June 25, 2007

IN THIS ISSUE

DMC/Providence Land Orthopedic Residency Program
Blues Lawsuit Deal Might Resolve Cases Nationwide
Groups Push Congress On Health IT
CMS Set To Launch Quality Initiative
Are You Using The NPI?
Take Care When Distributing Medication Samples

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DMC/Providence Land Orthopedic Residency Program

The Detroit Medical Center (DMC) was awarded, along with Providence Hospital, the DMC/Providence Medical Center Orthopedic Residency Program by the Residency Review Committee for Orthopaedic Surgery, part of the Accreditation Council for Graduate Medical Education (ACGME), according to a press release.

The program allows four orthopedic residents a year, over a five year span, totaling 20 residents, to rotate between DMC Children’s Hospital of Michigan, DMC Detroit Receiving Hospital, DMC Michigan Orthopedic Specialty Hospital and Providence Hospital.

“This will be an opportunity to attract new graduates to stay and practice in southeast Michigan,” stated Ben Carter, executive vice president and chief operating officer, DMC.

“I have been a teacher my entire career and I look forward to doing my small part in building a new program for future orthopedic surgeons and for the residents of southeast Michigan,” said orthopedic surgeon, Ralph Blasier, MD, JD, DMC/PMC Orthopedic Residency Program Director.

The DMC will also serve as a satellite site for the Michigan State University College of Osteopathic Medicine (MSUCOM) programs, and is working to establish future orthopedic programs with DMC Huron Valley-Sinai Hospital and DMC Sinai-Grace Hospital.

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Blues Lawsuit Deal Might Resolve Cases Nationwide

Editor’s note: The impact on Michigan cases was unclear at press time. MSMS is consulting with its attorneys to provide more clarity on the issue. Check back in this space in future issues for updates.

A $128 million settlement agreement between 23 Blue Cross and Blue Shield plans, the Blue Cross and Blue Shield Association and physicians across the country will, if approved, resolve several class-action lawsuits that had been consolidated into one case pending in US District Court in Miami. The first lawsuits were filed more than three years ago and dealt with payment and appeal policies, denial and delay of payments, medical guidelines and other concerns. In an American Medical Association news release, AMA President William Plested, MD, says that the settlement resolves “contentious business practices that have long frustrated physicians and jeopardized the delivery of quality patient care.”

But Michael Pope, a spokesman for the plans involved in the settlement and an attorney with McDermott Will & Emery, noted that “this is not an admission that anything said in the complaint is true. My clients came to me and said, ‘We don’t do the things that they say we do, but it doesn’t do anyone any good to have this litigation,’ ” Pope says. Pope says he expected the money to be released by year-end, and that physicians filing claims can designate that their share of the settlement be paid to them or to a charity of their choosing.

Settling plans will also pay court-determined legal fees up to $49 million, according to a news release.

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Groups Push Congress On Health IT

The AARP, Business Roundtable and Service Employees International Union have sent Congress a set of jointly endorsed principles for implementing the use of health information technology, which the organizations say would help reduce medical errors, and save time and money for patients and healthcare providers.

“The digital age has transformed virtually every other sector of the economy,” said Business Roundtable President John Castellani in a written statement released jointly by the three organizations. “It is time to bring the tremendous benefit of technology to our healthcare system by enacting health IT legislation.”

The principles, created in conjunction with the organizations’ health care-improvement campaign Divided We Fail, include recommendations that Congress pass legislation requiring payers and healthcare providers to use secure, uniform and interoperable technology; create grants, loans or tax credits that would assist providers in purchasing such technology; and set a timetable for a uniform healthcare IT system to be universally used.

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CMS Set To Launch Quality Initiative

On July 1, 2007, the Centers for Medicare and Medicaid Services (CMS) will begin the voluntary Physician Quality Reporting Initiative (PQRI).

To assist physicians and other eligible professionals who may elect to participate, the American Medical Association in collaboration with CMS, Mathematica Policy Research, Inc., and the National Committee for Quality Assurance, has developed participation tools. The tools are designed to:

 -aid in the selection of measures by physicians and other eligible

professionals wishing to participate in the program

 -link to background information on the quality measures, including

both the rationale and evidence base for each measure

 -aid in the data collection required to report clinical performance

data

 For each of the 74 measures in the program, the tools are now available online at www.ama-assn.org/go/toolsMedicarePQRI

 CMS also posted technical corrections to some of the program's measure specifications. Additional information can be found on the CMS

website:

 2007 Physician Quality Reporting Initiative (PQRI) Measure Specifications [PDF, 812KB] - Updated 06/19/07

 June 18, 2007 Technical Corrections Release Notes, Version 1.1 [PDF, 19KB]

 General CMS PQRI website for additional information:

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Are You Using The NPI?

The National Provider Identifier (NPI) is a Health Insurance Portability and Accountability Act (HIPAA) Administrative Simplification Standard. The NPI is a unique identification number for covered health care providers. Covered health care providers and all health plans and health care clearinghouses will use the NPIs in the administrative and financial transactions adopted under HIPAA. The NPI is a 10-position, intelligence-free numeric identifier (10-digit number). This means that the numbers do not carry other information about healthcare providers, such as the state in which they live or their medical specialty. Beginning May 23, 2007 (May 23, 2008, for small health plans), the NPI must be used in lieu of legacy provider identifiers in the HIPAA standards transactions. Covered entities may invoke contingency plans after May 23, 2007.

If you are a health care provider who bills for services, you probably need an NPI. If you bill Medicare for services, you definitely need an NPI! Getting an NPI is easy. Getting an NPI is free. The first step is to get your NPI. If you delay applying for your NPI, you risk your cash flow and that of your health care partners as well.

As outlined in the Federal Regulation, The Health Insurance Portability and Accountability Act of 1996 (HIPAA), covered providers must also share their NPI with other providers, health plans, clearinghouses, and any entity that may need it for billing purposes.

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Take Care When Distributing Medication Samples

It is often helpful and convenient to provide patients with sample medications. However, you should have safeguards in place to ensure they are properly stored, dispensed and documented, reports American Physicians Assurance Corp. Following are important tips provided by the company:

 ·Store sample medications in a locked cabinet with access limited to persons authorized to dispense them

·Dispense samples only under the order of a physician

·Include patient education inserts with all samples

·Record quantities of more than a week’s supply of samples in a log book or electronic tracking system

·Document in the patient’s medical record when the sample was provided

·Prior to dispensing, check samples for expiration dates and

properly dispose of any expired drugs

·In the event of a medication recall, be sure to notify patients

who received samples

For more risk management tips from American Physicians, visit www.apassurance.com (click “Risk Management” then “Tips”).

For additional information, policyholders may contact one of American Physicians' risk management consultants at (800) 748-0465.

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