Medicare Update

CMS to Host Conference Call on 2008 Physician Quality Reporting Initiative

The Centers for Medicare & Medicaid Services (CMS) recently announced that it will host a national provider conference call on the 2008 Physician Quality Reporting Initiative (PQRI).  The conference call will take place from 3:30 p.m. - 5:00 p.m. (EDT) on May 28, 2008.

During the conference call, CMS will provide an overview of the alternative reporting periods and alternative criteria for satisfactorily reporting quality measures for the 2008 PQRI as authorized by the Medicare, Medicaid and SCHIP Extension Act of 2007. Prior to the call, CMS will post a PowerPoint slide presentation in the Educational Resources section on the PQRI webpage. Following the presentation, callers will have an opportunity to ask questions.

To participate in the conference call, registration is required. Registration will close at 3:30 p.m. (EDT) on May 27, 2008 or when available space has been filled.  For those unable to participate in the conference call, a replay of the call will be accessible from 5:30 p.m. (EDT) on May 28, 2008 until 11:59 p.m. (EDT) on June 5, 2008.  To access the replay, one must call 1-800-642-1687 and use passcode 46870023.

CMS Seeks Clinical Data Registries for Physician Quality Reporting Initiative

The Centers for Medicare & Medicaid Services (CMS) recently announced that it is seeking self-nominations from clinical data registries interested in becoming part of the submission process for the 2008 Physician Quality Reporting Initiative (PQRI).  CMS has posted the selection criteria and process on the CMS website and is accepting self-nominations from registries through May 31, 2008.

The Medicare, Medicaid and SCHIP Extension Act of 2007 authorizes CMS to establish alternative reporting criteria and alternative reporting periods for the reporting of measures groups and for the submission of data on PQRI quality measures through clinical data registries.  CMS has posted a document on the CMS website establishing the new alternative reporting criteria and periods.

Senators Commend CMS Changes to Physician Quality Reporting Initiative

On April 18, 2008, Senate Finance Committee Chairman Max Baucus and Ranking Member Charles Grassley issued a Press Release commending the Centers for Medicare & Medicaid Services' (CMS) recent improvements to the Physician Quality Reporting Initiative (PQRI). In fact, in the Press Release, Chairman Max Baucus states:

"Expanding the physician quality reporting initiative will improve care and encourage the development of more meaningful, evidence-based ways to measure quality...The improvements CMS is making will drive the creation of better models for collecting and analyzing clinical information. This move is a step in the right direction on the long, careful path toward linking physician payments to the quality of care they provide.  We still have a ways to go, but I applaud CMS for its efforts..."

On April 17, 2008, CMS issued a Press Release announcing the steps that it has taken to encourage physicians and other eligible professionals to take part in PQRI. Some of those steps arise from the Medicare, Medicaid and SCHIP Extension Act of 2007, which authorized CMS to establish alternative reporting criteria and reporting periods for the reporting of measures groups and for the submission of data on PQRI quality measures through clinical data registries.

CMS Releases Alternative PQRI Reporting Periods and Criteria

On April 18, 2008, Centers for Medicare & Medicaid Services (CMS) released a document establishing alternative reporting periods and criteria for satisfactorily reporting quality measures for the 2008 Physician Quality Reporting Initiative (PQRI).  The Medicare, Medicaid and SCHIP Extension Act of 2007 authorized CMS to establish alternative reporting criteria and alternative reporting periods for the reporting of measures groups and for the submission of data on PQRI quality measures through clinical data registries.  The release of the document follows CMS' recent announcement that it will host a national provider conference call on the 2008 PQRI on April 30, 2008.

CMS to Host Conference Call on 2008 Physician Quality Reporting Initiative

The Centers for Medicare & Medicaid Services (CMS) recently announced that it will host a national provider conference call on the 2008 Physician Quality Reporting Initiative (PQRI).  The conference call will take place from 1:30 p.m. - 3:30 p.m. (EDT) on April 30, 2008.

The Medicare, Medicaid and SCHIP Extension Act of 2007 (Act) authorized CMS to establish alternative reporting criteria and alternative reporting periods for the reporting of measures groups and for the submission of data on PQRI quality measures through clinical data registries.  The Act also removed the cap on incentive payments. During the conference call, CMS is expected to address its new authority, including alternative reporting criteria and alternative reporting periods. Following the CMS presentation, callers will have an opportunity to ask questions.

CMS reports that materials for the conference call will be posted on the CMS website prior to the call in the Educational Resources section on the PQRI webpage. To participate in the conference call, registration is required. Registration will close at 1:30 p.m. (EDT) on April 29, 2008 or when available space has been filled.  For those unable to participate in the conference call, a replay of the call will be accessible from 3:30 p.m. (EDT) on April 30, 2008 until 11:59 p.m. (EDT) on May 7, 2008.  To access the replay, one must call 1-800-642-1687 and use passcode 42860144.

