GME FUNDING TO INCREASE BY $81 MILLION UNDER PROPOSED RULE CHANGE: The existing Arizona statute that covers AHCCCS GME funding, ARS Section 36-2903.01 (specifically, subsection 9), requires AHCCCS to prescribe a formula for funding of both direct costs and indirect costs of GME programs. This is patterned after the way CMS does GME funding at the federal level. Recent changes proposed by the Ducey Administration and AHCCCS would call for a simple, yet very significant change to the indirect costs part of the funding formula. AHCCCS describes their intention for updating the rule on GME funding for indirect costs "to modify the method of allocating funds for indirect GME costs to permit payments that will cover a greater portion of the costs incurred by the GME programs." In the current formula, the payments are limited to the lesser of two alternative calculations (described in the proposed rule). AHCCCS is proposing to modify it so that the payments are limited to the greater of the two alternatives. The rulemaking publication explains that this proposed rulemaking intends to calculate the maximum payment for the indirect costs of GME programs. It states that this rulemaking will benefit hospitals operating GME programs because the proposed rule amendment, which will not require additional State funding, will expand payments in support of GME. Payments to Arizona GME program hospitals are expected to increase or enhance payments by approximately $81 million annually - without use of additional State funds. The publication also notes that there is a public comment period on this proposed rule change and there will be some public meetings around the state in October.
AHCCCS EXPANSION IN ARIZONA CONSTITUTIONAL: Maricopa County Superior Court Judge Douglas Gerlach ruled that the simple majority vote that expanded AHCCCS in 2013 was constitutional. Last December, the Arizona Supreme Court ruled to allow a lawsuit challenging Governor Jan Brewer's AHCCCS (Arizona's Medicaid program) expansion plan to move forward. The high court agreed that 36 Republican lawmakers can sue Governor Brewer over the legality of a hospital assessment that funds the expansion plan, which was passed by a bare majority in the legislature. The Goldwater Institute, suing on behalf of lawmakers, argues that the assessment meets the criteria of tax and therefore requires a two-thirds majority in the legislature; state attorneys counter that the assessment is not a tax because it is collected from hospitals rather than the broad population. Without the assessment, Arizona would not have the matching funds needed to pay its share of the expansion that is now covering about 255,000 low-income Arizonans. In his ruling, Judge Gerlach stated that since hospitals directly benefit from the assessment, it is actually a fee rather than a tax. As the judge himself pointed out during the court hearing last month, his ruling means very little at this point as appeals will be filed regardless of his decision. The case will ultimately be decided by the Arizona Supreme Court. The Arizona Medical Association (ArMA), PCMS and Maricopa County Medical Society fully endorsed and actively supported Governor Brewer's work to expand the AHCCCS program.
ARIZONA HOME OF NARROW NETWORKS: A new study released from the University of Pennsylvania's Leonard Davis Institute of Health Economics finds the prevalence of narrow physician networks in the Health Insurance Marketplaces varies widely by state. The study considers networks narrow if 25% or fewer physicians in a rating area participate. According to the study, 73% of qualified health plans offered on the Marketplace in Arizona in 2014 were comprised of narrow networks making Arizona the fifth highest state in terms of narrow network prevalence.
AMA RELEASES PHYSICIAN PAY STUDY: The American Medical Association (AMA) has released a report on their 2014 Physician Practice Survey detailing how physicians outside of solo practice are paid. The survey, completed by 3500 physicians around the country, identifies six trends:
- Slightly more than one-half of physicians (51 percent) reported being paid by multiple methods.
- Salary and productivity-based payment were the most common payment methods.
- On average, one-half of physicians' total compensation was earned from salary.
- Being employed didn't necessarily mean a salary.
- Outside of group practice, salary was more often a key factor than inside group practice.
- Physician payment methods vary widely across specialties.
The study found that while the structure of physician payments has changed little since 2012, the use of productivity-based pay and bonuses both increased by about three percent.
AHCCCS 1115 WAIVER PROPOSAL: The Governor’s office and AHCCCS are holding a series of forums on the AHCCCCS CARE proposal to seek comments. The Tucson forum is scheduled for August 26, 10 a.m. to noon at Casino Del Sol - Ballroom B, 5655 W Valencia Rd.
