June 5, 2006

Editor's Column: Medicare Reimbursement - No Problem, Nothing To It
Be A Sentinel Provider
Get A Jump On The NPI
Education And Revelry
Health Alert: Fatal Mix Of Heroin And Fentanyl
News And Notes: Medicaid Crackdown
Searching For Authors

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Editor's Column:
Medicare Reimbursement - No Problem, Nothing To It

By JOSEPH WEISS, MD

Who says that the Sustainable Growth Rate (SGR) is a failure? Who demands a change? I recently spent two days in Washington, DC, on Capitol Hill, lobbying for reform in what my organization, The American College of Physicians, calls our dysfunctional health care system.

I learned that everyone in Congress, including the cleaning ladies, knows that the SGR formula doesn’t work. Anyone working on Capitol Hill who has voice and/or a vote will greet you with sympathy. You will hear what you already know: The SGR is broken and the recommendations for 4.8 percent increase in reimbursements as recommended by Congress’s advisory board – The Medical Physicians Advisory Committee – are appropriate. Furthermore, you will hear that the bill HR 3617 – The Medicare Physician Value Based Purchasing Act – sponsored by Connecticut Congresswoman Nancy Johnson, is eagerly waited by the rest of Congress. Then conversation on this question ends.

If you are fortunate, as you leave that meeting a real friend will take you aside. That friend will tell you that the truth is Congress is satisfied with the unsustainable SGR. The truth is that Representative Johnson introduced her bill in April 2005, and it is going nowhere as of June 2006.

The fact is Congress clings to the idea that doctors, all doctors, are more than rich already and don’t need more wealth heaped upon them. The fact is that Congress enjoys this game of seeing the medical profession threaten, then plead, and finally sweat, until Congress gives a 1 percent increase rather than a 4.5 percent decrease mandated by the SGR. The accustomed rhetoric follows: our leaders claim a victory and congressmen ask for our political action dollars in return for listening to our needs.

The same friend will also tell you that the scenario of 2005 – the last-second 1 percent increase – will be replayed this year, though the variation could be not even 1 percent increase, but just a freeze.
The change required for reimbursements to improve goes far beyond a fix of the SGR. That will be the subject of my next editorial.

Be A Sentinel Provider

Plan on being an influenza sentinel site! As an influenza sentinel, you will receive weekly faxed updates on influenza activity in Michigan, the avian influenza A (H5N1) epizootic, and other up-to-the-minute influenza news. In addition, sentinels are subscribed to two CDC journals: the Morbidity and Mortality Weekly Report and Emerging Infectious Diseases. Becoming aware of the infectious diseases circulating in your community, the nation, and the world will help you provide optimal health care to your clients this influenza season.

Start now by contacting Rachel Potter at (517) 335-9710 or potterr1@michigan.gov to find out more.

MDCH Web site to which readers can be directed for details:
http://www.michigan.gov/mdch/0,1607,7-132-2940_2955_22779-122498--,00.html

Get A Jump On The NPI

The National Provider Identifier (NPI) is an Administrative Simplification mandate of HIPAA. The NPI is a 10-digit number that will be used to identify you to your health care partners, including all payers, in all HIPAA standard transactions. The NPI will will replace the identifiers that you currently use when submitting claims to various payers.

All health care providers are eligible to receive NPIs. All HIPAA covered health care providers, whether they are individuals or organizations, must obtain an NPI to identify themselves in the HIPAA standard transactions.

You can obtain an NPI by applying online at http://nppes.cms.hhs.gov or by calling (800) 465-3203 to request a paper application.

The NPI compliance date is May 23, 2007. However, you should apply for your NPI as soon as possible so you are prepared for testing when the payers are ready.

For more information on the NPI, visit: http://www.cms.hhs.gov/NationalProvItentStand

For more information on reimbursement issues, contact Stacie Saylor at MSMS at (517) 336-5722 or ssaylor@msms.org

Education And Revelry

Henry Ford physicians and graduates of the residency and fellowship programs will reunite with colleagues and friends while learning about the latest technologies and leading edge research at the 2006 Medical Association Jubilee Reunion.

Jubilee events will take place June 22-24. The Reunion begins with a reception at 5 p.m. June 22 at the Henry Ford Estate on the University of Michigan-Dearborn campus. Complimentary cocktails, appetizers, tours of the estate and musical entertainment will be provided.

