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.

In a letter sent August 23, 2010, the NCMS provided input on the draft North Carolina Statewide Health Information Exchange Operational Plan. While pleased with the overall general direction outlined in the plan, the NCMS does have a concern with the issue of patient consent and believes further discussion is warranted.  The NCMS also supports equitable cost sharing so that smaller providers are not burdened with paying the same amount as larger, better capitalized, providers.

Click here to the read the entire NCMS letter regarding the draft NC Statewide Health Information Exchange Operation Plan, including the NCMS recommendation to amend Subsection 8.5, page 101, under Consent for Treatment Purposes.

On Monday, August 23, 2010, members of the Triad-area physician community attended a forum with third party payer medical directors and North Carolina Insurance Commissioner Wayne Goodwin.  The event entitled “Third Party Payer Meeting: Which is it? Health Reform or Insurance Reform?” was organized by the Greater Greensboro Society of Medicine and the High Point Medical Society.  North Carolina Medical Society Executive Vice President, CEO, Robert Seligson moderated the meeting, which was attended by about 100 physicians.

Also seated at the moderator’s table were:

William F. Hopper, MD, President, Greater Greensboro Society of Medicine

Perry E. Jones, MD, President, High Point Medical Society

Henry A. Fleishman, MD, President, Rockingham County Medical Societ

Palmer Edwards, MD, President , Forsyth-Stokes-Davie County Medical Society

North Carolina’s third party payers were represented by the following Medical Directors:

Bruce Norman, MD, Aetna

Catherine Palmier, MD, UnitedHealthcare

Edward N. Hunsinger, MD,CIGNA HealthCare

Don W. Bradley, MD, Blue Cross and Blue Shield of North Carolina

The panel of insurer representatives and Commissioner Goodwin answered prepared questions regarding medical loss ratio, most favored nation clauses, physician payment models and the future of the health care industry under new reform laws as well as a number of questions from physicians in the audience.

With the expansion of Medicaid and the individual mandate to obtain health insurance brought about by Health System Reform comes the need for expanded access to quality health care providers.   In an attempt to address the inevitable shortage of medical providers the Patient Protection and Affordable Care Act has called for the creation of a National Health Care Workforce Commission.   The legislation requires that this group be appointed and operational no later than September 30^th of this year and to prepare, the U.S. Government Accountability Office has been seeking recommendations for members throughout the summer. 

The Commission will be tasked with determining if the demand for health care workers is being met, identifying possible barriers to health care workforce development and making recommendations to Congress based on their findings.

Fifteen members will serve on the Commission, each appointed to three year terms by the Comptroller General. Health care professionals cannot constitute more than half of the workforce, leaving other seats open to representatives of employers, third party payers, health care economists, consumers, labor unions, educational institutions, and state or local workforce investment boards.

Legislators have penned specific priorities for the Commission to focus on throughout the course of their evaluations which include integrated workforce planning for nursing, oral, mental, public, allied, and emergency health providers.  Also of significance is the Commission’s ability to evaluate existing scopes of practice in the health care sector and make recommendations to Congress.

The creation of the National Health Care Workforce Commission is accompanied by a number of development grants for eligible State Workforce Development Boards to analyze local health care workforce needs and provide resources to help meet those needs. Individual providers may also apply for a number of workforce development grants or loan repayment programs.   Many of these opportunities are focused on growing the nursing field, however programs also exist to repay loans for pediatric and public health physicians as well.

The North Carolina Medical Society (NCMS), in its mission to provide Leadership in Medicine by helping physicians and patients navigate the transformation in health care, will partner with News Channel 14 to convene a televised forum on September 22 in Charlotte to engage leaders in the health care sector, elected officials and the public on the implementation of health system reform legislation.

The forum will be a panel discussion facilitated by a News Channel 14 anchor. Participants will include physician leaders in public health, rural and urban practice settings; a representative from the insurance industry; and representatives of both the hospital and physician perspectives.

The “Health Reform and You”  forum is scheduled for Wednesday, September 22, at 7 pm at the Harris Conference Center on the campus of Central Piedmont Community College in Charlotte.  The forum is open to the  medical community and the general public. Seating is limited and registrations are being accepted online.

