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Medigram - July 10, 2008


TOP STORY

Stunning Senate Medicare vote would prevent reimbursement cut; veto coming?

In a dramatic series of events, the U.S. Senate voted Wednesday 69-30 to approve HR 6331, which prevents the 10.6 percent Medicare physician reimbursement cut scheduled to take effect July 1. The margin is considered “veto-proof”—greater than the 67 votes needed to override a threatened presidential veto.

Senate debate began on another motion for “cloture,” or an end to debate, which requires 60 votes. Before leaving for the July 4 recess, the Senate mustered only 59 votes for cloture—an extremely close margin, especially considering the absence of a sure “aye” vote: that of Sen. Ted Kennedy (D-Mass.) who has been recovering from June brain surgery and was not expected to return to the Senate until September.

Rhetoric beginning the debate was much the same as it was for the failed June vote: Democrats decrying the scheduled cuts as disastrous to Medicare access, and some Republicans lamenting the bill’s cuts to Medicare Advantage plans and an inability to offer amendments to the bill. Another close-but-not-enough vote tally seemed certain. Roll call on the cloture vote began at 3:10 p.m.

Roll call votes in the Senate are still done by hand, with a clerk checking a box on a long sheet of paper. The process takes a while. At 3:15 p.m., Sen. Kennedy made a dramatic entrance onto the Senate floor, with a prolonged standing ovation spreading through the chamber. After a few minutes of greetings, Kennedy went to the clerk’s table, voted “aye,” and pumped both fists in the air.

A group of Republicans who had not yet voted then convened on one corner of the Senate floor. Among the group were senators from states where the AMA had targeted grassroots and media efforts in support of the bill—states where Republican senators are facing reelection (including Texas, Georgia, Tennessee and Florida). It became clear that the cloture motion would prevail on the strength of Sen. Kennedy’s arrival, and these senators each went to the clerk, voting “aye.”

Wisconsin’s Senators Feingold and Kohl once again listened to physicians asking for “aye” votes. Both voted to end debate and for passage of the bill. HR 6331 extends current reimbursement levels through the end of the year, and adds a 1.1 percent increase for 2009. To read a section-by-section summary of the bill, click here. Read a reaction to the vote from Wisconsin Medical Society President Steven Bergin, MD, here. Read the AMA’s reaction to the vote here. For more background on the flawed Medicare reimbursement system, click here and here to read articles written by Iowa physician Michael Kitchell, MD.

What’s next?
 President Bush could follow through on his veto threat, meaning an override vote would be required in both chambers. But with the margins for passage (the bill passed 355-59 in the House two weeks ago) surpassing the two-thirds total needed for an override, prospects are good that the bill could become law, notwithstanding the President’s objections.

Wednesday’s vote is a major victory for organized medicine. It shows the power physicians can wield when raising their voice and getting involved in the political process. Please take the time to contact Senator Kohl (202.224.5653) and Senator Feingold (202.224.5323) to thank them for their votes on HR 6331. Congressional offices rarely get thank you calls from constituents; doing so is easy and can have long-lasting positive effects.

Stay tuned to Medigram to learn if or when it is time to contact your U.S. House members to ask for an override vote. For more information, contact Mark Grapentine.

NEWS BRIEFS

Wisconsin Medicaid warns of denials on crossover claims

The Wisconsin Medical Society received confirmation from Wisconsin Medicaid that physician crossover claims submitted to Medicare may be denied by Medicaid. The reason for these denials is the lack of taxonomy codes forwarded to Medicaid by the Medicare Part B Carrier. Not all crossover claims will be denied. The main issues are physician groups without a one-to-one NPI match, where taxonomy is needed to correctly identify the billing provider. In addition, Wisconsin Medicaid is denying claims in instances where the physician submitting claims has yet to report their NPI directly to Medicaid as the provider cannot be identified.

The taxonomy issue is apparently being introduced upon acceptance of claims into the Medicare Part B contractors’ system and is resulting in instances where the provider taxonomy code, even when reported on the incoming claim, is not being carried through to the outbound 837 professional crossover claims process.

The Centers for Medicare & Medicaid Services (CMS) has been contacted about the issue. Current estimates are that a fix should be in production by the early part of August 2008 to rectify this situation. CMS will provide further updates if this timetable changes.

Automatic crossover claims received by Medicaid from Medicare on and after May 19, 2008, were released for processing beginning June 27, 2008. Claims were denied to the submitting electronic billing vendor in those instances where Wisconsin Medicaid was unable to identify the provider. These claims will not appear on a Remittance and Status Report. Providers should not resubmit their claims until they have received and reviewed their Remittance and Status report dated July 13, 2008. If crossover claims submitted on or after May 19, 2008, do not appear on a Remittance and Status Report, the claims will need to be resubmitted as provider initiated crossover claims directly to Medicaid. If the claims are resubmitted to Medicaid with only an NPI, please be sure that the NPI has been reported to Wisconsin Medicaid and that the claim includes the taxonomy and ZIP+4 code associated with the NPI on the claim.

