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Medigram - July 12, 2007


TOP STORIES

State budget: Conference Committee members named; IPFCF raid in play

State Legislative leadership named the eight members who will serve on a special conference committee tasked with rectifying different versions of the 2007-2009 biennial state budget. Committee membership will be Senators Judy Robson (D-Beloit), Russ Decker (D-Weston), Bob Jauch (D-Poplar) and Scott Fitzgerald (R-Juneau) and Assembly Representatives Mike Huebsch (R-West Salem), Jeff Fitzgerald (R-Horicon), Kitty Rhoades (R-Hudson) and Jim Kreuser (D-Kenosha). This follows Tuesday night’s action, when the Republican-controlled State Assembly passed its version of the budget, dramatically altering the version passed June 26 in the Democratic-run State Senate.

The Assembly version of the budget removes the $175 million transfer from the Injured Patients and Families Compensation Fund as well as the gross receipts tax on hospitals. That version also removed the proposed $1.25 per-pack increase in the cigarette tax - an increase the Society strongly supports. Another major difference in the Assembly budget is removal of the Senate Democratic "Healthy Wisconsin" health care reform proposal.

The committee will meet until it agrees on a final version of the budget, which would then go to each house for approval. Elements from both budget versions will likely constitute the final product. This means that even with the Assembly's action, the Fund could still be at risk.

Act now to protect the Fund!

Even if your senator and representative are not on the conference committee, all of the legislature’s caucuses will be meeting to prioritize items in the budget, and all 132 legislators need to hear from physicians and patients:
  • The Fund is for injured patients and their families, helping pay for costs due to a medical injury. The Fund’s actuaries predict that suddenly taking $175 million would jeopardize the Fund’s stability.
  • The Fund is a major pillar supporting Wisconsin's relatively stable medical liability climate.
  • There are no general tax dollars in the Fund. It is fully funded through annual fees physicians, hospitals and certain nurses are required to pay for this “umbrella” insurance.
  • Taking money from this Fund outside of its purpose may be illegal.
  • Keeping the Fund whole is a health care priority, and they should tell their leadership to prevent a raid.
Find who represents you here. For more information, contact Mark Grapentine, Jeremy Levin or a Membership Field Director.


Society to officially launch new Web site Monday

The Wisconsin Medical Society officially launches its redesigned Web site on Monday, July 16. In addition to a better search function and easier usability, the site will also serve as an entry point to DRconnection, the Society’s new physician information repository.

DRconnection holds demographic data including specialty, license number, education, practice information, hospital affiliations and more for all Wisconsin physicians. This information will be used to support
  • State health care quality improvement efforts
  • Workforce planning
  • Administrative simplification by making it easier for physicians to maintain and transfer their own information to hospitals, clinics, state government, health plans and other relevant entities
  • An on-line physician directory accessible by the public as a source for physician practice information
Demographic information can be easily updated by the physician on an ongoing basis, and all physicians are urged to do so. Watch the mail the week of July 23 for an oversized envelope labeled “DRconnection materials enclosed.” This will contain your unique username and password, along with step-by-step instructions for updating your information.

The launch of DRconnection marks a critical first step in the Society’s initiative to promote practice-level quality improvement that will ultimately lead to real change in our health care system. If you have any questions or would like additional information, please e-mail drconnection@wismed.org.

NEWS BRIEFS

Don’t waste good medicine!

Wisconsin has a fledgling new repository designed to let patients donate unused medicines rather than throwing them out. Each year a vast number of unused prescription drugs are discarded and destroyed once cancer and chronic disease patients no longer require them. The Cancer and Chronic Disease Drug Repository allows people to donate unused medications to participating pharmacies or medical facilities for eventual dispensing to uninsured or under-insured patients.

There are only 19 local community and clinic pharmacies participating out of the approximately 1000 pharmacies across the state, so physicians are being asked to become advocates in their communities or organization/institution by promoting the Repository and encouraging local pharmacies and hospice and nursing home facilities to become program participants.

Becoming a drug repository program participant or donor is quick and easy. Just log on to http://dhfs.wisconsin.gov/bqaconsumer/cancerdrugreposy.htm and complete the appropriate form.

For more information, e-mail the Bureau of Quality Assurance at Plicnsghomesfdds@dhfs.state.wi.us, attention Doug Englebert.


