late-breaking news from your medical association volume XX / no. 1 JANUARY 2013
local Health Chief Predicts Changes for Medicine With 2012 now closed, Mark Laret, CEO of UCSF Medical Center, offered up a number of comments and predictions about 2013: “The era of the standalone hospital, the solo practitioner, and the small group practice has come to an end. We are going to have to find ways to operate far more efficiently than we have in the past. And that affects everybody—health plans, providers, TPAs, everybody.”
Athenahealth Acquires Epocrates Athenahealth, of Watertown, MA announced its acquisition of Epocrates, the San Mateo mobile application developer. The deal amounts to $11.75 per share. Epocrates was named last year by Modern Healthcare Apps, as the No. 1 mobile application developer. The deal is subject to approval by Epocrates shareholders. Athenaheath, which was co-founded by federal Chief Technology Officer Togg Park, ranked in the top ten vendors among physicians using complete electronic medical record systems to attest to having met Medicare’s meaningful-use criteria.
Biotech Events in 2012 Elan Corp shuttered its SSF research center and shifted R&D to a new company after an ill-fated Alzheimer’s disease treatment, Bapineuzumab, fails two more late-stage trials. Bayer opens its CoLaborator, aimed at developing early-stage companies with which the drug giant ultimately can collaborate. Gilead wins approval of Truvada, its already-marketed HIV treatment, as the first approved drug to prevent the AIDS virus. Intarcia raises $210 million as it pushes its diabetes drug device into Phase III. The company, however, will move its HQ to Boston, keeping early development and manufacturing in the East Bay. Johnson & Johnson places one of its four global innovation center in the Bay Area as it scouts fo early innovation and tries to line up partnerships with universities and biotech companies. After its clinical trial failure in Alzheimer’s disease in 2010, Medivation has come back with the $7,450-per-month prostate cancer pill Xtandi. The drug was approved by the FDA at the end of August, hit the market September 13 and in the first 12 days registered net sales of $14.1 million.
state CNA and National Union of Healthcare Workers Join Forces The move for the two health care unions to join forces (CNA has 85,000 members and the National Union has 10,000) could threaten its powerful rival’s dominance and fuel new labor tensions with the Service Employees International Union, though it is much larger membership of 2 million. CNA has pledged to help NUHW in its campaign to defeat a large rival, an arm of SEIU, the United Healthcare Workers West, in an upcoming election for the right to represent 43,500 Kaiser Permanente service and technical workers.
state Santa Monica’s St. John’s Hospital Santa Monica’s St. John’s Hospital got quite a surprise at the end of December when, without notice, its top executives were ousted, along with most of the directors and thrust into public view a long-simmering debate about the hospital’s future. The out-of-town owners want to sell the hospital which was founded by Catholic nuns.
national HHS Approves More State Exchanges HHS conditionally approved eight more states to operate health insurance exchanges who will run their own statebased exchanges, including California, Hawaii, Idaho, Nevada, New Mexico, Vermont and Utah. Arkansas will partner with HHS to run its exchange. This brings to 19 states plus D.C. that have won conditional approval to either partially or fully run their own exchanges. By the way, the California and Washington exchanges will require people who buy medical insurance through the new health exchanges to also buy pediatric dental benefits regardless of whether they have children!
Bystander Effect On January 3, NEJM released a study conducted by the Yale School of Medicine relating to the “Genovese Syndrome,” the lack of bystander intervention, stating that the phenomenon is prevalent in healthcare as well. The phenomenon assumes no one does anything because they think others will take responsibility in an emergency. The study found in one case, more than 40 physicians were involved in the care of one intensive care unit patient. Because so many providers cared for the patient, the patient actually became sicker. The researchers found that the larger the group, the more likely the bystander effect may occur. The study authors suggested cross-specialty collaboration, as individuals may be more likely to act when they are friends with one another. Such collaborative improvement systems include TeamSTEPPS, an evidenced-based teamwork system from the Agency for Healthcare Research and Quality (AHRQ) used to improve healthcare quality, safety, and efficiency.
