News in brief - Dec. 24/31, 2007

Most seniors retain good access to doctors, survey finds - Medicaid entities owe $1 billion in taxes - State budgets squeezed by health care spending - Maine to scrutinize child sexual abuse reporting mandates - Grassley targets spending at Iowa QIO

Most seniors retain good access to doctors, survey finds

Most Medicare beneficiaries continue to report that they are able to get timely appointments with their physicians, but the percentage having trouble finding a new primary care doctor has gone up slightly this year, according to the Medicare Payment Advisory Commission.

At its meeting earlier this month, MedPAC began the process of determining a 2009 Medicare physician payment update recommendation for Congress. As part of its deliberations, the commission reviewed a September survey of program enrollees to see if any physician access problems had emerged because of payment rates to doctors.

MedPAC found that 75% of beneficiaries reported never encountering appointment delays for routine care, the same rate as in 2006. The percentage of Medicare patients who reported no problems finding a new primary care physician when needed, however, dropped from 76% in 2006 to 70% this year.

Physician organizations have warned that cuts or continued stagnation in Medicare payments to physicians will lead to increased access problems for seniors.

Medicaid entities owe $1 billion in taxes

While the vast majority of those treating Medicaid patients pay their taxes, more than 30,000 hospitals, nursing homes, physicians and others owe a combined $1 billion in federal taxes that should have been paid between 2000 and 2005, according to a report released last month by the Government Accountability Office. The GAO identified this group -- which represents about 5% of entities paid by Medicaid -- from a non-representative sample from seven states: California, Colorado, Florida, Maryland, New York, Pennsylvania and Texas.

Of the taxes owed, 56% were payroll taxes, 31% were individual income taxes and the rest were other taxes. The GAO was not able to specify how many of the 30,000 entities it identified are physicians, an agency spokesman said.

State budgets squeezed by health care spending

Health care costs in general and Medicaid in particular will continue to put pressure on state budgets over the next decade, according to a report released earlier this month by the National Governors' Assn. and National Assn. of State Budget Officers.

The Congressional Budget Office has estimated that state health spending will increase by an average of 8% annually over the next decade, the report noted.

Although Medicaid spending grew by just 1.7% in fiscal year 2006, the report estimates that there was a 7.3% increase in fiscal year 2007, due in part to state funding for Medicare Part D. Medicaid accounts for about 22% of state spending, and health care in general represents about one-third of state spending.

Maine to scrutinize child sexual abuse reporting mandates

Maine's Office of the Attorney General will clarify the scope of state laws requiring health care professionals to report the suspected sexual abuse of children younger than 14.

The announcement came after State Health and Human Services Dept. Commissioner Brenda M. Harvey, in a Nov. 1 letter to the attorney general, questioned how certain criminal reporting mandates affect the health department's obligation "to investigate so as to 'protect and assist abused and neglected children,' " or children at risk for such abuse.

Maine Medical Assn. officials are concerned that a broad interpretation of the laws could require doctors and other health care professionals to report to law enforcement officials any underage sexual activity, even without a reasonable suspicion of abuse. Doctors, particularly pediatricians, are worried that such an interpretation would impinge on their medical judgment and deter young patients from seeking necessary care for fear of being reported, the medical society said.

Grassley targets spending at Iowa QIO

Senate Finance Committee Ranking Member Charles Grassley (R, Iowa) is pressing the Centers for Medicare & Medicaid Services to explain how it is dealing with a Medicare quality improvement organization in Iowa that was involved in making inappropriate federal expenditures with agency approval. CMS is reviewing his request.

The Iowa Foundation for Medical Care, the state's QIO, was found by federal investigators to have incurred more than $200,000 in inappropriate spending over a three-year period, including more than $80,000 spent on electronic equipment for use by employees of CMS and the contractor. The investigation found that the QIO was directed to make the inappropriate purchases by a single agency employee, Grassley said.

"That CMS official needs to be held accountable for unauthorized expenditures, and CMS needs to make sure the problem isn't bigger than this one case and one employee," he said.

For several years, Grassley has been investigating what he views as questionable spending of taxpayer money by the QIOs, which -- among their other duties -- partner with physician practices to improve the quality of care provided to Medicare beneficiaries.

The doctors are in the house
The AMA's House of Delegates is holding its Interim Meeting Nov. 7-10 in Houston, addressing issues such as health system reform and physician payment.
AMA House - Slideshow - Updates