The Centers for Medicare and Medicaid Services issued a reminder this week to health care providers, health plans, clearinghouses and vendors about the approaching compliance dates for a new generation of diagnosis and procedure codes and updated standards for electronic health care transactions (ICD-10 code sets).

Beginning in January 2011, entities covered under the Health Insurance Portability and Accountability Act (HIPAA) should be ready to test with their trading partners the functionality of the entities’ practice management and/or other related software featuring Version 5010 standards (compliance with Accredited Standards Committee X12 Technical Reports Type 3, Version 005010). Use of the Version 5010 standards for HIPAA electronic care transactions, including claims, remittance advice, eligibility inquiries, referral authorization, and other administration transactions, will be mandatory on January 1, 2012. The Version 5010 standards also provide the framework needed for use of the revised medical data code sets (ICD-10-CM and ICD-10-PCS), that must be implemented on October 1, 2013.

To help health care providers, health plans, clearinghouses and vendors work toward the compliance dates for Version 5010 and ICD-10, to avoid delays in claims processing and payment, CMS has been conducting ongoing industry outreach and education, and most notably, has revised its ICD-10 website. Download all the free information at http://www.cms.gov/ICD10.

Click here to read the CMS press release that was issued on August 24, 2010.

The NCMS and the Western North Carolina/Buncombe County Medical Societies are hosting a Legislative Breakfast for physicians at the Doubletree Hotel in Biltmore on Monday, August 30, 2010, 7:30am – 9:00am. NCMS Director of Legislative Affairs Chip Baggett will be on hand to discuss the November 2010 Election and how physicians can become engaged in the political process to ensure their voice is heard during the 2011 legislative session and beyond. RSVP by emailing Jennie@bcmsonline.org.

Cindy Mann, Director, Center for Medicaid, CHIP and Survey and Certification (CMCS) for the Centers for Medicare and Medicaid, spent Wednesday in the Triangle meeting with state officials and health care leaders. Mann was the keynote speaker for the North Carolina Institute of Medicine’s annual meeting at the McKimmon Center in Raleigh. She spoke on Health Reform – A View from the Federal Level and participated in a question and answer session. Also participating was DHHS Secretary Lanier Cansler.

Click here to view remarks made by Cansler and Mann (this link is hosted by NC State University Continuing Education and may only be available for a limited time.)

While in the Triangle, Mann toured the Carrboro Community Health Center and talked with local officials and community leaders about the benefits of federal stimulus funds.  The Carrboro CHC is one of four entities in the Triangle to receive stimulus funding. The others include the Lincoln Community Health Center in Durham, Wake Health Services, Inc., in Raleigh, and the North Carolina Department of Health and Human Services.

The Health Resources and Services Administration funded nearly $190 million to North Carolina in 2009 for various areas, including health facilities, health professions, primary health care, rural health and for HIV/AIDS.  $2.2 million was given to Piedmont Health Services to assist with increased demand and capital improvements.  The NCMS joined Piedmont in celebrating its 40^th anniversary earlier this month at its headquarters in Carrboro.

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).

Deadlines are fast approaching for the Harris Award Nominations, House of Delegate Resolutions, Room Reservations and Early Bird Registration for the NCMS Annual Meeting, Oct. 22-24, and the 2010 Photo Contest.

...Enter the 2010 Photo Contest! Great new prize added: the winner gets a choice of free NCMS membership for 2011 or an iPod Touch. Send your high-res images by to kshipherd@ncmedsoc.org.  -  deadline Sept. 1

…Click here to submit your Resolution for the 2010 House of Delegates – deadline Sept. 8

…Click here for the NCMS Annual Meeting Early Bird Registration (to be eligible for a drawing for a GPS) - deadline Sept. 15

…Click here to nominate an outstanding physician for the 2010 Harris Award  – deadline Sept. 20

…Make your Hotel reservations for the NCMS Annual Meeting – deadline Sept. 21

Links to important information about practice management, professional development, and other items of interest to physicians.