If you have questions related to this issue, you may contact Provider Services at 800.947.9627 or 608.221.9883.


Wisconsin Medical Journal calls for papers on health care reform

To coincide with Society President Steven Bergin’s presidential theme, the December issue of the Wisconsin Medical Journal will focus on health system reform. The Journal is currently soliciting manuscripts about topics that emphasize ideas and approaches to health system reform, including new models of care and essential economic and organizational challenges for medicine in this state and country. To be considered for this issue, manuscripts must be received by August 15, 2008. Click here for instructions to authors. E-mail wmj@wismed.org for more information.


Updated Policy Compendium now on-line

The Wisconsin Medical Society 2008 Policy Compendium is now available on-line. The Compendium contains nearly 400 policies, which reflect the efforts of the House of Delegates (HOD), the Strategic Councils and Policy Panel and contributions from individual members. New and revised policies are identified at the end of each policy as follows: (HOD 04/08). For more information, contact Karen Carney or Beth Alvin.


AMA seeks Hispanic physician nominees for political leadership seminar

The AMA Minority Affairs Consortium is seeking Hispanic physicians to attend a political leadership seminar October 3-5 in Washington, DC. Based on the popular AMA-AMPAC Campaign School, this two-day seminar will provide Hispanic physicians with strategies and practical tools for effective political involvement and leadership.

At less than 3 percent of U.S. physicians, Hispanic physicians are significantly underrepresented in the profession. In addition, they often face unique challenges in the delivery of health care to their patients and frequently serve as the first line in providing care to Hispanic patients, an emerging majority of the U.S. population. Here are the main details regarding the seminar:
  • The AMA will cover all travel, housing and registration expenses for the selected participants.
  • Candidates must be of Hispanic origin and AMA members.
  • Candidates will be accepted by nomination only.
  • The application deadline is August 1, 2008.
To learn more, click here or request an information packet by e-mailing or calling 312.464.5622.


Save the date: AMPAC workshops schedule for 2009

The American Medical Association’s Political Action Committee (AMPAC) will hold its 2009 Candidate Workshop on February 13-15 and Campaign School on April 15-19. These programs provide political training for AMA member physicians and other friends of medicine who are interested in either seeking public office themselves or in working to elect allies. Both programs will be held at the Ritz-Carlton Pentagon City in Arlington, VA, near Reagan National Airport. You can view the AMPAC brochure for these workshops here. To apply for the program, complete this form.

AMPAC covers all costs for current AMA members, except transportation to Washington. If you have any questions please contact Jim Wilson at 202.789.7465.

YOUR PRACTICE. YOUR FUTURE.

DEA proposes regulations to allow e-prescribing of controlled substances

The Drug Enforcement Agency (DEA) published proposed regulations on June 27, 2008 in the Federal Register that would provide physicians with the option of writing prescriptions for controlled substances electronically. A copy of the proposed regulations can be viewed here.

Current regulations require a paper prescription with a physician’s signature for controlled substances. The DEA has been under pressure to change its e-prescribing regulations for some time, but has been reluctant to do so because of concerns regarding security and drug diversion. Many think the paper prescription requirement for controlled substances has reduced the adoption of e-prescribing technology, as physicians often do not want to use two different systems for prescribing. In late 2007, 19 U.S. Senators sent a letter to the U.S. Department of Justice urging the DEA to address concerns rather than delaying adoption of new e-prescribing regulations.

The new regulations focus largely on electronic security and authentication. If finalized, the new regulations would require physicians to undergo identity proofing, a process that would require face-to-face contact with an authorized entity, such as a DEA-registered hospital that previously granted a practitioner privileges or a state licensing board. Physicians would also be required to review monthly a log of prescriptions issued utilizing their DEA number.

Additionally, e-subscribing systems would be required to meet stringent security requirements, such as two-factor authentication, prohibitions on the ability to print prescription and automatic sign off after two minutes. The DEA would hold a prescriber of a controlled substance responsible if a prescription was transmitted electronically on a system that did not meet the requirements of the DEA regulations.

The DEA is soliciting comments on the proposed regulations. Written comments must be postmarked, and electronic comments must be sent, on or before September 25, 2008. Written comments sent via regular or express mail should be sent to Drug Enforcement Administration, Attention: DEA Federal Register Representative/ODL, 8701 Morrissette Drive, Springfield, VA 22152. Comments may be sent directly to DEA electronically by e-mailing dea.diversion.policy@usdoj.gov or by completion of a comment form.

QUALITY & EFFICIENCY

WHIO: A public-private collaboration in health care transparency

As part of Medigram’s continuing series of articles about the Wisconsin Health Information Organization (WHIO) and its role in health care transparency efforts underway in Wisconsin, this week's installment focuses on the State of Wisconsin’s involvement in WHIO. Previous installments include topics addressed at the Wisconsin Medical Society’s June 24 Quality Forum along with insight from Society CEO Susan Turney, MD, and Society members John Hartman, MD, and Tim Bartholow, MD, about different aspects of WHIO. Click here to read more.

