<?xml version="1.0" encoding="utf-8"?>
<recommendedContent xmlns="http://api.mspoke.com">
    <recommendedItem id="20100101_19_377"
                     title="Advisory Panel Rates Genomic Cancer Tests"
                     score="0.011"
                     href="http://www.medpagetoday.com/PublicHealthPolicy/Medicare/tb/18269?impressionId=1265769990119"
                     
      &lt;p&gt;Some genomic tests aimed at identifying patients most likely to respond to cancer drugs won a thumbs-up from a Medicare advisory panel, but others didn&apos;t make the grade.&lt;/p&gt;
&lt;p&gt;As part of a national coverage determination under way at the Centers for Medicare and Medicaid Services, members of the Medicare Evidence Development &amp;amp; Coverage Advisory Committee (MEDCAC) last week rated the clinical value of several pharmacogenomic cancer tests now available.&lt;/p&gt;
&lt;p&gt;The tests would be used to select patients for treatment with drugs including tamoxifen, irinotecan (Camptosar), trastuzumab (Herceptin), and imatinib (Gleevec).&lt;/p&gt;
&lt;p&gt;CMS has not previously decided whether such tests should be reimbursed by Medicare, although testing is already routine for some of these treatments.&lt;/p&gt;
&lt;p&gt;The FDA-approved labeling for trastuzumab requires such testing. Imatinib&apos;s approvals include chronic myeloid leukemia featuring the BCR-ABL &quot;Philadelphia chromosome&quot; mutation, although the label doesn&apos;t explicitly mention testing.&lt;/p&gt;
&lt;p&gt;&quot;CMS is aware that the body of evidence on the role of pharmacogenomic testing in cancer continues to evolve,&quot; according to the agency&apos;s notice of the meeting.&lt;/p&gt;
&lt;p&gt;&quot;Recognizing the rapid accumulation of such evidence, CMS seeks guidance from the panel to inform future coverage determinations. We want to ensure that Medicare beneficiaries have access to any demonstrated improved health outcomes of pharmacogenomic testing, and are protected from inaccurate or inappropriate pharmacogenomic testing that could compromise therapy or increase the risks of adverse events during therapy.&quot;&lt;/p&gt;
&lt;p&gt;MEDCAC panelists were asked to rate their confidence in the clinical utility of five tests and in the scientific evidence available for review.&lt;/p&gt;
&lt;p&gt;The five tests cover: &lt;ul&gt; &lt;li&gt;Polymorphisms in the CYP2D6 drug-metabolizing enzyme for breast cancer patients who are candidates for tamoxifen&lt;/li&gt; &lt;li&gt;Polymorphisms in the UGT1A1 gene for colon cancer patients considered for irinotecan treatment&lt;/li&gt; &lt;li&gt;Presence of HER/neu epidermal growth factor receptor expression in patients with breast cancer, indicating suitability for trastuzumab&lt;/li&gt; &lt;li&gt;Presence of the BCR-ABL mutation in patients with chronic myeloid leukemia who would be candidates for imatinib&lt;/li&gt; &lt;li&gt;Mutations in the K-ras gene for metastatic colorectal cancer patients eligible for cetuximab (Erbitux) or panitumumab (Vectibix)&lt;/li&gt; &lt;/ul&gt;&lt;/p&gt;
&lt;p&gt;The 15 panel members assigned values of one to five, reflecting low to high confidence, to each test. A score of two reflected medium-low confidence, while a four meant medium-high confidence.&lt;/p&gt;
&lt;p&gt;Most of the panelists agreed that the evidence underlying the tests for CYP2D6 and UGT1A1 polymorphisms was still too scant for an assessment of their clinical value. Mean scores for these tests were 2.07 and 1.83, respectively, with nearly all votes either a one or two.&lt;/p&gt;
&lt;p&gt;But MEDCAC members were more confident that the usefulness of the other three tests for diagnostic and monitoring purposes could be evaluated. Mean scores for those tests were all well above four.&lt;/p&gt;
