While enactment of SB 33 – Medical Liability Reforms was a major achievement for the NCMS Legislative Affairs team this legislative session, dozens of other bills of interest to physicians will also be included in the soon-to-be released 2011 Legislative Summary. Watch for more details in the Bulletin and at http://www.ncmedsoc.org/.

In last week’s Bulletin, we reported on legislation that falls under the category of Regulation of Medicine. That section includes 12 bills that will be summarized in the 2011 Legislative Summary, including the widely reported HB 854 – A Woman’s Right to Know Act. Like SB 33, HB 854 became law after the General Assembly overrode a gubernatorial veto.

Another major category of legislation falls under the Implement Federal Programs umbrella. Several of these bills deal with issues arising from the Patient Protection and Affordable Care Act (ACA):

HB 2 – Protect Health Care Freedom

SB 496 – PPACA/Required Fraud and Abuse Provisions

HB – 115 North Carolina Health Benefit Exchange Act

SB 375 – Facilitate Statewide Health Information Exchange

SB 607 – Conform Medical Records Law

In addition to the 2011 Legislative Summary, the NCMS offers more information and updates on a variety of provisions contained in the federal health care reform law, including Accountable Care Organizations (ACOs), the NC Health Benefit Exchange, and the NC Health Information Exchange. Physicians are urged to check the NCMS website to learn more about these programs and how they will be affecting your practices.

Related story:

Legislative Summary Highlights Major Accomplishments in 2011, Bulletin, August 5, 2011

A new resource from the AMA is available for physicians to better understand the movement toward accountable care organizations (ACOs) and other payment models resulting from the new federal health care reform law. Attorneys Steve Shaber, Kim Licata and Wilson Hayman from the Poyner Spruill law firm in Raleigh contributed to this resource. Shaber and Licata serve on the NCMS Accountable Care Task Force.

Click here to access a pdf-version of ACOs, CO-OPs and other Options: A “How-To” Manual for Physicians Navigating a Post-Health Reform World.   

Additional resources and information are available on the NCMS Toward Accountable Care webpage.  

On July 16, sixty physicians and practice managers from across the state gathered at the Hilton Raleigh-Durham Airport for a daylong seminar on ACOs hosted jointly by the NCMS and the AMA 2011 Pathways to Success Program. Moderated by AMA President-Elect Jeremy A. Lazarus, MD, the presentation focused on what physicians need to know about ACOs and the coming changes in payment practices. These presentations are available on the Toward Accountable Care Website and include:

• Pathways for Physician Success in Accountable Care Organizations and Healthcare Payment Reform – Harold D. Miller, Executive Director, Center for Healthcare Quality and Payment Reform (PDF-59 pages)
• Cornerstone Health Care: Running with the Bulls and Eating Elephants – Grace E. Terrell, MD, Practicing Physician at Cornerstone Health Care (PDF-41 pages)
• Health Care Reform or Health Care Dystocia? Where Do ACOs Fit in? – Craigan L. Gray, MD, MBA, JD, Director, Division of Medical Assistance, State of North Carolina (PDF-15 pages)
• Community Care of NC: Advancing Accountable Care in NC – Steven E. Wegner, MD, JD, Chair, North Carolina Community Care Network (PDF-20 pages).
• Specialist Strategies for Improving Quality and Lowering Costs – Alan M. Speir, MD, Chairman, Virginia Cardiac Surgery Quality Initiative (PDF-28 pages)
• Federal Policy on the Next Generation of Physician Payment – Jeremy A. Lazarus, MD, President-Elect, American Medical Association (PDF-12 pages)

Other Helpful Practice Resources Available from NCMS

In addition to the AMA resource on ACOs and other payment models, Wilson Hayman and Steve Shaber worked on the NCMS physician hospital contracting white paper and presentations, which are available on our Physician-Hospitals webpage at http://www.ncmedsoc.org/members/members/physician_hospital/HospitalPhysicianEmploymentAgreements.DOC.

