Photo by Daniel McCann

Claims for which medical records have been requested are now being completed by Palmetto GBA, and SFMS/CMA is hearing from physicians that many of the services are being down-coded.

In order to effectively communicate to CMS our members concerns and frustrations with the medical review audits being conducted by Palmetto GBA, we are collecting data to demonstrate the impact the audits have had on physician practices.

The results will assist us in our discussion points when we meet with CMS. If your office has received requests for medical records from Palmetto, please let us know by taking a moment to complete a brief survey.

Click here to complete the brief survey. It is critical that we receive your response no later than Thursday, February 2.

SFMS/CMA will continue to work with Palmetto and CMS so they understand the burden of locating, copying, and mailing off the requested patient records.

If you’ve experienced any difficulties with Palmetto GBA, please contact our member-only reimbursement helpline at (888) 401-5911.

Starting this summer, WellPoint Inc., which insures some 34 million Americans, will offer primary-care doctors a fee increase, typically of around 10%, with the possibility of additional payments that could boost what they get for treating the patients it covers by as much as 50%.

Wellpoint said Friday it will increase the fees it pays to doctor practices, and it will start paying for services like preparing care plans for patients with complex medical problems. It also will offer doctors an opportunity to share in some savings when better patient care leads to a reduction in costs.

WellPoint said it wants to give doctors a chance to do more for patients outside of episodic care, or just treating people when they become sick. That means, for example, working with overweight people who have diabetes to develop an exercise plan and then making sure they stay on it.

Source: Associated Press, January 27, 2012.

Dear Congresswoman Pelosi:

On behalf of the San Francisco Medical Society and its over 1,000 members, I want to thank you for your steadfast support over the years for a permanent fix to the Medicare SGR problem.  We know you are aware that the longer we postpone a permanent fix for the SGRs the more expensive the correction becomes.  We now urge you to reaffirm this commitment when the House meets this month to work out a budget deal.

With each short-term patch, the scheduled cuts get steeper and the cost of payment reform grows. In 2005, the formula could have been repealed for less than $50 billion over ten years. Today, the ten year cost is nearly $300 billion. In five years, the combined cost of short‐term patches and accumulated SGR debt will reach $600 billion.

It is irrational to invest more taxpayer money to support a policy that is a proven failure. A two-year patch will cost $39 billion and increase the cost of future efforts to repeal the SGR by an additional $56 billion and increase the projected cut in 2014 to 36%.  Further­more, if allowed to continue, the SGR will require rapidly escalating amounts of politically challenging “pay‐fors” in the future to prevent additional cuts.

On behalf of San Francisco physicians and their Medicare patients, we appreciate your steadfast work in finding a permanent solution to this problem.

Click here to view the full video and interview transcript.

Source: Medscape.com, January 25, 2012.

 “A slow cultural shift over the past 20 years led by television — from “St. Elsewhere” to “ER” — has been humanizing society’s view of the practice of medicine,” said John Maa, MD, an assistant professor in the UCSF Department of Surgery and SFMS board member. “… As physicians, we must now harness the power of storytelling to enlighten Capitol Hill to enact new laws” to support emergency health care personnel.

Maa spoke at UCSF Grand Rounds on “The Future of Emergency Care in America: Doctors as Storytellers.” The January 11 lecture took place 37 months to the day that his mother entered a West Coast emergency department, where delays cost crucial hours and possibly her life.

He wrote in the New England Journal of Medicine about the death of his mother, who was admitted with an irregular heartbeat and suffered a massive stroke two days later.

“I was amazed by the response of the nation and even the world,” Maa said.

He was joined in Cole Hall by Neal Baer, MD, executive producer and writer for television’s “ER” and “Law & Order: Special Victims Unit.”

“The key to caring well for patients is to learn their stories,” said Baer, whose TV shows have explored everything from AIDS and gun violence to fetal alcohol syndrome and the use of hormone blockers by transsexual teenagers.

The resounding response to Maa’s article came after pieces in the New York Times and Wall Street Journal. He took a leave to also tell his mother’s story on Capitol Hill and to media outlets, health officials and medical organizations. He listened to other stories as well, visiting more than 50 emergency departments in the United States and meeting with people who’d written to him.

“What was striking was the recurring theme of personal loss they, too, had suffered from an overwhelmed emergency system,” Maa said.

Helping to Change Laws

That system will be more deluged than ever when President Obama’s health care reform takes effect, he said. However, Maa is convinced that the crisis in emergency care is “entirely solvable” by attracting young doctors, rewriting legislation and telling powerful stories to help change laws.

Some things are encouraging, he said. More than 400 hospitals have dedicated emergency room surgeons since this model was introduced at UCSF in 2005. The Obama administration has proposed the creation of a General Surgery National Health Service Corp. that would send surgeons to rural America. There is also the progress of Gabrielle Giffords, the Arizona congresswoman shot in the head during a 2011 rampage in Tucson.

“The story of her amazing recovery catalyzed a positive change in perception in Washington, D.C., about the heroism and the courage of emergency physicians and trauma surgeons,” Maa said.

Baer, a longtime advocate for social change, has repeatedly witnessed the difference storytelling can make.

A survey of more than 1,200 “ER” viewers found that 53 percent learned from the show about important health issues and one in seven went to a health care provider because of something they’d seen on an episode.

A “Law & Order” show about untested rape kits prompted Los Angeles to reopen its huge backlog of cases. Baer also downloaded a 30-second video from the show onto Twitter and enlisted partners to run it, including Human Rights Watch, NBC, Nicholas Kristof and social action network Take Part. It received more than 3 million hits.

