BREAKING NEWS!

The House is voting on its proposed health care reform bill Sunday afternoon.  The NCMS is contacting each member of the North Carolina Congressional Delegation to discuss key elements in the current legislation.  Please be looking for a Special Bulletin detailing the latest developments in this ongoing story.

Yesterday afternoon, the U.S. House of Representatives released legislative language for the reconciliation bill that makes refinements to the Senate’s health reform bill, H.R. 3590. Key provisions include:

• Medicaid payment rates for primary care physicians to equal 100 percent of Medicare payment rates in 2013 and 2014. Provides 100 percent federal funding for the increased costs to states.
• Increased federal medical assistance percentage (FMAP) paid to states for individuals newly enrolled in Medicaid as a result of the expansion of eligibility to 133% FPL (100 percent for 2014-2016, 95 percent in 2017, 94 percent in 2018, 93 percent in 2019, and 90 percent for 2020 and later years), repeal of the special FMAP for Nebraska.
• Government payments to Medicare Advantage would be cut $132 billion over 10 years, a steeper cut than the $110 billion cut contained in the Senate bill.
• Independent Payment Advisory Board (IPAB) would remain in the reconciliation bill, but the expected Medicare savings would be about half of the Senate’s projected savings of $23 billion, because the House bill would impose greater cuts in Medicare Advantage plans.

House Majority Leader Steny Hoyer (D-MD) announced on the floor yesterday that debate will not begin until after members have had 72 hours to review the new provisions, which sets the time for the first potential floor votes to Sunday at 2:00 pm.

The Congressional Budget Office has issued a letter determining that these changes will bring the Senate health reform plan to a cost of $940 billion over 10 years.

The North Carolina Medical Board held a meeting on Tuesday, March 16, 2010 to discuss the potential creation of a Special Purpose License for Administrative Medicine.   Physicians who need a North Carolina medical license to work in non-clinical positions would be eligible to apply for this license type, including hospital executives, medical directors, and physicians who perform non-certification work for health insurers, pursuant to N.C. Gen. Stat. 58-50-61(d). Any physician holding an administrative license would be unable to practice clinical medicine and would have no prescriptive authority.

The NCMS will keep you updated of Board action on this item and future meeting dates that may be announced.  Your thoughts on this proposed license?

The Policy Committee of the North Carolina Medical Board met on Wednesday, March 17, 2010, to discuss a proposed policy on Telemedicine.  The Committee approved the draft Telemedicine policy in January; however, the full Board asked the Committee to continue to review the proposed policy, specifically seeking clarification of the “informed consent” language. 

At Wednesday’s meeting, the Policy Committee noted receiving feedback from a number of stakeholders on the issue of informed consent and as a result has developed a “Board comment” to address those concerns. The Policy Committee, with the Board’s approval, will continue to accept public feedback on the Telemedicine policy and intends to continue to discuss the policy at their next meeting in May.  If you would like to offer written comment on this policy you can do so by emailing the Medical Board at info@ncmedboard.org or writing to PO Box 20007, Raleigh, NC 27619.

The enrollment period for the 2010 State Health Plan (SHP) is now open and will extend into April, with coverage and benefits taking effect July 1.  A new component of the SHP this year places all members in a 70/30 Basic Plan, unless they meet the requirements for enrollment in the 80/20 Standard Plan based on compliance with a tobacco cessation requirement.

Smoking members and dependents who wish to enroll in the 80/20 Plan will be required to join a tobacco cessation program.  Once enrolled, those members may later be required to submit a one-page, physician-signed certification form.  Patients are expected to begin bringing these forms into doctors’ offices later in 2010.  The form may be completed by a physician, physician assistant, or nurse practitioner.

A copy of the form is available on the SHP website, at  http://www.shpnc.org/hbr-enrollment-matls/physician-cert-form.pdf.

The legislative study bill passed by the General Assembly last year allows the North Carolina Midwifery Joint Committee (MJC) to present recommendations during the next legislative session regarding the potential licensure of Certified Professional Midwives(CPMs).  On Tuesday, March 16, 2010, Melanie Phelps, NCMS Deputy General Counsel, spoke before the MJC to convey NCMS concerns regarding the licensure of these individuals.  The NCMS opposes CPM licensure standards that would put patients at risk by allowing relaxed training and education requirements and allow CPMs to practice without physician supervision.  The MJC holds monthly public meetings to discuss this issue. The next meeting will be held on Wednesday, April 14, 2010 at noon.

A RAND Corporation study published in the latest issue of the New England Journal of Medicine offers the first major assessment of physician cost profiling by health insurers. The study concluded that physician evaluations based on cost factors can be misleading and may not help save money. See the abstract,”Physician Cost Profiling – Reliability and Risk of Misclassification,” at http://content.nejm.org/cgi/content/short/362/11/1014?query=TOC (Abstract only; full article requires subscription or purchase).

“The Rand Corporation study verifies the AMA’s longstanding contention that there are serious flaws in health insurer programs that attempt to rate physicians based on cost-of-care,” said AMA President J. James Rohack, MD. “The Rand study shows that physician ratings conducted by insurers can be wrong up to two-thirds of the time for some groups of physicians. Inaccurate information can erode patient confidence and trust in caring physicians, and disrupt patients’ longstanding relationships with physicians who have cared for them for years.”

The AMA has called on the insurance industry to abandon physician evaluation and ranking programs and work with physicians to create programs that “produce meaningful data for increasing the quality and efficiency of health care.”

North Carolina Medicaid patients are now required to have prescriptions filled from a Preferred Drug List.  The new policy took effect March 15, 2010.  NC DHHS says taxpayers could see a savings of more than $90 million annually under the new policy, which requires recipients to use clinically effective generics and lower-cost alternatives to brand-name prescription medicines. DHHS stated in a news release  that the requirement will help to control Medicaid costs; however, Medicaid recipients will not experience any immediate changes.  As the Preferred Drug List takes effect, it will include all medications currently covered by NC Medicaid.  For more information and updates on the Preferred Drug List, go to www.ncdhhs.gov/dma/pharmacy/.

Special workshops and a screening of the documentary, “The Deadliest Disease in America,” will take place tomorrow, Saturday, March 20, 2010, beginning at 9:30am at the Duke University School of Nursing Auditorium. The screening will be followed by three participatory workshops (you may choose one):

• Doctor/Patient Communication
• Empowering Community Organizations to Work with Legislators for Change
• What Racism Looks Like in Health Care Delivery and Why You Should Report It

 To register, call (919) 599-4647.

 This event is open and co-sponsored by the North Carolina Medical Society; Durham Academy of Medicine, Dentistry and Pharmacy; Durham Committee on the Affairs of Black People; Durham Congregations In Action; and Old North State Medical Society.

North Carolina was recently awarded over $52 million to help improve the infrastructure for health information technology (HIT) and provide technical assistance to healthcare providers. Register today for this webinar, to be held March 25^th from 12-1pm, focusing on one of the HIT initiatives, Regional Extension Centers (REC).

The REC will support primary care providers in adopting electronic health records (EHRs) and utilizing HIT effectively to improve the quality of healthcare throughout the state.  For more information and to register, visit www.ncmedsoc.org.