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TOA
President's
Update: Contact Your Members of Congress
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By Timothy L. Beck, MD
President, Texas Orthopaedic Association
I am sure most of you received
the email from Dr. David Halsey, Chair of the AAOS Council on
Advocacy. However, this message is worth repeating and needs
your attention. Please contact your Members of Congress
today. Congress recesses without addressing Medicare
physician payment fix! |
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For more than five years, the American
Association of Orthopaedic Surgeons (AAOS), along with the Alliance of
Specialty Medicine, has advocated for a permanent fix to the flawed
Medicare physician payment formula. Yet again, we find the Congress
unable to implement a permanent, even temporary, fix in advance of
today’s July 1, 2008 deadline. AAOS leadership shares your frustration
about the impact a 10.6% cut will have on your practice and the delivery
of patient care, and we continue to work toward a permanent fix.
On June 26, 2008, in the Senate, Medicare legislation (H.R.
6331), which had earlier passed by a veto-proof majority in the U.S.
House of Representatives, failed to receive the 60 votes needed to
invoke cloture. Cloture would have ended debate and called for an
immediate vote on the bill. Neither Chamber considered a stop gap
measure that would have averted the cut for 30 days while Congress and
the President negotiated a compromise.
If passed, H.R. 6331 would eliminate the 10.6 percent reduction in
Medicare physician reimbursement, maintaining payments at current levels
for the remainder of 2008 and implementing a 1.1 percent increase in
2009. While there is political consensus that the 10.6% cut in physician
payments should be avoided, it is a disagreement over peripheral
provisions, including payment decreases to Medicare Advantage plans,
which has caused division and is currently holding up enactment of the
legislation.
The AAOS actively engaged with House and Senate leaders of both parties
to draft a bipartisan compromise bill that could pass the litmus test in
both Chambers and the White House. While H.R. 6331 would have avoided
the 10.6% cut scheduled for July 1, 2008, the passage of this
legislation would also result in a cut of more than 20 percent to
physician Medicare payments on January 1, 2010 - placing orthopaedic
surgeons in a position where they would be subjected to even worse cuts,
a provision the Academy finds impractical. Additionally, imaging
provisions included in H.R. 6331 may cause challenges for some
orthopaedic practices, and without more clarification on the impact of
these provisions, the bill is a threat to the ability of some of our
members to provide access to the best possible care for their patients.
With these provisions in mind, the AAOS could not support H.R. 6331 in
the public arena.
Senate Majority Leader Harry Reid has indicated that the Senate will
revisit Medicare legislation upon returning from the July 4th recess.
While it is likely that Senate leaders will achieve the 60 votes needed
to move to final passage of H.R. 6331, it is less certain that they will
secure the 67 votes needed to override a Presidential veto- a threat
already articulated by the White House due to reductions in the Medicare
Advantage plans. In the event of a veto, Congress will be forced to
negotiate a revised bill with the President.
While the package to be considered upon the Senate’s return contains
both helpful and problematic provisions,
AAOS members should click here to contact their Members of Congress to
encourage legislators to fix the physician payment formula with the
message: “Patient access to health care is at risk! Stop playing
partisan politics and fix the Medicare physician payment formula!
Immediately pass a Medicare bill that can become law.”
In order to limit disruptions in Medicare physician payments in the
current political gridlock, the Centers for Medicare and Medicaid
Services (CMS) has instructed its contractors to hold Medicare claims
for services provided in the first 10 business days of July. This
should have minimum impact on provider cash flow because, under current
law, electronic claims are not paid any sooner than 14 days (29 days for
paper claims) after the date of receipt. Meanwhile, all claims for
services delivered on or before June 30 will be processed and paid
without any delay or reduction in payments.
The AAOS leadership and the Office of Government Relations remain
engaged in this process and will continue to provide AAOS members with
updates on efforts to avert the payment cut in the short-term and to
achieve a permanent solution in the long-term.
