May 19, 2008

IN THIS ISSUE

Editor's Column: Once More Into The Breech
HFHS Announces Fifth Straight Year Of Revenue Growth
DMC Unveils Plans For $34-million Pediatric Center
Medicare Benefit Info Coming To 'web DENIS'
Webinar: Where Did All The Money Go?
AMA Tells Congress Medicare Regs Hurst Small Practices
Physicians Charge Health Insurer Merger Not In Public's Best Interest
Quality Consortium Reminds Docs Of Diabetes Recs

Click Here To Contact Us
 

Editor's Column: Once More Into The Breech

By JOSEPH WEISS, MD
Once more into the breech. I refer to the annual trek of physicians to Congress to request, implore, demand, entreat and plead for yet another stay of execution of Medicare reimbursements. We can expect that Congress, at the last moment, will grant a reprieve but not an end to our fiscal death sentence.

This annual physician spring offensive will not continue until the next millennium. Eventually, we will lose. The time will come when physicians will make the salary of college professors.

Physicians expecting more should keep in mind that Congress remains fixed on the zero-sum rule: If someone in the medical community makes more, someone else in the medical community makes less. We need to remember that Congress will place our request for more money in line with other financial calls, such as the high future expense of the present costly war. Other matters affecting the physician’s present fiscal position are the rising price of gas and the falling value of the dollar.

The day is coming when the American College of Oncology will raise $60,000 for a luncheon with the chairman of the Senate Finance Committee – but to no avail. The grim pictures of loss of patient care other specialists present to legislators will receive an answer of silence. The AMA will find that its armada of lobbyists will leave Congress unmoved.

Nor will the bill with a new cost formula as proposed by Sen. Stabenow prove helpful. No formula can predict the future or guide it. The only scenario worse for physicians than to have Stabenow’s bill fail in committee is to have it passed by Congress. No doubt soon after its implementation, her bill will reveal the same fatal flaws as the present Sustainable Growth Rate formula, used to calculate Medicare reimbursement.

Share Your Thoughts on this Article

  Back to top

HFHS Announces Fifth Straight Year Of Revenue Growth

For the fifth consecutive year, Henry Ford Health System reported that it has experienced positive revenue growth and net income.

Henry Ford reported total revenues of $3.47 billion in 2007, an increase of $228.7 million or a 7 percent increase from 2006. Net income in 2007 was $105.8 million.

The loss of jobs and the associated loss of health benefits throughout southeast Michigan are impacting hospitals across the region.

"Because of the continued recession in southeast Michigan, Henry Ford, like other hospitals, is experiencing softening in demand for health care services," says Nancy Schlichting, president and chief executive officer for Henry Ford.

There also has been a significant increase in the number of uninsured and underinsured patients, experienced by Detroit hospitals. For example, the amount of uncompensated care Henry Ford Health System provided in 2007 increased to $132 million, up from $105 million in 2006. 

Henry Ford's uncompensated care consists of:

• charity care, $25.3 million;
• unpaid cost of Medicaid, $59.2 million;
• and bad debt, $47.5 million

"Despite economic pressures, we do not anticipate reductions in staff. We are in a better position than others as we will be adding more than 1,600 jobs in the next 12 to 15 months with the opening of Henry Ford West Bloomfield Hospital and there will be many opportunities to shift employees if we see a change in volumes," says Schlichting.

In response to the challenging Michigan economy, Henry Ford continues to build for future revenue and growth through a number of initiatives which began in 2007.

As part of its strategy to offer a full range of medical and health services to patients in eastern Wayne County and Macomb County in 2007, Henry Ford Health System acquired:

• Cottage Hospital, located in Grosse Pointe Farms. The hospital is now called Henry Ford Cottage Hospital.
• St. Joseph's Healthcare, based in Clinton Township, became Henry Ford Macomb Hospitals, a 435-bed, multi-site system with a comprehensive, acute care hospital in Clinton Township, a specialty hospital in Mt. Clemens; and health centers in Bruce Township, Chesterfield Township and Fraser. In addition, Henry Ford Bi-County Hospital in Warren became integrated with Macomb Hospitals and has been renamed Henry Ford Macomb Hospital - Warren Campus.

Admissions for Health Ford Health System increased from 70,127 in 2006 to 81,571 in 2007 and Henry Ford's market share for southeast Michigan continues to growth. The average admissions for all southeast Michigan hospitals were down 1.5 percent in 2007, according to the Southeast Michigan Hospital Monthly Self-Report data.

