IRS TAX RETURN SCAM UPDATE: Over the past few months, we received feedback from numerous members who were victims of the IRS Tax Scam. Working through ArMA, we have been in contact with our resources at the IRS, FBI, and Secret Service and they continue to dedicate substantial resource toward uncovering the date breach that has impacted physicians in every state. This data breach is described as sophisticated, with multiple layers. For those who have been effected by the scam, our sources have informed us that, in order to allow you to file electronically in the future, all reported victims will be provided with a special individual pin number that will allow you to again file electronically. As we learn more, including when to expect this notification, we will pass it along.
HEALTHCARE DATA BREACHES INCREASING: The recent theft of 4.5 million medical records by hackers highlights one undeniable truth about healthcare data: it's valuable, and people want it. Identity thieves can sell patient information to be used for obtaining free medical care or to file bogus insurance claims. Since federal reporting requirements kicked in, the U.S.
Department of Health and Human Services' (HHS) database of major breach reports (those affecting 500 people or more) has tracked 944 incidents affecting personal information from about 30.1 million people. A majority of those records are tied to theft (17.4 million people), followed by data loss (7.2 million people), hacking (3.6 million), and unauthorized access accounts (1.9 million people). There are also many more incidents of smaller-scale breaches. In 2012, HHS received 21,194 reports of smaller breaches affecting 165,135 people, according to the department's most recent report to Congress. Healthcare data has seemingly become increasingly targeted, accounting for 43% of major data breaches reported in 2013, according to the Identity Theft Resource Center. That's the first time the healthcare sector topped the group's annual list, and it's on the same pace for 2014. Read more here: https://www.magnetmail.net/actions/email_web_version.cfm?recipient_id=1450658731&message_id=5994069&user_id=PIAA&group_id=1210335&jobid=21166378
SUNSHINE ACT EXTENDED: The Physician Payments Sunshine Act (Sunshine Act) requires manufacturers of drugs, medical devices and biologicals that participate in U.S. federal health care programs to report certain payments and items of value given to physicians and teaching hospitals. The data will be made publicly available through the Open Payments System on Sept. 30, 2014. Physicians wishing to review and potentially dispute their Sunshine Act financial disclosures must complete a three-step process to access their data:
Step 1: Register now in the Centers for Medicare & Medicaid Services (CMS) Enterprise Portal. This gateway provides access to a number of CMS programs, so many physicians may have already completed this step.
Step 2: Physicians are again able to request access to the Open Payments system. Physicians can do so by logging back into the CMS Enterprise Portal and following the appropriate steps.
Step 3: Physicians should review their individual report and seek corrections through the Open Payments System before Sept. 8.
According to CMS, the Open Payments System was taken offline on August 3 for repairs to conduct a full investigation into a physician complaint and found that manufacturers and group purchasing organizations (GPOs) submitted intermingled data, such as the wrong state license number or national provider identifier (NPI), for physicians with the same last and first names. This erroneously linked physician data in the Open Payments system. CMS has implemented system fixes to resolve the issue, and revalidated all data in the system to verify that the physician identifiers used by the applicable manufacturer or GPO are accurate, and that all payment records are attributed to a single physician. Incorrect payment transactions have been removed from the current review and dispute process and this data will not be published. Disputes that are filed before September 8 will be flagged as such in the initial public release September 30. Physicians will have until Dec. 31 to retrospectively file disputes about their data. The CMS Enterprise Portal is available here. Consider downloading a free smartphone app to track reportable transfers. Compatible with Apple® and Android platforms, "Open Payments Mobile for Physicians" is available through the Apple Store and Google Play® Store. A number of security features protect the privacy of the data you capture, which will be stored on one device and cannot be backed up to a cloud or other devices. Also urge your industry contacts to use the app so you will be able to capture the information you need to ensure accurate reporting.
AHCCCS CLARIFIES NEW REQUIREMENT FOR SAM COVERAGE: Physicians have asked AHCCCS to offer clarification of their new requirement regarding insurance coverage for Sexual Abuse and Molestation (SAM). According officials, SAM is discretionary.
