Medigram - October 16, 2008 | Wisconsin Medical Society

TOP STORY

Society Board passes new policy on money/gifts from health product industry

The Wisconsin Medical Society’s Board of Directors approved changes to Society policy regarding physician gifts at its October 11 meeting. The policy, ETH-004: The Relationship of the Profession to the Health Product Industry, states:

“Physicians shall accept no gifts from any provider of products that they prescribe to their patients such as personal items, office supplies, food, travel and time costs, or payment for participation in on-line CME. A complete ban eases the burdens of compliance, biased decision making, and patient distrust.”

The policy then cites a Journal of the American Medical Association article (JAMA 2006:295;429-433) detailing the effect such gifts can have on the trust in the physician-patient relationship. With that article as a guide, the updated policy also provides examples of ethical behavior in the areas of handling drug samples, physicians serving on formulary committees or speaker bureaus, and how the industry can still support needed Continuing Medical Education offerings.

Society President Steven Bergin, MD, in this press release called the new policy “strong and clear. It leaves no doubt that the Society’s physicians want to prevent even the impression that a gift—no matter how small—could get in the way of a physician’s decision-making.”

Doctor Bergin also stressed that the policy should not be implied as a condemnation of any specific group or industry. Rather, he said, “This policy simply puts the Wisconsin Medical Society on record that individual physicians should take a bright line approach to accepting items from companies that make products or drugs that the physicians might end up prescribing or recommending to his or her patients.”

NEWS BRIEFS

Reminder: 2008 Wisconsin Quality & Safety Forum October 20-21

It’s not too late to register for the 2008 Wisconsin Quality & Safety Forum, scheduled October 20-21 at the Kalahari Resort in Wisconsin Dells. The forum will feature two of the most recognized names in quality and patient safety innovation—John Nance and David Nash, MD—as keynote presenters. Additionally, 30 projects focused on current quality improvement and/or patient safety initiatives, submitted by 22 different organizations from around the state will be showcased.

Sponsored by the Society, the Wisconsin Hospital Association, MetaStar, the Wisconsin Collaborative for Healthcare Quality and the Wisconsin Health Information Organization, the forum is designed for physicians, quality improvement managers/specialists, risk managers, nurse executives, pharmacists, patient care services staff, chief executive officers, administrators, vice presidents and patient safety improvement team members. If you are interested in attending, on-site registrations will be accepted. Click here for more information.

CMS extends comment period for interim study on alternative payment locality structures

Medicare is required by law to adjust payments for physician fee schedule services to account for differences in costs due to geographic location. There are currently 89 different localities that have not been revised since 1997. Since then, many of these localities have experienced shifts in population and economic development. In some localities, areas that were once rural may now be suburban or urban, resulting in changes to the cost structure of rents and wages.

A previous issue of Medigram reported the availability of and comment period for a preliminary study titled “Review of Alternative GPCI Payment Locality Structures.” Produced by Acumen, LLC under contract to CMS, the report examines options for revising payment localities. The original deadline for submitting electronic comments was October 20, however, CMS has extended the deadline until November 3.

To access the report, click here. Although CMS has indicated that it does not propose making changes at this time, comments will be considered in the development of possible future notice and comment rulemaking. Comments may be submitted to MPFS@cms.hhs.gov.

Web-based seminar to address patient safety November 18

If you communicate directly with patients, there’s a one-hour, Internet-based seminar that’s geared to you. Communication Challenges: Strategies for Enhancing Patient Safety, will take place November 18 and 20, from noon-1 p.m. The goal of the program, which is sponsored by the Wisconsin Injured Patients and Family Compensation Fund, is to improve patient safety with respect to phone advice, verbal orders and notification of patient results.

The seminar qualifies for 1.0 American Medical Association Physician Recognition Award category 1 credit. Physicians and allied health professionals are encouraged to register for the November 18 program; and nurses, office staff, managers and medical assistance are encouraged to register for the November 20 program. For more information, click here or call 800.606.4193.

