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SDCMS "News You Can Use" (2009.11.04)

by: San Diego County Medical Society
Published November 4, 2009
Attachments:
application/pdf iconCPPIFindingsFINAL2009CYCLE.pdf
application/pdf iconFinalRuleImpactTable.pdf
application/msword iconFinalRuleSummaryFINAL.doc

SDCMS "News You Can Use"
— November 4, 2009

Help! Members and Nonmembers: We need you to take SDCMS' 2009 Workforce and Compensation Survey!
Only 65 docs so far have taken this critical 5-minute survey. Please pitch in by completing our 2009 Workforce and Compensation survey now: CLICK HERE

Healthcare Reform (HCR) in 30 Seconds:

  1. The House has split HCR into two bills:
    • SGR reform (eliminates SGR, adds system for adjusting for inflation) via HR 3961, and
    • Everything else in HCR that used to be in HR 3200 (including GPCI reform) via HR 3962. Pelosi/Stark/Waxman have created an expensive and expansive bill, which is (mostly) physician-friendly.
  2. The Senate HCR bill is awful for physicians - multiple, really bad, bad stuff - but Reid is having serious problems cobbling together the 60 votes needed to get it out of the Senate.
  3. The House/Senate conference committee is unlikely to meet before the Xmas holidays.
  4. We'll be in HCR "Overtime/Sudden Death" between Xmas and January 15, 2010.
  5. Time is the enemy of HCR - the longer it goes, the lower the probabilities - since the election campaign of 2010 has already started!

Executive Director Comment: Please tell us your stories (see directly below) as to how this will affect your patients for inclusion in a letter we plan on writing to our congressional delegation (email me at Gehring@SDCMS.org)! Absent a change, your coding for consultative services may need to change dramatically or your claims payment may be seriously delayed for use of non-recognized codes.

Medicare Consultation Codes: Big Change May Be Coming
We have just become aware that the 2010 CMS Final Rule on Medicare payments (which includes a 21% cut to Medicare rates because of the preposterous SGR formula, for which we will likely see another "last-minute SGR fix") included the elimination payment for longstanding inpatient and outpatient consultative codes. This would require all physicians to use CPT codes for office or inpatient services (9920x, 9921x, 9922x) for both primary and consultative services, with no recognition of the value of consultative services and reports. Further, the Final Rule includes significant cuts of 16-18% for reimbursement of the non-consultative codes compared to 2009 values.

  • Click here to read an AMA summary of the key provision. Click here to access the impact table.
  • It is unclear what this means for non-Medicare payers who use the already published consultative codes in the 2010 CPT.
  • We are working with our CMA and AMA staff to determine the next moves regarding these major changes in coding, and we will keep you advised. The AMA House of Delegates will take this up at its meeting this coming weekend, as well.

CONTENTS

  • H1N1 Updates From the County of San Diego
  • State Releases N95 Respirators From Stockpile (Oct. 22)
  • CDC Study: For Every Confirmed Case of H1N1, There Are Likely 79 Infections
  • CMA Publishes H1N1 Billing Guide for Member Physicians
  • H1N1 Video Presentations by and for San Diego County Physicians
  • Check Out SDCMS' Practice Management FAQ Website Search Tool!
  • "Preparing to Practice" Workshop • Saturday, November 14, 2009
  • Read SDCMS President's Op-ed in The San Diego Union-Tribune
  • Details on HCR bills (October 29, 2009)
  • HR 3962 and MICRA
  • Failed Senate Vote Clouds Future of SGR Reform
  • State Rejects Regulations That Would Expand Scope of Practice for Nonphysicians
  • 2009 CMA Findings on the California Physician Performance Initiative
  • "Top Doctors" Gala This Saturday, Nov. 7
  • POLST Training for Physicians, Nov. 12
  • CMA Publishes Toolkit to Help Physicians Understand the Impact Anthem Blue Cross Changes Will Have on Your Practice
  • FTC Red Flags Rule Delayed Until June 1, 2010
  • How Can Physician Assistants Help You in Your Practice?
  • Best Practices: Managing Call Volume
  • EVENTS

H1N1 AND SEASONAL INFLUENZA • UPDATES

H1N1 Updates From the County of San Diego

State Releases N95 Respirators From Stockpile (Oct. 22)
California will deploy up to half the state's emergency stockpile of specialized (N95) respirators to local health jurisdictions for dispersal to hospitals and clinics. Local public health officials will receive the respirators and issue them to facilities within their county.

