NEWS

• Medicaid reimbursement alert
• DHS releases educational materials to help prevent unsafe injection practices
• Clinical resource for available for Dane County tobacco-using patients
• Newsmakers: Radant named Family Physician of the Year

FEATURES

• Quality & Efficiency: Pharmacies collaborate on quality improvement project
• Capitol Insider: Federal health proposals already emerging
• Capitol Insider: Wisconsin Supreme Court race shapes up for Spring 2009
• Capitol Insider: Wisconsin legislative committees beginning to take shape
• Your Practice. Your Future. Pharmacies to be more regulated
• Educational Programs: 2009 CPT updates impact multiple specialties
• Educational Programs: December teleconferences target successful reporting for Medicare PQRI and e-prescribing incentives
• F.Y.I. For Your Insurance: Stan Starnes, CEO of ProAssurance, previews PIC WISCONSIN rate reductions for 2009
• Quality Corner: New inventory of HHS quality measures released to improve public- and private-sector performance measurement efforts
• FAQ

NEWS BRIEFS

Medicaid reimbursement alert

Implementation of ForwardHealth interChange is underway, and representatives from the Department of Health Services (DHS) said during a conference call Monday that a higher than expected number of suspended claims and denials were experienced during the first weekend claims cycle. Total payments were $19.5 million, about 50 percent lower than a normal payment cycle. (Click here for a summary of that call.)

Some system issues were discovered and have been resolved, and ForwardHealth is reviewing denied claims. Health care professionals can access the Provider Portal at any time to find out the status of their claims, and Help Line hours have been extended from 7 a.m. to 8:30 p.m.

Additionally, ForwardHealth has a transitional payment process for providers who are experiencing financial hardship due to claims denials or processing issues. Click here for information about requesting an interim payment.

Call 800.947.9627 if you have questions.

DHS releases educational materials to help prevent unsafe injection practices

Because public health officials are becoming more concerned with the prevalence of unsafe injection practices, the Wisconsin Division of Public Health and Division of Quality Assurance staff have developed educational materials to assist health care professionals in assuring strict adherence to safe injection practices and standard infection control measures. For more information, click here and look for the safe injection practices bullet.

Clinical resource for available for Dane County tobacco-using patients

Dane County physicians and other health care professionals can refer their patients who use tobacco and want to quit to the University of Wisconsin Center for Tobacco Research and Intervention (UW-CTRI) Smoking Cessation and Prevention Clinic. Patients will receive intensive counseling interventions, medication when appropriate, and follow-up.

Staffed by Society member Michael Fiore, MD, the UW-CTRI Director, and Douglas Jorenby, PhD, a clinical psychologist and professor of medicine at the University of Wisconsin, the clinic operates on Mondays.

Drs. Fiore and Jorenby develop a personalized quit plan for every patient. Attendees can also participate in an evening group support session. It allows them to learn more about others’ tobacco use and quitting experiences, and provides mutual support. Finally, a treatment plan is sent to the patient’s primary care physician.

While appropriate for all patients who smoke and want to quit, the clinic is specifically designed to help patients most addicted to tobacco. For more information, call 608.263.0573 or click here to visit UW-CTRI’s Web site.

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NEWSMAKERS

Radant named Family Physician of the Year

The Wisconsin Academy of Family Physicians named Society member Leon Radant, MD, of Mauston the 2008 Family Physician of the Year. Doctor Radant grew up in central Wisconsin, attended the University of Wisconsin School of Medicine and completed his residency at St. Mary’s in Madison. He has been practicing as a family physician in Juneau County since 1980.

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QUALITY & EFFICIENCY

Pharmacies collaborate on quality improvement project

The Pharmacy Society of Wisconsin (PSW) has launched a quality improvement demonstration project involving community pharmacies from across the state. This demonstration project is the work of the Wisconsin Pharmacy Quality Collaborative (WPQC), a group of public and private health insurance payors working with pharmacies to improve the quality and efficiency of pharmacy care for Wisconsin residents. The 54 participating community pharmacies from across the state represent a variety of pharmacy practices; chain pharmacies, independently-owned practices, health system clinic pharmacies, etc. and have implemented enhanced quality improvement processes to improve patient safety. Patients with Unity and Group Health Cooperative—South Central Wisconsin (GHC) drug coverage are currently eligible to receive services from pharmacists as defined by the WPQC program. These services may include medication adherence counseling and monitoring, enhanced medication device instruction and the provision of recommendations to decrease drug costs for the patient. All interventions and services require pharmacists to consult with a physician. In addition, high risk patients receive enhanced medication monitoring and education and pharmacists provide medication reconciliation. For more information, participating pharmacies, and how to refer a patient to a participating pharmacy, please click here.

