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By now you are all aware that President Bush has signed the Deficit
Reduction Act of 2005 and Empire Medicare Services (EMS) has issued
their revised 2006 fee schedule.
For nonparticipating Medicare physicians, there would be a 5% reduction to the participating fee schedule before applying the 115% federal limiting or 105% NYS limiting charge.
While the legislation reverses the 4.4% physician fee cut implemented in January, carriers have been instructed to use the 2005 conversion factor and 2006 Relative Value Units (RVUs). Therefore, this is not a true 2005 fee freeze.
Utilize only the fees as posted on the EMS website for our locality. Nassau is area 2. If you do not have internet access, call the EMS provide service line at
1-877-869-6504 to obtain a copy of the revised schedule. All claims fore services provided in 2006 retroactive to January 1, will be reimbursed at the 2005 conversion factor.
Physicians will not be paid what is owed then in one lump sum. According to CMS, carriers will issue checks periodically as they process batches of claims.
In his State-of-the-Union Address, the President included health care issues of great importance. I am pleased that among them he called for medical liability reform, and referred to limited access for patients noting that lawsuits are “driving many good doctors out of practice…”
Our local communities have endured increased insurance premiums in the face of decreased reimbursements. Physicians are making tough decisions, some limiting their practice or retiring early.
I remind you that the legislative process is an ongoing dynamic one, and as such, there will be opportunities in the next weeks and months to continue our education & lobbying efforts.
I encourage you to participate in the upcoming MSSNY Legislative Day in Albany on March 7 or, in the AMA National Advocacy conference on March 15-16 in Washington, DC.
If you are unable to attend, and wish to share anecdotal data, you may contact me or our Executive Director, Mr. Mark Cappola at 516-832-2300 ext 14.
Thank you all for your continued support as your medical society continues its work on your behalf.
| Patient
Direct Referral Bill Reported to Floor of Assembly |
Legislation
(A.5622A, Canestrari) that would expand the scope of practice for
physical therapists, allowing them to see and treat a patient without
the benefit of a medical diagnosis was reported by the Assembly Higher
Education Committee to the Floor of the Assembly this week.
Shockingly, amendments made to the bill at the close of last year’s
session also would prohibit physical therapists from being employed in a
health care professional’s office. As noted in last week’s Capital
Update article, the Medical Society of the State of New York strongly
opposes this legislation as does the NYS Society of Orthopaedic
Surgeons. Despite our opposition to date, the measure can be
voted upon as early as Monday, February 27th. All physicians are urged
to reach out to their elected Assembly representative to urge that their
Assemblyman or Assemblywoman vote against the bill. Physicians can call
1-518-455-4100 and ask to be connected to their Assembly Member’s
office or can send a letter to their Assembly Member by visiting our
Grassroots Actions Center at http://capwiz.com/mssny/issues/alert/?alertid=1739081
| Let
Your Legislator Know Your Concerns with Abusive Insurer Tactics |
You have the opportunity to impact whether legislation will be enacted that reforms the abusive practices of health insurance companies. Physicians concerned with these tactics should go the MSSNY Grassroots Action Center and send letters to their legislators on the following legislative proposals:
Legislation (S.1987, Maziarz/A.3106, Sweeney) to limit to six months the time period within which a health plan may demand a refund from a physician. The link to that letter is:
http://capwiz.com/mssny/issues/alert/?alertid=7477101&type=ML
.
Legislation (S.4392-A, Spano/A.7351-A, Bradley) to require health plans to process and make eligible for payment claims consistent with AMA-CPT coding rules. The link to that letter is:
http://capwiz.com/mssny/issues/alert/?alertid=7732951&type=ST
.
Legislation (S.3269-A Spano/A.6368-A, Bradley) to require health insurers to provide provisional reimbursement to a physician who has applied to participate in a managed care panel when the period of review is expected to exceed 90 days. The link to that letter is:
http://capwiz.com/mssny/issues/alert/?alertid=7733041&type=ST
.
Legislation (A.6458, Canestrari/S.3080, Hannon) to permit physicians the ability to collectively negotiate contract terms with health plans. The link to that letter is:
http://capwiz.com/mssny/issues/alert/?alertid=8367191&type=ST
.
Legislators need to hear from you! The managed care industry has been actively lobbying to defeat these measures. Physicians should also aware that MSSNY has also made available on its web site its “Managed Care Reform Tool Kit” at
http://www.mssny.org/members_only/prac_man/MCTool/Managed_Care_Toolkit.htm
.