Governor Doug Ducey has stated that his goals for modernizing Arizona's Medicaid program are to: (1) Engage Arizonans to take charge of their health; (2) Make Medicaid a temporary option; and (3) Promote a quality product at the most affordable price. Complete details of the plan are available on the AHCCCS website, including a fact sheet. The waiver proposal is subject to being modified based on feedback from the public forum process. Nothing in this proposal will go into effect unless and until formal approval is given by CMS. Two issues of concern are the elimination of non-medical transportation, particularly for behavioral health and rural patients, and the potential impact of coverage interruptions. We encourage physicians with AHCCCS patients to attend the public forums and provide your public comments.
GOVERNOR’S OFFICE RELEASES AHCCCS WAIVER PLAN: The Governor's Office unveiled the AHCCCS waiver proposal which will be submitted in September to CMS for approval. Governor Doug Ducey stated that his goals for modernizing Arizona's Medicaid program are to: (1) Engage Arizonans to take charge of their health; (2) Make Medicaid a temporary option; and (3) Promote a quality product at the most affordable price. The proposal is built around a new program called AHCCCS C.A.R.E. (the new acronym stands for Choice, Accountability, Responsibility and Engagement). The new CARE program is expected to apply to 250,000 to 350,000 members statewide including able-bodied adults, but excluding caretakers for children under 6 years old, as well as excluding SMI members and Native American tribal members. The proposed program incorporates tenets of health care savings accounts.
- Able-bodied adults on AHCCCS would pay up to up to 2% in premiums for their AHCCCS coverage on a sliding scale based on their annual income levels, with the premium payments going into their personal AHCCCS CARE accounts.
- From those CARE accounts, they would have to pay "strategic co-pays" (up to a max of 3% of their income) on designated health care services. These co-pays would NOT apply to primary care or to disease treatment medications; they would be targeted to encouraging members to use services wisely, and would apply to things like missed appointments and inappropriate ED visits.
- These co-pays would NOT have to be collected by the providers, ever. The providers will be paid the contracted rates by AHCCCS or the AHCCCS plans, and then AHCCCS would handle co-pay collection as a "back-office" process directly with the members' CARE accounts.
- The money in these CARE accounts could also be used by the members to pay for non-covered medical services (such as vision, dental and chiropractic).
- When members leave AHCCCS, they'll be able to take the leftover money in their CARE accounts with them to a private HSA.
The AHCCCS members in this program are expected to:
- Make timely premium payments into their CARE accounts;
- Meet "healthy behavior" wellness-oriented targets (age & gender specific) under a points system, with the targets to be designed by the AHCCCS plans with which they are enrolled, e.g. smoking cessation, disease management; regular physical exams/screenings, etc.; and,
- Unless already employed (or in job training or school), they must participate in the AHCCCS Works program, a new program to be administered through the Dept. of Economic Services (DES) which would include resume creation, job searching and job applications.
- If they don't meet requirements above (after a grace period), the members making over 100% of FPL would lose AHCCCS coverage as well as the ability to access the funds in their CARE accounts for six months. For members making under FPL, they would owe the state the money but wouldn't be disenrolled. The members would not forfeit their CARE accounts forever, the account would simply be frozen and not accessible until they again meet requirements. The program will allow employers and non-profits (and perhaps family members) to make all or portions of the premium payments for the members into their CARE accounts. Their intent is to allow these other ways to ensure that the members can meet the first requirement (premium payments) more easily.
The Governor's Office and AHCCCS will use the month of August to hold a series of public forums on the AHCCCS CARE proposal, to seek comment both oral and written. There will be forums in Phoenix, Tucson, Flagstaff and Yuma. Complete details of the plan are available on the AHCCCS website, including a fact sheet. Please bear in mind that this waiver proposal is subject to being modified based on feedback from the public forum process. And nothing in this proposal will go into effect unless and until formal approval is given by CMS.
HALF OF PHYSICIAN PRACTICES NOT READY FOR ICD-10: The ICD-10 compliance date is October 1, 2015. A survey conducted by Workgroup for Electronic Data Interchange (WEDI) in June 2015 found that nearly 25% of physicians' offices said they will not be ready for the transition, and another 25% said they were not certain they would be ready. The same survey found that about 20% of physician practices have started or completed external testing. CMS recently announced a transition period of 12 months following the compliance date, highlighting the following points:
- For the first 12 months ICD-10 is in place, Medicare claims will not be denied solely based on the specificity of the diagnosis codes as long as they are from the appropriate family of ICD-10 codes.
