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Medigram - April 24, 2008


TOP STORY

Workforce issue survey deadline extended to April 30

The Wisconsin Medical Society, in partnership with the Wisconsin Council on Medical Education and Workforce and the Wisconsin Hospital Association, would like to thank the physicians of Wisconsin for such an enthusiastic response to the surveys e-mailed March 31.

More than 1350 physicians have already responded to the survey. Preliminary results indicate some strong opinions about the physician workforce in Wisconsin, including:
  • 11 percent of physicians surveyed are very satisfied with their current practice environment, and 25 percent were either dissatisfied or very dissatisfied.
  • 32 percent of physicians surveyed are dissatisfied with the balance between the number of hours worked per week and their ability to pursue home life or personal interests, and nearly 10 percent were very dissatisfied.
  • While more than 50 percent of physicians surveyed are not contemplating changing a decrease in their clinical hours over the next three years, 17 percent were uncertain.
“In addition to the objective data, we’ve received a wealth of anecdotal testimony about the physician workforce environment,” said the Society’s Senior Vice President of Quality and Efficiency Nancy Nankivil.

The deadline for the surveys has been extended to April 30 to encourage anyone who has not fully completed the survey to do so. Chief Medical Officers are especially encouraged to revisit the survey or finish an incomplete survey so the results can accurately reflect the Wisconsin workforce.

If you have questions about the surveys, please contact Nancy Nankivil.

NEWS BRIEFS

GAO report: Bush administration’s directive on SCHIP violates law

The Government Accountability Office (GAO) reported in an opinion last week that the Bush administration overreached last August when it blocked states from covering more uninsured children under the State Children’s Health Insurance Program (SCHIP).

The opinion, which can be read here, states that the administration violated the Congressional Review Act when it implemented new rules without a public comment period or congressional approval. (In addition, the Congressional Research Service issued this opinion with a similar finding in January 2008.) Instead, according to this AP report, “the administration sent a letter to state health officials informing them of the changes they were making to the program.”

Several states have filed suit against the federal government over the directive. And in light of the report, Senators Jay Rockefeller (D-W.Va.) and Olympia Snowe (R-Maine) issued this press release calling for the Centers for Medicare and Medicaid Services (CMS) to rescind the rule. It is important to note, however, that the GAO opinion is not legally binding, and CMS has indicated that the directive will go into effect as planned.

To read additional media coverage of the GAO opinion, click on the following links:
“Bush’s SCHIP policy violates law, report says” (The Hill)
“President is rebuffed on program for children” (The New York Times)


CMS proposes to expand quality program for hospital inpatient services

The Centers for Medicare & Medicaid Services (CMS) last week proposed additional steps to strengthen the tie between the quality of care provided to Medicare beneficiaries and payment for the services provided when they are in the hospital.

CMS proposes expanding the list of conditions that are reasonably preventable through proper care and for which Medicare will no longer pay at a higher rate if the patient acquires them during a hospital stay. In addition, CMS is adding 43 new quality measures for which hospitals will have to report data in order to receive the full annual payment update for their services.

The proposed rule would apply to services provided to patients who are discharged from the hospital during fiscal year (FY) 2009, which begins on October 1, 2008. It would apply to more than 3,500 acute care hospitals paid under the Inpatient Prospective Payment System (IPPS).

The proposed rule is scheduled for publication in the Federal Register April 30, but it can be viewed here now. Comments on the proposed rule will be accepted through June 13. CMS will respond to comments in a final rule to be issued on or before August 1, 2008. For more information, click here.


OIG issues letter detailing changes to self-disclosure protocol

Inspector General Daniel R. Levinson issued an open letter to health care professionals last week announcing that the Office of Inspector General (OIG) for the Department of Health and Human Services has refined the requirements of the OIG Provider Self-Disclosure Protocol, under which health care providers can voluntarily report fraudulent conduct affecting Medicare, Medicaid, and other Federal health care programs.

The Self-Disclosure Protocol provides guidance to health care professionals who voluntarily disclose federal health care program compliance issues that may potentially violate federal criminal, civil, or administrative laws for which exclusion or civil monetary penalties are authorized. According to the open letter, health care professionals who disclose in good faith, fully cooperate with OIG, and provide requested information in a timely manner will generally not be required to enter into Corporate Integrity or Certification of Compliance Agreements with OIG.

The open letter also sets forth four additional self-disclosure submission requirements and emphasizes OIG’s commitment to streamline its internal process for self-disclosure case resolution. Click here to read the open letter.

NEWSMAKERS

Smith to receive UW-Madison 2008 Distinguished Alumni Award

Society member Linnea Smith, MD, of Black Earth is being honored with a 2008 Distinguished Alumni Award from the Wisconsin Alumni Association. Doctor Smith is the founder of the Yanomono Medical Clinic in Peru. Following a vacation to the area in 1990, she left behind a successful medical practice in Wisconsin to found a clinic for people who previously had to travel 50 miles by canoe to find a doctor. Doctor Smith earned her bachelor’s degree and medical degree from UW-Madison. She was previously recognized by the Society as a Physician Citizen of the Year.


Bailet appointed to AMA group practice advisory group

Society member Jeffrey W. Bailet, MD, of Lake Geneva, has been appointed to the American Medical Association’s Advisory Committee on Group Practice Physicians. Doctor Bailet, an otolaryngologist, is president of Aurora Medical Group.