Maintenance of Certification In 2000, the American Board of Medical Specialties (ARMS) and its 24 member boards commenced the maintenance of certification (MOC) program that promotes lifelong professional development based on the core competencies of the ACGME. This is typically to be undertaken every ten years. Many physicians bemoan how expensive and time-consuming the process is, while young physicians criticize the Board for grandfathering in physicians who were certified before 1990. Although the MOC is slowing gaining support from some leading institutions, physicians largely self-regulate their professional development. The goal of the program is to ensure physician specialists keep up with their discipline. However, only one percent of the 66,689 diplomats of the American Board of Internal Medicine (ABIM) who hold time-unlimited certificates choose MOC.
Average Private Health Premiums on Rapid Rise According to a report released by the Commonwealth Fund, the average premiums for private employer-sponsored family health insurance plans across states rose 62 percent from 2003 to 2011, rising faster than income for middleand low-income families. The average premiums rose from $9,249 to $15,022 per year between 2003 and 2011. At the same time, deductibles more than doubled for both large and small firms. As a result of the rapid increase in health insurance costs and the slow growth in income, 80 percent of the nation’s population lives in states where total premiums are equal to or exceed 20 percent or more of median income. For the full report go to www. commonwealthfund.org/publications/issue-briefs/2012/dec/state-trends-in-premiums-and-deductibles.aspx. Another report out of DHHS reports that the nation spent $2.7 trillion in 2011, which is 17.9 percent of the economy. This is the third year of historically low increases in the U.S.
Growth in Canadian Health Spending Declines For the third consecutive year, in 2012, total Canadian health care spending is projected to grow by 11.6 percent to $207 billion, but that represents a third consecutive year of declining growth in health spending. Slower economic
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growth and government budget deficits are moderating health spending. The provincial and territorial governments today are focused on controlling health care costs by improving productivity, reducing overhead, controlling compensation, and seeking value-for-money initiatives, rather than cutting programs. Data from the Canadian Institute for Health Information is available at https://secure.cihi.ca/free_products/NHEXtrendsreport2012EN.pdf.
Top 10 Political Contributors Among Pharmaceuticals/Health Products In 2011-12, according to Open Secrets’ Center for Responsive Politics, Pfizer led the pack with political contributions of $1,495,189, followed by Amgen at $1,228,321. The third top contributor was a little surprising: Health Foods of America, at $1,207,500. They were followed by Abbott at $1,041,734; Ischemix at $1,034,600; Exoxmis at $1,030,000; AstraZeneca at $940,217; Merck at $870,692; J&J at $835,118, and Eli Lilly at $768,825.
Funding for State and Local Public Health Preparedness Decreases According to a report entitled “Ready or Not? Protecting the Public from Diseases, Disasters, and Bioterrorism,” which was funded by the Robert Wood Johnson Foundation, federal funds for state and local public health preparedness have decreased 38 percent from fiscal year 2005-2012.
How Companies Reward or Penalize based on Biometric Measures from Health Risk Assessments The Kaiser Family Foundation and the Health Research & Educational Trust report that 38 percent of companies that offer health benefits ask employees to complete a health risk assessment (HRA). Of companies that ask employees to complete an HRA, 63 percent offer financial incentives to complete the HRA. Eleven percent of companies mandate that those with health risk factors shown in their HRA complete a wellness program or face financial penalties. Nine percent of companies reward or penalize employees based on biometric measures.
