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CMS releases proposal for 2009 Medicare physician fee schedule

The U.S. Centers for Medicare and Medicaid Services (CMS) has released its proposal for changes under the 2009 Medicare physician fee schedule. The proposal includes a statutory reduction in spending of 5.4 percent. Total Medicare spending under the 2009 physician fee schedule is projected at $54 billion, down 5 percent from the $57 billion projected for 2008. CMS is also proposing additional improvements to the Physician Quality Reporting Initiative (PQRI). Increasing the number of conditions covered by measures groups to nine; adding rheumatoid arthritis, care during surgery, and back pain to the original measures groups are among the suggested changes.
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Medicare Claims Processing after July 1

Congress recessed without resolving the Medicare payment fix and will revisit legislation after the July 4th recess. In order to limit disruptions of Medicare physician payments, the Centers for Medicare and Medicaid Services (CMS) will not process Medicare physician fee for service claims dated July 1 and thereafter, during the first 10 business days in July, instructing their contractors to hold the claims. Under current law, electronic claims are not paid until 14 days (29 days for paper claims) after the date of receipt, so this action should have minimal impact on provider cash flow. Claims for services provided July 1 and thereafter should reflect the same rates paid for services during the first half of 2008; however, patient co-payments should be collected based on the revised fee schedule effective July 1, as provided by the Medicare carrier. Medicare will make payments and adjustments once the legislature resolves the Medicare physician payment issue. Watch for email updates here and via AAOS Advocacy Now.
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AMA launches "cure for claims" campaign

The American Medical Association has launched a program to help reduce the administrative burden of ensuring accurate insurance payments for physician services. "The goal of the [Cure for Claims] campaign is to hold health insurance companies accountable for making claims processing more cost-effective and transparent, and to educate and empower physicians so they are no longer at the mercy of a chaotic payment system that take[s] countless hours away from patient care," said William A. Dolan, MD, AAOS fellow and AMA board member. Today, the AMA released a National Health Insurer Report Card, which is designed to provide physicians and the public with an objective and reliable source of information on the timeliness, transparency, and accuracy of claims processing by health insurance companies.
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Read more about the Cure for Claims campaign...

EMTALA proposal would allow hospitals to share resources

American Medical News reports that the U.S. Centers for Medicare and Medicaid Services (CMS) has proposed adjusting its on-call policies under the Emergency Medical Treatment and Labor Act (EMTALA), which was designed to prevent emergency departments (EDs) from "dumping" uninsured or Medicaid patients at public hospitals. Under terms of the proposal, a group of hospitals in a particular region would have the option of designating one of the facilities as the on-call site for a specific time period, for a specific service, or both. Individual hospitals with EDs still would be required to screen each emergency patient and to have a plan for how to proceed if a needed on-call physician was not available. Some hospitals have complained that they are being stretched too thin trying to meet the demands for physician availability under the terms of EMTALA. The American Association of Orthopaedic Surgeons submitted a comment in support of this proposal on June 13, 2008.
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House bill would delay competitive DME bidding

The U.S. House of Representatives is currently considering a proposal introduced by Reps. Pete Stark (D-Calif.) and Dave Camp (R-Mich.) to delay implementation of the Medicare durable medical equipment, prosthetics, orthotics and supplies (DMEPOS) competitive bidding program, which is currently scheduled to begin in 10 metropolitan areas on July 1. The Medicare DMEPOS Competitive Acquisition Reform Act of 2008 would delay implementation of the program, and among other things, make improvements to the bidding process and establish quality measures for DME suppliers in Medicare. The cost of the delay would be offset by a reduction in current DMEPOS payment rates. Additional features of the bill include: excluding physicians and other practitioners from DMEPOS accreditation requirements until CMS develops provider-specific standards and allowing physicians and other practitioners to supply "off-the-shelf orthotics" to their patients without being awarded a competitive bidding contract.
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Congress pushing curbs on physician-owned hospitals

