STAT
July 1, 2009 - Volume 39, No. 7
Reminder - Red Flags Rules Compliance Deadline is August 1 Legislative Update: Health Care Reform, Funding and Expansion Last Month to Receive Office-Based Surgery Accreditation Deadline August 1 Experts Wanted! Mark Your Calendar for OMA’s Interim Meeting/Fall Program Don’t Miss Final Program in AMA Stimulus Webinar Series – July 14 Register Now for RAC Educational Session on July 23 Reminder – 2010 AMA Publications Available to OMA Members at Discounted Prices Starting Next Month Multi-District Litigation Update New Business Associate Contract and Contract Addendum Templates Available OMB License Renewal Now Requires CME or Re-certification OMA Provides Review of CIGNA’s Physician Group Services Agreement for OMA Members PQRI and E-Prescribing Incentive Program News for 2009 2009 Health Care Payer Rankings Now Available Through athenahealth’s PayerView SM Certification Program in Global Health Member News AMA Therapeutic Insights Newsletter Focuses on Insomnia Member Deaths Special STAT Insert: MEDICAL ISSUES BRIEF Recovery Audit Contractors Set to Come to Oregon in August July Classified Ads – link to classified ads
Reminder - Red Flags Rules Compliance Deadline is August 1
As previously reported, effective August 1, 2009, the Federal Trade Commission will be enforcing the Red Flags Rules, which require financial institutions and creditors (including physicians and physician offices) to establish an identity theft protection program.
A Red Flags Rules resources web page has been developed on the OMA website at www.theOMA.org/redflagresources. Resources include template Red Flags Rules policies and procedures that offices can customize, and a brief overview of this Federal Trade Commission regulation. Members must login to access these exclusive resources. For login instructions, visit www.theOMA.org/Login.asp, or contact Stephanie Munoz at [email protected] or (503) 619-8000 for further login information.
Legislative Update:
Health Care Reform, Funding and Expansion As the 2009 legislative session came to a close, the biggest story of the session was the passage of a massive health reform package and an extension and restructuring of the provider tax. The reform package, HB 2009, is based on the recommendations of the Oregon Health Fund Board and establishes a Health Authority to take over the functions of various existing agencies with the task of improving quality and access to care while containing cost. Other OMA-supported Oregon Health Fund Board concepts are also included in this legislation.
The provider tax in HB 2116 proved to be the most controversial issue this session. The bill restructures the existing tax on hospitals and health systems that is set to expire in September. A one percent tax on health insurance premiums will fund the expansion of health coverage to 80,000 additional children, and a floating rate tax on hospitals will fund the expansion of the Oregon Health Plan. The tax revenue will secure Oregon around $1 billion in federal matching funds, which will be used to expand the Medicaid population and increase Medicaid reimbursement rates.
The final provider tax plan aligns with several of the OMA’s Health Care Funding Principles developed by the Legislative and Executive Committees. These include securing the federal matching dollars, expanding health care coverage, restructuring the existing provider tax so that it is affordable to institutions, and increasing Medicaid reimbursement. For more information on these bills or other legislation from this session, check out OMA’s News from Salem at www.theOMA.org/News_from_Salem.
Last Month to Receive Office-Based Surgery Accreditation by August 1 Deadline
As reported previously in STAT, August 1 is the deadline to comply with the requirement to certify medical offices where surgical procedures are performed. OMA offers a Board- recognized Office-Based Surgery Accreditation Program that enables Oregon physicians who perform conscious sedation in the medical office setting to comply with the Oregon Medical Board mandate (OAR 847-017-0005, October 2006).
The OMA program includes peer-review as well as telephone and on-site educational consultation and assistance. OMA’s rates are substantially below those of other accrediting bodies for this purpose, and OMA members are eligible for a 20 percent discount. Availability will become scarce as the deadline approaches. For more information, visit www.theOMA.org/page.asp?navid=746. For questions about becoming accredited or to enroll in the program, please contact D’arcy Renhard at [email protected], or call (503) 619-8000.
Experts Wanted!