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Complaints
Against Doctors Increase
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By MELISSA McEVER /
Valley Morning Star
BROWNSVILLE - More patients across the state are filing complaints
against doctors than in years past, and doctors are starting to feel
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unfairly targeted, officials and physicians said during meetings with
the Texas Medical Board this week. "Doctors have said that their perception
of the medical board has changed dramatically ... now, they're afraid
to get letters from the board," said Dr. Maria Dill, medical director
of the South Texas Health Care System, a state-funded clinic in
Harlingen. "And the only newsletter we get from the board lists
doctors' mistakes."
The medical board, which licenses doctors and regulates medical
practice in Texas, is holding a series of town hall meetings and
licensing seminars in Texas throughout June and July. Board
representatives were in Brownsville Monday and Tuesday to meet with
doctors and the public.
"It's the first time we're doing this across the state," Dr. Manuel
Guajardo, a Brownsville obstetrician-gynecologist and board member,
said. "We're here for your concerns and questions."
After the Texas Legislature gave the board additional funds for
enforcement in 2005, as well as handing down a mandate to better
police the medical profession, the board has stepped up its
investigations. By the end of fiscal year 2007, the board was
investigating 1,300 cases and had opened about 2,600 more, compared to
694 investigations and 1,900 open cases in 2004, according to TMB's
Web site.
The number of complaints the board receives from patients and family
members also has increased dramatically, said Mari Robinson, the
agency's director of enforcement. In the last two years alone,
complaints have increased by 62 percent, Robinson said.
"We don't know if more (problems) are occurring or more are being
reported," Robinson said.
Most of the complaints are about quality of care, she said. They range
from problems on the operating table to mishandling of medications,
she said.
Robinson said several factors could be contributing to the increase in
complaints. For one, the number of doctors in Texas is on the rise,
which leads to a correlating complaint increase.
Also, because the Legislature has imposed caps on medical malpractice
damages in Texas, more patients and family members are filing
grievances with the board rather than filing lawsuits, she said. And
finally, more patients know about the complaint process than in the
past, she said.
Doctors said they wanted more information about what types of
complaints the board is receiving, and help avoiding common errors.
"The board, I think, is doing its job, but we need to know more about
this complaint increase," said Dr. Pastor Alvarado, Brownsville
colorectal surgeon. "Where are the complaints coming from? And what
can we do to correct problems?"
Dill said that doctors need more guidance on what the board expects
from them.
"Physicians are trying to do the right thing for patients," she said.
"We need more information on how to do that."
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This Week In Texas: Mignon
McGarry Memos
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By Mignon McGarry
TOA Legislative Advocate / Memo: Wed. November 28th,
2007
TOA Online Version: All Memos
July 2, 2008, Wednesday
During this week when
Americans celebrate the birth of the United States, we thought
we would take a break from the hard hitting political
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news and give you some trivia to
impress your family, friends and neighbors during your local Fourth of
July barbeque or similar gathering:
A vexillologist is an expert on flag history.
Liberty, Texas is one of the 30 places in the United States with the
word “liberty” in its name.
Congress declared July 4th a federal holiday in 1941.
Professional fireworks shows used to last close to an hour as compared
with shows today last an average of 20 minutes. Cost is cited as a
major factor.
Fireworks can be legally sold in Texas only during three periods each
year, from June 24 through July 4, from December 20 through January 1,
and from May 1 through May 5 in locations not more than 100 miles from
the Texas-Mexico border. Due to drought conditions in Central Texas,
the Texas Pyrotechnic Association delayed the sale of fireworks in the
Austin area this year until July 1st.
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AMA Unveils
New Health Insurer Report Card
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Delayed
and inaccurate insurance payments add cost, inefficiency to
health care system
CHICAGO — To help reduce the substantial administrative burden
of ensuring accurate insurance payments for physician
services, the American Medical Association (AMA) today
launched the Cure for Claims
campaign to help heal the ailing system of processing medical
claims
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with health insurers,
campaign to help heal the ailing
system of processing medical claims with health insurers, and
unveiled the first AMA National Health Insurer Report Card on
claims processing.
"The goal of the AMA campaign is to hold health insurance
companies accountable for making claims processing more
cost-effective and transparent, and to educate and empower
physicians so they are no longer at the mercy of a chaotic
payment system that take countless hours away from patient
care," said AMA Board Member William A. Dolan, MD.
