Small Business Administration (SBA) loans to doctors have increased more than ten-fold in the past decade, according to a report on CNNMoney.com (Doctors living on loans, 1-20-12). SBA says loans to physician offices rose from less than $60 million in 2001 to $675 million in 2011. In North Carolina, SBC loans to physician offices dramatically increased from $2.5 million in 2001 to $37.5 million in 2011.

“In this ever-changing health care environment, implementing an Electronic Health Record (EHR) is a huge expense to a practice, as is upgrading diagnostic equipment such as adding digital X-ray,” NCMS President Robert W. Monteiro, MD, said. “With costs rising and payments declining, practices need a financial bridge when they face cuts or delays in payments.”

Tom Blue, Executive Director of the American Academy of Private Physicians, told CNNMoney.com that doctors are struggling and are cash-strapped as they take out loans to make payroll and pay monthly expenses. Among the factors cited by physicians are declining insurance reimbursements, changing regulations and rising practice, medical liability and drug costs.

Adding to the struggle is the continued impact created by the yet-to-be fixed sustainable growth rate (SGR) formula used to set Medicare physician reimbursements. Temporary fixes and delays by Congress have only led to a much wider gap between what physicians receive and the cost of delivering care, raising concerns about medical practice viability and access to care.

For assistance in selecting and financing an EHR or other practice technology, contact Terri Gonzalez, Practice Technical Assistance Coordinator, NCMS Foundation, at tgonzalez@ncmedsoc.org or 800-722-1350.

The NCMS joined with 47 physician organizations this week to ask Congress to repeal Medicare’s sustainable growth rate (SGR) formula by using excesses from Overseas Contingency Operations (no longer needed for wars in Iraq and Afghanistan).

In a letter to House Ways and Means Committee Chairman Dave Camp (R-Michigan), the organizations stated, “This long-stated goal of Congress (SGR repeal) is now within reach, and we urge you to take advantage of it immediately by using excess baseline projections for Overseas Contingency Operations (OCO) to help offset necessary Medicare baseline changes.“ The letter adds that further delays will only make future cuts deeper and more expensive to solve.

The Congressional Budget Office (CBO) projects that the cost of repealing the SGR is $290 billion and growing. The AMA says a two-year SGR patch will cost $39 billion in 2012, increasing the cost of repeal to $346 billion and expanding the size of the next scheduled cut to physician payments to 36 percent. Just before Christmas, Congress delayed a 27.4 percent cut, from January 1 to March 1, 2012. That cut is still pending.

Click here to read the letter.

NCMS urges you to please take a moment to send an e-mail to your Senators and Congressman to let them know that it is time to fix the broken SGR. We need a permanent fix.

CapWhiz call for action here. Contact your legislators today.

Physician organizations, including the NCMS and other state medical societies, have asked the Centers for Medicare and Medicaid Services (CMS) for written public policy guidance on how patients enrolled in Medicare may obtain reimbursement for covered services provided by physicians who are not enrolled in Medicare and bill their patients directly.

In a letter to Acting CMS Administrator Marilyn B. Tavener, the organizations state that Medicare materials typically describe three alternatives: being a participating physician, being a non-participating physician, or opting out of Medicare and privately contracting with patients who are enrolled in Medicare.

“Questions have recently been raised within the physician community about a fourth option, whereby physicians who do not enroll as Medicare providers bill their patients directly at fee levels that are set without regard to Medicare payment rates or limiting charges. Medicare patients pay the physician bills out of pocket and then seek reimbursement from Medicare using form CMS-1490S,” according to the letter.

The organizations note that electronic e-mail correspondence reveal, “it is the view of the CMS that the option of having physicians not enrolled in Medicare and having beneficiaries submit claims on their own using the form CMS 1490S is not consistent with Medicare law and un-enrolled physicians who engage in this type of practice are subject to penalties.”

Palmetto GBA (Government Business Administration) has informed the NCMS that the problem causing claims denials for Medicare patient office visits handled by physician assistants (PAs) and nurse practitioners (NPs) should be fixed this week. As we first reported in December, those denials were traced to a new policy based on a misinterpretation of Medicare guidelines. At that time, Palmetto GBA told us it would remove the erroneous edit from their system, retract the policy posted on their website, and reprocess all affected claims in a mass adjustment.