Expansion in Oakland County also continues to be a major part of Henry Ford's growth plan. The new Henry Ford West Bloomfield Hospital opens in March 2009 and has already received national attention for its unique focus on wellness through environment, food and alternative therapies.

In addition, the System has opened its 26th ambulatory medical center in southeast Michigan with the 130,000-square-foot Henry Ford Medical Center - Columbus in Novi.

In Detroit, Henry Ford continues to make the Henry Ford Hospital campus, its flagstaff facility, a destination for patients from all over the country. A five-year, $310 million expansion and renovation project will add 80 new private rooms when the two-floor West Pavilion addition opens later this year.

Henry Ford will capitalize on its world-renowned urology robotics program with a Center for Innovative Surgery that will expand the use of robotics and minimally invasive surgery to other medical specialties. Henry Ford's teaching program also continues to expand, with last year's opening of the $5 million, 12,000-square-foot Surgical Simulation Center, the largest educational facility of its kind in the Midwest.

"Notwithstanding operating in a challenging economic environment, our strategies of providing world class service and clinical quality will continue to position Henry Ford Health System as one of the growth leaders in the market," says Schlichting.

She notes that Henry Ford continues to offer patients conveniences that they can't get anywhere else in southeast Michigan. E-visits, which are online clinical visits with your primary care physician, are now offered by 75 doctors in the Henry Ford Medical Group, and will be expanded to every primary care physician by the end of the year.

Henry Ford Health System continued to show its commitment to investing in its employees in 2007 including, $19.6 million for employee merit/pay raises; $2.3 million in tuition reimbursement; and $600,000 in wellness incentives, as well as $2.4 million in employee appreciation gift card incentives.

   Share Your Thoughts on this Article

  Back to top

DMC Unveils Plans For $34-million Pediatric Center

The Detroit Medical Center plans to build a new $34 million pediatric care center across the street from its existing Children's Hospital of Michigan, expanding the footprint of the downtown campus for the first time in 30 years.

Hospital officials plan to build the 75,000-square-foot center on St. Antoine Street, on the site where a boarded-up Friendship Manor nursing home now sits. Along side the center will be a newly built parking lot on five acres of land that the DMC plans to buy from the city for about $900,000. The purchase agreement must get approval from the Detroit City Council, according to the News.

DMC officials said the new pediatric center will give Children's Hospital more space and updated facilities, while offering better access to patients who will be able to walk directly to the pediatric center from the parking lot without having to enter the DMC's main campus.

Last year, Children's Hospital, built in 1970, had about 171,000 outpatient visits, hospital officials said Thursday morning at a news conference.

Share Your Thoughts on this Article

Back to top

Medicare Benefit Info Coming On 'web DENIS'

Beginning this summer, Michigan physicians and hospitals will be able to go online to check eligibility and benefit information for people with Traditional Medicare coverage – through the Blue Cross Blue Shield of Michigan health care electronic data interchange clearinghouse and Web portal, web-DENIS.

The launch of the expanded service follows a successful pilot of the service started this past March by the Blues. The health information exchange initiative seeks to improve the quality and efficiency of health care delivery by minimizing redundant data collection, meeting national standards for information exchange, encouraging patient-centered care and promoting patient safety and quality.

The BCBSM electronic data clearinghouse is expected to process 270 million BCBSM, Medicare, Medicaid and other health insurance transactions in 2008, including eligibility and claims information. Web-DENIS is expected to process an additional 90 million inquiries or transactions.

Web-DENIS is used by more than 30,000 Michigan physicians and other health care professionals, all Michigan hospitals and medical facilities and medical billers. The system is used by nine out of 10 physician offices in the state.   

The move to include eligibility and benefit information for Traditional Medicare beneficiaries is another in a series of enhancements BCBSM has enacted over time to expand online access features for medical professionals and facilities. For example, in a past joint effort with the Michigan Department of Community Health, BCBSM provided physicians and hospitals with statewide access to Medicaid eligibility and benefit information online through web-DENIS. As a result of that effort, web-DENIS has grown over the past three years to handle 9.5 million Medicaid-related transactions annually.

Share Your Thoughts on this Article

 Back to top

Webinar: Where Did All The Money Go?

Webinar: Where Did All the Money Go?
Part 1

Are you trying to find unique and effective ways to save money in your practice?

The Wayne County Medical Society
of Southeast Michigan
is offering a webinar series to help practices find simple ways to save money without sacrificing quality.

