E-DMN - November 16, 2009

November 16, 2009

Editor's Column: BCBS Strikes Again
Letter: The AMA Misses Again
Physicians Push Congress For Medicare Payment Fix
Regulatory Changes Could Distance Physicians From Medicare Policy
AMA Remains Committed To Health Care Reform
2009 Children's Holiday Party Contributors
St. John Hospital & Medical Center CME Seminar
Inspiris: Physician Opportunities

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Editor's Column: BCBS Strikes Again

By JOSEPH WEISS, MD
In 2009, Michigan Blue Cross Blue Shield (BCBS) brought out its version of the Patient Centered Medical Home, it included 14 elements with 5-21 sets within each element. Now BCBS reaches even further. In 2010 the Blues will introduce the Accountable Care Organization.

The accountability is to BCBS. Under Accountable Care, primary care physicians in the BCBS Consortium of Independent Physicians Associations will be paid according to the results of their Evidence-Based Care reports based on 28 measures of evaluation, their radiology utilization, their emergency utilization for what BCBS calls “Primary Care Sensitive Conditions,” and inpatient utilization for “Ambulatory Care Sensitive Conditions.”

Physicians will receive dashboard reports, i.e. graphic summaries, from BCBS that will inform physicians of their progress or lack thereof in meeting these BCBS requirements. The dashboards include such statements as : Total patients ( Mixed Attribution), Hi Tech radiology & Low Tech radiology, unadjusted Ambulatory Care Sensitive Discharges per 1,000, and Unadjusted Primary Care Sensitive Visits per 1,000.

At present, no one outside of BCBS, whether consultant, IPA board member, or practicing primary physician knows what BCBS means by the terms Mixed Attribution, Hi Tech, Low Tech radiology, and Unadjusted Ambulatory Care. Physicians face what Alice dealt with in Wonderland when the Queen stated that what she said meant what she wanted it to mean at the time she said it.

Remember all these new evaluations are being undertaken by a BCBS organization that routinely places a doctor on its IPA listing, when that doctor is no longer with that IPA. Remember that these evaluations are being undertaken by a BCBS organization that includes in its Diabetes Care Report cardiology specialists who have nothing to do with diabetic care.

Now is not the time for BCBS to place yet another burden on the primary care physicians of Michigan. The medical community faces extensive adjustments in light of the loss of Medicaid funding and the failure by Washington to replace the SGR. The increasing complexity of re-certification requirements creates s a deep cut in the time primary care physicians have available to turn attention to new BCBS mandates. Pressures by hospitals regarding decreasing length of stay and increasing the severity of illness index force physicians to use further time fulfilling bureaucratic demands. Finally, the problems of providing continuing care to patients in hard economic times places further strain on Michigan physicians’ time and energy. If BCBS makes any changes in its attitudes toward physicians, it should be to simplify not increase the workload on the medical community.

BCBS should go no further then to refine the patient registry to becomes a regional tool for benchmarking and as a means for physicians, not billing claims, to report on patient care. Improving the registry will further patient care, whereas Accountability as BCBS wants it will only increase workload and confusion.

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The AMA Misses Again

It is without debate that the SGR is a severely flawed compensation formula. It has been, is, and will continue to damage physician practices. The SGR is intrusive on the ability to care for those patients trapped in it’s farcical web.

For the AMA to trade endorsement of “Obamacare” for cutting a deal on eliminating the SGR does produce a winner. Unfortunately it is not physicians but the legislators who have proposed this bribe that cannot and will not be honored. The House added the $250 billion dollar price tag for the proposed SGR ending legislation to a bill separate from any health care proposal. The nonsense was recognized and the bill was voted down as would be expected. A Senate bill adjusts reimbursement for only one year thus allowing only minimal impact on long term spending. The Senate bill does fit the goal of health care spending constraint but offers nothing for resolution of the physician reimbursement issue. It can be concluded that for Medicare, increasing access and cutting costs without increasing the age of eligibility or reducing benefits leaves only the reduction of provider reimbursement and price controls as solutions. Increased reimbursement to physicians as the “bone” to secure AMA support is a deceitful bargain, since this compensation promise will never occur.

So what we have is a deal to support “Obamacare” for a promise of revision to the current SGR payment formula that will not occur. All of the proposed plans do contain abundant punishment for physicians and abandon absolutely any consequential tort reform. What a deal.

Ridding medicine of the SGR is an appropriate goal because it makes sense on it’s own merit. This should not, however, be part of a disingenuous negotiation. Under no circumstances should it constitute a quid pro quo for supporting any of the currently proposed health care legislation.

