E-DMN - February 11, 2008

February 11, 2008

Editor's Column: Measuring, Monitoring and Meaning
DMC Trims Payment To WSU Docs
AG Calls Blues Bills 'Deeply Flawed' In Senate Testimony
Drivers' License Bill Needs Fix
Important NPI Changes: March 1 Is Critical
Some Solid Reasons To Act On Medicare

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Editor's Column: Measuring, Monitoring and Meaning

By JOSEPH WEISS, MD
The health insurers say their evaluations of us measure our cost and quality. Do you believe that the resulting stars and ratings really bring these aspects of our character to light? Physicians don’t know how the insurers’ computer algorithms work, and the explanation, in words, the insurers give us, is incomprehensible. No study, as yet, has shown if patients use the results like movie ratings or take the ratings into account in a manner not yet identified.

Groups like Public Citizen clamor for public listing of physicians disciplined by state licensure boards or subject to a large number of malpractice suits. These lists are of limited value. In Michigan, the number of physicians who would make these rolls could reach 200, but 26,000 doctors practice in the state.

We have reason to continue our skepticism of proposals that claim to be able to determine our worth through a sophisticated evaluation of claims data or by public display of a malfeasance inventory.

The quality of a physician, whether that doctor rates one star or four, is the patient’s decision. We should strive to keep that decision as free and personal we would fight to preserve the right of a secret ballot.

We can argue and go separate ways on single-payer, private payers, and government support in health care. But no matter what form health care takes, that approach must allow the patient the freedom to choose.

The slogan: POWER TO THE PEOPLE becomes us.

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DMC Trims Payment To WSU Docs

The Detroit Medical Center will cut its payments $10 million to $12 million to Wayne State University School of Medicine physicians who provide services for Medicaid patients beginning today, according to reports published in the Detroit Free Press and Detroit News Friday and Saturday.

The newspapers reported that the cuts are in response to Medicaid money approved in the state budget process last fall. The cuts are retroactive to Oct. 1, 2007 and were announced to WSU in a Feb. 1, 2008 letter from DMC Floyd Allen to WSUSOM Dean Robert Mentzer, MD, reported the Detroit News in its Saturday edition.

University officials were shocked by the announced cuts. “This puts us in an incredible dilemma…This could put a big hole in the safety net,” Associate Dean of Medicine Robert Frank, MD, told the Free Press. Dean Mentzer told the newspaper that the action was “completely unexpected” and contrary to the school’s signed agreement with DMC, a three-and-a-half year pact negotiated to conclusion in November.

Both newspapers reported no response to calls to DMC sources including DMC Mike Duggan and spokespeople for the medical center.

DMC/WSU Dispute Requires Common Sense Leadership

The following is a statement released by MSMS this morning.

The sudden flare-up between the Detroit Medical Center and the Wayne State University School of Medicine over funding issues will require common sense leaders seeking common ground for the common good.

"Access to health care is the only real bottom line that matters," said AppaRao Mukkamala, MD, president of the 15,000-member Michigan State Medical Society. "Patient care must not be compromised in this dispute."

According to media reports, the sudden cut of $12 million from DMC to the WSU School of Medicine could result in physician layoffs at the school. Layoffs, in turn, would continue to erode access to care. Many physicians at WSU care for patients at DMC, particularly patients eligible for Medicaid and those who are uninsured or underinsured.

"If the cut from DMC results in fewer physicians, that doesn't seem to make sense in a city that is crying out for a stronger health care safety net," Doctor Mukkamala said. "Many patients already have a difficult time getting the care they need. More patients would be forced to use emergency rooms. That doesn't seem to make economic sense, for DMC or for the entire health care system."

For decades, the collaborative relationship between DMC and WSU School of Medicine has been based on mutual respect and clear communication, Doctor Mukkamala pointed out. He said the Michigan State Medical Society and the Wayne County Medical Society of Southeast Michigan are committed to helping resolve this issue immediately so that patient care is not compromised and physicians are not lost.