Steve Shaber offers review of medical staff by-laws, employment contracting and other services. Click here for the Resources for Employed Physicians flyer.

To see the NCMS Model Medical Staff Bylaws, please visit http://www.ncmedsoc.org/pages/organized_medstaff/org_medstaff.html.

Questions about these resources may be directed to Melanie Phelps, mphelps@ncmedsoc.org or 919-833-3836.

Physicians from across the state and region will be learning more about accountable care organizations (ACOs) at a seminar hosted by the AMA and NCMS tomorrow at the Hilton Raleigh-Durham Airport in Research Triangle Park. On-site registration is available beginning at 8:00 am. The daylong event, 9:00 am – 3:00 pm, will feature several speakers and a panel discussion, all designed to help physicians and other health care professionals better understand the concept of ACOs and the associated new payment and health care delivery models.

For more than a year, the NCMS has been developing resources to guide physicians in understanding how ACOs and other new models of care will transform health care delivery. At the NCMS Toward Accountable Care webpage, you will find a host of resources that address ACOs and related topics.

More help is available at The Centers for Medicare and Medicaid (CMS) Innovations Center, which was established by the Affordable Care Act to “rapidly test innovative care and payment models and scale up successful models” in order to bring health care improvements at reduced cost. This site offers links to three important programs:

Pioneer ACO Model

Designed for health care organizations and providers that are already experienced in coordinating care for patients across care setting, enabling them to move from a shared savings payment model to a population-based payment model consistent with, but separate from, the Medicare Shared Savings Program. NCMS understands that the revised ACO Shared Savings Program regulations will more closely resemble the Pioneer program.

Advance Payment

Designed to assist emergent ACOs with capital costs.

Accelerated Development Learning Sessions

Provides regional meetings that offer core competencies for ACO development.

One of the four meetings has already been held (Minneapolis, June 20-22). To view videos from the first session, click here.   

Click here to register for one of the following Accelerated Development Learning Sessions (additional information will be provided by CMS):  

• September, San Francisco Bay area, CA
• October, Philadelphia, PA area
• November, Atlanta, GA area

Questions about ACOs may be directed to NCMS Deputy General Counsel Melanie Phelps, mphelps@ncmedsoc.org, or 919-833-3836.

Join your colleagues for the Saturday, July 16, 2011 seminar, What physicians need to know about ACOs and the coming revolution in payment practices, at the Hilton, Raleigh-Durham Airport, Durham, 9:00 am – 3:00 pm.

Register today as space is limited and demand is high.

For more information on this event, click here.

Featured speakers:

• Harold D. Miller, Executive Director of the Center for Healthcare Quality and Payment Reform, will explore new approaches to physician payment and delivery of care.
• Jeremy A. Lazarus, MD, President-Elect of the AMA, will discuss how physicians can lead in this new payment revolution, as well as describe the Washington landscape with regard to new federal pilot programs.
• Grace E. Terrell, MD, CEO, President of Cornerstone Health Care, will discuss delivery innovations at Carolina Regional Heart Center and a next generation clinical information system to improve population health.
• Craigan L. Gray, MD, Director of the State of North Carolina Division of Medical Assistance (DMA) will survey the landscape of new models of care in the state.

Panel Discussion:

Steven E. Wegner, MD, JD, chair of the North Carolina Community Care Network, will lead a panel discussion examining Specialist and primary care strategies for improving quality and lowering costs.

Panelists:

• Alan M Speir, MD, chairman of the Virginia Cardiac Surgery Quality Initiative,  will discuss the dramatic improvement in patient care that this statewide program has achieved.
• Jeffrey G. James, CEO of Wilmington Health Associates, will explain how physicians can transform the culture of health care to support comprehensive and accountable care.
• L. Allen Dobson, Jr., MD, president and CEO of Community Care of North Carolina, will describe how patient-centered medical homes can expand to become medical neighborhoods through coordination with specialist physicians.

This seminar is an American Medical Association program presented in conjunction with the North Carolina Medical Society. Register today!

