CMS Proposes Changes to Physician Fee Schedule

CMS Proposes Changes to Physician Fee Schedule, from ACEP / EM Today

Last week, the Centers for Medicare & Medicaid Services (CMS) issued a notice of proposed rule making that concerns changes to the Medicare Physician Fee Schedule for 2007, including a revision of physician work Relative Value Units (RVUs) that could mean an increase in emergency physician reimbursement for providing Evaluation and Management (E/M) services.

Although the values published in the proposed rule will not be final until the comment period ends and the final rule for the 2007 Medicare Fee Schedule is published in late fall, work RVUs for emergency department E/M codes should have significant increases. The actual financial impact for each member will depend on several factors such as patient volume, payer mix, service mix, and frequency distribution. The combination of these factors can have a significant impact on the total annual Medicare payment in the ED.

Family Presence in ED Resuscitations Video

Hospitals are allowing loved ones into the ER, even when the going gets rough. CNN’s Tom Foreman reports.

Doctors’ Average Pay Fell 7% in 8 Years, Report Says

From the NY Times, via Symtym:

The Dr. Smiths are having trouble keeping up with the Mr. Joneses.

A report planned for release today indicates that the average physician’s net income declined 7 percent from 1995 to 2003, after adjusting for inflation, while incomes of lawyers and other professionals rose by 7 percent during the period.

The researchers who prepared the report say the decline in doctors’ inflation-adjusted incomes appears to be affecting the types of medicine they choose to practice and the way they practice it — resulting in fewer primary care doctors and a tendency to order more revenue-generating diagnostic tests and procedures.

Primary care doctors, who are already among the lowest-paid physicians, had the steepest decline in their inflation-adjusted earnings — a 10 percent drop — according to the report by the Center for Studying Health System Change, a nonprofit research group in Washington.

The average reported net income for a primary care physician in 2003 was $146,405, according to the study, after expenses like malpractice insurance but before taxes. The highest-paid doctors were surgeons who specialize in areas like orthopedics, who had an average net income of $271,652, nearly double what the primary care doctors said they earned.

The report was based on a national telephone survey of roughly 6,600 physicians in 2004 and 2005 and earlier surveys by the research center. “These are large enough changes that physicians are responding,” said Paul B. Ginsburg, the center’s president and a health economist.

Doctors, he said, are reacting to the financial incentives under the current payment system by choosing to specialize and work in fields where they can increase their income by providing more services, like diagnostic tests or procedures, he said.

Dr. Cecil B. Wilson, the chairman of the board of the American Medical Association, said that for practicing physicians the survey “confirms what they already know from their own practices: payments are not keeping up with inflation.

Physicians barred from using cursive to write prescriptions

From the Seattle Post-Intelligencer, via Symtym:

Physicians, heal thy handwriting.

On June 7, a new law went into effect that could paralyze the penmanship-impaired. It says that if a prescription isn’t hand-printed, typed or electronically generated, it can’t be filled, Jeff Smith of the state Health Department explained.

Cursive is illegal.

Dr. Richard Goss, medical director of quality improvement at Harborview Medical Center, said he is in favor of the bill because his own handwriting is hard to read.

“One of the comic strips on my office wall is a physician’s guide to the alphabet,” he said. “Each letter is illegible.”

Goss said his handwriting probably was readable when he was in junior high, but it went downhill from there. Years of fast handwriting and note-taking took their toll.

As a result, he’s been forced to slow down when he writes prescriptions, print carefully, read them over and make sure someone else can read them. He also double-checks figures.

If physicians, veterinarians and other prescription writers want to assign blame for this bill, Dr. William Robertson of the Washington Poison Center is willing to accept it.

Robertson said it’s taken him 27 years to make scrawled prescriptions illegal. Lots of doctors are opposed to this, but it will save drug errors, he said.

Increased CMS Payments for Emergency Medicine

From ACEP:

American College of Emergency Physicians is proud to announce that the Centers for Medicare and Medicaid Services will increase payments for emergency medicine Evaluation and Management codes beginning in January 2007.

According to a proposed notice released by CMS this week, the Relative Value Units for emergency medicine E/M codes will increase from 8.1% to 60%, or about 25% across the board. The actual financial impact for each ACEP member will depend on several factors, including patient volume, payer mix, and frequency distribution.

You can calculate the impact these increases will have on your payments by going to We have created an interactive calculator that will allow you to see what you can expect to be reimbursed in 2007.

US hospitals sued in class action over nurse pay

From Reuters:

Nurses backed by the biggest U.S. health-care union on Tuesday filed four class-action lawsuits against some of the biggest U.S. hospitals, including No. 1 chain HCA Inc., claiming they conspired to depress wages for nurses amid a national shortage.

The lawsuits, which also target the biggest U.S. Catholic hospital system, Ascension Health, charge the hospitals regularly discussed nurses’ wages in meetings, over the telephone and in written surveys, in an effort to coordinate and suppress pay.

