Make the NCMS Workers’ Comp webpage your source for the latest news and resources as the NCMS Workers’ Compensation Task Force continues its long-standing mission to improve how doctors of all specialties treat injured workers and interact with the workers’ compensation system. NCMS Past President Richard Bruch, MD, chairs the Task Force, and Keith Kittelberger, MD, serves as Vice Chair.

The NCMS played a key role in the negotiations that led to the enactment of HB 709 – Protect and Put North Carolina Back to Work. This workers’ comp reform bill addressed many issues important to physicians, such as second opinions, independent medical exams, and access to medical information by employers. The law also directed the Industrial Commission to adopt rules that will require electronic billing and payment, standardize the medical documentation that accompanies claims to carriers, and require carriers to accept 5010 transactions and ICD-10 diagnosis codes.

NCMS members may contact the Member Resource Center with questions about workers’ compensation at kfreeman@ncmedsoc.org or by calling 800-722-1350.

See related Bulletin articles:

NC Industrial Commission Delivers on E-Billing and Electronic Payment in Workers Comp (6-17-11)

NCMS Efforts to Secure E-Billing Mandate in Workers’ Comp Gets National Attention (11-4-11)

Speaking for the NCDA were David Ollila, MD, Professor of Surgery at UNC-Chapel Hill and Co-Director of the UNC Melanoma Program; and Craig Burkhart, MD, Assistant Professor of Pediatric Dermatology at UNC-Chapel Hill. Also providing supporting statements were Amy Whited on behalf of the NC Medical Society and Christine Weason for the American Cancer Society.

Some of the key points in the NCDA’s testimony included:

• The science is clear: there are no health benefits from tanning beds that cannot be obtained more safely and without the risk of skin cancer.
• There are safe alternatives to tanning beds that many tanning bed operators are already offering.
• UV radiation in tanning booths can be up to 15 times greater than the sun.
• Every visit to a tanning bed increases the odds of developing melanoma.
• Melanoma incidence is rising at alarming rates.
• Melanoma ranks second among all cancers in years of productive life lost.
• Melanoma is the most common form of cancer for young adults 25-29 years old and the second most common form of cancer for adolescents and young adults 15-29 years old.
• Melanoma is increasing faster in females 15-29 years old than males in the same age group.
• Even minimal exposure to UV radiation from tanning beds before the age of 35 can increase the risk of developing melanoma by 75 percent.
  [IARC. International Journal of Cancer: 2006 March 1;120:1116-1122.]
• A person who has used tanning devices for more than 50 hours, 100 sessions, or 10 or more years is 2.5 to 3 times more likely to develop melanoma than a person who has never tanned indoors.
  [Lazovich D, Vogel RI, Berwick M, Weinstock MA, Anderson KE, Warshaw EM.  Indoor tanning and risk of melanoma: a case-control study in a highly exposed population. Cancer Epidemiol Prev 2010;19:1557-68.]
• North Carolina laws currently protect children’s health by restricting their access to: 
        -Tobacco         -Alcohol         -OTC medications
• The estimated total direct cost associated with the treatment of melanoma in 2010 was $2.36 billion
• Protecting children from tanning beds will save lives and millions of dollars in avoidable health care costs

The indoor tanning industry was represented by a paid consultant, Mr. Lee Feldman, who asserted that the research on indoor tanning was of poor quality and that the science is inconclusive. 

Following deliberation, the committee voted to send a recommendation to the full Child Fatality Task Force that it should support an increase on the age limit for indoor tanning from 14 to 18 years of age. The Task Force is scheduled to take up this issue at the April 16 meeting.

Questions about the indoor tanning issue may be directed to Alan Skipper, Director of Speciality Society and Meeting Services, at askipper@ncmedsoc.org.

On Wednesday, February 1, 2012, CBS News reported that a new congressional report accused tanning salons of lying to customers just to get their business. Click here to view Probe: Tanning Salons Lure Teens with Lies, by Correspondent Nancy Cordes.

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.

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!

