U.S. Houses passes Bill to revoke Sustainable Growth Reduction of 1995

U.S. Houses passes Bill to revoke Sustainable Growth Reduction of 1995 The Bill will now be voted on in the U.S.  Senate.

It has been on the 'books' since  1995 and has never been used.

Contact your  Senator now and tell him to vote to revoke the SGR.

Read the Bill Summary

1. Send an urgent email to your senators reinforcing the need for SGR repeal now.
2. Contact key senators still undecided on this most critical issue directly through their own social media channels and share with your own Facebook friends and Twitter followers as well.

ERRATUM Dr. House on TWITTER

The previous post was afflicted with micrographia .

It was due to a technical issue.  I suggest using your browser zoom features. I use Chrome (Ctrl  +  or Ctrl - )

Dr. House on #Twitter

• about the author
• medicine and social media: compilation
• milestones of scienceroll
• medical disclaimer

Dr. House on Twitter: Interview on Babel Guide

We resource and reference many internet sites for our blog articles, here and on Digital Health Space.

Science roll and Bertalan Berci Mesko are one of my favorite links for information about social media 

in medicicne and his vision for the future of medicine.  

Dr. Mesko ix the #hcsm guru for Central Europe.  

Recently he presented at the Salzberg Global Seminar. I have provided the podcast link

SoundCloud podcast

Berci has been in the 'game' of social media since he was in elementary school. 

It comes naturally to him and others of his generation as a Sony Walkman came to mine.  

HealthCare came to him when he became a physician.  His other DNA is 'GEEK'.

While others of my generation have to add #hcsm to our medical careers, it can and is 

being done by many.

Physcians use social media for education, training, marketing, and opinioinating.  The

 number of social media sites expands mo nthly, some catching on and growing

 (Google +, Facebook + Linkedin or Twitter.   Medical social media sites include Sermo, 

Doximity, and others that came and went.

I identify with him, and since retiring from clinical practice I am immersed in all things 

#social media, not just medical.

My blog focuses on current events stemming from health information technology,

 health policy and reform, CMS mandates and the outlook for the new acronyms in health care

(ACO, ACA, PQRS, ICD 10, SGR)  You can usually find me  "bloviating' about 

endless questions with no solutions.

Health care consultants,  hospital administrators often like to 'pontificate' and offer their point

of view for our future of medicine.  It is much lile playing 'roulette'.  You place your ball in the 

slot, then spin.  So too is our spin here and elsewhere.

Our goal is to let our patients know that almost all of our gripes have to do with providing 

their care unencumbered by financial realities and rules cast upon us by ignorant politicians and 

administrators from HHS and CMS.

What Does the SGR Fix Really Mean to Doctors?

After More Than a Decade, a "Doc Fix": 5 Key Points

National Physicians Call-In Day on Tuesday, March 24. Please help spread the word to your colleagues - we want as many physicians as possible to be flooding the phone lines of their U.S. representatives to make the case for SGR repeal now! Make sure you call on Tuesday: (800) 833-6354.

After 17 years of kicking the can down the road it seems the SGR  will blow away in a  cloud of dust, leaving what ?

In this era of novel payment models, accountable care organizations (ACOs), patient-centered medical homes (PCMHs), and other acronyms and initiatives, some have pondered whether the SGR is really still significant.  It is true, the landscape of  reimbursement and health financing barely resembles that of 1997 when the SGR (Sustainable Growth Rate) adjustment was designed to  counteract the increase in the senior demographic becoming eligible for Medicare.  

Medicare payments barely resemble those of 1994 when draconian cuts were made to fees to physicians unrelated to an SGR.  Cuts of 2 to 5 % had been expected each year, and now 15 years later the SGR lies fallow like an abandoned ICBM rusting in the South Dakota plains.

Chronic diseases have become a major category of spending, new treatment models, payments dependent  upon outcomes, quality of care, and a decreased emphasis on a strict fee for service. The new buzz acronym is P4P (Pay for performance).