The advisory committee, which is comprised of representatives from 11 group and faculty practices throughout the country, advises the AMA Board of Trustees on policy matters relating to group and faculty practices.


Waukesha physician elected President, Wisconsin Council of Child and Adolescent Psychiatry

Society member Joseph O’Grady, Jr., MD, of Waukesha, has been elected president of the Wisconsin Council of Child and Adolescent Psychiatry (WCCAP).

Doctor O'Grady, who has served on the WCCAP executive board for six years as secretary and treasurer, is assistant professor of psychiatry and behavioral medicine in the division of child and adolescent psychiatry at the Medical College of Wisconsin. He has been with the Medical College since 1991, and practices at the Tosa Center Campus Clinic.

The WCCAP, which is a regional organization of the American Academy of Child and Adolescent Psychiatry (AACAP), is comprised of more than 100 child and adolescent psychiatrists in Wisconsin. It promotes mental health in children, adolescents and families through research, training, advocacy, prevention, comprehensive diagnosis and treatment, and peer support and collaboration.

CAPITOL INSIDER

Budget repair agreement: still waiting

While talks apparently continue among Senate Majority Leader Russ Decker (D-Weston), Assembly Speaker Mike Huebsch (R-West Salem) and Governor Jim Doyle over how to fix a $652 million biennial budget deficit (or $525 million, depending how different media outlets total the deficit), it is unclear if an actual agreement is imminent despite some of the players professing progress. The Legislature could come back to Madison as soon as next week to vote on a Great Lakes compact, so action on a budget agreement during that special session would be convenient.

Some news coming from the talks centers on areas of disagreement rather than accord. A weekend story in the Wisconsin State Journal suggested that a tax on hospital gross receipts—an option supported by the Governor and Senate Democrats—could be dead. Meanwhile, the Governor frowns upon one of the lone areas of DEM-GOP legislative agreement: postponing a school aids payment from this biennium into the next.

As the calendar moves toward election season (which historically kicks into full gear during July 4 parades), legislators face the possibly conflicting desires of fixing the budget deficit quickly, but doing so in a way that does not run afoul of political philosophy. Stay tuned to future Medigrams for the Society’s analysis of what potential impact a budget deficit agreement could mean for physicians and medicine.

For more information, contact Mark Grapentine or Jeremy Levin.

F.Y.I. FOR YOUR INSURANCE

PIC risk management teleconference and event updates April 29

Physicians and their staff members are invited to participate in a free teleconference next week that will focus on communication principles that can help avoid misunderstandings and potential claims. “Avoiding Miscommunications with Patients: Tips for Busy Practices” will be hosted by PIC Risk Management Consultant Kyle Fromm Tuesday, April 29 from noon to 1 p.m.

Participants must register by Friday, April 25 to receive call-in instructions. To register, call Susan Jacobson at 800.279.8331, ext 8347. For more information, click here. And to see a full listing of PIC Risk Management events scheduled throughout the year, click here.

For your everyday insurance needs, contact a Wisconsin Medical Society Insurance and Financial Services agent at 866.442.3810 or complete this on-line contact form.

QUALITY CORNER

PQRI national provider conference call with Q&A April 30

The Centers for Medicare & Medicaid Services’ (CMS) Provider Communications Group will host the second in a series of national provider conference calls on the 2008 Physician Quality Reporting Initiative (PQRI). This toll-free call will take place from 12:30 p.m. – 2:30 p.m., Wednesday, April 30.

PQRI law now allows CMS to offer:
  • New reporting approaches that give physicians more options to successfully participate;
  • New, alternate reporting period to allow physicians to begin reporting as late as July 1, 2008, and still receive an incentive payment (1.5 percent of allowable charges for services provided from July 1 through December 31, 2008); and
  • New option to submit quality measures data to CMS through a qualified, established clinical data registry, in which physicians may already be participating.
The new law also removed the limit on the incentive (which was based on the actual volume quality measures data reported) for the 2008 reporting period. In 2007, this cap may have reduced a successful participant’s incentive below 1.5 percent.

A PowerPoint presentation will be posted to the PQRI Web page to download prior to the call. Participants must register to receive call-in information. Registration will close at 12:30 p.m. April 29, or when available space has been filled. To register, click here.

A replay option will be available from 2:30 p.m. April 30 through May 7. To listen to the replay, call 800.642.1687; the passcode is 42860144.

FAQ

Question:
At the “Mastering Medicare in 2008” seminar, I was told that we could not bill Part B for the Zostavax vaccine. In fact, I was told it may be considered abuse. Please advise on correct or acceptable billing for Zostavax.

Answer:
Since Zostavax is not covered by Medicare Part B, it is not necessary to submit a claim, nor should the provider routinely submit a claim to Medicare Part B for this service. Only in those infrequent situations such as when the beneficiary does not have Medicare Part D, should a claim for Zostavax be submitted to Medicare Part B.

This question was submitted following a Medicare seminar hosted by the Wisconsin Medical Society. To view other questions submitted and their answers, click here.

For answers to other Frequently Asked Questions about coding matters and more, click here to review our Education Department’s FAQ archive, or e-mail efaq@wismed.org.