Governor Perdue has appointed senior policy advisor Al Delia as Acting Secretary.  Her office said Friday that Sec. Cansler will be taking a job in the private sector and will serve as the unpaid chairman of a state commission on affordable health care, according to a report in The News and Observer (1-14-12, “Health agency head resigns”).

The NCMS learned of Cansler’s decision on Friday, but it was not formally announced until after the NCMS Bulletin had been published. Published reports indicated that Cansler’s letter of resignation was dated December 13, 2011.

In a prepared statement from the Governor’s Office, Cansler said DHHS had “eliminated waste and consolidated agencies – all to make state government more efficient without neglecting our core mission of serving the people.”  The decision follows the recent release of a state audit that was critical of the costs associated with a new Medicaid claims system. The audit report comes as legislators  continue to wrestle with ongoing budget deficits that are  expected to impact the budget debate when the General Assembly convenes in May.

The state budget and the Medicaid program are high priorities of the NCMS Legislative Affairs team. We will be providing updates and analysis throughout the year at www.ncmedsoc.org and in the Bulletin.

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

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. ]]> http://www.ncmedsoc.org/blog/index.php/archives/15346/feed 0 http://www.ncmedsoc.org/blog/index.php/archives/15311 http://www.ncmedsoc.org/blog/index.php/archives/15311#comments Fri, 13 Jan 2012 19:52:34 +0000 Will Barnett http://www.ncmedsoc.org/blog/?p=15311 A fundamental part of achieving the successes of the NC Medical Society, like passing medical liability reform, is the NCMS Political Action Committee (NCMS PAC). The NCMS PAC is the essential political branch of the North Carolina Medical Society and is governed by a Board of Directors of politically active NCMS members.

The NCMS PAC strives to empower physicians to make more knowledgeable decisions about the legislative issues affecting the practice of medicine, in the hopes that they will become more engaged in the political process. In addition, your staff works to establish and maintain relationships with key office holders who have your best interest at heart. More than anything, the NCMS PAC serves as your champion to elect healthcare friendly candidates to the North Carolina Legislature.

Help us achieve this goal by making a donation to the NCMS PAC today. With trial lawyers fundraising aggressively, it is more important to give now than ever.  Please, invest in the future of medicine in your state. With your help, we can continue to show results like those in 2012. Together, we can make our goals a reality. 

Don’t wait, donate now!

For more information contact Will Barnett, Assistant Director, Legislative and Political Action, at 919-833-3836 or wbarnett@ncmedsoc.org.

Today Congress approved a mere 2 month patch to the Sustainable Growth Rate (SGR) formula.  Please take a moment to send another e-mail to your Senators and Congressman to let them know that it is time to stop kicking this can down the road. We need a permanent fix.

Take Action! Contact your legislators today.

Review the AMA’s Special Alert on today’s developments below:

The US Supreme Court announced Monday that it will hear arguments on the Patient Protection and Affordable Care Act March 26-28, 2012, devoting an unprecedented full week to address the constitutionality of the federal health care reform law. The first day of arguments on March 26 will focus on whether Congress can require all Americans to purchase health care insurance or pay a fine. Arguments on March 27 and 28 will consider whether the remainder of the federal health care law can take effect if the mandate is ruled to be unconstitutional, and whether the federal government can cut off funding to states that refuse to participate in the federal health care reform plan.

Uncertainty over Medicare Physician Fee Schedule Prompts Hold on 2012 Medicare Claims in January

Palmetto GBA, the Medicare Administrative Contractor (MAC) for North Carolina, will hold claims containing 2012 services paid under the Medicare Physician Fee Schedule for the first ten business days of January. CMS announced the action on Tuesday as Congress continued to grapple with whether to delay 27.4 percent cuts in physician reimbursements scheduled to take effect January 1, 2012. The US Senate voted Saturday to delay the cuts until March 1, 2012, but the issue remained unresolved in the House as the Bulletin went to press today. It’s part of a legislative package involving a payroll tax provision and unemployment benefits.

