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|June 17, 2011|
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June 30th eRx Participation Deadline Looming
Medicare providers have until June 30, 2011 to meet the eRx participation deadline. To avoid a 1 percent reduction in total Medicare reimbursement, providers must complete 10 separate eRx transactions for Medicare fee for service beneficiaries with a qualified eRx provider.
The Electronic Prescribing Incentive Program (eRx) is an incentive program for eligible professionals (EPs) who are successful electronic prescribers as defined by the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA). The eRx incentive payment for both 2011 and 2012 is 1.0 percent of total estimated allowed charges. For 2013, the incentive payment will be reduced to 0.5 percent. Beginning in 2012, there will be a penalty for not participating in eRx. The penalty will be a reduction in Physician Fee Schedule payments by 1.0 percent in 2012, 1.5 percent in 2013 and 2.0 percent in 2014.
In order to avoid a penalty in 2012, an eligible professional or group practice must have 10 unique eRx events between January 1 and June 30, 2011. To avoid a penalty in 2013, an eligible physician must have 25 unique eRx events in calendar year 2011. The CMS has not yet announced whether or not eRx filings in 2012 will count toward avoiding penalties in 2013. Due to this ambiguity, we strongly recommend not
waiting until 2012 to start filing.
EPs do not need to participate in PQRS to participate in the eRx program or even sign up to participate. In order to qualify, EPs must have and use a qualified eRx system and report on his or her adoption and use of the eRx system. The EP must also meet the criteria for successful electronic prescriber specified by the CMS for a particular reporting period. Finally, at least 10 percent of a successful electronic prescriber’s Medicare Part B covered services must be made up of codes that appear in the denominator of the eRx measure.
Reporting eRx participation only involves a single quality data code:
G8553: At least one prescription created during the encounter was generated and transmitted electronically using a qualified eRx system. (G codes were different for 2010)
eRx Exemption Codes
There is possibility for hardship exemptions from the eRx penalty, provided that the physician falls under one of the following G codes:
G8642: The eligible professional practices in a rural area without sufficient high-speed Internet access and requests a hardship exemption from the application of the payment adjustment under section 1848(a)(5)(A) of the Social Security Act.
G8643: The eligible professional practices in an area without sufficient available pharmacies for electronic prescribing and requests a hardship exemption from the application of the payment adjustment under section 1848(a)(5)(A) of the Social Security Act.
G8644: The eligible professional does not have prescribing privileges.
House Strips Amendment to Limit FDA Tobacco Authority
This week, the House of Representatives voted to strike language from the fiscal year 2012 Agriculture appropriations bill that would have limited the Food and Drug Administration’s (FDA) authority to regulate tobacco products.
The amendment sponsored, Rep. Rehberg (R-MT), intended the amendment to address FDA actions on veterinary products. However, sweeping language had broader implications. The amendment would have clearly prevented the FDA from moving forward with any rule that removes flavorings from tobacco products.
The American Thoracic Society and its partners in the medical and tobacco control communities will continue to oppose any legislation that would weaken or delay the FDA’s authority to regulate tobacco products.
House Defeats Amendment to Cut Tobacco User Fees
In related action, the House voted down an amendment offered Rep. Stearns (R-FL) to provider a tax cut to tobacco companies.
The same law that gave the FDA authority to regulate tobacco products also created a set of user fees to be charged to tobacco companies that will fund the FDA’s tobacco program. The law gradually phased these user fees in over time.
The amendment offered by Rep. Stearns would have frozen the tobacco user fees – effectively saving tobacco companies $395 million in user fees and defunding the FDA tobacco control program. Rep. Stearns suggested his amendment would reduce the deficit, but in fact, it would not have done so. The tobacco user fees are not part of general federal revenue and can only be used to regulate tobacco products.
ATS Testifies at Clean Air Hearing
This week, ATS member Alfred Munzer, MD, testified before the Senate Environment and Public Works Committee about the value of the Clean Air Act. In his comments, Dr. Munzer noted that the act has made great strides in improving America’s health and protecting vulnerable population–like patients with respiratory diseases–from the adverse health effects of air pollution.