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AG Calls Blues Bills 'Deeply Flawed' In Senate Testimony

Attorney General Mike Cox Feb. 6, in testimony before the Senate Committee on Health Policy, said that a package of bills promoted by Blue Cross (HBs 5282-5285) is "deeply flawed."

"Any reform package should focus on consumers first and Blue Cross second," Cox said.

Cox called upon legislators to gather independent data before making any sweeping reforms, including a thorough audit of Blue Cross. Cox also urged lawmakers to mandate that OFIS, the Office of Financial and Insurance Services, in collaboration with groups such as AARP and the Area Agencies on Aging, create an annual 'Affordability Index' to keep track of health care costs and measure the impact of any changes to Michigan's health care system.

Cox began by stating that the starting point for reform should be in response to three questions:

What is the state of Blue Cross?
What is the trend for those individuals who have to pay for their own insurance?
What is the state of individual health care costs in Michigan compared to other states?

"Blue Cross controls more than 70 percent of Michigan's health insurance market, and its surplus has doubled since 2001 to $2.8 billion," Cox said. "Which begs the question: what problems are these bills solving?"

The effect of the four bills under consideration, Cox said, would be to:

eliminate community rating and institute rate bands, so that health care consumers could be segregated by age and by community - otherwise known as redlining;
allow Blue Cross to charge new customers with serious illnesses as much as 250 percent above their current premiums;
enable Blue Cross to deny coverage for those who seek individual coverage on pre-existing conditions for up to 12 months; and,
establish a hefty profit margin for Blue Cross, as high as 30 percent.

Cox outlined eight areas for lawmakers to examine in connection with the changes being sought by Blue Cross. Those areas include the use of independent data; the use of workgroups to more fully understand the broad ramifications of proposed changes; restore the oversight by OFIS and the AG's office; examine the necessity of a high-risk pool and its ramifications; establish an 'Affordability Index' to measure the financial impact of any changes; re-examine the scope of any new loss ratios; provide more guidance on the use of reserves; and limit the scope of any new businesses to be purchased by Blue Cross.

According to the American Health Insurance Plans Center for Policy and Research, Michigan has the fourth most-affordable insurance in individual markets. "That's one ranking Michigan should strive to keep," Cox noted.

Cox noted that Blue Cross was created "to secure for all people of this state ... the opportunity for access to health care services at a fair and reasonable price," and that Blue Cross is a "charitable and benevolent institution."

"Let us not forget the mission of Blue Cross is to put people over profits and not profits over people," Cox concluded.

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Drivers' License Bill Needs Fix

Contact Representatives Now to Urge a Fix On Wednesday the Michigan Senate approved a bill that would allow non-permanent residents to get temporary licenses. The bill contains provisions that would immediately reverse the Jan. 22 ban on giving driver's licenses to non-permanent residents. That ban was a consequence of the Secretary of State's interpretation of an Attorney General's opinion, and it adversely affects some IMGs and other international physicians, residents and students.

The measure that passed the Senate now is headed to the House for a hearing in the House Transportation Committee, followed by a vote by the full House.

MSMS President AppaRao Mukkamala, MD, has explained the urgent need for a fix to lawmakers and the media this way: "The Secretary of State's interpretation of the Attorney General opinion impairs the ability of individuals legally residing in Michigan from obtaining a driver's license. This particularly affects medical students, medical residents, and physicians recruited from other countries."

"The day-to-day delivery of health care relies heavily upon the services provided by medical residents," Dr. Mukkamala said. "In some communities, international medical graduate physicians comprise well over half of the medical residents at a facility.

"Additionally, as the country is facing an overall physician shortage, IMG physicians are helping to fill the demand. International medical graduates already undergo considerable scrutiny upon entering in the country," he added. "Restricting the issue of a drivers' license not only creates a hardship on the individual but also deprives communities from attracting talented medical professionals to provide care."

TAKE ACTION NOW - The issue now moves to the House. Use the MSMS Action Center (www.msms.org/action (http://www.msms.org/action) ) to send a message to your state representative, urging a fix to the non-permanent residents driver's license situation.

