Implementation of the Patient Protection and Affordable Care Act of 2010 is underway and impending changes to the health care delivery system present new challenges and opportunities for physicians and their patients.  The North Carolina Medical Society (NCMS), in its mission to provide Leadership in Medicine, is partnering with News 14 Carolina to convene a televised forum to engage physicians and other health care leaders about preparing for health reform and what it means to patients and medical practices. 

NCMS members and the medical community at large are invited to attend the discussion, which will be taped for broadcast, on September 22, 7:00 pm, at the Harris Conference Center in Charlotte.   The forum will be a panel-style discussion facilitated by News 14 Carolina Anchor Heather Waliga.

Panelists include: Michael Dulin, MD, Family Medicine, Charlotte; Jeffrey P. Engel, MD, State Health Director; Ophelia Garmon-Brown, MD, Family Medicine, Charlotte; Maureen O’Connor, Executive Vice President/Chief Strategy Officer, Blue Cross Blue Shield of North Carolina; Robert Seligson, Executive Vice President & CEO, NCMS; and Michael C. Tarwater, CEO, Carolinas Healthcare.

Attendance is limited to 150, so register today.  To reserve your seat, visit https://secure.ncmedsoc.org/legacysecure/pages/meetings_and_events/event_reg_form.jsp?id=707.

Physicians have just over one month left to submit claims for a share of a $350 million settlement agreement between United Healthcare and the American Medical Association (AMA). Claims for a share of the settlement must be postmarked by October 5, 2010.

The settlement was formed to help compensate physicians and patients for artificially low payments that were provided by United  for out-of-network services over the past 15 years. The case was originally brought to expose a price-fixing scheme used by United to underpay physicians and patients.

The AMA has developed and released several online resources to assist physicians and practices with determining eligibility, compiling documentation, and filing claims under the settlement. You can learn more about the case and access those settlement resources at www.ama-assn.org/go/ucrsettlement. The “Step-by-Step Guide” is especially informative and will guide you through the claims filing.

Again, claim forms need to be completed and submitted by October 5, 2010.

Governor Beverly Perdue today announced her intention to roll back Medicaid provider rate reductions that were to be implemented next week.  The announcement came in a meeting this morning with representatives of the North Carolina Medical Society (NCMS), the North Carolina Hospital Association (NCHA) and the North Carolina Healthcare Facilities Association (NCHFA). Changes in the wording of the State’s budget will be required to achieve this reversal.  The changes would allow use of increases in funding for the Federal Medicaid Assistance Percentage (FMAP) to avoid rate cuts.  The Governor is expected to meet next week with legislative leaders, seeking commitments to make the wording change early next year.  Physicians, hospitals and nursing home representatives will be contacting legislative leaders to ask for their support as well.  We thank Governor Perdue for her decision.

“We want to thank NCHA President Bill Pully and NCHFA President Craig Sousa for their support in working with the governor to achieve the rollback,” NCMS EVP, CEO Robert Seligson said.

Earlier this week, the NCMS and NCHA sent letters to the editor of the News & Observer in an effort to clarify the issues surrounding the organizations’ opposition to a proposed 1.35% cut in Medicaid physician payments. The letters were in response to an article published by the newspaper on August 22.

In the letters, Mr. Seligson and Mr. Pully offered evidence of how the Medicaid budget had been cut twice in the past two years, with physicians and hospitals receiving fewer Medicaid dollars as health care costs continue to rise.  Both leaders pointed out that Congress recently gave the state an additional  $124 million, making a third cut in the Medicaid budget unnecessary.

Read the article, “Doctors bicker with Gov. Perdue over Medicaid reimbursement,” by Benjamin Niolet.

Read the NCMS letter to the editor. “Medicaid and Medical Providers,” Aug. 25.

Read the NCHA letter to the editor, “Strains on Medicaid,” Aug. 24.

The NCMS Foundation is offering you a special opportunity to recognize the many ways women contribute to the medical profession through a special donation in celebration of Women in Medicine Month, September 2010. You can thank those women who have served as mentors, role models, teachers, leaders and others in the medical profession by making a tax-deductible contribution of $35 per honoree (or $100 for three). The Foundation will send a personalized card acknowledging your recognition, with each honoree also recognized on the NCMS and Foundation websites. Your gift will not only show these women how much you care but also help to increase access to quality health care for all North Carolinians.

Click here to download a gift form (PDF).  Read a special letter from Abe Walston, II, MD, Chair, Gifts and Grants Committee, NCMS Foundation Board of Trustees (PDF).

The North Carolina Medical Society (NCMS) hosted almost 100 physicians and consultants in Raleigh at the ACO Summit on Saturday, August 7, 2010.  Accountable Care Organizations (ACOs) are an emerging model for health care delivery for Medicare services under Health System Reform.  ACOs link groups of providers together to coordinate and improve quality and efficiency in health care by fostering greater accountability in the delivery of care.

ACO Summit attendees heard presentations offering perspectives on ACOs from the Brookings Institute, Crescent PPO, Community Care of North Carolina, Poyner and Spruill, LLP, and Smith Anderson.  Participants discussed how new business models can improve the delivery of health care and how physician participants can use existing successful programs as a foundation for ACOs.  The Summit also reviewed the NCMS current draft policy on Accountable Care Organizations, to be considered by the NCMS Board of Directors in September.

Presentations and materials from the ACO Summit can be found on the NCMS Health System Reform page http://www.ncmedsoc.org/healthreform. If you would like to offer feedback on the draft policy on ACOs or provide information on ACOs being developed in your area, please complete and submit the feedback form also found on the Health System Reform page.  Please submit feedback regarding the draft policy by August 30, 2010.