…Wondering if you’re getting the best deal on practice supplies and services? Attend this free luncheon sponsored by NCMS Partner GroupSource to find out. September 17, noon.

…Register for Fall 2010 Care Share Health Alliance Regional Workshop, September 24 (Asheville), October 5 (Greenville), and October 21 (Greensboro). Click here for more details.

Events/meetings involving NCMS staff working on your behalf this week.

The North Carolina Medical Society (NCMS) and the North Carolina Hospital Association (NCHA) are partnering with Moses Cone Health System and WakeMed Health & Hospitals to work with Thomson Reuters and CareEvolution to launch the North Carolina Healthcare Information Exchange (NCHEX).  The exchange will allow physicians to assemble a “continuity of care” record for each patient, comprising the patient’s clinical information from all of the providers participating in the exchange. The enhanced patient information will enable better quality and more efficient patient care.

NCHEX, which is launching with seven hospitals, three freestanding emergency departments and 57 physician practices, is the first step toward a statewide health information exchange (HIE) for North Carolina. It meets all the criteria for an HIE outlined in the ARRA HITECH Act for Meaningful Use.

The exchange will be open to all NC healthcare providers and will actively seek to contract with existing regional health information organizations, health information exchanges, and healthcare information technology systems by leveraging Nationwide Health Information Network Connect and other HIE standards.

Organizations and physician practices interested in joining NCHEX or seeking additional information can visit http://www.nchex.net/.

Thomson Reuters is an international company that provides information for businesses and professionals.  Read the Thomson Reuters news release about NCHEX.

The Patient Protection and Affordable Care Act expands state Medicaid eligibility to almost anyone under the age of 65 with income up to 133% of the Federal Poverty Line (FPL).  As of 2009, this percentage equals $29, 327 for a family of four.  A family of four with an income of 400%  of the FPL (approximately $88,000 per year)  will also be eligible for subsidies.  This drastically changes the current face of the Medicaid program, especially due to the inclusion of many childless adults. Taking into account the drastic mandate for eligibility and other new requirements of the law, the ultimate reach of the program will be heavily dependent upon implementation at the state level.

The North Carolina Institute of Medicine, together with the NC DHHS Secretary Lanier Cansler and NC Insurance Commissioner Wayne Goodwin, has convened a Medicaid Work Group to begin looking at the major changes ahead for the NC Medicaid program.

By 2014, the Department of Health and Human Services estimates over 500,000 new Medicaid enrollees due to expanded eligibility as well as current eligibles who are not enrolled at this time. Half of this influx will be comprised of childless adults.  Other sources have projected this number to be even higher based on past enrollment trends.

The Act allows states to implement the new eligibility category options today, but only at the original NC FMAP rates.  At this time the state does not plan to implement this option due to the loss of future federal matching funds.

The law as currently written requires the federal government to finance the majority of spending for newly eligible Medicaid enrollees.  States will receive 100% funding from 2014-2016, 95% in 2017, 94% in 2018, 93% in 2019 and 90% thereafter.  However, the state will be financially responsible for those who are currently eligible but who have not enrolled in the past. The law also requires states to maintain eligibility standards that were in place as of the date of passage (March 23, 2010).  

The Kaiser Family Foundation estimates that the state of North Carolina will spend anywhere from $1.02 to $1.8 billion during the first five years of Medicaid expansion. This will increase total spending on Medicaid from the current $12 billion to over $17 billon.  This range is based upon expected enrollment of the total eligibility ranging from 57-75%.  The federal government will pay the remaining 93-95% of costs, totaling $21-25 billion in North Carolina alone.  Under the new law states must also increase reimbursement for primary care procedures to 100% of Medicare payment rates. The federal government will cover the cost of the enhanced rate in 2013 and 2014.

The mass expansion of Medicaid coverage to over half a million new patients and the pending provider rates cuts at both the state and federal levels threatens patient access to care more than ever before. To address this challenge, we must stand together to ensure that the value of your services provided under the physician fee schedule is preserved.  State budget shortfalls and fallout from the recession should not be borne on the backs of the physicians and PAs that are providing the highest quality and most cost effective medical care to our Medicaid population.