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Medigram - March 13, 2008


CONTENTS


TOP STORY

Reminder: April 1 deadline for use of tamper-resistant prescription pads nears

Effective April 1, all hand-written or computer-generated prescriptions paid for by Medicaid, SeniorCare or BadgerCare fee-for-service must be written or printed on tamper-resistant prescription pads or computer paper. To help physicians comply with this new law, the state’s Department of Health and Family Services (DHFS) has a limited supply of free pads available upon request. A request form must be completed and submitted; to view the requirements visit the most recent DHFS bulletin on this issue.

As described in the September 20, 2007 Medigram (click here for information about the requirement, which was originally scheduled to go into effect on October 1, 2007 before Congress pushed back the start date), at least four companies are currently providing tamper-resistant pads in states where similar requirements already exist: For more information, contact Jeremy Levin or Mark Grapentine.

NEWS BRIEFS

Wisconsin first state to screen all newborns for ‘Bubble Boy disease’

Wisconsin has approved adding Severe Combined Immune Deficiency (SCID), more commonly known as “bubbly boy disease,” to the Wisconsin newborn screening panel. The addition means that Wisconsin now screens approximately 70,000 newborns annually for 48 genetic disorders, including hearing loss (which is not mandated). These tests include all 29 of the core panel of tests recommended by the American College of Medical Genetics Newborn Screening Expert Group in 2006.

The Wisconsin State Laboratory of Hygiene (WSLH) at the University of Wisconsin-Madison began reporting SCID results on the newborn screening report form on February 18. WSLH performs all newborn screening testing in the state. Physician consultants are available to Wisconsin physicians whose patients receive a "Possible Abnormal SCID (Immunodeficiencies) Report" form.

The pilot program to develop the SCID screening test began a year ago as a funding and scientific collaborative effort between the WSLH, the Children’s Hospital of Wisconsin (CHW) in Milwaukee, and the Jeffrey Modell Foundation, which focuses on prevention of primary immunodeficiency diseases.

During the pilot, scientists at CHW and the WSLH (Dr. Mei Baker-WSLH, Dr. Jack Routes-CHW, and Dr. William Grossman-CHW) developed a testing method based on measurement of T-cell receptor excision circles (TRECs) by real-time polymerase chain reaction (PCR) technology using DNA extracted from newborn screening specimens (ie, dried blood spots). TRECs are by-products generated during T-cell maturation and are consistently absent, or present in low numbers, in newborns with SCID. The procedure was tested on 10,000 residual de-identified blood specimens from Wisconsin’s nationally recognized newborn screening program.

As with all disorders screened on the Wisconsin newborn screening panel, the benefits of testing for SCID will be evaluated over time.

For more information on the Wisconsin newborn screening program, visit www.slh.wisc.edu/newborn, including the "Health Care Professional's Guide to Newborn Screening." A PDF version is available on the web site.


2007 Physician Quality Reporting Initiative releases preliminary participation results

The Iowa Foundation for Medical Care, in collaboration with the Physician Performance Information Center, recently provided the Centers for Medicare & Medicaid Services (CMS) with interim participation and reporting statistics related to the 2007 Physician Quality Reporting Initiative (PQRI). Eligible professionals who successfully reported the 2007 PQRI quality measures will receive a financial incentive of 1.5 percent of total allowed charges for covered Medicare physician fee schedule services furnished July 1, 2007 through December 31, 2007.
    Points of interest
  • Nationally, 99,319 TIN/NPI (Tax Identification Number)/(National Provider Identifier) combinations (15.74 percent of those eligible) attempted to participate.
  • In Wisconsin, 2,442 TIN/NPI combinations (18.38 percent of those eligible) attempted to participate.
  • The average number of measures attempted per NPI/TIN is greater than 3 measures both nationally (3.58) and in Wisconsin (3.80).
    Submission by measure
  • The number of NPIs eligible varies a great deal by measure, from fewer than 30 for the pediatric measures (#65 and #66) to 499,593 for Advanced Care Plan (#47) and 445,158 for the Fall Risk Measure (#4).
  • The number of NPIs reporting varies a great deal by measure. The measures with the largest number of NPIs submitting are #54 ECG for Non-Traumatic Chest Pain (19,938) and #55 ECG for Syncope (15,584).
  • While several measures had fewer than 1 percent of eligible NPIs submitting (eg, Antidepressant Meds #9, Asthma #53 and #64, Assessment for UI #48 and Medication Reconciliation #46), the Timing of Prophylactic Antibiotic measure (#30) had 80.99 percent of eligible NPIs submitting and ECG for Syncope (#55) had 51.03 percent of eligibles submitting.
    Submission errors by carrier
  • Nationally, 9.53 percent of NPIs were reporting correctly for every Quality Data Code (QDC) occurrence while only 7.15 percent of NPIs were reporting incorrectly for every QDC occurrence, and 83.32 percent reported correctly for some but not all QDC occurrences.
    Submission errors by measure
  • The measures with the highest proportion of reporting attempts accepted were #71 Breast Cancer - Hormonal Therapy (86.47 percent of QDC attempts reported correctly) and #38 ESRD Hematocrit (84.48 percent of attempts reported correctly).
  • There are nine measures with reporting accuracy rates below 15 percent (ie, fewer than 15 percent of QDC occurrences accepted).
  • The measures with the highest percentage of errors due to missing NPIs were #48 Assessment of UI in Older Women (36.6 percent of errors associated with the measure) and #39 Osteoporosis - Screening or Therapy (31.86 percent of errors). The largest number of missing NPIs appeared for #47 Advance Care Plan (97,516 attempts with no NPI) and #12 Optic Nerve Evaluation for Glaucoma (97,403 attempts with a missing NPI).
    Reporting rates by measure
  • There were a few measures with very high reporting rates. These included #33 Stroke-Anticoagulants for A Fib (100 percent), #30 Timing of Antibiotic - Administering Physician (96.83 percent), and #53 Asthma - Pharm Therapy (88.37 percent).
  • The lowest non-zero reporting rate was for #46 Medication Reconciliation (32.91 percent).
    Reporting rates by measure
  • The measure with the largest number of instances of “clinical performance met” was #15 Assessment of Visual Functional Status (391,035).
  • The national median performance rate was 100 percent for 11 measures.
  • Two measures had 0 percent national median performance rates, #61 GERD - Upper Endoscopy and #34 Stroke- t-PA Considered.
  • There were some measures with a high number of reported instances excluded by the provider. These include #5 Heart Failure ACE or ARB for LVSD (36,867 instances excluded) and #47 Advance Care Plan (34,586 excluded).