&lt;p&gt;For the HER/neu, BCR-ABL, and K-ras tests, since members believed the evidence was adequate for assessment, MEDCAC also voted on whether their use actually would improve health outcomes in cancer patients.&lt;/p&gt;
&lt;p&gt;A third ranking provided the committee&apos;s views on whether the conclusions could be generalized to the Medicare population and patients in the community.&lt;/p&gt;
&lt;p&gt;Mean scores for those rankings were all also above four, indicating the panel&apos;s support for these tests as clinically beneficial.&lt;/p&gt;
&lt;p&gt;On the other hand, when asked whether there was enough evidence to assess the utility of the BCR-ABL test in detecting treatment failure, panelists didn&apos;t think so. Most of those votes were twos, and the mean was 2.47.&lt;/p&gt;
&lt;p&gt;CMS has not given a time line for deciding whether to approve Medicare coverage for the tests.&lt;/p&gt;

    </recommendedItem>
    <recommendedItem id="20100101_19_309"
                     title="Increasing Copays: Penny-Wise but Pound-Foolish? (CME/CE)"
                     score="0.006"
                     href="http://www.medpagetoday.com/Geriatrics/GeneralGeriatrics/tb/18173?impressionId=1265769990119"
                     
      &lt;p&gt;Raising seniors&apos; copayments for ambulatory care to offset increasing healthcare costs may backfire on insurers, researchers asserted.&lt;/p&gt;
&lt;p&gt;Seniors enrolled in Medicare plans that increased copayments had significantly fewer outpatient visits but spent more time in the hospital than patients in plans that left copayments untouched, according to Amal Trivedi, MD, MPH, of Brown University in Providence, R.I., and colleagues.&lt;/p&gt;
&lt;p&gt;Assuming an average reimbursement of $60 for an outpatient visit, seven annual visits per enrollee, and an average copay increase of $8.50 per visit, a plan should save $7,150 for every 100 enrollees, they noted in the Jan. 28 &lt;em&gt;New England Journal of Medicine&lt;/em&gt;.&lt;/p&gt;
&lt;p&gt;But, assuming an average cost of $11,065 per hospitalization of a person 65 to 84, the researchers estimated that the costs for inpatient care would actually increase by $24,000 for every 100 enrollees in the year after copays are increased.&lt;/p&gt;
&lt;p&gt;Even using more conservative criteria, the increased costs for inpatient care would nearly double any savings from increasing copays, they argued.&lt;/p&gt;
&lt;p&gt;&quot;Cost-sharing has generally been thought to reduce total healthcare spending without harming health for the average person,&quot; the researchers wrote, but these results suggest increasing copays in Medicare beneficiaries &quot;may be a particularly ill-advised cost-containment strategy.&quot;&lt;/p&gt;
&lt;p&gt;Increasing copayments may be particularly harmful to older patients, they said, because they have lower incomes and are more likely to have poor health and greater out-of-pocket healthcare expenses than younger patients.&lt;/p&gt;
&lt;p&gt;To explore the issue in a Medicare population, Trivedi and colleagues compared the use of outpatient and inpatient care between enrollees in 18 plans that increased copays for ambulatory care and 18 that did not. The study included 899,060 patients.&lt;/p&gt;
&lt;p&gt;According to data from the Medicare Healthcare Effectiveness Data and Information Set from the Centers for Medicare and Medicaid Services, mean copays increased during the study period for both primary care ($7.38 to $14.38) and specialty care ($12.66 to $22.05) in the case plans.&lt;/p&gt;
&lt;p&gt;Mean copays remained stable at $8.33 and $11.38 for primary and specialty care, respectively, in the control plans.&lt;/p&gt;
&lt;p&gt;In both groups, there were increases in the number of ambulatory visits over time, but the increase was smaller in the plans that raised copays.&lt;/p&gt;