CDC Study: For Every Confirmed Case of H1N1, There Are Likely 79 Infections
Click here for more information.

CMA Publishes H1N1 Billing Guide for Member Physicians
Click here to access this easy-to-read chart. For assistance in logging into CMA's website or to request a copy of the chart, contact CMA's Reimbursement Helpline at (888) 401-5911 or at jblack@cmanet.org.

H1N1 Video Presentations by and for San Diego County Physicians
Below is a series of three "quick and easy" videos for physicians and office staff on H1N1:

MEMBER BENEFITS

Executive Director Comment: This (directly below) is a treasure trove of answers to questions that we've been collecting now for three years — check it out!

Check Out SDCMS' Practice Management FAQ Website Search Tool!
Did you know you have access as an SDCMS member to hundreds of practice management questions and answers at SDCMS' website? SDCMS members can search from among hundreds of economic, legal, employment, licensure, and other topics critical to managing your practice. If you don't find the answer you need, you can as well submit your question from our website and we'll get it to you. For assistance in logging onto SDCMS' website, contact Kyle Lewis at (858) 300-2784 or at KLewis@SDCMS.org.

"Preparing to Practice" Workshop • Saturday, November 14, 2009
Young physicians, residents, and physicians just starting your practices, on Saturday, November 14, 2009, we will hold our bi-annual free workshop: "Preparing to Practice: What You Need to Know BEFORE You Begin Your Practice." Contact Lauren Wendler at (858) 300-2782 or at LWendler@SDCMS.org for further information or click here.

HEALTHCARE REFORM 2009 • UPDATES

Read SDCMS President's Op-ed in The San Diego Union-Tribune
SDCMS Website • SignOnSanDiego Website •  PDF Document

Details on HCR bills (Oct. 29)
Click here for HR 3962 (the big House bill).  Click here for HR 3962 timeline. Click here for HR 3961 (the little House bill which fixes SGR).

HR 3962 and MICRA
Section 2531 of HR 3962 will NOT invalidate MICRA or otherwise prohibit or limit MICRA's caps on economic damages or attorneys' fees.

Failed Senate Vote Clouds Future of SGR Reform
The procedural failure in the Senate of the bill to repeal SGR (and the concomitant defeat of frozen pay rates for the next 10 years) does not bode well for any help for physicians in Senate. Click here to read more.

STATE

Executive Director Comment: This is a huge victory for patients (see directly below) that you'll probably never hear about except from us. This prevents unqualified healthcare professionals from carrying out the duties of a physician or surgeon!

State Rejects Regulations That Would Expand Scope of Practice for Nonphysicians
The California Office of Administrative Law has rejected regulations proposed by the California Department of Public Health (CDPH) that would have expanded the scope of practice of psychologists and potentially all other healthcare practitioners working in licensed healthcare facilities. CMA vigorously fought the proposed regulations through the regulatory process to ensure that the state understood the severe impact that these regulations would have on patient care and medical staff independence. Click here for more information.

