July 2008 Practice Update (part two)

Medicare Legislation Becomes Law: What's the Impact on Your Practice?
Congress overrode President Bush's veto of the Medicare Improvements for Patients and Providers Act of 2008 on July 15, 2008. As a result, the mid-year 2008 Medicare Physician Fee Schedule (MPFS) rate of -10.6 percent has been replaced with a +0.5 percent update, retroactive to July 1, 2008, and physicians will receive a 1.1 percent increase in fees on January 1, 2009.    

Physicians can anticipate that they will begin receiving payment at the 0.5 percent update rates by about July 26.  Medicare contractors are currently working to update their payment system with the new rates. To avoid a disruption to the payment of claims, Medicare contractors will continue to process the claims that have been on hold on a rolling basis (first in/first out) for payment at the -10.6 percent update level. After your local contractor begins to pay claims at the new 0.5 percent rate, to the extent possible, the contractor will begin to automatically reprocess any claims paid at the lower rates. For additional information, visit the Medicare Web site.
 
Congress used this bill as a venue to push forward many of its priorities including adoption of electronic health records, expanding coverage on the "Welcome to Medicare" visit, creating a physician feedback program around value-based purchasing, and increasing bonuses for participation in the Physician Quality Reporting Initiative.   

ASH thanks all members who participated in the Society's advocacy efforts to stave off this Medicare crisis. Because this bill does not create a long-term fix for the sustainable growth rate (SGR), ASH will continue to work on this issue to provide stable and appropriate physician payment in the future.

ASH Analysis of Proposed 2009 Hospital Outpatient Prospective Payment Systems and Payment Rates for Ambulatory Surgical Centers
On July 7, the Centers for Medicare and Medicaid Services (CMS) released a proposed rule to change the hospital outpatient prospective payment system (HOPPS). CMS also outlined its proposed payment rates for ambulatory surgical centers (ASC). Once finalized, these changes would apply to services furnished on or after January 1, 2009.

CMS proposes to raise the base outpatient prospective payment rate by the full market basket increase of 3.0 percent. If the rule is finalized as is, major teaching hospitals would receive an overall increase in HOPPS payments of 3.9 percent in 2009, compared to an average of 3.5 percent for minor teaching hospitals and non-teaching hospitals.

ASH has prepared an in-depth analysis and will be submitting comments to CMS by the September 2 deadline. Please contact Carol Schwartz if you have any questions or would like additional information.

Medicare Announces Bonus Payments for PQRI
On July 15, CMS announced bonus payments totally more than $36 million would be made to many of the professionals who satisfactorily reported quality information to Medicare under the 2007 Physician Quality Reporting Initiative (PQRI). The average incentive amount for individual professionals was over $600, and the average incentive payment for a physician group practice was over $4,700.

The recent Medicare Improvements for Patients and Providers Act extends the PQRI program through 2010, and provides for incentive payments to be increased to 2 percent (as opposed to the 1.5 percent payments in 2007-2008). Visit the PQRI section of the ASH Web site for more information about the PQRI program.

Comments Due August 11 on J4 MAC Draft Local Coverage Determination
ASH submitted comments to TrailBlazer Health Enterprises, the Medicare Administrative Contractor (MAC) in the Jurisdiction 4 (J4), in response to the draft policy on Erythropoiesis Stimulating Agents (ESAs). The J4 region includes: Colorado, New Mexico, Oklahoma, and Texas.

The draft policy can be found on the Trailblazer Web site and is open for public comment until August 11, 2008. ASH Members in the J4 region are strongly encouraged to send letters consistent with ASH comments to Trailblazer as local physicians carry significant weight with local carriers and MACs.

If you have additional questions or would like further information, please contact ASH Government Relations Manager Stephanie Kart at 202-776-0544.

ASH Recommendations Influence Local Policies in J12 Region
Highmark Medicare Services (HMS), the Medicare Administrative Contractor (MAC) in the Jurisdiction 12 region (J12) recently posted its MAC LCD Consolidation - Final Listings. Most of ASH's recommendations submitted during the spring public comment period were incorporated into the updated policies. The J12 region includes Maryland, Pennsylvania, New Jersey, Delaware, the District of Columbia, and Northern Virginia counties. Visit the Highmark Web site for more information regarding the transition to these new policies.

Congress Continues Development of Health IT Legislation
Representatives John Dingell (D-MI) and Joe Barton (R-TX) of the House Committee on Energy and Commerce continue to put the finishing touches on H.R. 6357 – The PRO(TECH)T Act of 2008 – which aims to promote the development of Health Information Technology. A full Committee vote on this legislation is expected soon, though its political outlook beyond that point remains unclear.

Some of the bill's provisions remain to be finalized; however, as it currently stands, the legislation codifies into law the Office of the National Coordinator of Health Information Technology (ONCHIT) and provides for the creation of advisory committees that allow public and private stakeholders to provide input and assistance to that office. The bill also establishes funding for federal grants and loans to incentivize the widespread adoption of Health IT. Finally, the legislation outlines numerous privacy protections that must be followed in the development of Health IT standards, such as consent guidelines, data segregation capabilities, and breach notification requirements.

As currently drafted, this legislation leaves many specific Health IT standards to be developed by the federal rule-making process, rather than through legislative channels. ASH will continue to keep its members apprised of any developments around this important issue.

PhRMA Issues Revised Guidelines on Manufacturer Interactions With Health Care Professionals
The Pharmaceutical Research and Manufacturers of America (PhRMA) announced new voluntary guidelines. See the ASH Advocacy Update for details.

2008 ASH State-of-the-Art Symposium
Don't miss your chance to attend the 2008 ASH State-of-the-Art Symposium being held on September 12-13 in Chicago, IL. At this CME symposium you will be able to discuss the latest research and treatment options for hematologic malignancies, myelodysplasia, and myeloproliferative diseases with expert speakers and colleagues. Remember to make your hotel reservation at the Palmer House Hilton by August 21 and to register before August 29 to receive the discounted advance registration rate.

Blood Moves to Weekly Publication in 2009
Blood, the journal of ASH, will change from a semimonthly to weekly schedule effective with the January 1, 2009, issue.

The shift of the journal to weekly publication was stimulated by a number of factors, including advertising sales and the move to weekly publication schedule by comparable sub-specialty journals. The schedule change will provide several key benefits for members and subscribers, including increased portability of the print journal due to more convenient size, greater visibility for ongoing and new content features, and increased traffic to the journal's Web site based on distribution of a weekly e-Table of Contents.

With a weekly publication schedule, an almost-immediate online prepublication, and a seven-week average time from acceptance to print publication, Blood will deliver the timeliest, high-quality content that leads the world in reporting basic and clinically relevant hematology research.

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