Videos posted on YouTube are helping to emphasize the urgency to repeal Medicare’s flawed sustainable growth rate (SGR) formula that is used to set physician reimbursements. The AMA released the videos as the March 1 deadline approaches for Congress to prevent a more than 27 percent cut in Medicare physician payments.

The videos—one geared toward Congress and the other toward seniors—warn that temporary patches to the SGR threaten access to care and choice of physician for seniors while increasing the taxpayer burden. The Congressional Budget Office has estimated that it will cost $298 billion to fix the SGR, with the cost continuing to rise as long as Congress continues to apply only temporary patches. The AMA projects that the cost will rise to $320 billion if Congress does not act in 2012.

As reported in the Bulletin last week, the NCMS has joined other physician organizations in calling on Congress to repeal the SGR by using excesses from Overseas Contingency Operations (no longer needed for wars in Iraq and Afghanistan). See Physician Organizations Propose Offset for Congress to Repeal SGR.

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.

CapWiz call for action here. Contact your legislators today.

William Pully, President of the North Carolina Hospital Association (NCHA), was honored as the 2012 recipient of the Ronald Levine Legacy Award in recognition of his contributions to public health in North Carolina. The award was presented at the annual 2012 State Health Director’s Conference on January 27, 2012. It is named in honor of the former State Health Director and long-time NCMS leader, Ron Levine, MD, who presented the award along with outgoing State Health Director Jeffrey Engel, MD.

“Bill is well deserving of this prestigious recognition for his leadership in helping create a statewide disease event tracking system and the Public Health and Hospital Collaborative,” NCMS EVP, CEO Robert W. Seligson said. “These advancements contribute greatly to the quality of care given our citizens and to the public health of our great state.” 

The Collaborative is a public-private partnership between the Division of Public Health, NCHA, the NC Institute for Public Health and the NC Center for Health Quality that has developed standards for community health assessments as required for non-profit hospitals by the federal health care reform law and the Public Health Exchange.

Pully, a Rocky Mount native began his career with NCHA as director of government relations. He became president of the association in 1999.

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.

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

The NCMS Accountable Care Task Force met this week in Raleigh. The group, chaired by Steven Wegner, MD, discussed the progress of several North Carolina entities that are implementing programs to improve quality and bring greater accountability to the practice of medicine.  Many of these groups are in the process of applying to become Accountable Care Organizations (ACOs) under the Medicare Shared Savings Program while others are implementing new models of care.

Click below to review each of the presentations given:

• Steven Wegner, MD, JD: Advancing Accountable Care
• Grace Terrell, MD: Case Study: Cornerstone Health Care
• John Rezen: Pinehurst Surgical
• Jeff James: Wilmington Health/Community Partners Health Plans

The Task Force is working on educational modules to help medical practices work toward new models of care delivery. More information regarding NCMS efforts to move toward accountable care can be found by visiting our Accountable Care webpage.

NC Medicaid Offers Guidance on Grace Period for 5010 Implementation

The North Carolina Division of Medical Assistance (DMA) has issued a response to the recent announcement from the federal Office of E-Health Standards and Services that it will observe a 90-day grace period for compliance with 5010. (See 5010 Deadline Just Around the Corner, Bulletin, 12-9-2011) 

DMA will continue to process claims filed in 4010 and  5010 formats ONLY until March 31, 2012.  Providers who continue to submit 4010 claims after January 1, 2012 will be required to submit a transition plan documenting their plan to reach 5010 compliance by March 31, 2012. The transition plan must document the steps that have been completed, the remaining steps that need to be completed, the Medicaid provider numbers impacted and contact information, including email address and phone number. 

For questions or assistance regarding this information, please contact Hewlett Packard Enterprise Services (HPES), ECS at 800-688-6696 or 919-851-8888; press option 1.  Click here to read the official notice from DMA.