medicare Fiscal Cliff Congress, finally acted on January 1, passing HR 8, the American Taxpayer Relief Act of 2012, narrowly averting the socalled “fiscal cliff.” The bill includes another one-year Medicare fee-for-service physician payment freeze, meaning the 26.5% SGR cut has been averted, and a two-month deferment of the 2% sequestration cuts. It also extends the work Geographic Practice Cost Index (GPCI) floor for another year. Other health-related actions in the Act include creating a path for physicians to furnish relevant and timely data needed in new delivery and payment modes; allowing physician participation in clinical registries to meet Medicare quality reporting requirements; and providing a oneyear reauthorization of funding for the National Quality Forum. The Medicare temporary fix will be paid for by extending the statute of limitations for recouping overpayments to hospitals; rebasing the Disproportionate State Hospital (DSH) payments to hospitals; adjusting the equipment utilization rate for advanced imaging services and equalizing steriotactic radiology hospital outpatient services with physician services; rebasing end-stage renal disease payments based on utilization of drugs; reducing multiple procedure payments when more than one therapy procedure is provided on the same day; cutting the Affordable Care Act’s (ACA) CO-OP program; eliminating funding for the Medicare Improvement Fund (a slush fund for the federal HHS for “Medicare improvements); eliminating the ACA long-term care (LTC Class Act), though it does establish an LTC Commission; and adjusting Medicare Advantage payments to account for differences in coding practices between fee-for-service and managed care risk adjustment formulas.
Medicare Payment Rates Some carriers are not expected to post their new 2013 rates until at least next week. The 2013 fee schedule amounts you received from your carrier in November include both the SGR and the GPCI reductions, and thus significantly understate the current Medicare fee schedule. Most commercial health insurer physician contracts contain language that sets the billed charge as the cap on payment, similar to Medicare. Thus, physicians who accept assignment should review their retail fee schedules and update them to reflect their current practice costs before billing Medicare in 2013. It is recommended that you consider deferring submission of claims for 2013 dates of service until the new 2013 dates of service are published, or bill your updated retail rates.
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FIRST CLASS MAIL U.S. POSTAGE PAID SAN MATEO, CALIF PERMIT NO. 668
ADDRESS SERVICE REQUESTED RETURN POSTAGE GUARANTEED 777 MARINERS ISLAND BOULEVARD, SUITE 100 SAN MATEO, CALIFORNIA 94404
medicare 2013 Medicare Claims CMS released an announcement regarding updated 2013 Medicare payment amounts, claims processing, and reopening of the participation enrollment period, stating that in order to allow sufficient time to develop, test, and implement the revised 2013 Medicare physician fee schedule, Medicare contractors have been instructed that they can hold claims with January 2013 dates of service for up to 10 business days.
Medi-Cal Primary Rate Hikes Delayed The California Department of Health Care Services (DHCS) announced that it will delay the implementation of higher reimbursement rates for EDI-Cal primary care physicians, which were set to go into Effect on January 1 under the ACA. The federally funded increase is intended to recruit more physicians to treat patients who will be newly eligible for health coverage under the ACA; however, DHCS states that they will not implement the increase until summer 2013 at the earliest.
Medicare ePrescribing Hardship Exemption The deadline is almost here, so if you plan to file for a Medicare electronic prescribing hardship exemption, but did not file by the June 30, 2012 deadline, you have another opportunity to apply before January 31. If you have questions or needs assistance submitting a hardship exemption request, please contact the QualityNet Help Desk at (866) 288-8912 or qnetsupport@sdps.org. They are available Monday through Friday from 7 a.m. to 7 p.m. Central Standard Time.
upcoming events SMCMA Seminar: Owner vs. Employee MD? What Is Your Strategy for the Future? This program will present a balanced discussion of options and issues for physicians to consider before making imporant decisions about their practices. Presenter Debra Phairas, President of Practice & Liability Consultants, LLC, has worked with more than 1,600 practices since 1985.
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Date and Time:
Wednesday, January 30, 2013 - 6:30-7:45 P.M.
Cost:
$99 for SMCMA members
Registration/Info:
Please contact Shannon Goecke at (650) 312-1663 or sgoecke@smcma.org.
JANUARY 2013