PROVIDER COMMENTS WANTED CONCERNING AHCCCS RATE CUTS: Tom Betlach, AHCCCS Director, is asking physicians for their comments concerning the 5% reduction in reimbursement rates that take effect on October 1 and run through September 30 of next year.
He asked that comments address:
1) Medicaid population (s) served
2) Operating margins
3) Factors driving provider costs
4) Impacts of rate reductions
Comments will be accepted through May 15 and must be emailed to firstname.lastname@example.org. All submissions will be part of the public record and will be posted on their web page so submit your comments now; make your voice heard.
More information on the process is available at the AHCCCS
FROM ASHBY WOLFE, MD - CMS OPEN PAYMENTS PROGRAM: The Centers for Medicare & Medicaid Services’ (CMS) Open Payments program collects data from drug and device manufacturers and group purchasing organizations (GPOs) about payments they make to physicians and teaching hospitals. The program also reports information about ownership interests in drug and device manufacturers and GPOs held by physicians and their immediate family members. It’s important that physicians and teaching hospitals confirm the accuracy of the financial relationships reported about them.
CMS encourages physicians to register and review any payments reported about them. There are instructions and quick tips to help. The review period opened on April 6, 2015, and will be open for at least 45 days. Reporting inaccuracies helps to make sure that the information posted to the Open Payments website is correct. The only way for physicians and teaching hospitals to confirm that the data reported about them is correct is to register and review that data now during the current review period.
Last fall, CMS reported 4.45 million payments valued at $3.7 billion which were made in the last five months of 2013. These payments were for items such as medical research, conference travel and lodging, gifts and consulting (along with physician ownership or investment interest in industry). CMS will collect this data annually and continue to make it publicly available, downloadable, and searchable. Data from the full 12 months of 2014 has been collected and will be released publicly by CMS on June 30, 2015.
Collaboration benefits physicians, teaching hospitals and drug/device manufacturers in the design and delivery of many life-saving drugs and devices. Open Payments gives patients a tool to become more involved and informed health care consumers by empowering them to discuss these relationships with their physicians. CMS has had nearly 6 million views of Open Payments data and we’re pleased with the continuing engagement of stakeholders on this important transparency initiative.
Learn more about the Open Payments program or send questions to: email@example.com.
TAX SCAM CONTINUES TO TARGET PHYSICIANS: The IRS tax scam that emerged during the 2014 tax season continues to plague physicians and other health care providers during 2015. Last year, more than 120 Arizona physicians were victims of the IRS tax scam. We have already had a number of Arizona physicians fall victim to the scam this year. According to reports, fraudulent federal income tax returns using physician names, addresses and Social Security numbers are being filed electronically. IRS officials believe this scam is an attempt to fraudulently collect tax refunds through a sophisticated electronic redirection of refunds to fraudulent bank accounts that can then be accessed by the perpetrators. Victims are unaware of the identity theft until they attempt to file their taxes electronically, at which time they discover that a return has already been filed under their Social Security number. The IRS is sending 5071C letters to suspected fraud victims with instructions to contact the IRS identity theft website or call the IRS at (800) 830-5084. At this time, physicians are encouraged to go to www.experian.com/fraud and place themselves on a 90-day credit fraud alert. This could potentially slow or halt further attempted identity theft activities. This is only suggested out of an abundance of caution - we have no reason to believe that every physician is at risk. We understand that Experian will feed this information and fraud alerts to the other two major credit reporting agencies. If you remain concerned, it is suggested that you go back onto www.experian.com/fraud after 89 days to initiate subsequent 90-day credit fraud alerts. If you are NOT affected, our IRS agent contact does not recommend filing paper returns. In fact, it is considered best to file electronically as early as possible so as to prevent the bad guys from getting there first.
If you are a victim of this scam, please notify Bill Fearneyhough at firstname.lastname@example.org. Please provide your full name, home address and phone number. The information will be shared with ArMA so please let us know in your email that you authorize release of your contact information, including email address.
