Surgery News - February 2009 - (Page 4) THE FEBRUARY 2009 • SURGERY NEWS 20/20 Else vier Global Medical Ne ws Relicensing Proposal on the Table State Medical Boards (FSMB) has been considering how state medical boards could change these policies to ensure that licensees are competent. In 2008, the organization’s House of Delegates approved guiding principles for developing maintenance of licensure and called for additional research on the impact that the new requirements would have on state medical boards and licensed physicians. Once that research is complete, the draft policy would likely be considered by the FSMB House of Delegates at their meeting in May, said Carol Clothier, vice president of strategic planning and physician competency initiatives for the FSMB. “Nobody wants to create more work for physicians,” she said. The idea is to try to take advantage of what physicians already are doing to demonstrate competence and use those activities to satisfy state licensure requirements. State medical boards are feeling pressure from the public to ensure physician competency in light of rapidly changing science and technology. Current requirements generally include some continuing medical education, but don’t meet the public’s expectations of oversight of physicians, she said. If the maintenance of licensure policy is accepted by the FSMB House of Delegates, it still would be a model policy only, Ms. Clothier said. Individual states and territories would decide whether to adopt, revise, or ignore the model policy on the basis of their politics, she said. “I think it makes good sense,” said Dr. Frank R. Lewis Jr., an ACS Fellow and executive director of the American Board of Surgery. By allowing the elements of the maintenance of certification process to satisfy the relicensure requirements, it ensures that physicians don’t have to fulfill requirements in two parallel processes, he said. And those already engaged in maintenance of certification can clear any new licensing hurdles fairly easily. Surgeons are just getting started with the maintenance of certification process, Dr. Lewis said. As time goes on, all surgeons will have to engage in maintenance of certification at the time of recertification. There are still a small number of general surgeons with lifetime certification through the board, he said, but they account for only about 3% of diplomates and all are nearing retirement age. Defining a pathway for those surgeons who are licensed but not board certified (estimated to be from 10% to 15%) will be a more difficult task, Dr. Lewis said. In addition to state medical boards, other entities also are looking to use maintenance of certification as a marker for physician competence, Dr. Lewis said. But he cautioned hospitals and payers to move slowly because inclusion of comprehensive outcomes data is still lacking in the maintenance of certification program. VISION B Y M A RY E L L E N S C H N E I D E R hysicians could face increased requirements when renewing their state medical licenses under a draft model policy currently being evaluated by the Federation of State Medical Boards. Under the draft policy, relicensure would become more comprehensive and require physicians to demonstrate continuing skills and knowledge in their area of practice. As proposed, the maintenance of licensure process would closely mirror the American Board of Medical Specialties’ requirements for maintenance of certification. The draft policy is a model that state medical boards could use, but actual implementation would be determined state by state. Over the last 5 years, the Federation of P Hospitals Slowly Bestow EMR Aid to Physicians B Y M A RY E L L E N S C H N E I D E R COMMENTARY Value-Based Health Care its annual income from Medicare payroll taxes. Beneficiary Part B premiums fimagine that you are a 66-year-old pa- nance only 25% of Part B program tient with intermittent claudication. spending. The rest comes from TreaYou have Medicare Part A and Part B sury general revenues (personal and corcoverage, and a Medigap policy that cov- porate taxes), which also fund 77% of ers your deductible and coinsurance. Part D costs. Medicare faces some tough choices if Which treatment would you choose? A) Medical management (smoking ces- it is to remain sustainable for even the short-term future. What sation, exercise, and medicaabout increasing Part A intions) and a less-than-5% risk come from payroll taxes? To of major amputation over 10 finance Part A through 2080, years. the Medicare payroll tax have B) A single major open revasto increase from 2.9% to cularization procedure with a 6.44% of earned income. 95% chance of symptom resWhat about increasing perolution, a 5% chance of needsonal and corporate income ing a second procedure withtaxes? This solution will likein 10 years, and an all-cause ly be necessary given our ecoperiprocedural mortality risk DR. BORMAN nomic troubles, but fixing of 5%. C) An endovascular intervention with an Medicare would substantially drive up 85% chance of symptom resolution, a the increases needed. How about shifting 10% chance of needing a second proce- more costs to beneficiaries? From 2004 to dure within 3 years, and an all-cause 2008, the Part A deductible was raised by 17%, and the Part B deductible by 35%. periprocedural mortality risk of 0.5%. Imagine that the mean 10-year total For 60% of the elderly, Social Security cost of treatment (all interventions and comprises 75% of their income, and their aftercare, including long-term sur- more than 25% of their Social Security veillance) has been determined to be income is paid back into Part B plus Part $3,000 for Option A, $15,000 for B, and D premiums. Medicare must cut expenses, and since $20,000 