On April 17, 2008, CMS also issued a Press Release announcing the steps that it has taken to encourage physicians and other eligible professionals to take part in PQRI.

Legislation Introduced to Avert Medicare Payment Cuts for Physicians

On March 13, 2008, Senator Debbie Stabenow introduced the Save Medicare Act of 2008 (S.2785). If enacted, S.2785 would continue the 0.5 percent Medicare payment update for physician services for the last 6 months of 2008. S.2785 would also establish a 1.8 percent Medicare payment update for physician services in 2009.

On December 29, 2007, President Bush signed the Medicare, Medicaid and SCHIP Extension Act of 2007 into law preventing a 10.1 percent reduction in Medicare physician payments that was scheduled for 2008 and giving physicians a 0.5 percent increase through June 30, 2008. The 10.1 percent reduction in Medicare physician payments was driven by the statutory sustainable growth rate (or SGR) formula, which is intended to control the growth in aggregate Medicare expenditures for physician services. 

As reflected in Transmittal 312, the Centers for Medicare & Medicaid Services will implement a 10.6 percent reduction in physician payments (i.e., the 0.5 percent update will no longer apply and a negative 10.1 percent update will take effect) for dates of services on or after July 1, 2008 unless Congressional action is taken.

MedPAC Releases Medicare Payment Policy Report for 2009

On February 29, 2008, the Medicare Payment Advisory Commission (MedPAC) issued a News Release announcing the release of its Report to Congress: Medicare Payment Policy for 2009 (Report).  In the Report, MedPAC makes updates and policy recommendations for certain Medicare fee-for-service payment systems for 2009.  In brief, MedPAC recommends the following updates:

• Hospital Inpatient & Outpatient Services. MedPAC recommends that Congress increase payment rates in 2009 by the projected rate of increase in the hospital market basket index, concurrent with implementation of a quality incentive payment program.  The Centers for Medicare & Medicaid Services' (CMS) current projection of the market basket increase for fiscal year 2009 is 3.0 percent.  MedPAC also recommends that Congress reduce the indirect medical education adjustment by 1 percent to 4.5 percent per 10 percent increment in the resident-to-bed ratio. 
• Physician Services. MedPAC recommends that Congress increase the physician fee schedule conversion factor by the projected change in input prices less MedPAC's adjustment for productivity growth.  With the current estimate of input cost changes in 2009 of 2.6 percent and MedPAC's productivity adjustment of 1.5 percent, MedPAC's recommended 2009 update would be 1.1 percent.  MedPAC also recommends that Congress enact legislation requiring that CMS establish a process for measuring and reporting physician resource use on a confidential basis for a period of 2 years.
• Outpatient Dialysis Services. MedPAC recommends that Congress update the composite rate in calendar year 2009 by the projected rate of increase in the end-stage renal disease market basket index (2.5 percent) less MedPAC's adjustment for productivity growth (1.5 percent).  This would update the composite rate by 1 percent.  MedPAC also recommends that Congress implement a quality incentive program for physicians and facilities that treat dialysis patients.
  
• Skilled Nursing Facility Services. MedPAC recommends that Congress eliminate the update to payment rates for skilled nursing facility (SNF) services for fiscal year 2009 and that Congress establish a quality incentive payment policy for SNFs.  Further, to improve quality measurement for SNFs, MedPAC recommends that CMS:
  • add the risk-adjusted rates of potentially avoidable rehospitalizations and community discharge to its publicly reported post-acute care quality measures;
  • revise the pain, pressure ulcer, and delirium measures currently reported on CMS' Nursing Home Compare website; and
  • require SNFs to conduct patient assessments at admission and discharge.
• Home Health Services. MedPAC recommends that Congress eliminate the update to payment rates for home health care services for calendar year 2009. 
• Inpatient Rehabilitation Facility Services. MedPAC recommends that the update to the payment rates for inpatient rehabilitation facility services be eliminated for fiscal year 2009.
• Long-Term Care Hospital Services.  MedPAC recommends that the payment rates for long-term care hospital (LTCH) services be updated by the market basket index less MedPAC's adjustment for productivity growth (1.5 percent).  MedPAC reports that, under current market basket assumptions, this recommendation would update LTCH payment rates by 1.6 percent.

MedPAC is an independent Congressional agency established by the Balanced Budget Act of 1997 to advise Congress on issues affecting the Medicare program.  MedPAC meets publicly to discuss policy issues and formulate its recommendations to Congress.  Two reports, issued in March and June each year, are the primary outlets for MedPAC's recommendations.

CMS Requests Quality Measure Suggestions for Physician Quality Reporting Initiative

The Centers for Medicare & Medicaid Services (CMS) recently announced that it is accepting quality measure suggestions for possible inclusion in the proposed set of quality measures to be published in the 2009 Medicare Physician Fee Schedule (MPFS) Proposed Rule for the Physician Quality Reporting Initiative (PQRI). CMS expects to publish the 2009 MPFS Proposed Rule no later than August 15, 2008.

