Wayne County Medical Society of Southeast Michigan

January 5, 2009

Point: Direction Or Diversion?
Counterpoint: The Business Of Health Care
Health Care Reform Measures Could Be Ominous For Docs
Urge Feds To Delay ICD-10
Doctors Who 'ePrescribe' Get Bonus Medicare Payment
ePrescribing Guide
Participation Tools: Individual Quality Measures For 2009 PQRI
Kevin Kelly Memorial Service

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Point: Direction Or Diversion?

By JOSEPH WEISS, MD
“The strength of the American economic system is it allows us to take risks—to create, to innovate, to grow, to succeed and sometimes to fail. Every time government endeavors to alter any of these dynamics, it [the government] undermines and distorts the forces at work in all of them.” So says Sen. Richard Shelby, R-Alabama, when asked to explain his opposition to loans to Detroit’s automakers.

Shelby’s words sum up the opposition of a number of physicians to the role of government in health care. These physicians see the Constitution as granting limited power to the federal government, a power that government has expanded beyond its constitutional scope. These physicians feel that federal policy on health care means patients have no reason to drive down the cost of care. These physicians believe that what people should have is catastrophic health insurance and beyond that floor, each person should decide how much more insurance, if any, that person and/or the family needs. These physicians say let the marketplace, not the government, decide on matters of health care, policy and price.

These physicians point out that spending more on health care is not leading to better care, rather it is possible that spending less may take us to better health. To these physicians, any change that may bring “socialized” medicine closer, is an alarming change, akin to an invasion on our shores.

What we need from the market-oriented physicians is a turn away from rhetoric such as “social justice is a collectivist egalitarian notion not compatible with a free society,” and toward concrete proposals to meet current health needs. For example, what should be the response by the medical community to our patients who have not only lost their jobs, but lost their health coverage when the plants and businesses they worked for went bankrupt and closed? These workers have no money to buy an individual health insurance plan; and charity from the individual physician cannot suffice if that person needs hospitalization for acute appendicitis, or a CT or possibly an MRI following a fall.

What those of us who are not wedded to a marketplace economy need is guidance on how to change from what we must live with now to what we can work with better tomorrow. Tell us how to free ourselves from the bondage of government aid, intervention, direction and dictatorship, and tell us not by rant but by reason.

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Counterpoint: The Business Of Health Care

By ALLAN DOBZYNIAK, MD
While the medical profession engages the challenge of inventing and providing an appropriate level of clinical services for all, the rest of the health care reformers are busy with financial models.

Medicare is an open-ended entitlement predicted to have a future financial shortfall of $35 trillion. The federal deficit is expanding exponentially with $25 billion to $50 billion in consideration for the Big Three automakers and a $700 billion “TARP” as recent additions. The states collectively add more than $700 billion in additional debt. There are additionally billions of dollars in under-funded private and public legacy costs for pensions and health care.

Given these facts, is it surprising that physician incomes have been steadily decreasing adjusted for inflation since 1992?

Medicare is a monopoly that by any sane evaluation inappropriately determines provider compensation. If this is not draconian enough, the private insurance business model is a Faustian bargain. Insurance company profits depend upon goods and services not being provided. Strategies to decrease their costs are destructive to both doctors and patients. There are schemes for care rationing using denial of authorization, increasing co-payments for patients, massive paperwork, pay-for-performance and other bureaucratic hurdles, and steadily decreasing fee recovery for doctors. It is non-physicians in political and financial suits who now run the professional lives of physicians.

What is incredulous is doctors continue to cling to this disastrous model that can be best compared to an addiction. Even worse, many physicians and their professional societies are loath to talk about money and, in fact, perpetuate the fantasy that insurance (public and private) is paying.

No matter the scrutiny, this financial model of physician compensation is non-sustainable, diminishing, destructive (primary care is a clear example), bureaucratic, onerous and, I would contend, even unethical.

Physicians are bright and can certainly begin to invest time and effort into creating a variety of new opportunities relating to the business side of health care. Committees to invent new financial models, entrepreneurial initiatives and create true innovation in the business of health care are as important to the future of medicine as clinical excellence.

