Networking – - Wine and Cheese Reception

Program

• Stephen G. Ruby, MD, MBA, ISP President, Moderator
• Jane Pine Wood, McDonald Hopkins, Out of Network Billing in Illinois
• Robert DeCresce, MD, Direct Billing and Out of Network pending legislation in Illinois
• Jack Bierig, Sidley Austin, LLP, Mayo v Prometheus Labs: The Supreme Court rules on the patentability of lab tests

To retister: Contact ISP Offices at 847 441 7200, pcramer@illinoispathology.org

The $3.8 trillion budget proposal, released this morning, repackages many of the healthcare measures that the president presented last fall to the Joint Select Committee on Deficit Reduction, the so-called super committee, which was charged with recommending at least $1.2 trillion in deficit reduction. The bipartisan committee became another partisan warfare committee and failed to reach its goal. In a continuation of governmental trench warfare, Obama’s budget proposal for fiscal 2013 is already under attack by Congressional Republicans. In a press release, House Speaker John Boehner (R-OH) called it “a collection of rehashes, gimmicks, and tax increases that will make our economy worse.”

As they feared, hospitals take it on the chin in the president’s new set of numbers. Under the plan, hospitals would receive $36 billion less over the course of the next 10 years in Medicare funds that offset unpaid deductibles and copayments owed by patients. At this time, Medicare covers 70% of patient bad debt. The Obama administration considers a 25% offset more reasonable. Medicare funding of residency training programs also would fall by $10 billion, with the Obama administration reasoning that they are overcompensated for their costs.

Physicians do not go entirely unscathed in the proposed budget for the fiscal year, which begins on October 1, 2012. The plan would reduce Medicare payments for advanced imaging procedures by $820 million through 2022. The Medicare Payment Advisory Commission (Medpac) has called for such a decrease in light of burgeoning expenditures for diagnostic imaging, which Medpac sees as a signal of overpricing. Furthermore, the president’s budget would require prior authorization for the most expensive imaging services, “to protect…[Medicare] beneficiaries from unwarranted, and potentially harmful, imaging use.”

Physicians also would find themselves paying civil monetary fines under the proposed budget if they do not update their Medicare enrollment information. Unreported changes in provider information invite fraud, according to the Obama administration. The proposed budget estimates that the government will collect $90 million worth of these fines in the coming 10 years.

More Affluent Medicare Beneficiaries Would Pay More

Obama’s new mantra is that everyone “does their fair share” to reduce the federal deficit. His budget for fiscal 2013 applies that principle to affluent Medicare beneficiaries, who would shoulder a bigger share of healthcare costs.

•Beginning in 2017, beneficiaries who are charged higher Medicare Part B and Part D premiums because of their high income would pay 15% more.

•The annual deductible for Medicare Part B would increase by $25 in 2017, 2019, and 2021 for new beneficiaries, with the hope that it would spur seniors to seek good care at lower prices.

•Beneficiaries would owe a $100 copayment for home-health episodes with 5 or more visits that are not preceded by a hospitalization.

•Seniors who buy MediGap policies to pay for costs not covered by Medicare (eg, copays) tend to use more services, which boosts Medicare spending. The administration wants to tack a surcharge onto Medicare Part B premiums beginning in 2017 whenever beneficiaries buy a MediGap policy that subjects them to little, if any, cost-sharing. The surcharge would equal roughly 30% of the Part B premium.

Lip Service on “Doc Fix,” but No Details

One subject dear to physicians that received only a passing reference in the budget proposal was Medicare’s sustainable growth rate (SGR) formula for calculating physician reimbursement. The SGR formula will trigger a 27.4% reduction in Medicare rates on March 1 unless Congress acts to avert it, something lawmakers have done with scheduled cuts every year going back to 2003. Repealing the SGR formula and merely freezing Medicare rates for the next years would cost $316 billion, according to the Congressional Budget Office.

In its previous budget for fiscal 2012, the Obama administration provided a detailed plan for a 2-year “doc fix” for the Medicare reimbursement crisis, priced at $54 billion. The new proposed budget for fiscal 2013 does not outline any path forward. However, “the administration is committed to working with the Congress to fix the SGR, providing predictable Medicare physician payments that incentivize quality and efficiency in a fiscally responsible way,” the budget document states. “Failing to do so masks the long-run deficit.”

Federal Deficit in Fiscal 2013 Would Drop to $901 Billion

Overall, the federal deficit would shrink by more than $4 trillion over the course of 10 years under Obama’s proposed budget. For every $2.50 in spending cuts, the budget raises $1 in new revenue from higher taxes on those making more than $250,000 a year and closed tax loopholes for corporations. The budget includes the $1 trillion in cuts to discretionary spending that were called for in the Budget Control Act passed last year.

The president’s proposed budget would lower the federal deficit from $1.33 trillion in fiscal 2012 to $901 billion in fiscal 2013. As a share of the gross domestic product (GDP), the deficit would decrease from 8.5% to 5.5% during this time. By fiscal 2022, the projected federal deficit would be $704 billion, or 2.8% of GDP.

