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.

Senator Kay Hagan (D-NC) voted for the temporary extension, but Senator Richard Burr (R-NC) voted against it. To see how Senators voted on HR 4961, go to: http://www.senate.gov/legislative/LIS/roll_call_lists/roll_call_vote_cfm.cfm?congress=111&session=2&vote=00032.

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.

Letter from Rep. Jones on SGR

Letter from Rep. Etheridge on SGR

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.

Back to Bulletin

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.”

Back to Bulletin

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.

Back to Bulletin

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.

Back to Bulletin

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 3^rd, 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.

Back to Bulletin

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.

Back to Bulletin

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.

To find out more visit the NCMS Foundation’s website, or download a gift slip now (PDF).

Physicians give so much to ensure our health. This year, tell them how much you appreciate that commitment.

Back to Bulletin

Twenty-one Greenville-area physicians have volunteered so far for the 2010 WITN-TV Doctors on Call.  More physician volunteers are needed for this annual community outreach, which allows viewers to talk with a physician at no charge. The program will air from the WITN-TV studio in Greenville on Wednesday, April 21, 2010, 12:00noon –6:00pm. You can sign up online for one of several shifts or register for this event by contacting Lyric Wohlgemuth, lwohlgemuth@ncmedsoc.org 800-722-1350; or by contacting Karen Bean, kbeanpcms@earthlink.net,  252-758-8833. Doctors-on-Call is co-sponsored by WITN, Pitt County Medical Society and the NCMS.

Back to Bulletin

Special workshops will be part of a screening of the documentary, “The Deadliest Disease in America,” on Saturday, March 20, 2010, beginning at 9:30am at the Duke University School of Nursing Auditorium. The film was produced and directed by Crystal Emery.  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

Please RSVP by March 15 at http://www.urutherighttobe.org/register, or 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 Durham; People’s Alliance; and Old North State Medical Society.

To preview a trailer of the film please visit this website: http://www.urutherighttobe.org/, operated by the non-profit, community-based URU The Right to Be, Inc.

Back to Bulletin