Deep elected to ACP Council of Young Physicians

Society Member Noel N. Deep, MD, FACP, of Antigo has been elected to the American College of Physicians (ACP) Council of Young Physicians. He will begin serving a three-year term this May. As an at-large representative of the Council, Dr. Deep will join A. Kenneth Musana, MD, of Marshfield who is currently serving on this Council.


Wisconsin Medical Journal needs your expertise

The Wisconsin Medical Journal is seeking reviewers to add to our list of highly qualified reviewers for manuscripts. We need contributions from reviewers who can be objective, insightful, and respond in a timely manner. Manuscript review is an important collegial act and is essential to the integrity of the Journal.

Reviewers receive manuscripts electronically and are asked to review and return the manuscript with comments within four weeks. All reviews can be returned on-line.

Interested physicians should e-mail wmj@wismed.org with their name, e-mail address, specialty, at least three areas of expertise or interest, their current and previous practice location, and how often in 12 months they would be willing to serve as reviewers.

CAPITOL INSIDER

Hospital tax is budget repair centerpiece

In an effort to fill a biennial budget deficit of more than $650 million, Governor Doyle released his plan Tuesday to rectify the state’s books. The proposal’s centerpiece: a tax on hospitals’ gross patient revenues designed to capture additional federal money, which will help increase Medicaid hospital reimbursement and apply $125 million in proceeds toward the deficit. The proposal would sunset the tax at the end of the biennium. Citing the need for a Medicaid reimbursement update, the Wisconsin Hospital Association and various individual hospitals support the proposal.

Another $330 million will come from various administration spending cuts and a “transfer” from the transportation fund. Additional spending cuts (since the original budget passed in October 2007) complete the Governor’s balancing plan.

Late Wednesday night, Republicans in the State Assembly amended Doyle's plan and removed the hospital tax. The Assembly plan requires the Doyle administration to cut $250 million in state spending, taps into a “rainy day” fund and pushes a general school aids payment into a future fiscal year. That plan passed on a 51-46 vote, primarily along party lines. As of Thursday morning, Democratic leadership in the State Senate has said that house will not address the amended bill today, instead referring the measure (now known as 2008 Special Session Assembly Bill 1 to the bipartisan, bicameral Joint Committee on Finance.

For more information, contact Mark Grapentine or Jeremy Levin.

F.Y.I. FOR YOUR INSURANCE

Risk Management Solutions available through PIC WISCONSIN

PIC WISCONSIN, a ProAssurance company, has held a primary position in Wisconsin’s medical professional liability market for many years. One reason for this position lies in their experienced risk management staff, which includes clinical, legal and insurance professionals who work closely with physicians, clinics and hospitals on their specific issues and concerns.

PIC WISCONSIN offers highly focused risk management seminars (see PIC’s 2008 list of seminars on our Web site calendar), one-on-one consultations, and timely articles and publications loaded with proven strategies to help reduce risk. Click here for a recent article, “When Good Drugs Go Bad.”

For additional risk management information or policy information with PIC WISCONSIN complete Wisconsin Medical Society Insurance & Financial Services on-line contact form or call 866.442.3810.

QUALITY CORNER

Joint Commission urges development of a national performance measurement data strategy

Health care organizations, practitioners, purchasers, oversight bodies and the public all rely on performance data to determine priority areas for quality improvement, evaluate performance, and make informed health care decisions. Yet, most performance measurement efforts operate in isolation from one another, rarely provide a consistent picture of overall quality, and represent a significant cost to the health care industry, according to a call for action released last week by The Joint Commission.

The Joint Commission’s newest public policy white paper, “Development of a National Performance Measurement Data Strategy,” proposes a framework for creating a data infrastructure to support performance measurement activities that improve the quality of American health care. The detailed solutions, proposed by a special Joint Commission expert Roundtable, focus on creating a data infrastructure that addresses consumer expectations for data privacy, supporting a data highway that allows for data sharing and linkages, and operating under an agreed-upon set of rules and governance structure.

Click here to download a complete copy of the white paper.

FAQ

Question:
Does our office have to collect and pay sales tax on copies of medical records?

Answer:
The Wisconsin Department of Revenue takes the position that sales tax must be paid on copies of medical records if a fee is charged. If no fee is charged, no tax is due. Even if the office fails to collect the sales tax, it is still responsible for paying the tax to the department.

For answers to other Frequently Asked Questions regarding legal issues click here (members only).