--Allan Dobzyniak, MD

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Physicians Push Congress For Medicare Payment Fix

Urging swift passage of a bill to repeal the broken Medicare physician payment formula that threatens seniors’ access to care, the AMA added a new dimension to its Medicare campaign today with radio ads airing in markets across the nation, the physician group reported. In addition to the ads, the AMA is activating its nationwide grassroots network of patients and physicians and intensifying communication to physicians through online and social media. The AMA and more than 100 of its federation partners – state and specialty medical societies – sent a letter today to Speaker Pelosi, which calls for bill passage and states that “without Medicare physician payment reform, the goals of health system reform will remain out of reach.”

Without congressional action, the formula will cause a 21 percent cut next year to physicians caring for seniors and military families, with more cuts in years to come. The new radio ad reminds listeners that Congress made a promise to seniors that they will always have access to high-quality health care. The ad says “making sure our seniors and military families get the care they’ve earned is a promise worth keeping.” It urges Americans to call their members of Congress to vote yes on the Medicare Physician Payment Reform Act (HR 3961). Listen to the ad.

“Congress made a commitment to America’s seniors with the creation of Medicare, and they must fulfill it through repeal of the Medicare physician payment formula that threatens access to care and choice of physician,” said AMA President J. James Rohack, MD. “Seniors, baby boomers and military families are at risk of reduced access because the cuts will force physicians to make difficult practice decisions in order to keep their practice doors open.”

According to a recent AARP/AMA poll, nearly 90 percent of people age 50 and older are concerned that the current Medicare physician payment formula threatens their access to care. In just two years, the first wave of baby boomers will reach Medicare age and they will expect access to high-quality care and choice of physician.

“Fixing the problem once and for all is an essential element of comprehensive health reform,” said Dr. Rohack. “Both Republican and Democratic members of Congress have said time and again that the formula must be repealed to ensure seniors’ access to care. It’s time to make good on that promise. Swift passage of H.R. 3961 is a crucial step to repeal of the payment formula this year, and we urge the House to vote yes on the bill (this) week.”

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Regulatory Changes Could Distance Physicians From Medicare Policy

In a move that could lessen physician input on Medicare policy the Center for Medicare & Medicaid Services (CMS) is considering replacing an existing system of physician input and education regarding Medicare’s carriers with a more consolidated system that meets less often and increases its reliance on electronic communication rather than live meetings.

“CMS is strongly considering revamping the Contractor Advisory Committee (CAC) process to the detriment of physicians and we are deeply concerned,” reported the AMA in comments submitted to an Oct. 29 CMS Town Hall meeting on the possible transition.

The AMA is also concerned about lack of physician input regarding the potential new system, called the Jurisdictional Advisory Committee (JAC).

The CACs disseminate information about the Medicare program to state and specialty medical societies and discuss inconsistent or conflicting policies, among other things.

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AMA Remains Committed To Health Care Reform

The American Medical Association (AMA) House of Delegates today voted on health system reform policies, reaffirming the AMA’s commitment to health system reform. The AMA's House of Delegates is the nation's broadest, most inclusive assembly of physicians and medical students. Delegates representing every state and medical specialty debate and vote on behalf of their physician peers.

“Now is a defining moment in the history of the AMA,” said AMA President J. James Rohack, MD “In a democratic process, the AMA House of Delegates today voted to continue AMA’s commitment to health system reform for patients and physicians. The time to make health system reform a reality is now.”

The AMA reaffirmed its support for health system reform alternatives that are consistent with AMA policies concerning pluralism, freedom of choice, freedom of physician practice and universal access for patients. It also outlined specific elements it will actively and publicly support and oppose as the health system debate continues.

The AMA’s support for H.R. 3962 and H.R. 3961 remains in place. “HR 3962 is not the perfect bill, and we will continue to advocate for changes that help make the system better for patients and physicians as the legislative process continues,” Dr. Rohack said.

AMA reiterated that health system reform must include Medicare physician payment reform to preserve access to care for seniors, baby boomers and military families. “Ensuring the security and stability of Medicare must serve as the foundation for any serious health system reform this year," Dr. Rohack said. “In less than 60 days, Medicare physician payments are scheduled to be cut by 21 percent, with more cuts in years to come. According to a recent AARP poll, nearly 90 percent of people age 50 and older are concerned that the current Medicare physician payment formula threatens their access to care. We must pass HR 3961 as an essential element of health reform and to fulfill Congress’ obligations to current and future Medicare patients.”

