June 2010

WA-ACEP's looking for volunteers: Get Involved!

Do you want to get involved in your state specialty organization? The WA-ACEP Board of Directors has voted to implement standing committees to keep you and your practice up to date with the most current education, legislation and practice management resources. We are looking for volunteers to serve on the following committees: Education, Legislative, Membership, and Rural Medicine.

Are you interested? Please email the WA-ACEP office at smc@wsma.org.

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President Signs Latest Congressional Short-term SGR Patch. Cut Reversed. Update Provided

This morning, President Obama signed into law the “Preservation of Access to Care for Medicare Beneficiaries and Pension Relief Act of 2010.” The measure, already approved by the Senate, was passed by the House last evening on a 417 to 1 vote. This law reverses the 21% cut to Medicare Part B physician rates that went into effect June 1.

The law establishes a 2.2% update to the Medicare Physician Fee Schedule (MPFS) payment rates, retroactive from June 1, 2010 through November 30, 2010.

According to the Centers for Medicare and Medicaid Services (CMS):

  • The agency has directed Medicare claims administration contractors to discontinue processing claims at the negative update rates and temporarily to hold all claims for services rendered June 1, 2010 and later, until the new 2.2% update rates are tested and loaded into the Medicare contractors’ claims processing systems.
  • CMS expects to begin processing claims at the new rates no later than July 1, 2010. Claims for services rendered prior to June 1 will continue to be processed and paid as usual.
  • Claims containing June 2010 dates of service which have been paid at the negative update rates will be reprocessed as soon as possible.
  • Under current law, Medicare payments to physicians and other providers paid under the MPFS are based upon the lesser of the submitted charge on the claim or the MPFS amount. Claims containing June dates of service that were submitted with charges greater than or equal to the new 2.2% update rates automatically will be reprocessed.
  • If you submitted claims containing June dates of service with charges less than the 2.2% update amount, you’ll need to contact the local Medicare contractor to request an adjustment. Submitted charges on claims cannot be altered without a request from the physician/provider.
  • You should not resubmit claims already submitted to their Medicare contractor.

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Revolving Door of ED Readmissions

A new database covering hospitals in 12 states shows the problem of readmissions and use of emergency room resources is more problematic than originally thought, according to a report from the Agency for Healthcare Research and Quality.

About four in 10 patients who sought acute care between 2006 and 2007 made multiple visits to the hospital either for an inpatient stay or an emergency visit or both.

"Most readmission studies only report information on patients who have multiple hospital inpatient stays," the AHRQ report says. "They exclude patients who sought care in the ED." By including emergency department utilization, the researchers discovered that the rate of multiple visits was increased by more than one-third, from an average of 1.5 to 2.1 acute care hospital visits per patient.

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ACEP Leadership Conference Report

The ACEP’s 2010 Leadership and Advocacy Conference was a great success this year, with our largest-ever attendance. Washington State attendees included John Milne, MD, WACEP President, Carl Heine, MD and Nathan Schlicher, MD. While there, the physicians discussed the impact of the recently enacted health care reform legislation on emergency patients, implementation of the new law, the unstable Medicare physician payment system, and many invited their legislators to visit their emergency departments when back home.

Additionally, the NEMPAC annual campaign set a new record of nearly $50,000, including a $30,000 contribution from the Florida Emergency Physicians. And eight members of Congress were presented with the 2010 ACEP Congressional Leadership Award, including Senator Murray for her efforts to include trauma center support in the national reform bill.

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Ambulance Transport to the ED

Patients with Medicare or Medicaid, the uninsured, the elderly and the critically ill are the heaviest users of ambulances for transport to the emergency department, making them most vulnerable during periods of ambulance diversion. The results of a study of more than 30,000 patients taken to emergency departments by ambulance were published online Friday in Annals of Emergency Medicine (At-Risk Populations and the Critically Ill Rely Disproportionately on Ambulance Transport to Emergency Departments).

“The most surprising and somewhat disturbing finding in our study was close to half of critically ill patients come to the ER on their own, without ambulance transport,” said lead study author Benjamin Squire, MD, of Harbor-UCLA Medical Center in Los Angeles. “It has shed a whole new light on how dangerously ill some of the patients in the waiting room are. When a patient comes to the emergency department by ambulance, he is being monitored continually, which is not the case for a patient coming in on his own. This finding changed my view of triage.”

Only 57 percent of critically ill patients (defined as intubated, dying later in the emergency department, or transferred from the emergency department directly to the cardiac catheterization lab, ICU or surgery) went to the emergency department by ambulance. Among the critically ill, privately insured patients were less likely to rely on ambulance transport than those with Medicare, public insurance or no insurance.

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New Washington Health Program (WHP) Begins July 1

With more than 100,000 people on a waiting list for the state’s Basic Health program, low-income Washington residents are finding few affordable options for health care coverage. To address this need, the state is introducing the Washington Health Program (WHP)—non-subsidized version of the Basic Health Program (BHP).