IRS - If you are a victim of this scam, you'll note the IRS 5071C letter provides instructions about contacting the IRS through its identity theft website guide or by phone at (800) 830-5084 to let officials know you did not file the return referenced in their letter. If you are a victim, you will not be able to electronically file your return this year since a return with your Social Security number has already been filed. You'll need to file a paper return and attach an IRS 14039 Identity Theft Affidavit to describe what happened. Attach copies of any notices you received from the IRS, like the 5071C letter. Be sure to let your tax preparer know if this happens to you. Verify with the IRS and your tax preparer where to mail your paper tax return, based on the type of return you are filing and your geographic area. Work with your tax preparer to file paper returns with Form 14039 (identity theft affidavit) and Form 8948 (e-file opt-out). You will also need an affidavit and a government issued ID (driver's license or passport). The process of an individual filing the paper return with the Form 14039 notifies IRS that the paper return is the correct filing. IRS then removes the fraudulent filing from the taxpayers account, posts the correct tax return and if due a refund, issues the refund. The major way it impacts someone due a refund is that the process takes longer.
Federal Trade Commission (FTC) - File a complaint with the FTC here. This not only helps the FTC identify patterns of abuse, but the printed version becomes your Identity Theft Affidavit. Along with a police report, that affidavit becomes your Identity Theft Report, which you will need. The FTC recommends other immediate steps and provides helpful information at www.consumer.ftc.gov/topics/repairing-identity-theft.
Police report - Consider filing a report with the local police where you reside. Bring all documentation available, including any state and federal complaints you filed. This will likely be necessary if there is financial account fraud as a result of the identity theft. However, if the only fraud is tax fraud, the police report will be necessary only if requested by the IRS.
Social Security - Call the Social Security Administration's fraud hotline at (800) 269-0271 to report fraudulent use of your Social Security number. In case your number is being used for fraudulent employment, you can also request your Personal Earnings and Benefit Estimates Statement at www.ssa.gov/ or call (800) 772-1213. Check it for accuracy.
Credit Bureaus - Contact a fraud unit at one of three credit bureaus: Equifax, TransUnion and Experian
Office of the Arizona Attorney General - Physicians affected can find additional guidance through the office of the Attorney General. Their website lists resources and steps for identity theft victims to take at https://www.azag.gov/identity-theft.
If you have not received a notification from the IRS but believe your personal information may have been used fraudulently or are concerned about whether you may have been victimized, call the IRS Identity Protection Specialized Unit at (800) 908-4490. Find more information from the IRS, including forms, at the IRS website.
ArMA and PCMS will keep you informed of further developments and information.
NOMINATE A COLLEAGUE FOR “PHYSICIAN OF THE YEAR”: A highlight of every PCMS/Alliance Stars on the Avenue event is the presentation of several recognition awards including “Physician of the Year.” If you would like to single out a colleague for the prestigious 2015 POY Award please forward a brief letter or email outlining why they should be 2015’s Physician of the Year and mail it to 5199 E. Farness Drive, Tucson, AZ 85712 or email to Executive Director Bill Fearneyhough at email@example.com. For more information call Bill at 795-7985.
DOUBLE DIGIT MEDICARE CUT AVOIDED: On April 14, Congress passed and the President signed the Medicare Access and CHIP Reauthorization Act of 2015. The law eliminates the 21% scheduled to take effect as of April 1, 2015, for the Medicare Physician Fee Schedule. In addition, provisions allowing for exceptions to the therapy cap, add-on payments for ambulance services, payments for low volume hospitals, and payments for Medicare dependent hospitals that expired on April 1 have been extended. CMS will immediately begin work to implement these provisions.