However, physician practices have continued to experience claims denials for these services in January. The NCMS again contacted Palmetto GBA and learned that corrective action had not been taken. Palmetto has now assured the NCMS that the erroneous edit has been turned off, and once testing is completed, mass adjustments will be begin this week. The adjustments should cover all affected claims going back to December. This will eliminate any additional paperwork on the part of practices to get the claims paid.

Please contact the NCMS Member Resource Center at kfreeman@ncmedsoc.org or 800-722-1350, if your practice continues to experience problems associated with this issue. The NCMS will continue to watch this situation closely and provide necessary updates in the Bulletin and at http://www.ncmedsoc.org/.

Due to a high volume of questions coming in through the Member Resource Center, the NCMS will provide a Frequently-Asked-Question (FAQ) for its members each week to make them more aware of current medical and health care issues that their colleagues are having.

Q: What can I do if a clearinghouse, billing company, or third-party payor is not prepared for 5010, or is not following other federally-mandated standards for electronic transactions under HIPAA?

A: The North Carolina Medical Society recommends that you first contact the appropriate trading partner and/or third-party payor to learn more about the problem you are experiencing with your claims. It is important to ask a lot of questions and to gather as much information as possible about the issues you are having.

If the problem does not get resolved, you can file a complaint through the federal Office of E-Health Standards and Services (OESS), which enforces HIPAA’s Administrative Simplification provisions.  To file a complaint, access OESS’s online Administrative Simplification Enforcement Tool. The first time you file a complaint, you will need to create an account. Once you have done so, click on “New Complaint.”  The tool will then lead you through a series of prompts, asking for information about the entity that you are complaining about.

Taking such action will incentivize our vendor and payor partners to work to make industry-wide transitions like 5010 and ICD-10 much smoother.  The NCMS also offers Version 5010 and ICD-10 Resources that will help you with these transitions. Please contact the NCMS Member Resource Center at (919) 833-3836 with any questions or concerns regarding the transition.

Douglas D. Sheets, MD, understands the connection between a strong PAC and strong advocacy.  As Past President of both his county and state Medical Societies, chairman of multiple committees, and a member of the NCMS PAC, Dr. Sheets has a wealth of knowledge and experience in the issues affecting the practice of medicine in North Carolina. 

Even before he acted as president of the North Carolina Medical Society, Dr. Sheets was actively involved in your NCMS PAC. Through his involvement, Dr. Sheets learned, “how important relationships with legislators are.”  During a recent conversation, he recalled a time he contacted multiple members of Congress and the General Assembly to talk about issues with Medicaid.  It’s conversations like these, he said, that allow your representatives to know what affects a physicians ability to provide optimal patient care.    

It’s important to “help the people that have helped us,” said Dr. Sheets.  This allows us to maintain access and provide better feedback to legislators. 

Speaking on the recent medical liability reforms, Dr. Sheets said, “We won a battle, and one battle is not a war.  The war goes on.”  Recently, our PAC developed a sustained giving model, which Dr. Sheets participates in.  This way, donors can use a credit card to have a certain amount automatically drafted every month.  With sustained giving, we can make sure we are ready for the next battle. 

Less than 6 percent of NCMS members participate in the NCMS PAC.  We are consistently out raised and less engaged than the trial lawyers.  Now, with the passage of medical liability reform, comes responsibility.  Like Dr. Sheets, take your responsibility seriously.  Please, take the next two minutes to make a gift online.  For less than you spend in a month on coffee, you can help secure the future of your profession.           

DONATE NOW!

In addition to announcing that she would not seek reelection this week, Governor Beverly Perdue announced that Laura Gerald, MD, former Executive Director of the Health and Wellness Trust Fund, would become State Health Director, effective February 1, 2012, and will lead the newly combined Division of Prevention, Access and Public Health Services. Outgoing State Health Director Jeffrey Engel, MD, will move to a broader policy-making role and become a special advisor on health policy to the Secretary of the Department of Health and Human Services (DHHS). Both Dr. Gerald and Dr. Engel are active members of the NCMS.

The leadership moves coincide with the Governor’s executive order encouraging agencies to consolidate and realign state government, to improve service and efficiency, according a DHHS news release.

