New CMS estimate for upcoming Medicare reimbursement cut is highest ever scheduled at nearly 30 percent!

AMA, 130 Medical Organizations Call for Bipartisan Solution to Medicare Physician Payment System

March 10, 2011
WASHINGTON – The AMA was joined by 130 state and medical specialty societies in sending a letter to both the U.S. House of Representatives and Senate calling for a permanent solution this year to the broken Medicare physician payment formula. The letter was sent on the same day that CMS announced, in a letter to MedPAC, that the cut set to occur on January 1 would be 29.5 percent - the highest ever scheduled.
“The new estimate from CMS should serve as a wake up call to Congress that physicians who serve Medicare and TRICARE patients are facing a debilitating cut of nearly 30 percent on January 1,” said Cecil B. Wilson, M.D., AMA President. “This cut is the highest ever scheduled under the broken Medicare physician payment system, and it threatens access to care for our nation’s seniors, military families, and the baby boomers now entering Medicare.”
In the joint letter, the 131 organizations urged Congress to work in a bipartisan, bicameral manner to enact permanent reform this year. The organizations noted that the cycle of scheduled cuts and frequent short-term delays cause disruptions for patients and physicians. In 2010 alone, Congress acted five times to pass short-term measures to stop scheduled Medicare physician payment cuts.
“The AMA will work with policy-makers on both sides of the aisle to replace the broken Medicare physician payment system with a system that better reflects the costs and practice of 21st century medical care, and provides stability for physicians and their Medicare patients,” Dr. Wilson said.

Many Hospitals and Doctors Plan to adopt EHRs

www.managedcarealt.com

Four-fifths of the nation’s hospitals, and 41 percent of office-based physicians, currently intend to take advantage of federal incentive payments for adoption and meaningful use of certified electronic health records (EHR) technology, according to survey data released by the Office of the National Coordinator for Health Information Technology (ONC). The survey information was released as the registration period opened for the Medicare and Medicaid EHR Incentive Programs.Non-hospital-based physicians and other eligible professionals can obtain incentive payments of as much as $44,000 under Medicare or $63,750 under Medicaid. Under both Medicare and Medicaid, eligible hospitals may receive millions of dollars for implementing and meaningfully using certified EHR technology.

The data comes from surveys commissioned by ONC and carried out in the course of regular annual surveillance by the American Hospital Association (AHA) and the National Center for Health Statistics (NCHS), an agency of HHS’ Centers for Disease Control and Prevention (CDC).
The NCHS survey found that 41 percent of office-based physicians are currently planning to achieve meaningful use of certified EHR technology and take advantage of the incentive payments. Four-fifths of these, or about a third of all office-based physicians (32.4 percent), responded that they will enroll during Stage 1 of the programs. Only 14 percent of respondents said they were not planning to apply for meaningful use incentives. Additional survey data from NCHS show that significantly increasing numbers of primary care physicians have already adopted a basic EHR, rising by 50 percent from 19.8 percent of primary care physicians in 2008 to 29.6 percent in 2010. Basic EHRs provide a beginning point for use of electronic health records in physician offices, but most physicians would need to further upgrade their EHR systems or their use of the systems in order to qualify for meaningful use incentive payments. To qualify for incentive payments, under the Medicare EHR Incentive Program, providers must achieve meaningful use of certified EHR technology, under regulations issued by CMS and ONC. Medicaid providers can receive their first year’s incentive payment for adopting, implementing, and upgrading certified EHR technology but must demonstrate meaningful use in subsequent years in order to qualify for additional payments.

Information about the incentive payments program is available on the CMS website at www.cms.gov/ehrincentiveprograms .

New Medicare Billing System Part of Small Business Lending Act

http://www.managedcarealt.com/

According to reports, the Small Business Lending Act signed into law this past June includes an anti-fraud provision that will require Medicare to do more to prevent fraud.

"Medicare fraud has been a problem for far too long," notes Alan Weinstock, insurance broker at www.MedicareSupplementPlans.com. "CMS uses an outdated billing system which I understand actually helps to facilitate over $60 billion in Medicare fraud annually."

Under the new provision, the Centers for Medicare and Medicaid Services (CMS) will be required to stop its long-held policy of approving claims without first verifying them.

Medicare Billing Software

Part of what the law implements is new Medicare billing software with a predictive modeling component, a type of analytical technology that already has been adopted in the credit card industry to identify potentially fraudulent bills. Medicare billing contractors will be required to use the new technology for hospitalization and outpatient services, which make up the bulk of Medicare's spending. It is estimated that predictive modeling could save the government more than $20 billion a year.