&lt;p&gt;There was also a rise in the number of hospitalizations, the proportion of patients who were hospitalized, and the length of time spent in the hospital in both groups, but there were larger increases in the plans that increased copays.&lt;/p&gt;
&lt;p&gt;Compared with the control plans, in the year after the increase in copays, case plans had: &lt;ul&gt; &lt;li&gt;19.8 fewer annual outpatient visits per 100 enrollees (95% CI 16.6 to 23.1)&lt;/li&gt; &lt;li&gt;2.2 additional annual hospital admissions per 100 enrollees (95% CI 1.8 to 2.6)&lt;/li&gt; &lt;li&gt;13.4 more annual inpatient days per 100 enrollees (95% CI 10.2 to 16.6)&lt;/li&gt; &lt;li&gt;A 0.7% increase in the proportion of enrollees who were hospitalized (95% CI 0.51% to 0.95%)&lt;/li&gt; &lt;/ul&gt;&lt;/p&gt;
&lt;p&gt;The findings were amplified among enrollees living in areas of lower income and education, black patients, and those who had hypertension, diabetes, or a history of myocardial infarction.&lt;/p&gt;
&lt;p&gt;Trivedi and colleagues noted some limitations of the analysis: it was not randomized, and unmeasured differences could have influenced the results.&lt;/p&gt;
&lt;p&gt;Also, the case and control plans could not be matched in a geographic area smaller than census region because of the small number of Medicare plans, and data were lacking on diagnoses, procedures, and costs associated with hospital admissions and outpatient visits.&lt;/p&gt;
&lt;div style=&quot;float:left;border-style:solid;border-width:1px;border-color:#8dabbc;font-family:arial;font-size:12px;background-color:#DBE9F2;padding:5px;&quot;&gt;&lt;p&gt;Trivedi is the recipient of a Pfizer Health Policy Scholars Award and a career development award from the Veterans Affairs Health Services Research and Development Services.&lt;/p&gt;&lt;p&gt;The authors reported no relevant conflicts of interest.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;
    </recommendedItem>
    <recommendedItem id="20100101_19_304"
                     title="&apos;Virtual&apos; Colon Scans Effective in Seniors (CME/CE)"
                     score="0.005"
                     href="http://www.medpagetoday.com/HematologyOncology/ColonCancer/tb/18164?impressionId=1265769990119"
                     
      Patients 65 and older are as suitable as younger individuals for CT colonography, said researchers conducting a large retrospective study.&lt;br&gt;
&lt;br&gt;Advanced neoplasias were detected with CT colonography  --  often called &quot;virtual colonoscopy&quot;  --  in older patients at more than double the rate in the general screening population, reported David H. Kim, MD, of the University of Wisconsin in Madison, Wis., and colleagues in the February issue of &lt;em&gt;Radiology&lt;/em&gt;.&lt;br&gt;
&lt;br&gt;They found that 7.6% of older patients had advanced neoplasias, compared with 3.2% of all patients screened in the university&apos;s clinic (&lt;em&gt;P&lt;/em&gt;&amp;lt;0.001).&lt;/p&gt;
&lt;p&gt;On the basis of this and other findings in 577 individuals 65 and older versus the entire group of 3,120 patients undergoing the procedure, Kim and colleagues concluded that &quot;CT colonography performance is maintained in an older cohort.&quot;&lt;/p&gt;
&lt;p&gt;&quot;Overall, the observations from this clinical experience confirm that CT colonography may be a valuable screening modality in the older population,&quot; they wrote.&lt;/p&gt;
&lt;p&gt;On the other hand, the study did not address several objections raised by the Centers for Medicare and Medicaid Services (CMS) in its decision last year to deny Medicare coverage for the procedure. (See &lt;a href=&quot;http://www.medpagetoday.com/PublicHealthPolicy/Medicare/14186&quot; mce_href=&quot;http://www.medpagetoday.com/PublicHealthPolicy/Medicare/14186&quot; target=&quot;_blank&quot;&gt;Medicare Finalizes Denial of Virtual Colonoscopy Coverage&lt;/a&gt;)&lt;/p&gt;