“As we move to enact the Governor’s executive order, the focus shifts to a more integrated approach to improving the health of all North Carolinians,” outgoing DHHS Secretary Lanier Cansler said. He will be working in consultation with incoming Acting Secretary Al Delia to begin the formation of the new division.

Related articles:

State health official stepping down, 1-24-12, Winston-Salem Journal, by Richard Carver

Governor Names Delia Acting DHHS Secretary, Bulletin, 1-20-12

Special Report: DHHS Secretary Cansler Resigns, Doctor to Doctor Blog, 1-14-12

Join the North Carolina Medical Society Foundation (NCMSF) on Wednesday, February 8, 2012, 12:00 pm, for a webinar, co-sponsored by the North Carolina Medical Group Management Association (MGMA), that will help physicians understand the Patient Centered Medical Home (PCMH) as well as Blue Cross and Blue Shield of North Carolina (BCBSNC)’s Blue Quality Provider Programs ^SM (BQPP). This webinar is free, but registration is required.

Webinar participants will learn how to register for BQPP and how to navigate the National Committee for Quality Assurance (NCQA)’s certification process for PCMH. Joy Simmons, BCBSNC’s Program Manager Associate, and Paige Robinson, NCQA’s Manager Customer, Outreach and Support for Clinician Recognition Programs, will be speaking at the webinar.

Click here to register. The registration limit is 110 and those who are interested in attending have until Monday, February 6, 2012, to register. Questions can be directed to Jackie Fannell, NCMSF Programs Coordinator, at (919) 833-3836 or jfannell@ncmedsoc.org.

The American College of Physicians (ACP) North Carolina Chapter will be hosting the 2012 Scientific Session from Friday, February, 24, - Saturday, February, 25, 2012, at the Grandover Resort & Conference Center, Greensboro. Attendees can receive up to 10.5 AMA PRA Category 1 credits(s)™.

The meeting is designed for general internists, subspecialty internists, family physicians, fellows in subspecialty training, allied health practitioners, residents and medical students who are interested in internal medicine. Meeting highlights include:

• Updates in Infectious Diseases and Stroke Management
• North Carolina Legislative Update
• Advance Directives in North Carolina: Strategies for Enhancing Patient-Centered Care Near the End of Life
• Management of Hepatitis C
• Osteoporosis Update
• Clinical Skills Sessions
• Special Interest Group Lunch Roundtables
• Patient-Centered Medical Home

Rooms are still available at the Grandover Resort & Conference Center. Call (800) 472-6301 for reservations. Click here or contact Nancy Lowe, NCMS Associate Director Specialty Society and Meeting Services, at (919) 833-3836 or nlowe@ncmedsoc.org for more information.

There’s a new sign at the corner of Moye Boulevard and Stantonsburg Road in Greenville. It reads “Vidant Medical Center,” which is part of the name change for the former University Health Systems (UHS) and Pitt County Memorial Hospital (PCMH). Eight new signs were unveiled in a special ceremony held on Wednesday, at Greenville and eight other eastern North Carolina communities with hospitals in the Vidant Health system. During the past decade, the system has grown from one hospital to a network of interconnected physician practices, more than 11,000 employees, 10 hospitals, home health and hospice programs, and wellness facilities.

See related story:

University Health Systems Becomes Vidant Health in 2012 (Bulletin, 12-2-11)

Medicaid medical homes saved $1billion in North Carolina, 1-12-12, American Medical News

Staff Writer Doug Trapp reports on how North Carolina’s Medicaid medical home program has saved nearly $1 billion in state and federal spending over four years. The article includes quotes from NCMS President Robert W. Monteiro, MD, and Community Care of North Carolina President and NCMS member L. Allen Dobson, Jr., MD.

Efficiency a key factor in top practices: MGMA-ACMPE, 1-25-12, Modern Physician

Writer Andis Robeznieks looks at a new report from MGMA-ACMPE (formerly Medical Group Management Association) on what distinguishes better-performing practices.

Florida bill would make doctors, health centers post prices, 1-24-12, South Florida Sun-Sentinel

Writer Bob LaMendola reports on a bill being considered by Florida legislators that would force doctors and some medical centers to post prices in their waiting areas.

Lawmakers hear Rex Hospital complaints, 1-24-12, The News and Observer

Staff Writer Mandy Locke reports on a legislative committee looking into whether the state should own Raleigh’s Rex Hospital.