On June 23, physicians will attend a continuing medical education program highlighting latest technologies and research at Henry Ford Health Systems, followed by an awards presentation, reception and banquet at the Ritz-Carlton, Dearborn.

For more information call (313) 874-2182.

Health Alert: Fatal Mix Of Heroin With Fentanyl

The Wayne County Medical Examiner is reporting an increase in the number of deaths due to drug use. Most of these drug deaths have been associated with heroin that is combined with another drug named fentanyl.

Fentanyl is a drug that is related to heroin and morphine, but is much more potent, especially when used in combination with heroin.

The Medical Examiner has also seen fentanyl mixed with cocaine.

People who use street drugs should be made aware that they may come in contact with drugs that are much more powerful than what they are used to, and that these drugs may result in death.

Help is available!
Substance Abuse Treatment Services:

STATEWIDE
24-Hour Substance Abuse Hotline (888) 736-0253

DETROIT
Bureau of Substance Abuse
24-Hour Hotline (800) 467-2452
www.drugfreedetroit.org

COMMUNITIES OUTSIDE DETROIT
Southeast Michigan Community Alliance
24-Hour Hotlines (800) 686-6543 TDD (800) 649-3777
www.semca.org

News And Notes: Medicaid Crackdown

Medicaid Cracks Down On Illegal Recipients
"Self-attestation of citizineship and identity is no longer an acceptable practice" for obtaining Medicaid benefits, President Bush stated in a letter, reported the New York Times June 4. Instead, beginning July 1 people who apply for or recertify their eligibility will be required to present a birth certificate, passport or other approved form of identification. States generally redetermine eligibility every three to 12 months, reported the Times.

The law, which allows people 45 days to provide the proof of citizenship (90 days for disabled people), is intended to increase the amount of Medicaid money available to citizens. The Times reported that about 50 million recipients will be required to provide the proof of citizenship specified in the law.

Some Employers To Reduce, Drop Health Coverage
A study unveiled at the recent Mackinac Conference for businesspeople and policy makers revealed that 61 percent of companies are considering reducing health care coverage and 27 percent might eliminate coverage altogether, reported the Detroit News. The study was a survey of 203 local companies by John Bailey & Associates, Troy.

The news reported that the three-quarters of the business executives surveyed thought that smokers should pay a larger share of their health care costs and that those who take good care of themselves should pay less.

St. John Modernizes Rooms, Plans For Big ER By '09
East Side health care giant St. John Hospital and Medical Center is gearing up for the biggest expansion project in its history reported the Detroit Free Press. The expansion will feature 144 private patient rooms by 2009 and double the size of the facility's emergency room.

The Free Press reported that the hospital's expansion plans are driven by patient and provider preferences such as private rooms and added amenities.

The first phase is expected to be open by September 2007 and will allow the hospital to move the radiology department and begin work on the new emergency room and the upper three floors, which should be complete by 2009. St. John currently has 685 beds and 4,900 employees.

Flu Fiascos?
A report obtained by the Associated Press indicates that a small number of the countries that pledged $2 billion to fight bird flu have made good on their obligations. Of the 34 donor countries who gathered in Vienna in January those who paid their pledge include Japan ($158 million), Switzerland ($4.7 million), Finland ($3.4 million) and the Czech Republic ($200,000). So far, the United States has dispursed about $71 million; it pledged $334 million.

In other flu news, The New York Times reported June 4 that the avian flu might be spreading between humans more than previously thought. Scientists ar studying "clusters," groups of in close proximity to one another for extended periods of time, such as families and the health care professionals who care for them. Several clusters have been infected with the disease, though scientists debate whether the cases are being transmitted from human to human or from birds in that area to humans. Investigations are often complicated further because in many cases local authorities kill all domestic fowl in the area and cover everything with lime, reported the Times. Even if the disease is transmittable between humans, the human-to-human transmission process has been described as "very inefficient" by at least one scientist who is an expert on the matter.

Searching For Authors

If you are a WCMSSM member who has written a book on anything (wines, hunting, fiction, non-fiction, medicine) please let us know. We can help you publicize your work. Contact us at info@wcmssm.org

This publication brought to you by Natinsky Publishing Network.

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