&lt;p&gt;CMS had pointed to relatively low sensitivity of CT colonography compared with optical colonoscopy in prospective trials, especially for small lesions.&lt;/p&gt;
&lt;p&gt;The agency also determined that CT colonography increased the costs of positive findings, since abnormalities in the CT scans must be confirmed with optical colonoscopy. In addition, CMS said there was no evidence to support claims that the less invasive imaging procedure would be more acceptable to patients and therefore would raise screening rates.&lt;/p&gt;
&lt;p&gt;The data analyzed by Kim and colleagues did not allow for calculations of false-negative rates or predictive values of positive or negative findings. Nor did the researchers report cost information.&lt;/p&gt;
&lt;p&gt;Mean age of their older cohort was 69.2 (SD 3.8). The oldest was 79.&lt;/p&gt;
&lt;p&gt;The researchers reported that 15.3% of the older patients were referred for optical colonoscopy on the basis of the CT results, compared with 7.9% of the overall screening group.&lt;/p&gt;
&lt;p&gt;Less than 4% of positive findings were determined to be false with the optical procedure (3.6% for polyps 6 to 10 mm in diameter, 2.1% for larger lesions).&lt;/p&gt;
&lt;p&gt;Of the 59 advanced neoplasias identified in the older patients, all but three were at least 10 mm in size.&lt;/p&gt;
&lt;p&gt;The scans also suggested abnormalities outside the colon in 89 (15.4%) patients. Of these, 45 received a full workup, which revealed substantial and previously unsuspected diagnoses in 21 cases  -- 18 were vascular aneurysms. The other three included one lung tumor, a femoral hernia, and a malrotation.&lt;/p&gt;
&lt;p&gt;Kim and colleagues reported that no &quot;substantial complications&quot; such as perforations or major hemorrhage occurred in the older patients, either with the CT scan or follow-up colonoscopy.&lt;/p&gt;
&lt;p&gt;They also indicated that the ratio of large to small neoplasias was similar in the older patients compared with their CT screening group as a whole. Histologic and morphologic findings were similar as well.&lt;/p&gt;
&lt;p&gt;The researchers cited the observational nature of the study, in which negative findings were not corroborated with optical colonoscopy, and its restriction to a single center as its main limitations.&lt;/p&gt;
&lt;div style=&quot;float:left;border-style:solid;border-width:1px;border-color:#8dabbc;font-family:arial;font-size:12px;background-color:#DBE9F2;padding:5px;&quot;&gt;&lt;p&gt;No external funding for the study was reported.&lt;/p&gt;&lt;p&gt;Kim and one co-author reported relationships with Viatronix and Medicsight and are co-founders of a company called VirtuoCTC, which produces educational materials on CT colonography.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;
    </recommendedItem>
    <recommendedItem id="20100101_19_253"
                     title="Week 29: After Mass. Election, Healthcare Reform Is Anybody&apos;s Guess"
                     score="0.001"
                     href="http://www.medpagetoday.com/Washington-Watch/Reform/tb/18111?impressionId=1265769990119"
                     
      WASHINGTON, Jan. 22  --  Following a politically turbulent week that derailed healthcare reform efforts, Democrats are regrouping and hoping to develop a new plan for passing a healthcare bill.&lt;/p&gt;
&lt;p&gt;&lt;a href=&quot;http://www.medpagetoday.com/Washington-Watch/Reform/18053&quot; mce_href=&quot;http://www.medpagetoday.com/Washington-Watch/Reform/18053&quot; target=&quot;_blank&quot; title=&quot;GOP&amp;#8200;Scores&amp;#8200;Win&amp;#8200;in&amp;#8200;Massachusetts&amp;#8200;Senate&amp;#8200;Race&quot;&gt;&lt;/a&gt;&lt;/p&gt;