Physician Assistants, Please Continue to Hold your Medicaid Enrollment Applications

After receiving inquiries about Medicaid enrollment for physician assistants (PAs), the NCMS would like to remind all PAs and their medical practices to hold their Medicaid enrollment applications until the Centers for Medicare and Medicaid Services (CMS) approves the State Plan Amendment and the Division of Medical Assistance (DMA) clarifies details around billing, rates, and other applicable requirements for these practitioners. The North Carolina Medical Society will continue to provide updates on this issue as we receive them.

Please contact the NCMS Member Resource Center at (919) 833-3836 or kfreeman@ncmedsoc.org with any questions or concerns.

See related articles:

Physician Assistant Medicaid Enrollment Update (Bulletin, November 4, 2011)

Physician Assistants, Hold Your Medicaid Enrollment Applications! (Bulletin, October 7, 2011)

Reminder: Important EHR Incentive Program Deadlines Are Approaching

The NCMS would like to remind its members of the following deadlines approaching for the Medicare Electronic Health Record (EHR) Incentive Program:

• Providers have until Wednesday, February 29, 2012, to register and attest to meeting meaningful use in order to receive payment for calendar year (CY) 2011 through the Centers for Medicare and Medicaid Services (CMS) EHR Incentive Program Registration and Attestation System.
• Providers also have until Wednesday, February 29, 2012, to submit any pending Medicare Part B claims from CY 2011. Please notice: CMS allows 60 days after December 31, 2011, for all pending claims to be processed.

More Important Information:

• Medicare EHR incentive payments to providers are based on 75 percent of the Part B allowed charges for covered professional services furnished by the EP during the entire payment year.
• If providers do not meet the $24, 000 threshold in Part B allowed charges by the end of CY 2011, CMS expects to issue an incentive payment for providers in April 2012 for 75 percent of their Part B charges from 2011. Please contact the Division of Medicaid Assistance (DMA) at (866) 844-1113 for more details about payments.

Questions regarding the CMS EHR Incentive Program can be directed to Terri Gonzalez, Practice Technical Assistance Coordinator, at 919-833-3836 or tgonzalez@ncmedsoc.org.

CMS Offers Program to Assist Physician ID Theft Victims

The Centers for Medicare and Medicaid Services (CMS) has developed the provider victim validation/remediation initiative for physicians whose identification has been stolen and used to defraud federal health programs. Physicians can seek resolution from Medicare program safeguard and zone program integrity contractors, which operate according to region and state and can investigate instances of identity theft after being notified by a potential victim. The AMA lists information about the contractors at www.ama-assn.org/resources/doc/washington/identity-theft-victim-program-letter-oct2011.pdf. The Medicare program integrity contractor serving North Carolina is AdvanceMed.

Physicians who believe they are victims of identity theft but have not yet suffered any financial liability should contact Palmetto GBA, the Medicare administrative contractor (MAC) for North Carolina, or the federal Health and Human Services (HHS) Office of Inspector General hotline at 800-HHS-TIPS (800-447-8477).

Sign Up Today for ICD-10 Training

The North Carolina Health Information Management Association (NCHIMA) has partnered with North Carolina Area Health Education Centers (NC AHEC) to provide North Carolina physicians with ICD-10 training. The following Continuing Education class, “ICD-10-CM Training & Implementation Issues (Phase II) for the Provider Office” will be taught at:

Click here to sign up for any of the ICD-10 sessions. Questions or concerns regarding ICD-10 can be directed to Franklin Walker (fwalker@ncmedsoc.org), NCMSF Director of Programs and Practice Management, or Terri Gonzalez (tgonzalez@ncmedsoc.org), NCMSF Practice Technical Assistance Coordinator, at (919) 833-3836.

The North Carolina Medical Society can assist its members in the transition to 5010 and ICD-10. Click here for additional resources on the NCMS website regarding ICD-10.

