June 19, 2006

Editor's Column: Don't Blame Me, I'm Only The Messenger
Executive Director's Column: Geekisms & Technobabble
Blues Suit Update
WSU, Oakwood Ink GME Deal
Urge Lawmakers To Fix Medicaid Reimbursement
When P4P Goes Awry
Searching For Authors
Fix Blue Cross
Medicare Billing Tip

Click Here To Contact Us

Editor's Column:
Don't Blame Me, I'm Only The Messenger

By JOSEPH WEISS, MD

Sometime, possibly in the near future, you may receive a petition from me asking your support if I shoot someone. The someone I have in mind is the next person who exhorts me to: “think outside the box.” The reality is that the person who so addresses you is likely wearing Rolex watch, a pin-striped shirt with matching tie, and is coming from a manicure, pedicure and custom haircut with attention to exposing just the tips of graying hair. Furthermore, if I told that out-of-the box person what I am about to say now, that person would look at me with a combination of horror, surprise and incomprehension as if I were trying to explain Einstein’s Theory in medieval Latin.

What I heard in Washington, DC, was discussed in the second basement of the Cannon House Building, a place people will go in case of a Nuclear attack. Even then, the discussants spoke only in whispers. The concepts I am about to present are not outside of a box, but in the corners of the minds of physicians like us who work like we do, and see the dislocations of medical effort and effect that we experience daily.

Here is that basement talk: Present reimbursement rests on pillars of volume and procedures. Doctors get paid for how many patients they see, and how many procedures they do. That formula needs change. For the health of the nation, medical care payments should go for prevention and longitudinal care. Prevention should go far beyond the checks and annual examinations now called preventive care. Longitudinal means following patients outside the office, that is, realizing that the 15 minutes to half an hour spent with a patient in the examining room is the least part of their health care. It is the other 23 ½ hours after the appointment and the three months before the next office visit that requires medical guidance and assistance.

To allow us to practice such medicine requires a huge change in reimbursement. The feeling among those talking in the basement is that sometime in the future medical care will hit “rock bottom” and we will turn to single-payer national health insurance. Next, single-payer will “hit rock bottom” and we will turn to single-salary, single payer. Then we will implement the concepts of preventive medicine and longitudinal care the country and profession need to fulfill the promise of medical research and behavior we are capable of today.

Don’t throw this column away, print it and place it in the papers of your last will and testament. Have proof that you were aware now of what will happen then.

Executive Director's Column: Geekisms & Technobabble
EHR, EMR, HIT, RHIO*

By ADAM JABLONOWSKI, MPA

More geekisms, more techno-babble, more headaches! The electronic revolution is upon us and perhaps is spinning out of control. Here is another opportunity for physicians to control the practice of medicine on into the future. The vendors, health systems, managed care companies, insurers and assorted consultants are ready, willing and waiting to take over the health information highway, from your office computer to wherever the information might go - hospital, lab, insurance company, another physician, pharmacy, etc. and back again to you. Currently, nationally and at the state, government is planning the future of medical care information in the electronic age. Here in SE Michigan a private consortium of organizations is developing a regional health information organization to integrate all health data generated by health providers, including physicians.

Where all this is going, depends on you the physicians of our community. Currently, a handful of physicians participate in the meetings that are setting the standards for data transmission and retrieval. If the profession is to have its say about any of this development, physicians must be present at the conference table.

I urge you to get involved in this important work, not only for your own benefit but also for your colleagues of today and tomorrow. For more information, contact me at arj@msms.org or (313) 874-1360, ext 12. More information will be available in our September issue of the DMN. In addition, on October 27, 2006, during the MSMS Annual Scientific Meeting, WCMSSM will sponsor an educational session from 1 to 4 p.m. on this subject. Stay informed.

*electronic health record, electronic medical record, health information technology, regional health information organization

Blues Suit Update

By DONNA WELCH LAGOSH
OCMS Executive Director

The Sixth Circuit Court in Cincinatti June 9 entered an order declining to re hear the appeal lost by Blue Cross/ Blue Shield of Michigan in the case of Genord et. al. vs. Blue Cross/ Blue Shield of Michigan. The petition to re hear the case was circulated among all sitting judges on the federal bench in Cincinnati and not one judge voted to re hear the case. The case brought by the plantiffs alleges that Blue Cross/ Blue Shield are in violation of the federal Racketeer Influenced and Corrupt Organizations Act (RICO), by using a scheme to deny clean claims and delay payment of clean claims by means of false pretenses. The refusal of the court to re hear the appeal is significant and allows the case to move forward in federal court.