&lt;p&gt;&lt;a href=&quot;http://www.medpagetoday.com/Washington-Watch/Reform/18053&quot; mce_href=&quot;http://www.medpagetoday.com/Washington-Watch/Reform/18053&quot; target=&quot;_blank&quot; title=&quot;GOP&amp;#8200;Scores&amp;#8200;Win&amp;#8200;in&amp;#8200;Massachusetts&amp;#8200;Senate&amp;#8200;Race&quot;&gt;Tuesday&apos;s election of Republican Scott Brown&lt;/a&gt;  --  the Massachusetts state senator who came from obscurity to beat Democratic state attorney general Martha Coakley Senate for the seat that belonged to the late U.S. Edward M. Kennedy  --  was a major upset for Democrats, to say the least.&lt;/p&gt;
&lt;p&gt;The win emboldened Republicans, who are now saying the healthcare bill is dead.&lt;/p&gt;
&lt;p&gt;&quot;Our goal is to stop this monstrosity,&quot; House Minority Leader John Boehner (R-Ohio) said at a Thursday press conference. &quot;We need to stop, scrap the bill and start over  --  and start over in a bipartisan way.&quot;&lt;/p&gt;
&lt;p&gt;Democrats would counter that they have aimed for bipartisanship all along: Three Democratic senators spent months conferencing with three Republican senators over the summer until the Republicans withdrew from the talks. But in the end, nothing in the healthcare reform bills was to the GOP&apos;s liking.&lt;/p&gt;
&lt;p&gt;Achieving bi-partisan support will be difficult, but Sen. Chuck Grassley (R-Iowa), the ranking member on the Finance Committee, has one idea of a starting point: medical malpractice reform.&lt;/p&gt;
&lt;p&gt;&quot;I&apos;d just suggest one of many things that it would take to get it to be bipartisan, but one would be medical malpractice lawsuit reform,&quot; Grassley said in a Thursday radio interview with an Iowa radio station.&lt;/p&gt;
&lt;p&gt;&quot;Because that&apos;s not only going to reform a system that needs to be reformed, but it&apos;s probably going to save 10 percent of the money spent on health care because  --  because doctors practice defensive medicine, because they think you&apos;re going to sue you, so they give you a bunch tests that maybe normally they wouldn&apos;t give you.&quot;&lt;/p&gt;
&lt;p&gt;This is a longstanding Republican issue that Democrats, and their allies among the nation&apos;s trial lawyers, have long opposed.&lt;/p&gt;
&lt;p&gt;When asked at a press conference whether bipartisanship was even possible, given the current political climate, Speaker of the House Nancy Pelosi (D-Calif.) said Republicans &quot;are always welcome at the table,&quot; and that &quot;We have a responsibility always to find our common ground.&quot;&lt;/p&gt;
&lt;p&gt;Democrat like Pelosi are not willing to admit defeat on healthcare, but many are suggesting that the caucus take a &lt;a href=&quot;http://www.medpagetoday.com/Washington-Watch/Reform/18074&quot; mce_href=&quot;http://www.medpagetoday.com/Washington-Watch/Reform/18074&quot; target=&quot;_blank&quot; title=&quot;Dems&amp;#8200;Say&amp;#8200;They&apos;ll&amp;#8200;Take&amp;#8200;a&amp;#8200;Breather&amp;#8200;in&amp;#8200;Push&amp;#8200;for&amp;#8200;Healthcare&amp;#8200;Reform&quot;&gt;breather&lt;/a&gt; and re-focus efforts to pass healthcare reform. Pelosi said that Democrats are still committed to passing a bill, but members of the House aren&apos;t keen on either option under consideration.&lt;/p&gt;
&lt;p&gt;One option would be for the House to pass the version of the bill approved by the Senate. But there are a number of provisions in that bill  --  notably on abortion and taxing high-benefit insurance plans  --  that members of the House oppose.&lt;/p&gt;
&lt;p&gt;&quot;In its present form without any change, I don&apos;t think it is possible to pass the Senate bill in the House,&quot; Pelosi said.&lt;/p&gt;
&lt;p&gt;Another option would be to pass portions of the bill that most members of Congress can agree on, such as expanding coverage to more people and enacting certain insurance market reforms.&lt;/p&gt;
