Smoking Coverage Expanded

Physicians will be reimbursed for counseling any Medicare patient about smoking cessation, not just those with tobacco-related illness, under new guidelines approved by the CMS. Previously, a patient needed to at least show signs of illness related to smoking before Medicare would pay. Now, any smoker covered by Medicare can have up to eight smoking cessation sessions per year from a physician or another Medicare-recognized health practitioner, CMS said. American Medical Association President Cecil Wilson applauded the coverage expansion. “More than 400,000 Americans die needlessly every year as a direct result of tobacco use,” Dr. Wilson said in a statement. “This expansion of coverage takes an important step toward helping Medicare patients lead healthier, tobacco-free lives.”

Productivity, Ownership Linked

Billable work per patient appears to be increasing only at physician groups under the “private practice model,” but expenses have also grown, according to a Medical Group Management Association study. Over the past 5 years, relative value units per patient rose by 13% at private medical practices, but declined nearly 18% at practices owned by hospitals or integrated delivery systems, analysts found. Meanwhile, operating costs for private practices increased by nearly 2% last year, in contrast to a slight decline for practices owned by the larger entities. MGMA attributed part of the increase in expenses for private practices to the cost of implementing electronic health record systems. “In the private practice model, EHR incentives have provided a catalyst for practices to purchase systems and deploy electronic health records, therefore increasing the practice's information technology expenditures,” said Kenneth Hertz, a principal with MGMA Health Care Consulting Group, in a statement.

Outcomes Research Funded

HHS will provide grants totaling nearly $17 million for “patient-centered outcomes research” (PCOR), which focuses on treatments and strategies that might improve health outcomes from the patient's point of view. Most of the announced grants will support outcomes research in primary care, HHS said. As part of the grant program, five health organizations will attempt to show that providers and academic institutions can partner on PCOR. Each organization – in California, Illinois, Massachusetts, New York, and Oregon – will receive about $2 million over 3 years to create a national network for evaluating the patient-centered approach in patient populations that are not always adequately represented in other studies, according to HHS. “Patient-centered outcomes research can improve health outcomes by developing and disseminating evidence-based information to patients, providers and decision-makers about the effectiveness of different treatments,” said HHS Secretary Kathleen Sebelius in a statement.

Claims Processors Deemed So-So

About 70% of physicians reported they were satisfied with the contractors who process their Medicare claims, in the annual Centers for Medicare and Medicaid Services survey on contractor performance. Meanwhile, 14% of physicians said they were neither satisfied nor dissatisfied, and more than 15% said they were dissatisfied with contractor performance. Hospitals were slightly happier, with three-quarters saying they were satisfied with contractor performance. Improvements in several areas would increase provider satisfaction, according to the CMS. For example, providers said they don't like having to make multiple inquires of claims processors to resolve problems. They also want better information through an automated telephone system, promptly returned calls, and consistently correct information.

California Limits CT Radiation

California Gov. Arnold Schwarzenegger (R) has signed a bill that limits the radiation dose provided in computed tomography scans. The new law comes in the wake of patients at at least six California hospitals having received up to eight times the normal radiation from their CT scans. Beginning in 2012, technicians must record the radiation dose from every scan, and radiology reports must include that information. Each year, a medical physicist will be required to confirm each CT machine's readings. Beginning in 2013, medical imaging facilities need to report to the state any medical injury from CT radiation and any instance in which certain doses have been exceeded.

Off-Label Promotion Targeted

The Food and Drug Administration is warning that it will pursue disciplinary action against physicians, other practitioners, and manufacturers that promote medical devices for off-label uses, according to the Gray Sheet. The newsletter (published by Elsevier, as is this newspaper) reported that Deborah Wolf, a regulatory counsel in the Center for Devices and Radiological Health's Office of Compliance, said that the agency has been sending warning letters to physicians and others. An FDA staff member gave an example of a violation: a laser that is FDA approved for osteoarthritis treatment being promoted for killing toe fungus. “FDA doesn't regulate the practice of medicine but does in fact regulate promotion,” Ms. Wolf said. She spoke to the industry group called the Food and Drug Law Institute.

Stop-Smoking Coverage Expanded

Physicians will be reimbursed for counseling any Medicare patient about smoking cessation, not just those with tobacco-related illness, under new guidelines approved by the CMS. Previously, a patient needed to at least show signs of illness related to smoking before Medicare would pay. Now, any smoker covered by Medicare can have up to eight smoking cessation sessions per year from a physician or another Medicare-recognized health practitioner, CMS said. American Medical Association President Cecil Wilson applauded the coverage expansion. “More than 400,000 Americans die needlessly every year as a direct result of tobacco use,” Dr. Wilson said in a statement. “This expansion of coverage takes an important step toward helping Medicare patients lead healthier, tobacco-free lives.”