QUALITY & EFFICIENCY

Society Board approves transparency principles

“Transparency” is a concept frequently referenced in health care reform discussions. Policymakers from all points of the political spectrum believe that transparency, in various forms, may serve to positively impact health care quality, cost and access issues. The Society has recognized that issues leading to transparency are deeper and more complex than campaign bullet points and if not well considered can actually have a negative impact on patient care. This past weekend, the Society’s Board of Directors took action to inject more clarity and depth to discussions about transparency by approving a set of transparency principles. Click here to read more.

CAPITOL INSIDER

WISMedPAC Board responds to HOD Resolution; no endorsements for 2008 cycle

At its October 9 meeting, the WISMedPAC Board of Directors voted to not make political endorsements for the November 2008 elections. In April 2008, the Society’s House of Delegates (HOD) passed Resolution 11, urging WISMedPAC to “consider adopting strategies for lobbying that do not include formal political endorsements.” A petition to the WISMedPAC Board of Directors was also circulated at the HOD, with those signing pledging to donate to the PAC or Conduit (WISMedDIRECT) should a decision be made not to issue endorsements. Taking those opinions into consideration, the Board voted to not make endorsements this cycle and gauge whether it has any effect on physician involvement with WISMedDIRECT.

With the elections less than three weeks away, physicians can still have an impact on races around the state, as well as enhance the reputation physicians have regarding political awareness. The Society’s Government Relations staff has been in contact with leaders from each major political party in both legislative houses, and know which races are considered to be most important. As you make your contributions to candidates for office, please do so through your WISMedDIRECT account. If you would like to know where your contributions can have the most impact, contact Mark Grapentine, JD, Jeremy Levin or Beth Alvin.

Campaign Focus: State Senate Districts 12 and 32

Medigram has been highlighting competitive races for State Senate elections this November. For a recap of last week's article, click here.

Senate District 12 seat became vacant last May when then-Senator Roger Breske (D-Eland) was appointed the state’s railroads commissioner. Now former State Representative and Tourism Secretary Jim Holperin (D-Conover) and small business owner Tom Tiffany (R-Hazelhurst) are vying to fill the seat, which represents the large district in northeastern Wisconsin that stretches from the Upper Peninsula border southwest into Lincoln and Langlade Counties

Tiffany says his experience as a small business owner makes him very aware of the challenges of finding affordable health care. According to his Web site, Tiffany’s health care proposals “includ[e] consumer-driven reforms and full disclosure of all costs for you in the health care system.”

Holperin’s Web site does not contain any description of health care opinions—the site purports itself as “simple and to the point.” It does, however, have pages related to logging, energy and other issues.

The seat is a particular target of Senate Republicans, because all three State Assembly seats in the district were Republican in 2007-2008, and could therefore result in a Republican Senate seat in an election where Democrats are expected to fare well.

Recent news coverage of the race from the Lakeland Times can be found here and here.

Senate District 32
Senate District 32, which stretches from La Crosse County in the north to the confluence of the Wisconsin and Mississippi Rivers at its southern border, is another hotly contested seat. The Coulee Region has been an epicenter of sorts in Wisconsin politics, with the state Senate seat switching between Republican and Democratic control and its role as a destination point for presidential candidates in the last three elections.

Incumbent Senator Dan Kapanke (R-La Crosse), currently seeking his second term, is a former regional sales manager for Kaltenberg Seed Farms and is well-known for owning the La Crosse Loggers baseball team. His Web site has links to recent campaign television ads and a biography.

Challenger Tara Johnson (D-La Crosse) is a current La Crosse County Board member, and arguably represents the Democrats’ biggest hope for unseating a sitting Republican Senate incumbent. Information about her campaign can be found on her Web site.

A recent La Crosse Tribune news story about the race concentrated on the two candidates’ opinions on health care. Other area news stories on the race can be seen here and here.

For more information on these or other state legislative races, contact Mark Grapentine, JD, Jeremy Levin or Beth Alvin.