The Wisconsin Medical Society has recently joined the Steering Committee of the demonstration project. The Society's role on the committee is two-fold: to shape and influence the appropriate hand-offs in patient care associated with the demonstration project and to communicate the progress and results of this effort to the physician community.

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CAPITOL INSIDER

Federal health proposals already emerging

As President-elect Barack Obama prepares to become the 44th President of the United States, critical White House staff and Cabinet positions are the order of business; yesterday Obama named former U.S. Senate Majority Leader Tom Daschle his incoming Secretary of Health and Human Services (a quick review of his health policy work here). Some of Daschle’s former peers are not waiting for the official beginning of the Obama Administration to launch their plans for reforming the nation’s health care system—two major players in the Democratic Senate are making waves over their health proposals.

Senate Finance chairman Max Baucus (D-Montana) released a 98-page proposal for health care reform called “Call to Action: Health Care Reform 2009.” While he explicitly states in the paper that the plan “is not intented to be a legislative proposal,” it is certainly an influential senator planting his marker for where the health reform debate should begin. Major elements of the plan include requiring all Americans to have health insurance (a major difference with President-elect Obama’s plan), increased emphasis on preventive care and moving physician payment away from procedure-based to quality-based reimbursement.

Meanwhile, Senate Health Committee chairman Edward Kennedy (D-Mass), battling a malignant brain tumor for much of 2008, made health news simply for making an appearance at the Capitol this week, countering those who assumed he would be giving up his chair next session to concentrate on his personal battle. While praising Baucus for his effort, Kennedy told reporters he plans to introduce his own bill to provide universal health care and be the Senate lead in partnering with the Obama administration. The Washington Post, however, reports that some on the Obama team are now considering expanded coverage “a longer-term goal” due to economic constraints.

The insurance industry added itself into the mix late Wednesday, with two major insurance groups stating that they would be willing to accept all who apply for insurance as long as the government mandates that all citizens must have insurance. Such a mandate differs from President-elect Obama’s health care proposal, which held such a mandate for children but not adults.

The Society is working with the AMA in analyzing the Baucus plan and will do the same as other federal legislation is introduced. For more information, contact Mark Grapentine, JD.

Wisconsin Supreme Court race shapes up for Spring 2009

While the November elections are still in the rear view mirror, another important election is just over the horizon: a seat on the Wisconsin Supreme Court. For the third straight year the state will see a competitive battle for a 10-year term on the seven-seat court, as Jefferson County Circuit Court Judge Randy Koschnick announced he will seek the seat currently held by longtime incumbent Chief Justice Shirley Abrahamson. The general election is April 7, 2009; if more than one challenger emerges, a primary will be held on February 17, 2009.

Abrahamson was first appointed to the court in 1976 by then-Governor Patrick Lucey. She has stood for reelection three times since that appointment, winning a healthy majority of votes each time: 65 percent in 1979, 55 percent in 1989 and 63 percent in 1999. She became Chief Justice in 1996, and was the first woman justice elected to the court.

In his press conference announcing his candidacy, Koschnick told reporters that his “conservative judicial philosophy” separates him from the incumbent, and cited the Ferdon v. Patients Compensation Fund Supreme Court opinion as an example of Abrahamson’s differing philosophy. The 2005 Ferdon decision, in which Abrahamson wrote the majority opinion, removed the state’s cap on noneconomic damages in medical liability cases. (Nine months after the Supreme Court decision the State Legislature reinstated a cap of $750,000 for noneconomic damages, the culmination of significant efforts from the Society and other health care entities.)

With 2007 and 2008 Supreme Court elections noted for their rancor, the 2009 campaign has at least started off politely. Abrahamson welcomed Koschnick into the race in a statement stressing the desire for a nonpartisan contest. Koschnick’s approach reached for the same theme, including offering a clean campaign pledge.

For more information, contact Mark Grapentine, JD.

