Increased Awareness of Legislative and Regulatory Issues

Increased Awareness of Legislative and Regulatory issues

Impact on your practiceGet involved

C Richard Schott MD FACCVice Chair PMS Board of Trustees

Chair PMS Specialty Cabinet

National Advocacy

bull Medicare fee schedule reductions20 reduction scheduled for 2010Need to fix SGR Formula

bull ICD 10 Codes

bull Presidential Candidates Plans for Health Care Reform

Advocacy Agendas

bull National Advocacy Agenda

bull Pennsylvania Advocacy Agenda

bull Political Advocacybull Practice Advocacybull Patient Advocacy

bull PMS-Specialty Society interfaces

A proposal by tbe US Department of Health amp Human Services requiring all physician practices and other providers to adopt a new ICD-10 code set by 2011 would dramatically increase costs for physician practices and clinical laboratories according to a new cost study initiated by a group of provider organizations and conducted by Nachimson Advisors According to the Medical Group Management Association the costs associated with implementing ICD-10 in such a short timeframe are markedly higher than what CMS has estimated and will place a major burden on providers taking valuable time away from their patients and straining other resources needed to invest in health information technology The total estimated cost for a 10-physician practice to move to ICD-10 would be $285240 while the total cost for a small three-physician practice is estimated to be $83290 and for a large 100-physician practice the estimated cost to implement ICD-10 is more than $27 million Medical Group Management Association October 14 2008

AMA and PMS oppose timeline for ICD-10 implementation

The US Department of Health and Human Services has proposed implementing new ICD-10 code sets by Oct 1 2011 and new HIPAA electronic transaction standards by April 1 2010 a time frame opposed by both the AMA and the Pennsylvania Medical Society

Pennsylvania Advocacy Agenda

bull Mcare Abatement Retirement of the Mcare fund Unfunded Liability = $17 Billion

Physician Retention Fund - $600000000 Cigarette Tax and Auto Cat Fund

Excess ContributionPhysicians and Hospitals Estimate=$112000000

Practice Advocacy ndash ReimbursementsPMS State of Medicine 2005

bull Pennsylvania physiciansrsquo operating costs as a percentage of revenue are similar to the rest of the countrymdash603 for Pennsylvania and 5959 nationally

bull Physicians in the eastern region of the USmdashincluding Pennsylvaniamdashare among the lowest paid in the country

bull Pennsylvaniarsquos private commercial insurers pay at some of the lowest levels in the country for EampM services

Practice Advocacy - Results

bull Independence Blue Cross (IBC) will increase physician reimbursement by a weighted average of 9 percent for in-network primary care physicians and specialists effective Dec 1 2008

bull Highmark-IBC Merger

Mcare Political ConsiderationsGovernor Tied Mcare Abatement to Uninsured Cover All Pennsylvanians PA-ABC AdultBasic ndash Add Psych and Prescription Coverage Senate Linked to PHC4 Concerns over SustainabilityHospital Association Opposed reduction in Disproportionate ShareOrganized Medicine Unity ndash Penna Ortho Society Concern with increased costs for Non-High Risk Physicians

Mcare Negotiations FailedFailed to Reach Compromise

Negotiations between the administration and Senate Republicans failed to reach a compromise on health coverage for the uninsured MCARE abatement or PHC4 reauthorization

The administration rejected what it said was a verbal offer from the Senate Republicans to add $50 million to the states low-cost insurance program adultBasic which would have added about 14000 people to the program that has a waiting list of 118000 uninsured Pennsylvanians

In an earlier letter to GOP leaders Rendell had proposed adding at least 100000 people to adultBasic and expanding the program benefits to include prescription drugs and mental health coverage

House Bill 2648

bull 2 year abatementbull Restores HC4

Senate has acted on this versionIn House Rules CommitteeIf House action (without amendment) would not

require additional Senate approvalStill threat of Governorrsquos vetoConsidered a ldquolong shotrdquo

Covering the Uninsured

Pennsylvaniarsquos 800000 uninsured = 9-25 by CountiesNational Average = 15PA Facing a $3 Billion Budget Deficit this yearMassachusetts ldquoUniversal Coveragerdquo Experiment

cost = $21 Billion1st three years -gt $25 Billion for next three yearsCurrently 5 uninsured California = 67 Million uninsured 4 out of 5 from working families $7Billion budget deficit this year

Massachusetts ldquoUniversal Coveragerdquo Experiment

bull For the first time oncology neurology and dermatology specialties all reported shortages according to the annual Massachusetts Medical Society workforce study Thatrsquos in addition to nine other specialities dealing with ongoing shortfalls in talent emergency medicine general surgery neurosurgery orthopedics psychiatry urology vascular surgery internal medicine and family medicine

bull More than 440000 Massachusetts residents became newly insured over the past year and are looking for primary care doctors

bull The study found that 2008 was the third consecutive year that both internal medicine and family medicine specialities were in short supply

Presidential Candidates Plans for Healthcare Reform

Presidential Candidates Plans

Obamarsquos Plan

Shifted from Single Payer Universal Health Care

Bigger Government ndash Mandates Regulations and Subsidies

ldquoPlay or Payrdquo

Regulations and restrictions on Third Party Payers

Presidential Candidates Plans

McCainrsquos PlanLevels playing field for Employer vs Private Based

InsuranceTax Credits $5000 Help for those not covered at work $5000 Tax Credit-Offset for Taxable Benefit Net saving 15 Bracket (up to $63000)=$3200year 25 Bracket (637-1285K) =$2000year Savings into Health Savings Account Purchase insurance across State Borders