MICA-insureds can find a newsbrief that notes, subject to the terms of the policy, MICA’s medical professional liability insurance policy provides for defense of an insured when faced with these kinds of claims. For non-MICA policy holders, check with your carrier about coverage but don’t be pressured into purchasing coverage that you already have, or may not need.
DEA RESCHEDULES VICODIN, OTHER HCPs: The US Drug Enforcement Administration (DEA) published the final rules moving hydrocodone combination products (HCPs) from Schedule III to the more restrictive Schedule II. Current analysis by HHS and the DEA shows HCPs have a high potential for abuse. The rule will take effect on Oct. 6, 2014. The rule is published in the Federal Register.
AMB LICENSING UPDATE: Earlier this year the Executive Directors from Pima County Medical Society, Maricopa County Medical Society and the Arizona Medical Association met with new Arizona Medical Board Executive Director to develop solutions to the current physician licensing backlog. Our meetings paid dividends.
In mid-year, Maricopa County Medical Society’s credentialing service was awarded an $800,000 contract to aid AMB in revalidating physician licenses. AMB is also working to increase staffing and provide web-based monitoring of physician applications. This will go a long way in improving the processing time which had gone from 11 days to more than 120 day. However, if your practice is currently being impacted by the backlog situation, contact Bill Fearneyhough at billf5199@gmail. He will share your information with AMB.
FOUNDATION SPOTLIGHTS CANCER TREATMENT: The Pima County Medical Foundation hosts another of its CME, dinner programs on Tuesday, September 9 at the Society building, 5199 E. Farness Drive. Drs. Rich Ahmano and Mitch Sokoloff will present New Medical and Surgical Treatments for Prostate Cancer. Dinner is at 6:30 p.m. RSVP by noon, Sept. 8 at 795-9484.
SYPHILIS CASES ON THE RISE IN PIMA COUNTY: The Pima County Health Department (PCHD) is reporting that as of July 31, seventy-eight (78) primary and secondary cases of Syphilis have been confirmed. The dramatic increase, as compared to recent years, has prompted PCHD to issue a “Public Health Alert.”
Dr. Francisco Garcia, director & chief medical officer for PCHD, is calling for all providers to heighten their index of suspicion for the disease and get informed about reporting, diagnostic and treatment recommendations by clicking on the “Provider Resources” tab at http://webcms.pima.gov/cms/One.aspx?portalId=169&pageId=136859. Clinicians may also receive assistance by calling 724-3916.
CDC ISSUES EBOLA GUIDELINES: The Centers for Disease Control and Prevention (CDC) continues to work closely with the World Health Organization (WHO) and other partners to better understand and manage the public health risks posed by Ebola Virus Disease (EVD). To date, no cases have been reported in the United States. The purpose of this health update is 1) to provide updated guidance to healthcare providers and state and local health departments regarding who should be suspected of having EVD, 2) to clarify which specimens should be obtained and how to submit for diagnostic testing, and 3) to provide hospital infection control guidelines. U.S. hospitals can safely manage a patient with EVD by following recommended isolation and infection control procedures. View the complete advisory at http://emergency.cdc.gov/han/han00364.asp.
ADHS RELEASES INFECTIOUS DISEASES MANAUAL: The Arizona Department of Health Services recently released “An Introduction to Arizona’s Infectious Diseases” manual. To view the new guide click here: http://www.scribd.com/doc/236048552/Arizona-Dept-of-Health-Physician-Manual?secret_password=J281p3z1rxz2HUEL24tS
IOM REPORT STIRS GME FUNDING CONTROVERSY: The federal government, mostly via the Medicare program, currently provides more than $11 billion per year in payments to support graduate medical education (GME), the training of doctors who have graduated medical school. Most of these funds go to the hospitals that sponsor interns and residents. States, through the Medicaid program, contribute nearly another $4 billion annually. But there is little data on how those funds are spent and how well they contribute to the preparation of a medical workforce needed for the 21st century. This week saw the release of a report from an expert panel by the Institutes of Medicine (IOM) that recommended a complete overhaul of the way government pays for the training of physicians. The five major recommendations the committee made were:
- Medicare should maintain its GME support but should be replaced in phases by a new payment system.
