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Medigram - November 15, 2007


A LETTER TO SOCIETY MEMBERS

Dear Fellow Members,

Since the raid of the Injured Patients and Families Compensation Fund (Fund), we have heard from many of you. Responses have demonstrated outrage, confusion and/or support. We understand the differing emotions, and we welcome your support. A year ago, following the November 2006 elections, the Society Board of Directors knew the Fund was a likely target for another raid attempt. The Society's Executive Committee and Board discussed many options and strategies. The Board debated long and hard, reviewing Society policy and available information while considering advice from legal counsel. Tough decisions were made—always with the intention of protecting the Fund. The Board also instructed Society staff to prepare for legal action if the Fund was raided.

It is outrageous to think our state government can use a budget law to change language, thereby allowing money to be taken from an “irrevocable trust.” Accountability for Society strategy and legal action falls on the elected physician leaders: the Society Board of Directors. Accountability for taking the money from the Fund rests with those in state government who proposed a raid and/or voted “yes” on the state budget.

Many of you have called wondering what more you can do to support the Society’s lawsuit against the State. First, help get the word out to educate all physicians and patients. Second, physicians need to keep a unified message: taking money from the Fund is illegal and harms injured patients and their families. Third, your membership in the Society sends a strong message that doctors are united in their efforts to protect patients and will fight to keep the Fund safe. Finally, please become more involved in developing Society policy and direction. We are involved in numerous efforts from health care access and financing to quality to ethics. (Click here for more info.) Your views and input are welcome.

It is during these challenging times—when we have been forced to go to court to defend the Fund—that all physicians need to stand united, for ourselves and our patients. There are numerous other interests working the halls in our Capitol hoping the physician voice will fracture. It is imperative that we do not allow this to happen.

Clarence Chou, MD, President
Thomas Luetzow, MD, Board Chair

TOP STORY

Unless Congress acts, physicians face 10% Medicare payment reduction

The Centers for Medicare and Medicaid Services (CMS) final 2008 Medicare physician fee schedule rule establishes an average 10.1 percent cut effective January 1, 2008. This cut is the largest ever proposed, and that percentage may vary for specific services in particular locations for several reasons:
  • The final rule includes the every-three-years update to the Geographic Practice Cost Indices (GPCI). Currently, Wisconsin is in the bottom 35 percent of these geographical districts in terms of reimbursements.
  • CMS is continuing to employ a separate adjustment to the physician work relative values to achieve budget neutrality from the five-year review instead of applying budget neutrality across-the-board through the conversion factor. The work adjustment will increase from 10 percent in 2007 to 12 percent in 2008, and this will have differential effects on payment rates for different services and specialties.
  • 2008 will be the second year of a four-year transition to revised practice expense relative values.
For the past five years, lawmakers have intervened to stop Medicare payments cuts, and physicians are urged to call Senators Feingold and Kohl today and ask them to stop the cuts again! Click here for their contact information and let them know that:
  • Wisconsin will lose $100 million in health care funds due to the projected 10 percent cut in 2008 alone, and the state will lose $2.9 billion by 2015 due to eight subsequent years of Medicare physician payment cuts.
  • Millions of Baby Boomers are about to retire and enter into the Medicare system, yet an AMA survey found that if the Medicare cuts go through, 45 percent of physicians will stop accepting or decrease the number of new Medicare patients they accept.
  • Preventing this cut should be a top health care priority.
CMS’s final rule, which was released November 1, will be published in the Federal Register on November 27. It is available in the interim on the CMS Web site. Click here to access it.

NEWS BRIEFS

United Healthcare to pay preventive and problem-focused visits on the same day

United Healthcare has agreed to begin paying physicians separately for problem-focused services provided during a preventive medicine visit. The policy change, effective December 8, allows for partial payment (50 percent of contracted rate) of a problem-focused evaluation and management (E/M) service when performed on the same day as a preventive E/M for the same patient when submitted with modifier 25. Currently, United only reimburses physicians for one of the two procedures if performed on the same day.

