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1. CMS Releases Details of NPI Contingency Plan
The Centers for Medicare & Medicaid Services (CMS) Friday announced the details of its National Provider Identifier (NPI) contingency plan for Medicare fee for service claims.
CMS in May will assess the number of claims submitted with NPIs. If this analysis demonstrates a sufficient level of readiness among providers, Medicare will begin to reject claims without NPIs on July 1. If, however, the May analysis shows a low level of readiness, the situation will be reassessed in June. If the June analysis demonstrates a sufficient level of readiness, claims without NPIs will be rejected as of August 1. CMS may extend the deadline even further based on the results of the June analysis.
CMS will also be hosting a conference call on this issue on May 10, from 11 a.m. to 12:30 p.m. Pacific time. Registration details will be available soon.
Click here for more information.
Contact: CMA’s legal information line, 415/882-5144 or legalinfo@cmanet.org.
2. Governor Schwarzenegger Speaks to CMA Physicians,
Guarantees Health Care Reform this Year
 More than 500 physicians, medical students, residents, and medical executives from throughout the state gathered in Sacramento Tuesday for CMA’s annual Legislative Leadership Conference. Attendees were treated to a keynote speech from Gov. Arnold Schwarzenegger, who confidently predicted health care reform this year. “I guarantee it,” he said. The governor also told attendees that he is committed to securing, not weakening, the patient-physician relationship and that he will continue to work with CMA to that end.
“We are encouraged that in the governor’s talk to our physician leaders in Sacramento today he indicated a strong and sincere interest in all of us working together to move beyond our few differences on health care reform,” says CMA president Anmol S. Mahal, M.D. “We look forward to continuing to work together so that all Californians can have access to health care while also preserving the physician-patient relationship.”
Click here information, including photographs from the event and an audio recording and a transcript of the governor’s speech.
Contact: Susan Bassett, 916/444-5532 or sbassett@cmanet.org.
3. CMA Submits Medicare Payment Reform Proposal to Congress
CMA recently submitted to Congress a multipronged plan to overhaul the broken Medicare payment system. The proposal, developed by CMA’s Medicare Technical Advisory committee and approved by the Board of Trustees, would, among other things, eliminate the flawed sustainable growth rate (SGR) formula, provide payment updates based on practice cost increases, and update the geographic payment localities. The proposal also presents credible alternatives to the SGR “spending target” approach to containing costs.
CMA President Anmol S. Mahal, M.D., personally presented CMA’s plan to California Congressman Pete Stark, chairman of the powerful Ways and Means Health Subcommittee, which presides over all Medicare issues. “CMA is the first medical association in the country to present a proactive, long-term plan to Congress to resolve the difficult and expensive SGR problem. Physicians in California cannot sustain future Medicare payment cuts and be at the whim of Congress’s last-minute actions,” says Dr. Mahal. “We have presented Congress with a credible long-term road map to ultimately pay physicians fairly and encourage appropriate medical care. We are asking everyone to give up something in order to achieve long-term reform. Mr. Stark was genuinely appreciative of our efforts to take the lead in developing a plan and he is interested in working very closely with us to achieve reform.”
Below are summaries of the proposal’s major elements:
Medicare Advantage Reform: Key to CMA’s plan is a proposal to equalize Medicare Advantage health plan rates with fee-for-service rates. Currently, Medicare Advantage plans receive 12 to 20 percent more than fee-for-service physicians for providing the same services to Medicare beneficiaries. Bringing plan rates in line with fee-for-service physician rates could save as much as $100 billion. CMA’s proposal would apply this significant savings to fund a switch from the flawed sustainable growth rate formula to a formula based on actual medical practice costs.
The proposal also requires Medicare Advantage plans to spend 90 percent of every premium dollar on medical care. To address the concerns of Permanente physicians and physicians who contract with Medicare Advantage plans, CMA’s plan would phase in the rate reductions over 3 to 5 years to give plans and beneficiaries time to make appropriate adjustments.
Eliminate the SGR: CMA has for years been fighting for a long-term fix to Medicare’s flawed sustainable growth rate (SGR) formula. The formula allows Medicare spending on physician services to grow at the rate of the gross domestic product (GDP), but it actually penalizes physicians because the cost of physician services rises more rapidly than the GDP. The SGR also establishes a national spending target and once that target is reached, physician fees are cut. Physician payments will be cut by 10 percent on January 1, 2008, unless Congress intervenes to stop the cuts.
CMA’s proposal would eliminate the SGR for 2008 and beyond and replace it with a formula based on the Medical Economic Index (MEI), which is a market index of actual medical practice costs.