With so much changing so rapidly in health care, media coverage of the issues important to OMA is sure to pick up speed over the coming months. Physicians should play a crucial role in good coverage of some of the most important stories of the day. One of the functions the OMA staff routinely take on is speaking to members of the press about stories and issues that affect Oregon physicians and their patients. The assistance we provide to journalists is an important part of the advocacy work we do, whether it relates to public health efforts or the legislative sphere. It’s important that we identify OMA members in communities around the state, who are knowledgeable on a range of topics, to serve as regional or local resources for members of the media. Currently, we would like to identify OMA members who have subject- matter expertise on:
Field burning and asthma/allergies
Obesity and related comorbid conditions
Access to care for the underserved
Business-related impacts on the practice of medicine (e.g., administrative burdens, regulatory challenges, malpractice insurance rates)
Physician-hospital relations
Physicians who agree to serve as references on these issues will receive tips for speaking with the media, assistance when writing op-ed pieces, and recognition in OMA publications as part of our volunteer base. Getting to know the local media is also a great way to build your profile in your community and help spread messages to your patients and the public, encouraging healthful behaviors.
To volunteer for this opportunity, contact Betsy Boyd-Flynn at [email protected]. Include a list in your email of any topics you are prepared to discuss, and your most- current and most-frequently accessed communications preference. Journalists often work on short deadlines, so contacting you quickly (e.g., by phone or email) may be essential.
Mark Your Calendar for OMA’s Interim Meeting/Fall Program
The Interim House of Delegates meeting will take place October 3-4 at OMA Headquarters in Portland. The meeting will follow a similar format to last year’s meeting with panel presentations and abbreviated House business. Presentation topics will include federal health care reform, Oregon’s public health response to the H1N1 flu, and other topics shaping medicine right now. Resolutions and reports are due September 2 at 5:00 pm. Since the business of the House will be abbreviated to allow for panel presentations, resolutions submitted should be of a time-sensitive nature (i.e., cannot be held for the 2010 Annual meeting). Please send resolutions to Theresa Hansen at [email protected].
Don’t Miss Final Program in AMA Stimulus Webinar Series – July 14
The AMA has been hosting a webinar series that covers the HIT provisions of the American Recovery and Reinvestment Act of 2009. The final program in this series, titled Stimulus 103: Real World Perspectives, will take place on July 14 at 10:00 am and will help you determine whether or not your practice is ready to maximize stimulus opportunities. You will also hear from practices using EHR systems about how they were able to transition their practices. To register, visit http://enews.ama- assn.org/t/865054/3165759/74751/0/.
Register Now for RAC Educational Session on July 23 The Recovery Audit Contractors program is administered by the Centers for Medicare and Medicaid Services to identify improper payments made on claims of health care services provided to Medicare beneficiaries. Improper payments may be overpayments or underpayments.
Health care providers that might be reviewed include hospitals, physician practices, nursing homes, home health agencies, durable medical equipment suppliers and any other provider or supplier that bills Medicare Parts A and B.
The OMA will be hosting a RAC program educational session with CMS and HealthDataInsights (the RAC for Oregon) for physicians and their staff on July 23 at OMA Headquarters. There will be two identical programs to choose from - a morning session (9:30 am-12:30 pm) and an afternoon session (2:00-5:00 pm). Space is limited so register early to secure your spot. To register for either program, visit www.theOMA.org/rac (be sure to turn off your pop-up blocker, if there are issues accessing the online registration form).
Reminder –2010 AMA Publications Available to OMA Members at Discounted Prices Starting Next Month
Look for your 2010 AMA publication order form in next month’s STAT. Coding books and other AMA publications are available at discounted prices for OMA members. Get an early start on ordering your 2010 publications. For further information on this discount program, contact Christi Donaugh at [email protected] or (503) 619-8000.
Multi-District Litigation Update
WellPoint/Anthem Settlement Agreement Expires July 15
The WellPoint/Anthem national multi-district litigation class action settlement is set to expire on July 15. After this date, WellPoint/Anthem will no longer have to comply with the settlement terms.
The American Medical Association has developed a resource to help physicians understand this settlement, which also includes a summary of key settlement provisions. Visit www.ama-assn.org/ama1/pub/upload/mm/368/wellpoint_flyer.pdf.
For further information on this and other MDL settlements, visit www.hmosettlements.com.
Blue Cross Blue Shield Settlement Compliance Process in Effect
Make Sure You Are Being Paid Correctly
As of April 21, 2009, all the provisions in the Blue Cross Blue Shield Settlement Agreement have taken effect. This means that settling Blue Cross Blue Shield plans:
May not seek overpayment recovery beyond 18 months
Must use a clinically based definition of medical necessity Must adhere to most CPT© coding rules including payment for E&M codes appended with a 25 modifier and payment for add-on codes
Must provide 90 days advance notice of material adverse change
May not require physicians to participate in all products
Must disclose their methodology for determining UCR amounts
If you believe a Blue Cross Blue Shield company (or any of the other settling insurers) has violated a provision of the settlement agreement, you should file a compliance dispute by completing the simple two page form available on www.hmosettlements.com. There is absolutely no cost to physicians to file disputes.