Plan to attend the Saturday, July 16, 2011 seminar, What physicians need to know about ACOs and the coming revolution in payment practices, at the Hilton, Raleigh-Durham Airport, Durham, 9:00 am – 3:00 pm.

Register today as space is limited and demand is strong. For more information on this event, click here.

Steven E. Wegner, MD, JD, chair of the North Carolina Community Care Network, will lead a panel discussion examining Specialist and primary care strategies for improving quality and lowering costs.

Panelists include:

• Alan M Speir, MD, chairman of the Virginia Cardiac Surgery Quality Initiative,  will discuss the dramatic improvement in patient care that this statewide program has achieved.
• Jeffrey G. James, CEO of Wilmington Health Associates, will explain how physicians can transform the culture of health care to support comprehensive and accountable care.
• L. Allen Dobson, Jr., MD, president and CEO of Community Care of North Carolina, will describe how patient-centered medical homes can expand to become medical neighborhoods through coordination with specialist physicians.

Featured speakers:

• Harold D. Miller, Executive Director of the Center for Healthcare Quality and Payment Reform, will explore new approaches to physician payment and delivery of care.
• Jeremy A. Lazarus, MD, President-Elect of the AMA, will discuss how physicians can lead in this new payment revolution, as well as describe the Washington landscape with regard to new federal pilot programs.
• Grace E. Terrell, MD, CEO, President of Cornerstone Health Care, will discuss delivery innovations at Carolina Regional Heart Center and a next generation clinical information system to improve population health.
• Craigan L. Gray, MD, Director of the State of North Carolina Division of Medical Assistance (DMA) will survey the landscape of new models of care in the state.

This seminar is an American Medical Association program presented in conjunction with the North Carolina Medical Society. Register today!

Want to learn more about Accountable Care Organizations (ACOs)?  Plan to attend the Saturday, July 16, 2011 seminar, What physicians need to know about ACOs and the coming revolution in payment practices. The seminar will be held at the Hilton, Raleigh-Durham Airport, Durham, 9:00 am – 3:00 pm.

Register today as space is limited and demand is strong. For more information on this event, click here.

Included will be a panel discussion led by Steven E. Wegner, MD, JD, chair of the North Carolina Community Care Network, examining Specialist and primary care strategies for improving quality and lowering costs.

Panelists include:

• Alan M Speir, MD, chairman of the Virginia Cardiac Surgery Quality Initiative, will discuss the dramatic improvement in patient care that this statewide program has achieved.
• Jeffrey G. James, CEO of Wilmington Health Associates, will explain how physicians can transform the culture of health care to support comprehensive and accountable care.
• L. Allen Dobson, Jr., MD, president and CEO of Community Care of North Carolina, will describe how patient-centered medical homes can expand to become medical neighborhoods through coordination with specialist physicians.

Also featured:

Harold D. Miller, Executive Director of the Center for Healthcare Quality and Payment Reform, will explore new approaches to physician payment and delivery of care.

Jeremy A. Lazarus, MD, Speaker of the AMA House of Delegates, will discuss how physicians can lead in this new payment revolution, as well as describe the Washington landscape with regard to new federal pilot programs.

Grace E. Terrell, MD, CEO, President of Cornerstone Health Care, will discuss delivery innovations at Carolina Regional Heart Center and a next generation clinical information system to improve population health.

Craigan L. Gray, MD, Director of the State of North Carolina Division of Medical Assistance (DMA) will survey the landscape of new models of care in the state.

This seminar is an American Medical Association program presented in conjunction with the North Carolina Medical Society. Register today!

Register for a one hour webinar offered by CCME to learn more about legislation on Accountable Care Organizations (ACO’s) Preparing practices for reporting on quality measures and participating in continuity of care.

Practice Implications for Accountable Care Organizations
Monday, July 25, 2011 | 3:30 p.m. – 4:30 p.m.
Friday July 29, 2011 | 10:00 a.m. – 11:00 a.m.