United has agreed to make the new policy retroactive, and claims with dates of service of October 15 to December 7 will automatically be reprocessed.

To view the statement released October 29, 2007 from United Healthcare, click here.


When ‘dolor’ means ‘pain’, and you’re not sure where to go from there

To help physicians and other health care professionals communicate with patients who know a limited amount of English, the AMA recently published an updated “Office Guide to Communicating with Limited English Proficient Patients.” The guide details how limited English proficient (LEP) patients may require a different approach to their care. It also offers strategies to address the language needs of patients in an ethically, culturally and linguistically appropriate manner. Commonly asked questions and tips for working with interpreters are also included.

To access the guide on-line, click here.

YOUR PRACTICE. YOUR FUTURE.

AMA urges physicians to share concerns about insurers’ profiling programs

Physicians are being encouraged by the AMA to share their concerns with inaccurate physician profiling systems. This comes after a letter issued by the Office of the New York State Attorney General to United Healthcare and other health insurers stated such programs could be “causing consumer confusion, if not deception.” To help facilitate responses, the AMA has developed the following questions about some of the key weaknesses you may encounter with physician profiling programs:
  • Has the insurer provided you with a complete listing of the quality measures that it used to determine your quality rating based upon your specialty? Are these measures appropriate?
  • Were you provided with all of the data that the insurer used to rate your quality of care and/or cost of care (efficiency) prior to publishing it?
  • Do you know the number of cases used by the insurer to determine your rating?
  • Has the insurer provided you with a detailed explanation of the methodology used to rate your performance? Risk adjustment systems are often minimal, and expert opinions indicate that all risk adjustment systems used to profile physicians are woefully inadequate.
  • If the insurer’s data did not belong to you or was incorrect, has the insurer reconsidered your rating?
  • Did the insurer respond to your request for a reconsideration of your rating and, if so, did you receive an adequate explanation?
  • If you were not included in the “preferred” network because you did not have enough cases to be profiled, was the insurer willing to consider cases covered by other insurers?
Please send a copy of your letter detailing your specific experience to the AMA, either via e-mail or postmarked to the American Medical Association, Physician Practice Advocacy, 515 N. State St., Chicago, IL 60610.

To help physicians challenge their network profile, the AMA has created a one-page flyer, which outlines eight steps to follow. Click here to learn more.

Note: This article is adapted with permission from the October 26, 2007 AMA eVoice.

EDUCATIONAL PROGRAMS

Looking ahead for 2008

Society educators will focus on topics that affect nearly every medical practice in 2008 including Medicare, Medicaid, Evaluation and Management coding, and medical records. From teleconferences to full-day seminars, you and your staff can select educational offerings based on your learning style, skill level, budget and time. For a glimpse at some of the programs scheduled for next year, click here.

Meanwhile, there is still time to prepare for the numerous CPT coding changes coming in 2008. In December the Society will present “CPT Code Updates–What’s New for 2008” in Waukesha, Madison, Green Bay, Wausau and Eau Claire. Click here to learn more.

FYI: FOR YOUR INSURANCE

PIC WISCONSIN announces rate reduction for 2008

PIC WISCONSIN has great news! The insurer has announced an average rate reduction of 7.5 percent for 2008. Wisconsin Medical Society members may continue to receive the 7.5 percent Member Benefit Plan credit.