EDUCATIONAL PROGRAMS

Collecting cash up front—making the process seamless

Health care professionals have to collect, and where better than the office front-line? Registration and scheduling staff—the first point of contact for most patients—have the best opportunity to collect co-pays, deductibles and co-insurances. Learn why registration staff and backend collections must understand each other’s jobs, how data collection during the registration process improves backend collections, how to deal with difficult people at the time of registration, and specific dialog on how to ask for cash at the time of scheduling and point of service. Join guest speaker Kenlyn Gretz from Americollect on October 29 from noon-1:15 p.m. for a teleconference you won’t want to miss. Click here for more information or to register for this call.

QUALITY CORNER

Medicare Medical Home Demonstration project focus of upcoming forum

A Special Open Door Forum conference call is being held Tuesday, October 28 from 1 to 3 p.m. to inform physician practices and physicians about the design of the Medicare Medical Home Demonstration (MMHD) project. During this call, the Centers for Medicare & Medicaid Services (CMS) will describe the definition of a Medicare Medical Home along with other demonstration information, including the goals of the demonstration, practice eligibility and beneficiary eligibility requirements. CMS will also present the core capabilities required to qualify as a Medical Home and the monthly Medical Home fee amounts.

The Medicare Medical Home Demonstration is authorized by Section 204 of the Tax Relief and Health Care Act of 2006 (TRHCA), which directs the Secretary to establish a demonstration project that will examine using a system of targeted, accessible, continuous and coordinated family-centered medical care directed at high-need populations. The demonstration applies to Medicare beneficiaries with chronic or prolonged illnesses that require regular medical monitoring, advising or treatment. The Medical Home will provide coordination of services for all enrolled beneficiaries through a “personal physician.” These services include safe and secure technology to promote patient access to personal information and improved physician-patient relationship that allows for patient participation in his/her health care decisions.

This is a three-year demonstration that will begin by soliciting physician practices, Federally Qualified Health Centers and Community Health Centers to enroll in the demonstration. Outreach and recruitment of eligible practices is expected to begin in January 2009. Approved practices will be required to submit documentation demonstrating they meet the core capabilities to become a Medical Home. Monthly Medical Home fee payments will begin in January 2010.

For background material including the slide presentation for this special forum, Medical Home Demonstration Design Report, Recommended Diagnoses for the Medical Home Demonstration (Hwang List), the Definition of two Medical Home Tiers (Table 2), the PPC-PCMH Tool and the Medical Home Descriptors, click here.

To participate in the call, dial 800.837.1935, Reference Conference ID 65752061. Capacity is limited, so CMS encourages participants to dial in early.

FAQ

Question:
If a physician evaluates a very sick patient in the office or nursing home and determines that the patient needs admission to the hospital, but the physician does not physically see the patient in the hospital until the next day, can the office/nursing home visit be coded as initial hospital care using codes 99221-99223?

Answer:
No. To bill using the initial hospital care codes 99221-99223, there must be an actual face-to-face encounter in the hospital. “Principles of CPT Coding” states, “The guidelines for this series of codes indicate that they are intended to be reported for the first hospital inpatient encounter with the patient by the admitting physician. This date may not be the same as the date the patient was actually admitted to the hospital. For example, the physician provides an E/M service to the patient in the office on Wednesday and subsequently admits the patient to the hospital on the same day. However, the physician does not have an inpatient encounter with the patient until Thursday morning. In this example, the appropriate office or other outpatient level of E/M service for the initial hospital care will be Thursday’s date—the date the admitting physician had the first hospital inpatient encounter with the patient.”

If the physician has an inpatient encounter on the same day as the office or nursing home visit following order for admission, all services provided on the same day by the same physician should be included in determining the initial hospital care level of service. CPT states, “when the patient is admitted to the hospital as an inpatient in the course of an encounter in another site of service, all evaluation and management services provided by that physician in conjunction with that admission are considered part of the initial hospital care when performed on the same date as the admission. The inpatient care level of service reported by the admitting physician should include the services related to the admission provided in the other sites of service as well as in the inpatient setting.”

For answers to other Frequently Asked Questions about coding matters and more, click here to review our Education Department’s FAQ archive, or e-mail efaq@wismed.org.