Physician volunteer sought for anti-global warming group

The environmental advocacy group Clean Wisconsin is creating a global warming task force consisting of researchers and scientists, and would like to include a physician member as well.

“We are seeing it as a way to get more of the research data regarding the impact of climate change in Wisconsin out to the public in an accessible form,” says group member Karen Stevenson. Stevenson estimates that this commitment would likely involve meeting two to four times per year. The goal would be to synthesize research information and conclusions from the various group members into a report that could inform and influence the Governor's Task Force on Climate Change, as well as be released to the media.

If you are interested in participating, please contact Dana Jansen.


Health literacy input sought

Health literacy is defined in Healthy People 2010 as “...the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions.” Iowa Health System is in the process of creating a guidebook for health care organizations to address this issue, and they are soliciting input.

You are invited to complete a brief 14-item on-line survey of your perceptions about what is needed to address health literacy in your organization. It will only take a few minutes, and your input will be helpful in designing the format and content of the guidebook. The deadline is Friday, July 13.

To access the survey, simply click on this link. If you have any problems taking the survey, please contact Amanda Schill at schillal@ihs.org. And if you have questions about the survey’s content, contact Dr. Mary Ann Abrams at abramsma@ihs.org.



YOUR PRACTICE. YOUR FUTURE.

Law allows CMS to revoke Medicare enrollment and billing privileges for physicians convicted of certain felonies

The Centers for Medicare and Medicaid Services (CMS) can revoke a currently enrolled provider or supplier’s Medicare billing privileges based on a felony conviction within 10 years of enrollment or revalidation of enrollment. The regulation, 42 C.F.R. § 424.535 (which was published in the October 1, 2006 edition of the Federal Register), applies to felony convictions under state or federal law that “CMS has determined to be detrimental to the best interests of the program and its beneficiaries.”

Felonies listed in the regulation include the following:
  1. felony crimes against persons, such as murder, rape, assault and other similar crimes for which the individual was convicted, including guilty pleas and adjudicated pretrial diversions
  2. financial crimes such as extortion, embezzlement, income tax evasion, insurance fraud and other similar crimes for which the individual was convicted, including guilty pleas and adjudicated pretrial diversions
  3. any felony that places the Medicare program or its beneficiaries at immediate risk such as in malpractice suits that result in a conviction of criminal neglect or misconduct
  4. any felony that would result in mandatory exclusion under § 1128(a) of the Social Security Act (which includes program related crimes, crimes related to patient abuse or neglect, and conviction of a felony related to health care fraud or controlled substances)
Denial or revocation of enrollment is for a period to be determined by the Secretary but no less than 10 years from the date of conviction if the individual has been convicted on one previous occasion for one or more offenses.

It appears that CMS is applying this new regulation retroactively, which means that physicians are at risk for losing their Medicare privileges even if they received a felony conviction before the regulation was published last October.

Criminal convictions in Wisconsin for felony medical negligence offenses, such as the felony negligence charge filed last year against nurse Julie Thao, could result in a loss of Medicare enrollment and billing privileges according to this new regulation. In the case of State v. Julie Thao, the felony charge was ultimately amended to two misdemeanor offenses pursuant to a plea agreement.

Physicians who are concerned about how this change will affect them should contact their attorney.


WPS Medicare Part B clarifies E/M Table of Risk

Following inquires from the Wisconsin Medical Society Education Department, WPS Medicare Part B has provided clarification on two commonly asked questions pertaining to the E/M Table of Risk. The first question involved where six procedures fall within the table. MRI without contrast, CT without contrast and EMG are classified as “minimal” risk; MRI with contrast and CT with contrast are “low” risk; and epidural is “moderate” risk.

The second question related to the “Management Options Selected” column and whether options discussed (e.g. surgical interventions discussed, but not chosen) could be included in the selection of the appropriate level. WPS indicated that only management options that are acted on may be counted when assigning the level of risk.

If you have questions about this issue, please e-mail Society educator Penny Osmon, BA, CPC.

EDUCATIONAL PROGRAMS

Earn up to 17 CEUs in 2½ days

The 8th Annual Coding and Practice Management Symposium is just around the corner, and the Wisconsin Medical Society Education Department is pleased to announce that the American Academy of Professional Coders (AAPC) has approved this year’s Symposium for up to 17 CEUs. Featured topics at this year’s Symposium, which is October 14-16 in the Wisconsin Dells, include General Surgery, E/M, Healthcare Collections and much, much more! There truly is something for everyone. And if you register before September 7, you will receive an $80 discount. To view this year’s agenda and to register, click here or e-mail Laura Kritz for additional information.

