Welcome Guest, if you have an account you may login

Medigram - July 24, 2008


TOP STORY

How would you change the health care system? We want to hear from you!

In an effort to better gauge Wisconsin physicians’ attitudes on health care reform, the Wisconsin Medical Society recently completed a statewide scientific mail survey of 2,500 Wisconsin physicians. Now those physicians who were not included in the mail survey are being encouraged to participate in the same survey via a Web site hosted by the Wisconsin Survey Center.

The survey was developed through a partnership with the University of Wisconsin School of Medicine and Public Health (and additional support from the American College of Physicians). You can view and complete the survey by clicking here.

Health system reform is a predominant theme of the upcoming November elections, and it is vital that Wisconsin physicians assume a strong leadership position in the development of state and national health policy. As the recent victory in Congress over physician Medicare reimbursement shows, organized medicine can wield significant power when rallying around a common cause. Please add your input to the health care reform debate.

NEWS BRIEFS

Participating physicians to receive over $36 million for 2007 PQRI efforts

The Centers for Medicare & Medicaid (CMS) announced last week more than $36 million in bonus payments to many of the more than 56,700 health professionals who satisfactorily reported quality information to Medicare under the 2007 Physician Quality Reporting Initiative (PQRI).

“Creating a value-based purchasing system is a critical way to improve our health care systems,” said Health and Human Services Secretary Michael Leavitt in this press release. “By collecting quality data, health care providers can use the information to improve the quality care of beneficiaries.”

Physicians, physician group practices, and other PQRI-eligible professionals should receive their payments by August 2008. The average incentive amount for individual professionals is over $600 and average incentive payment for a physician group practice is over $4,700, with the largest payment to a physician group practice totaling over $205,700.

For more information about the PQRI program, including how eligible professionals can participate and the criteria to qualify for an incentive payment, click here.


Collaborative releases medical home purchaser guide

The Patient Centered Primary Care Collaborative (PCPCC), a coalition representing more than 150 national business leaders, consumer groups, organizations representing primary care physicians and other health care stakeholders, released its Purchaser Guide to the patient-centered medical home. The Guide is a handbook for understanding the medical home model and taking action to advance its implementation. For more information, click here. To download the Guide, click here.


Input needed for blood management measures

The Blood Management Performance Measures Technical Advisory Panel (TAP) has identified 19 Blood Management Candidate Measures addressing key aspects of Blood Management. At this time, The Joint Commission is requesting stakeholder review and public comment on these measures. You can access the survey here. Responses must be received by Tuesday, August 19, 2008. Additional Information about the Blood Management Performance Measures Project is available here.

QUALITY & EFFICIENCY

Society keeps pulse on key physician issues in WHIO

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 discusses WHIO's efforts to stay in the forefront of key physician issues. 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, the state of Wisconsin's involvement in WHIO, and the upcoming Methods, Measures and Policy Impact symposium. Click here to read more.

CAPITOL INSIDER

Special Committee on School Safety meets at Capitol

While election-year summers generally mean slow times at the Capitol, special legislative study committees meet to examine specific issues and gauge the need for future legislation. The nonpartisan Legislative Council organizes these meetings, which generally last through the fall, and a committee of state senators and Assembly representatives approves the topics (see that list here).

One group the Society will monitor is the Special Committee on School Safety, co-chaired by Sen. John Lehman (D-Racine) and Rep. Don Pridemore (R-Hartford). The group includes various representatives from a diverse array of educational backgrounds, all with a keen interest in public school safety. At its initial meeting on July 22, the committee briefly discussed the possibility of drafting mental health parity legislation in the coming legislative year, citing many students who cannot afford mental health coverage. The committee also discussed whether the benefits of sharing private mental health records with key individuals in the given child’s educational setting would outweigh privacy concerns. The group is still working toward defining the scope of their future work and plans to meet again in September 2008.

The Society will also follow the Special Committee on Performance-Based Disease Management Programs for Large Populations, which holds its initial meeting on July 24. For more information, contact Beth Alvin.

YOUR PRACTICE. YOUR FUTURE.