&lt;p&gt;But many of the provisions in the bill are interconnected. For instance, insurance companies only agreed to no longer deny coverage based on a person having a pre-existing health condition in exchange for the bill imposing a mandate that would require every person to have insurance.&lt;/p&gt;
&lt;p&gt;&quot;Well, I don&apos;t think anybody disagrees with, &apos;Let&apos;s pass the popular part of the bill,&quot; &lt;span&gt;Pelosi &lt;span&gt;said&lt;/span&gt; at the Thursday press conference, &quot;&lt;/span&gt;But some of that popular part of the bill is the engine that drives some of the rest of it.&quot;&lt;/p&gt;
&lt;p&gt;Democrats had hoped to reach a compromise on how to combine the House and Senate bill before President Obama delivered his State of the Union address, but now it&apos;s clear they won&apos;t reach that goal. Obama is scheduled to deliver the address on Jan. 27.&lt;/p&gt;
&lt;p&gt;&lt;strong&gt;Groups Lobby for SGR Fix &lt;/strong&gt;&lt;/p&gt;
&lt;p&gt;Meanwhile, another deadline is approaching: On March 1, unless Congress intervenes, Medicare will cut reimbursements to physicians by 21%. Of course, doctors have successful lobbied Congress seven times to stop the cuts, usually at the 11th hour, but the American Medical Association (AMA) and AARP are &lt;a href=&quot;http://www.medpagetoday.com/Washington-Watch/Washington-Watch/18094&quot; mce_href=&quot;http://www.medpagetoday.com/Washington-Watch/Washington-Watch/18094&quot; target=&quot;_blank&quot; title=&quot;AMA&amp;#8200;Pushes&amp;#8200;for&amp;#8200;Permanent&amp;#8200;Doctor&amp;#8200;Pay&amp;#8200;Fix&quot;&gt;calling for an permanent doctor fix.&lt;/a&gt;&lt;/p&gt;
&lt;p&gt;At issue is the flawed sustainable growth rate (SGR) formula, which was developed in 1997 as a way to prevent Medicare payments from growing too quickly. The formula indexes reimbursements to changes in the gross domestic product (GDP).&lt;/p&gt;
&lt;p&gt;But healthcare spending has been growing much faster than GDP, so applying the SGR formula would have resulted in actual reimbursement cuts year after year.&lt;/p&gt;
&lt;p&gt;Months ago, members of Congress promised to repeal the SGR as part of healthcare reform, but those measures were stripped out of the bills to bring down the total costs of the legislation. After it was clear that a doctor payment fix wouldn&apos;t be part of a reform package, the AMA lobbied for a stand-alone bill, which &lt;a href=&quot;http://www.medpagetoday.com/Washington-Watch/Washington-Watch/16551&quot; mce_href=&quot;http://www.medpagetoday.com/Washington-Watch/Washington-Watch/16551&quot; target=&quot;_blank&quot; title=&quot;SGR&amp;#8200;Fix&amp;#8200;Fails&amp;#8200;in&amp;#8200;the&amp;#8200;Senate&quot;&gt;failed in the Senate&lt;/a&gt;, but later &lt;a href=&quot;http://www.medpagetoday.com/Washington-Watch/Washington-Watch/17117&quot; mce_href=&quot;http://www.medpagetoday.com/Washington-Watch/Washington-Watch/17117&quot; target=&quot;_blank&quot; title=&quot;House&amp;#8200;Passes&amp;#8200;Medicare&amp;#8200;Payment&amp;#8200;Fix&quot;&gt;cleared the House&lt;/a&gt;.&lt;/p&gt;
&lt;p&gt;It&apos;s likely that Congress will just approve yet another one-year fix. But Nancy Nielsen, MD, immediate past president of the AMA, said pushing the debt down the road will only make it more expensive to pay off when Congress does finally approve a permanent fix.&lt;/p&gt;

    </recommendedItem>
    <recommendedItem id="20090101_19_2105"
                     title="CMS Announces New Payment Rules that Benefit Primary Care Docs"
                     score="-0.005"
                     href="http://www.medpagetoday.com/PublicHealthPolicy/Medicare/tb/14944?impressionId=1265769990119"
                     
      WASHINGTON, July 2 -- The Centers for Medicare and Medicaid Services (CMS) has announced proposed changes that will increase Medicare payments for primary care physicians by an estimated 6% to 8%. 
