Metro Med has long had an online presence with our website and have been on social media outlets like Facebook for a few years now. However, blogging is new to us. This blog is a way for us to share all the great content that is published in our quarterly magazine with a larger audience – we hope you’ll stick with us. Guest posts are always welcomed. Contact Patti Sosa at communications at metromedkc dot org and we will feature your news here!

If you and your practice are intersted in getting started in building your online presence, there is no greater site to go to than, www.kevinmd.com.  Kevin Pho, MD has been blogging for more than 10 years on topics related to social media and physicians.  A recent post address a commonly asked question of “how-to” start blogging. Read more about his tips and suggestions here.

Physician Compare Redesign Open Door Forum Registration

In 2012, CMS initiated a full redesign of the Physician Compare website based on feedback from site users, physicians and other healthcare professionals, and other stakeholders. The goal of the redesign was to improve the accuracy and currency of the information available on the website as well as improve the usability and functionality for all users. Two primary enhancements of the redesign include an overhaul of the underlying database and the addition of a new Intelligent Search functionality.

The redesigned Physician Compare website will be launched soon. You are invited to participate in an Open Door Forum where CMS will unveil the redesign. The Open Door Forum will be conducted via webinar. If you are interesting in participating, please send an email with your name, affiliation, and email address to the Physician Compare team at PhysicianCompare@Westat.com. Please put “ODF” in the subject line. The Physician Compare team will email logistical details and instructions for the webinar to everyone who registers the week of the ODF.

Mandatory Payment Reductions in the Medicare FFS Program — “Sequestration”

As required by law, President Obama issued a sequestration order on March 1, 2013 requiring across-the-board reductions in Federal spending.

In general, Medicare FFS claims with dates-of-service or dates-of-discharge on or after April 1, 2013, will incur a 2 percent reduction in Medicare payments. Therefore, to prevent making overpayments, interim and pass-through payments related to the Medicare cost report will be reduced by 2 percent.   Beginning April 1, 2013 the 2 percent reduction will be applied to Periodic Interim Payments (PIP), Critical Access Hospital (CAH) and CancerHospital interim payments, and pass-through payments for Graduate Medical Education, Organ Acquisition, and Medicare Bad Debts. Questions about reimbursement should be directed to your Medicare Administrative Contractor.

CMS to Begin Accepting Suggestions for Potential PQRS Measures and Measures Groups in May

In May, CMS will begin accepting quality measure suggestions for potential inclusion in the proposed set of quality measures in the Physician Quality Reporting System (PQRS) for future rule-making years. CMS is seeking a quality set of measures that are outcome-based and fall into one of the National Quality Strategy (NQS) Priorities domains where there are known measure and performance gaps. The measure gaps that CMS most wishes to fill include clinical outcomes, patient-reported outcomes, care coordination, safety, appropriateness, efficiency, and patient experience and engagement.

Measures submitted for consideration will be assessed to ensure that they meet the needs of the Physician Quality Reporting Program. In addition, CMS encourages eligible providers to submit measures that do not have an adequate representation within the program for participation. When submitting measures for consideration, please ensure that your submission is not duplicative of another existing or proposed measure. Each measure submitted for consideration must include all required supporting documentation. Documentation requirements will be posted on the Measures Management System Call for Measures web page on or around May 1, 2013. Only those measures submitted in the provided format will be accepted for consideration.

Suggested measures must address the CMS measure selection core criteria to be considered for inclusion in the PQRS. Measure submissions omitting the required core criteria will be disqualified from consideration.

• Measure addresses an important condition/topic with a performance gap and has a strong scientific evidence base to demonstrate that the measure, when implemented, can lead to the desired outcomes and/or more appropriate costs (i.e., the National Quality Forum’s Importance criteria)
• Measure addresses one or more of the six NQS Priorities:
• Patient Safety
• Person and Caregiver-Centered Experience and Outcomes
• Communication and Care Coordination
• Effective Clinical Care
• Community/Population Health
• Efficiency and Cost Reduction
• Promotes alignment with specific program attributes and across CMS and HHS programs
• Program measure set includes consideration for health care disparities
• Measure reporting is feasible

This Call for Measures will run from May 1 through July 1, 2013. All required documentation must be completed for each measure submitted for consideration no later than 5pm ET July 1, 2013.