NCMS is closely monitoring this situation and will provide updates from CMS and Palmetto GBA as they become available. Updates will be provided on the NCMS Website and in the Bulletin.

More information is also available from Palmetto GBA at: http://www.palmettogba.com/palmetto/palmetto.nsf/DocsCat/Home.

NCMS Opposes Proposed Revisions to Hospital Conditions of Participation (CoPs)

The NCMS has joined with other state and national physician organizations in opposing some proposed changes to the conditions that hospitals must meet to participate in the Medicare and Medicaid programs. In a letter to Acting CMS Administrator Marilyn B. Tavenner, RN, MHA, the organizations expressed support for CMS’ efforts to identify and eliminate burdensome regulations. However, they expressed concern and opposition to some specific revisions to CoPs involving medical staffs and governing bodies:

• Detrimental impact to the health and safety of patients in the hospital setting if CMS adopts proposed changes to the medical staff and governing body CopS, and lack of statutory authority for CMS to do so.
• Support for medical staff self-governance for each hospital within a multi-hospital system and not a single and separate staff for all hospitals in the system.
• Support for medical staffs to perform the important function of peer review and not a single medical staff that has little familiarity with the standard of care in that physician’s community.
• Opposition to a proposal to that would divide a hospital’s physicians into two distinct groups: those who are members of the medical staff, and those who are not. The organizations believe this would allow hospitals to grant privileges outside the medical staff and have a negative impact on peer review and raises concerns about possible fraud and abuse.
• Objection to CMS’ endorsement of the replacement of physicians with non-physician practitioners throughout the proposed rule, and the CMS’s effort to encourage states to widen their scope of practice laws.
• Revision of a proposal that would allow a governing body to grant privileges in accordance with hospital policies and procedures without the recommendation of the medical staffs.
• Support for each hospital facility to have a separate governing body and opposition to a proposal that would allow hospitals in multi-hospital systems to be governed by a single governing body.
• Opposition to a proposal to allow podiatrists to hold leadership positions within the medical staff of any hospital.
• Support for a proposal that provides for all orders, including verbal orders, must be dated, timed, and authenticated promptly by the ordering practitioner or another practitioner who is responsible for the care of the patient.

Click here to read the letter, to be delivered December 23, 2011.

The NCMS staff wishes you Seasons’ Greetings as we look forward to serving you in 2012.

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)

Originally passed in 2006 and delayed several times, the statute called for all federal, state and local government payments to those providing services or goods to have 3 percent of their payment withheld until the following tax year in an effort to increase tax compliance. However, the American Medical Association led efforts to amend the measure as the original statute was considered overly broad and would have applied even to Medicare payments made to physicians.

The Joint Legislative Oversight Committee on Health and Human Services met on Tuesday, November 8, 2011, to receive a progress update regarding the $359 million in reductions required of the DHHS in this year’s budget. DHHS Secretary Lanier Cansler reported to the Committee that a majority of the necessary budget reductions have been successfully implemented and that aside from significant Medicaid shortfalls the Department was on track to meet legislative targets. Most of those shortfalls have arisen from one-time costs and unbudgeted liabilities, including overdrawn federal receipts. View DHHS’s update on the budget here.

A key partner in reducing recurring costs in the Medicaid budget is Community Care of North Carolina (CCNC). Allen Dobson, MD, presented on behalf of CCNC pointing out areas of expansion as well as a number of new initiatives by various physician, hospital and other provider groups in partnership with CCNC. View CCNC’s presentation to the Committee here.

Total reductions within the Medicaid program have fallen short of expectations due in part to the Department’s slow enrollment of high-cost patients into CCNC, who has been tasked with saving the state $180 million over the two year budget cycle. CCNC is currently on track to exceed that goal according to Sec. Cansler. However, this slow enrollment in the first year of the biennium and the Department’s other unbudgeted liabilities caused the Secretary to solicit the Committee’s guidance on how to best address the 2011 shortfall that now totals $139 million.