The conversion to payments for quality of outcomes is not  a total abandonment of fee for service. Not at all !.  It is not a  pre-paid formula, or a payment model designed like a DRG (Diagnosis related group) where payments are tied to the disease being treated.

What is occuring is the use of fee for service with a bonus incentive/penalty for non compliance. This will be administered with a thick overlay of algorithms following a mystery calculus of big data forthcoming from meaningful use standards built into the federal HIT system.  The system of EHRs and the HIEs still yet to be built are the bedrock of this new as yet implemented feature of the ACA.  Never you mind the additonal acronym of  ACO (Accountable Care Organization).

Yes, our nation is one of  'Exceptionalism" (except for this, or for that).

So the SGR was not important.....it never was, just to use as a negotiating point and used as a bishop at the last minute in the war on physicians, who invested untold millions of dollars via the AMA and other physician group lobbying on the hill the past 15 or more years.

The final shovel of dirt will fall on the SGR casket with the change to ICD-10 making all previous ICD 9 codes obsolete and fossilized.

The SGR never had a chance to become a fossil, rather it never lived and it's DNA became extinct before it was born.  Conceived, yes, then miscarried before it's birth.

National Physicians Call-In Day on Tuesday, March 24. Please help spread the word to your colleagues - we want as many physicians as possible to be flooding the phone lines of their U.S. representatives to make the case for SGR repeal now! Make sure you call on Tuesday: (800) 833-6354.

House Speaker John Boehner and Minority Leader Nancy Pelosi have put forth a deal that would result in a vote on a full SGR repeal. It would also reauthorize the Children's Health Insurance Program (CHIP) before the latest (of 17) SGR "patches" expire on April 1. The Congressional offices I've spoken with expect there to be a vote by Thursday. What chance does this have and what do you need to know about this proposed legislation?

Point 1. This (Still) Matters

"It's not a doc fix. It's a fix for America's seniors so that they can continue to see their doctors under Medicare." –Pelosi^[1]

Point 2. Approval Is Not a Sure Thing

This "fix" is essentially no different from the bipartisan, bicameral (House and Senate) SGR Repeal and Medicare Provider Payment Modernization Act of 2014

Point 3. Organized Medicine Is United in This Effort

Last Monday, a letter^[2] endorsed by over 750 physician membership organizations was delivered, urging Congress to pass legislation, based on last year's bill, before the SGR patch expires on April Fool's Day.

Point 4. The Bill Does More Than Just Fix the SGR (And Should Do Still More)

Throughout lobbying efforts restoring Medicaid Primary Care Pay Parity has been a linked objective. Additionally, the Medicare Primary Care Incentive Program, which has provided internists and other primary care physicians 10% bonus payments on their office visits and other designated services since 2011, is set to expire at the end of 2015.

Point 5. The Time to Act Is Now

Medicine is not receiving everything it has asked for. Medicine is not receiving undue gifts or treatment. Primary care, which takes care of vast numbers of Medicare recipients in this country, remains dramatically undervalued to the great detriment of public health and national economic productivity, and is still inhibited from delivering the moral breadth and depth of services smoothly and thoroughly across the nation's towns and neighborhoods for which those of us in the profession chose this life.

It is essential that every physician and every patient who receives, or hopes to receive, primary care call their representatives, and especially their Senators, NOW to encourage an affirmative vote prior to the April recess.

National Physicians Call-In Day on Tuesday, March 24. Please help spread the word to your colleagues - we want as many physicians as possible to be flooding the phone lines of their U.S. representatives to make the case for SGR repeal now! Make sure you call on Tuesday: (800) 833-6354.

Attribution :  Medscape

Supreme Court Ruling Could Limit Medical Board Authority

State medical boards may find it harder to fence off the practice of medicine from nonphysicians — think nurse practitioners — in the wake of today's Supreme Court decision in a case about teeth whitening.

