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Two days before the U.S. House of Representatives planned to vote on a major health system reform bill, the American Medical Association came out in support of that measure and a companion bill that would address long-term Medicare pay for doctors.

AMA President J. James Rohack, MD, announced the Association's support for the Affordable Health Care for America Act during a Nov. 5 conference call with reporters as House Democratic leaders prepared the legislation for floor consideration. Leaders were aiming for an unusual Saturday vote on the primary reform bill on Nov. 7 but had not yet scheduled a floor debate for the Medicare Physician Payment Reform Act of 2009. That bill would repeal the sustainable growth rate formula that determines doctors' rates.

"These are separate bills but must be passed together," Dr. Rohack said. "Both are essential to achieving meaningful health system reform this year."

But Dr. Rohack stopped short of saying the Association would definitely withdraw its support for the larger health system overhaul bill if the Medicare pay piece did not accompany it. He also noted that the AMA's support for the Affordable Health Care for America Act was not a full endorsement, saying the legislation meets the organization's main principles for health system reform but still needs improvement.

"This legislation isn't perfect, but this debate is not over, and the work is not done," Dr. Rohack said. "The AMA will continue to work constructively with members of Congress and the White House to improve legislation and to make sure the voices of physicians and our patients are heard."

Because of the speed at which the bill was proceeding in the House, the AMA stated its position before the official start of its Interim Meeting, Dr. Rohack said. The AMA's policymaking House of Delegates is scheduled to meet in Houston Nov. 7-10.

The AMA is still seeking changes to the House reform bill, Dr. Rohack said, including a provision to open up more graduate medical education slots in general surgery, childhood and adolescent psychiatry, addiction medicine and other areas where training opportunities are lacking. The current bill expands GME only in primary care.

Dr. Rohack acknowledged that at least two state medical societies, the Texas Medical Assn. and the Illinois State Medical Society, came out against the House system reform legislation before the floor vote. But he also noted that numerous medical specialty organizations have joined the AMA in supporting the House bill.

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Washington The Centers for Medicare & Medicaid Services on Oct. 21 began accepting bids from accredited durable medical equipment, prosthetics, orthotics and supply companies in nine metropolitan areas to decide whether they can participate in the Medicare program.

The round one rebid for the DMEPOS competitive bidding program will be open for 60 days. It initially was launched July 1, 2008, but was halted after only two weeks when lawmakers agreed to an 18-month moratorium, citing patient access concerns raised by suppliers.

Earlier this year, the Obama administration reviewed the program and said it would move forward after making several revisions. The nine metropolitan statistical areas involved in round one are: Cincinnati-Middletown; Cleveland-Elyria-Mentor; Charlotte-Gastonia-Concord, N.C. and S.C.; Dallas-Fort Worth-Arlington; Kansas City, Mo. and Kansas City, Kan.; Miami-Fort Lauderdale-Pompano Beach; Orlando; Pittsburgh; and Riverside-San Bernardino-Ontario, Calif.

Ninety-three percent of all medical equipment suppliers in the country have met Medicare's accreditation requirements, CMS said.

In October, the agency also announced it had made several modifications to the bidding program to help suppliers successfully submit a bid, including:

• An early comprehensive bidder education program to help suppliers understand all aspects of the bid submission and evaluation process.
• A more user-friendly bid submission process that provides a new online system, upgraded instructions and a special process for suppliers to have their financial bid documents reviewed for completeness.
• Enhanced scrutiny of bidders, including up-front licensure verification, accreditation of subcontractors and bidder disclosure of subcontractors.

"We expect that these and other refinements will result in the selection of quality contract suppliers offering a choice of products to beneficiaries at a substantial savings," said Jonathan Blum, director of the CMS Center for Medicare Management.

The bidding program has been staunchly opposed by the American Assn. for Homecare, which represents DMEPOS suppliers. The association said the return of competitive bidding will allow Medicare to contract selectively with a small fraction of equipment suppliers while putting most of them out of business.

The association is pushing a bill introduced Oct. 13 by Rep. Kendrick Meek (D, Fla.) that would repeal the competitive bidding program.

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Evan Paul Nadler, MD surgeon at Children's National Medical Center and colleagues from New York University have found laparoscopic adjustable gastric banding (Lap band) to improve the health of morbidly obese adolescents.

The study, reported in the Journal of the American College of Surgeons, involved nearly 50 girls and boys ages 14-17. The participants showed significant decreases in total and android fat mass 2 years after surgery. Android fat has been associated with the development of obesity-related illnesses, such as diabetes, heart disease, and insulin resistance.

"This study is the first to demonstrate the improvements in overall health and distribution of weight loss after Lap band surgery in adolescents," said Evan Nadler, MD, the main author and pediatric surgeon at Children's National. "While weight-loss surgery should always be a last resort for adults and adolescents, these findings show us that surgery in adolescents reduces the risk of significant health complications".

The study observed that Lap band surgery improved glucose metabolism, reducing the adolescents' risk of developing insulin resistance. Additionally, bone mineral density was not impacted by the surgery, suggesting that bone growth is not affected.

Dr. Nadler is the co-director of the Obesity Institute at Children's National Medical Center, which is comprehensively addressing the epidemic of childhood obesity. Staff includes pediatricians, nutritionists, psychology experts, heart specialists, gastroenterologists, and surgeons who treat patients and families in a clinical setting. The Obesity Institute also includes scientists looking at genetic differences and racial disparities, especially among children and adolescents, as well as community-based research among different ethnic groups.

Dr. Nadler was an investigator for Allergan, which makes the device used in the study. Funding was provided by the Harris Obesity Prevention Effort at New York University and performed at NYU Medical Center.


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Posted by: Evelyn    Source

Physicians in smaller practices may not need to grapple for long with a federal regulation mandating the implementation of an identity theft prevention program. The House on Oct. 20 passed legislation that would exempt most practices from the "red flags" rule, which has an enforcement date of Nov. 1.

The Federal Trade Commission regulation requires entities that regularly extend credit or defer payment for services to implement a formal policy for detecting and preventing identity theft. Despite objections from the American Medical Association and other organizations, the commission counts physician practices as creditors if they bill patients for past services or allow patients to set up payment plans.

But the new legislation, authored by Rep. John Adler (D, N.J.), would amend the definition of a creditor to exclude businesses with 20 or fewer employees, including health care practices. The bill now heads to the Senate for consideration.

Other provisions would exempt entities that:

• Know all of their customers individually.
• Only perform services in or around the residences of its customers.
• Have never experienced incidents of identity theft or are in an industry where such occurrences are rare.

The legislation leaves it up to the FTC to determine whether a particular business meets the criteria for an exemption.

The AMA has not taken a position on the bill but is generally supportive of efforts to remove doctors from the rule's scope. The Association has argued to the FTC and lawmakers its position that physicians are not creditors under the law, and the mandate would unnecessarily burden small physician practices both administratively and financially.

Efforts by organized medicine have resulted in three prior delays of the final enforcement of the red flags rule.

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