Further cuts to optional services and an 18% reduction in provider rates were discussed as an option for DHHS to close the gap. Ultimately, legislators agreed that cuts to neither provider rates nor optional services were feasible in order to maintain a viable Medicaid provider network and recommended that lawmakers and the Department work together to further cut costs and perhaps use cash reserves to remedy the one-time shortfall.

On Tuesday Judge Eagles ruled that those challenging the new law were likely to prove that this provision violates the Constitution and therefore temporarily blocked implementation. Other provisions of the Woman’s Right to Know Act became effective this week, including a 24 hour waiting period for abortion procedures except in emergency situations.

Read the complaint filed against the State here, and the Court’s opinion here.

Since the adoption of the national model in 2008, the NCSBN has pushed for adoption in all fifty states. North Carolina is next on this list.  The advisory committee in North Carolina was comprised of 16 members including 14 nurses and two public representatives.

The committee met four times and presented its recommendations to the NC Board of Nursing at the September 2011 meeting. These recommendations include:

• Sole regulation of all advanced practice registered nurses by the NC Board of Nursing, eliminating the shared regulatory role of the NC Medical Board over Nurse Practitioners (NP).
• Elimination of physician supervision requirements for Nurse Practitioners (NP) and Certified Nurse Midwives (CNM).
• Grant prescriptive authority to Certified Registered Nurse Anesthetists (CRNA) and Clinical Nurse Specialists (CNS).

The NCMS is watching this issue very closely and will continue to offer updates in the Bulletin as they become available.   NCMS policy supports the requirement of physician supervision of mid-level practitioners who perform medical acts, tasks, and functions (Physician Relationship With Mid-Level Practitioners).

Related legislation is expected to become a priority for the NCMS legislative team during the upcoming session of the NC General Assembly. Read the entire report from the APRN Advisory Committee here.

The overview of the 2011 Legislative Session provides an informative review of NCMS legislative advocacy, including successes, such as SB 33—Medical Liability Reforms and HB 542 – Tort Reform for Citizens and Business. The Summary not only covers accomplishments, but it also serves as a reference to help prepare for 2012—a Presidential Election year – and the Legislative Short Session that convenes in May.

“It is more important than ever for you to become an engaged member of organized medicine and encourage your colleagues to do the same. The short session is just around the corner — please join us in shaping the future of medicine in 2012,” Robert Monteiro, MD, President-Elect and Chair, the NCMS Legislative Cabinet.

Following the presentation by the Department, the Committee heard testimony regarding the current climate for hospital operations from the NC Hospital Association as well as a presentation by Noah Huffstetler, a partner with the law firm Nelson Mullins. View the NCHA presentation here and the presentation by Mr. Huffstetler here.

The committee is scheduled to meet again in the first of several meetings to be held across the state on Thursday, October 20, 2011, at 6:00 pm at the WNC Agricultural Center, 1301 Fanning Bridge Road, Fletcher, NC.

The committee will take a look at the overall CON process. Additionally, the committee will look at two specific issues raised in bills during the 2011 long session:  HB 743 raised questions about the academic medical centers exemption, and HB 812 addressed the county line rule used in making need determinations. The NCMS Legislative Staff will provide updates and more information in the Bulletin and at http://www.ncmedsoc.org/. Questions may be directed to Chip Baggett at mailto:cbaggett@ncmedsoc.org or call 919-833-3836.

Regular House Select Committee on Certificate of Need and Related Hospital Issues Meeting with Presentations on COPA and public comment to follow:

DATE: Thursday, October 20, 2011

TIME: 6:00 PM

LOCATION: Western NC Ag Center

COMMENTS: Virginia C. Boone Mountain Heritage Building, 1301 Fanning Bridge Road, Fletcher, NC  28732

Regular House Select Committee on Certificate of Need and Related Hospital Issues with Public Comments:

DATE: Thursday, November 3, 2011

TIME: 6:00 PM

LOCATION: The Citizens Center

COMMENTS: Council Chamber, 400 East Central Avenue, Mount Holly, NC  28120

The additional public meetings will likely be in the eastern part of the state.  Tentative dates for those meetings are Nov. 17 and Dec. 1.  Starting in January, the committee will meet on the third Thursday of the month in Raleigh.

