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This conference has a maximum of 12.5 AMA PRA Category 1 Credit

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Come learn about latest Diabetes information, Certified Diabetes Educator talk
(bring your office manager)

Date 03/13/12 Tuesday
Time: 6:30 Registration

Program starts at 7:00 pm

Location: The Water Club
Between 29th and 32nd (cannot be reached via 30th), 500 East 30th Street,
New York, NY

Agenda

6:00 pm – 7:00 pm             Registration
7:00 pm – 7:05 pm            Opening Remarks
Lisa Eng, DO
President, ACAP

7:05 pm – 7:30 pm            Diabetes recognition program
Ms. Bronwyn Starr
NYS Health Foundation

7:30 pm – 8:15 pm             Incretin System: differentiating DPP-4 Enzyme and Native GLP-1
Michael Radin, MD
Medical Director – Winthrop Comprehensive Diabetes Center
Winthrop University Hospital, New York, NY

8:15 pm – 8:30 pm The role of Diabetes Educator
Jason Exter
Certified Diabetes Educator

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Please complete the form and enroll as a member to enjoy the great benefits offered by Medical Society of the State of New York

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The Chinese Exclusion Laws involved legislation Congress passed between 1879 and 1904 that explicitly discriminated against persons of Chinese descent based on race.

The laws imposed increasingly severe restrictions on immigration and naturalization. Congress repealed the laws as a wartime measure in 1943,

without any express acknowledgement that the laws violated fundamental civil rights.

To learn more go to  http://www.1882project.org/

CMS Registration for the Medicaid EHR Incentive Program is now open in New York State!

CMS registration for Medicaid EHR Incentive has just opened up in New York. Through the Medicaid EHR Incentive Program, health care practitioners can qualify for up to $63,750 in incentive payments over six years.

Remember, in order to qualify for the Medicaid EHR Incentive, you must, over a 90 day period, have adopted, implemented, upgraded, or demonstrated meaningful use of certified EHR technology and your patient volume during the 90-day reporting period must be at least 30% Medicaid (some exclusions apply).

To begin the process, register here: https://ehrincentives.cms.gov/hitech/login.action

 ECAP and MDLand are here to help. In order to help member physicians apply for the CMS EHR Incentive Program, ECAP is working closely with MDLand (a preferred vendor of multiple REC centers throughout the country) to host a series of informational sessions geared specifically toward the Medicaid Incentive Program which will include some background on the program, payments, and a look at how by using new features in the ONC certified version of iClinic, MDLand can assist you in if you qualify for the Medicaid EHR Incentive Program. Please contact MDLand for more details at (212) 363-8000 or support@mdland.com.

For more information regarding the NYS Medicaid EHR Incentive Program, please visit the NYS Department of Health.

Appeals Court Voids Lower-Court Ruling Against Individual Mandate

Robert Lowes

September 8, 2011 — Citing technical grounds, a federal appeals court in Richmond, Virginia, today tossed out a lower-court decision that declared the healthcare reform requirement to obtain insurance coverage unconstitutional.

Today’s decision by the US Court of Appeals for the Fourth District in Richmond vacated a ruling by US District Court Judge Henry Hudson, also in Richmond, who said that the individual mandate “would invite unbridled exercise of federal police powers.” In a unanimous decision by a 3-judge panel, the appeals court stated that the state of Virginia, which was the plaintiff in the case, lacked legal standing to bring its suit. The appeals court did not rule on whether the individual mandate was constitutional or not.

The appellate judges today also rendered a split decision on another lower-court decision involving the embattled Affordable Care Act. In November 2010, US District Judge Norman Moon in Lynchburg, Virginia, declared that the individual mandate lies within the power of Congress to regulate interstate commerce under the Constitution’s Commerce clause. The requirement, Moon stated, is a proper corrective to the healthcare marketplace problem of cost-shifting caused by the uninsured.

Writing a majority opinion, 2 of the 3 appellate judges vacated Moon’s ruling on the grounds that the suit brought against the Affordable Care Act by Liberty University should be dismissed for lack of subject matter jurisdiction.