Budget:

There is a lot to be said about the new budget just enacted by the NC General Assembly. This was arguably the most difficult budget year in modern times for health-related issues. Medicaid funding was already seriously undermined by the actions of the NC General Assembly and the NC Department of Health and Human Services in 2009. Moreover, Congress has not yet extended supplemental funding to deal with ballooning Medicaid enrollment during the economic downturn (known as Federal Medical Assistance Percentage, or FMAP). If not ultimately approved by Congress, North Carolina will lose up to $500 million in Medicaid funding in 2010-11.

To address this problem, the NC General Assembly chose to enact contingency provisions in the budget. It is in the contingency budget that physician Medicaid payments are being targeted. In addition to the $82 million planned cut from 2008-09 levels, enacted in last year’s 2009-10 budget (which, incidentally, was arbitrarily increased to $101 million by North Carolina DHHS), the General Assembly cut rates in the contingency budget by another $26.6 million. The NCMS, working within a coalition of medical organizations, was able to insert two provisions in the final budget to minimize the damage.

First, if the federal funding is approved to help with ballooning Medicaid enrollment, there will be no further reductions in the rates paid to physicians. While this obviously does not address our goal of maintaining physician unity, equalizing rates for all specialties in Medicaid, and protecting the primary care “engine” (CCNC) that produces savings for the whole program, it does take further cuts off the table if adequate FMAP funding is enacted by Congress.

Second, a provision was added to make clear that the only reduction to physician rates that will occur in the contingency budget is the $26.6 identified by the General Assembly. Other across-the-board cuts in the contingency budget will not apply to Medicaid rates. The Secretary of NC DHHS has discretion, however, regarding the implementation of rate cuts in the contingency budget, and could implement the cuts even before Congress had finished debating the question of supplemental funding. NCMS and the coalition pushed for protection from further cuts if the Secretary determines that early implementation of the contingency budget is necessary, but the General Assembly did not provide that protection.

The NCMS will continue fighting to restore reasonable fees for services provided to Medicaid enrollees.

Scope of Practice:

Physical Therapy – Within the physician community, there has been tremendous interest in efforts by the national PT advocacy groups to eliminate physician-owned PT services (POPTS). The PTs have been successful in a few states. Recent proposals by PTs in the NC General Assembly, if passed, would move North Carolina closer to prohibiting POPTS. The NCMS supports POPTS and has worked to ensure this option continues to be viable in North Carolina. There has also been concern about the use of electrodiagnostic testing by PTs. Today, the PTs claim authority to perform the tests based on a letter once sent to the PT Board by the NC Medical Board. According to the Board’s letter, PTs are prohibited from making a medical diagnosis based on the test. The PT proposal would have added electrodiagnostic testing and diagnosis to their scope of practice. NCMS does not support those provisions. To address our concerns, we negotiated several provisions in this year’s PT bill. The bill did not move because the PTs were not able to resolve concerns raised by the Athletic Trainers regarding their role in delivering PT services.

Midwifery – The Joint Midwifery Committee, organized to regulate nurse midwives, was asked by the General Assembly in 2009 to consider recommendations for the licensure of lay midwives in North Carolina. The committee met throughout the period between the 2009 and 2010 sessions of the General Assembly. In its final recommendations, the group did not recommend licensure of lay midwives. This is attributable to the excellent work of the physicians who participated in the study, and the physicians and other individuals who worked on the issue for the NC Ob/Gyn Society and NC Medical Society.

Naturopathy – For the seventh consecutive year, the licensure of naturopathic practitioners has been proposed. After opposing the measure for several years, the NCMS, in 2006, spelled out some conditions under which it could remove its opposition to licensure of some naturopathic practitioners. The NCMS naturopathy white paper has been widely circulated to educate legislators and others involved in the debate. The naturopaths promoting the legislation, who have better training than the naturopaths opposing the legislation, initially agreed to the preconditions identified by the NCMS. Since then, there has been persistent controversy regarding a number of issues related to patient safety. The NCMS has continued to oppose bills that do not meet its preconditions. Again in 2010, NCMS opposed naturopathy licensure legislation proposed by Sen. Ellie Kinnaird (D, Orange). The bill did not move during the 2010 session.

Uniform Apportionment of Tort Responsibility Act, (a.k.a. Repeal of Contributory Negligence):

The NCMS worked within a coalition of business representatives to address concerns with a proposal made by the NC Advocates for Justice (i.e., the plaintiffs’ bar) to move from a contributory negligence to a comparative fault system in North Carolina. NC is one of four jurisdictions in the United States that has a contributory negligence statute on the books, barring a plaintiff from recovery if they negligently contributed to their own injury.  In contrast, comparative fault systems permit plaintiffs to recover from others even if they are partially responsible for their own injury.  

The legislation passed the House in 2009, and was then referred to a subcommittee in the Senate for study. The last proposal from the subcommittee contained several provisions that were unacceptable to the coalition. The coalition proposed changes that were reasonably aimed at addressing genuine concerns, and that ensure a balanced civil justice system for North Carolina. Throughout the coalition’s discussions, the NCMS advocated for a balanced proposal that addresses the concerns of the medical profession.  One provision in the coalition’s proposal supported by NCMS is a proposal to allow juries to hear accurate information about the amounts actually paid by injured parties for past medical care, rather than hearing only about full charges before contractual and government reductions. The balanced proposal offered by the coalition was rejected by the plaintiff’s bar. The bill ultimately failed to get a hearing in the Senate, and the session ended without further action on the bill. There is a provision in the study bill, however, that is likely to bring this issue back before the General Assembly in 2011.