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2009 Children's Holiday Party Contributors

The following is a list of contributors to the WCMS Foundation’s 24^th Annual Holiday Party for underprivileged children. This year’s event is Dec. 5 at the New Detroit Science Center. For more information, or to contribute, call (313) 874-1360 or visit www.wcmssm.org

Gehring T. Sauter, MD

Dr. & Mrs. E. N. Obianwu

Dr. B.J. & Marcia Woodley

Dr. Estigarribia

George H. Shade Jr., MD

Karen Chapel, MD & Doug Arenberg, MD

Dr. & Mrs. Kost Elisevich

Terrence R. Lock, MD

Halim D. Haber, MD

Dr. & Mrs. James Fordyce

Thomas J. Ruane, MD

Clara and Federico Mariona

Dr. Richard & Gail Smith

Jeff & Wendy Page

Dr. & Mrs. Gilbert B. Bluhm

Robyn J. Arrington, Jr., MD

Irene and Oscar Signori

Fred R. Nelson, MD

Ronald E. Trunsky, M.D. & Judy Jenkins Trunsky

Michael R. Harbut, MD

Dorothy M. Kahkonen

Dr. and Mrs. H. Michael Marsh

Lisa T. Cooper, MD

Volna Clermont, MD

Robert Brent, MD

William Knapp, MD

Nancy Goll

Elizabeth Edmond, MD

Martin Daitch, MD

Benjamin Ramos, MD

Peter Cracchiolo

Robert Borchak, MD

Julian Alvarez, MD

Beth Ann Brooks, MD

Dr. & Mrs. Sajal Choudhury

William L. and Betty G. Knapp

Drs. Safwan Halabi & Razan Asbahi

Joe Weiss & Marilyn Shapiro

Dr. & Mrs. George C. Hill

Neela Sripathi

Homer M. Smathers, MD

Sidney Baskin, MD

John C. Somogyi, MD

Charla Blacker, MD

Todd R. Williams, MD

Iris and Fred Whitehouse

Joseph M. Beals, MD

Stephanie Flom, MD

Dr. & Mrs. Mark F. Pezda

Eudoro Coello, MD

Christopher W. Hughes, MD & Debra J. Hughes

Claus Petermann, MD

Richard D. Cieslak, MD

Daniel S. Moore

Drs. Peter & Alice Watson

Drs. Rachel and Brian Silver

Kathleen Yaremchuk, MD

Anne-Mare' Ice, MD

John M. Malone, MD

Anne Nachazel, MD

Eastside Surgical Specialists

Paul Mazzara, MD

Dr. Richard Pollard

Michael G. Taylor, MD, FACS

Drs. Kenneth & Deborah Granke

Aaron Lupovitch, MD

Keith P. Bartold, MD

Rev. William and Dr. Mary Logan

Scott Monson, MD

Arthur J. Frazier, MD

M. Natacha Umlauf, MD

Phyllis A. Vallee, MD

Michael Schaldenbrand, MD

Heidi R. Gunderson, DO

Paul J. Sullivan, MD

S.V. Mahadevan, MD

Indu & Bala Pai

Chris and Janet Bush

Eve M. VanEgmond, MD

Taufiek Alhadi, DO

Gwendolyn H. Parker, MD

Dr. Ray and Mrs. Marcia Littleton

Drs. Daniel & Margarita Morris

Dr. & Mrs. Laurence E. Stawick

Dr. & Mrs. John Calwell

S. Rao Talla, MD

Ghaus M. Malik, MD

Eastlake Pediatrics PC

Vernon F. Strand, MD and Jane P. Strand

Martin H. Daitch, MD

John Kurtz, MD

Dr. & Mrs. Dan Michael

Mohammed Arsiwala, MD

Livonia Urgent Care

Margaret Dowling, MD

Dr. S. Maitra

George Mogill, MD

Dr. MaryJean Schenk & David Fry

Dr. Grace Engler & Ms. Anna Fedor

Dr. & Mrs. Donald M. Ditmars Jr.

James A. Rowley, MD

Sion Soleymani, MD

Madjid Mesgarzadeh, MD

Dr. & Mrs. Allan Dobzyniak

Helene C. Dombrowski, MD

Drs. Lalitha and Babu R. Vemuri

Robert G. Borchak, M.D.

Patricia A. Kolowich, MD

Joan & Bob Allaben

Advanced Family Health Care

Marcie Treadwell & Gregory Goyert

Dr. Michael Sandler

Tom & Nancy Coles

William G. Nutting, MD

Dr. & Mrs. Edmund M. Barbour

Dr. Philip C. Hessburg

Ron & Diane Strickler

Joseph Mark Tuthill, MD

Deloris Ann Berrien-Jones, MD

Vincent C. Yu, M.D.

Andrew J. Mitchell, MD

Barbara & Adrian Sheremeta

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St. John Hospital & Medical Center CME Seminar

Arrhythmia-Electrophysiology Update
Wednesday, December 2, 2009
11:30 a.m. – 6 p.m.
Grosse Pointe Farms
Call (313) 343-3877
Click Here For More Information

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Inspiris: Physician Opportunities

INSPIRIS, a unique care and care management company focused on improving thehealth care and the quality of life for the medically complex, chronically ill, frail and elderly patient is looking for physicians in:

Detroit, Grand Rapids and Lansing, MI
CLICK HERE FOR MORE INFORMATION

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