With cuts still planned on Medicare rates for July it is imperative that practices find ways to cut costs without sacrificing quality and service . Practices, hospitals, and clinics must continually reduce spending in order to stay within their budget. For most medical practices this means searching for new and innovative ways to reduce costs  in areas that won't affect their primary goal.... taking care of your patients. Fortunately,
there is a new and unique opportunity for practices to substantially reduce cost.

Items covered in this webinar will be how an Equipment Maintenance Program:

• Creates immediate hard dollar savings in the 15%-25% range
• Drives out costs associated with existing vendor service agreements
• Provides greater management control over your asset base by enhancing your organizations visibility into total equipment life cycle cost
• Delivers total account management services to reduce the level of internal resources your organization currently has allocated
• Implementation is simple and cost effective.

Please RSVP if you are able to attend by Monday, May 26.

The webinar will last 20 minutes.

After you register you will receive a confirmation code and call in instructions.

WEBINAR - Where Did All the Money Go? Part 1

Wednesday, May 28 or Thursday, May 29
1:00 p.m. est

No Charge for WCSSM Members
$30 non-members

By calling the WCMSSM ( 313-874-1360) or
Premier Asset Solutions (866-922-2323)
webinar@premierassetsolutions.com

Space is Limited. Register Now!

This webinar is provided by our Corporate Partner Premier Asset Solutions . Premier provides creative solutions to save your practice money in the field of medical and office equipment.

CLICK HERE FOR MORE INFORMAITON ON THE WEBINAR.

866-922-2323

www.medbluebook1.com

webinar@premierassetsolutions.com

   Share Your Thoughts on this Article

Back to top

AMA Tells Congress Medicare Regs Hurt Small Practices

AMA Board Member and practicing orthopedic surgeon William Donlan testified May 14 before the U.S. House of Representatives Committee on Small Business, Subcommittee on Regulations, Health Care and Trade. Here are his remarks.

“I want to thank you for inviting me to testify here today on the impact of CMS regulations and programs on small health care providers.

“Approximately 75 percent of physician practices are composed of fewer than eight physicians. For the majority of these small physician practices, including mine, burdensome regulations can take valuable time away from patient care. We believe this is particularly true with regard to the Recovery Audit Contractor (or RAC) program and the ICD-10 implementation.

“The RAC program employs contractors to analyze and audit physician reimbursement claims for billing errors. The pilot program, which began in 2005, and will expand nationwide this year, has been extremely burdensome on the affected physicians and does nothing to educate them about common billing mistakes. Instead, the program embraces “bounty hunter” techniques that provide RACs with incentives to deny claims. 

“While we strongly oppose the RAC program, we believe there are things CMS can do prior to the national rollout that would improve it.

“Specifically, CMS should consult with the AMA on RAC/physician communications. In addition, they should make RAC monthly financial reports public and maintain an accessible list of commonly audited procedures.

“CMS should preclude RACs from reviewing claims from the past 12 months. Failure to do so will result in RACs reviewing claims still under review by carriers and other Fiscal Intermediaries. 

“RACs should not be permitted to review billing issues arising from Evaluation & Management services or medical necessity determinations as they are extremely individualized and require extensive clinical review. 

“CMS should limit the number of medical records requested from individual physicians. I know of a urologist in California who was hit with 50 RAC requests. CMS should also raise the minimum claim level from $10 to at least $25.

“Finally, CMS should encourage the pursuit of underpayments as well as overpayments by requiring RACs to accept case files from providers for underpayment reviews, and including as an underpayment, those situations where a physician mistakenly neglects to report a delivered service.

“The AMA also has concerns about the rollout of ICD-10, the 10th version of the International Classification of Diseases used in outpatient and inpatient settings. 

“While the AMA recognizes the importance of updating the current coding system, ICD-9, we believe that due to the complexity and costs of this extensive transition, a plan and timeline must be developed prior to national rollout. Any transition must take into account the fact that physicians are already struggling to implement the HIPAA electronic transactions standard and the transition to the National Provider Identifier.

“Given the costs and complexities involved with the move to ICD-10, the AMA suggests that the HIPAA electronic transactions standard be upgraded to version fifty-ten prior to the national rollout, as the current standard, forty-ten, is not compatible with ICD-10. 

“In addition, the ICD-10 coding system should be pilot tested so that problems can be identified and resolved in advance of the national roll-out.