CMS is required to launch a competitive bidding process by January 2011 for predictive modeling software contractors and then begin actually implementing the technology by July in the 10 states with the highest Medicare fraud rates. U.S. Senator George LeMieux (R-FL), who coauthored the Small Business Lending Act and wrote the Medicare anti-fraud initiative, has a personal interest since Florida is one of the states where Medicare fraud rates are the highest.

After the first year of implementation, Health and Human Services will be required to submit a report to Congress detailing the actual savings on Medicare fraud. If the savings are substantial, some of that money could be used to implement the technology in 10 more states.

A Third Judge Validates Health Care Overhaul Law

A third federal judge upheld the constitutionality of the Obama health care law on Tuesday, reinforcing the divide in the lower courts as the case moves toward its first hearings on the appellate level.

 

Judge Gladys Kessler of Federal District Court for the District of Columbia became the third appointee of President Bill Clinton, a Democrat, to reject a constitutional challenge to the Affordable Care Act. Two other federal district judges, both appointed by Republican presidents, have struck down the law’s keystone provision, which requires most Americans to obtain health insurance starting in 2014.
One of those judges, in a case filed in Florida, ruled that the rest of the law could not be severed from that provision, and suggested that the entire act was therefore invalid. The Justice Department, which represents the Obama administration in the cases, has asked the judge for clarification of his ruling, which left states confused about whether to continue carrying out the law.
Although the issue will almost certainly be determined by the Supreme Court, each lower court ruling contributes to the balance of legal opinion that the justices will consider. More than 20 challenges to some aspect of the sprawling act have been filed around the country. Oral arguments in the first appellate reviews are scheduled for May and June.
The District of Columbia case was filed by five individuals represented by the American Center for Law and Justice, a conservative Christian legal group.
Judge Kessler adopted the government’s position on whether Congress’s authority to regulate interstate commerce is so broad that it can require people to buy a commercial product. Past Supreme Court decisions have established the standard that Congress can control “activities that substantially affect interstate commerce.”
The judge suggested in her 64-page opinion that not buying insurance was an active choice that had clear effects on the marketplace by burdening other payers with the cost of uncompensated medical care.
“Because of this cost-shifting effect,” she wrote, “the individual decision to forgo health insurance, when considered in the aggregate, leads to substantially higher insurance premiums for those other individuals who do obtain coverage.”
Judge Kessler added: “It is pure semantics to argue that an individual who makes a choice to forgo health insurance is not ‘acting,’ especially given the serious economic and health-related consequences to every individual of that choice. Making a choice is an affirmative action, whether one decides to do something or not do something.”
The judge also tossed out a claim that the law restricted the plaintiffs’ exercise of religious freedom because the mandate to buy health insurance conflicted with their belief that God would provide for their well-being. She wrote that such a burden, if it existed at all, was too minor to require invalidation of the law.

HOW TO SELECT AN EHR FOR YOUR PRACTICE

www.managedcarealt.com

Basically, three steps are involved in this process: assessment, planning, and selection.

1. ASSESSMENT - what do you want, what do you need, what can you afford?  Assess the practice to identify opportunities to improve processes for patient care, improve your staff morale and integrate health care informations technology into your practice.  Decide whether or not to use outside help  - such as the regional extension centers established by the HITECH Act or a private consultant - to assist you in finding the best product for your specific needs.

2. PLANNING - Identify goals, priorities, and barriers.  Identify what are your highest priority needs, features and functions of an EHR from the practice perspective.  Make your staff aware of the anticipated changes in processes and workflow and seek their input regarding specific priorities you may not have identified.  Consider how to handle legacy paper charts and new paper-based data that will inevitably accompany new and follow-up patients.  One of the options you can consider is to scan patient charts, thus making an electronic image which may or may not be searchable.

3. SELECTION - Be certain of your practice's requirements before making a final decision.  Do you need a new billing system (practice management system)?  If you do not, does your current practice management system support an interface to an EHR.  If you are happy with your current practice management system, do not believe high-pressured sales pitches that indicate you must use an integrated practice management/EHR package.  Focus your decision on the activities you do 95% of your time.   Consider what your employees indicate their needs are:  e.g. email, instant messaging, patient education tools and forms.  Remember that there is no guarantee that even the maximum Medicare or Mediaid incentive payments will totally cover the costs of implementing an EHR.

A final suggestion would be to issue a Request for Proposal.  This will structure the selection process and allows the risks and benefits to be identified clearly up front.