Space is limited.
Reserve your Webinar seat now for Monday July 25th at:
https://www1.gotomeeting.com/register/965950944

Reserve your Webinar seat now for Friday July 29th at:
https://www1.gotomeeting.com/register/605953928

COURSE TOPICS:
at the conclusion of this activity, participants will be able to:

1.  Understand the meaning of ACOs and other key terms.
2. Meet legal and ethical guidelines for development and participation in an ACO.
3. Learn the proposed payment structures for ACOs and the risk/reward relationship associated with each.
4. Outline the current legal and administrative barriers to implementing ACOs.

A letter from the North Carolina Medical Society to the Administrator of the Centers for Medicare and Medicaid Services earlier this month represents many hours of work on behalf of physicians in addressing concerns over the Proposed Rule for Accountable Care Organizations (ACOs).

The letter from NCMS President John R. Mangum, MD, on behalf of the NCMS, expressed support for the goals of the Medicare Shared Savings Program to improve health and quality and to control costs. However, the NCMS strongly believes the proposed ACO rules are seriously flawed and if substantive changes are not made, the program will likely fail.

Concerns over the proposed ACO rules arose from a lengthy process in which NCMS staff divided the 400-plus page rule into about 20 separate pieces that were reviewed by the ACO Task Force. Conference calls and e-mail exchanges were used to develop and finalize comments that were contained in two letters: click here to read the letter to the Federal Trade Commission/Department of Justice on the antitrust policy statements; click here to read the letter to CMS on the Proposed ACO Rule.

NCMS views the Shared Savings Program, if structured appropriately, as a viable interim approach to implementing physician-led improvements in the delivery of health care. But the review raised grave concerns about the proposed ACO rules, with similar concerns also expressed by the American Medical Association (AMA), the American Medical Group Association (AMGA), the Medical Group Managers Association (MGMA), the American Hospital Association (AHA), and numerous national specialty societies.

In the five-page letter, the NCMS addresses the overall proposal; assignment; benchmarking and beneficiary risk adjustments; shared savings and risk assumption; quality; governance; governance, leadership and administrative considerations; legal considerations; and other requirements contained in the proposed rules.

Generally, the NCMS is convinced the proposed rules are too onerous, even for more sophisticated practices and health care organizations, and that more options are needed that are less intrusive, costly and risky.

Recommendations include:

• Revising the assignment structure to create a conducive environment for the achieving the Triple Aim (three-part): (1) improve the health of the defined population; (2) enhance patient care experiences including quality, access and reliability; (3) control per capita cost of care. This includes utilizing prospective beneficiary assignment and requiring beneficiaries to choose to be assigned to an ACO.
• Allowing the benchmark to be risk adjusted for each year, with more consideration given to risk adjustment methodologies.
• Providing at least one track with no down-side risk for a new ACO, with the option of participating in that track for at least two to three year agreement periods so that these ACOs are not forced to take on down-side risk before they are ready.
• Eliminating the minimum savings rate (MSR) or cap it at one percent.
• Eliminating the withholding of all shared savings bonuses, which are needed for reinvestment in the ACO
• Significantly reducing the number of quality measures and gradually phase in more each year.
• Retaining (support) the proposed requirement that 75 percent control of the governing board is by ACO participants to promote physician-leadership.
• Retaining (support) the ACO’s clinical management and oversight to be managed by senior-level medical director licensed and present in the state where the ACO is located.
• Extending the proposal to waive Stark Law, Anti-Kickback Statute and Civil Monetary Penalties Act for distribution of shared savings among ACO participants to allow additional collaborative activities beyond the Medicare Shared Savings program and other CMS-sponsored programs.
• Adopting a more graduated approach to participating in the Shared Savings Program on multiple levels.
• Preemption of state laws that conflict with the Shared Savings Plan, with a strong recommendation that CMS and the OIG act to preempt the corporate practice of medicine doctrine and the state equivalents of the federal Civil Monetary Penalties Law, Anti-Kickback Statute, and Anti-Referral (Stark) Law, but only insofar as these state laws might otherwise apply to properly organized and operated ACOs.

