Executive order supports HIT and quality measures

An executive order signed by President Bush on Aug. 22 requires four federal agencies and their contractors to make information about quality and cost of health care available to their beneficiaries, enrollees and providers. The executive order also requires that the agencies use interoperable health information technology and standard quality measures as well as develop and identify practices to promote high-quality care. Read the complete story on TAFP’s Web site.

TAFP recommends postponement of ICD-10

On Aug. 25, TAFP sent a letter to Sen. Kay Bailey Hutchison, Sen. John Cornyn and the full complement of Texas Representatives commenting on the replacement of the International Classification of Diseases, 9 th edition, Clinical Modification (ICD-9-CM) diagnosis and procedure billing codes with ICD-10-CM/PCS codes. Legislation being considered in Congress would set a 2009 deadline for the switch.

The change would mean an almost 10-fold increase in the number of codes from 13,000 to 120,000, with major reclassifications for disease states and causes of mortality. The make-up of the codes is different, too. ICD-10 codes start with an alphabetical character and use six digits with the possibility of a seventh digit extension, a change from the five-digit ICD-9-CM codes that do not universally use alphabetical characters.

The switch to ICD-10 and other changes delineated in H.R. 4157 would implement health information technology initiatives aimed to improve the quality, safety and efficiency of health care. But the retooling of hardware and software, the retraining of staff, plus added cost of equipment and staff time makes the 2009 compliance deadline one of grave concern, TAFP President Douglas Curran, M.D., stated in the Academy’s letter. To allow for a longer test period and staff training on new hardware and software, Curran asks that H.R. 4157 be modified to extend the compliance deadline to 2012.

Read TAFP’s letter to the Texas congressional delegation.

Advocacy round up

TAFP has been working hard to represent the interests of family medicine and increase awareness of the importance of primary care. In the past month TAFP staff and leadership have presented important letters and testimony to key national policymakers on issues such as Medicare and Medicaid changes, several health information technology issues and family physicians’ roles in performing electrodiagnostic studies. TAFP will continue to educate the public and lawmakers through these advocacy efforts and others to come.

Read the letters linked below:

Letter to the Centers for Medicare and Medicaid Services Administrator Mark McClellan, M.D., Ph.D., on Medicare payment changes.

Letter to Texas Medical Association President Ladon Homer, M.D., encouraging TMA to join TAFP in its advocacy efforts.

Letter to Trailblazer Health Enterprises on electrodiagnostic studies.

Testimony presented to the Senate Committee on State Affairs on health care cost containment.

Letter to the Texas congressional delgation on replacing the International Classification of Diseases, 9th edition, Clinical Modification (ICD-9-CM) diagnosis and procedure billing codes to ICD-10-CM/PCS codes.

Texas Lawmaker proposes Medicare payment fix

Rep. Mike Burgess, M.D., an obstetrician from Lewisville, Texas, introduced a bill to the House of Representatives in July that proposes a fix to the Medicare physician payment formula. The bill, known as the “Medicare Physician Payment Reform and Quality Improvement Act of 2006,” would give physicians a pay increase for 2007 and thereafter link the annual physician payment formula to the Medicare Economic Index rather than the Sustainable Growth Rate.

Current projections for physician pay in 2007 show an estimated cut of 5.1 percent. In an AAFP News Now story, AAFP President Larry Fields, M.D., warned of severe consequences of such a large cut.

“We can’t live with this cut or even the threat of a cut,” he said. “It’s difficult for family physicians to plan for the future when they are unsure of their income. It also is hard on patients, who live with uncertainty about whether their physicians will leave the program.”

The Medicare Physician Fee Schedule is updated annually according to a formula. The formula specifies the update by using the SGR—the ideal rate of growth calculated with medical inflation, projected economic growth, projected growth in the number of Medicare beneficiaries and any changes to laws or regulations—to adjust the MEI. The MEI is a measure of inflation based on practice costs and general wage levels of physicians.

AAFP says Burgess’s legislation would ensure physicians “full and fair payment” for their services, create quality performance measures for Medicare providers, improve quality improvement organization accountability and flexibility and find reasonable methods to pay for these benefits.

“It may not be a perfect solution, but it would be great to get rid of the SGR,” said AAFP government relations representative Jerome Connolly in another AAFP News Now article. “The current Medicare payment system for physicians does not work. The SGR formula must be repealed and replaced with a stable and predictable annual update… Such payments should be linked to health care quality and efficiency and should reward the patient and physician behavior that provides the best results.”

For more information on Rep. Burgess’ bill, visit the Library of Congress THOMAS Web site and search bill number HR 5866.

CMS to host forum on the National Provider Identifier

All health care providers with questions about the National Provider Identifier can participate in the Centers for Medicare and Medicaid Services’ national NPI roundtable on Tuesday, Sept. 26, 2006 from 1 - 2:30 p.m. CT. At the roundtable, CMS representatives will answer questions submitted before Sept. 8 about obtaining and using the 10-digit numeric identifier as it pertains to Medicare. As the compliance deadline nears—nine months remain until May 23, 2007—CMS encourages all physicians to request their NPI that aims to smooth medical claims processing and payment issues.

To participate in the roundtable, call 1-877-203-0044 and enter the pass code, 4795739. Questions should be submitted by Friday, Sept. 8 for consideration. Medicare providers who bill a Fiscal Intermediary should sent questions to NPIQuestionsfromFIBillers@cms.hhs.gov, Medicare providers who bill a Carrier should send questions to NPIQuestionsfromCarrierBillers@cms.hhs.gov, and Medicare providers who bill a Durable Medical Equipment Regional Carrier (DMERC) should send questions to NPIQuestionsfromDMERCBillers@cms.hhs.gov.

More information on the NPI can be found on the CMS NPI Web page.

Don’t forget about upcoming CME opportunities from TAFP

The 2006 Primary Care Summit will be held at the Westin Oaks in Houston Oct. 13-15. Register online now for one of TAFP’s most anticipated conferences. The Primary Care Summit is worth almost 24.75 AMA PRA Category 1 Credits, including one hour of EB CME presented by Howard Marcus, M.D. on Point of Care.

The 2007 Doctors in Motion conference will be held Jan. 12-17 in Breckenridge, Colo. Start the year off right by earning 25 AMA PRA Category 1 Credits. Register online today.

Deficit Reduction Act mandates that Medicare payments stop Sept. 22-30

How about a nine-day holiday? Medicare check writers think it’s a great idea, but physicians probably won’t. To save money in this year’s federal budget, CMS will not pay any claims during the last nine days of the fiscal year. Read AAFP’s News Now story for more information on what planning family physicians should do to ensure adequate cash flow from Sept. 22-30. Read it here.

What family physicians need to know about pay for performance

The rising popularity of pay for performance projects makes the quality measure issue one of great importance to family physicians. Do you have a grasp on how P4P could affect your practice? In case you missed it, an in-depth article from the July/August edition of AAFP’s Family Practice Management analyzes what primary care physicians can expect in the coming months and years. Read it here.

Copyright 2006, Texas Academy of Family Physicians