The NCMS Legislative Cabinet met Thursday night for their first meeting of 2012.  Members of the 2012 Legislative Cabinet include: John Reynolds, MD, Chair Robert Schaaf, MD, Vice Chair Richard Bruch, MD Craig Burkhart, MD, MS Hadley Callaway, MD Brian Forrest, MD Frank Hobart, MD Mary Lane, MD Matthew Martin, MD Robert McBride, MD Prashant Patel, MD Stephen Small, MD Zane Walsh, MD Robert Monteiro, MD, NCMS President Francine Sembert, Consultant

John L. Reynolds, MD, (left) Chair of the Legislative Cabinet, speaks with Chip Baggett, NCMS Director of Legislative Relations

NCMS Legislative Counsel Dave Horne (Smith Anderson law firm) discussed the tumultuous political climate that is expected to continue through the rest of 2012. Political tensions are only expected to rise as we draw closer to the primaries currently scheduled for early May, and the general elections in November.

A broad range of issues that are currently being considered by the NC General Assembly and the US Congress were also discussed. Issues ranged from defending the current improvements to medical malpractice liability, to protecting Medicaid physician rates from further cuts and improving insurance regulations that currently place onerous burdens on physician practices.

The Legislative Cabinet began a process of identifying key legislative priorities for the 2012 NC General Assembly Short Session that begins on May 16, 2012. Those priorities will be part of a pre-session publication that NCMS members can expect to receive in February. The publication is intended to be a tool to facilitate a conversation between NCMS members and their respective legislators in advance of the short session.

A new regulation announced Thursday by the US Department of Health and Human Services establishes Electronic Funds Transfers (EFT) standards that, when implemented by health plans, will save physician practices and hospitals between $3 billion to $4.5 billion over the next ten years. The rule—the Adoption of Standards for Health Care Electronic Funds Transfers and Remittance Advice—creates streamlined standards for a health plan to follow when paying claims to a provider electronically and to issue a Remittance Advice notice. Remittance Advice is a notice of payment sent to providers that may or may not accompany the payment the provider receives.

The NCMS is a strong proponent of federal initiatives to alleviate the administrative burden placed on physician practices. HHS Secretary Kathleen Sebelius said, as a result of the rule, health care professionals will spend less time filling out paperwork and more time focusing on delivering the best care for patients.

Physicians spend about 12 cents of every dollar they receive from patients to cover the costs of filling out forms and performing other administrative tasks, according to a May 2010 study in the journal Health Affairs. Researchers found that simplifying these systems could save four hours a week of a physician’s professional time and five hours of support staff time.

The new EFT rule is the second in a series of regulations required by the Patient Protection and Affordable Care Act. The first—Adoption of Operating Rules for Eligibility for a Health Plan and Health Care Claim Status—was adopted last June and set standards for how physicians and other health care providers use electronic systems to determine a patient’s eligibility for health coverage and check on the status of a claim.

HHS is working on further administrative simplification rules that will include a standard unique identifier for health plans, a standard for claims attachments, and requirements that health plans certify compliance with all HIPAA standards and operating rules.

Click here to view the HHS News Release on streamlining electronic funds transfers in health care.

A CMS (Centers for Medicare & Medicaid Services) open door forum was held yesterday, January 5, 2012, to discuss the Advance Payment Accountable Care Organization (ACO) Model and its application template. The payment model is for physician-based and rural ACOs participating in the Medicare Shared Savings Program. Advanced Payment Model participants will receive up-front payments that are recouped from their earned shared savings.

A transcript and audio recording of the forum will be posted to the CMS website beginning Friday, January 13, 2012. Participating physicians and ACOs can also refer to the updated information offered by CMS that explains the application process, including how to obtain login credentials for the web tool.

Please note: CMS is now collecting applications for the Advance Payment Model. Applications for the April 1, 2012 start date were available Tuesday, January 3, 2012, and will be collected through Wednesday, February 1, 2012. Applications for the July 1, 2012 start date will be collected between Thursday, March 1, 2012, and Friday, March 30, 2012.