Titan project would cost millions in health care, report says, 1-24-12, Wilmington Star-News

Writer Kate Elizabeth Queram reports on a study of a proposed cement plant project and its potential impact on health care costs in the Wilmington area.

What We Give Up for Health Care, 1-21-12, The New York Times

An op-ed by Ezekiel J. Emanuel, MD, oncologist and former White House Advisor and a vice provost and professor at the University of Pennsylvania, on why liberals are wrong to ignore costs when it comes to health care reform.

Infection control training mandated at assisted living centers, 1-24-12, The News and Observer

Staff Writer Thomas Goldsmith looks at a new law requiring specific infection control training for assisted living staff members.

From Foam to Filters: What’s New in Venous Disease, which is co-sponsored by the Duke University School of Medicine and the American College of Phlebology, will be held from Thursday, February 2, 2012 – Saturday, February 4, 2012, at Washington Duke Inn & Golf Club. The registration fee is $249 for physicians and $149 for non-physicians. There is also an optional ultrasound workshop with a registration fee of $100. Click here for more information or to register.

Partners in POLST: Honoring Patient Wishes across Care Settings, which is being held in conjunction with the CCCC Conference, will be on Thursday, February 16, 2012, 8:00 am – 5:15 pm at the Catamaran Resort Hotel & Spa, San Diego, CA. Join end-of-life and palliative care leaders from across the country who are advancing the POLST (Physician Orders for Life-Sustaining Treatment) Paradigm to translate patient wishes into medical orders that are honored in care settings. Attendees will have the chance to learn innovative strategies for implementing POLST. Click here for more information and to register. Participation by an endorsed POLST state in the Networking Session from 2:30 pm – 3:30 pm is also being requested. Click here for more information.

NC Neurological Society Annual Meeting, will be held on Friday, February 17, 2012 — Saturday, February 18, 2012, at the Grandover Resort and Conference Center, Greensboro. The meeting is designed for practicing neurologists and physician extenders in neurology practices. Attendees will be able to increase their knowledge and improve their diagnosis and treatment skills for illnesses such as headaches, movement disorders, stroke, Multiple Sclerosis (MS), and mitochondrial disorders. Medicare regulations that pertain to the practice of neurology will also be discussed. A maximum of 7.0 AMA PRA Category 1 Credits™ can be earned. Click here for more information and to register. Questions can be directed to Nancy Lowe, NCMS Associate Director Specialty Society and Meeting Services, at (919) 833-3836 or nlowe@ncmedsoc.org.

Quality Improvement 101 – A Toolbox for Improvement Wave 10, which addresses planning and implementing improvement, will be offered by Charlotte AHEC on Tuesday, February 21, and Wednesday, February 22, 2012 (Workshop 1). This professional development program includes four on-site workshops in February and June which allows participants to build skills and knowledge in quality improvement. By attending, participating hospital teams, clinical practices, AHEC regional offices, and other healthcare organizations can accelerate the application of quality improvement methods. The textbook “The Improvement Guide” by Gerald J. Langley et al., (2009), and both breakfast and lunch for each workshop is included in the registration fee. For more information contact Mary Webster at (704) 512-6545 or click here to register.

2012 NC OB/GYN Society Annual Meeting, which is sponsored by the American College of Obstetricians & Gynecologists, will be held Friday-Sunday, April 20-22, 2012, at the Embassy Suites Charlotte-Concord Golf Resort and Spa. The common conditions and concerns related to women’s health care will be addressed. Attendees can receive a maximum of 12 AMA PRA Category 1 Credits™. The registration deadline is Monday, March 19, 2012. For more information about the meeting, contact Nancy Lowe, NCMS Associate Director Specialty Society and Meeting Services, at (919) 833-3836 or nlowe@ncmedsoc.org. Click here to register.

Cracking the Codes: Coding and Billing for Influenza Virus Vaccines Across Multiple Sites, a webinar from October 2011 offered by Sanofi Pasteur, is now available for viewing at all times. The webinar features an expert-led review of coding and billing for influenza vaccination in various health care settings. Click here to view the webinar.

Federal law requires the NCMS to notify members that 19.3% of the Medical Society’s 2012 dues amount paid by members are not deductible in accordance with IRC section 6033. As a reminder, your 2011 dues were 13% non-deductible.