In an effort to minimize financial effects on providers, CMS previously instituted a 10-business day processing hold for all impacted claims with dates of service April 1, 2015, and later. While the Medicare Administrative Contractors (MACs) have been instructed to implement the rates in the legislation, a small volume of claims will be processed at the reduced rate based on the negative update amount. The MACs will automatically reprocess claims paid at the reduced rate with the new payment rate.
No action is necessary from providers who have already submitted claims for the impacted dates of service.
AMB UPDATE: Eighteen months after the initial Arizona Ombudsman-Citizens' Aide report that launched a firestorm surrounding practices at the Arizona Medical Board, the Arizona Auditor General has now issued its own report. The medical board has already responded to the Auditor General findings by revising applications, updating a licensing manual, and developing additional policies and procedures. The backlog of new licenses was a serious issue on which the Arizona Medical Association, PCMS, and MCMS advocated to correct through passage of SB1149, which eliminated background checks for currently licensed physicians, and which appropriated funds to reimburse physicians who had already paid the $50 fee for fingerprinting on their license renewals. The signing into law last week of SB1258, the follow-up bill to resolve the AMB's licensing backlog, gives the AMB emergency rulemaking authority to clean up some outdated regulations. It is our belief that these bills will remove all known roadblocks to normal credentialing.
IRS PHYSICIAN TAX SCAM UPDATE: We are receiving feedback from medical societies around the country that the tax scam that impacted thousands of physicians last year may be resurfacing. If you file your taxes and are informed that a tax filing has already been completed on your behalf, please contact Chic Older, ArMA Executive Vice President, at (602) 246-8901. We have maintained our communication with the IRS, FBI and Secret Service, and will notify those agencies. Last year, more than 120 Arizona physicians were victims of the IRS tax scam, in which physicians and other health care providers discovered upon filing their taxes that a fraudulent federal income tax return had already been filed under their information.
PRACTICES PENALIZED UNDER NEW MEDICARE QUALITY METRICS: The government's new quality of care payment system that will soon apply to all physicians who accept Medicare has dealt an unpleasant surprise for many practices. The quality metrics used to judge physicians vary by specialty. There are 250 quality measures, of which groups and physicians must report a selection of their choice, generally nine different measures - or else be automatically penalized. This year, 319 large medical groups are having their reimbursements reduced by 1% because they did not meet Medicare's reporting standards. According to Medicare, out of 1,010 large physician groups that the government evaluated, just 14 are getting payment increases this year. Within three years, the Obama administration wants quality of care to be considered in allocating nine of every 10 dollars.
ADHS HEALTH NOTICE: Along with tick season, Rocky Mountain spotted fever (RMSF) season has begun. There have already been six cases of RMSF in Arizona this year. RMSF is difficult to clinically diagnose in Arizona. Cases here present NEITHER classically NOR consistently, and patients often lack a rash or history of a tick bite. Unfortunately, without immediate treatment, RMSF can have fatal outcomes. Empiric treatment with DOXYCYCLINE MUST NOT BE DELAYED for patients with febrile illnesses or sepsis that live on or have visited tribal lands. Children, in particular, have good outcomes with early doxycycline, and have not been shown to have teeth staining from this treatment dose and indication. All suspected cases of RMSF must be reported to public health: www.azdhs.gov/phs/oids/contacts.htm#L. More information on RMSF is available at www.azdhs.gov/phs/oids/vector/rocky-mountain-spotted-fever/, www.cdc.gov/rmsf, or www.cdc.gov/rmsf/doxycycline/index.html.
LEGISLATIVE WEEK 12: Despite contrary predictions that adjournment wasn't realistic until next week, the Senate and House Leadership decided to go "pedal to the medal" and pushed to finish the session before the Easter/Passover holiday. Well, at least the Senate did. They packed it in around 1:30 am early Friday morning, voting to adjourn (and abruptly leaving the building) in a move that sent shock waves through the House and led to several bills dying unceremoniously. That was followed by a disjointed and chaotic finish on the House side, but not until 3:37 a.m. Friday. This legislative session was one of the shortest in modern state history - a mere 81 days. That's the shortest session here since 1968, when they finished by the 74th day of that session (March 21st). And it's only the fourth time in the last 45 years that they've finished a regular session in less than 100 days.