Additional CAN-SPAM rules issued by Federal Trade Commission

The CAN-SPAM Act of 2003 (Act) imposes tough rules on those sending commercial e-mail messages. The Act defines commercial e-mail as any message that has the "primary purpose" of advertising or promoting a commercial product or service, including content on a Web site that is operated for a commercial purpose. The Act requires commercial e-mail messages to:
  • Clearly, and noticeably, state that the e-mail is an advertisement.
  • Include subject line that accurately portrays the content of the message.
  • Include an e-mail or other Internet-based mechanism by which the recipient can opt out of receiving e-mail messages in the future. All opt-out requests must be honored within 10 business days of receipt.
  • Provide an electronic opt-out mechanism that recipients can use to opt-out of future commercial e-mail solicitations (e.g., adding a line to the bottom of a commercial e-mail that says, "If you do not wish to receive any further commercial e-mails from our business, please reply to this e-mail").
  • Include the valid physical postal address of the sender.
In May 2008, the Federal Trade Commission (FTC) adopted four new rules under the Act. The new rules clarified the meaning and intent of the existing rules by providing the following direction:
  • The Act applies to any individual, group, unincorporated association, limited or general partnership, corporation or other business entity. The FTC made clear that nonprofit organizations were not exempt from the Act.
  • The recipient of commercial e-mail cannot be required to pay a fee, provide information other than his or her e-mail address and opt-out preferences or be required to do anything more than send a reply e-mail message or visit a single Internet Web page to opt-out of receiving future e-mail from a sender.
  • The postal address of sender can be a post office box or private mailbox registered with the U.S. Postal Service.
  • Definition of sender modified to provide for a single opt-out mechanism and postal address in commercial e-mails sent as part of a joint marketing campaign.
The FTC considered, but did not adopt, a rule that would have reduced the 10 business day requirement for honoring opt-out requests to three business days. It also did not establish how long an opt-out request will remain effective.

View the FTC’s press release on the new rules here and additional information on the requirements of the Act here.

EDUCATIONAL PROGRAMS

Legal issues in the office—Get your most common questions answered

Join Wisconsin Medical Society Staff Attorney Brian Buchanan on August 6, 2008 for a lunch and learn teleconference that will focus on five legal issues that impact your office: cash discounts, professional courtesy, patient incentives and more! Sign up today for this valuable opportunity to get your most common questions answered. For registration information on this and other upcoming educational opportunities from the Society, click here.


Coding Symposium early bird deadline extended

The early bird deadline for the Wisconsin Medical Society's 9th Annual Coding and Practice Management Symposium has been extended. When you register by September 5 you'll save $80. Click here for information. If you would like to recieve a hard copy of the brochure, e-mail Mary Oleson.

Quality Corner

2008 National Scorecard on U.S. Health System Performance results released

The Commonwealth Fund Commission on a High Performance Health System recently found that the United States fell far short of benchmarks for access, quality, efficiency, and other key measures of health system performance. The 2008 edition of the scorecard paints an even bleaker picture, with the U.S. scoring an average of 65 out of a possible 100 across 37 indicators—slightly below the overall score in the 2006 report. To read the report, click here.

FAQ

Question:
When selecting an E/M code that requires two of the three components (history, exam and medical decision making), does medical decision making have to be one of the two?

Answer:
The Summer 1992 CPT Assistant states, “When three out of three components must be met or exceeded to report a code, determining the extent of medical decision making is required. However, when two out of three of the key components must be met or exceeded in order to report a code, it is not mandatory that the level of medical decision making be met in order to report the code. Any two of the three key components may be met; one of these two does not have to be medical decision-making. Also, when a code is reported based on counseling/coordination of care dominating more than 50 percent of the face-to-face encounter, medical decision making would not assist in selecting a code.

"Medical decision making may vary on a daily basis depending on the patient’s condition and what the physician performed that day. If the diagnosis or symptoms of the patient change during the course of treatment, indicating the new diagnosis/symptoms may help to demonstrate the necessity for a particular code being selected.” Keep in mind that the overall medical necessity of the service must still be met in order to select a code, and this applies to history, exam and medical decision making. Be cautious not to overcode a level of service based on documentation of history and exam that does not support overall medical necessity. Medicare’s definition of medical necessity can be found in 1862(a)(1)(A) of the Social Security Act.

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