Want to learn more about the Medicare Shared Savings Program? Click here for an overview and to view YouTube slideshow presentations and podcasts about Medicare Shared Savings and the Advanced Payment Model.  Additional links on the webpage include updated information about Medicare ACO quality measures and performance standards as well as steps to submitting a Medicare Shared Savings Program application.

NCMS also provides additional resources toward Accountable Care.

Section 3022 of the Patient Protection and Affordable Care Act (PPACA) mandates the creation of the Medicare Shared Savings Program. The Shared Savings Program establishes the goals of providing better care, improving population health and lower growth in expenditures.

Final Rules for the program were released on October 20, 2011, and published in the Federal Register on November 2, 2011. The application and instructions for the Medicare Shared Savings Program can be found on the CMS website, https://www.cms.gov/sharedsavingsprogram/37_Application.asp#TopOfPage.

Application Timeline:

Notice of Intent

The first step in the application process is to submit your Notice of Intent (NOI) to Apply to the Shared Savings Program. After completing this form, CMS will assign you an ACO identification number. The NOI must be completed by 5 pm EST on January 6, 2012, for the April 1, 2012 program start date and by February 17, 2012, for the July 1, 2012 program start date.

Obtain a CMS User ID

Following the submission of your NOI form you will receive a confirmation e-mail from CMS containing your ACO ID and instructions on how to complete the CMS User ID application.  Without these two ID numbers you will not be able to fully access the modules of the 2012 program application.

Complete the CMS User ID form and return it to CMS via tracked mail no later than January 12, 2012, for the April 1, 2012 program start date and no later than February 23, 2012, for the July 1, 2012 program start date.

Apply for the Shared Savings Program

Once both ID numbers have been received complete the application packet found on the CMS website, https://www.cms.gov/sharedsavingsprogram/37_Application.asp. The application is due by January 20, 2012, for the April 1, 2012 program start date and by March 30, 2012, for the July 1, 2012 program start date.

Applications will be approved or denied no later than March 16, 2012, for the April 1, 2012 program start date and by May 31, 2012, for the July 1, 2012 program start date.

If your application is denied you may request a CMS reconsideration review. This request must be made within 15 days of the date of your denial letter.

Any questions regarding the Medicare Shared Savings Program Application can be directed to SSPACO_Applications@cms.hhs.gov.

This week the Joint Legislative Commission on Governmental Operations cleared the way for the NC Department of Insurance (NCDOI) to spend $12.4 million in federal grant money for the establishment of a state-controlled health insurance exchange. If the state does not establish an exchange under the guidelines of the Affordable Care Act, the federal government must step in and run the exchange for the state.

These federal grant dollars will be used to begin the process of contracting for technology services and hiring staff to create and manage the operations of the exchange.

See related stories:

NCMS Convenes Meeting with Benefits Exchange Stakeholders (Bulletin, 10-7-11)

Proposed Rules Released and Funds Awarded to Help States Build Affordable Health Benefit Exchanges (Bulletin, 8-19-11)

Focus on Health System Reform: Health Benefit Exchanges, Part 1 (Bulletin, 7-23-10)

Focus on Health System Reform: Health Benefit Exchanges, Part 2 (Bulletin, 7-30-10)

Physicians will be among those eligible to apply for Health Care Innovation Challenge Grants, announced this week by the Centers for Medicare and Medicaid Services (CMS) Innovation Center. The Challenge is a $1 billion program to test creative ways to deliver high quality medical care and reduce costs. CMS says the grants will go to applicants who implement the most compelling new ideas to deliver better health, improved care and lower costs to people enrolled in Medicare, Medicaid and the Children’s Insurance Program (CHIP), particularly those with highest health care needs. The grants are funded through the Affordable Care Act.