On the legislation front, the House took final action (after a whole lot of waiting) on several important bills. They unanimously passed the amended version of SB1258 (as did the Senate), the follow-up bill to resolve the AMB's licensing backlog, which was strongly supported by PCMS and ArMA. The bill had been amended to further clarify what is supposed to happen after the AMB has issued an RFI (request for information) to qualified vendors for the credentialing verification functions of the Board. It also gives the AMB emergency rulemaking authority to clean up some outdated regulations. It is our belief that this bill removes all known roadblocks to normal credentialing. The House also gave final approval to SB1290, a bill to protect physicians who perform independent medical exams (IMEs) in workers' comp cases, which passed third read on a strong 59-0 vote. Also unanimously approved in the final hours was HB2556, a bill that extends peer review protections now enjoyed by hospitals to non-institutional settings. All three bills now head to Governor Ducey for signature.
HB2645 completed its legislative journey without difficulty, passing the House 60-0 on final concurrence after being amended in the Senate. It passed the Senate 26-2. The bill, which allows patients to self-refer for lab testing, had significant momentum behind it with the backing of both Speaker Gowan and Governor Ducey (who is fully expected to sign it). Concerns about expanded direction for self-referral fell on deaf ears amidst a general attitude dismissive of the facts.
House members said no to SCR1003, a Senate resolution to oppose the model interstate medical licensure compact legislation that has already been introduced in 17 states and enacted in 3 (SD, UT & WY). Members paid heed to strong concerns that a consequence of passing this SCR would ultimately lead to limitations in the availability of physicians to Arizona patients, and would discourage debate on an issue that should be thoughtfully considered by the Legislature and the medical community in Arizona. The SCR was soundly rejected on a vote of 16-40.
PCMS MEMBER APPOINTED TO AMB: Gary Figge MD, an emergency physician at Northwest Medical Center, won Senate confirmation to the Arizona Medical Board last week. He joins fellow PCMS and AMB member R. Screven Farmer.
AMB APPOINTS NEW EXEC DIRECTOR: The Arizona Medical Board has appointed Patricia McSorley as executive director. Ms. McSorley has been employed by the Arizona Medical Board since 2005. For more than eight years, she managed the Investigations Department. On two occasions, she has been asked by the Board, and has served, as the Acting Interim Executive Director. Ms. McSorley holds a Juris Doctorate from Brooklyn Law School. Previously, she served as the Assistant Commissioner for the Bureau of Investigations and Trials with the New York City Fire Department. On February 26, the Board's Executive Director Committee appointed her as the Executive Director of the Arizona Medical Board and the Arizona Regulatory Board of Physician Assistants.
SCOTUS SETS TROUBLING PRECENDENT: In the case of North Carolina Board of Dental Examiners v. Federal Trade Commission, the U.S. Supreme Court ruled that the dental regulatory board illegally suppressed competition when it issued an edict against non-dentists offering teeth-whitening services. In effect, the ruling sets a precedent that state boards can be sued for antitrust. As it is common practice for regulatory boards to consist mostly of members of the profession, the case was of interest to physicians. The American Medical Association (AMA) had filed an amicus brief in support of North Carolina Board of Dental Examiners. There are serious concerns that this ruling could blur the line on determining whether certain medical procedures might be inappropriately undertaken by non-physicians, as dissent from the regulatory board of professionals can now be interpreted as an antitrust issue rather than a patient safety issue. The Arizona Medical Board has 12 members; it requires that four be non-physicians, one of which must be a licensed practical or professional nurse. The implications of this case for Arizona are both unclear and of concern.
