The North Carolina Medical Society continues to lobby the North Carolina Congressional Delegation asking that our Representatives and Senators consider several areas of concern with national health system reform.
In a letter sent to the Delegation on March 8, 2010, the NCMS asked members of the House and Senate to consider the following priorities as they debate any bill that might go to reconciliation:
A permanent repeal of Medicare’s flawed physician payment formula
Meaningful liability reform
Physicians and patients having the right to privately contract without penalties
Increased provider reimbursement to offset Medicaid expansion
Medicare bonus payments for primary care and the expansion of primary care residency positions
Elimination of penalties for physicians who do not successfully participate in the Physician Quality Reporting Initiative (PQRI)
Elimination of the proposed Medicare Independent Payment Advisory Board (IPAB)
Safeguards on Accountable Care Organizations and payment-bundling pilot programs
Limit barriers to new physician-owned hospitals
Please read the letter (PDF) for more details. Contact your Representative and Senators and urge the need for health system reform that will provide adequate access for patients, a sustainable workforce, and support improved quality and administrative effectiveness while managing costs. Your voice is important and needed.
More information about health system reform can be found on the NCMS website, www.ncmedsoc.org/healthreform, where you can access updates and the Doctor-to-Doctor blog, which allows you to comment on issues and read what your colleagues are saying.
The NCMS is advocating these priorities on a daily basis with members of the NC Congressional Delegation. Be watching for this week’s Bulletin for more information about health system reform and other timely issues.
The Senate voted 78-19 late Tuesday evening to pass H.R. 4691, the Temporary Extension Act of 2010, which included provisions to extend 2009 Medicare physician payment rates through the end of the month. As a result, the 21% payment cut that took effect on March 1 has been postponed until April 1.
After President Obama signed into law the Temporary Extension Act of 2010 on Tuesday, CMS announced it would stop its ten-day hold on physicians’ Medicare claims.
Blue Cross and Blue Shield of North Carolina (BCBSNC) is launching a Physician Hotline for physicians and their practices to call when faced with ongoing problems related to billing, claims, coverage determinations, credentialing, and other issues that aren’t getting resolved.
The debate over health system reform took a more partisan turn this week when President Obama called for Congress to take an up or down vote on the health care reform bill.
The Senate voted 78-19 late Tuesday evening to pass H.R. 4691, the Temporary Extension Act of 2010, which included provisions to extend 2009 Medicare physician payment rates through the end of the month. As a result, the 21% payment cut that took effect on March 1 has been postponed until April 1.
As Congress was preparing to act on 4691, NCMS President Douglas Sheets, MD, and CEO, EVP Robert Seligson were in Washington, DC lobbying members of the N.C. Congressional Delegation to support a permanment fix of the sustainable growth rate (SGR), the formula used to establish Medicare physician reimbursement rates. Also attending the 2010 National Advocacy Conference were Ophelia Garmon-Brown, MD, MDiv, President, Mecklenburg County Medical Society (MCMS); Robert “Bob” Schafermeyer, MD, President-Elect, MCMS; Carolyn Scruggs, Executive Director, MCMS; and William W. Truslow, MD, President-Elect, Greater Greensboro Society of Medicine.
After the President signed the bill, the AMA reported that discussions were underway in the House and Senate on the next steps that will be taken to address the Medicare payment crisis. Proposals are being circulated that would implement still another short-term patch to the sustainable growth rate (SGR) formula, including proposals that would postpone cuts for 90 days, 7 months, or through the end of 2010.
Yesterday, AMA President J. James Rohack, MD, sent a letter to all members of the Senate, urging them to use the 31-day reprieve from the 2010 Medicare physician payment cut to delovop a legislative pathway toward a permanent repeal of the SGR formula. The NCMS and the AMA continue to press for the repeal rather than repeating the pattern of short-term remedies that serve to make future payment cuts more severe and increase the cost of permanent Medicare reform.
This week US Representatives Bob Etheridge (D-NC Dist. 2) and Walter B. Jones (R-Dist. 3) responded to letters sent by the NCMS urging them to support HR 3961, the Medicare Physician Payment Reform Act.
Physicians are urged to keep up the pressure, especially in the Senate, for enacting legislation to permanently resolve the Medicare physician payment crisis. Use the AMA’s Grassroots Hotline: 1-800-833-6354 or go to the NCMS Legislative Action Center to contact your Senators or Representatives.
After President Obama signed into law the Temporary Extension Act of 2010 on Tuesday, CMS announced it would stop its ten-day hold on physicians’ Medicare claims. In an announcement released on March 3, CMS stated:
“Among other things, this law extends through March 31, 2010, the zero percent update to the Medicare Physician Fee Schedule that was in effect for claims with dates of service January 1, 2010, through February 28, 2010. Consequently, effective immediately, claims with dates of service March 1 and later which were being held by Medicare contractors will be released for processing and payment. Please keep in mind that the statutory payment floors still apply and, therefore, clean electronic claims cannot be paid before 14 calendar days after the date they are received by Medicare contractors (29 calendar days for clean paper claims). In addition, the new law extends through March 31, 2010, the exception process for therapy claims reaching the annual cap, retroactive to January 1, 2010. Affected providers may submit claims for exceptions to the annual therapy caps, with dates of service January 1 through March 31, 2010, using the KX modifier, following the pre-January 1, 2010, requirements for therapy cap exception. Please watch your listserv and contractors website for more information about the new legislation.”
