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SDCMS "News You Can Use" (2009.11.17)

by: San Diego County Medical Society
Published November 17, 2009

SDCMS "News You Can Use"
— November 17, 2009

We Still Need More Physicians to Take SDCMS' 2009 Workforce and Compensation Survey!
Please take five (5) minutes to complete the 2009 Workforce and Compensation survey now: CLICK HERE. We need, for so many reasons, to have more than the 300 respondents we have now. And thanks to all of you have taken the survey.

Executive Director Comment: This Thursday (Nov. 19) They're Voting in the House of Representatives on Medicare Rates. Please Take the Time to Let Your Representative Know How You Feel!
Please contact your congressperson to support HR 3961, which would permanently repeal the (un)sustainable (non)growth rate (SGR) formula for Medicare (which will, unless repealed, slash Medicare payments by 21% across the board). Call (800) 833-6354 to be directly connected with your representative. Potential talking points:

  • Explain, in your own words, the direct impact on your patients if congress fails to resolve the SGR mess.
  • Short-term patches that only make future cuts deeper and the cost of a permanent solution more expensive are not the answer.
  • Vote "YES" on HR 3961.
  • Send an email directly to your representative through AMA's Grassroots Action Center.
  • Or click here to take action via SDCMS' website (phone, email, or fax).

Executive Director Comment: Healthcare Reform (HCR) — the 30-second Version (See Below)

  • HCR is in trouble. The closer we get to the November 2010 mid-term elections, the harder it gets to round up the votes for healthcare reform.
  • The margin for the House of Representatives bill, HR 3962 (the house healthcare reform package, less the Medicare payment-for-physicians fix), was stunningly and surprisingly small: 2 votes.
  • The House bill (HR 3962) does not reduce cost. In the parlance of DC, it does not "bend the cost curve."
  • Senator Reid will have a real challenge in collaring 60 votes in the Senate for anything, and the results of the 2009 governor's races in New Jersey and Virginia will cause moderate democrats to think twice.
  • Costs are high — giving 15+ million citizens Medicaid is no free lunch!
  • Access improvements are problematic. Since reimbursements for Medicaid in California are abysmal (literally, worst in the nation), finding a physician who takes Medicaid will be a real challenge.
  • Support for HCR among seniors is dropping (and it was low already).
  • Less than half of the general public thinks HCR will improve either the broad U.S. healthcare system or their own healthcare situations (recent Gallup poll).
  • Thirty-eight percent (38%) of Americans would advise their congressperson to vote against a new healthcare bill this year, while 29% would advise their member to vote for it, and about a third have no opinion. These results are more negative than those from early October (recent Gallup poll).

CONTENTS

  • H1N1 Updates From the CDC
  • H1N1 Updates From the County of San Diego
  • H1N1 Video Presentations by and for San Diego County Physicians
  • H1N1 Billing Guide for Member Physicians
  • Healthcare Reform: CMA Letter to Congress on HR 3962
  • Healthcare Reform: AMA Perspective
  • For-profit Insurers Keeping Between 1/5 and 1/3 of the Premium Dollar
  • Blue Shield Planning to Publish Physician Ratings Based on Faulty CPPI Data
  • Appeals Court Protects California's Voter-Enacted Drug Treatment Program
  • 2010 Medicare Payment Rule
  • Medicare Consultation Codes: Big Change May Be Coming
  • AHA Report Disputes Geographic Healthcare Spending Theory
  • Pay-for-Performance Participation Can Be Pricey for Docs
  • SDCMS Board of Directors Call for Self-Nominations
  • EVENTS

H1N1 AND SEASONAL INFLUENZA • UPDATES

H1N1 Updates From the CDC
A very detailed and thoughtful H1N1 webinar, presented by CDC personnel at the AMA interim meeting, can be accessed by clicking here.

H1N1 Updates From the County of San Diego

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:

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.

HEALTHCARE REFORM 2009 • UPDATES

Healthcare Reform: CMA Letter to Congress on HR 3962
Click here to access CMA's letter to California's congressional representatives regarding HR 3961 and HR 3962, the two House health reform bills.

Healthcare Reform: AMA Perspective
At this year's Interim Meeting, the House of Delegates (HOD) reaffirmed AMA's commitment to health system reform. Specifically, the HOD outlined elements for AMA to actively and publicly support and oppose as the health system reform debate continues. The HOD also asked for timely information on exactly what transpired at the meeting regarding health system reform. Visit http://www.ama-assn.org/go/interim2009 and click on "Resources" to view these documents.