WHP provides essentially the same benefits as the BHP, but with no subsidy and no cost to the state. Enrollees pay the full premium, plus a small amount for administrative costs. The HCA is contracting with Community Health Plan (CHP) of Washington to provide Washington Health coverage. Premiums are as low as $100 per month. WHP is available to any state resident who is not enrolled in the BHP, Medicaid, or eligible for Medicare. While designed for low income people, there are no income limitations, and it is available anywhere in the state. Coverage begins July 1. Patient applications are being taken now through the Washington Health website at www.washingtonhealth.hca.wa.gov . Applications can also be requested toll-free at 1.800.660.9840.

Physicians who already contract for the Basic Health program who do not wish to also see the additional WHP patients or those payments at the BHP rates, will need to opt out of that portion of the CHP network. If you wish to opt out, send written notification to CHP. If you wish to join the CHP network, contact CHP Customer Service at 800.440.1561 and request a provider contract for WHP.

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California Senate Health Committee Approves Legislation to Eliminate ER Overcrowding

The Senate Health Committee has approved a bill that establishes new requirements on hospital emergency rooms to reduce dangerous overcrowding levels. Introduced by Assembly member Ted Lieu (D-Torrance), Assembly Bill 2153 requires hospitals to institute guidelines that will reduce high levels of overcrowding in California´s already over-burdened emergency rooms in an attempt to save lives.
"California´s emergency rooms are our healthcare safety net and the front lines of any public health emergency," said Assembly member Lieu. "Overcrowding in California hospitals is a serious issue, and a threat to the health and safety of patients, and to all of us."

AB 2153 would require all California hospitals to create and implement a full capacity protocol plan. This plan would require the hospital and ER to assess the results of an overcrowding scale every four hours, and then provide solutions at each stage of this scale.

Many hospitals across the nation, including LA-USC Medical Center, have developed full capacity protocol plans that ease tension in emergency departments and cut wait times for many patients. These plans assess the level of overcrowding in an emergency department and set guidelines for hospital operations at each level of overcrowding. The full capacity protocol plan has been overwhelmingly successful in achieving safe and reasonable emergency procedures for both hospitals and emergency departments. Wait times and patient boarding have been significantly reduced as a result of the full capacity protocol plan in place at LA-USC.

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UnitedHealth Settlement—Resources from AMA

A new online resource from the AMA can help thousands of physicians file claims in the record-breaking settlement reached in the AMA's legal victory against UnitedHealth Group - the nation's largest health insurer.

More than $350 million is available to compensate physicians and their patients for 15 years of artificially low payments for out-of-network services, and this new resource provides physicians with step-by-step assistance in determining eligibility, assembling documentation and filing a claim under the terms of the settlement.

Access the resource online at www.ama-assn.org (Advocacy, Current Topics, Private Sector Advocacy, Health Insurer Settlements, then UnitedHealth Group...).

The deadline for filing a claim to share in the settlement fund is Oct. 5. The settlement claims administrator began mailing the settlement notice and claim forms to physicians April 16. Physicians should keep an eye out for their claim forms, which contain important information that can help with filing the claim. In addition, AMA members can get personal assistance with filing a claim from the AMA's Practice Management Center by visiting www.ama-assn.org/go/pmc or calling 1.800.621.8335.

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Reminder: Tamper-Proof Prescriptions Required July 1

Starting July 1, 2010, all prescriptions written in Washington state must be on Washington state Board of Pharmacy approved tamper-resistant prescription paper or pads (TRPP). While the layout will be much the same as previous forms—with two signature lines for prescriber and patient information—the forms must include the seal of approval in the lower right-hand corner of the prescription form. Only Board of Pharmacy approved forms are to be used for a hard copy given to a patient or designee, including prescriptions printed from an electronic medical record.

The Board of Pharmacy advises that it is permissible for vendors to provide legitimate requestors with blank stock of the board-approved tamper resistant paper, which can then be printed by the practice. Check the TRPP webpage www.doh.wa.gov/hsqa/trpp for more information.

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CMS Confirms Medicaid Integrity Contractor Audits “on Hold” for Washington

The WSMA has received confirmation via the office of Senator Patty Murray that CMS has placed “on hold” the egregious Medicaid Integrity Contractor (MICs) audits for Washington State. These audits, conducted via CMS’ contractor, HMS, have imposed excessive, confusing and unfair burdens on physicians’ practices in the course conducting the MICs audits. The WSMA is working closely with Senator Murray’s office, CMS and the AMA to introduce fair and reasonable safeguards for physicians’ practices.