In a 6–3 vote, the high court ruled that North Carolina's dental board violated the Sherman Antitrust Act when it shut down nondentists who were whitening teeth in malls and beauty shops because the board, composed mostly of practicing dentists, was not actively supervised by the state. Active supervision, the court said, would have shielded the board from a Sherman violation.

"[The Sherman Act] does not authorize the states to abandon markets to the unsupervised control of active market participants, whether trade associations or hybrid agencies," the court said, upholding a move by the Federal Trade Commission (FTC) to block the dental board's actions in the name of fair competition.

Dissenting from the majority opinion were Associate Justices Samuel Alito Jr, Antonin Scalia, and Clarence Thomas.

The American Medical Association (AMA) and other medical societies had asked the Supreme Court to hear the case — and uphold the decision of the North Carolina dental board — in light of the antitrust implications for state medical boards.

"If state licensing decisions are subject to invalidation by federal agencies with no particular expertise in the healing arts, then those federal agencies will become the final arbiters of matters of public safety, tasks that they are ill-equipped to perform," the AMA and its allies stated.

The medical societies warned that if the FTC got its way, medical boards might be loath to crack down on nonphysicians engaged in "the illegal practice of medicine" for fear of triggering an antitrust suit. They cited the example of nurse practitioners who provide services that were beyond their qualifications without any physician supervision.

Rallying behind the FTC in the Supreme Court case were the American Nurses Association, the American Association of Nurse Practitioners, the American Association of Nurse Anesthetists, the American College of Nurse Midwives, and the National Association of Clinical Nurse Specialists. In a friend-of-the-court brief, these associations said that active state supervision was needed for physician-dominated medical boards because they have a history of unfairly limiting the scope of practice for nurses.

In response to today's ruling, AMA President Robert Wah, MD, said that his organization would work with other medical societies "to secure policy changes to reinforce long-held antitrust protections" for state medical boards.

"The AMA agrees with Justice Alito, speaking for the three dissenting justices, that today's decision 'will spawn confusion' by creating far reaching-effects on the jurisdiction of states to regulate medicine and protect patient safety," Dr. Wah said in a statement emailed to Medscape Medical News.

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Medicare's Sustainable Growth Rate--(SGR)

As reported in iHealthbeat, a publication of the California Health Care Foundation (CHCF)

It has been over 15 years since Congress enacted the SGR, an act which has been put on hold each year since t hen.  The accumulative value is now over 20%, which if enacted would reduce Medicare payments to providers by 20%.

Each year health providers have lobbied Congress to keep the SGR on hold.

Since 1994 many changes have occured in the administration of CMS and payment reforms.  As Congress considers repealing the SGR other changes have occured, the Affordable Care Act and other changes in payment models from fee for service payment to value based payments.