Productivity, Ownership Linked

Billable work per patient appears to be increasing only at physician groups under the “private practice model,” but expenses have also grown, according to a Medical Group Management Association study. Over the past 5 years, relative value units per patient rose by 13% at private medical practices, but declined nearly 18% at practices owned by hospitals or integrated delivery systems, analysts found. Meanwhile, operating costs for private practices increased by nearly 2% last year, in contrast to a slight decline for practices owned by the larger entities. MGMA attributed part of the increase in expenses for private practices to the cost of implementing electronic health record systems. “In the private practice model, EHR incentives have provided a catalyst for practices to purchase systems and deploy electronic health records, therefore increasing the practice's information technology expenditures,” said Kenneth Hertz, a principal with MGMA Health Care Consulting Group, in a statement.

Outcomes Research Funded

HHS will provide grants totaling nearly $17 million for “patient-centered outcomes research” (PCOR), which focuses on treatments and strategies that might improve health outcomes from the patient's point of view. Most of the announced grants will support outcomes research in primary care, HHS said. As part of the grant program, five health organizations will attempt to show that providers and academic institutions can partner on PCOR. Each organization – in California, Illinois, Massachusetts, New York, and Oregon – will receive about $2 million over 3 years to create a national network for evaluating the patient-centered approach in patient populations that are not always adequately represented in other studies, according to HHS. “Patient-centered outcomes research can improve health outcomes by developing and disseminating evidence-based information to patients, providers and decision-makers about the effectiveness of different treatments,” said HHS Secretary Kathleen Sebelius in a statement.

Claims Processors Deemed So-So

About 70% of physicians reported they were satisfied with the contractors who process their Medicare claims, in the annual Centers for Medicare and Medicaid Services survey on contractor performance. Meanwhile, 14% of physicians said they were neither satisfied nor dissatisfied, and more than 15% said they were dissatisfied with contractor performance. Hospitals were slightly happier, with three-quarters saying they were satisfied with contractor performance. Improvements in several areas would increase provider satisfaction, according to the CMS. For example, providers said they don't like having to make multiple inquires of claims processors to resolve problems. They also want better information through an automated telephone system, promptly returned calls, and consistently correct information.

Some physicians looking for the steady income and slower pace of concierge medicine who have not wanted to give up their traditional practice have found a new solution: a hybrid practice that lets them devote a small percentage to the retainer side while keeping their roster of traditional patients.

So far, the full concierge model has not proven to be very popular. Only a tiny fraction of the nation's almost 1 million physicians have chosen the concierge route, according to a recent study for the Medicare Payment Advisory Commission (MedPAC).

Researchers at the University of Chicago's National Opinion Research Center and Georgetown University determined that about 750 physicians have gone to such retainer-only practices in which patients pay a monthly fee in exchange for longer appointments, same-day appointments, annual physicals, and the ability to reach the physician directly by e-mail or cell phone.

The hybrid model is being promoted as an alternative by Concierge Choice Physicians, a Rockville Centre, N.Y.–based private company. CCP says more than 300,000 traditional and concierge patients are being managed by physicians who have contracts with the company.

Dr. Gary Levinson, an internist in private practice in San Diego, is one of the physicians who has chosen to try a hybrid approach with CCP. Dr. Levinson said that he was looking for a way to spend more time with patients; besides a busy office practice, he is also on call.

After hearing CCP's pitch, Dr. Levinson says he was sold, largely because the company's model would give him an opportunity to keep his existing patients. He and his partner have 3,500-4,000 patients. Of those, less than 100 are in the concierge practice. These patients pay $1,800 a year for an annual physical (the practice bears the costs of all diagnostics), faster and longer appointments, and direct access to the physicians.

Initially, CCP mailed letters to the practice's patients to let them know there was a new concierge option and invited them to meet with Dr. Levinson and his partner over two evening sessions. At those sessions, the physicians described why they went into medicine, and what they saw as the merits of the concierge practice, Dr. Levinson said. Some patients signed up on the spot, while others joined later.

So what kinds of patients signed up? Some have serious chronic illnesses, but others are just more proactive about their health, he said.

Dr. Levinson said that his office has a separate staff member who's devoted to concierge patients. An hour each morning is blocked for the concierge patients; if the slot is unused, Dr. Levinson takes advantage of the time to catch up on paperwork or uses it to accommodate a non–concierge patient.

He's also found that the concierge patients do not abuse the 24/7 personal access. So, while it could be a burden, it has ended up being completely manageable, he said.

Even so, to keep an appropriate balance between the concierge side and traditional practice, he's capping the number of patients he'll enroll at 150.