According to CMS, individuals and organizations interested in suggesting measures for possible inclusion in the proposed set of measures should email suggestions to pqritemp@cms.hhs.gov by 5:00 p.m. (EST) on March 24, 2008.  Measure suggestions should contain the final measure title, measure description, date of expected development completion and date of expected AQA Adoption or NQF Endorsement.

For more information on the suggestion of quality measures, visit the "Notice of 2009 Measure Suggestions" download on the Measures/Codes page of the CMS website.

CMS to Host Physicians, Nurses & Allied Health Professionals Open Door Forum

The Centers for Medicare & Medicaid Services (CMS) recently announced that the next Physicians, Nurses & Allied Health Professionals Open Door Forum will take place at 2:00 p.m. (EDT) on March 11, 2008.

There are 2 ways to participate in the Open Door Forum.  To participate by telephone, one must dial 1-800-837-1935 and reference conference ID 33257655.  To participate in person, one must RSVP to CMS PHYSICIANODF-L@cms.hhs.gov by 2:00 p.m. (EDT) on March 7, 2008 and include your name, organization or representation, telephone number and "Physician ODF" in the subject line. The Open Door Forum will take place at the Hubert H. Humphrey Building, 200 Independence Ave. SW, Washington, DC.

Beginning 2 hours after the Open Door Forum, CMS will also make an audio recording of the Open Door Forum available. To access the audio recording, one must dial 1-800-642-1687 and reference the conference ID.  The audio recording will be available for 3 business days.

OIG Issues Advisory Opinion on Disease Screening Kiosks in Physicians Offices

On February 22, 2008, the Department of Health and Human Services' Office of Inspector General (OIG) posted OIG Advisory Opinion No. 08-05 (Advisory Opinion).

In the Advisory Opinion, a company that develops, manufacturers and markets pharmaceuticals (Company) for a number of diseases and conditions, including 4 disease states (Disease States), inquired about a proposal to place electronic kiosks, which offer patients free Disease State screening questionnaires, in physicians' offices (Proposed Arrangement). 

Specifically, the Company inquired whether the Proposed Arrangement would violate the Federal anti-kickback statute or the prohibition against beneficiary inducements and result in the imposition of related sanctions. Based on the facts presented, the OIG concluded that the Proposed Arrangement would not violate the Federal anti-kickback statute or the prohibition against beneficiary inducements.

Under the Proposed Arrangement, the Company would place freestanding kiosks, which offer interactive questionnaires about the Disease States, in the waiting rooms of physicians. Use of the kiosks would be voluntary. The kiosks would generate a printout containing the screening questions and the patient's responses. The printouts would not provide any conclusions regarding whether a patient has a particular condition or requires a particular therapy, but would advise patients to talk to their physician about the screening results.  According to the Company, the kiosks would help patients determine whether they should discuss symptoms of the Disease States with a physician.

Furthermore, the Company would offer to place the kiosks in the writing room of physicians whom the Company expects would treat a large number of patients with the Disease States, including Federal health care program beneficiaries.  However, the physicians would not be required to prescribe the Company's drugs in return for the kiosks. The physicians would also neither pay the Company, nor receive payment from the Company, for hosting the kiosks. The physicians could have the kiosks removed at any time.

Moreover, the questionnaires would not mention the Company's drug products or contain any advertisements or incentives for using the kiosks. However, the kiosks would carry a small image of the Company's logo with wording similar to "brought to you by [Company]" and a footer on the printouts that would display the Company's logo and a copyright notice.  The Company would obtain the aggregate data from the kiosks, but no individual identifying data.

The OIG examined the Proposed Arrangement under 2 possible kickback scenarios. However, after examining both scenarios, the OIG found that the Proposed Arrangement would not generate prohibited remuneration under the Federal anti-kickback statute. 

First, the OIG considered whether there would be a potential kickback from the Company to the patient users of the kiosks to induce them to self-refer to the Company's drugs.  Since the kiosks would only provide a printout reprising the questionnaire and each patient's answers and not offer incentives for using the kiosks, the OIG found that the Proposed Arrangement would not provide anything of value to the patients and not implicate the Federal anti-kickback statute.  However, the OIG noted that its conclusion would most likely be different if the kiosks were used to communicate offers of remuneration to patients (e.g., coupons, gifts or services).

Second, the OIG considered whether there would be a potential kickback from the Company to the participating physicians to induce them to prescribe the Company's drugs.  However, the OIG found that the kiosks would "amount to little more than high-tech interactive brochures" and have no independent value to the physicians. The OIG pointed out that the kiosks would remain the property of the Company, physicians would not receive any space rental, utilities fees or other compensation, and found that the kiosks would not influence prospective patients to select a particular physician.

For the same reasons that the Proposed Arrangement would not generate prohibited remuneration under the Federal anti-kickback statute, the OIG concluded that the Proposed Arrangement would not violate the prohibition against beneficiary inducements.