Other Important Elements Needed

Accessibility

Affordability

Portability

Pre-existing clauses eliminated or modified

Break down Insurance Monopolies

Blues ndash non-complete provisions

PMS-Specialty Society interfaces

Expansion of the Board ndash 14 Specialty Members includes 3 Cardiologists (Vice Chair Cardiology Representative Young Physician Representative)

Association Management Services=$133000yr ndash 25 reduction in cost

PMS Specialty CabinetMedical Imaging ndash Cardiology and Radiology ndash Resolved at Specialty Cabinet

Certificate of Need Physician Self Referral ndash HB 305 Phyllis Mundy (D-Luzerne)

Collaboration with Orthopedic Society and Hospital Association on Mcare

CME Group Tracker

PMS Publications On Line

bull wwwpamedsocorg

Capital Insights Patient Connection Vital Lines Consult Intouch PAMPAC eNews Studies in Patient Safety Member Opinion Panel

GET INVOLVED

National Level Cardiology PAC AMPAC

Pennsylvania PAMPAC Endorsed Attorney General Tom Corbett ndash Reelection Kim Ward (Senate-Westmorland ndash Husband is

Nephrologist PAMPAC Supported Candidates

A Good Return on Your Investment

CMS Releases Final 2009 Medicare Physician Payment Rule

bull

bull The Centers for Medicare and Medicaid Services (CMS) yesterday released the final 2009 Medicare Physician Fee Schedule which includes some good news for cardiology in terms of administrative burden but some unfortunate news about physician payment While ACC staff continues to review the rule in detail highlights include the following

bull IDTFs CMS is deferring a final decision on its proposal to require physician practices that provide diagnostic testing services to register as IDTFs The ACC working in coalition with other cardiovascular societies has opposed the proposal because it would create significant administrative burdens on practices without necessarily increasing the quality of diagnostic testing provided CMS explained that the passage of the Medicare Improvements for Patients and Providers Act (MIPPA) in July 2008 was one reason that it decided not to finalize this proposal at this time MIPAA includes accreditation requirements for providers of the technical component of advanced imaging in order to be paid for services provided to Medicare patients beginning in 2012 The ACC strongly supported this component of MIPPA

bull Payment Rates Although MIPPA put in place a 11 percent update to the Medicare conversion factor CMS projects that overall Medicare payments to cardiology will fall by 2 percent in 2009 This cut results primarily from two policy changes First the third year of the four-year transition to a new formula for calculating practice expense relative value units (RVUs) will reduce payments for a number of cardiovascular imaging services Second MIPPA requires that the current budget neutrality adjustment applied to work RVUs be incorporated into the conversion factor As a result payments for services with a significant practice expense element (imaging procedures in-office procedures) will receive a reduced payment Conversely services with more physician work elements (evaluation and management interventional cardiology and electrophysiology procedures performed in a hospital) will have payments increase by more than 11 percent

bull Coding Changes CMS also announced the payments for a series of new codes related to cardiac device monitoring as well as new bundled codes that describe transthoracic echocardiography with spectral and color flow Doppler and stress echocardiography with stress ECG monitoring The ACC and MedAxiom are holding a special Webinar to address these changes on Nov 14 Click here to register

bull The final rule also includes detailed requirements for the 2009 Physician Quality Reporting Initiative (PQRI) and electronic prescribing (e-prescribing) The final rule increases the bonus payment for PQRI participation to 2 percent and adds additional reporting methods including using the ACCs IC3 Program as a reporting alternative Physicians in 2009 may also receive a separate 2 percent bonus for qualified e-prescribing as created under MIPPA The ACC is developing educational tools to assist members in learning how to participate in each of these programs

bull Watch wwwaccorg and upcoming issues of Cardiology magazine for additional information on the final rule and upcoming Webinars explaining the various provisions

bull

Register Now for Cardiac Device Monitoring Webinar

bullIn 2009 cardiovascular health care professionals will see a fundamental shift in coding for cardiac device monitoring services including pacemaker and ICD interrogations and programming sessions remote monitoring ICMs and ILRs CPT 2009 includes 23 new codes for reporting these services To help members understand the new structure the ACC and MedAxiom will hold a Webinar on Nov 14 from 200 to 330 pm ET to discuss the changes The Webinar is designed for physicians practice administrators coders and clinical staff and will feature presentations by physicians who wrote the new codes Register now httpwccwebeventservicescomviewwlrhtme=124603amps=1ampk=513D47BE12AC09B7CFFE567F36EEA942ampcb=genesysThe Webinar will also available by dialing (866) 847-7863

bull In related news the Centers for Medicare and Medicaid Services (CMS) later this week will release the final 2009 Medicare Physician Fee Schedule which is likely to include revisions to the anti-markup rule RVUs echocardiography services cardiac device monitoring services the 2009 Physician Quality Reporting Initiative as well as interim regulations on electronic prescribing Watch ACCorg for more information following the release of the final rule

bull Working Harderbull Working Smarterbull Working TOGETHER

TOGETHER WE ARE STRONGER

THANK YOUTHANK YOU