for C. Which would you choose? Imagine that your 10-year allowance its administrative costs are among the to treat claudication from Medicare + lowest in the health care industry, savings Medigap combined is $17,000. Which must come from payments to facilities and providers. Value-based care is the option would you choose? If you were the surgeon caring for this pa- leading viable alternative to wholesale tient, which option would you recommend? Medicare payment cuts, and Congress Far-fetched? Not at all. Welcome to has told Medicare to become a “valuevalue-based health care delivery! Could based purchaser.” Will you be ready? this happen? Yes. Why? Read on. Medicare is going bankrupt. In 2008, DR. BORMAN is professor of surgery at the expenditures for the Hospital Insurance University of Central Florida in Orlando (HI) trust fund, which funds inpatient and serves on the Medicare Payment stays and other postacute care, exceeded Advisory Commission. B Y K A R E N R . B O R M A N, M . D. , FA C S Else vier Global Medical Ne ws S ome hospitals are slowly offering subsidies on electronic medical record software to small groups of closely affiliated physicians, while others are offering only IT support services or extending their vendor discounts, according to an analysis of 24 hospitals by the Center for Studying Health System Change. In 2006, the Health and Human Services Department announced that it had created two safe harbors that would allow hospitals to subsidize up to 85% of the cost of electronic medical record (EMR) software and IT support services for physicians. For their part, physicians would be responsible for the full cost of the required hardware. The regulations are scheduled to sunset at the end of 2013. Funded by the Robert Wood Johnson Foundation, the analysis is based on indepth interviews with hospital executives. According to the analysis, 11 of the 24 hospitals were considering offering some type of subsidy to physicians to help cover their EMR costs. The remaining 13 hospitals were not planning to provide direct subsidies to physicians, but some were considering extending their EMR vendor discounts or offering IT support services. Some hospitals chose not to offer direct financial support to physicians because they opposed the idea of offering EMR subsidies to physicians. Others said that granting access to vendor discounts was a sufficient incentive for physicians preparing to adopt EMRs. And some hospitals were interested in providing the financial subsidies directly to physicians but couldn’t afford to do so. For those hospital executives who were considering a direct subsidy to physicians, improving patient care and forging closer relationships with referring physicians were the top reasons to advance EMR assistance. “Hospital executives expected physicians would be more likely to maintain, and even expand, their relationship with the hospital because of the improved efficiency from interoperability with the hospital’s IT systems,” the researchers wrote. One factor that appears not to be driving the trend toward hospital subsidies is interest on the part of physicians. The arrangement has some potential drawbacks for physicians, according to the analysis. For example, under the safe harbors physicians are still responsible for 15% of the software costs and 100% of the hardware costs associated with setting up the EMR system. Physicians using the hospital-sponsored EMR may have difficulty storing records for patients treated at other hospitals where the physicians provide care for patients. Also, the hospital-sponsored EMR could serve as a barrier if physicians later wanted to switch their hospital affiliations, according to the analysis. “While hospitals have strategic incentives to provide support, particularly to tie referring physicians to their institution, the effects of the regulatory changes on physician EMR adoption will ultimately depend both on hospitals’ willingness to provide support and physicians’ acceptance of hospital assistance,” Joy M. Grossman, Ph.D., one of the study authors, said in a statement. I
Table of Contents Feed for the Digital Edition of Surgery News - February 2009 Surgery News - February 2009 Contents The 20/20 Vision ICD-10 Looms News From the College: MedPAC Flak Oncology: Best for Breast General Surgery: Weighty Problem Surgery News - February 2009 Surgery News - February 2009 - Contents (Page 1) Surgery News - February 2009 - Contents (Page 2) Surgery News - February 2009 - Contents (Page 3) Surgery News - February 2009 - Contents (Page 4) Surgery News - February 2009 - The 20/20 Vision ICD-10 Looms (Page 5) Surgery News - February 2009 - The 20/20 Vision ICD-10 Looms (Page 6) Surgery News - February 2009 - The 20/20 Vision ICD-10 Looms (Page 7) Surgery News - February 2009 - News From the College: MedPAC Flak (Page 8) Surgery News - February 2009 - News From the College: MedPAC Flak (Page 9) Surgery News - February 2009 - News From the College: MedPAC Flak (Page 10) Surgery News - February 2009 - News From the College: MedPAC Flak (Page 11) Surgery News - February 2009 - Oncology: Best for Breast (Page 12) Surgery News - February 2009 - Oncology: Best for Breast (Page 13) Surgery News - February 2009 - Oncology: Best for Breast (Page 14) Surgery News - February 2009 - Oncology: Best for Breast (Page 15) Surgery News - February 2009 - Oncology: Best for Breast (Page 16) Surgery News - February 2009 - Oncology: Best for Breast (Page 17) Surgery News - February 2009 - Oncology: Best for Breast (Page 18) Surgery News - February 2009 - General Surgery: Weighty Problem (Page 19) Surgery News - February 2009 - General Surgery: Weighty Problem (Page 20)
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