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: My practice is looking to open a cash clinic. Does the NCMS offer any resources to help with this process?

A: Yes, the North Carolina Medical Society offers resources to physicians who are looking to open a cash clinic. Franklin Walker, NCMS Foundation Director of Programs and Practice Management, can assist your practice with any practice management needs, including opening a cash clinic. For further assistance contact Franklin at (800) 722-1350 or fwalker@ncmedsoc.org.

You can also contact Physician Care Direct (PCD), a partner of the NCMS, who can help your practice transition to and provide cash-only services to your patients. For more information about the services offered by PCD, call (919) 729-5594.

You can also refer to the American Medical Association (AMA)’s “Cash practice alternative: Considerations for physicians,” for additional information.

Have a question? Contact the NCMS Member Resource Center at (919) 833-3836 or kfreeman@ncmedsoc.org.

The North Carolina Medical Society would like to remind its members that February is American Heart Month. Please take the time during this month to spread awareness to your colleagues, patients, friends and family, about the importance of heart health.

Several ways to do this includes encouraging healthy eating, consistent exercising and to promote an overall healthy lifestyle. You can also participate in the Department of Health and Human Services’ (DHHS) Million Hearts™ campaign. This national initiative strives to prevent 1 million heart attacks and strokes in the United States over the next five years. For those who are interested in participating in the campaign, simply follow the link above, and find out what you need to do to become a partner. Partners of the campaign help spread awareness, make sure those with high cardiac risk are receiving appropriate treatment, promote healthy diet and physical activity, and support smoke-free environments to reduce current and future cardiac risk.

Please do your part and spread the word about this campaign. Together we can make North Carolina, and the rest of the United States, a healthier place to live. The Million Hearts™ campaign is co-led by Centers for Medicare and Medicaid Services (CMS) and the Centers for Disease Control and Prevention (CDC).

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.

The first National POLST (Physician Orders for Life-Sustaining Treatment) Paradigm Conference will be held on Thursday, February 16, 2012, in San Diego, California. Join end-of-life and palliative care leaders for Partners in POLST: Honoring Patient Wishes Across Care Settings. Get more information here. Early bird registration ends on January 9, 2012.

The NC Office of Rural Health and Community Care hosted a celebration Thursday in honor of the first annual National Rural Health Day, on the Governor Morehead School Campus in Raleigh. The event recognized the work of the state agency in helping to establish 86 rural health centers across North Carolina since it was founded in 1973. Honorees included representatives of the NCMS Foundation and other private charitable organizations and representatives of state agencies that have supported efforts to improve access to care in rural areas of North Carolina over the past 38 years.

The NCMS Foundation’s Community Practitioner Program (CPP) works closely with the Office of Rural Health and Community Care in helping to recruit physicians, physician assistants and nurse practictioners to medically underserved communities in North Carolina.

For more information about the Office of Rural Health and Community Care, visit: http://www.ncdhhs.gov/orhcc/.

Click here to learn more about the NCMS Foundation and its programs and services.

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.

The Centers for Medicare and Medicaid Services (CMS) reminds physicians that applications for the Innovation Advisors Program are due next Tuesday, November 15, 2011. The program seeks to help professionals enhance skills that will drive improvements to patient care and reduce costs.

More information can be found at: http://innovations.cms.gov/innovation-advisors-program.

Applications for the Innovation Advisors Program can be accessed at: http://orise.orau.gov/IAP.

Questions may be emailed to IAP@orau.org.

For more information about the CMS Innovation Center, please visit: http://innovations.cms.gov/.

The Electronic Health Records (EHR) Incentives Program of the Centers for Medicare and Medicaid Services (CMS) is now providing updated information for physicians and others participating in the EHR Incentives Program. The new Frequently Asked Questions (FAQs) include information about clinical quality measures (CQMs), meaningful use, attestation, and other related topics.

Click here to read the updated FAQs.

The National Ambulatory Medical Care Survey (NAMCS) is conducted by the Centers for Disease Control and Prevention’s National Center for Health Statistics (NCHS). The NAMCS is designed to produce national estimates which describe the utilization of ambulatory medical care services in the United States. Findings are based on a national probability sample of visits made by ambulatory patients to community health centers and nonfederal physicians who are in office-based practice and engaged primarily in direct patient care. The data provide insight into ambulatory medical care and stimulate further research on the use, organization, and delivery of ambulatory care.

NAMCS data are used by public health policy makers, health services researchers, government agencies, medical schools, physician associations, epidemiologists, and the print and broadcast media to describe and understand the changes that occur in medical care requirements and practices. The data are disseminated in the form of NCHS reports, journal articles, and downloadable data files. Previously, the NAMCS has provided only national-level estimates. For the first time starting in 2012, NAMCS poses a unique opportunity to produce state-level data as well as national and census divisional estimates. Moreover, your particular state is one among 34 of which NCHS will be able to provide state level estimates. Below are a few highlights of the 2012 NAMCS survey:

• Survey data will now be collected using a computerized instrument; which will simplify data collection activities and reduce data entry errors and omissions, thus improving data quality. 
• Sample size has been increased nearly five-fold to allow NAMCS to provide estimates for the top 34 most populated states in the United States.
• Findings will allow physician offices and community health centers at the state level to baseline themselves against national estimates (including 9 Census divisions).

To learn more about NCHS, please visit the CDC website: http://www.cdc.gov/nchs/data/factsheets/factsheet_overview.htm.

If you would like more information about NAMCS, check out this link:  http://www.cdc.gov/nchs/ahcd/namcs_participant.htm.