2009 CMA Findings on the California Physician Performance Initiative
Click here to access CMA's 2009 findings on the California Physician Performance Initiative that CMA sent to the California Cooperative Health Care Reporting Initiative (CCHRI) on October 23, 2009. The inaccuracies of the CPPI data are very real and may be detrimental to about 13,000 California physicians (mostly primary care physicians, cardiologists, endocrinologists, OB/GYN, allergy/immunologists, colorectal surgery, pulmonologists, gastroenterologists, and rheumatologists) if the results are published. Our findings and recommendations include:

  1. Health insurer-generated claims data is unreliable to measure the true quality of care provided by physicians because they are incomplete, which inevitably leads to inaccurate results.
  2. Several CPPI methodologies are inherently flawed, which significantly contributes to the inaccurate results.
  3. Patient compliance to a recommended procedure is critical in measuring the overall quality of care provided by physicians.
  4. CCHRI should not presume that the report cards of the 11,000 physicians who declined to partake in the reconsideration process are accurate.
  5. Health plans should find a way to pre-scrub their claims data prior to releasing it to physicians or compensate physicians for correcting the claims data.
  6. The patient and procedure attribution methods in the PPO setting must be revisited.
  7. The look back period for colonoscopy must either be extended or colonoscopy should be discarded from the project altogether.
  8. Specialty physician designations must be addressed at the outset.
  9. Federal privacy rules disallowing physicians from accessing records of former patients needs to be addressed.
  10. Health information technology used by health plans to capture claims data should be reviewed.

CMA is requesting that CCHRI not publish the 2009 CPPI results because they are based on faulty data and publication of those results would be misleading to the public. CMA is also recommending that CCHRI dedicate the required due diligence in correcting the deficiencies we raised before moving forward in 2010. Feel free to write your own letter or share this letter to all interested parties.

LOCAL

"Top Doctors" Gala This Saturday, Nov. 7
It's not too late to get tickets to this fabulous affair — we expect over 500 attendees. You can purchase tickets at the door or click here for online ticket sales. Time: 6:30pm-9:30pm. Location: 200 West Island Avenue, San Diego 92101. Valet Parking available.

POLST Training for Physicians, Nov. 12
Presented by Glenn Panzer, MD, and Lynette Cederquist, MD, as part of the San Diego POLST Initiative. Thursday, November 12, 2009. North County Health Services, San Marcos Office, 727 W. San Marcos Blvd., Ste. 112, San Marcos, CA 92078. 6:30pm-7:30pm. CME available. Contact KDotson@SDCMS.org.

PRACTICE MANAGEMENT

CMA Publishes Toolkit to Help Physicians Understand the Impact Anthem Blue Cross Changes Will Have on Your Practice
The Blue Cross tool kit contains information on all of the Blue Cross changes, including important dates and links to important documents and sample letters. For assistance in logging into CMA's website or to request a copy of the chart, contact CMA's Reimbursement Helpline at (888) 401-5911 or at jblack@cmanet.org.

FTC Red Flags Rule Delayed Until June 1, 2010
On October 30, 2009, the Federal Trade Commission announced that the Red Flags rule is delay until June 1, 2010. Click here for more information on the FTC's decision.

How Can Physician Assistants Help You in Your Practice?
The following short video presentations provide insights into PAs as partners in your practice:

  • "An Introduction to Physician Assistants" • Click Here
  • "Laws, Regulations, and Reimbursements Associated With Physician Assistants" • Click Here
  • "Physician Assistants: Who We Are and What We Do" • Click Here
  • "Physician Assistants: Supervising Physicians" • Click Here

Best Practices: Managing Call Volume
For many medical offices, the volume of phone calls received daily is overwhelming. During periods of heavy call volume, calls may be dropped and wait times may be long, frustrating patients and staff alike. Chapter 3 of CMA's Best Practices tool kit (published with generous support from the Physicians' Foundation to help physicians improve the efficiency, and in turn the quality, of their practices) will show physician practices how to reduce unnecessary call volume by systematically evaluating the reason for the calls and creating a plan for change. In addition to learning how to assess your call volume, the tool kit will also teach you:

  • How to find and keep qualified staff.
  • How to build a defensible fee schedule.
  • When it makes sense to cancel a payor contract.
  • How to make sense of your revenue stream.
  • How to improve the patient experience.
  • And much more.

EVENTS

"Courage is the price that life exacts for granting peace."
— Amelia Earhart (1897-1937)

Read more about: H1N1, Healthcare News and Updates, healthcare reform, SDCMS News and Updates, Workforce and Compensation Survey, News You Can Use

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