              &lt;p&gt; 
              &lt;p&gt;Changes include refining the definition of practice expenses, eliminating payment for consultation codes, and revising treatment of malpractice premiums, as well as adjustments to the physician fee schedule (PFS), according to a CMS press release. 
              &lt;p&gt; 
              &lt;p&gt;One of the biggest changes would remove physician-administered drugs, such as chemotherapy agents, from the &quot;physician services&quot; category used under the sustainable growth rate (SGR) formula. 
              &lt;p&gt; 
              &lt;p&gt;Doctors have long lobbied CMS to put the drugs under Medicare&apos;s Part D drug benefit, rather than keeping them in Part B, the section of Medicare that determines how much physicians are paid.   
              &lt;p&gt; 
              &lt;p&gt;CMS has finally agreed. 
              &lt;p&gt; 
              &lt;p&gt;Here&apos;s how it works: To calculate payment updates under the PFS, the current SGR formula looks at overall spending on physician services, regardless of specialty. 
              &lt;p&gt; 
              &lt;p&gt;That would include payment for, for example, expensive chemotherapy drugs administered by oncologists. Those costs -- really drug costs -- increase the overall price paid for &quot;physician services,&quot; and all doctors, even primary care physicians who don&apos;t administer expensive drugs, are tagged with that cost, said Ted Epperly, MD, president of the American Academy of Family Physicians. 
              &lt;p&gt; 
              &lt;p&gt;Every year, when the SGR is calculated, the rate of growth in spending on physician services has been much higher than the government&apos;s target rate -- which is based on such factors as the growth in the number of Medicare beneficiaries, physician practice expenses, and the gross domestic product. 
              &lt;p&gt;
              &lt;p&gt;So automatic payment cuts are scheduled. 
              &lt;p&gt; 
              &lt;p&gt;By moving the cost of drugs to Part D from Part B, the government&apos;s estimate of physician practice expenses should decrease. So, when the SGR is recalculated, it won&apos;t appear that physician spending missed the government&apos;s target by quite so much.  
              &lt;p&gt; 
              &lt;p&gt;Without legislative action this year, physicians will face a 21% reimbursement cut in 2010 and an additional 6% annual decrease for several years thereafter.
              &lt;p&gt; 
              &lt;p&gt;CMS says the proposed change will not affect the update for services in calendar year 2010, but &quot;would reduce the number of years in which physicians are projected to experience a negative update.&quot;
              &lt;p&gt; 
              &lt;p&gt;Moving drug costs to Part D is &quot;a very positive thing to do. Every physician group will be happy with this,&quot; said Dr. Epperly, who is a family practice physician in Boise, Idaho. 
              &lt;p&gt; 
              &lt;p&gt;He said oncologists would probably be pleased with the change, too, since they&apos;ve long complained that chemotherapy drugs were driving up their costs in Part B.
              &lt;p&gt; 
              &lt;p&gt;A call to the American Society of Clinical Oncologists was not returned. 
              &lt;p&gt; 
              &lt;p&gt;The AMA, which has been a major opponent of including the drugs in Part B, lauded the change. 
              &lt;p&gt; 
              &lt;p&gt;&quot;We are very pleased that the Obama administration agrees with the AMA that drugs do not belong in the physician payment formula,&quot; said AMA president James Rohack, MD.
              &lt;p&gt; 
              &lt;p&gt;While that single change appears to effect all specialties equally, another proposal was met with anger from specialists: CMS said it will reduce payments for expensive imaging services and transfer the savings to primary care physicians. 
              &lt;p&gt;
              &lt;p&gt;According to CMS, current payment rates estimate that a physician uses such equipment 50% of the time. But the agency cited new data indicating that usage is closer to 90%. 
              &lt;p&gt; 
              &lt;p&gt;Thus, the agency argues &quot;the per-treatment costs for purchasing, maintaining, and operating the expensive equipment declines, making a reduction in payment appropriate.&quot;
              &lt;p&gt; 
              &lt;p&gt;&quot;That assumption is wildly overinflated,&quot; said Shawn Farley, director of public affairs at the American College of Radiology. 