The inefficient and unpredictable system of processing medical
claims adds unnecessary cost to the health care system,
estimated as much as $210 billion annually, without creating
value. Physicians divert substantial resources, as much as 14
percent of their total revenue, to ensure accurate insurance
payments for their services.
"Eliminating the inefficiencies
of the billing and collection process would produce
significant savings that could be better used to enhance
patient care and help reduce overall health care costs," said
Dr. Dolan. "To diagnose the areas of greatest concern within
the claims processing system, the AMA has developed its first
online rating of health insurers."
The AMA's new National Health Insurer Report Card provides
physicians and the public with an objective and reliable
source of information on the timeliness, transparency and
accuracy of claims processing by health insurance companies.
Based on a random-sample pulled from more than 5 million
electronically billed services, the report card provides an
in-depth look at the claims processing performance of Medicare
and seven national commercial health insurers: Aetna, Anthem
Blue Cross Blue Shield, CIGNA, Coventry Health Care, Health
Net, Humana and United Healthcare.
Key findings include:
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Denials. There is wide
variation in how often health insurers pay nothing in
response to a physician claim (from less than 3 percent to
nearly 7 percent), and in how they explain the reason for
the denial. There was no consistency in the application of
codes used to explain the denials, making it extremely
expensive for physician practices to determine how to
respond.
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Contracted payment rate
adherence. Health insurers reported to physicians the
correct contracted payment rate only 62 to 87 percent of the
time. Additional analysis will be necessary to determine how
often these errors were tied to inaccurate payment. When
health insurers report an amount that does not adhere to the
contracted rate, it adds additional, unnecessary costs to
the physician practice to evaluate the inconsistency.
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Transparency of fees and
payment policies. More than half of the health insurers do
not provide physicians with the transparency necessary for
an efficient claims processing system.
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Compliance with generally
accepted pricing rules. There is extremely wide variation
among payers as to how often they apply computer generated
edits to reduce payments (from a low of less than .5 percent
to a high of over 9 percent). Payers also varied on how
often they use proprietary rather than public edits to
reduce payments (ranging from zero to as high as nearly 72
percent). The use of undisclosed proprietary edits inhibits
the flow of transparent information to physicians, adding
additional administrative costs to reconcile claims.
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Payment timeliness. Prompt pay
laws appear to have been effective in ensuring a relatively
quick response to physician's electronic claim. Further
analysis will be necessary to determine the extent to which
this response is accompanied by accurate payment if the
claim.
The report card will be
available on the AMA Web site.
"Physicians want to focus on caring for their patients, not
fighting health insurance red tape that may delay, deny or
shortchanged payments for their services," said Dr. Dolan.
"The report card provides a useful snapshot of how each of the
nation's biggest health insurers can improve the process they
use to pay their bills."
The report card demonstrates the inconsistency and confusion
that results from each health insurer using different rules
for processing and paying medical claims. This variability
requires physicians to maintain a costly claims management
system for each health insurer.
The report card also suggests that both physicians and health
insurers can help reduce unnecessary administrative costs if
electronic transactions and full transparency are widely
adopted. The costs of re-submitting claims can also be reduced
if health insurers make better use of voluntary fields and
reason and remark codes in electronic transactions to
communicate crucial information to physicians about their
claims.
The AMA Cure for Claims campaign will empower physicians to
create a systematic approach to claims management so they
spend less time and resources on payment hassles with health
insurers. To help physicians submit timely and accurate
claims, the AMA has created the Practice Management Center, an
easy-to-use online resource offering physicians and their
staff members tools for preparing claims, following their
progress and appealing them when necessary.
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TOA Survey - Insurance Carrier
Report Card
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Please complete the
TOA Insurance Carrier Survey that can be accessed online by clicking
here
and entering icrc-07-07-08 as the
access password. Or you may download the survey in PDF format by
clicking
here, and fax the completed survey to 866-864-1568. This
information will be of great interest to TOA
members who are trying to decide who are the really "bad actors"
of the insurance industry
in Texas. You can review the findings of this survey in next month's
TOA E-Connect. Thank you.
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