“I’ve found the best doctors to be excellent storytellers,” Baer said. “They empathize with patients, they listen carefully and they have a knack for asking good questions that can reveal the often hidden cause of a patient’s problems.”

For example, as a third-year-medical student working in a Boston hospital, Baer was mystified by the chest pains of a seemingly healthy 65-year-old runner until he realized he didn’t know the man’s entire story. After scrutinizing the patient’s charts, Baer ordered standard tests that revealed severe anemia, causing stress that triggered a heart attack.

“I’ll never forget that patient because he taught me to tell stories with depth and detail and to look for twists and turns that can reveal stunning answers,” Baer said.

After Grand Rounds, UCSF resident Sierra Matula said, “This is very apropos. The most important thing is to just listen to patients instead of being rushed and hurried. If you let them talk, they’ll tell you exactly what’s going on.”

Source: UCSF News, January 24, 2012.

The decision to decide is part of a settlement agreement with the National Resources Defense Council. The FDA took three years to respond to the environmental group’s petition.

“Every day, millions of American consumers are exposed to this dangerous chemical, commonly used in packaging for canned foods, beverages and even baby formula,” said Dr. Sarah Janssen, a senior scientist in the NRDC’s San Francisco offices. “The FDA has an obligation to protect us from toxic food additives. As thousands of studies have already shown, BPA is a dangerous chemical that has no place in the food chain. Its use in food and beverage containers needs to be banned.”

BPA can be found in the linings of beer, soda, vegetable and soup cans as well as liquid infant formula containers and reusable water bottles. Trace amounts of BPA have been detected in the urine of 91% of Americans tested.

Governor Brown has signed the Toxin-Free Infants and Toddlers Act (AB 1319) into law that requires that BPA be eliminated in baby bottles and sippy cups made or sold after July 1, 2013. However, exposure from food packaging remains.

Click here to view another article about BPA featuring SFMS Member and BPA researcher William Goodson, MD.

SFMS would like to thank our members, sponsors, and special guests Supervisor David Chiu and Dr. Anthony Iton of the California Endowment for their support of this event and the medical society.

Click here to view more photos from the Annual Dinner.

2012 SFMS Officers

UCSF students with their physician sponsors

Supervisor David Chiu addressing the crowd

Along with the American Medical Association (AMA), SFMS/CMA sent a letter to the Congressional Conference Committee currently addressing this issue. In addition to asking for an end to the SGR, the letter asks Congress to use projected spending that will not be needed as the wars in Iraq and Afghanistan wind down to help pay for ensuring access to health care for military families and seniors on Medicare. With the early troop withdrawals in Iraq and Afghanistan, there are hundreds of billions in savings in the Overseas Contingency Operations (OCO) account. Last week, House Democratic leaders, including Congressmen Waxman and Becerra, joined a growing group of Republican and Democratic Senators in supporting the use of OCO funds to repeal the SGR.

With a 27 percent cut scheduled to take effect March 1, 2012, the letter also asks the committee to act now before the cost to taxpayers grows. As recently as 2005, the cost of permanent repeal would have been $48 billion. Today the cost is estimated to be nearly $300 billion. The cost is expected to double again in the next five years.

Poll results show that an overwhelming number of Americans, 94 percent, believe a massive Medicare cut, like the one scheduled for March 1, is a serious problem for seniors. Congress’s own Medicare advisory committee has said that one in four seniors seeking a new primary care physician in Medicare has had trouble finding one.

In repealing the SGR, Congress will be able to bring stability to programs that are necessary to some of the most vulnerable of our patients. Please help the campaign by contacting Senators Dianne Feinstein and Barbara Boxer and ask them to protect access to care in California by using OCO funds to repeal the Medicare SGR. Let them know that that SGR cuts must be stopped before the March 1 deadline. Using the AMA Grassroots Hotline at (800) 833 635, plug in your ZIP code and you will automatically be connected to your Senator.

• Anesthesia codes that include the phrase “not otherwise specified” in their code descriptors (procedure codes 00100 through 01996) do not meet the criteria of a non-specified procedure code and do not require a description to be supplied in the SV101-7/SV202-7 data elements.
• Anesthesia procedure code 01999, “Unlisted anesthesia procedure(s)” meets the requirements of a non-specified code and continues to require additional information to be supplied in the SV101-7 data element.
• Some pathology and laboratory codes identified in procedure code section 8800 and a variety of other NOC codes have been removed. These codes do not meet the criteria of a non-specified procedure code and do not require a description to be supplied in the SV101-7/SV202-7 data elements.

Medicare FFS’s complete listing of the NOC codes can be found at http://www.CMS.gov/ElectronicBillingEDITrans/40_FFSEditing.asp. Medicare will be updating the code set, at minimum, on a quarterly basis (January, April, July, and October) as the NOC list is refined and the parent code sets are updated.

For more information on Version 5010 and D.0, please visit http://www.CMS.gov/Versions5010andD0.

Target Audience: Vendors, clearinghouses, and providers who need to make Medicare FFS-specific changes in compliance with HIPAA Version 5010 requirements.

• HIPAA Version 5010 implementation update
• Question & answer session

If you would like to submit a question related to this topic in advance of, during, or following the call, please email your inquiry to 5010FFSinfo@CMS.hhs.gov.  Please note that this resource box will only accept emails the day before, the day of, and the day after this call; your emailed questions will be answered as soon as possible, and may not be answered during the call.

Registration Information:  In order to receive the call-in information, you must register for the call. Registration will close at 12pm on the day of the call or when available space has been filled; no exceptions will be made, so please register early.  For more details, including instructions on registering for the call, please visit http://www.eventsvc.com/blhtechnologies.