Hunt Batjer, MD, makes a connection
for the Northwestern team at the 5th Annual Neurosurgery Charity Softball Tournament, www.columbiakidsneuro.org/cst/index.html. The June 7 event, hosted by Columbia University, was held in New York’s Central Park. Harvard defeated Emory 4-2 to claim the championship and the J. Lawrence Pool Memorial Trophy. Since its inception the event has raised $150,000 for pediatric brain tumor research. (Contributed by Ricardo J. Komotar, MD, New York, N.Y. Disclosure: Dr. Komotar, a resident at Columbia University, is founder of the Columbia University Pediatric Brain Tumor Research Fund.)
Legislation to Halt Medicare Physician Payment Cut Fails Before July 1 Deadline: AANS and CNS Did Not Support Legislation Proposed in June
At press time, members of Congress were unable to reach a compromise and pass a bill that would halt the 10.6 percent cut in Medicare physician reimbursement scheduled to take effect July 1. Congress was expected to reconvene on July 7 and pass legislation to address the payment cut retroactively. In the meantime, Medicare was to hold new claims for 10 days; Health and Human Services Secretary Michael O. Leavitt said in the New York Times that the freeze was intended to “minimize the impact” of the fee reduction.
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While the AANS and CNS found that the legislation had several positive aspects—it would have: extended the current 0.5 percent update through the end of 2008; given physicians a 1.1 percent payment increase in 2009; extended the Medicare Physician Quality Reporting Initiative program through 2010, allowing physicians who qualify to earn 2 percent bonus payments on all Medicare-allowed charges; and extended rural physician payment increases through Dec. 31—the AANS and CNS did not support the legislation because the bills contained a number of provisions deemed potentially detrimental to neurosurgeons, among them:
- The payment cut for 2010 would have been 21 percent rather than 5 percent
because of the way in which the temporary fee increase is financed.
- Medicare would have been required to publicly report the names of physicians
who satisfactorily submit data on quality measures on the CMS Web site; to
establish the “Physician Feedback Program” to improve efficiency and control
costs; to develop a plan for transitioning to a value-based purchasing program
for physicians; and to create a demonstration project on diagnostic imaging
appropriateness criteria.
- Mandatory e-prescribing would have started in 2012, and physicians not e-prescribing would have had their payments cut by 1 percent in 2012, by 1.5 percent in 2013, and by 2 percent in 2014 and in each subsequent year.
The 2008 AANS/CNS legislative agenda is summarized in Washington Watch. Additional information on legislative matters is available from the AANS/CNS Washington office.
Report Calls for Drastic Change in CE Delivery
A new monograph on the November 2007 Continuing Education in the Health Professions
conference details recommendations for change in the way continuing education,
CE, is financed and delivered. The committee, led by Suzanne W. Fletcher,
MD, of Harvard Medical School, found that “traditional lecture-based CE has
proven to be largely ineffective in changing health professional performance
and in improving patient care,- and the report recommends moving toward practice-based
learning, interactive scenarios and simulations, among other things. The
committee also found the conflicts of interest between healthcare professionals
and industry to be irreconcilable: “No amount of strengthening the ‘firewall’
between commercial entities and processes of CE can eliminate the potential
for bias,” the report states. The committee proceeds to call for organizations
that provide CE to decline “any commercial support from pharmaceutical or
medical device companies” whether such support is direct or indirect.
www.josiahmacyfoundation.org
Medicare No-Pay List: Final Rule Expected by Aug. 1
By Aug. 1 the Centers for Medicare and Medicaid Services is expected to release
the final rule on the expanded list of conditions that the CMS says are “reasonably
preventable through proper care and for which Medicare will no longer pay
at a higher rate if the patient acquires them during a hospital stay.” The
rule would apply to patients discharged from the hospital in fiscal 2009,
which begins Oct. 1. The expanded list includes clostridium difficile-associated
disease, diabetic ketoacidosis, some types of coma, delirium, legionnaires’
disease, deep vein thrombosis or pulmonary embolism, iatrogenic pneumothorax,
surgical site infections after specific procedures, staphylococcus aureus
septicemia, and ventilator-associated pneumonia. As of Oct. 1, Medicare will
not reimburse for the eight conditions on the original “no-pay” list: air
embolism, blood incompatibility, catheter-associated urinary tract infections,
mediastinitis after coronary artery bypass surgery, object left behind in
a surgical patient, pressure ulcers, some types of falls and trauma, and
vascular catheter-associated infection.
https://www.cms.gov ; www.ama-assn.org/amednews/ 2008/07/14/prsa0714.htm
Expanded Low Back Pain Guideline Announced
The American Pain Society announced in May an expanded evidence-based, clinical
practice guideline on diagnosis and treatment of chronic low back pain that
includes recommendations on surgery and other interventional treatments.
“In general, noninvasive therapies supported by evidence showing benefits
should be tried before considering interventional therapies or surgery,”
stated Roger Chou, MD, director of the American Pain Society’s Clinical Practice
Guideline Program. The expanded guideline will address the unproven status
of invasive diagnostics for diagnosing various spinal conditions, epiduralstenosis injections as an option for short-term pain relieffor persistent
radiculopathy, other interventional therapies that are not supported by convincing
and consistent evidence of benefits from randomized trials, the effectiveness
of surgery to treat radiculopathy and spinal stenosis, and the uncertain
effectiveness of surgery for nonradicular low back pain. The guideline builds
on the first APS Clinical Practice Guideline on Low Back Pain, intended for
primary care physicians, which was published in the Annals of Internal Medicine
in 2007.
www.ampainsoc.org/press/2008/downloads/LBP_Guidelines_2008.pdf