In addition to the Blue Cross Blue Shield Settlement Agreement, settlements with Anthem/WellPoint, HealthNet and Humana remain in effect. For more information, please go to www.hmosettlements.com, www.ama-assn.org/go/settlements or contact the compliance dispute facilitators, Deborah Winegard at [email protected] for Blue Cross Blue Shield and Humana disputes or Cameron Staples at [email protected] for Anthem/WellPoint and HealthNet disputes.
New Business Associate Contract and Contract Addendum Templates Available
Includes new compliant language
A new version of the business associate contract and a new contract addendum are now available that include the required language to comply with the Red Flags Rules and the American Recovery and Reinvestment Act privacy and security provisions. For more information on the new ARRA privacy/security provisions, visit the ARRA summary from the May issue of STAT available at www.theOMA.org/arra and scroll to the “Privacy and Security Provisions” section.
Require all existing business associates to sign the contract addendum; and
Use the new version of the business associate contract with any new business associates; and
Use the new version of the contract when renewing business associate contracts.
OMA also recommends practices create a timeline that will be followed to execute the contract addendum with all existing business associates, which demonstrates due diligence and a documented effort to comply with the Red Flags Rules.
To access these new templates, as well as other HIPAA policy and procedure templates, visit www.theOMA.org/hipaa and select the “templates” link under the “HIPAA Privacy Rule” section. Members must login to access these exclusive resources. For login instructions, visit www.theOMA.org/Login.asp, or contact Stephanie Munoz at [email protected] or (503) 619-8000 for further assistance. OMB License Renewal Now Requires CME or Re-certification
At its January meeting, the Oregon Medical Board approved a new rule regarding license renewal. When renewing a license, physicians must demonstrate their competency either through ongoing participation in a re-certification program or by taking 30 hours of relevant Category 1 Continuing Medical Education each year. Re-certification can be done through an American Board of Medical Specialties board, the American Osteopathic Association’s Bureau of Osteopathic Specialists, the National Commission on Certification of Physician Assistants, or the National Certification Commission for Acupuncture and Oriental Medicine. Prior to the new rule, Oregon was one of only three states that did not require CME for licensure. OMB is considering changing the CME requirements to 60 hours per two calendar years. For more information on license renewal rules, visit www.oregon.gov/OMB/PainMgt.shtml.
OMA Provides Review of CIGNA’s Physician Group Services Agreement for OMA Members
The OMA has completed a review of the Connecticut General Line Insurance Company, or CIGNA, Physician Group Services Agreement for OMA members. The review relates to the non-price terms of the proposed Agreement and covenant/ agreements physicians and their groups must make as a condition of participation.
The review contains general and specific observations regarding the contents of the Physician Group Services Agreement. The specific observations outline several sections within the Agreement that may need further clarification. However, it does not make any recommendations as to whether or not physicians should participate in this Agreement.
This review is only available to members upon request. To request a copy of a review of CIGNA’s Physician Group Services Agreement, please contact Christi Donaugh at [email protected] or (503) 619-8000.
PQRI and E-Prescribing Incentive Program News for 2009
The Centers for Medicare & Medicaid Services has announced that a new educational resource has been posted to the PQRI web page on the CMS website. The article, intended for office managers, outlines step-by-step how to get started in reporting 2009 PQRI measures. The article is available as a downloadable document at www.cms.hhs.gov/PQRI/31_PQRIToolKit.asp and is accessible by scrolling down to the Downloads section and selecting the “2009 PQRI and E-Prescribing Implementation Advice” link.
CMS has also announced three PQRI Help Desk Resources for eligible professionals: the Provider Call Center Directory, External User Services, and the QualityNet Help Desk.
All publicly available information on the CMS Physician Quality Reporting Initiative can be found at www.cms.hhs.gov/PQRI.
For information on the 2009 Electronic Prescribing Incentive Program, the CMS website features two new section pages: an E-Prescribing Measure page at www.cms.hhs.gov/ERxIncentive/06_E-Prescribing_Measure.asp, and an Educational Resources page at www.cms.hhs.gov/ERxIncentive/09_Educational_Resources.asp.
Publicly available information on the CMS Electronic Prescribing Incentive Program can be found at www.cms.hhs.gov/ERxIncentive. New and updated information will continually be added.