- For all quality reporting completed for program year 2015, CMS will not subject physicians to penalties for the Physician Quality Reporting System, the value-based payment modifier or meaningful use based on the specificity of diagnosis codes as long as they use a code from the correct ICD-10 family of codes.
- CMS will set up a communication center to monitor issues and resolve them as quickly as possible.
- CMS will name an ICD-10 Ombudsman to help receive and triage physician and provider issues.
- CMS is offering assistance through resources available at www.cms.gov/icd10 and for small physician practices through the "Road to 10" program, which includes primers, a new interactive case study tool, and specialty specific resources, at www.roadto10.org/.
- CMS has now updated its Q & A document related to this announcement.
VETERAN’S HEALTHCARE – CHOICE ACT AND NON-VA PHYSICIANS: According to the VA, there are two mechanisms through TriWest that allow private practice, or non-VA physicians to see veterans. They are:
- Choice Act
To become part of PC3 and/or Choice Program Network of Providers
- All PC3 providers are automatically eligible to participate in the Choice Program
- If a provider is interested in becoming a PC3 provider, they must establish a contract with one of the Third Party Administrators (TPAs), Health Net or TriWest.
- TPA and provider must have an agreed upon reimbursement amount
- If a provider is not interested in becoming a PC3 provider, but wants to become a Choice provider, they must establish a provider agreement with Health Net or TriWest
- Providers must accept Medicare rates
- Providers must meet all Medicare Conditions of Participation and Conditions for Coverage as required by the U.S. Department of Health and Human Services. See CMS website for further details.
- Any provider on the Centers for Medicare and Medicaid Services (CMS) exclusionary list shall be prohibited from network participation.
- All services, facilities, and providers shall be in compliance with all applicable federal and state regulatory requirements.
- All providers shall have a full, current, unrestricted license in the state where the service(s) are delivered and must have same or similar credentials as required by VA staff.
- Providers must submit a copy of the medical records to the TPA for the medical care and services provided to the Veteran for inclusion in the Veterans VA electronic record.
Here is a link to the complete interested provider fact sheet with contact information for the TPAs: http://www.va.gov/opa/choiceact/documents/FactSheets/Fact-Sheet-For-VACAA-Providers.pdf
MEDICARE AND MEDICAID CELEBRATE 50 YEARS: Medicare and Medicaid were enacted by federal law on July 30, 1965. Before the passage of the Social Security Amendments of 1965, about half of Americans age 65 and over lacked health insurance, forcing them to pay out of pocket or forgo needed care. Today, that figure is two percent. On its 50th anniversary, Medicare covers more than 55 million Americans, with over one million covered in Arizona. As of May 2015, Medicaid provides comprehensive coverage to about 70 million eligible children, pregnant women, low-income adults, people living with disabilities, and seniors. A recent Medicare Trustees report projected that the Medicare trust fund financing hospital insurance coverage will remain solvent until 2030.
ARIZONA LAW AND PHYSICIAN ASSISTANT SUPERVISION: Do you have or are you thinking of bringing physician assistants into your practice? Arizona law sets forth requirements for physician assistant (PA) licensing, scope of practice and physician supervision of PAs. As a reminder, the pertinent laws include ARS 32-2531 and 32-2533, and include the following points:
- The physician assistant may provide any medical service that is delegated by the supervising physician if the service is within the physician assistant's skills, is within the physician's scope of practice and is supervised by the physician.
- The physician assistant may perform health care tasks in any setting authorized by the supervising physician, including physician offices, clinics, hospitals, ambulatory surgical centers, patient homes, nursing homes and other health care institutions.
- Supervision must be continuous but does not require the personal presence of the physician at the place where health care tasks are performed if the physician assistant is in contact with the supervising physician by telecommunication. If the physician assistant practices in a location where a supervising physician is not routinely present, the physician assistant must meet in person or by telecommunication with a supervising physician at least once each week to ensure ongoing direction and oversight of the physician assistant's work. The board by order may require the personal presence of a supervising physician when designated health care tasks are performed.
