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6 Victories in 6 Months and a Medicare Win Too! Managed Care Reform Legislation In July, then Governor Pataki signed into law a Medical Society initiative that begins to re-balance the business relationship between physicians and health insurers. This bill Reduces the denial look back period from six years to two years
This is only the beginning. We are optimistic that more victories will ensue with the political changes taking effect in Albany this year. Aetna – Payment for Anesthesia Services Associated with Endoscopy Procedures Early last year, Aetna announced that it would no longer pay for certain anesthesia services for endoscopy procedures. In concert with several national specialty societies, we objected to this proposal. After discussion with Aetna’s Chief Medical Officer and other company representatives, Aetna withdrew its proposal. The company is currently revising the policy. Through the communication bridges that we are building, we will have the opportunity to comment on the revised policy before it is finalized. Excellus Blue Cross/Blue Shield – Proposed Reimbursement Cut in Oswego County In the first quarter of 2006, Excellus announced that, effective June 1, 2006, reimbursement rates paid to Oswego County physicians would be reduced from 7-30%. Upon receiving this information, Oswego County physicians, the County Medical Society and MSSNY strenuously objected to the proposal both politically and publicly. We were able to negotiate an agreement with Excellus where no rate cut would take effect until a mutually selected consultant could analyze each affected physician’s situation to determine whether a rate cut was justified. Physicians in the county have not lost a dime, and patients’ access to care has not been negatively affected. The consultant’s report has been completed. We are reviewing the results and are confident of being able to negotiate an amicable long term solution with the company. Success in Oswego County will mean success in other counties where health insurers seek similar rate reductions. Empire Blue Cross/Blue Shield –
Financial Responsibility for Non-Network Services Aetna – Facility Fees GHI/HIP Merger PLUS Congress has passed legislation preventing the 5% Medicare physician fee cut originally scheduled to go into effect on January 1, 2007, as well as additional cuts affecting physicians in rural areas. The bill also provides a 1.5% bonus incentive payment to physicians who voluntarily report quality data beginning July 1, 2007. While we will continue to seek a permanent fix to the flawed Medicare reimbursement formula for the future, we are glad to report these savings to you now, especially since the Medicare fee schedule affects payments of so many other insurers, as well. Get on board and give your support to strengthen our ability to accomplish these and other things for the profession. Don’t ask yourself “How can I afford to be a member?” Ask yourself “HOW CAN I AFFORD NOT TO?”
The prevalence of diabetes among Nassau County adults is 7.8%, with estimates for some communities as high as 11.0%. Due to the impact that diabetes has on an individual’s life, Nassau County Department of Health has instituted a new program to support physicians who provide care to diabetics. The Physician Review for Diabetes Excellence (PRIDE) is based on a nationally recognized model for quality improvement to assure evidence-based care for those with, or at risk for, pre-diabetes and diabetes as well as to assist physicians in maximizing time management, billing, and reimbursement in their offices. The program includes a free and confidential assessment of medical charts to evaluate diabetes prevention, diagnosis, and management strategies in individual physician offices. PRIDE is based on National Committee for Quality Assurance’s (NCQA) Diabetes Physician Recognition Program and National Diabetes Quality Improvement Alliance (NDQIA) performance measures for adult diabetes. A board-certified family physician conducts chart reviews in individual physician offices to determine adherence to the most recent guidelines for primary, secondary, and tertiary prevention of pre-diabetes and diabetes. After careful analysis, data from each practice is presented to the individual physician offices and an educational session with the board-certified physician is conducted. The health department will be contacting physician offices in the coming weeks to review the details of the program. For more information regarding this program, please contact Nassau County Department of Health at (516) 571.3748.
The International Federation of Pharmaceutical Manufacturers and Associations, a trade group that represents pharmaceutical companies worldwide, on Wednesday announced that members no longer can provide expensive gifts to physicians under a revised code of ethics reports. Under the code, which IFPMA revised on Jan. 1 for the first time in 10 years, members cannot provide physicians with money or expensive gifts – such as trips to golf resorts or stays in luxury hotels. In addition, according to the 21-page code, medical and scientific meetings held by members should not occur at "renowned or extravagant venues." The code allows members to provide physicians with gifts that are related to prescription drugs or that are inexpensive, such as pens or stethoscopes. IFPMA has established a network of pharmaceutical industry sources to monitor compliance with the code, as well as a panel of experts to hear complaints and appeals. In addition, IFPMA will make violations of the code public. IFPMA members include Pfizer, GlaxoSmithKline, Sanofi-Aventis, Eli Lilly, AstraZeneca, Merck and Novartis. The guidelines are available at the IFPMA website. These guidelines are in general agreement with the federal guidelines issued in 2004.
Do you want the chance to speak to your legislator about physician issues? This is it! On Tuesday, March 6, MSSNY is sponsoring its Annual State Legislation. The morning session consists of breakfast and key healthcare speakers. Lunch will be followed by a visit to legislators in their offices. All appointments will be made well in advance of your visit. MSSNY will provide you with background information, and you will be accompanied by your county executive and physicians from your area who will bring you up to date on all the important issues. Call 516-832-2300 ext 14 to make transportation arrangements.