Aside from the revenue boost that's come with the hybrid model, everyone – from his staff, to his patients, to himself – is happier, Dr. Levinson noted. He gets to know the concierge patients better, which makes him a sharper practitioner. The traditional practice patients reap the benefits of his lowered stress levels. “Overall, I'm happier. I enjoy my job more because I'm not beating myself up to make a living,” he said.

Dr. Robert Altbaum, an internist in Westport, Conn., said that he's also been a lot happier since adopting the CCP hybrid approach. He first began looking at a concierge model about 8 years ago when Medicare physician fee cuts appeared to be something that could happen.

But he and his six partners decided to table the idea because they worried that they would lose too many patients. Ironically, a few years later, some of the practice's patients started migrating to a concierge model.

The partners started searching again for a way to fend off Medicare cuts and better serve patients. After reading about the hybrid approach, four of the seven partners decided to give it a try a year ago.

Dr. Altbaum said he's limited his concierge patients to 5% of his practice, or 100 patients. He comes in a half hour earlier and leaves a half hour later – concierge patients get the first and last slots of the day – which has added 5 hours to his week.

He has given up what used to be a day off, but, it has added 20% to his bottom line for about 10% of his time. And, he said it's made him more available to his other patients because, in a sense, he's now seeing 100 fewer patients.

All his patients are “uniformly happy,” he said, adding that he's more relaxed.

Dr. Altbaum and Dr. Levinson both reported no conflicts of interest.

Dr. Gary Levinson has less than 100 concierge patients out of 3,500-4,000 in the practice.

Source Courtesy Dr. Ari Laliotis

Some physicians looking for the steady income and slower pace of concierge medicine who have not wanted to give up their traditional practice have found a new solution: a hybrid practice that lets them devote a small percentage to the retainer side while keeping their roster of traditional patients.

So far, the full concierge model has not proven to be very popular. Only a tiny fraction of the nation's almost 1 million physicians have chosen the concierge route, according to a recent study for the Medicare Payment Advisory Commission (MedPAC).

Researchers at the University of Chicago's National Opinion Research Center and Georgetown University determined that about 750 physicians have gone to such retainer-only practices in which patients pay a monthly fee in exchange for longer appointments, same-day appointments, annual physicals, and the ability to reach the physician directly by e-mail or cell phone.

The hybrid model is being promoted as an alternative by Concierge Choice Physicians, a Rockville Centre, N.Y.–based private company. CCP says more than 300,000 traditional and concierge patients are being managed by physicians who have contracts with the company.

Dr. Gary Levinson, an internist in private practice in San Diego, is one of the physicians who has chosen to try a hybrid approach with CCP. Dr. Levinson said that he was looking for a way to spend more time with patients; besides a busy office practice, he is also on call.

After hearing CCP's pitch, Dr. Levinson says he was sold, largely because the company's model would give him an opportunity to keep his existing patients. He and his partner have 3,500-4,000 patients. Of those, less than 100 are in the concierge practice. These patients pay $1,800 a year for an annual physical (the practice bears the costs of all diagnostics), faster and longer appointments, and direct access to the physicians.

Initially, CCP mailed letters to the practice's patients to let them know there was a new concierge option and invited them to meet with Dr. Levinson and his partner over two evening sessions. At those sessions, the physicians described why they went into medicine, and what they saw as the merits of the concierge practice, Dr. Levinson said. Some patients signed up on the spot, while others joined later.

So what kinds of patients signed up? Some have serious chronic illnesses, but others are just more proactive about their health, he said.

Dr. Levinson said that his office has a separate staff member who's devoted to concierge patients. An hour each morning is blocked for the concierge patients; if the slot is unused, Dr. Levinson takes advantage of the time to catch up on paperwork or uses it to accommodate a non–concierge patient.

He's also found that the concierge patients do not abuse the 24/7 personal access. So, while it could be a burden, it has ended up being completely manageable, he said.

Even so, to keep an appropriate balance between the concierge side and traditional practice, he's capping the number of patients he'll enroll at 150.

Aside from the revenue boost that's come with the hybrid model, everyone – from his staff, to his patients, to himself – is happier, Dr. Levinson noted. He gets to know the concierge patients better, which makes him a sharper practitioner. The traditional practice patients reap the benefits of his lowered stress levels. “Overall, I'm happier. I enjoy my job more because I'm not beating myself up to make a living,” he said.

Dr. Robert Altbaum, an internist in Westport, Conn., said that he's also been a lot happier since adopting the CCP hybrid approach. He first began looking at a concierge model about 8 years ago when Medicare physician fee cuts appeared to be something that could happen.

But he and his six partners decided to table the idea because they worried that they would lose too many patients. Ironically, a few years later, some of the practice's patients started migrating to a concierge model.

The partners started searching again for a way to fend off Medicare cuts and better serve patients. After reading about the hybrid approach, four of the seven partners decided to give it a try a year ago.