“Physicians, their staffs, coders, and other health care stakeholders will need adequate education and training early on in the transition process.

“Due to the significant resources, administrative complexities, and advance planning required to retool or replace our systems and processes that currently depend on ICD-9 logic, HHS should work collaboratively with health care industry stakeholders to develop a realistic transition process and timeline.

“The AMA looks forward to working closely with the Small Business Committee to ensure that physician practices, especially the smaller practices, like my own, are able to manage the RAC audit process and prepare for the ICD-10 transition without compromising the delivery of health care.”

   Share Your Thoughts on this Article

 Back to top

Physicians Charge Health Insurer Merger Not In Public's Best Interest

Department of Justice's enforcement action in Sierra acquisition was inadequate and should be rejected

The American Medical Association, Nevada State Medical Association and Clark County Medical Society May 15 announced they have filed joint comments seeking to reject the final judgment proposed by the Department of Justice (DOJ) in the acquisition of Sierra Health Services by United Health Group.

The three physician organizations filed comments to the DOJ and the federal court in the District of Columbia under the Antitrust Procedures and Penalties Act (Tunney Act) because the DOJ's actions are seriously inadequate to protect high-quality medical care from the anti-competitive nature of this merger.

"The acquisition of Sierra by UnitedHealth creates an unprecedented level of market concentration in Southern Nevada," said AMA Immediate Past President William G. Plested, MD. "The merger permanently transforms the health insurance market in Las Vegas, allowing UnitedHealth to acquire a 90 percent share of the health maintenance organization (HMO) market."

"After an 11-month investigation, the DOJ's modest response to the merger left several hundred thousand people in Nevada's fragile health care system vulnerable to a health insurer with a near-monopoly in the HMO insurance market," said Richard P. Seher, MD, president of the Nevada State Medical Association. "Contrary to claims of greater efficiencies and lower costs, consolidation in the health insurance industry, in fact, has been shown to raise premiums and decreased patient access to care."

Physicians charge that the DOJ's limited enforcement action in the merger fails to protect Nevada from:

• inadequate levels of service and quality; 
• higher patient insurance premiums; and
• one-sided, coercive contractual provisions.

The physician organizations urged the court to critically scrutinize the DOJ's decision not to bring an enforcement action challenging the anti-competitive effects of the merger in Nevada's commercial health insurance market.

"The decision to approve the Sierra acquisition, despite the anti-competitive concerns in the Las Vegas market, was a step backward for the DOJ's enforcement actions,' said Dr. Plested. "If the DOJ has changed its enforcement policy on health insurance mergers, it should disclose the reasons for those changes so that the court can determine whether the proposed final judgment is in the public's interest."

Citing the negative effects of consolidated market power, the DOJ in 2005 required significant divestiture in another UnitedHealth mega-merger involving PacifiCare. This meaningful action to protect high-quality medical care from dominant market power acquired by UnitedHealth stands in stark contrast to the DOJ's current actions in the Sierra buyout where the threat of an anti-competitive monopoly is much higher.

"The Department of Justice dropped the ball in protecting Nevada's health care system and that mistake should be reversed," said Dr. Seher. "In the interim, we are looking forward to working with the Nevada State Attorney General to implement the broader protections she has ordered as conditions of the merger."

   Share Your Thoughts on this Article

 Back to top

Quality Consortium Reminds Docs Of Diabetes Recs

This month, the Michigan Quality Improvement Consortium wants to remind physicians and other health care professionals of the Focused Recommendations for Management of Diabetes.

Smoking Cessation
●Advise all patients not to smoke.
●Include smoking cessation counseling and other forms of treatment as a routine component of diabetes care.

Hypertension
●Measure and record blood pressure at each visit.
●Treat hypertension using up to 3-4 anti-hypertensive medications to achieve adult target of < 130 systolic and < 80 diastolic.

Lipids
●Lifestyle modification focusing on reduction of saturated fat and cholesterol intake, weight loss if indicated, and regular physical activity.●Statin therapy for persons age 40 and over without overt cardiovascular disease or who have an LDL-C > 100 mg/dl.
●Statin therapy for all persons with overt cardiovascular disease.
Glycemic Control
●Develop or adjust the management plan to achieve normal or near-normal glycemia with an A1c goal of < 7%

To access a list of participating MQIC health plans and organizations or the MQIC diabetes, tobacco control, hypertension and hyperlipidemia guidelines visit www.mqic.org.

   Share Your Thoughts on this Article

 Back to top 

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