This is a reprint from Medscape, who is responsible for this content.
This is presented here because it was thought to be of interest to the ISP membership.

The original deadline had been October 1, 2013. Sebelius stated that HHS will announce a new compliance deadline after reexamining the pace of implementing ICD-10. “We have heard from many in the provider community who have concerns about the administrative burdens [of ICD-10],” she said.

The AMA complained to Sebelius in a letter earlier this month that switching to ICD-10 would pose an economic hardship on physician practices, which would have to spend anywhere from $83,000 to more than $2.7 million on the conversion, depending on their size. ICD-10 hassles also would make it harder for physicians to migrate to electronic health records and electronic prescribing, which they must do to avoid Medicare penalties, the association warned.

ICD-10 is shorthand for the International Statistical Classification of Diseases and Related Health Problems, 10th Revision, developed by the World Health Organization. It will replace the current code set, called ICD-9. The Centers for Medicare and Medicaid Services ordered the switch to ICD-10 in 2009 as part of carrying out the Health Insurance Portability and Accountability Act.

ICD-10 contains 68,000 diagnosis codes, or about 5 times the number found in ICD-9. The complexity of ICD-10 codes decried by physicians goes beyond sheer volume. The new codes contain as many as 7 characters compared with a maximum of 5 in the current codes.

The AMA has asked HHS to consider developing another set of codes to replace ICD-9, but Sebelius gave no suggestion in today’s announcement that this wish would be granted. An HHS press release stated that “ICD-10 codes provide more robust and specific data that will help improve patient care and enable the exchange of our health care data with that of the rest of the world that has long been using ICD-10.”

More information on how to retool a medical practice’s software and business operations to comply with ICD-10 is available at the CMS Web site.

This is a reprint from Medscape, which is responsible for this content.
This was provided here, because it was thought to be of interest to the ISP membership.

Here is a link to her Obiturary in the Chicago Tribune

Donations may be made in her honor to UNICEF, 1.800.486.4233.

If not, continue to read the posting, copied from the ISMS e-mail letter:

Not only is it “about time” Illinois law requires all automobile passengers to wear seat belts, the law itself is “about time” – buckling a seat belt takes only seconds, but may save years of precious life in the event of an accident.

Thanks to a new ISMS-supported Illinois law, all passengers will be required to buckle up beginning January 1st. Previously only the driver, front seat passengers, and certain passengers under the age of 19 were mandated to wear seatbelts.

The National Highway Traffic Safety Administration estimates an injury occurs in a traffic collision every 15 seconds and a fatality occurs every 13 minutes.   It is also estimated that only 68 percent of Americans use seat belts.  It’s about time Illinois makes a dent in those numbers.

Without the support of our membership and its many volunteer members, we would not be able to provide the advocacy and support that we do, which benefits ALL IL pathologists.

Not a member?   Why not?  Your additional support will help in many ways, beyond the nominal dues.  A greater percentage of membership provides the ISP with a stronger voice when advocating for pathologists.

Do you know a pathologist who is not a member?  Invite them to join us, and help move pathology forward in Illinois.

Do you know a pathologist in another state society?  Let them know that there is a site for their state or territory society to post a page.  We are trying to get the word out about this.  Please help us.

Last, it has been a busy month (as I am sure for you also).  I fell behind on postings, but we are back to posting interesting and informative information on the site.  Please visit often and provide feedback, or….even better, send me YOUR posting of interesting information.  You can do that by sending the information to PCramer@IllinoisPathology.org.  When received, we can get it on the site!

Happy Holidays!
Stephen G. Ruby, MD, MBA, FCAP
President, ISP

■Is 1,235 pages long.

■Includes payment information for roughly 10,000 physician services.

■Classifies 56 patient encounters as eligible for the electronic prescribing incentive program.

■Identifies 120 advanced diagnostic imaging services as subject to the multiple procedure payment reduction policy.

■Lists 240 individual reporting measures for the physician quality reporting system.

Sources: Centers for Medicare & Medicaid Services, 2012 fee schedule
See the whole document here

(ofr.gov/ofrupload/ofrdata/2011-28597_pi.pdf)

The sustainable growth rate formula would cause Medicare doctor payments to drop by 27.4% in 2012 unless Congress acts. Here’s what the effect would be on some common physician services.

Service                                           2011 rate    2012 rate        Change

New patient office visit              $102.95       $76.23             -$26.72

Established patient office visit $68.97         $51.07             -$17.90

Chest x-ray                                  $23.78          $17.27             -$6.51

Mammogram                             $81.20          $58.96            -$22.24

Rechanneling of artery         $1,128.70      $806.25          -$322.45

Total hip arthroplasty          $1,440.26    $1,047.79          -$392.47

Source: Centers for Medicare & Medicaid Services, 2012 fee schedule

See the whole schedule here