The appellate decision follows a ruling on August 12 by an US appeals court in Atlanta, Georgia, that declared the individual mandate unconstitutional. The opposite conclusion was reached by an appeals court in Cincinnati, Ohio, in June.

There is plenty of legal ball left to play on the controversy. More rulings on the provision’s constitutionality are forthcoming from the US appeals court in the District of Columbia, as well as a number of US district courts. Legal experts and lower-court judges alike predict the US Supreme Court will eventually take up the case to settle conflicting decisions at the appellate and district levels.

Congress Passes Debt Deal; Could Reduce Medicare Payments

Robert Lowes

August 2, 2011 — With a 74 to 26 vote by the Senate today, a contentious Congress finally passed a bill that both shrinks federal spending and raises the $14.3 trillion federal debt ceiling, just in time to beat an August 2 deadline and avert a catastrophic government default.

The House did its part yesterday by approving the bill 269-161 in a grudging bipartisan vote, with Democrats unhappy that envisioned spending cuts topping $2 trillion were not accompanied by any tax increases, which Republicans vehemently opposed. Next comes the expected signature of President Barack Obama, who had crafted the measure with congressional leaders.

The agreement may calm the financial markets by maintaining the credit worthiness of Uncle Sam, but it is troubling physicians and hospital executives, who could see their Medicare reimbursements trimmed in the process. Those potential cuts would come at a time when providers already face other major Medicare reductions.

Physicians, for example, are scheduled for a 29.5% decrease on January 1, 2012, unless Congress intervenes. The bill passed today does not include a “doc fix” to the Medicare reimbursement crisis, disappointing organized medicine, which had lobbied for such a provision.

“It looks like a double cross,” Jack Lewin, MD, chief executive officer of the American College of Cardiology (ACC), told Medscape Medical News. “I’m sure doctors will feel frustrated when they find out (about the possible debt-deal cuts).”

The debt legislation lays out a serpentine path to an additional Medicare pay cut. It calls for an initial $917 billion in savings over 10 years by capping federal discretionary spending, meaning that mandatory entitlement programs such as Medicare and Social Security are off-limits. That move would permit a $900 billion increase in the debt ceiling.

Then, a special 12-member congressional committee must identify at least another $1.5 trillion in savings that Congress must enact by December 23, allowing a second debt-ceiling hike of $1.5 trillion. If Congress fails to chop at least $1.2 trillion from the budget through 2013, then Obama would be limited to a corresponding increase in the debt ceiling.

At the same time, failure to hit the $1.2 trillion savings target would trigger automatic cuts in both discretionary and mandatory programs, including Medicare, from 2013 through 2021. However, the Medicare cut could not exceed 2% in any given year.

A summary of the bill posted on the White House Web site explains that potential Medicare cuts would be “limited to the provider side.”

No One Knows Where Medicare Provider Cuts Would Fall

The provider side has responded sourly to the debt-reduction legislation, decrying the prospect of more rate cuts as opposed to reimbursement relief.

“Physicians feel like they’ve already been thrown under the bus,” Dr. Lewin said about the new law. “Now [Congress] is backing up the bus over them.”

Roland Goertz, MD, president of the American Academy of Family Physicians (AAFP), warned in a statement released yesterday that lower Medicare pay would cause many physicians to either close their practices or limit the number of Medicare patients they treat — reducing access to care either way.

“The debt ceiling/deficit reduction plan…offers a potentially false promise to patients,” said Dr. Goertz. “It guarantees benefits but, by ignoring Medicare physician payment issues, it potentially denies the actual medical care those benefits cover.”

Richard Umbdenstock, president and chief executive officer of the American Hospital Association (AHA), makes a similar argument in calling for Congress to exempt Medicare from the debt-deal budget ax. “Cuts to Medicare funding for hospital care,” Umbdenstock said in a press release yesterday, “could overload emergency rooms, shut down trauma units and reduce patient access to the latest treatments.”

What dials up the anxiety factor further is that the bill passed by Congress today does not specify how automatic cuts would be applied to Medicare. The program consists of 4 parts — Part A for hospitals, Part B for physicians, Part C for Medicare managed-care plans, and Part D for prescription drugs. Kevin Burke, director of government relations for the AAFP, told Medscape Medical News that Congress could trim each part equally, or confine the cut to just 1 or 2 parts.