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2010 PQRI Reporting Options Available July 1

If your practice is not yet participating in the Physician Quality Reporting Initiative (PQRI), remember four reporting options soon become available for the six-month reporting period that runs from July 1 through Dec. 31. These options include:

  • Claims-based reporting of individual measures for 80 percent or more of applicable patients on at least three individual measures or on each measure if less than three measures apply;
  • Claims-based reporting of one measures group for 80 percent or more of applicable Medicare Part B fee-for-service patients of each eligible professional (with a minimum of eight patients);
  • Registry-based reporting of at least three individual PQRI measures for 80 percent or more of applicable Medicare Part B fee-for-service patients of each eligible professional; and
  • Registry-based reporting of one measures group for 80 percent or more of applicable Medicare Part B fee-for-service patients of each eligible professional (with a minimum of eight patients).

PQRI research, conducted in early 2010, practices participate in the PQRI for a variety of reasons. One reason is to prepare for when quality measure reporting is required. Sec. 3002 of the Patient Protection and Affordable Care Act stipulates future PQRI incentives. These incentive payments are:

  • 2011: 1 percent incentive*
  • 2012 through 2014: 0.5 percent incentive*
  • 2015: 1.5 percent penalty if practices are not successfully participating
  • 2016 and beyond: 2 percent penalty

For more information, CMS created the 2010 PQRI Implementation Guide and the lists the Qualified Registries for 2010 PQRI Reporting.

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DEA Regulation on e-Prescribing of Controlled Substances

The Drug Enforcement Administration’s (DEA) Interim Final Rule (IFR) on electronic prescriptions for controlled substances, published on March. 31, 2010, is now in effect. The interim final regulations provide clinicians with the option of writing prescriptions for controlled substances electronically and also permit pharmacies to receive, dispense and archive these electronic prescriptions. Although the regulations went into effect on June 1, 2010, the DEA has sought further comments on a number of key issues. It may take many months before the infrastructure is in place to support the full implementation of these rules in ambulatory care settings.

Access the DEA interim final rule on e-prescribing

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Interpreter Fee Schedule Change Effective July 1, 2010

Effective July 1, 2010, the Department of Labor and Industries (L&I) fee for group and individual interpreter services will be $0.79 per minute. L&I is faced with difficult decisions to control costs and achieve budget goals for the State Fund Workers’ Compensation Program. We believe that our fees are still competitive with other payers, including other state programs.

L&I has completed the healthcare payment policies and fee schedule for 2010 and will be published on the web by June 1, 2010. You may request a CD with the updated fee schedule and payment policies in June as well.

If you have any questions, comments or would like to request a CD please contact Cecilia Maskell by phone: (360) 902-5161 or by email: Mili235@Lni.wa.gov.

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HealthGrades Evaluates Hospital Emergency Medicine for the First Time

The first annual HealthGrades Emergency Medicine in American Hospitals Study just released, examines mortality rates for patients entering hospitals through emergency departments. This study examined more than 5 million Medicare records of patients admitted through the emergency department of 4,907 hospitals from 2006 to 2008 and identified hospitals that performed in the top 5% in the nation in emergency medicine.

Comparing the group of hospitals in the top 5% with all others, the study found that the group had a 39% lower risk-adjusted mortality rate. These top-performing hospitals improved their outcomes over the years 2006 through 2008 at a faster rate than all other hospitals, 16% compared with 10%.

The first-annual analysis is based on risk-adjusted mortality outcomes for patients admitted through the emergency department for eleven of the most common life-threatening diagnoses in the Medicare population. If all hospitals performed at the level of the top 5%, 118,014 individuals could have potentially survived their emergency hospitalization.

The American College of Emergency Physicians commented on the analysis of the mortality date of the study stating is in not a measure of emergency care. “Efforts to gather data on emergency medicine are critical, especially as the nation embarks on health care reform,” said Dr. Angela Gardner, president of ACEP. “This new report makes several critical points about the negative effects of delays in care and anticipated increases in emergency visits. However, the mortality rates in this report are a measure of inpatient hospital care, not just emergency care.”

“Less biased measures of emergency care would include the timely flow of patients, appropriate medical treatment per diagnosis and accuracy of diagnosis,” said Dr. Gardner. “While emergency physicians appreciate the objective of giving awards to emergency departments, it’s important to base the awards on data related to emergency care.”

Hospitals in the top 5% were identified on www.healthgrades.com as recipients of the HealthGrades 2010 Emergency Medicine Excellence Award – 255 in total.

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Membership Report
Please welcome the following
members to WA-ACEP

Philip Green, MD – Centralia
Richard S French, MD, FACEP - Seattle
Lucas D Hansen, MD – Olympia
Joseph F Pellicer, MD – Olympia
Erik E Penner, MD – Olympia
Robert M Russell, MD - Everett

2033 Sixth Avenue
Suite 1100
Seattle, WA 98121

(206) 441-9762 ext. 3038
1 (760) 552-0612 ext. 3038