For more information, contact Colin Ford at MSMS at 517-336-5737 or cford@msms.org.

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Important NPI Changes: March 1 Is Critical

Prior to March 1, 2008: Claims with both an NPI and a Medicare legacy number are rejected if the pair is not found on the Medicare NPI Crosswalk.

Claims submitted with just a Medicare legacy number are being paid (unless of course, they have other errors that cause them to be rejected).

As of March 1, 2008:

Claims with both an NPI and a Medicare legacy number will continue to be rejected if the pair is not found on the Medicare NPI Crosswalk.

Claims without an NPI in the primary provider field will be rejected!

Claims with only a Medicare legacy number in the primary provider field will be rejected!

This means that you will not be able to get paid for any Medicare services you provide until you begin using your NPI. Also, if needed, you must correct any data which may be preventing an NPI/legacy match on the NPI crosswalk. The correction might require that you file a CMS-855 Medicare Provider Enrollment form with your Medicare carrier, A/B MAC, or DME MAC a process which can take a number of months to accomplish.

TEST NPI-only NOW: If you have been submitting claims with both an NPI and a Medicare legacy number and those claims have been paid, you need to test your ability to get paid using only your NPI by submitting one or two claims today with just the NPI (i.e., no Medicare legacy number).

If the Medicare NPI Crosswalk cannot match your NPI to your Medicare legacy number, the claim with an NPI-only will reject. You can and should do this test now! If the claim is processed and you are paid, continue to increase the volume of claims sent with only your NPI. If the claims reject, call your Medicare carrier or A/B MAC enrollment staff for advice right away. The enrollment number is likely to be quite busy after the March 1 deadline, so don't wait.

Not sure what an NPI is and how you can get it, share it and use it? As always, more information and education on the NPI can be found through the CMS NPI page www.cms.hhs.gov/NationalProvIdentStand on the CMS website. Providers can apply for an NPI online at https://nppes.cms.hhs.gov <https://nppes.cms.hhs.gov/> or can call the NPI enumerator to request a paper application at 1-800-465-3203. Having trouble viewing any of the URLs in this message? If so, try to cut and paste any URL in this message into your web browser to view the intended information.

Note: All current and past CMS NPI communications are available by clicking "CMS Communications" in the left column of the www.cms.hhs.gov/NationalProvIdentStand CMS webpage.

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Some Solid Reasons To Act On Medicare

Congressional action is needed to preserve seniors’ access to physicians. Current Medicare physician payment rates are scheduled to be cut 10.6 percent on July 1, 2008, and an additional 5 percent on Jan. 1, 2009. Legislation must be passed to replace the cuts with payment updates that cover practice cost increases.

Senior citizens and people with disabilities who rely on the Medicare program for their health care needs are counting on Congress to act in time to prevent a crisis:

§ In an AMA survey of almost 9,000 physicians, more than half said they could not meet their current payroll with a 10 percent Medicare pay cut and would be forced to reduce their staff.

§ Even more – 60 percent – said they would have to limit the number of new Medicare patients they treat if the pay cuts are not stopped.

§ The Medicare Payment Advisory Commission reports that 30 percent of Medicare patients looking for a new primary care physician already have trouble finding one.
Two-thirds of physicians say the steep cuts will also prevent them from investing in health information technology that can be used to improve the quality of care.

Today’s Medicare physician payment rates (before the July 2008 cut) are on average the same as in 2001, while practice costs have risen 20 percent since then. The widening gap between payment rates and the cost of care will make it extremely difficult for physicians to stay involved with the Medicare program … just as millions of baby boomers are about to become eligible for Medicare.

Congress has promised America’s current and future seniors health care benefits through Medicare. Lawmakers must keep their promises by acting soon to enact legislation that will:

stop the pay cuts for 18 months;
extend the positive 2008 update through the rest of the year;
provide a positive 2009 update that covers the increase in the cost of care, and;
begin to pave the way for permanent replacement of the physician update formula.

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