The potential for Medicare provider cuts is not lost on Wall Street. Stocks for a number of publicly traded healthcare companies, including those that operate hospitals, fell sharply this morning.

AMA Still Lobbying for Elusive Doc Fix

For physicians, the bill is a far cry from an earlier debt-reduction proposal in Congress that would have protected their Medicare reimbursement. That proposal, authored by the bipartisan “Gang of Six” senators, called for voiding the 29.5% pay cut set for 2012 and scrapping the sustainable growth rate formula that triggered it. The Gang of Six would have offset the cost of this doc fix — priced at $298 billion over 10 years — with unspecified savings in Medicare. The AHA worried that hospital reimbursement would be sacrificed for the sake of physicians.

Organized medicine has not given up petitioning Congress for the elusive doc fix, which almost became a part of the 2010 healthcare reform law before Democrats erased it because of its high cost. In a statement released yesterday, Peter Carmel, MD, president of the American Medical Association, said his group anticipates that the 12-member congressional committee charged with finding budget savings would address the Medicare reimbursement crisis.

“Everyone agrees that a 30% cut in payments to those who care for Medicare patients would hurt seniors’ access to the healthcare they need and deserve,” said Dr. Carmel.

Dr. Lewin said he had wished and hoped that Congress would incorporate a doc fix in a grand debt-reduction deal, but not expected it to actually happen, given the composition of the Republican-controlled House. With the advent of Tea Party Republicans, he said, there is less of a consensus in the House to enact a doc fix.

“The Tea Party doesn’t want to spend any money,” he said. “They don’t care if doctors stop seeing patients.”

He said the ACC would urge the the 12-member congressional committee on debt reduction to return to the problem of Medicare reimbursement. However, instead of trying to tame runaway costs through “futile” price-control solutions such as the sustainable growth rate formula, the committee ought to introduce reforms to reward physicians for quality and efficiency. Such an indirect approach to cost control would have a better chance of succeeding, Dr. Lewin said.

Robert Lowes

August 10, 2011 — Six family physicians in Georgia have accused the Medicare program in a federal lawsuit of illegally relying on a committee of the American Medical Association (AMA), which they hold responsible for paltry reimbursement rates for primary care physicians and inflated ones for proceduralists.

The lawsuit, filed this week in a US district court in Maryland, is the latest sign of a long-standing rift between primary care clinicians and specialists over Medicare compensation. The professional feud has been obscured recently by organized medicine’s united efforts to replace the sustainable growth rate formula that Medicare uses to set physician pay.

However, the division along specialty lines over Medicare rates has resurfaced in the form of not only a the new lawsuit but also legislation from Rep. Jim McDermott, MD (D-WA). His bill would require the Centers for Medicare and Medicaid Services (CMS) to hire independent analysts to identify overpaid and underpaid services in addition to listening to the AMA committee’s advice.

The AMA body in question is the AMA/Specialty Society Relative Value Scale Update Committee (RUC). It came into existence in 1991 at the same time that the US Congress approved the resource-based relative value system for determining Medicare rates for medical services. Each service, from an office visit to a liver transplantation, is assigned a relative value unit (RVU), which reflects the level of physician work (time, effort, skill, and stress), the physician’s practice expenses, and a malpractice-premium element. A complicated formula converts the RVU into a dollar amount.

RUC’s job is to recommend annual updates to RVUs — increasing or decreasing their value — based on changes in medical practice and coding. A particular procedure might become less demanding due to technological advances or more demanding, for example. New services emerge, older services disappear.

Designed to cover all specialties, including the primary care specialties, RUC has 29 members, 23 of whom are appointed by national medical societies. Twenty-six of the 29 have voting rights.

Illegal Advisory Committee?

Medicare has long been criticized for underpaying primary care physicians and overpaying specialists, and RUC is being blamed for contributing to the inequity. The case against RUC is laid out in the federal lawsuit, filed by 6 family physicians practicing at the Center for Primary Care in Evans, Georgia.