This is a solid victory in favor of the physicians. We will keep you updated on the case as things move forward.

WSU, Oakwood Ink GME Deal

Wayne State University (WSU) and Oakwood Healthcare, Inc. (OHI) signed an affiliation agreement June 5 to create an academic and clinical care partnership of With Wayne State University in Detroit. The program will encompass new programs in graduate medical education (GME), research and clinical care.

The agreement, which includes the School of Medicine's affiliated faculty physicians, the Wayne State University Physician Group, creates a long-term partnership between both institutions that will result over time in the creation of programs that support enhanced, medical education, research and clinical care.

The agreement is non-exclusive. Oakwood can accept students from other universities into its clinical programs and affiliate with other universities. WSU has the right to enter into affiliation agreements with other health care providers or medical centers.

Wayne State University is a premier institution of higher education offering more than 350 academic programs through 11 schools and colleges to more than 33,000 students.

Wayne State University School of Medicine With more than 1,000 students, the Wayne State University School of Medicine is the nation's third largest medical school.

Oakwood Healthcare, Inc., is a comprehensive regional network of hospitals, healthcare centers, skilled nursing centers and related healthcare facilities. Oakwood has a medical staff of more than 1,200 doctors, and provides service to more than 1.2 million people in 35 southeastern Michigan communities.

Urge Lawmakers To Fix Medicaid Reimbursement

The Michigan House of Representatives passed an omnibus budget bill that contains funding for the Medicaid program. The deliberations in the House resulted in a four percent increase to the physician services line. The increase is a significant outcome because nearly all other segments of the budget were either flat or cut. The budget now will go to the Senate for concurrence in order to be sent to the Governor. Please contact your senator and representative to let them know about the importance of maintaining access for patients.

Visit www.msms.org/grpa/stategov/stategov.html to find your representatives and senators. For more information, contact Colin Ford at (517) 336-5737 or cford@msms.org .

When P4P Goes Awry

A June 2 article that appeared in the Seattle Times demonstrated what can happen when pay-for-performance plans are implemented without input from doctors and patients.

The Times reported that approximately 500 physicians who had been snipped from a new Regence BlueShield insurance network will get to stay on another year. The plan serves engineers who are members of a labor union and work at Boeing, the major airplane manufacturer.

In May, the Times reported, Regence told about 8,000 patients that their doctors were excluded from from the health plan. Employees wre angry that physicians who had been part of the plan for a long period of time were deemed unworthy for the new performance-based network. This forced patients to move to a more expensive plan to continue to see their doctors or find new physicians.

According to the Times, Regence's controversial rating system attempts to measure physician performance to identify those who spend too much money compared to thier peers or don't deliver widely accepted treatments.

the company decided to delay the implementation of its network for about a year, but is still committed to pay-for-performance concepts.

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

Fix Blue Cross

In January, Blue Cross initiated new funding for its performance-based incentive program for physicians. Physician organizations participating in the BCBSM Physician Group Incentive Program provide physicians in their groups the opportunity to earn financial incentives based on specific performance indicators. MSMS supports the intent of this program; however, changes to the payment voucher have created confusion for physicians who are not eligible to receive the incentive and have necessitated edits to practice billing systems for those that post electronically. TAKE ACTION: Send letters to BCBSM and lawmakers through the MSMS Action Center (http://action.msms.org) . For more information, contact Julie Novak at (517) 336-5768 or jnovak@msms.org.

Medicare Billing Tip

Pre-operative Chest X-rays or EKGs Wisconsin Physician Services (WPS) posted this "tip of the week" on its May 30 listserv. I wanted to share this tip with you in case you are not on the WPS listserv.

Pre-operative chest x-rays or EKGs ordered for all patients undergoing a surgical procedure do not meet the medical necessity criteria. Medicare Part B does not cover this indication alone because it does not meet medical necessity requirements. For a pre-operative chest x-ray or EKG to be covered, the patient must have a condition or symptom, which requires assessment or reassessment prior to surgery. Inappropriate billing of these services may constitute abuse.

If you are not currently signed up with the WPS listserv and would like to be, you can sign up at (http://www.cms.hhs.gov/apps/mailinglists) .

For more information about reimbursement issues, contact Stacie Saylor at MSMS at (517) 336-5722 or ssaylor@msms.org . Get additional news and information from MSMS publications, such as Medigram, Michigan Medicine and the Monthly Top 10, online at (http://www.msms.org)

This publication brought to you by Natinsky Publishing Network.

Problems seeing this email? You may view it online at http://www.wcmssm.org
To subscribe or unsubscribe to this newsletter contact info@wcmssm.org