Published 1/1/2013

Second Look-Advocacy

AMA principles for physician employment
The American Medical Association (AMA) has adopted new principles for physicians entering into employment and contractual arrangements. The principles address six potentially problematic aspects of the employer-employee relationship, including conflicts of interest, advocacy, contracting, hospital-medical staff relations, peer review and performance evaluations, and payment agreements. According to the AMA, more physicians are expected to enter into employment and other contractual relationships with hospitals, group practices, and other health systems over the coming years.

The AAOS has a primer for physicians considering employment opportunities and one on hospital–physician alignment strategies. Both can be downloaded at no charge from the online practice management center, www.aaos.org/pracman

Survey: Inadequate communication on referred patients
An internationally conducted survey published online in Health Affairs finds that primary care physicians in many countries, including the United States, say that communication with specialist physicians is often lacking. Just 11 percent of U.S. primary care physicians reported receiving timely information from specialists regarding referred patients. In addition, U.S. physicians were the most likely of all groups to report that they spent substantial time grappling with insurance restrictions and that their patients often went without care because of costs.

Advantages, concerns with bundled payments
An article in the New England Journal of Medicine (NEJM) (Nov. 15, 2012) discusses the four basic payment models for bundled payments under Medicare and examines the advantages and disadvantages of the models and bundled payments in general. The authors argue that the success of bundled payments initiatives will depend on how well the system protects participants against losses resulting from both random and systematic variation in illness severity.

SGR delay will cost $25 billion
According to information obtained by The Hill, the U.S. Congressional Budget Office (CBO) estimates that a 1-year delay for cuts mandated under the Medicare Sustainable Growth Rate (SGR) formula will cost $25 billion—an increase from previous projections of $18.5 billion. The CBO further estimates that a 2-year SGR delay would cost $41.5 billion, while a 10-year delay would cost nearly $244 billion.

ICD-10 transition help
The U.S. Centers for Medicare & Medicaid Services (CMS) has prepared a list of questions for providers that may be helpful in talking with vendors about making the transition to the International Classification of Diseases Version 10 (ICD-10) revision of diagnostic and procedural codes. The questions cover such topics as transition status to Version 5010 standards for electronic transactions, gauging progress in the ICD-10 transition process, designation of a primary contact for ICD-10 transition, claims testing, and more. A proposed final rule previously announced by CMS delays adoption of the new system from Oct. 1, 2013, to Oct. 1, 2014, but the agency recommends that providers begin the transition process as early as possible.

DOJ reports record recovery of fraud funds
The Washington Post
reports that the U.S. Department of Justice (DOJ) civil division pursued fraud settlements and judgments under the False Claims Act to recover a record $5 billion during the past fiscal year. According to DOJ, much of the fraud money was recovered from the healthcare industry, with a $1.5 billion payment from GlaxoSmithKline to resolve allegations that the company promoted drugs for off-label use and paid physicians to prescribe the drugs.

These items originally appeared in AAOS Headline News Now, a thrice-weekly enewsletter that keeps AAOS members up to date on clinical, socioeconomic, and political issues, with links to more detailed information. Subscribe at www.aaos.org/news/news.asp (member login required)