The suit alleges that:

• RUC membership is “highly biased” toward procedural specialties and only 2 seats of the 29 total truly represent primary care. The internal medicine seat does not — an oncologist occupies it.
• RUC recommendations are based on practice data collected by medical societies using a survey method that experts describe as “inherently biased and arbitrary and capricious.”
• The RUC functions for all intents and purposes as a federal advisory committee, yet it does not obey laws requiring such committees to field a balanced membership and conduct public meetings. (For its part, the AMA states on its Web site that RUC is not an advisory committee to CMS but an independent group “exercising its First Amendment right to petition the federal government,” with final payment decisions resting with CMS. RUC meetings are not closed, it adds. Government officials can attend them.)

All of these circumstances combine, the suit alleges, to tilt Medicare rates in favor of specialty care and devastate primary care in the process. Medical students choose more lucrative specialty careers, leaving primary care shorthanded. Those who do toil in that field are hard pressed to meet the needs of their current patients, much less millions of new patients in the future as a result of healthcare reform, according to the suit.

The Georgia physicians are asking the federal court, among other things, to force RUC to operate as an official and transparent federal advisory committee and prohibit CMS from implementing its physician fee schedule until that happens.

In an interview with Medscape Medical News, plaintiff Paul Fischer, MD, founder of The Center for Primary Care, described RUC as “bizarre.”

“We have doctors who do certain procedures determining what they should be paid for those procedures…but nobody is determining whether those procedures have any value,” said Dr. Fischer, who helps operate a Web site called Replace the RUC! A saner approach would give Medicare more value for the money it spends, he said. “Why should the government pay $50,000 for a stent when I can treat you with pills from Walmart that cost $4?”

When asked to comment on the suit, the AMA provided Medscape Medical News with a statement from Barbara Levy, MD, RUC’s chairperson:

“The RUC is an independent panel of physicians from all medical specialties, including primary care, who make recommendations to CMS as all citizens have a right to do. These volunteers provide physicians’ voice and expertise to Medicare decision-makers through their recommendations.”

Forty-Seven Medical Societies Oppose McDermott Bill

Representative McDermott justifies his RUC bill, called The Medicare Physician Payment Transparency and Assessment Act, with much the same arguments that appear in the federal lawsuit, which he supports.

“For two decades now, this panel has been dominated by specialists who undervalue the essential and complex work of primary care providers and cognitive specialists, while often favoring unnecessarily complex, costly, and excessive specialty medical services,” he stated in a press release this spring. “The result of this is clear — there is a shortage of family doctors, patients don’t necessarily get the services they need, and medical costs are increasingly driven higher.”

His legislation does not eliminate the RUC but rather requires CMS to gather additional recommendations from independent analysts about adjusting Medicare rates up or down, based on their own survey data, which would be public.

Two medical societies representing primary care physicians — the American Academy of Family Physicians and the Society of General Internal Medicine — have endorsed the legislation, whereas a consortium of 47 societies, mostly in the specialty realm, have lined up against it. This opposition group includes the American College of Surgeons, the American College of Cardiology, the American College of Obstetricians and Gynecologists, the American College of Radiology, and the American Osteopathic Association.

Missing from the list is the giant American College of Physicians (ACP), representing internists. An ACP spokesperson told Medscape Medical News that the group has urged the US Department of Health and Human Services to consider creating an expert panel to supplement RUC.

In a letter to House Speaker John Boehner (R-OH) earlier this year, the 47 medical societies against the McDermott bill said a second panel of payment experts would duplicate RUC’s work and “add yet another bureaucratic layer to an already complicated process.” Previous CMS attempts to bring outside contractors into the update process, the groups said, proved unsuccessful.

In addition, the medical societies wrote, RUC has consistently supported “our esteemed primary care colleagues” by recommending significant rate increases for the kind of services they perform, particularly evaluation and management. The societies credit RUC with the lion’s share of a 22.5% increase in Medicare payments to primary care between 2006 and 2011, a time when other physicians were seeing many of their rates cut.

The AMA also cites RUC recommendations to boost primary care pay. Committee members, it asserts, understand the work of these physicians.

Rep. McDermott cites another statistic, however — since RUC’s debut, the income gap between primary care physicians and their specialist colleagues has widened from 61% to 89%.