Health system reform legislation has switched from the fast lane to park as Congressional leaders ponder what direction they might want to take. The NCMS remains committed to its long-standing position that changes are needed in health care delivery. As our recent member survey showed, most doctors want health system reform, but they do not support the legislation that is currently being debated in the U.S. House and Senate.

Physicians need to stay engaged so that health system reform remains on the front burner. As the NCMS has outlined in letters to the NC Congressional Delegation, there are provisions of HR 3590 that we feel should be kept and strengthened, if possible:

• Health insurance market reforms
• Coverage for prevention and wellness initiatives without co-payments or deductibles
• Administrative simplification
• Reduced overpayments to Medicare Advantage plans
• Bonus payments and graduate medical education (GMS) expansion for primary care, but not at the expense of Medicare or GME slot reductions for other specialties
• Expanded access to primary care and increases in rates for primary care, but not financing these changes by reductions in rates for specialist services
• Implementation of health homes for patients with chronic conditions

Other sections of HR 3590 are inadequate and would damage patient care, and we urge physicians to encourage House and Senate members to support the following provisions:

• Sustainability from a financial standpoint
• Addition of a provision to establish a permanent replacement for Medicare’s sustainable growth rate (SGR) formula
• Inclusion of incentives for states to enact meaningful tort reform that reduce defensive medicine costs and create savings that offset increased health insurance premiums
• Elimination of provisions that would create an Independent Medicare Advisory Board with the power to mandate payment cuts for physicians
• Elimination of provisions that would redistribute Medicare payments among physicians and providers based on untested and arbitrary treatment standards that do not improve the quality of patient care
• Elimination of penalties for physicians who do not successfully participate in the Physician Quality Reporting Initiative (PQRI)
• Elimination of provisions that create an unintended incentive to pay a fine for not having required insurance coverage
• Elimination of the 5-percent excise tax on elective cosmetic surgical and medical procedures
• Elimination of enrollment fees for Medicare
• Continuation of supplemental federal medical assistance payments at 2009 levels for at least two more years, to ensure that access to care for Medicaid patients does not deteriorate any further
• Addition of safeguards to the proposed demonstration projects to bundle payments for the provision of integrated care for Medicaid patients
• Amending limitations on the participation of physician-owned hospitals in the Medicare and Medicaid programs

Further details about these provisions are found in the NCMS Guiding Principles to Health System Reform and letters sent to NC US House and Senate members, which can be accessed at www.ncmedsoc.org/healthreform.

The NCMS stands firm in its pursuit of health system reform. We will continue to keep you informed through the Bulletin and at our website, http://www.ncmedsoc.org/, and we will continue to survey members to learn where you stand on health system reform issues. We appreciate your comments and urge you to contact your US Representative or Senators today and ask them to give health system reform the attention it needs so that you can deliver the kind of care your patients deserve.

Resources on health system reform are available in the health reform section of the NCMS Web page and on the Doctor to Doctor blog.

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The NC Division of Medical Assistance (DMA) recently sought feedback from provider representatives about concerns over the new Medicaid provider agreement.  The North Carolina Medical Society in coordination with the North Carolina Hospital Association, North Carolina Healthcare Facilities Association and the North Carolina Association of Non-Profit Homes for the Aging has submitted a written proposal of suggested changes to the agreement that can be viewed here.  The NCMS will continue to provide updates on the provider agreement in the Bulletin and on the NCMS website.

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The Medicare Improvements for Patients and Providers Act of 2008 requires providers who wish to continue providing advanced imaging services to Medicare patients to obtain accreditation from one of three national organizations by January 1, 2012.

The three accrediting bodies recently designated by CMS are the American College of Radiology (ACR), the Intersocietal Accreditation Commission (IAC), and The Joint Commission (TJC).

The accreditation requirement applies to the technical component of MRI, CT and nuclear medicine paid for under the Medicare Physician Fee Schedule; it does not apply to a provider’s interpretation of the images.

Factors to be covered in the accreditation process include qualifications of physicians and non-physician personnel, safety procedures and accuracy of interpretation.

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Blue Cross Blue Shield of North Carolina (BCBSNC) is sending three separate letters to physicians about changes in the administrative process related to selected hypnotic agents, selective serotonin reuptake inhibitors, and certain triptan products. Effective April 1, 2010, these drugs will be considered restricted access drugs that will require a physician to provide a written certification to BCBSNC prior to the drug being covered by a BCBSNC member’s prescription drug benefits.

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Blue Cross Blue Shield of North Carolina has informed the NCMS of updated medical policies for January 5, 2010 and January 19, 2010, and the Notification of Policy Revisions Effective April 13, 2010 (Posted January 5, 2010).  The changes are due mainly to the addition of new codes. View these policies.

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Providers continue to take advantage of the Blue Cross Blue Shield Association’s (BCBSA) offering of one year free credit monitoring service.  The offer followed a security breach in August 2009 involving an unauthorized transfer of data and a laptop stolen from a BCBSA employee. Blue Cross Blue Shield of North Carolina (BCBSNC) notified providers (read the letter)   about the incident because BCBSNC had submitted provider data to the BCBSA for a provider locator tool maintained on the BCBSA website.  Originally, providers were given until December 31, 2009, to activate the credit monitoring service code. To ensure that providers who may not have activated the service still have an opportunity to do so, the Association has extended the activation deadline of all outstanding codes to February 28, 2010.

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The North Carolina Medical Group Managers Association and the NCMS Foundation PractEssentials are jointly hosting a webinar on Thursday, February 11, 2010, 12:00 noon – 1:00 pm, on 2010 Consulting Code Changes. The coding changes went into effect January 1, 2010 and affect every physician. The webinar will provide guidelines and help practices learn how to code and bill for maximum reimbursement.  Register at: http://www.ncmedsoc.org/legacy/pages/meetings_and_events/calendar_detail.jsp?id=634.

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The Carolinas Center for Medical Excellence (CCME) will offer a webinar on Friday, February 12, 2010, 1:00 pm – 2:00 pm, on the Proposed Meaningful Use Content and Comment Period. Included will be the new proposed rules update from the Office of the National Coordinator (ONC) for the American Recovery and Reinvestment Act (ARRA), the latest Meaningful Use definitions, and information on the public comment period. The webinar will help attendees understand Meaningful Use and prepare physicians to claim their (up to) $44,000 each for Medicare providers or (up to) $63, 750 for qualifying Medicaid providers.  CME credit is available. For more information and questions, contact Sarah Stein, MPH, at 800-682-2650, ext. 2202, or by email at EHRServices@thecarolinascenter.org.

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The Durham-Orange County Medical Society is hosting the Caring for the Caregiver—2010 Workshop, Leadership Strategies for Your Medical Career, on Saturday, March 6, 2010, 9:00am – 3:00pm, at Stedman Auditorium, Center for Living, at Duke University.  The two-part workshop includes a morning session on assessing career development and an afternoon session on leadership strategies for working with others.  To register, visit http://www.docmedsoc.org/, or download a flyer, or contact Richard Skinner at 919-833-3836, ext. 158, or email rskinner@ncmedsoc.org.

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