A newly formed House Select Committee on Certificate of Need (CON) Process and Related Hospital Issues has been named. It will be chaired by Rep. Fred Steen (R-Rowan) and Rep. John Torbett (R-Gaston). You can find a complete list of the committee here. The committee is scheduled to meet on Wednesday, September 14, 2011 at 10:00 am in Room 544 of the Legislative Office Building in Raleigh.

The committee will take a look at the overall CON process. Additionally, the committee will look at two specifiic issues raised in bills during the 2011 long session:  HB 743 raised questions about the academic medical centers exemption, and HB 812 addressed the county line rule used in making need determinations. The NCMS Legislative Staff will provide updates and more information in the Bulletin and at http://www.ncmedsoc.org/. Questions may be directed to Chip Baggett at cbagget@ncmedsoc.org or call 919-833-3836.

Insurance Bills Included in 2011 Legislative Summary

Eight bills that fall under the Insurance category will be among the dozens of bills that will be reviewed in the soon-to-be released NCMS 2011 Legislative Summary. Insurance-related measures that will be in the summary include:

House Bill 496 – Insurance Co-pays for Chiropractic Services  (NCMS opposed)

Senate Bill 608 – Health Care Sharing Organizations (Passed)

House Bill 709 – Protect and Put NC Back to Work (Senate Bill 544) (Passed)

Senate Bill 517 – Freedom to Negotiate Health Care Rates (NCMS supports)

Senate Bill 774 – Update Electronic Prescription Rules (Not debated)

House Bill 138 – Amend Health Insurance Risk Pool Statutes (NCMS supports)

House Bill 298 – Insurance Amendments A-B (Passed)

Senate Bill 323 – State Health Plan/Appropriations and Transfer II (Passed)

Get Ready for 2012: Primary, Legislative Short Session and Election

Issues of importance to physicians and their patients will be part of the 2012 Election Year. The NCMS 2011 Legislative Summary will provide background to help you better understand many of these issues. Since 2012 is a Presidential Election Year, there will be increased voter interest in issues like health care reform, Medicare and Medicaid, jobs, and economic improvements. Your NCMS Legislative Staff will be working to provide timely information to help you understand these issues, and how you can engage with legislators at the state and national level. This information will be made available through the Bulletin, Member Alerts, Legislative Updates , and the NCMS website, http://www.ncmedsoc.org/. By being informed and involved, you can help us continue our efforts to provide access to quality health care for all North Carolinians.

Many more hours were spent working on legislation involving the Medicaid budget, scope of practice, mental health, and implementation of federal programs. The soon-to-be-released 2011 Legislative Summary will provide members more details about this year’s legislative activity.

Six public safety measures of interest to physicians were considered during the session:

House Bill 407 – Modify ATV Helmet Use Requirements  (NCMS opposed)

House Bill 392 – Modify Motorcycle Helmet Requirements (NCMS opposed)

House Bill 792 – Gfeller-Waller Concussion Awareness Act (NCMS supported)

See related story: Important Information for Healthcare Professionals Dealing with Student Athletes (Bulletin, 8-19-11)

Senate Bill 757 – Interscholastic Sports/Concussions (NCMS position: amendments needed)

Senate Bill 471 – Youth Skin Cancer Prevention Act (NCMS supported)

Senate Bill 697 – Patient Advocacy and Protection Act (NCMS opposed)

Look for an announcement about the 2011 Legislative Summary in the Bulletin and at http://www.ncmedsoc.org/.

Related articles:

Coming Soon: 2011 Legislative Summary (Bulletin, 8-19-110

2011 Legislative Session: Medical Liability Reforms and Much More (Bulletin, 8-12-11)

Legislative Summary Highlights Major Accomplishments in 2011 (Bulletin, 8-5-11)