District of Columbia Announces Plan to "Clawback" 20% of Medicaid Payments Made to Physicians in 2011

     In a transmittal dated February 2, 2012, (click here) the Department of Health Care Finance announced its intent to implement a 20% rate reduction effective March 1, 2012.  All Medicaid claims submitted on or after that date are being processed with a Medicaid fee schedule paying 80% of the Medicare rate.  This is consistent with the FY 2011 Budget Act passed by the Council in Spring of 2010. The Medicaid payment reduction contained in that budget was strongly opposed by the Medical Society at the time, citing its effect of placing our City's most vulnerable citizens at greater risk of losing access to much-needed medical care.

     The far more dire consequence of the February transmittal is that the Department of Health Care Finance now plans to recoup 20% of all Medicaid monies paid to physicians from January 1, 2011, though February 29, 2012, - an amount totaling nearly $11 million that could be crippling to the viability of physician practices.  In response to this "clawback", Medical Society leadership met with the Director of the Department of Health Care Finance, Wayne Turnage, and senior Medicaid officials as well as with representatives of the Centers for Medicare and Medicaid Services to seek additional details on the plan and  secure a resolution to the attempted "clawback".  MSDC was joined by other stakeholders who will severely impacted by any such "clawback".  The American Medical Association supported the Medical Society and our physician members at the meeting and has contacted senior officials at CMS to see what options may be available to physicians.  The Medical Society repeatedly expressed both its concern about access to care for Medicaid recipients and to the practice viability of certain providers should the City move forward in any attempt to recoup the monies.  MSDC will continue to pursue all avenues to overturn the City's decision and will keep you informed as we make progress towards that goal.

For a copy of the February 2nd transmittal, click here.

For a copy of our testimony opposing the Medicaid payment rate reduction, click here.

Continuing to push for the Medicare Patient Empowerment Act

    The AMA and MSDC continue to educate members of Congress about HR 1700, "The Medicare Patient Empowerment Act."  This bill is based largely on policy supported by MSDC at the AMA House of Delegates meeting in 2010, and allows Medicare patients and their physicians to enter into private contracts without penalty to either party. 

     Effective January 1, 2012, Diversified Service Options, Inc. (DSO), a wholly-owned subsidiary of Blue Cross and Blue Shield of Florida Inc., acquired Highmark Medicare Services (HMS) from its parent company, Highmark Inc. As a result, HMS changed its name to Novitas Solutions, Inc. (Novitas). Novitas, pronounced Nō-va-tahs with an emphasis on the first syllable, is the Latin word for "newness", and we will be designing a new logo and brand management system to support the new company identity during the next few months.

     Novitas will continue to be the Medicare Administrative Contractor (MAC) for J12 and the Section 1011 Administrative Contractor. Their mission "to provide quality services and responsive solutions in the administration of our contracts according to our core values and in support of the goals of our stakeholders" remains unchanged.

     As they move through the migration to their new name, Novitas will provide additional announcements and frequently asked questions (FAQs) on their Website that will cover any potential impacts to their customers. 

      Effective March 10, 2012, Novitas Solutions has begun migrating the current Highmark Medicare Services website to our new Novitas Solutions website. They are targeting completing their name-change to all active webpage content by March 30, 2012. The new Novitas Solutions website URL will be www.novitas-solutions.com. As this migration takes place, you will notice the following:

• Visiting www.novitas-solutions.com today will already take you to the current Highmark Medicare Services website.
• The Highmark Medicare Services website will be renamed to www.novitas-solutions.com and our main header logos will be changed to reflect our new company name.
• Throughout the website, they will be changing the verbiage within active webpages from "Highmark Medicare Services" to "Novitas Solutions."
• There will be some historical documents on our website that will not be changed to the new company name. These documents (e.g., past Medicare Report issues) were issued under their previous company name, and it is appropriate to keep these documents as they were originally issued.

AMA resource helps physicians prepare for success under risk-based

payment systems
     The AMA recently published a comprehensive physician resource entitled, "Evaluating
and negotiating emerging payment options." Developed by the AMA and experts in physician payment issues, this resource helps physicians take the practical steps needed to succeed under the risk-based payment arrangements that will likely become more commonplace over the next several years. It is designed to help physicians: 

1. evaluate the risk-based payment contracts offered to them; 
2. understand the contract negotiation process and maximize the likelihood that they will be able to negotiate acceptable contract terms; and 
3. successfully monitor and manage risk over the course of the
   risk-based payment arrangement. 