SGR Replacement Bill Has Big  Implications for Health IT On Thursday, Senate and House lawmakers introduced bipartisan, bicameral legislation (HR 1470) to permanently replace Medicare's sustainable growth rate formula that includes several health IT provisions, Modern Healthcare reports (Tahir, Modern Healthcare, 3/19). Congress last year approved a short-term delay to scheduled reductions to Medicare physician reimbursement rates called for by the SGR. Providers face about a 21% reduction in Medicare reimbursement rates unless Congress acts by April 1, 2015 (Hughes, Wall Street Journal, 3/19). Meaningful Use Provisions The new legislation would replace the SGR with a merit-based incentive payment system that would consolidate several federal incentive programs, including the meaningful use program, physician quality reporting system and value-based modifiers, into one value-based payment reporting system. Under the 2009 economic stimulus package, providers who demonstrate meaningful use of certified electronic health records can qualify for Medicaid and Medicare incentive payments. Specifically, the SGR replacement measure would: Sunset meaningful use penalties (Gold et al., "Morning eHealth," Politico, 3/20); Make eligible professionals who meet the program criteria eligible for a bonus (Modern Healthcare, 3/19); Require eligible professionals to demonstrate that they have not "knowingly and willfully taken action ... to limit or restrict the compatibility or interoperability of the certified EHR technology"; and Encourage medical professionals to use EHRs even if they are not eligible for the meaningful use program via incentives, such as streamlined reporting of quality metrics (Goedert, Health Data Management, 3/20). The legislation also would mandate that HHS work with stakeholders to develop measures to quantify interoperability by July 2016 ("Morning eHealth," Politico, 3/20). Additional Health IT Provisions The bill also would: Clarify that Medicare is able to pay for telehealth services in alternative payment models ("Morning eHealth," Politico, 3/20); and Incentivize telehealth services and remote patient monitoring by including them as clinical practice improvement activities (Modern Healthcare, 3/19). In addition, the legislation would call for several reports, including: A study by HHS on ways to potentially assist providers with comparing EHR systems, which would be due in one year ("Morning eHealth," Politico, 3/20); and A study by the comptroller general assessing how insurers are encouraging remote patient monitoring and the obstacles to more widespread use of remote monitoring technology in Medicare (Modern Healthcare, 3/19). The replacement legislation does not mention the ICD-10 transition. It seems that the simplicity of repealing the SGR has bcome obfuscated by all of the ramifications of the Affordable Care Act, transitioning to a value-based payment model, HIT incentives, the patient quality reporting sysem (PQRS). The bottom line is that savings afforded by the Affordable Care Act combines with incentives may equal or outweigh the theoretical reductions of the SGR, rendering the SGR irrelevant.

The Conundrum of Blue Shield of California

Officials Revoke Blue Shield of California's Tax-Exempt Status

Blue Shield has always served as one of the beacons of the health insurance industry.

The Corporate History of Blue Shield of California  It was formed in 1938 by the California Medical Associaton

What happened to the Mission and Values of Blue Shield  ? "  Was the fox in the henhouse ?

Their website describes their Code of Conduct"

 Blue Shield of California's Code of Conduct (PDF, 1.3 MB)

The California Franchise Tax Board has stripped the not-for-profit Blue Shield of California of its tax-exempt status, the Los Angeles Times reports.

Background

According to the Times, the tax-exempt status revocation comes as Blue Shield has faced criticism over its:

• Executive pay;
• Rate hikes; and
• $4.2 billion surplus.

For Care,  Not for Profit (what does Blue Shield mean?). from the web site

As a not-for-profit health plan, we put the care of our members before profits. See what we mean by:

Affordable Care 
Comprehensive Coverage and Service
Access to Quality Care
Doing the Right Thing

According to the Times, Blue Shield's surplus at the end of 2014 was four times as much as what the Blue Cross and Blue Shield Association requires insurers to stockpile to cover future claims.

Advocates also have criticized Blue Shield for failing to serve Medi-Cal beneficiaries. Medi-Cal is California's Medicaid program.

In addition, critics have raised concerns about Blue Shield's lack of transparency. For example, the insurer's 2012 filings did not list any executive employees by name.

Michael Johnson, former public policy director at Blue Shield, said that the insurer has been "shortchanging the public" for years. Johnson said that he plans to launch a campaign to convert the insurer into a for-profit company and force it to return billions of dollars to the public.

Details of Revocation

A California Franchise Tax Board spokesperson declined to comment on why Blue Shield's tax-exempt status was revoked, but officials have ordered the insurer to file tax returns for each year back to 2013.

On Tuesday, Blue Shield said it would protest the decision.

Blue Shield spokesperson Steve Shivinsky said, "Blue Shield as a company and management team firmly believes it is fulfilling its not-for-profit mission and commitment to the community."

Reaction

Anthony Wright, executive director of Health Access, said, "It's important to have this debate over Blue Shield's public-service mission and how they are fulfilling it."

In addition, Dena Mendelsohn, a health policy analyst at Consumers Union, said that the insurer's "lack of transparency makes it hard to understand whether Blue Shield is holding up their end of the bargain with the public" (Terhune, Los Angeles Times, 3/18).