See how NAMCS data is used (click titles):

NCHS 2010 DATA BRIEF: POPULATION AGING AND THE USE OF OFFICE-BASED PHYSICIAN SERVICES

SELECTED 2009 SUMMARY TABLES: PHYSICIAN AND PHYSICIAN PRACTICE CHARACTERISTICS

Questions? Feel free to call this toll free number: 1-800-392-2862.

The Centers for Medicare and Medicaid Services (CMS) offers the 2012 Electronic Prescribing (eRx) Payment Adjustment Feedback Report. Eligible health care professionals can access individual National Provider Identifier (NPI)-level reports through their Carrier/Medicare Administrative Contractor (Palmetto GBA in NC), or via a new Quality Reporting Communication Support Page, when it becomes available at http://www.qualitynet.org/pqrs.

In last week’s edition of the Bulletin, NCMS announced the CMS release of final rules regarding Accountable Care Organizations. This week we bring you a broad overview of the new rules, authored by Kim Licata of Poyner Spruill LLP.  The summary details CMS discussion of the rules during a recent Open Door Forum and lets physicians know what shared savings may mean for them. Read the summary here.

CMS will also be holding an in-person meeting to help physicians understand the goals of Accountable Care Organization (ACO) models. CMS will provide an overview of the Medicare Shared Savings Program Final Rule and new tools that will help physicians and other health care providers improve quality of care. The meeting will be held on Monday, November 21, 2011, 1:00-2:00 pm at the Centers for Disease Control & Prevention, Tom Harkin Global Communications Center, Atlanta, Georgia.

There will be a listen-only conference line available to those who cannot attend the meeting. Call (877) 267-1577 and enter meeting ID 4494 to listen to the meeting.

Additional helpful links regarding Accountable Care:

• Advanced Payment Model
• Office of Inspector General (OIG) Waivers
• FTC/DOJ Statement

Questions for the November 21 meeting should be submitted by November 15, to Teresa Wilson, Health Insurance Specialist, at tersea.wilson@cms.hhs.gov. If time permits, there will also be a Q&A session at the end of the meeting.

The federal government continued its push toward accountable care as it launched two initiatives derived from the Affordable Care Act (ACA) on Thursday–the Medicare Shared Savings Final Rule and the Advance Payment Model. The Centers for Medicare and Medicaid Services (CMS) said the Final Rule incorporates many changes recommended by hospitals and physician groups that were critical of the draft Rule, when it was first published in March. More than 1,200 comments were submitted, according to the CMS. One notable change was a reduction in quality measures that would be monitored by CMS, from 65 in the original proposal to 33 in the Final Rule.

The Shared Savings Program Final Rule can be seen at: http://www.ofr.gov/OFRUpload/OFRData/2011-27461_PI.pdf.

In June, the NCMS Accountable Care Task Force addressed the proposed Rule in a letter to CMS Administrator Donald Berwick, MD. NCMS President John R. Mangum, MD, stated in the letter, “While the NCMS strongly supports the goals of the Shared Savings Program to improve health and quality and to control costs, we are convinced that the proposed ACO rules are seriously flawed and that, as currently structured, the Shared Savings Program is likely to fail.”

The letter followed an intensive eight-week review of the Rule by the NCMS Task Force, chaired by Steve Wegner, MD, JD. Read the letter here.   

CMS says the Advance Payment Model will provide additional support to physician-owned and rural providers participating in the Medicare Shared Savings Program. Included are start-up resources to build needed infrastructure, such as new staff or information technology systems. Details about the Model are available at http://innovations.cms.gov/areas-of-focus/seamless-and-coordinated-care-models/advance-payment.

The NCMS will be reviewing the Medicare Shared Savings Final Rule and Advance Payment Model and will provide additional updates in future Bulletins and in the Toward Accountable Care section of the NCMS website.

Consistent with national health care goals to expand electronic health record (EHR) system use and functionality, the Centers for Medicare & Medicaid Services (CMS) is encouraging providers to begin reporting Physician’s Quality Reporting System (PQRS) measures using the EHR option (as opposed to claims- or registry-based). Practices not reporting PQRS measures by 2015 may experience payment penalties.

The PQRS assistance program, a joint program offered by CMS and The Carolinas Center for Medical Excellence (CCME) can help qualifying practices avoid these penalties. Through this program, CCME will provide free assistance in developing PQRS measures from EHR systems and support in the effective use of these measures for quality improvement. There are currently 28 EHRs “qualified” to report PQRS data using the EHR option. Users of a PQRS-certified EHR are an exclusive group of providers invited to join this program to receive free assistance with earning incentives under PQRS.

For more information about this program, visit:  www.ccmemedicare.org/PQRS. For additional information and enrollment into this program, please contact CCME care improvement specialist, Maureen Schwarzer, BSN, RN, at mschwarzer@thecarolinascenter.org or 800-682-2650.

The Personalized Medicine Coalition (PMC) will present a panel discussion on The Case for Personalized Medicine, on Wednesday, November 16, 2011, 4:00 pm – 7:00 pm, at the North Carolina Biotechnology Center, 15 T.W. Alexander Drive, Research Triangle Park.

Jennie Hunter-Cevera, PhD, Executive Vice President, RTI International, will serve as the moderator for the panel discussion.  Panelists include:

            Amy Abernethy, MD, Director, Duke Cancer Research Program

            Peter Collins, PhD, Vice President, Diagnostics, GlaxoSmithKline

            David King, CEO, Laboratory Corporation of America

Registration is free for PMC members; non-members pay $25.

Register online at http://conta.cc/q9JgUM or at the door. The event is sponsored by RTI International.