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The American Medical Association and MSSNY concur with MedPAC's recommendation that Congress stop the 2008 Medicare physician payment cut and update payments in line with medical practice cost increases, and thanks the commission for its thoughtful review. Current payments are essentially the same as they were in 2001, and over the next eight years Medicare physician payments are slated to be cut about 40 percent, while practice costs increase nearly 20 percent. The AMA is concerned that without congressional action, seniors will pay the price of this flawed payment policy with reduced access to physician care. According to a statement sent to all legislators by Cecil Wilson, AMA Board Chairman, "The last thing doctors want to do is stop caring for this vulnerable population, but the repeated specter of steep payment cuts forces doctors to make difficult decisions. A MedPAC survey of patient access in 2006 found that about 25 percent of Medicare patients seeking a new primary care physician continue to have problems finding one, and for the first time the number of Medicare patients having problems finding a new specialist was higher than the rate of privately insured patients. Also of concern, the share of Medicare patients reporting 'big problems' finding a specialist 'significantly increased' between 2004 and 2006. In a forthcoming report mandated by Congress, the Commission has also laid out an alternative that would expand the Medicare spending limit currently applied only to physician services to hospitals and other Medicare providers. No amount of tinkering can fix what is broken beyond repair. Instead of expanding the broken physician payment formula to other providers, physician payment updates should be determined using the same approach used for other providers - based on the cost of providing care." Patients Should Call 1-800-Medicare Not Upstate Medicare Division. The Upstate Medicare Division (UMD) has been receiving calls on our provider toll-free line from beneficiaries who state their provider gave them the telephone number. We would like to remind all providers that when you advise your patients to call Medicare for information, please direct them to call 1-800-MEDICARE (1-800-633-4227). For more information about the beneficiary toll-free telephone number, see page 10 of the June 2004 Medicare B Hotline Bulletin.
REGRESSIVE LIABILITY MEASURES REINTRODUCED Two bills that would drastically expand liability expansion against physicians have again been re-introduced early in the 2007 Legislative Session. The first bill, S.790 (DeFrancisco) would remove the current statutory limit on the fees attorneys can make in medical liability actions. The second bill, S.1266 (DeFrancisco), would expand the damages awardable in a wrongful death action. MSSNY has successfully fought these proposals in past legislative sessions, warning the Legislature that, if either of these bills were to pass, it could literally shut down the health care system due to the unsustainable liability exposure it would create against physicians. However, as it is often said, past success is not a guarantee of future results. Physicians need to again remind their legislators that medical liability exposure must be decreased, not increased. Physicians are already at a breaking point due to the squeeze between decreasing reimbursement from insurance companies on the one side and rapidly rising liability insurance costs on the other. Physician liability premiums increased an aggregate 15% this past July and have gone up 30-47% in the last four years. MSSNY MEETS WITH KEY POLICYMAKERS ON WORKERS’ COMP MSSNY President-elect Robert Goldberg, DO, met with key Assembly and Senate members and staff this week to urge adoption of MSSNY’s proposals to reform the state’s workers’ compensation system. Workers’ compensation reform has been identified by Governor Spitzer as one of his major goals for the 2007 Legislative Session. Many physicians have expressed concern that the “hassle factor” and insufficient fees involved in Workers’ Compensation have caused them to limit the number of workers’ compensation patients they will treat. Among the areas discussed by Dr. Goldberg for needed reforms include: reducing the ability of insurance carriers to inappropriately delay injured worker’s needed care; raising the fee schedule for the first time in over a decade; providing for an expedited dispute resolution process; and greater enforcement of awards granted by the Workers’ Compensation Board. ASSEMBLY HEALTH COMMITTEE HOLDS FIRST MEETING OF THE NEW SESSION MSSNY issued memoranda of support for two bills on the Assembly Health Committee agenda this week. A538 by Assemblywoman Paulin (D-Westchester) prohibits smoking in all (public and private) dormitories, residence halls, and other group residential facilities. The Health Committee acted favorably on this bill and it was reported to the Assembly Codes Committee which has jurisdiction over the penalty provisions. The movement on this legislation came at the same time that SUNY took the initiative to ban smoking in all dorms, as reported last week in Capital Update. In other action, the Committee chose to defer a vote on A277 by Assemblyman Wright (D- Manhattan). This bill establishes a data collection and assessment system analyzing health care data to determine the degree of disparity of care delivered to minority populations. Following review, amendments were suggested to ensure patient confidentiality and ensure that the onus is on the department of health, not individual hospitals, to collect and analyze the data. The bill is expected to be amended and brought back on the Committee’s agenda in the near future.
As of May 22, 2007, most physicians will have to use a National Provider Identifier (NPI) number when submitting claims and conducting most transactions with the Centers for Medicare and Medicaid Services (CMS) and with most health plans and healthcare clearinghouses. According to a final rule issued by CMS on April 21, all physicians who are enrolling with Medicare for the first time or changing any of their practice information with their Medicare Carrier, will have to have an NPI now to do so. It is, therefore, essential for all physicians to know what an NPI is, why and when it might be needed and how to get it. MSSNY offers answers to these and related questions below. How do I obtain an NPI?
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AMA
Concurs With MedPAC to Update 2008 Medicare Physician Payment