This is just one of the many reasons why Wisconsin Medical Society Insurance and Financial Services, Inc. is proud to recommend PIC WISCONSIN for your practice. But if that’s not reason enough to consider PIC WISCONSIN, consider these facts:
  • Exclusive member benefits — The Wisconsin Medical Society Member Benefit Plan includes increased coverage limits and discounted rates for eligible Society members.
  • Strong physician involvement – PIC WISCONSIN, a physician-founded company like the rest of the ProAssurance family, relies heavily on physician advisory panels to shape claims and underwriting policies.
  • Stable base rates – Unlike carriers that offer unsustainable rates only to hike them later or withdraw from the Wisconsin market, PIC WISCONSIN premiums are set to provide for claims-paying ability and financial strength for the long run. Over the past 20 years, the average annual base rate increase for Wisconsin policyholders has been less than 2 percent–an enviable record.
  • Effective claims defense – PIC WISCONSIN’s favorable outcomes mirror those of other ProAssurance Group companies and far exceed the industry average. Since any settlements paid on your behalf become part of your permanent record in the National Practitioner Data Bank and may affect your future employment, insurability and cost of insurance, it makes sense to have PIC WISCONSIN on your side:
    • For the past 10 years (1997-2006), PIC WISCONSIN closed an average of 93.7 percent of its Wisconsin medical professional liability claims without an indemnity payment.
    • During the same period, PIC WISCONSIN defended 285 physicians to jury verdict, resulting in 224 defense verdicts, a 78.5 percent win rate.
For more information, please call your Wisconsin Medical Society Insurance agent, e-mail us at insurance@wismed.org or complete our on-line contact form.

FOUNDATION FOCUS

A semester off turned into 24 years…

Amy Lavin, a promising pre-med student, decided to “take a semester off.” That one semester somehow turned into 24 years. But now, with a son in college and a daughter in high school, Lavin is determined to fulfill her passion for health care. She is currently in the nursing program at UW-Eau Claire at the satellite site in Marshfield. Her goal upon graduation is to work at St. Joseph’s Hospital in Marshfield in the ICU or emergency care and then continue her education toward a degree as a nurse practitioner.

In her letter thanking the Foundation for a scholarship Lavin said, “I sincerely wish to thank you … Funding an education is difficult with the rising costs of tuition and government decreases in financial aid for college students. It has been especially financially challenging with my son and I both working toward college degrees at the same time …Your support will not be forgotten.”

A majority of Foundation scholarship funds are directed in support of medical students, but some funds are targeted in support of nurses and other allied health careers based on workforce shortage data. Your donations to the Wisconsin Medical Society Foundation provide much-needed financial assistance and encouragement to traditional students as well as to returning adults like Lavin. It took more than 24 years, but Lavin’s desire for a degree in health care will soon be realized. Our donors can be proud to help her achieve that goal.

Please consider making a tax-deductible donation to the Foundation when renewing your Wisconsin Medical Society dues or with a gift before the end of the 2007 tax year.

Please Note: Donations for the tax year 2007 must be postmarked by December 31. To contribute on-line, click here. You can also mail your check to Wisconsin Medical Society Foundation, 330 E. Lakeside St., Madison, WI 53715 or contact Renee Reback at 608.442.3720 or toll-free at 866.442.3800.

FAQ

Question:
When a Medicare patient presents for a screening colonoscopy and the procedure is converted to a diagnostic colonoscopy for purposes of removing a polyp, what order should I report the ICD-9 codes for the visit?

Answer:
The Centers for Medicare and Medicaid Services released “MLN Matters Number SE0746” on November 9, 2007. This article clarifies that the reason for the encounter is in fact for the screening, the ICD-9 code for the screening should be the first diagnosis listed on the claim. The second diagnosis would be the abnormal finding, etc. and the CPT pointer would be linked to the second diagnosis. These guidelines are consistent with ICD-9 guidelines as well.

Article SE0746 also clarifies that when a Medicare patient has a screening colonoscopy that is then converted to a diagnostic procedure any deductible will apply since the test is no longer considered a screening. To read this release, please click here.

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

QUALITY CORNER

Patient-Centered Care: What Does It Take?

Based on interviews with leaders of patient-centered organizations and initiatives, a Commonwealth Fund report released October 24 identifies seven key factors for achieving patient-centered care at the organization level. Click here to read “Patient-Centered Care: What Does It Take?”