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Health Care Reform Measures Could Be Ominous For Docs

By PAUL NATINSKY
A Congressional Budget Office (CBO) report issued at the end of last year portends a potentially costly future for physicians.

The CBO analyzed 115 options contained in health reform proposals, including measures to expand coverage and reduce health spending, and found the changes costly to implement and likely to achieve little in the way of savings.

Contrary to other recent analyses, the CBO predicted substantial savings from forcing physicians to adopt health information technology, particularly electronic medical records as a condition of participating in Medicare.

Unfortunately for physicians, the principal means of cost cutting for Medicare remains reducing payments to health care professionals. The CBO notes in its report that current law will reduce fees paid to doctors by 21 percent in 2010 and 5 percent in subsequent years. To freeze rates at 2009 levels, the CBO reports, would cost the government $318 billion over the next decade.

Closing the infamous “donut hole,” which forces Medicare pharmaceutical beneficiaries to pay the full cost for prescription medicines after a threshold is reached and resumes coverage after a higher threshold is crossed, would cost about $130 billion over 10 years.

Proposed cost-saving measures, such as taxes on cigarettes and sugary soft drinks and allowing Medicare to negotiate drug prices with pharmaceutical manufacturers are expected to yield little savings, according to the CBO.

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Urge Feds To Delay ICD-10

The MSMS Board of Directors recently voted to support a delay in the implementation of The International Classification of Diseases, Tenth Revision (ICD-10), which is set to take effect on October 1, 2011. MSMS contends that physicians and their staff will not have adequate time to transition smoothly from 17,000 to 155,000 codes (an almost tenfold increase) by that date, and that the transition must allow for steps that cannot be rushed, such as physician education, software vendor updates, coder training, and testing with payers.

MSMS is exploring avenues for physician input on this process and will continue to monitor federal activity on a potential delay.

The ICD is published by the World Health Organization (WHO), and is used worldwide for morbidity and mortality statistics, reimbursement systems, and automated decision support in medicine. This system is designed to promote international comparability in the collection, processing, classification, and presentation of the statistics.

For more information, contact Stacie Saylor, CPC, at MSMS at 517-336-5722 or ssaylor@msms.org.

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Doctors Who 'ePrescribe' Get Bonus Medicare Payment

Under the Medicare payment bill that became law last year, physicians who prescribe electronically for Medicare Part D patients in 2009 will get an incentive payment equal to two percent of all the Medicare services they provide for the year. This bonus will phase down over five years and disappear at the beginning of 2014.

Starting in 2012, physicians who are still paper-only will see a cut in their total Medicare payment for the year. A physician may be exempt from the penalties if Medicare determines that compliance would represent a significant hardship. The law cites an example of doctors who practice in rural areas without Internet access.

The US Centers for Medicare & Medicaid Services (CMS) will issue rules later this year that will determine exactly how the incentive system will work and when bonuses will be paid. CMS plans to host a conference this fall to educate physicians about what technology to use and how to use it.

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ePrescribing Guide

Medicare’s practical guide to the E-Prescribing Incentive Program is now available online.

The guide explains the e-prescribing incentive program, how eligible professionals can participate, and how to choose a qualified e-prescribing system. To read or print the guide, visit: http://www.cms.hhs.gov/partnerships/downloads/11399.pdf.

By adopting e-prescribing through Medicare’s program, eligible professionals can save time, enhance office and pharmacy productivity, and improve patient safety and quality of care while earning incentives from Medicare.

For additional information about e-prescribing, you also can visit:

· www.cms.hhs.gov/PQRI Select “E-prescribing Incentive Program”

· www.cms.hhs.gov/eprescribing (for information on Part D e-prescribing standards that will be effective April 1, 2009)

· www.ehealthinitiative.org to download “A Clinician’s Guide to Electronic Prescribing”

Internet-based Medicare Enrollment

Now there is a better way for physicians and non-physician practitioners to enroll or make a change in their Medicare enrollment information. The Internet-based Provider Enrollment, Chain and Ownership System (PECOS) will allow physicians and non-physician practitioners to enroll, make a change in their Medicare enrollment, view their Medicare enrollment information on file with Medicare, and check on the status of a Medicare enrollment application via the Internet.