  1. Highlights of HOD Action on Health System Reform
  2. AMA Perspectives on HR 3962, the "Affordable Health Care for America Act"

For-profit Insurers Keeping Between 1/5 and 1/3 of the Premium Dollar
A recent analysis of regulatory filings from the Senate Commerce Committee suggests that as little as 66 cents of each premium dollar paid to for-profit insurance companies goes toward physician and hospital bills. The data come from some of the largest for-profit companies, including WellPoint, UnitedHealth Group, Aetna and Cigna, who spent approximately 74 cents out of every dollar on medical care in the individual market, according to the information released. Insurers often refer to the percentage of premiums spent on medical claims as the "medical loss ratio" and often cite the industry average as 87 cents per dollar. Current healthcare reform legislation in the House would initially require insurers to spend at least 85 cents of every dollar in premiums on medical claims. Click here to read the complete article.

STATE

Executive Director Comment: This is the calm before the storm for state healthcare issues. Be ready for more budgetary crises (think "Groundhog Day") as revenues continue to be outpaced by expenses.

Blue Shield Planning to Publish Physician Ratings Based on Faulty CPPI Data
The California Cooperative Healthcare Reporting Initiative (CCHRI) is operating a quality reporting pilot project called the California Physician Performance Initiative (CPPI). Over the past two years, CPPI has used claims data from private PPO patients from Anthem Blue Cross, Blue Shield, and United Healthcare to measure physicians on a set of quality measures. SDCMS and CMA continue to have serious concerns with the validity and accuracy of the data that has been collected. Results of CCHRI's own reconsideration process in 2009 found significant inaccuracies, with 33 percent of physician scores being overturned during the reconsideration process. Despite the recommendation from CCHRI's physician advisory group not to release the faulty data, Blue Shield has indicated that it will likely publish the results. At this point, Blue Cross and United have not said whether they will publish the 2009 CPPI results. CMA continues to work to dissuade payors from publishing the 2009 CPPI results, and to persuade CCHRI to fix the flaws in the CPPI data gathering process before moving forward with the project.

Appeals Court Protects California's Voter-Enacted Drug Treatment Program
A California Appeals court recently upheld a decision blocking a legislative attempt to radically alter Proposition 36, California's landmark drug-treatment-instead-of-incarceration initiative. Click here for more information.

FEDERAL

2010 Medicare Payment Rule
CMS released its final 2010 Medicare payment rule on October 30, 2009, which includes a 21.2% physician payment cut. The rule will be published in the Federal Register on November 25, 2009. Understandably, there is much concern in the physician community about what this will mean for their practices. CMA is working to pass a permanent SGR fix as part of the health reform package. Repealing the SGR through the federal health reform package remains CMA's top federal priority. Short-term fixes year after year have grown the problem. In four years the cost of a permanent solution has ballooned from $49 billion to more than $200 billion and the cuts physicians are facing have increased from under 5% to a whopping 21.2%. CMS is also planning to implement a controversial change that would eliminate payments for all consultation codes other than the G codes that are used to bill for telehealth consultations, which would effectively cut payments to specialists. CMA and AMA are also seeking legislation or administrative action to stop this change. Although CMA fully supports increased payments for primary care, those increases cannot be paid for by cutting payments to other specialties. Click here for additional details on the "final" 2010 payment rule, and click here for a chart detailing the impact of the new payment rule by specialty.

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. CMA is strenuously lobbying to address this "robbing Peter to pay Paul" approach.

AHA Report Disputes Geographic Healthcare Spending Theory
The American Hospital Association (AHA) recently released the report, "Geographic Variation in Health Care Spending: A Closer Look," asserting that the Dartmouth Atlas of Health Care, the foremost source for determining regional spending data, fails to signal that a "complex interplay of variables influences an area's level of spending." AHA's report found that spending variation is less pronounced when adjusted for federal support for graduate medical education and disproportionate-share payments. The report also found that the Dartmouth Atlas data does not adequately address the true factors that drive utilization, such as the prevalence of chronic illnesses; diabetes; demographics; and the number of people that are uninsured and more likely to have health problems when they become Medicare beneficiaries. With this report, AHA may challenge the notion held by many stakeholders that regional variations in healthcare spending are a roadmap to controlling costs.

Pay-for-Performance Participation Can Be Pricey for Docs
According to a survey published last week in the Annals of Family Medicine, participating in quality reporting programs is expensive. The researchers studied eight physician practices participating in four quality reporting programs in North Carolina, and considered costs of four incentive programs: Medicare's Physician Quality Reporting Initiative (PQRI), Improving Performance in Practice in North Carolina and Colorado (IPIP), Bridges To Excellence (BTE) implemented by Blue Cross/Blue Shield of North Carolina, and Community Care of North Carolina (CCNC). Requirements such as responding to requests for data, proper planning, training, coding, data entry, and modification of electronic systems cost physician practices between $1,000 to $11,100 in implementation costs per doctor, and from about $100 to $4,300 per year per clinician after the program was launched.

EVENTS

"Good advice is something a man gives when he is too old to set a bad example."
— François de La Rochefoucauld (1613–1680), Noted French Author of Maxims

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

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