CDC RECOGNIZES ARIZONA DESIGNATED EBOLA CENTER: This week, the Centers for Disease Control and Prevention (CDC) identified Maricopa Integrated Health System and University of Arizona Health Network as two of the 55 Ebola Treatment Centers in the United States. These two systems had already been designated Infectious Disease Treatment Centers of Excellence by the Governor's Council on Infectious Disease Preparedness and Response in fall of 2014. The Council was formed in response to concerns during the Ebola outbreak of 2014. CDC has posted a brand new list of all designated facilities and determined, because more than 80% of returning travelers from West Africa are within 200 miles from a designated treatment center, they will no longer be adding additional centers to their list. The plan and support from the Council allowed the Arizona facilities to be visited early by the CDC Rapid Ebola Preparedness Team and meet the requirements under a very short time period.
ARIZONA ADHS / VACCINE NEWS: ADHS Immunization Program Office released the latest edition of Arizona Vaccine News today. The publication provides an overview of vaccine news, new literature and resources. This edition covers topics in pertussis, measles and influenza, and recommendations for pneumococcal immunization of patients over 65 years of age, as well as CMS policy on Medicare payments. The edition also includes information on the efficacy of a new dengue vaccine.
CMS SHIFTING MEDICARE PAYMENT MODELS: The Department of Health and Human Services (HHS) has announced goals and timelines for Medicare related to quality and the use of alternative methods of healthcare delivery. By 2016, HHS intends that 30 percent of Medicare fee-for-service payments will tie to alternative payment models, such as Accountable Care Organizations (ACOs) and bundled payments, and 85 percent will be based on quality. These percentages will increase to 50% and 90%, respectively, by 2018. The HHS goals are intended to increase value and promote care coordination across the healthcare continuum by focusing on three areas:
- Payment incentives - rewarding value and care coordination, rather than volume and duplication of care
- Care delivery improvement and innovation - supporting providers to find ways to coordinate and integrate care with an emphasis on prevention and wellness
- Sharing information - creating more transparency on cost and the quality of health care; using electronic health information to inform care; and having the most recent scientific evidence available to help providers in clinical decision making.
HHS plans to work with state Medicaid agencies, private payers, providers, and others to expand alternative payment models into their programs. For additional information, visit the HHS website.
ADHS RELEASES OPIOID PRESCRIBING GUIDLEINES: The Division of Public Health Services at the Arizona Department of Health Services has released the final version of the state’s Opioid Prescribing Guidelines. They are the result of input and expertise of practitioners from across the state representing professional associations, health plans, academic institutions, federal health care providers and others.
The objective of the guidelines is to balance the appropriate treatment of pain with approaches to more safely prescribe opioids and complements other statewide “best practice” guidelines for Emergency Department Controlled Substance Prescribing and Dispensing Controlled Substances.
An important next step to encourage use of the Arizona Opioid Prescribing Guidelines is training that will help prescribers implement Arizona’s guidelines. The University of Arizona is in the process of putting together free, online training that is expected to be available in January. We will notify you when the training is available.
PCMS / FAVORITE STAFFING SERVICE: If you need staffing, contact Favorite our affiliate medical staffing service. Favorite provides a full range of services including direct hire, contract, temp- to-perm, permanent placement and “just –in-time” per diem. Special rates are given to member physicians. Call Amy Erbe at 319-5766. She is anxious to assist.
WALK-WITH-A-DOC: The Society is teaming with the Arizona Chapter of the American College of Physicians (ACP) to host and provide physician leaders for the monthly Walk-With-A-Doc outings. Walkers sign in at the ramada east of Swan Bridge on the south bank.PCMS physicians are encouraged to urge patients to participate in the program. Each walk begins with a brief discussion on a health topic and includes a one- or two-mile walk on level ground. Please contact Dennis Carey at 795-7985 or firstname.lastname@example.org with questions. There is one more walk scheduled for 2013. It's on December 14. In 2014 walks will be held on January 11, February 8, March 8, April 12, September 13, October 11, November 8 and December 13. They begin at 8 a.m.