FYI: FOR YOUR INSURANCE

CME available for ‘Medical Professional Liability Insurance: A Practitioner’s Primer’

Medical Professional Liability Insurance: A Practitioner’s Primer (Primer) is a continuing education program sponsored by the Physician Insurers Association of America (PIAA). Planned and developed in accordance with the ACCME’s Essential Areas and Policies, satisfactory completion of the activity’s examination qualifies for 2.0 hours of category 1 CME credit toward the AMA Physician’s Recognition Award (PRA). The PIAA is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to sponsor CME for physicians.

The primer is available through Wisconsin Medical Society Insurance and Financial Services. To receive a copy, call 866.442.3810 toll-free or use our on-line contact form. You can also contact any one of our agents who would be happy to deliver a copy to you.

To learn more about the complete line of products and services offered through Wisconsin Medical Society Insurance and Financial Services, click here.

FOUNDATION FOCUS

New donor recognition wall installed

The next time you are in the Wisconsin Medical Society headquarters, please take a moment to check out the newly installed Wisconsin Medical Society Foundation donor recognition wall. Located in the reception area, the wall includes both annual gifts and nameplates for individuals who have contributed $2500 or more over the last several decades.

“Our ability to increase support for scholarships and grants is the direct result of the generosity of our individual and corporate donors and we are very pleased to acknowledge their gifts in this way,” said Eileen Wilson, who oversees donor relations for the Foundation.

Annual donors will be updated on a yearly basis, while lifetime gifts will be updated bi-annually, giving the Foundation the opportunity to recognize ongoing generosity at the appropriate level. The most recent Society president and Presidential Scholar Award recipient are pictured behind the annual donor list, representing current and future leadership in medicine.

For information about your giving history or to make a contribution, contact Eileen Wilson at eileenw@wismed.org.

FAQ

Question:
If our physician admits a patient into the hospital who came in through the Emergency Department (ED) does that physician still have to mention all elements of the Past Family Social History (PFSH) if it is stated in the ED report?

Answer:
A review of systems (ROS) and/or PFSH obtained during an earlier encounter does not need to be re-recorded if there is evidence that the physician reviewed and updated the previous information. This may occur when a physician updates his or her own record in an institutional setting or group practice where many physicians use a common record. The review and update may be documented by:

  • Describing any new and/or ROS and/or PFSH information or noting there has been no change in the information; AND
  • Noting the date and location of the earlier ROS and/or PFSH.
The date and location of the earlier ROS and/or PFSH is key to the documentation and to a clinician.

If you have questions about this or other coding matters, click here to review the Society’s FAQ archives, or e-mail efaq@wismed.org.

QUALITY CORNER

Commonwealth Fund 2006 survey results indicate value of insurance coverage and medical homes

When adults have both health insurance coverage and a medical home, racial and ethnic disparities in access and quality tend to disappear. That’s according to a new Commonwealth Fund report entitled “Closing the Divide: How Medical Homes Promote Equity in Health Care.” The analysis—based on a Fund survey of more than 2830 adults nationwide—reveals that linking minority patients to a medical home can help them better manage chronic conditions and obtain critical preventive care. To read the report, click here.

Agency for Healthcare Research and Quality releases new evidence report on care coordination

AHRQ recently released Closing the Quality Gap: A Critical Analysis of Quality Improvement Strategies. This report shows how care coordination strategies that use family members, case managers, physicians and other clinicians to coordinate health care for a patient appear to improve patient outcomes. However, more research is needed to determine if it is more effective to coordinate care based on disease, health care setting, geographic region or payor.

Most studies that evaluated care coordination included patients with mental health conditions or heart failure. There is some evidence that care coordination strategies are cost-effective for patients with depression and decrease hospitalizations in elderly patients, but cost-effectiveness has not been well-studied for these and other diseases. A related white paper evaluates the use of care coordination strategies for children with chronic illnesses and physical, behavioral or emotional conditions that require complex health care services.

To access the report, click here; to access the white paper, click here. Or request print copies of both via e-mail: ahrqpubs@ahrq.hhs.gov.