The purpose of the tool kit is to generate physician grassroots action on the above legislative initiatives. The tool kit includes talking points, sample letters to the Legislature (similar to the letters on the Grassroots Action Center), and sample letters to send to your local newspaper regarding these issues.
| Eye
on Albany: PHYSICIANS MUST USE FORGE-PROOF PRESCRIPTION FORMS BY APRIL 19
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A reminder - all prescriptions written in New York must be written on the new official New York State forge-proof prescription forms as of April 19, 2006. If you have not yet registered to obtain these new prescription forms or have questions, please call the Department of Health (DOH) at 1-866-811-7957. The prescription forms are available free of charge. It should be noted that physicians registered with the program are offered the option of ordering their official prescriptions online by utilizing the Department's secure Health Provider Network (HPN). By establishing an HPN account, physicians may order larger quantities of official prescriptions. Moreover, if they order through an HPN account, physicians may also order official prescriptions for all members of a group practice to use. One final note - we have recently been made aware of certain e-prescribing vendors advertising themselves as having been “exempted” from the new law. Physicians should be aware that all electronic prescribing is exempt from the new law; however, the DEA has not as of yet finalized regulations that would permit prescriptions for controlled substances to be sent electronically.
MANAGED CARE BILLS APPROVED BY ASSEMBLY
Two bills supported by the physician community were approved by the NYS Assembly this week. A2206 would ensure that a true clinical peer is reviewing claims prior to a decision to deny coverage. Similar language, supported by MSSNY, has been included in Budget language. A2210 would require that timely information regarding the external appeal process be communicated to patients and their physicians. The bill also repeals the $50 filing fee for an external appeal. Both bills are sponsored by Assembly Health Committee Chair Gottfried and passed the Assembly in 2005 but were not acted upon by the Senate. Physicians are urged to contact their state representatives to communicate their support for the legislation, which has now been referred to the Senate Health Committee.
FLU VACCINE UPDATE
Prebooking of Vaccine for 2006-07 |
Sanofi pasteur will begin prebooking Fluzone vaccine for the 2006-2007 influenza season on Tuesday, January 31, 2006, at 12:00 noon EST. Influenza vaccination is the primary method of preventing influenza and its severe complications. Prebooking your influenza vaccine now is the best way to prepare for the upcoming 2006-2007 influenza season.
Sanofi pasteur offers four influenza vaccine product presentations:
- Fluzone®, Influenza Virus Vaccine - 5 mL vial
- Fluzone®, Influenza Virus Vaccine, No Preservative - 0.5 mL prefilled syringe (36 months of age and older)
- Fluzone®, Influenza Virus Vaccine, No Preservative - 0.5 mL unit-dose vial (36 months of age and older)
- Fluzone®, Influenza Virus Vaccine, No Preservative: Pediatric Dose - 0.25 mL prefilled syringe (6-35 months of age)
How to Prebook
To help our customers prepare for the upcoming influenza season, there are two methods to prebook Fluzone vaccine.
- On-line: http://www.vaccineshoppe.com
(on-line requests receive a 2% savings)
- Telephone: 1-800-VACCINE (1-800-822-2463)
All prebook requests will be processed with the same attention and care, whether the request is placed on-line or over the telephone. (Please
note: fax requests will not be accepted.) http://www.influenzaconnection.com/pdf/prebookletter2006.pdf
For more information on 2006 pricing for Fluzone vaccine, please refer to the following customer letter:
http://www.influenzaconnection.com/pdf/priceletter2006.pdf
Customers will receive confirmation of receipt of their request via e-mail or fax within 72 hours. Prior to shipping, customers will receive notification of their request, the estimated time for shipment and the amount of vaccine to be provided in the shipment.
We encourage you to share this important information with your colleagues and immunization partners
| Medicare: Rx Makers Crafting Program to Address 'Doughnut Hole' |
A group of seven pharmaceutical companies is working on a plan that would provide discounted prescription drugs to Medicare beneficiaries whose annual drug costs fall into the so-called "doughnut hole," or the gap in coverage under the new Medicare drug benefit, the Wall Street Journal reports. Under the drug benefit, Medicare beneficiaries are responsible for all drug costs between $2,250 and $5,100 in total spending, or between $750 and $3,600 in out-of-pocket costs.