Read AMA comments on the Proposed ACO Rule.

Read AMA comments to the FTC/DOJ.

Physicians who have successfully initiated performance programs will be part of the Saturday, July 16, 2011 seminar, What physicians need to know about ACOs and the coming revolution in payment practices. The seminar will be held at the Hilton, Raleigh-Durham Airport, Durham, 9:00 am – 3:00 pm.

Register today as space is limited and demand is strong. For more information on this event, click here.

Steven E. Wegner, MD, JD, chair of the North Carolina Community Care Network will lead a panel discussion on Specialist and primary care strategies for improving quality and lowering costs. Panelists include:

• Alan M Speir, MD, chairman of the Virginia Cardiac Surgery Quality Initiative,  will discuss the dramatic improvement in patient care that this statewide program has achieved.
• Jeffrey G. James, CEO of Wilmington Health Associates, will explain how physicians can transform the culture of health care to support comprehensive and accountable care.
• L. Allen Dobson, Jr., MD, president and CEO of Community Care of North Carolina, will describe how patient-centered medical homes can expand to become medical neighborhoods through coordination with specialist physicians.

Also featured:

Harold D, Miller, Executive Director of the Center for Healthcare Quality and Payment Reform, will explore new approaches to physician payment and delivery of care.

Jeremy A. Lazarus, MD, Speaker of the AMA House of Delegates, will discuss how physicians can lead in this new payment revolution, as well as describe the Washington landscape with regard to new federal pilot programs.

Grace E. Terrell, MD, CEO, President of Cornerstone Health Care, will discuss delivery innovations at Carolina Regional Heart Center and a next generation clinical information system to improve population health.

Craigan L. Gray, MD, Director of the State of North Carolina Division of Medical Assistance (DMA) will survey the landscape of new models of care in the state.

This seminar is an American Medical Association program presented in conjunction with the North Carolina Medical Society. Register today!

On June 6, the North Carolina Medical Society submitted comments on the Proposed Rule for Accountable Care Organizations (ACOs) to Donald Berwick, MD, Administrator for the Centers for Medicare and Medicaid Services (CMS).

John R. Mangum, MD, President of the NCMS, stated in the letter, “While the NCMS strongly supports the goals of the Shared Savings Program to improve health and quality and to control costs, we are convinced that the proposed ACO rules are seriously flawed and that, as currently structured in the proposed rule, the Shared Savings Program is likely to fail.”

Click here to read the NCMS letter.

The comment letter was a culmination of an intensive eight-week review of the lengthy proposed regulations by the NCMS Accountable Care Task Force. The task force, chaired by Steve Wegner, MD, JD, was instrumental in framing the feedback provided to CMS.

A special thanks to the following task force members and consultants for reviewing in detail and identifying issues in certain sections of the proposed rule and related documents:

NCMS Board member Paul Cunningham, MD, and Janice Van Riper from Brody School of Medicine, Greenville; John Godehn, MD, Hendersonville; Nancy Henley, MD, Department of Internal Medicine, UNC-Chapel Hill; Genie Komives, MD, BCBSNC, Chapel Hill; Grace Terrell, MD, Cornerstone Health Care, High Point; Fran Sembert, Eagle Physicians, Greensboro; and Steve Shaber, Esq., and Kim Licata, Esq., with the Poyner Spruill law firm in Raleigh.

For a summary of comments filed by other major health care interest groups, click here.

More speakers have been confirmed for the July 16, 2011 seminar, What physicians need to know about ACOs and the coming revolution in payment practices, 9:00 am – 3:00 pm, Hilton Raleigh-Durham Airport, Durham, NC. Register today as space is limited and demand is strong.