The suits, filed in federal courts in Chicago; Memphis, Tennessee; Albany, New York; and San Antonio, Texas, seek back compensation and legal costs totaling “hundreds of millions of dollars” under federal antitrust laws.

Reasons for Being Admitted to the Hospital through the Emergency Department, 2003

More HCUP Highlights, from Statistical Briefing #2

Circulatory disorders (diseases of the heart and blood vessels) were the most frequent reason for admission to the hospital through the ED, accounting for 26.3 percent of all such admissions; injuries accounted for 11.4 percent.

The top 20 specific conditions accounted for more than half of all hospital admissions through the ED, with pneumonia as the single most common specific condition at nearly one million (5.7 percent) of all such admissions.

Complications of procedures, devices, implants, and grafts ranked as the ninth most common reason for admission through the ED and included postoperative infections, malfunction of orthopedic devices, and infection of arteriovenous fistulas used for dialysis.

The top 20 specific conditions admitted through the ED included several chronic conditions: chronic obstructive lung disease, asthma, diabetes, and mood disorders. Also included were fluid and electrolyte disorders; urinary, skin, and blood infections; gall bladder disease, gastrointestinal bleeding, and appendicitis; and hip fracture.

While up to 82 percent of the most frequent acute conditions were admitted through the ED, a large percentage of chronic conditions were also admitted through the ED; for example, 72 percent of cases with conestive heart failure, chronic obstructive lung disease, and asthma were such admissions.

Highlights: Hospital Admissions That Began in the Emergency Department, 2003

From the HCUP project website, Statistical Brief #1

In 2003, 55 percent of 29.3 million hospitalizations (excluding pregnancy and childbirth) began in the ED.

Relative to the populations in each region, individuals in the Northeast were more likely to enter the hospital through the ED, while individuals in the Western states were less likely.

Government payers, Medicare and Medicaid, bear the greatest burden of hospital admissions through the ED, covering 66 percent of all admissions through the ED.

The mean cost for hospitalizations that began in the ED was $7,400.

The mean costs for hospitalizations that began in the ED were highest in the West ($8,500) compared to all other regions of the country ($7,200 or less).

The mean costs for hospitalizations that began in the ED were greatest for government payers.

The mean cost for uninsured stays that began in the ED was less than the cost of stays billed to Medicare and Medicaid but comparable to stays billed to private insurance.

Institute of Medicine Report on Hospital-Based Emergency Medicine

From the IOM website:

Despite the lifesaving feats performed every day by emergency departments and ambulance services, the nation’s emergency medical system as a whole is overburdened, underfunded, and highly fragmented, says this series of three reports from the Institute of Medicine.

As a result, ambulances are turned away from emergency departments once every minute on average and patients in many areas may wait hours or even days for a hospital bed. Moreover, the system is ill-prepared to handle surges from disasters such as hurricanes, terrorist attacks, or disease outbreaks.

The Institute of Medicine’s Committee on the Future of Emergency Care in the United States Health System was convened in 2003 to examine the state of emergency care in the U.S., to create a vision for the future of emergency care, including trauma care, and to make recommendations to help the nation achieve that vision. Their findings and recommendations are presented in three reports:

Hospital-Based Emergency Care: At the Breaking Point explores the changing role of the hospital emergency department and describes the national epidemic of overcrowded emergency departments and trauma centers.
Emergency Medical Services At the Crossroads describes the development of EMS systems over the last forty years and the fragmented system that exists today.
Emergency Care for Children: Growing Pains describes the unique challenges of emergency care for children.
The wide range of issues covered in this report, Hospital-Based Emergency Care: At the Breaking Point, includes:

The role and impact of the emergency department within the larger hospital and health care system.
Patient flow and information technology.
Workforce issues across multiple disciplines.
Patient safety and the quality and efficiency of emergency care services.
Basic, clinical, and health services research relevant to emergency care.
Special challenges of emergency care in rural settings.

Hospital drug ads make some critics feel ill

From The Gazette (Montreal):

It’s safe to assume that most people don’t have sex on the brain in a hospital emergency room.

That might explain why the Viagra ad in the ER area at the Montreal General Hospital once caused a bit of a fuss.

“It wasn’t the ad itself,” said Francoise Chagnon, director of professional services at the McGill University Health Centre.

But doctors felt it didn’t belong in a clinical area. “When you looked at the big ad, it kind of stood out right when you came to register in the emergency room and that wasn’t appropriate,” Chagnon said.

That incident aside, Chagnon said commercial advertising in the hospital hasn’t sparked complaints. But the revenue-generating practice isn’t without critics.

In the late 1990s, the Montreal General began accepting commercial advertising as a way to drum up new revenue. Some other cash-strapped hospitals are doing the same thing. However, even among hospitals there is no consensus on the practice.

“This is not the way we should be raising money,” said Paul Saba, a spokesperson for the Coalition of Physicians for Social Justice.