              &lt;p&gt; 
              &lt;p&gt;Farley said the 90% estimate was based on a survey of six urban hospitals,  which likely used their imaging equipment with a far greater frequency than physicians&apos; offices would, particularly those located in rural areas. 
              &lt;p&gt; 
              &lt;p&gt;He said radiologists will see a 30% cut in reimbursements because of the change. 
              &lt;p&gt; 
              &lt;p&gt;Cardiologists, meanwhile, expect an 11% cut in reimbursements, according to the American College of Cardiology (ACC). 
              &lt;p&gt; 
              &lt;p&gt;&quot;The American College of Cardiology is shocked that CMS has proposed to cut payments to cardiology services by 11 percent in a single year,&quot; Alfred Bove, MD, president of the ACC, said in a release. 
              &lt;p&gt; 
              &lt;p&gt;&quot;Services that have improved countless lives by diagnosing and treating cardiovascular disease are scheduled to have payment cuts in the range of 25 to 42%.&quot; 
              &lt;p&gt; 
              &lt;p&gt;Most of the cuts would come from reduced payments for left heart catheterizations, transthoracic echocardiograms, and EKGs, said Amy Murphy, ACC&apos;s associate director of media relations. 
              &lt;p&gt; 
              &lt;p&gt;In addition, CMS will begin requiring that suppliers of the technical component of advanced imaging services be accredited beginning in 2012. 
              &lt;p&gt; 
              &lt;p&gt;This would not affect physicians who interpret images, but would apply to physicians&apos; offices and testing facilities that create the images. 
              &lt;p&gt; 
              &lt;p&gt;CMS will also eliminate a category of high-cost billing codes typically used by specialists. 
              &lt;p&gt; 
              &lt;p&gt;Instead of using the &quot;consultation&quot; codes, physicians will have to use the similar, but less expensive &quot;evaluation and management&quot; codes traditionally used for a standard office visit.
              &lt;br&gt;
              &lt;p&gt;This change will likely benefit primary care physicians but negatively affect specialists, such as radiation oncologists and interventional radiologists, who were reimbursed more highly for technical consultations, said Farley. 
              &lt;p&gt; 
              &lt;p&gt;Another move that will benefit primary care physicians is higher reimbursement for its &quot;Welcome to Medicare&quot; visits, bringing payment &quot;more in line with rates for higher-complexity services.&quot;
              &lt;p&gt; 
              &lt;p&gt;One move that should make specialists happy, though, is a change in how Medicare recognizes the cost of malpractice insurance. 
              &lt;p&gt; 
              &lt;p&gt;Although the agency did not spell out the mechanism by which this would happen, it noted that the move will &quot;redirect the portion of Medicare&apos;s payment for professional liability insurance to those physicians that have the highest malpractice costs.&quot; 
              &lt;p&gt; 
              &lt;p&gt;In its announcement on Wednesday, CMS said the payment changes are in &quot;anticipation of enactment of legislation to provide fundamental reforms to Medicare physician payment.&quot; 
              &lt;p&gt; 
              &lt;p&gt;The idea of &quot;shifting&quot; payments from specialists to primary care physicians has been a popular one in the healthcare reform discussion. 
              &lt;p&gt; 
              &lt;p&gt;Specialists, with their expensive machines and big salaries, are often viewed as major drivers of costs. Meanwhile, primary care physicians have been cast as an underpaid, but crucial element for reform, largely for their expertise in preventing expensive diseases before they happen. 
              &lt;p&gt; 
              &lt;p&gt;CMS also said it would begin using a national survey that collects data on practice costs and patterns to help calculate physician payments. The survey is designed and conducted by the AMA.  
              &lt;p&gt; 
              &lt;p&gt;CMS will accept comment on the new rules until Aug. 31 and will issue a final rule by Nov. 1. The new payment rules will apply to physician services provided after Jan. 1, 2010. 
             
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