     "Evaluating and negotiating emerging payment options" begins with an introduction outlining the differences between fee-for-service and the budget-based methodologies that underlie all risk-based payment arrangements. Subsequent chapters provide practice guidance concerning: 

1. how physicians can determine their baseline practice costs; 
2. ongoing fee-for-service payment issues, including issues that arise when fee schedules are based on the Medicare Resource-based Relative Value System; 
3. pay-for-performance programs; 
4. capitation; 
5. shared savings (currently under development); 
6. bundled payments; 
7. withholds and risk pools; 
8. risk adjustment; 
9. stop-loss insurance; 
10. working with actuaries; 
11. negotiating the deal; 
12. joint contracting/collective bargaining; and 
13. ethical implications of financial incentives in managed care contracts.

     Visit www.ama-assn.org/go/payment to access this important resource.

Tell us: Are you experiencing significant problems with HIPAA V. 5010? 

     The AMA has been monitoring the transition to HIPAA Version 5010 and communicating concerns to CMS as we hear of them. As you are aware, the compliance date for using Version 5010 was January 1, 2012 but CMS has elected not to enforce compliance until April 1. We continue to encourage physicians to submit complaints using our complaint form at http://www.ama-assn.org/resources/doc/washington/hipaa-5010-complaint-form.pdf and for all other payers at https://amaassn.qualtrics.com/SE/?SID=SV_9BO3cQAuwO7H7fu&SVID=Prod.

     In February 2012, the Medical Society and Alliance Foundation contributed $10,000 to the Sterling Ruffin Fund.  Physicians are not immune from the need to confront personal issues, such as substance abuse and mental illness. MSDC's Physician Health Program has provided assistance to over one hundred of its members over the years, for treatment and rehabilitation services.  Through the Sterling Ruffin Fund, MSAF continues to provide additional support for this important physician health program.

If you have any questions about the Physician Health Program, please contact Barbara Allen at ballenphp@gmail.com. 

     Injection Drug Users (IDUs) in the United States (U.S.) are at increased risk of acquiring human immunodeficiency virus (HIV) infection. Despite a recent reduction in the number of HIV infections attributed to injecting drug use in the U.S., IDUs remain a substantial proportion of those becoming infected with HIV. In 2009, 9% of new HIV infections in the U.S. occurred among IDUs.

     To monitor HIV-associated behaviors and HIV prevalence among IDUs, CDC's National HIV Behavioral Surveillance System (NHBS) conducts interviews and HIV testing in selected metropolitan statistical areas (MSAs). NHBS is a behavioral surveillance system used to monitor prevalence and trends in 1) HIV-related risk behaviors, 2) HIV testing, and 3) use of HIV prevention services among populations at high risk for acquiring HIV, including MSM, injection-drug users, and heterosexuals at increased risk for HIV infection. Data are collected in annual cycles from one risk group per year so that each group is surveyed once every 3 years. This report summarizes data from 10,073 IDUs interviewed and tested in 20 MSAs in 2009 as part of NHBS.

     The report shares increased evidence of risk behaviors for persons at high risk for HIV infection. Of IDUs recruited in 20 U.S. cities, 9% tested positive for HIV, of whom 45% were unaware of their infection. Among those at risk of acquiring HIV infection, 34% reported sharing syringes and 69% reported having unprotected vaginal sex in the past 12 months. Less than half the IDUs reported having been tested for HIV (49%) or participating in a behavioral intervention (19%) during the same time period. HIV infection among IDUs in the U.S. remains a significant challenge. Although incidence data show that HIV incidence among IDUs is low, these data suggest that risk behaviors and lack of awareness of infection remain high.

     Given the prevalence of drug and sexual risk behaviors among IDUs, efforts should be made to provide HIV prevention for IDUs - such as increased access to HIV testing, sterile syringes, and condoms.  Multiple reviews find that Syringe Exchange Programs (SEPs) can reduce needle sharing among IDUs, resulting in positive behavior change that can reduce HIV transmission. The reviews also note that SEPs do not result in negative consequences such as increases in injection frequency, in injection drug use, or in unsafe disposal of needles in the community.  SEPs can also provide a positive pathway to prevention for substance abusing persons. Proven prevention strategies remain critical for those at high risk for HIV, such as individuals with multiple sex partners, those in relationships with HIV-positive individuals and IDUs.

Read the full report.

     Atlantic Health Partners offers MSDC members the overall best purchasing terms for Sanofi's Fluzone, Merck's Afluria, and MedImmune's Flumist.  As the leading vaccine buying group in the country, Atlantic can assist your practice with reserving flu doses for the upcoming flu season, including Sanofi's High-Dose and Intradermal Fluzone.

     Furthermore, Atlantic provides our members with the lowest costs for the complete spectrum of Sanofi and Merck vaccines.  Thousands of physicians nationwide have seen how Atlantic can improve the financial and operational practice performance of providing immunizations to your patients.

      In addition Atlantic offers a unique program that enables physicians to provide vaccines like Zostavax to Medicare Part D patients with fair and timely reimbursement.

     We encourage you to contact Atlantic to determine how their program can be of benefit to your practice.  You can reach Jeff or Cindy at 1-800-741-2044 or at info@atlantichealthpartners.com