Dr. Munzer also noted that the science that underpins the health-base standards issued by the EPA is under attack. “The science documenting the adverse health effects air pollution has on human health is comprehensive, consistent and compelling. Unfortunately, that science is also under attack. Industry regulated by the EPA has started a campaign to discredit the research that is used to support the EPA’s regulations under the Clean Air Act. Some members of Congress appear to be taking up the mantra of discrediting or openly discounting the validity of EPA-sponsored research. This is a mistake and is a distraction from what we all should be focusing on: reducing air pollution to improve everyone’s health.”
Dr. Munzer went on to describe key U.S. and international studies that document the serious adverse health effects air pollution has on humans and urge the EPA to continue its efforts to issue strong health-based regulations to protect Americans from air pollution.
House Appropriations Committee Begins Consideration of FY2012 Spending Bills
The House Appropriations Committee, chaired by Rep. Hal Rogers (R-KY), has begun consideration of FY2012 spending bills through its relevant subcommittees. Several bills have already been passed through full committee, including the Agriculture, Energy and Water, and Military Construction and Veterans Affairs Appropriations bills.
Under the VA FY2012 bill, the ATS is very concerned about a 12-percent funding cut outlined for the Dept. of Veteran’s Affairs Research program. The bill adopted the President’s proposed $72 million cut, which would reduce funding for the program from $580 million to $508 million. The ATS will be working through its VA subcommittee, chaired by James Brown, MD, and Linda Nici, MD, to prevent this cut from being passed into final FY2012 appropriations legislation.
The Labor-Health and Human Services and Education subcommittee, chaired by Rep. Rehberg (R-MT), has scheduled a vote on the FY2012 health spending bill, which includes funding for the National Institute of Health (NIH) and Centers for Disease Control and Prevention (CDC), for July 26. According to the allocation it received from the full committee, the subcommittee will be tasked with attempting to cut $18 billion in funding from labor, health, human services and education programs. The ATS will be working to prevent funding cuts to the NIH and CDC programs, such as those focused on tuberculosis and asthma. The State Department and Foreign Operation Subcommittee, chaired by Rep. Granger (R-TX), which allocates funding for global health programs like USAID’s tuberculosis program, will consider its spending bill on July 27.
ATS Submits Comments on Accountable Care Organizations
This week, the ATS submitted comments on the Centers for Medicare and Medicaid Services’ (CMS) proposed rule on the creation of accountable care organizations (or ACOs, which are authorized under the Affordable Care Act). The goal of ACOs is to provide coordinated quality care to patients while reducing system costs and allowing providers to share the savings generated. Under the current proposal, networks of physicians, hospitals and other healthcare providers that serve at least 5,000 patients for at least a three-year term and adhere to certain quality standards can set up ACOs in January 2012.
In its letter, the ATS explained that ACOs could potentially deliver quality, coordinated care, which would allow for better management of chronic diseases such as COPD. That said, the Society has concerns about the proposed risk structure and lack of payment flexibility.
The CMS has proposed that ACOs choose from two risk models. In the one-sided risk model, ACOs share savings only for the first two years. In the third year, they share savings and losses. The two-sided risk model allows shared savings and losses during all three years. The ATS noted that the shared savings approach will make it difficult for ACOs to recoup the substantial up-front investments that physician practice must make in information systems and other infrastructure costs. The ATS "urge[ed] CMS to work with physician organizations to minimize the down-side risk of ACOs. The ATS recommends that thr CMS consider including a payment option that includes shared savings only (“one-sided risk”) without the mandatory shared loss provision." The Society also expressed its belief that allowing ACOs to receive shared savings, without the down-side risk, will encourage wider participation by physician practices."The ATS also recommended that the final rule include some flexibility in quality benchmarks to account for high-cost patients. The CMS has proposed utilizing AHRQ Quality Indicator on screening and early detection of COPD. In its comments, the ATS noted that" implementation of this measure will ensure early identification of COPD that will reduce costs enable appropriate care coordination and ultimately improve outcomes for patients with COPD.”
The Washington Letter is written by the American Thoracic Society government relations office and emailed to all ATS members living in the United States. The letter keeps clinicians, scientists, and patients abreast of legislative, judicial, and regulatory issues in pulmonary, critical care, and sleep medicine. Each week's edition is archived on the ATS Web site, www.thoracic.org. If you have any questions or one more information about becoming involved in advocacy, please contact the ATS Washington office at 202-296-9770.