Wisconsin legislative committees beginning to take shape

The organization of the 2009-2010 session of the Wisconsin Legislature continues with announcements of who will serve on various legislative committees. The first committee to be filled is also arguably the most important: the budget-writing Joint Committee on Finance. Unique in the nation, the JCF is a 16-member committee with membership coming from both legislative houses and both political parties. Besides handling substantive spending requests from the governor's administration, the JCF is the main legislative body that tackles the governor's biennial budget proposal, which is usually released in Februrary of odd-numbered years.

Last session the committee saw an 8-8 partisan split. With the Assembly swinging to Democratic control, JCF will now have 12 Democratic and 4 Republican members. Senate membership is the same as last session: Co-chair Mark Miller (D-Monona), Dave Hansen (D-Green Bay), Lena Taylor (D-Milwaukee), John Lehman (D-Racine), Judy Robson (D-Beloit), Julie Lassa (D-Stevens Point), Alberta Darling (R-River Hills) and Luther Olsen (R-Ripon). The Assembly co-chair is now Mark Pocan (D-Madison), with Pedro Colón (D-Milwaukee), Cory Mason (D-Racine), Jennifer Shilling (D-La Crosse), Gary Sherman (D-Port Wing) and Tamara Grigsby (D-Milwaukee) comprising the majority party Assembly members. Reps. Robin Vos (R-Racine) and Phil Montgomery (R-Green Bay) represent the Assembly minority party.

Other full committee memberships are forthcoming. Society members are reminded that any relationships with Joint Finance legislators can help aid in shaping the state's budget to a more patient- and physician-friendly final product. If you have such a relationship, please let Society staff know about it.

(Note: In a press conference this afternoon, Governor Doyle announced that the state's biennial budget deficit now stands at $5.4 billion. Doyle said he will submit a budget repair bill to the legislature in early 2009. Stay tuned to future Medigrams for the latest updates.)

For more information, contact Mark Grapentine, JD, Jeremy Levin or Beth Alvin.

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YOUR PRACTICE. YOUR FUTURE.

Pharmacies to be more regulated

President Bush signed the Ryan Haight Online Pharmacy Consumer Protection Act of 2008 into law October 15. The Act, which will take effect in April 2009, amends the Controlled Substances Act, creates new requirments for "on-line pharmacies" and increases penalties for unlawful distributors/dispensers of controlled substances.

To read a summary of the Act by Amy Bradshaw, JD, and Sarah Coyne, JD, of Quarles & Brady LLP, click here.

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EDUCATIONAL PROGRAMS

2009 CPT updates impact multiple specialties

EKGs, newborn care, the Medicare Initial Physical Preventive exam, hernia surgery, critical care and ESRD coding are all affected by CPT changes for 2009. To help ensure you are coding correctly in 2009, the Wisconsin Medical Society is offering a series of three teleconferences in December. Fresh from the CPT Symposium in Chicago, Society educator Penny Osmon, CHC, CPC, CPC-I, PCS, will guide you through all of the 2009 CPT changes, including Medicare payment policy and relative value unit (RVU) information. Attend one teleconference or all three to learn how to use the new code and determine which ones are reimbursement winners or losers. For more information or to register, click here.

December teleconferences target successful reporting for Medicare PQRI and e-prescribing incentives

The 2009 Medicare Physician Final Rule outlines incentives tied to the Physician Quality Reporting Initiative (PQRI) and e-prescribing. Together, these incentives could bring health care professionals an additional 4 percent of Medicare revenue in 2009. The Centers for Medicare and Medicaid Services (CMS) offers many resources on these programs, but knowing where to begin can be overwhelming.

To help you report PQRI and e-prescribing measures in 2009, the Wisconsin Medical Society is offering two teleconferences in December. On December 16, we will guide you into PQRI claims-based reporting by providing tips for picking your measures, walking through some “real-clinic” scenarios, discussing short cuts to implementation and directing you to the resources you need. On December 17, we will help you assess your readiness for reporting the e-prescribing measure to capture the 2 percent incentive payment. We will define a qualified system, explain submission requirements and provide guidance on e-prescribing system selection. (The e-prescribing program is currently voluntary, but there will be a penalty in 2012 for not prescribing electronically.)

Click here for more information or to register for one or both sessions.

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F.Y.I. FOR YOUR INSURANCE

Stan Starnes, CEO of ProAssurance, previews PIC WISCONSIN rate reductions for 2009