- A supervising physician shall not supervise more than four physician assistants who work at the same time.
- A supervising physician shall develop a system for recordation and review of all instances in which the physician assistant prescribes schedule II or schedule III controlled substances.
We encourage you to review the complete law, available online at http://www.azleg.gov/ars/32/02531.htm and http://www.azleg.gov/ars/32/02533.htm.
NORIDIAN PROVIDES GUIDANCE ON PATIENT OXYGEN: The Comprehensive Error Rate Testing (CERT) contractor has identified multiple errors in the claims received for oxygen equipment and supplies. Your medical record documentation determines whether your patient can receive the oxygen equipment and supplies you have prescribed and the amount of the patient's out of pocket expenses. Your medical record documentation must show that other alternative treatments (e.g., medical and physical therapy directed at secretions, bronchospasm and infection) have been tried or considered and deemed clinically ineffective. The documentation must show the patient was seen within 30 days prior to the start of oxygen therapy. The medical record must show the medical condition necessitating the home use of oxygen therapy. The medical record and/or prescription would indicate the oxygen flow rate (e.g., 2 liters per minute), and the estimation of the frequency (10 minutes per hour), duration of use (12 hours per day) and duration of need (6 months.) You must specify the type of oxygen delivery system to be used (i.e. portable/stationary concentrator, compressed gas portable/stationary, liquid portable/stationary.) Medicare can make payment for home oxygen supplies and equipment when the patient's medical record shows the patient has significant hypoxemia and meets medical documentation, test results, and health conditions as specified in the CMS Internet-Only Manual (IOM) Publication 100-03, Section 240.2. You must complete and sign Form CMS-484 (Certificate of Medical Necessity (CMN): Oxygen.). However, the CMN itself is not considered part of the medical record. All information included in the CMN must be supported by the contemporaneous medical record. You can find instructions on completing this form in the CMS IOM Publication 100-08, Chapter 5.
ACS CHALLENGES SURGEON RATINGS: With the rollout this week of a ProPublica database calculating complication rates for 17,000 surgeons around the country, the American College of Surgeons [ACS] has released a statement cautioning against the perceived usefulness of the data. The following is excerpted from the ACS statement. "[ACS] strongly believes that patients and their families deserve to have meaningful information available to assist them in selecting the right surgeon. This week, two public interest groups launched websites promising to assist with surgeon evaluation. Unfortunately, the usefulness of the information they shared is questionable for a number of reasons. The two groups used differing methodologies, including how many years of Medicare data they reviewed, procedures studied, and rating scales used. A patient who visited both websites could potentially find the same surgeon rated very differently or only find a surgeon on one of the two websites. Use of clinically validated data would have more fully taken into account the severity of the patient's condition when assessing surgeon performance...Without factoring in surgeons' success rate with the more challenging patients, the potential for wrongly directing patients away from these surgeons certainly increases. And as troubling, some insurers might restrict access to these surgeons in the future. The importance of relying on clinical data to accurately measure surgeon performance is well documented in scientific literature, and clinical registries are considered the standard for collecting this information...Collection and dissemination of accurate clinical data, however, is a shared responsibility because it is a labor- and cost-intensive process. Private payors, government, professional societies, and public interest groups-all of whom are invested in transparency-must share this responsibility. Two other issues bear consideration. First, surgery is a team experience. The surgeon works closely with the anesthesiologist and surgical nurses during an operation. While using clinical data can get us closer to measuring surgical performance, the reality is that in the operating room, many factors and many individuals contribute to the surgical outcome. Rating a surgeon's skill in performing a particular operation, without factoring in these other considerations, leads to an incomplete analysis. Second, we must ask ourselves how much data is helpful to a patient's decision. The American College of Surgeons fully supports sharing the right data with the right person at the right time." Read the complete ACS statement here. The ProPublica database and commentary are available here.
