Volume 17, No 28 Aug. 2, 2015
Make an August House Call on Your U.S. Senators and Representative
This month, members of Congress will be home for the August recess. The Texas Medical Association urges physicians to make appointments with your U.S. representatives in August to share medicine’s prescription for federal health care changes.
In meeting with U.S. Sens. John Cornyn and Ted Cruz and your U.S. representative (find contact information on the TMA Grassroots Action Center), TMA encourages you to discuss these critical issues pending in Washington:
Maintenance of Certification
Language in the bill that repealed the Medicare Sustainable Growth Rate formula leaves many physicians worried that Maintenance of Certification will become a condition for participation in Medicare, Medicaid, and other government health care programs.
TMA is asking Congress to clarify that there is not and will not be such a requirement.
The Centers for Medicare & Medicaid Services (CMS) announced a one-year “grace period” protecting physicians from the coding errors and technical glitches that likely will accompany the Oct. 1 mandatory transition to the ICD-10 coding system. This is a start, but just a start. The press release is long on words but short on action.
TMA is asking Congress to maintain strict oversight of the ICD-10 rollout, be prepared to act quickly in the event of a technical disaster, and to ensure that:
- Claims will not be reduced or denied based on failure to fully comply with the new coding system,
- Physicians will not be penalized or audited for errors or malfunctions of CMS’ systems, and
- CMS makes advance payments available to help physicians experiencing serious payment delays.
Medicare pays recovery audit contractors, or “RACs,” like bounty hunters to find overpayments made to physicians and health care providers. This provides these contractors incentives to disrupt doctors’ practices as they comb through patient files looking for the tiniest of errors.
TMA is asking Congress to establish incentives for RACs to make more accurate audit findings, to reduce the period for which claims may be audited, to direct RACs to focus only on practices with demonstrated inappropriate billing patterns, and to provide due process and fair procedures for physicians who are subject to a RAC audit. Please ask your member of the Texas delegation to sign on as a cosponsor of HR 2568, the Fair Medical Audits Act of 2015, by Rep. George Holding (R-N.C.).
Section 6001 of the Affordable Care Act (ACA) prohibits new doctors from investing in hospitals that take Medicare patients; no physician-owned hospitals may start nor may current ones expand. This significantly inhibits physicians’ legal right to own or invest in hospitals and other facilities that provide their patients high-quality care. TMA strongly supports responsible physician investment in technology, facilities, services, and equipment. Congress should focus not on who owns the medical facility but on the quality of the facility and appropriateness of patient care.
TMA is asking Congress to repeal Section 6001 of the ACA.
Medicare typically pays two to three times as much for a service or procedure provided in a hospital clinic or outpatient department as it does for the same service or procedure done in a physician’s office. The purported rationale is to help hospitals cover the costs of expensive operations such as laboratories and emergency rooms.
TMA is asking Congress to require Medicare to pay appropriately for services and procedures regardless of where they are performed instead of paying hospitals more in one area and then cost-shifting.
Medicare payments to residency programs for graduate medical education (GME) have been frozen since 1997. This has placed increasing pressure on governments, medical schools, and hospitals in fast-growing states like Texas to find ways to establish enough residency slots to keep up with demand for new physicians. In addition, most of the Medicare funding for GME flows to hospitals even though a large portion of residency training now takes place in outpatient settings.
We need to make sure Congress continues to provide opportunities for graduate medical education to ensure we have appropriate numbers of health professionals to meet the needs of 21st-century America.
The Medicare Patient Empowerment Act would allow seniors to use their current Medicare coverage to see a doctor who is not accepting Medicare. It would strengthen patient choice and access to physicians. It would ensure that seniors can see any doctor they choose and still use the Medicare benefits for which they have paid, without having to change their Medicare plan. The act would allow Medicare patients and their physicians to enter into private contracts without penalty.
TMA is asking Congress to pass the Medicare Patient Empowerment Act.
EVPGram Takes Summer Break
This will be your last regular issue of the EVPGram for the summer. We’ll be back in your in-box after Labor Day. Of course, we’ll keep you up to date through our Action newsletter and through Texas Medicine, and I’ll send out special editions of the ’Gram when necessary.