- A GME policy council should be created in the Office of the Secretary of Health and Human Services, as well as a GME Center within the Centers for Medicare and Medicaid Services.
- The single Medicare GME fund should be divided into two parts: an Operational Fund to support residency training positions that are currently approved and a Transformation Fund to develop and test new GME programs.
- Medicare should make a single payment to GME programs based on a national, geographically adjusted, per-resident amount.
- Medicaid funding for GME should remain at the discretion of individual states.
The Association of American Medical Colleges issued sharp criticism of the report, stating that the recommendations threaten the viability of excellent training programs. The panel did not recommend lifting the current cap on residency slots currently supported by Medicare which were established with the 1997 Balanced Budget Act.
CMS ISSUES 2015 MEDICARE PHYSICIAN PAYMENT PROPOSED RULE: Major changes in the Medicare physician payment policy were proposed by the Centers for Medicare & Medicaid Services (CMS) with the release of its annual notice of proposed rulemaking July 3. Public comments on the proposed rule are due September 2. The final rule is expected to be issued by November 1, and implementation is scheduled for January 1. Some of the key issues addressed in the CMS proposal include:
- Unbundling of the 10- and 90-day global surgical services
- Changes to the process and timelines for revising relative values
- New payment policies and rates for chronic care management services
- Changes to the Sunshine Act regulationsModifications to the Medicare performance-based payment programs, such as the Physician Quality Reporting System and Value-Based Modifier
These proposals and others are outlined in several fact sheets available on the CMS website: http://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2014-Fact-sheets.html.
PHYSICIANS SHIFTING TO EMPLOYMENT RATHER THAN PRIVATE PRACTICE: Jackson Healthcare this week released the findings of a survey on physician practice environment, workload and patient access. A total of 1,527 physicians across the nation completed the survey this spring. When comparing previous survey results, this year's findings noted that the percentage of hospital-employed primary care physicians doubled from 10 percent in 2012 to 20 percent in 2014. The number of primary care physicians with an ownership stake in a single-specialty practice decreased from 12 percent in 2012 to 7 percent in 2014. When responding to why they chose employment, overall, the lifestyle that employment offers is the underlying factor driving physician preference. The number of physicians taking call in 2012 (77 percent) dropped to 57 percent in 2014. Eighty-five percent of physician practices reported accepting new Medicare patients. Sixty percent reported accepting new Medicaid patients. Survey details here: http://www.jacksonhealthcare.com/media-room/articles/physician-trends/physician-data-on-practice-environment-workload-and-patient-access.aspx
CMS EXTENDS DEADLINE FOR MEANINGFUL USE STAGE TWO: Under a proposed rule and joint announcement by CMS and the Office of the National Coordinator for Health Information Technology issued this week, CMS extended the deadline for providers to meet Meaningful Use Stage 2. Healthcare providers will have an extra year to use 2011 Edition software in their electronic health record (EHR) systems, and providers scheduled to jump to the program's Stage 2 criteria will have another year to stay at Stage 1. The agencies cited the slow delivery and implementation of the upgraded 2014 Edition software as the reason for the delay. Although providers have been urging CMS to delay Stage 2 implementation, the timeline of the protracted rulemaking process still means many providers have to make implementation decisions before the rule can take effect. Learn more here.
Meaningful Use is a set of criteria for the use of Electronic Health Record (HER) systems to improve patient care by healthcare providers. The concept of meaningful use was developed by the National Quality Forum (NQF); their ideas included improved population health, coordination of care, improved safety, and patient engagement. The U.S. Healthcare Information Technology for Economic and Clinical Health Act (HITECH) established incentives for adopting Meaningful Use criteria beginning in 2012, with the possibility of penalties for failure to achieve the standards by 2015. In August 2012, CMS released the final rules for meaningful use Stage 2.