2009 Health Care Payer Rankings Now Available Through athenahealth’s PayerViewSM
On May 28, 2009, athenahealth, Inc., released its fourth annual PayerView Rankings, the industry’s first quantitative report that addresses the fundamental pain points that currently exist between insurers and providers. The rankings reflect each payers’ average score across seven specific metrics, which roll into three categories: Financial Performance, Administrative Performance and Medical Policy Complexity. This year, Humana assumed the top spot for national payers. To see how other national, commercial and regional payers fared, visit www.athenahealth.com/payerview. athenahealth hosted a webinar on June 16, 2009 on how PayerView is changing the way providers and payers work together. The webinar is free and available “on-demand” at www.athenahealth.com/oma. For information on athenahealth, an OMA-endorsed member benefit company, or PayerView, contact Jennifer Nordgaard at (503) 619-8000 or [email protected].
Certification Program in Global Health Offered
In an effort to address world health needs with an available supply of physicians, OHSU is offering a new course, Physician Training in Global Health, which offers extensive training for practicing medicine in developing countries and in disaster relief.
While the world economic crisis, regional wars and instability, epidemic infections, and the looming medical consequences of global climate change are all conspiring to adversely affect the health of the world’s poorest people, there is an unprecedented number of physician “baby boomers” in the United States who will reach retirement age within the next decade. Many semi-retired or newly retired physicians would like the opportunity to use their medical skills, honed over many years in practice, to improve the lives of medically underserved people.
Physician Training in Global Health (PTGH) targets physicians who are approaching retirement or are semi-retired, because these practitioners presumably have more time to volunteer overseas. This course was launched in the fall of 2008 with a highly successful pilot project. PTGH is now expanding to a class of ten physicians in the fall of 2009.
Physician Training in Global Health is offered by OHSU’s Dean of Graduate and Continuing Medical Education. The intensive ten week training starts September 10 and includes 90 hours of CME credit and the clinical preceptorships. A Certificate of Global Health is awarded by OHSU upon completion of the training. Primary care physicians who don’t need the preceptorships can take just the didactic portion of the course.
An active or emeritus Oregon medical license is a prerequisite, but personal liability insurance is not required. For more information, or for the curriculum or an application, contact course director, Andy Harris, MD at (503) 871-2011 or email [email protected].
Member News
Richard Allen, MD, received the American College of Obstetricians and Gynecologists Distinguished Service Award at ACOG’s 57th Annual Clinical Meeting in May. The award recognizes outstanding individuals in obstetrics and gynecology who have made important contributions within ACOG, government, research, teaching or in direct patient care.
Debbie Clarke, wife of Edward Clarke, MD, has been recognized with the Robert R. Herb Leadership Award. Mrs. Clarke has been an active participant in the OMA Alliance and groups such as Tuality Healthcare Foundation and Oregon Health Forum, among others.
Bradley Titus, MD, a Portland Cardiologist, received the AMA’s Physician’s Recognition Award in May. The PRA was established in 1968 to recognize physicians who demonstrate their commitment to staying current with advances in medicine by participating in certified continuing medical education activities.
Neda Shamie, MD, a corneal and anterior segment surgeon from Devers Eye Institute at Legacy Good Samaritan Hospital & Medical Center, has performed the first artificial corneal transplant in Oregon.
Judah Askew, MD, a new OMA member and recent Chief Resident in Cardiothoracic Surgery at Brigham and Women’s Hospital at Harvard Medical School, has joined Swanson-Gately Cardiothoracic Surgeons.
Ron Schwerzler, MD, director of medical services at Serenity Lane, is among the first physicians in the United States to be certified by the American Board of Addiction Medicine, a new independent specialty medicine board.
He is currently the only physician in Lane County who has received this certification.
The Neurological Clinic West Division of the Oregon Clinic opened a new office in June on the Providence St. Vincent Medical Center campus on Portland’s west side. Leslie McAllister, MD, Hubert Leonard, MD, Joshua Ramseyer, MD, and Kyle Smoot, MD are located at the Neurological Clinic West Division, along with Daniel Gibbs, MD.
AMA Therapeutic Insights Newsletter Focuses on Insomnia
The American Medical Association has released “Management of Chronic Insomnia in Adults,” the latest AMA Therapeutic Insights newsletter. This free online newsletter is written by top disease experts in collaboration with the AMA. One disease condition is highlighted per issue, and physicians can see exactly which medications are being prescribed for the featured conditions. AMA PRA category 1 CreditTM is also available. Visit www.ama-assn.org/go/therapeuticinsights to read this issue and previous newsletters.