Washington -- Ten large physician practices participating in one of the first Medicare pay-for-performance projects have proven that such programs lead to better performance, according to government officials. But only two practices were able to reduce costs enough to receive any additional pay.

Last month, the Centers for Medicare & Medicaid Services released first-year results from the Medicare Physician Group Practice Demonstration, which launched in April 2005. CMS asked 10 practices to implement care management improvements that would lead to higher quality of care. In return, the practices were eligible to receive as a bonus a portion of the money that they saved Medicare by improving patient care in a targeted group of Medicare enrollees.

CMS found that all of the participants were able to hit or exceed standards on at least seven out of the 10 clinical quality measures for the treatment of diabetes, the only condition targeted in the project's first year. For the pilot's second and third years, the agency is adding congestive heart failure, coronary artery disease and preventive care measures.

Two of the participants, Forsyth Medical Group in Winston-Salem, N.C., and St. John's Health System in Springfield, Mo., were able to make the grade on all diabetes measures.

The physicians and other health professionals involved in the pilot saved Medicare money, in part, by reducing repeat office visits, hospitalizations and trips to emergency departments, federal officials said.

[...]

Private health plans' push for pay-for-performance and Medicare's first steps in that direction have garnered much attention. But the trend isn't confined to these two sectors. State Medicaid agencies have quietly entered the game in an effort to try to improve enrollees' care.

As of mid-2006, at least 28 states had 35 Medicaid pay-for-performance programs. Two were specifically designed for primary care physicians, although others involve doctors.

Physicians can expect to see more initiatives. In the next two years, at least 34 states are planning 47 new programs, including nine directly involving primary care doctors, according to a recent report by the Commonwealth Fund.

However, doctors shouldn't expect to see a tidal wave of comprehensive changes because most programs have tailored goals, such as improving childhood immunization rates and care of patients with chronic diseases, or controlling costs.

That narrow focus is partly due to a lack of evidence-based standards for children, said E. Susan Hodgson, MD, chair of the American Academy of Pediatrics' Steering Committee on Quality Improvement and Management. About half of Medicaid enrollees are children.

Many states are using or customizing the National Committee for Quality Assurance's Healthcare Effectiveness Data and Information Set measures. HEDIS standards mostly focus on adult care.

The Alliance for Pediatric Quality, formed in 2006 by four pediatric organizations, is working to fill the standards gap. The alliance, which includes the AAP, is developing evidence-based standards for children and electronic medical records compatible with children's care.

[...]

Washington -- Add the State Children's Health Insurance Program to the list of issues on which Congress and President Bush fundamentally disagree.

On July 17, Bush promised to veto a bipartisan Senate SCHIP reauthorization bill to increase the program's five-year funding by $35 billion, from $25 billion to $60 billion. The measure, approved 17-4 by the Senate Finance Committee on July 19, with six Republicans voting in favor, would allow another 3.3 million uninsured children to gain coverage. SCHIP now covers 6 million children.

The veto threat cast a shadow over the Senate bill, a compromise carefully negotiated over several weeks. The measure backed away from the $50 billion boost, for total five-year funding of $75 billion, approved by House and Senate lawmakers May 7 in their budget resolution.

House leaders were expected to stick with the $50 billion funding increase in their SCHIP reauthorization legislation, said a House Energy and Commerce Committee aide. At press time, that measure was scheduled for a committee vote on July 25.

Bush said he views the Senate bill as an attempt to federalize health care. He also objected to lawmakers' plan to raise the extra $35 billion by increasing the national cigarette tax by 61 cents to $1. "If Congress continues to insist upon expanding health care through the SCHIP program -- which, by the way, would entail a huge tax increase for the American people -- I'll veto the bill," Bush said.

[...]

Washington -- Oregon will offer health insurance to all uninsured residents by 2010 if the state can carry out a recently adopted plan and if voters approve a cigarette tax.

In late June, Oregon Gov. Ted Kulongoski signed the Healthy Oregon Act, a 14-page road map for reforming the state's health care system and covering all of the state's roughly 615,000 uninsured residents -- about 17% of the population. The law calls for a health insurance pool for the uninsured and suggests an individual insurance mandate.

One of the measure's sponsors, Sen. Alan Bates, DO, compared the task at hand -- providing universal insurance access while improving health care quality and reducing costs -- to climbing Mount Everest. "We've just established base camp," said Dr. Bates, a family physician.

The measure creates the seven-member Oregon Health Fund Board to design a plan for the insurance pool and overall reforms. On July 9, Kulongoski appointed as the board's executive director Barney Speight, his deputy chief of staff and former deputy administrator for the Washington State Health Care Authority. The Oregon board will issue an interim report in February 2008 and final reform recommendations that October.

Democratic lawmakers also are asking voters to approve a constitutional amendment boosting the cigarette tax by 84.5 cents to provide health insurance for children up to age 19. The tax, part of Kulongoski's Healthy Kids Plan, would increase the cigarette levy to $2.025 and raise $152.7 million by 2009 to cover 117,000 uninsured kids. The vote split along party lines, so House Democrats didn't reach the 60% majority required for tax increase passage.

[...]

I had an inquiry last week from Taradel, a print services firm that does some specialty print work in the CAM/holistic industry, particularly with chiropractors. If you're in the US and considering any print work, particularly newspaper inserts, you may want to check them out. Here's a snippet from what I received from them:
Business owners who visit Taradel.com are able to plan, design, target, print, and deliver full-color newspaper inserts and flyers directly into the homes of potential clients.

Dr. Glenn Muller, an innovative chiropractor who runs a family-owned practice in Richmond, VA, has used print advertising to become one of the area’s premier spinal correction centers. “We order at least 50,000 newspaper inserts at a time and we distribute them on a weekly schedule. As soon as our inserts go into circulation we receive phone calls and schedule new appointments for the following ten days.” Muller’s practice, the Spinal Correction Center of Richmond, has successfully combined patient testimonials, high quality graphics, and valuable information pertaining to their new spinal decompression practice into their practice growth campaigns.

Taradel offers a growing library of chiropractic marketing resources, free of charge, for practice owners to review and incorporate into their own advertising. The site features free podcasts, in-depth articles, instructional webcasts, and even samples of previously successful chiropractic inserts. For only $375, chiropractors can print 10,000 full-color, glossy newspaper inserts. That’s less than $0.04 each!

Taradel offers a bunch of free practice growth resources on their site, as well as a number of other print services like postcards, booklets, etc. I know there are a zillion printers out there, but sometimes it's helpful to deal with someone who has some experience with your market, and testimonials to boot. If you give them a try, let us know how it goes.

http://www.taradel.com/practicegrowth