Dr. Altbaum said he's limited his concierge patients to 5% of his practice, or 100 patients. He comes in a half hour earlier and leaves a half hour later – concierge patients get the first and last slots of the day – which has added 5 hours to his week.

He has given up what used to be a day off, but, it has added 20% to his bottom line for about 10% of his time. And, he said it's made him more available to his other patients because, in a sense, he's now seeing 100 fewer patients.

All his patients are “uniformly happy,” he said, adding that he's more relaxed.

Dr. Altbaum and Dr. Levinson both reported no conflicts of interest.

Dr. Gary Levinson has less than 100 concierge patients out of 3,500-4,000 in the practice.

Source Courtesy Dr. Ari Laliotis

Some physicians looking for the steady income and slower pace of concierge medicine who have not wanted to give up their traditional practice have found a new solution: a hybrid practice that lets them devote a small percentage to the retainer side while keeping their roster of traditional patients.

So far, the full concierge model has not proven to be very popular. Only a tiny fraction of the nation's almost 1 million physicians have chosen the concierge route, according to a recent study for the Medicare Payment Advisory Commission (MedPAC).

Researchers at the University of Chicago's National Opinion Research Center and Georgetown University determined that about 750 physicians have gone to such retainer-only practices in which patients pay a monthly fee in exchange for longer appointments, same-day appointments, annual physicals, and the ability to reach the physician directly by e-mail or cell phone.

The hybrid model is being promoted as an alternative by Concierge Choice Physicians, a Rockville Centre, N.Y.–based private company. CCP says more than 300,000 traditional and concierge patients are being managed by physicians who have contracts with the company.

Dr. Gary Levinson, an internist in private practice in San Diego, is one of the physicians who has chosen to try a hybrid approach with CCP. Dr. Levinson said that he was looking for a way to spend more time with patients; besides a busy office practice, he is also on call.

After hearing CCP's pitch, Dr. Levinson says he was sold, largely because the company's model would give him an opportunity to keep his existing patients. He and his partner have 3,500-4,000 patients. Of those, less than 100 are in the concierge practice. These patients pay $1,800 a year for an annual physical (the practice bears the costs of all diagnostics), faster and longer appointments, and direct access to the physicians.

Initially, CCP mailed letters to the practice's patients to let them know there was a new concierge option and invited them to meet with Dr. Levinson and his partner over two evening sessions. At those sessions, the physicians described why they went into medicine, and what they saw as the merits of the concierge practice, Dr. Levinson said. Some patients signed up on the spot, while others joined later.

So what kinds of patients signed up? Some have serious chronic illnesses, but others are just more proactive about their health, he said.

Dr. Levinson said that his office has a separate staff member who's devoted to concierge patients. An hour each morning is blocked for the concierge patients; if the slot is unused, Dr. Levinson takes advantage of the time to catch up on paperwork or uses it to accommodate a non–concierge patient.

He's also found that the concierge patients do not abuse the 24/7 personal access. So, while it could be a burden, it has ended up being completely manageable, he said.

Even so, to keep an appropriate balance between the concierge side and traditional practice, he's capping the number of patients he'll enroll at 150.

Aside from the revenue boost that's come with the hybrid model, everyone – from his staff, to his patients, to himself – is happier, Dr. Levinson noted. He gets to know the concierge patients better, which makes him a sharper practitioner. The traditional practice patients reap the benefits of his lowered stress levels. “Overall, I'm happier. I enjoy my job more because I'm not beating myself up to make a living,” he said.

Dr. Robert Altbaum, an internist in Westport, Conn., said that he's also been a lot happier since adopting the CCP hybrid approach. He first began looking at a concierge model about 8 years ago when Medicare physician fee cuts appeared to be something that could happen.

But he and his six partners decided to table the idea because they worried that they would lose too many patients. Ironically, a few years later, some of the practice's patients started migrating to a concierge model.

The partners started searching again for a way to fend off Medicare cuts and better serve patients. After reading about the hybrid approach, four of the seven partners decided to give it a try a year ago.

Dr. Altbaum said he's limited his concierge patients to 5% of his practice, or 100 patients. He comes in a half hour earlier and leaves a half hour later – concierge patients get the first and last slots of the day – which has added 5 hours to his week.

He has given up what used to be a day off, but, it has added 20% to his bottom line for about 10% of his time. And, he said it's made him more available to his other patients because, in a sense, he's now seeing 100 fewer patients.

All his patients are “uniformly happy,” he said, adding that he's more relaxed.

Dr. Altbaum and Dr. Levinson both reported no conflicts of interest.

Dr. Gary Levinson has less than 100 concierge patients out of 3,500-4,000 in the practice.

Source Courtesy Dr. Ari Laliotis