Featured Speakers:

Craigan L. Gray, MD, Director of the Division of Medical Assistance (DMA) for the State of North Carolina

Jeffrey G. James, CEO, Wilmington Health Associates

Jeremy A. Lazarus, MD, Speaker of the AMA House of Delegates

Harold Miller, Executive Director of the Center for Healthcare Quality and Payment Reform

Alan M. Speir, MD, Chairman, Virginia Cardiac Surgery Quality Initiative

Grace E. Terrell, MD, CEO, President of Cornerstone Health Care

This seminar is an American Medical Association program presented in conjunction with the North Carolina Medical Society. Register today!

The AMA has notified the NCMS that the Centers for Medicare and Medicaid Services (CMS) has extended the deadlines for letters of intent and applications for the Pioneer Accountable Care (ACO) Model, which was released last month.

The CMS Innovation Center has modified the deadlines as follows:

• Letters of Intent will now be due on Thursday, June 30, 2011. (Previous deadline was today, June 10)
• Applications must be postmarked on or before Friday, August 19, 2011. (Previous deadline was Monday, July 18)

The Pioneer ACO Request for Application, the Letter of Intent form, and the Application form may be accessed at http://innovations.cms.gov/areas-of-focus/seamless-and-coordinated-care-models/pioneer-aco.

The North Carolina Medical Society has provided feedback on the proposed Statement of Antitrust Enforcement Policy Regarding Accountable Care Organizations (ACOs) Participating in the Medicare Shared Savings Program. NCMS President John R. Mangum, MD, says the NCMS has “significant concerns about the deterrent effect the proposed regulations and related documents, including the proposed Antitrust Policy Statement, will have on participation in the Shared Saving Program if these proposals are not substantially modified.”

Dr. Mangum’s comments were contained in a letter to Federal Trade Commission Secretary Donald Clark on May 31, 2011. The NCMS is urging the FTC to rework the proposals to ensure that participation in the Shared Savings Program is feasible for physician practices of all sizes and capabilities. The NCMS supports the goals of the Shared Savings Program and the AMA’s recommendations for the Proposed Antitrust Policy Statement.

The American Medical Association (AMA) today submitted comments to CMS on their proposed rule for accountable care organizations (ACOs). The AMA comments to CMS come a week after the AMA submitted comments to the FTC and DOJ regarding their proposed policy on antitrust enforcement of ACOs.

Due to high demand, physicians are urged to sign up early for Pathways to Success: What physicians need to know about ACOs and the coming revolution in payment practices, a seminar presented by the NC Medical Society in conjunction with the AMA, Saturday, July 16, 2011, 9:00 am – 3:00 pm, at the Hilton Raleigh-Durham Airport Hotel near Research Triangle Park. A buffet lunch is included. Accommodations are limited, so register now.

Featured speakers:

• Harold Miller, executive director of the Center for Healthcare Quality and Payment Reform
• Jeremy A. Lazarus, MD, speaker of the AMA House of Delegates
• Grace E. Terrell, MD, president, CEO, of Cornerstone Health Care

These national and local experts will explore how physicians can find success with new payment practices resulting from the new federal health care reform law.

Participants will be eligible for AMA PRA Category 1 Credits™. Look for more details at www.ama-assn.org/go/paymentpathways. Watch for updates in the Bulletin and on the NCMS website.

Physicians are urged to mark their calendars for July 16, 2011 to attend the seminar, Pathways to Success: What physicians need to know about ACOs and the coming revolution in payment practices, at the Hilton Raleigh-Durham Airport Hotel near Research Triangle Park, 9:00 am – 3:00 pm, with a buffet lunch.  Demand for this seminar is strong, so register early to reserve a spot.

Watch for additional information in a future Bulletin and on the NCMS website. 

Keynote speaker Harold Miller, executive director of the Center for Healthcare Quality and Payment Reform, and other national and local experts, will explore how physicians can find success with new payment practices.

The seminar is an AMA program presented in conjunction with the NCMS and is eligible for AMA PRA Category 1 Credits™.   Look for more details at http://www.ama-assn.org/ama/pub/about-ama/strategic-issues/payment-model-resources/payment-models-seminar.page.