The New York Times reports on efforts in the U.S. Senate and House of Representatives to limit the spread of hospitals that are owned by physicians. On three occasions in the last 10 months, either the House or the Senate has approved legislation that would bar doctors from referring Medicare and Medicaid patients to hospitals in which the doctors have an ownership interest. None of the proposals have gotten all the way through the legislative process.Part of the problem is that influential senators and well-connected lobbyists are advocating for exemptions for a few institutions. The special treatment has drawn criticism from conservatives who oppose restrictions on physician-owned hospitals, and liberals who favor stringent rules with no exceptions.
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Georgia

According to the Atlanta Journal-Constitution, the Georgia Trauma Care Network Commission is rushing to distribute $58 million in funding to trauma facilities and specialists before a July 1 deadline. The money is a one-time infusion and remains the sole state funding for trauma care. State legislators were unable to come to an agreement this year on a separate plan to provide $74 million annually for trauma care. Research shows that Georgia’s death rate for trauma victims is 20 percent higher than the national average.
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Orthopaedic participation in Physician Practice Information study is needed!

The AAOS, American Medical Association, and more than 70 other organizations are conducting a comprehensive multi-specialty survey of America’s physician practices. The results will be used to positively influence national decision makers to ensure accurate and fair representation for all physicians and patients, and to articulate the challenges of running a practice that provides expert patient care while operating a sustainable business. Of particular importance is the section of the study pertaining to practice expenses and the amounts that are attributable to you. CMS has indicated it will use the results of this study to help determine physician payment. The survey firm, dmrkynetec, will be randomly contacting selected physicians and practice managers to collect responses. All responses will remain confidential.

At the last report, only 34 orthopaedic practices have completed the survey. Please alert your staff regarding your willingness to participate in this survey and the importance of accepting incoming calls, faxes or e-mails from dmrkynetec. In June, AMA will be sending a postcard to physicians that have been selected to participate. If you have been selected or have any questions about this survey, you can speak with one of dmrkynetec’s executive interviewers about the 2008 Physician Practice Information Survey by calling toll-free: (877) 816-8940.

Physicians meet with legislators to discuss Medicare package

CongressDaily reports that staff from the Senate Finance Committee has been meeting with physician specialty groups to discuss a legislative package that would halt a 10.6 percent cut to Medicare physicians' payments—currently scheduled to go into effect on July 1—and institute a 0.5 percent increase in reimbursement through the end of 2009. Leaders in both the Republican and Democratic parties have advanced Medicare proposals that are similar on key physician-related issues, such as requiring physicians to adopt electronic prescribing systems by 2011 or face reimbursement penalties up to 2 percent. Physicians who adopt e-prescribing would receive payment bonuses of up to 2 percent and scaling back to 0.5 percent. Both proposals also increase the current 1.5 percent bonus for physicians who participate in a quality reporting initiative to 2 percent in 2009 and 2010. Democrats and Republicans are primarily split over how to fund the entire package. Democrats want to reduce additional payments to private Medicare Advantage plans, while Republicans have indicated they will only accept Medicare Advantage cuts to indirect medical education payments.

The American Association of Orthopaedic Surgeons (AAOS) staff in the office of government relations will continue to participate in all Medicare discussions and keep the AAOS membership updated on any provisions that would affect the orthopaedic community. The AAOS is advocating for a bipartisan bill that would combine provisions from both the Democratic and Republican packages in an effort to ensure the physician payment formula is fixed in advance of the July 1, 2008, deadline and is not delayed by a presidential veto.

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Massachusetts

The Boston Globe reports that a recent Massachusetts law requiring state residents to carry health insurance has had the unintended result of highlighting a shortage of physicians. According to data from the Massachusetts Medical Society, in 2006, 53 percent of patients making an appointment with a primary-care physician were able to see a physician within a week of initiating contact, but in 2007, only 42 percent were able to do so. A member of an advocacy group that helped to draft the new law states that healthcare reform should not have been attempted without first addressing workforce shortages.
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