American College of Physicians: Internal Medicine — Doctors for Adults ®

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Washington briefs

From the November 1997 ACP Observer, copyright 1997 by the American College of Physicians.

CLIA fees to increase Jan. 1

Starting Jan. 1, 1998, medical laboratories will have to pay the government more to get their the biennial certificates required by the federal Clinical Laboratory Improvement Amendments of 1988 (CLIA).

While most physician office labs will see an increase of $50, bringing their overall cost to $150, some labs will pay more based on a sliding scale that represents the quantity of tests they do. The labs that perform the highest volume of tests will pay more than 10 times more than the current fee—$7,940—under the new fee schedule.

The 71,000 labs with certificates that limit them to "waived" tests will have to pay $150 every two years for their CLIA certificate, up from $100. Those that hold certificates allowing them to do provider-performed microscopy—27,000 labs have registered in this category—will pay $200, up from $150, every two years.

According to HCFA officials, the new fees are needed to cover the cost of administering the program. When Congress authorized CLIA five years ago it was to be funded entirely by user fees. The increase is needed because fewer labs participate than Congress anticipated when it authorized CLIA. The new payment schedule was announced in the Aug. 29 Federal Register.

ACP urges 'meaningful standards' to improve quality

As the President's Advisory Commission on Consumer Protection and Quality in the Health Care Industry works to draft a "consumer bill of rights," which is expected to be completed this fall, the College sent a letter urging adoption of "meaningful standards" so that the financial incentives present in many managed care systems will not "undermine efforts to maintain high quality care."

According to the letter sent last month to the commission's co-chairs, ACP recommends standards that establish a framework for quality assurance and improvement. This would include ongoing monitoring and evaluation of care through an accreditation process; dissemination of comparative information concerning the quality of care provided by a health plan; and provision of financial incentives for quality improvement.

The College also urged the commission to include in its "bill of rights" the "Principles of Accountable Managed Care," a document that was endorsed by a coalition of organizations that included ACP. It lays out a series of rights for plan enrollees and potential enrollees that include access to care, quality assurance and improvement, consumer information, education and choice.

Internists appointed to payment panel

Three internists were named last month to the new Congressional Medicare Payment Advisory Commission (MedPAC), which was established in the new federal budget law to replace the Physician Payment Review Commission and the Prospective Payment Assessment Commission.

Appointed were Woodrow A. Myers Jr., FACP, the director of health care management at Ford Motor Company in Dearborn, Mich.; John W. Rowe, FACP, president of Mount Sinai Medical Center in New York; and Donald T. Lewers, FACP, a practicing physician in Easton, Md., and a member of the AMA Board of Trustees.

The 15-member commission will be chaired by Gail R. Wilensky, PhD, senior fellow at Project Hope; the vice chair will be Joseph P. Newhouse, PhD, a professor of health policy and management at Harvard University. MedPAC will advise Congress on issues relating to how Medicare pays providers.

HFCA reinstates full funding for med-peds residents

HCFA will now fund housestaff in their fourth and final year of combined medical-pediatrics residency programs, not just for the three years it takes for residents in either internal medicine or pediatrics to become board eligible.

The new legislation reverses HCFA's 1995 ruling in which the agency said it would fund housestaff in combined residency programs only for the number of years it took residents to become board eligible in the longer of the two programs. For medical-pediatrics residents that meant funding ended after three years.

However, residents in combined medical-pediatrics programs are not eligible to take either board exam until they have completed the entire four-year training program.

The new legislation was included in the budget reconciliation bill as part of the Primary Care Promotion Act of 1997. It was passed in part due to efforts by the College, which argued in letters to and meetings with members of Congress that HCFA should fund the full four years of training.

"The new legislation will assure that Medicare will provide its full share of GME funding for the four years required to complete residency training in these combined primary care programs," said Jack Ginsburg, ACP's Senior Associate for Policy Analysis.

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