An estimated 6.9 million Medicare beneficiaries are expected to reach the doughnut hole in 2006, according to the Kaiser Family Foundation, the Journal reports. According to documents filed on Jan. 12 with the HHS Office of Inspector General, the pharmaceutical companies are joining together to provide discounts of at least 50% on their drugs when qualifying Medicare beneficiaries reach the doughnut hole.
The Bridge Rx program, which the companies hope to announce in April and launch in May, would have co-payments of at least 15%, the Journal reports. Medicare beneficiaries with annual incomes between $14,000 and $18,620 would qualify for the program, as would beneficiaries who have annual incomes lower than $14,000 and assets that make them ineligible for additional financial help under the drug benefit.
The projected budget for the program's first year is $30 million, with projected enrollment in 2006 of more than 500,000 Medicare beneficiaries.
MSSNY’S LEGISLATIVE DAY
SCHEDULED FOR MARCH 7TH |
MSSNY’s Legislative Day has been scheduled for March 7th. The focus of the day will be on achieving structural reform of three areas of significant interest to the physician community: medical liability relief; managed care; and Medicaid reform. Attendees will be informed of the comprehensive grassroots driven strategies being employed this year by MSSNY to effectuate meaningful changes in each of these areas.
Currently ongoing in the liability area is the work of MSSNY’s President, Robert A. Scher, MD and MSSNY’s Medical Liability Reform Committee, chaired by William B. Rosenblatt, M.D., to educate the public, the business and insurance industry, and elected officials of the dire need for reform of our civil justice system. In the managed care area, MSSNY has developed and begun to engage in a proactive effort with group practice managers, physicians and their patients to achieve meaningful redress on retrospective adjustment, coding and credentialing practices of the managed care industry. Lastly, MSSNY is working with other interested parties to develop a coalition to protect and enhance access and quality of care provided to the Medicaid population. Senate Majority Leader Joseph L. Bruno, Assembly Higher Education Chairman, Ronald Canestrari, the Commissioner of Health, the Legislative Chairs of the Health and Insurance Committees of the respective Houses will all participate at this event. Please make plans to attend this very important event.
NYAMR LOBBIES FOR STEM CELL RESEARCH FUNDING
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The New Yorkers for the Advancement of Medical Research (NYAMR), a coalition of patient advocacy groups, medical colleges and biotechnology research institutions, held a lobby day to advocate for state funding for regenerative medicine including stem cell research. Senate Majority Leader Joseph Bruno and Speaker Sheldon Silver both spoke to the group. Majority Leader Bruno is pushing an $800 million public/private biomedical research initiative than he and Gov. George Pataki proposed earlier this year. This initiative would include and “does not exclude stem cell research,” said Majority Leader Bruno. Speaker Silver is the sponsor of a bill (A6300) that would allocate $300 million in state funds for regenerative medicine, including all types of stem cell research. Bruno did suggest the possibility of a compromise between the two plans.
PREPARING FOR THE MSSNY HOUSE OF DELEGATES
 On January 24, the Nassau County Delegates and Alternate Delegates met to review Resolutions to be submitted to the 2006 MSSNY House of Delegates.
This year, the MSSNY House of Delegates will be held at the Adam’s mark Hotel in Buffalo, NY from April 28-30.
In addition to resolutions submitted by members, the Society is also considering supporting resolutions that will be presented by other county and specialty societies as well as other individual members.
ACADEMY AND SOCIETY PRESENT PROGRAMS ON INFECTION CONTROL
AND THE 2006 MEDICARE UPDATES FOR MEMBERS AND STAFF
 On January 19, the Nassau County Medical Society hosted its annual 2006 Medicare Update Seminar for members and their staff.
The program, which is presented by Empire Medicare Services, was attended by over 100 physicians and staff.
On January 25, the Nassau Academy of Medicine presented the NYS Mandatory Infection Control Training Program The CME Cat. 1 program was attended by over 150 physicians and other health care providers
| Upcoming
Meetings and Programs |
NCMS Executive Committee
April 11, 2006, May 16, 2006, June 6, 2006
Nassau Academy of Medicine Board of Trustees
March 21, 2006, May 23, 2006, Sept. 19, 2006
NCMS/NAM Membership meetings
March 28, 2006, May 30, 2006
MSSNY State Leg Day - Albany
March 7, 2006
MSSNY House of Delegates - Buffalo, NY
April 28-30, 2006
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February
2006
In the News This Month...
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