The Centers for Medicare & Medicaid Services (CMS) announced that Internet-based PECOS is available to physicians and non-physician practitioners in the District of Columbia and the following States:

Delaware     Minnesota    New Jersey
Idaho          Missouri       North Carolina
Illinois         Nebraska      Pennsylvania
Iowa           Maryland      Tennessee
Kansas        Michigan      Wisconsin

Physicians and non-physician practitioners in the District of Columbia and the States shown above who wish to access Internet-based PECOS may visit https://pecos.cms.hhs.gov.

CMS will expand the availability of Internet-based PECOS for physicians and non-physician practitioners to all states over the next two months. In addition, CMS will make Internet-based PECOS available next year to all physicians, other health care providers and suppliers [except durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) suppliers].

By submitting the initial Medicare enrollment application through Internet-based PECOS, a physician or non-physician practitioner’s enrollment application can be processed as much as 50 percent faster than by paper. This means that it will take less time to enroll.

Physicians and non-physician practitioners are required by regulation to report certain changes in their enrollment information within specified timeframes. Internet-based PECOS will allow them to update, make corrections, and check on the status of their Medicare enrollment applications faster than by paper. Changes include a change in practice location, ownership, or final adverse action (e.g., medical license suspension or revocation). For additional information about the types of changes that must be reported, go the download section of www.cms.hhs.gov/MedicareProviderSupEnroll.

Internet-based PECOS meets all required government security standards in terms of data entry, data transmission, and the electronic storage of Medicare enrollment information. Only authorized individuals can enter enrollment information into PECOS or view PECOS data from the Internet. Authorized individuals include physicians and non-physicians practitioners. Their User IDs and passwords protect access to their enrollment information. After physicians or non-physician practitioners create User IDs and passwords or change their passwords, they should keep this information secure and not share it with anyone. By safeguarding their User IDs and passwords, they are taking an important step in protecting their enrollment information. CMS does not disclose Medicare enrollment information to anyone except when they are authorized or required to do so by law.

Internet-based PECOS is a scenario-driven application process with front-end editing capabilities and built-in help screens. The scenario-driven application process will ensure that physicians and non-physician practitioners complete and submit only the information collected on the CMS-855I, physicians and non-physician practitioners no longer will see questions that are not applicable to their enrollment scenarios when using Internet-based PECOS.

For information about Internet-based PECOS, including important information that physicians and non-physician practitioners should know before submitting a Medicare enrollment application via Internet-based PECOS, visit www.cms.hhs.gov/MedicareProviderSupEnroll.

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Participation Tools: Individual Quality Measures For 2009 PQRI

The 131 individual quality measures eligible for claims-based reporting in the 2009 PQRI program are listed at this link:

http://www.ama-assn.org/ama/pub/category/20358.html

The measures are sorted alphabetically by disease/condition. For each measure that you feel might be applicable to your practice, click on any of the three PDF documents listed at the link for additional information.

These participation tools are intended for CLAIMS-BASED reporting of INDIVIDUAL measures.

Participation Tools Disclaimer

These participation tools include measures and specifications (“Participation Tools”). The American Medical Association, the Physician Consortium for Performance Improvement®, its members and other measure and specifications developers (“Measure Developers”) do not warrant that the information contained in the Participation Tools is in every respect accurate and/or complete. The Measure Developers assume no responsibility for use of the information contained in the Participation Tools. The Measure Developers assume no responsibility for and expressly disclaim liability for damages of any kind arising out of the use of, reference to, or reliance on the content of the Participation Tools.

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Kevin Kelly Memorial Service

As a way for MSMS members and others to honor and remember former MSMS Executive Director Kevin A. Kelly, MSMS has created a web page for users to post their own comments and/or memories of Kevin. Click here to post your own comment and read more about Kevin’s life.

A public memorial service has been scheduled for Wednesday, January 14, 2009, at 1 p.m., at The Peoples Church in East Lansing.

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