If you are struggling with Meaningful Use, contact Arizona's Regional Extension Center! REC logo Important & Time Sensitive: The Office of the National Coordinator for Health Information Technology (ONC) recently granted a no-cost extension award to the Arizona Regional Extension Center (REC) program. This extension allows the REC to continue offering eligible providers free assistance towards achievement of Stage 1 Meaningful Use. This award is particularly helpful for providers who are still struggling with Meaningful Use requirements, or are at risk of receiving payment adjustment penalties in 2015. The no-cost extension provides additional time, until April 5, 2015, for the REC to sign up eligible providers who are currently using an EHR or are considering EHR adoption. Learn more and find out if you qualify - call the REC at 602-688-7200 or fill out an interest form at www.arizonarec.org!
PHYSICIANS CHALLENGED BY ACA PLANS: A new study released by the Medical Group Management Association (MGMA) surveyed 728 practices representing 40,000 physicians in 46 states during April 2014. Almost 80% of the medical groups reported their practice is participating with new health insurance products sold on the ACA exchanges, and over 90% of these practices have already seen patients with this coverage. These practices report that verification processes were more difficult and lengthy than with commercial plans. Nearly 60% of respondents indicated that it is more difficult to verify patient eligibility, obtain cost-sharing or network information, or get information about the plan's provider network, in order to facilitate referrals. For practices not participating with ACA insurance exchange product, 48.1% cited concerns about assuming financial liability during a 90-day grace period for ACA exchange enrollees. For practices that chose to participate with ACA insurance exchange products, 57.6% cited remaining competitive in the local market as the reason for doing so. Almost half of respondents reported they have been unable to provide covered services to exchange patients because their practice is out of the patient's network. About 36.6% of respondents indicated that average payment rates for ACA exchange insurers were equal to payment rates from traditional commercial and traditional Medicare contracts; 32% indicated that average payment rates were somewhat lower. The American Medical Association (AMA) has created a physician practice resource page for grace period information. Resources include model language and sample letter forms for notifying patients.
WEBSITE OFFERS ACCESS TO CLINICAL TRIALS: Participating in vital health-related research to help improve or saves lives has gotten easier, thanks to a new website that features the clinical trials at the Arizona Health Sciences Center. The new Clinical Research Studies website facilitates access to research studies at the University of Arizona for the general public and for researchers recruiting people to their studies. The UA Clinical Research Studies website is searchable by health topic and makes access to information about the studies easy to find. The studies are listed by disease area and in laymen's terms for ease of navigation and understanding, and more in-depth medical information also is included for both UA and community health-care providers. Currently, there are over 100 UA studies focusing on a variety of diseases. The studies are led by nationally renowned researchers who are working to identify new cancer therapies, treatments for heart disease, asthma and lung disease, depression, Alzheimer's disease, Parkinson's disease, diabetes, and to find innovative uses for technology in health care.
ICD-10 CODING: The requirement to use the ICD-10 coding system has been extended to Oct. 1, 2015, however if your practice hasn’t developed an implementation plan these resource sites can assist.
Online ICD-10 Guide: http://www.cms.gov/Medicare/Coding/ICD10/ICD-10ImplementationTimelines.html
Introduction to ICD-10: http://www.cms.gov/Medicare/Coding/ICD10/ProviderResources.html
Basics for Small and Rural Practices: http://www.cms.gov/Medicare/Coding/ICD10/Medicare-Fee-for-Service-Provider-Resources.html
AMA’s What You Need to Know for the Upcoming Transition to ICD-10: http://www.azmed.org/ckfinder/userfiles/files/icd-10-transition.pdf
AMA’s Your 12-Step Transition Plan for ICD-10: http://www.azmed.org/ckfinder/userfiles/files/AMA_icd-10-action-plan-12-step-transition.pdf
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.