These CMA-proposed reforms would cost approximately $314 billion. Recognizing that it would be financially and politically impossible to win approval for a proposal that does not also include a plan for reducing costs, CMA’s proposal would offset much of the cost through physician-driven care management programs, Medicare Advantage rate reductions, and cuts to hospital, nursing home, and home health programs (consistent with Medicare Payment Advisory Committee recommendations). CMA is also asking Congress to find some new money to help pay for the reforms.
Care Management/Cost Containment Demonstration Projects: CMA also proposes a number of five-year demonstration projects to study cost-saving mechanisms to coordinate care, manage volume, and reward appropriate use of medical services. Such mechanisms could include quality initiatives, peer comparisons on utilization, chronic disease management, reducing geographic variation in care, and physician-driven accountable health care organizations.
While the demonstration projects are being tested, the CMA proposal would update physician payments each year for five years, according to the MEI minus the MedPAC productivity adjustment. This would result in average physician payment increases of 2 to 2.5 percent a year during that period.
After the demonstration projects are completed, CMA, AMA, and others in organized medicine would work with Congress to implement a long-term payment system that includes automatic payment updates based on the MEI in tandem with a variety of the demonstration project programs that proved to be successful in managing costs and care. Permanent implementation of worthy demonstration programs would replace the SGR spending target as the Medicare physician cost containment mechanism.
The proposal would also apply some of the Medicare Advantage savings to fund the reauthorization of the Healthy Families program that has covered uninsured children in California for nearly a decade.
Click here for more information, including details of the proposal.
Contact: Elizabeth McNeil, 415/882-53376 or emcneil@cmanet.org.
4. Medicare Hosts Open-Door Forum on New Quality Reporting Program
The Centers for Medicare & Medicaid Services (CMS) will host an open-door forum and conference call to help physicians understand and prepare for Medicare’s Physician Quality Reporting Initiative (PQRI). The forum is 11 a.m. to 2 p.m. Pacific time, Monday, May 14.
The forum will focus specifically on the potential use of registries for reporting quality data.
Participation is free, but registration is required. Available phone slots fill up quickly, so interested physicians are urged to register as soon as possible. Registration closes at 1 p.m., May 9.
Physicians who are unable to participate in the call can access an on-demand audio replay beginning at the close of business on May 18. A written transcript of the discussion will also be available.
Click here for more information.
Contact: Diane Stern, 410/786-1133 or diane.stern@cms.hhs.gov.
5. Earn 30 CME Hours for Just $35
Register by May 1 for Pri-Med West and pay just $35. This CMA member discount is available online only.
This year’s conference and exhibition is May 9 to 12 at the Anaheim Convention Center. Attendees can select from over 50 clinical issue sessions and earn up to 30 AMA PRA Category 1 Credits.
Click here for more information.
6. Last Chance to Resubmit Aetna Modifier 57 Claims;
Deadline Is Monday, April 30
Aetna is currently accepting resubmissions of previously denied claims for E&M services provided on the same day as a decision for surgery. Previously denied claims with dates of service between January 1, 2005, and February 11, 2006, can be resumbitted. with dates of service back to January 1, 2005, The resubmission deadline is April 30.
Click here for more details.
Contact: CMA's legal information line, 415/882-5144 or legalinfo@cmanet.org.
7. Benefit of the Week:
6% Off Online Practice Management from athenahealth
CMA members receive 6 percent off athenahealth’s unique web-based practice management service, which integrates web-based practice management, EMR software, and back office processing specialists into a single service.
athenahealth helps physicians get paid quickly, correctly, and with minimal hassle: On average, practices that use athenahealth get paid 30 percent faster and see a 5 to 10 percent increase in collections.
For more details, contact Joe Donnelly at 339/221-2954 or jdonnelly@athenahealth.com or visit http://www.athenahealth.com/cma.
Join Us for a Special Dinner Presentation May 16 in Riverside
Physicians in the Riverside/San Bernardino area are invited to a special dinner presentation May 16 at the historic Mission Inn in Riverside from 6 to 9 p.m. to learn more about how athenahealth can help you improve your bottom line. This event is free, but registration is required. Please let us know if you’ll be attending no later than May 10 by contacting Jenise Solorio at the San Bernardino County Medical Society at 951/787-7700 or jsolorio@sbcms.org.
Click here for more information on your membership benefits.
Contact: CMA’s membership hotline, 888/233-2937 or lgodward@cmanet.org.
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No. 2092
Audio Podcast