ADHS NOTICE: The latest newsletter from the Arizona Immunization Program Office features vaccine news, updates on vaccine safety, literature and other resources, including: New CDC Recommendations about Nine-Valent Human Papillomavirus Vaccine; Measles-induced Immune Suppression May Increase Childhood Infectious Disease Deaths Strategies to Decrease Pertussis Transmission to Infants; First Dose of Pertussis Vaccine in Infancy Helps to Prevent Infant Mortality; Early, Full Hepatitis B Vaccination Is Protective against Perinatal Transmission; Vaccine Status of Patients in 2015 United States Measles Outbreak; FDA Sentinel Study Finds No Association with 4vHPV Vaccine and Blood Clots; and Another Large Study Again Shows No Link between MMR and Autism. The complete newsletter is available on the ADHS website.
ORGANIZATIONS BRING LAWSUITE TO THROW OUT SB1318: A new Arizona law, SB 1318, would require physicians to tell their patients both on the phone and in person that it "may be possible" to reverse the effects of a medical abortion. It was scheduled to take effect July 3, 2015. In June, a lawsuit was filed against the legislation by Planned Parenthood and three Arizona physicians. The lawsuit alleges the law violates physicians' First Amendment rights since it forces them to communicate "a state-mandated message that is not medically or scientifically supported." The lawsuit further alleges the law violates patients' 14th Amendment rights because they are getting "false, misleading and/or irrelevant information." The Arizona Medical Association (ArMA) has determined SB 1318 requires physicians to present non-peer reviewed, questionable medical information that could be both misleading and dangerous for patients. In accordance with that position, ArMA has joined as amicus the American Medical Association (AMA) and the American Congress of Obstetricians and Gynecologists (ACOG) in support of legal action to stop implementation of the requirements set forth in SB 1318. Although state attorneys agreed not to enforce the law until mid-September, when the U.S. District Court judge will be able to hold hearings and make a decision on the lawsuit, the Attorney General's Office representing the Arizona Medical Board and ADHS Director Dr. Cara Christ have filed with the court a request to throw out the lawsuit, contending that it should only proceed if a physician refuses to make the required statement. Comprehensive media coverage of the legal filings is available here.
2016 PHYSICIAN FEE SCHEDULE RELEASED: CMS has issued the first proposed physician fee schedule following the passage of the Medicare Access and CHIP Reauthorization Act (MACRA) earlier this year. MACRA repealed the sustainable growth rate (SGR) payment formula and set the stage for a shift towards value-based payment models. The proposed rule released this week includes an overall 0.5 percent increase in Medicare payments to physicians, although some specialties will see cuts (i.e. gastroenterologists, radiation oncologists) and others will see a significant increase (i.e. pathologists). The proposed rule also calls for payment for end-of-life counseling. CMS will accept public comments on the proposed rule until September 8. More detailed media coverage is available here.
LAW ON SELF-REFERRED LABORATORY TESTING: Arizona recently passed a law that allows a person to obtain any laboratory test from a licensed clinical laboratory on a direct access basis without an order if the laboratory offers that laboratory test to the public on a direct access basis. The law also requires the report of the test results to be provided by the lab to the person who was the subject of the test. The report must state in bold type that it is the responsibility of the person who was tested to arrange with the person's "health care provider" for consultation and interpretation of the test results. The law further provides that if the provider did not order the laboratory test:
- The provider's duty of care to a patient does not include any responsibility to review or act on the laboratory test result;
- andThe provider is not subject to the liability or disciplinary actions for the failure to review or act on the results of the laboratory test.
- A provider has no duty to review and act on such test results.
It’s likely some patients who obtain direct access labs will have them sent to their providers whether or not they request interpretation. Until a patient requests that it be interpreted as part of a consultation, there is no duty to review it and act on it. However, if you voluntarily or inadvertently review the test results, you have likely assumed a duty and therefore potential liability to the patient for failure to appropriately review and/or act upon the results. As to whether a provider may refuse to interpret the test results on request with a patient, it may be acceptable to refuse if the test is outside of your scope of practice, if the patient refuses to make an appointment, or refuses to pay for the consultation. On the other hand, some providers may be pleased that their patients are proactively engaged in their own care, which is one of the claimed benefits of the law, and decide to review and follow-up on the results without a request for consultation or payment. However, if the patient is willing to comply with the law and arrange for a consultation, and the test is within the scope of your practice, a refusal could be a violation of the law and medical practice acts.
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.
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.
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.
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.