Blue Cross and Blue Shield of North Carolina (BCBSNC) is launching a Physician Hotline for physicians and their practices to call when faced with ongoing problems related to billing, claims, coverage determinations, credentialing, and other issues that aren’t getting resolved. The Hotline is designed to offer physicians an additional option when the usual troubleshooting resources have not yielded results. Susan Menendez, Director of Network Management for BCBSNC, will staff the Hotline and serve as a physician advocate.
This new service is a product of the ongoing work of the BCBSNC Joint Advisory Group (JAG), which was established by the 2009 Thomas/Love Settlement “to facilitate communication and cooperation between physicians and BCBSNC.” Physician-members of the JAG voiced the need for a central point person at BCBSNC who could communicate with and assist physicians who wish to express their concerns and problems.
BCBSNC’s agreement to provide the Hotline service is an important development in efforts to improve relations between BCBSNC and physicians and their practices. Calls to the Hotline may not always generate a different end result for physicians. However, physicians can call the Hotline to get a fresh look of their issue from BCBSNC.
Access the Hotline by calling (919) 765-4035, faxing (919) 765-7109, or emailing susan.menendez@bcbsnc.com.
The debate over health system reform took a more partisan turn this week when President Obama called for Congress to take an up or down vote on the health care reform bill. Read his remarks on the New York Times web page.
Reporters Sheryl Gay Stolberg and Robert Pear put the President’s remarks in context in this story, which explains what the President’s advisors are expected to ask Congress to do.
While the NCMS supports meaningful health system reform, it is not supporting the bill now before the House and Senate. (See Health Care Reform: Looking for Direction, Bulletin, February 5, 2010). NCMS members are urged to review the Health System Reform section on the NCMS web page, http://www.ncmedsoc.org/healthreform, and contact their Representatives and Senators explaining the need to rethink and amend current reform legislation.
In late December, BCBSNC announced that it had revised its medical policies for Intensity Modulated Radiation Therapy (IMRT), and that the new policies would take effect April 1, 2010. The changes prompted concerns from members of the radiation oncology community. In response, NCMS coordinated and hosted a meeting between representatives of BCBSNC and six radiation oncologists from around the state and two representatives of the NC Medical Group Managers Association. Led by Kevin Roof, MD, of Charlotte, the group also included the chairs of the Departments of Radiation Oncology from Duke, UNC, and Wake Forest Medical Schools. During the meeting, which took place on Wednesday, March 3rd, Genie Komives, MD, VP, senior medical director, healthcare quality, for BCBSNC, explained the rationale for the policy changes and the process for obtaining expedited appeals when the procedure is denied as investigational. The group provided significant information about the efficacy of IMRT for cancers that the policies indicate are investigational and therefore not covered (as of 4/1/10, IMRT will be covered only for prostate and head and neck cancers, although IMRT denials for other cancers can be appealed on an expedited basis if necessary). At the request of Dr. Komives, one month after the policy has been in effect, the group will reconvene to review the cases that were initially denied and subsequently overturned to see if a change in the policies are warranted.
A record 199 physicians and PAs submitted 2009 PQRI data through NCMS’s partnership with DocSite. NCMS offered to pay the entire $350 submittal fee for any NCMS member who did not take advantage of a similar offer in 2008. Individual EPs who submitted data to CMS’s satisfaction qualify to earn a PQRI incentive payment equal to 2.0% of their total estimated Medicare Part B PFS allowed charges for covered professional services furnished during that same reporting period. A survey reported 100% of responding participants would recommend participating in the NCMS/DocSite PQRI Reporting to another practice.
Feedback reports and bonus incentive payments for the 2009 PQRI will not be available until Fall of 2010.
The NCMS membership often tells us that they find themselves “in the dark” as to what goes on outside the hospital walls or the practice front door. As most doctors can attest, the day-to-day bubble is all-consuming, often leaving doctors (and therefore their patients), unaware of opportunities for education and advancement.
Such being the case, we’ve taken a quick snapshot below of events and classes for NC medical students and medical professionals across the month of March. Our advice is only as good as the feedback from docs on the ground, so if you or any of your patients attend one of these events across the month, drop us a line and let us know how it goes so we can share that insight with the entire community. (Plus, we’d love to hear your stories.)
As always, the Triangle-area is a hotbed of activity across March, with a number of events at Duke and UNC, WakeMed:
National Doctor’s Day provides an opportunity for patients, colleagues and others to remember and thank special physicians who have made a real difference to their patients and in their communities. Please join the NCMS and its Foundation in honoring these individuals by making a contribution in their name during March. Your suggested donation of $35 per physician ($100 for three) will not only say thank you to these deserving physicians, but it will also provide much-needed support to the Foundation’s programs, which are at work every day to increase access to quality health care across North Carolina.