Grants are expected to range from approximately $1 million to $30 million over three years and will support programs that can begin within six months. Applications are open to physicians and other health care providers, payers, local government, community-based organizations, and particularly to public-private partnerships and multi-payer approaches. Each project will be evaluated and monitored for measurable improvements in quality of care and savings generated.

For more information, including a fact sheet and the Funding Opportunity Announcement, visit: http://innovations.cms.gov/initiatives/innovation-challenge/index.html.

Meeting in New Orleans, the AMA House of Delegates this week adopted new policies covering a wide range of health care issues:

Guidelines for Health Insurance Exchanges created by Affordable Care Act

The new policies include support for using the open marketplace model for exchanges to increase competition and maximize patient choice, and the involvement of state medical associations in the legislative and regulatory processes concerning state health insurance exchanges.

Stop the Implementation of ICD-10

The House of Delegates voted to work vigorously to stop implementation of ICD-10 (The International Classification of Diseases and Related Health Problems, 10^th Revision), a new code set for medical diagnoses. ICD-10 has about 69,000 codes and will replace the 14,000 ICD-9 codes currently in use. AMA says the implementation of ICD-10 will create significant burdens on the practice of medicine with no benefit to individual patients’ care.

Virtual Medical IDs

New policy encourages the availability of portable medical identification alert systems for patients. Virtual medical identification systems allow emergency medical personnel to access a patient’s medical history and emergency contact phone numbers through a pin number that can be attached to clothing, a key, or stored in a wallet.

Combat National Drug Shortages

New AMA policy supports federal drug shortage legislation, such as HR 2245 and SB 296, that would require manufacturers to notify the FDA of any discontinuance, interruption, or adjustment to the manufacture of a drug that may result in a shortage. In the past few years, AMA reports that shortages of medically necessary drugs have worsened appreciably, with the number of FDA identified shortages tripling between 2005 and 2010.

For more on AMA House of Delegates Actions, visit:

http://www.ama-assn.org/ama/pub/news/news/2011-11-15-ama-adopts-new-policies.page, or

http://www.ama-assn.org/ama/pub/meeting/index.shtml.

The Centers for Medicare and Medicaid Services (CMS) will host a National Medicare Provider Call, Tuesday, November 15, 2011, 1:30 pm – 3:00 pm, to discuss the application process for the Medicare Shared Savings Program and the Advance Payment Model. This call-in forum is designed to help providers participate in the Medicare Accountable Care Organizations to improve quality of care for Medicare patients. A question and answer session will follow the presentation.

In order to participate and receive call-in information, you must register for the call. Registration will close at 12:00 pm on Tuesday, November 15, 2011, or when available space has been filled.

For more details, including instructions on registering for the National Provider Call, please visit: http://www.eventsvc.com/blhtechnologies.

Click here for more information about the November 15 Open Door Forum, as well as details on the November 7, 2011 Physicians, Nurses and Allied Health Professionals Open Door Forum to discuss the pending 2012 Physician Payment Rule.

Updates and other information about Accountable Care can be found on the NCMS Toward Accountable Care webpage.

The Centers for Medicare and Medicaid Services (CMS) Innovation Center is reminding physicians and practices that letters of intent to participate in the Comprehensive Primary Care Initiative are due next Tuesday, November 15, 2011. The Center announced the initiative on September 28, 2011, stating it was designed to help primary care practices deliver higher quality, better coordinated, and more patient-centered care.

Click here for a Fact Sheet on the Comprehensive Primary Care Initiative.

The Letter of Intent is non-binding and confidential, and should include:

Payer Name

Corporate Address

Corporate City

Corporate State

Point of Contact name, title and address (if different)

Point of Contact email address

Information about the areas that have provider network(s) and are considering participation in the initiative, fill out the CMS Innovation Center’s geographic service area worksheet template at: http://innovations.cms.gov/areas-of-focus/seamless-and-coordinated-care-models/cpci/. (This link also provides more information and instructions.)

Questions may be sent to: mailtoCPCi@cms.hhs.gov.