CAPITOL INSIDER

Election matchups set for November

The November election slate is now almost completely set, as candidates for state and federal offices were required to file nomination papers with the state's Government Accountability Board on July 8. At least five state senators and 17 State Assembly representatives are will run unopposed, leaving 11 Senate and 82 Assembly races contested this fall. That number may be reduced, however, if some filings fail to reach the minimum number of required signatures (this could affects one senate primary and two assembly races).

Three physicians have filed for election: incumbent Rep. Chuck Benedict, MD, (D-Beloit) is running for a third two-year term. Rep. Sheldon Wasserman, MD, (D-Milwaukee) has left his State Assembly seat to run for the 8th Senate District slot currently held by Sen. Alberta Darling (R-River Hills). Former Society Board Chairman Thomas Luetzow, MD, (R-Watertown) faces a three-way Republican primary in a bid to unseat incumbent Democrat Andy Jorgensen (D-Fort Atkinson).

Individual races determine which party will control each of the two legislative houses. Conventional wisdom says Democrats will likely continue to hold the majority in the State Senate, although the current 18-15 margin could change. The State Assembly is the wild card this election season, with the slim 52-47 Republican majority up for grabs. An extra twist was revealed yesterday, when incumbent State Rep. Jeff Wood (I-Chippewa Falls) announced that he would run for reelection as an independent, shedding his former Republican affiliation. Read an article about that decision from the Leader-Telegram here.

On the federal front, all eight Wisconsin members of the U.S. House of Representatives face challengers: Rep. Jim Sensenbrenner (R-Menomonee Falls) has both a primary and an independent challenger; Rep. Gwen Moore (D-Milwaukee) drew an independent opponent. The most hotly contested general election race will likely be seen in the 8th House district, with freshman Rep. Steve Kagen, MD (D-Appleton) facing a rematch against former State Assembly Speaker John Gard (R-Suamico). Kagen prevailed in the 2006 contest on a 51-49 percent margin.

For a list of all candidates, including links to campaign Web sites, click here. For more information, contact Mark Grapentine, Jeremy Levin or Beth Alvin.

FOUNDATION FOCUS

Foundation announces 2009 grant opportunities

The Wisconsin Medical Society Foundation will award approximately $65,000 for 2009 programs. The Foundation’s Grant Program focuses on providing support for physician-led, community-based programs to improve health through education and outreach. The application deadline is Monday, October 13, 2008, and preference is given to those programs that include a letter of recommendation from a Society member and/or direct involvement of a Society member. Medical students are eligible to apply on behalf of their student organizations. For details and application materials, click here.



Pictured: Site Director Jenny Stevenson (left) with volunteers Janet Finn and Robert Durnin, MD, showcase the medical herb garden at the Fort Crawford Medical Museum. The garden is one of several new and improved exhibits made possible by a 2008 Foundation grant from the Earl and Alice Thayer Medical History Fund.

Foundation offers free public lecture
Menopause, Mood and Depression: What's a Woman To Do?

Research in the last decade demonstrates a clear link between the onset of menopause, mood disorders and depression. During that same time guidelines for hormonal replacement treatment to prevent or modify many of the symptoms and health problems linked to menopause have changed dramatically because of the risks attached to such replacement therapy approaches.

Menopause, Mood and Depression: What's a Woman To Do?, the 2008 Charles W. Landis, MD, Memorial Lecture will be held Thursday, September 27, 7-8:30 p.m. at the Monona Terrace Convention Center in Madison. For more details or to order information cards for your patients click here.

QUALITY CORNER

Open door forum July 15 to discuss PQRI participation

The Centers for Medicare and Medicaid Services (CMS), along with the American College of Physicians (ACP) will host a special open door forum to discuss participation in the 2008 Physician Quality Reporting Initiative (PQRI). This toll-free call at 2:30 p.m. Tuesday, July 15 will encourage PQRI participation and provide simple steps that physicians can use to collect and report quality data to be eligible for an incentive payment from CMS. Internists and/or a designated staff member, such as an office manager, are encouraged to participate on the call.

Call 800.837.1935 and enter reference conference ID 53531371 to participate in the forum. Space is limited, so dial in early.

An audio recording of this forum will be posted to the Special Open Door Forum Web site and will be available beginning July 22.

FAQ

Question:
How much notice must a physician give if he or she wishes to discontinue providing care to a patient?

Answer:
Once a physician-patient relationship is established, the physician is obligated to treat the patient until the relationship is terminated or risk violating the malpractice tort known as “abandonment.” While physicians are generally under no obligation to accept patients, once the relationship is established the physician must continue to be available to treat or arrange for treatment of the patient and can be held liable for any resulting harm the patient suffers. Physicians should notify patients in a clear and proper manner when terminating the physician-patient relationship, and should consult any managed care contracts to determine if other requirements must be met.

To read the rest of the answer, click here.