February 29, 2008

1. Working Group Provides Recommendations to NIH Peer Review Process

2. CMS Finds 16% of Physicians Report Quality Data

1. Working Group Provides Recommendations to NIH Peer Review Process

On Thursday, February 21, 2008, the National Institutes of Health (NIH) Advisory Council to the Director (ACD) Working Group on Peer Review released its draft recommendations for enhancing the efficiency and effectiveness of the NIH peer review system. The goal of the working group was to “identify the most significant challenges to the system used by NIH to support science and propose recommendations that would enhance this system in the most transformative manner.”

The recommendations that emerged from the investigative process broadly focus on a reduction of administrative burden, enhancement of the grant review and rating system, and an increase in support for varying career stages and pathways. In particular, the recommendations include shortening the application length, denoting ineffective or insignificant applications as “not recommended for resubmission,” and implementing new priorities—each receiving a unique score—for proposals that focus on significance and innovation. In order to maintain the quality and scientific merit of applications, all resubmitted (A1 or A2) applications would be considered “new.” Applicants may resubmit applications with or without revisions and reviewers would not receive the previous cycle’s reviewer comments when assessing the resubmitted grant.

To provide support for career development, the working group also recommends a minimum percent effort on research project grants—principal investigators would be required to devote a minimum of 20% effort, unless less effort is explicitly justified to the sponsoring institute or center. To better support new investigators, the working group proposes increasing the number of R01s for first-time investigators, and suggests reviewing early career investigators separately and ranking them in relation to each other to enhance the risk-taking and innovation of applicants.

NIH Center for Scientific Review (CSR) Director Antonio Scarpa, MD, PhD, presented the efforts of the working group and CSR to the Association of Professors of Medicine (APM) membership at their 2008 Winter Meeting Thursday, February 28, 2008. Dr. Scarpa highlighted changes to the peer review system that were implemented prior to the formal peer review assessment, particularly pilot studies for shortened applications and timelines, incentives for study section reviewers, and reorganization of the CSR divisions and integrated review groups. He discussed many of the working group’s recommendations in detail; in addition to those mentioned above, Dr. Scarpa addressed the proposed national volunteer registry for study section members and methods to ease the burden on reviewers, including electronic and video conferencing review meetings and moving some study section meetings to the West Coast. Dr. Scarpa cautioned the recommendations are in early form and require approval from NIH Director Elias A. Zerhouni, MD.

The list of recommendations emerged out of a diagnostic phase that began in the summer of 2007, during which NIH staff, the extramural community, advocacy groups, professional society groups, deans and other stakeholder communities were invited to provide comments and suggestions for strengthening the scientific competence, fairness, and integrity of the NIH peer review process. A summary of gathered comments and data was released to the public in November 2007. A formal presentation of the recommendations will be made to Dr. Zerhouni, Friday, February 29, 2008. Subsequent steps will include the formation of an implementation team to establish a more detailed timeline for the proposed recommendations, which will then be submitted to ACD.

more information on the NIH Peer Review System, please visit the peer review website.

2. CMS Finds 16% of Physicians Report Quality Data

According to Centers for Medicare & Medicaid Services (CMS) Acting Administrator Kerry Weems, 99,000 physicians and health care professionals (16% of the total number of eligible professionals) participated in Medicare’s 2007 physician quality reporting initiative (PQRI). Mr. Weems reported the progress of PQRI in a letter sent to the Senate Finance Committee Tuesday, February 26, 2008.

According to Mr. Weems, PQRI is an important first step toward creating a value-based purchasing program for physicians. Regarding the 16% participation rate, Mr. Weems believes it will increase over time, similar to the steady increase in participants for the Medicare participating physician program, which jumped from 30% to 90% in its first 10 years. In addition, Mr. Weems believes the participation rate in 2007 is significant considering the incentives were applied for only six months, and health professionals cited “uncertainty about continuation of payment incentives after 2007” as adversely affecting the decision to participate in the program. Experts believe the number of physicians who take part in PQRI may increase due to legislation passed in January (PL 110-173) that will extend the 1.5% incentive payments to physicians who successfully report measures during 2008 (AAIM Connection, January 11, 2008).

In his letter, Mr. Weems notes three specialties in particular—emergency medicine, anesthesiology, and ophthalmology—had above average rates of participation. In regions with the highest participation, reporting rates reached approximately 20%. To have been considered a participant in PQRI, a health care professional must have submitted quality data at least once during the 2007 reporting period, which began July 1, 2007, and ended November 30, 2007.

Mr. Weems reported that he is “encouraged by the preliminary success of the 2007 PQRI program.” In addition, Senate Finance Committee Chair Max Baucus (D-MT) praised the progress of the initiative stating, “the proof lies in the results, and CMS must now take important steps to improve how it collects information and provider performance and expand opportunities for doctors to participate.”

The Alliance for Academic Internal Medicine—the nation’s largest academically focused specialty organization—consists of the Association of Professors of Medicine, the Association of Program Directors in Internal Medicine, the Association of Subspecialty Professors, the Clerkship Directors in Internal Medicine, and the Administrators of Internal Medicine.

Please contact AAIM Vice President for Policy Charles P. Clayton (cclayton@im.org), AAIM Policy Coordinator Nicole V. Baptista (nbaptista@im.org), AAIM Policy Associate Allison L. Haupt (ahaupt@im.org) or AAIM Policy Assistant Jessica L. O'Hara (johara@im.org) at (202) 861-9351 with questions or comments about this week’s Merlin.