Note: Suggesting individual measures or measures for a new or existing measures group does not guarantee the measure(s) will be included in the proposed or final sets of measures of any Proposed or Final Rules that address the PQRS. CMS will determine which individual measures and measures group(s) to include in the proposed set of quality measures, and after a period of public comment, the agency will make the final determination with regard to the final set of quality measures for the PQRS.

Show Me Tort Reform

Pelopidas LLC and the Missouri State Medical Association (MSMA) teamed together to  launch www.ShowMeTortReform.com this week in an effort to fuel support for medical malpractice reform legislation. House Bill 112 and Senate Bill 105 would reinstate reasonable caps on non-economic damages in bodily injury claims, which were ruled unconstitutional this summer by the Missouri Supreme Court. There are two months left to send a bill to Governor Nixon and that success is largely dependent on physician engagement. Senators and Representatives are very responsive to constituent feedback, as ten calls or emails into a legislator’s office can put an issue at the top of their radar. By taking a few minutes to contact a few legislators, physicians can create a significant momentum shift in this debate and help prevent another medical malpractice crisis in Missouri.

Who You Can Contact & What You Can Say: Below are links that will give you contact information for your state Representative and Senator within a few seconds. We also recommend calling or emailing members of House and Senate leadership to express the importance of medical malpractice reform. When calling, you will likely speak to someone on their staff; however, it is not uncommon to get a call back from the legislator.  Whether talking to someone on their staff or the legislator, we recommend keeping your message simple and concise by urging their support for House Bill 112 or Senate Bill 105 and covering a few key points, such as:

1)      Access to Care: Passing tort reform will help attract and retain physicians. Missouri added over 1,000 new doctors from 2005-2012 when there were caps on non-economic damages. ;

2)      Lower Costs: Caps on non-economic damages lower the number of frivolous lawsuits, which has a direct impact on premiums, cost of defensive medicine, and money spent toward patient care instead of the classroom. The cost of defending lawsuits dropped from $81 million in 2005 to $30 million in 2011.

3)      Fair System for Patients: The numbers of lawsuits against doctors decreased by 49% after caps were installed in 2005, hitting a historic low the first year they were in effect. By lowering the number of lawsuits and unclogging the legal system, it is easier to identify patients who deserve attention and fair compensation.

Find more information on www.ShowMeTortReform.com

Calling All Metro Med Photographers!

Have you wanted to see your work as a cover shot? Well, here’s your chance. Metro Med’s Communication Committee is running a photo contest open to all members. We will select 3 winning shots for the cover of The Greater Kansas City Medical Bulletin. All submissions will be available to view online, at metromedkc.org.

CLICK HERE to download the official entry form. Deadline is June 15th!

Show Me Tort Reform

A new website, www.ShowMeTortReform.com, has been launched in a statewide effort to fuel support for medical malpractice reform legislation. Missouri House Bill 112 and Senate Bill 105 would reinstate reasonable caps on non-economic damages in bodily injury claims, which were ruled unconstitutional this summer by the Missouri Supreme Court.

There are two months left to send a bill to Governor Nixon and that success is largely dependent on physician involvement.

Who You Can Contact & What You Can Say: Below are links that will give you contact information for your state Representative and Senator within a few seconds. We also recommend calling or emailing members of House and Senate leadership to express the importance of medical malpractice reform. When calling, you will likely speak to someone on their staff; however, it is not uncommon to get a call back from the legislator. Whether talking to someone on their staff or the legislator, we recommend keeping your message simple and concise by urging their support for House Bill 112 or Senate Bill 105 and covering a few key points, such as: engagement. Senators and Representatives are very responsive to constituent feedback, as ten calls or emails into a legislator’s office can put an issue at the top of their radar. By taking a few minutes to contact a few legislators, physicians can create a significant momentum shift in this debate and help prevent another medical malpractice crisis in Missouri.

1) Access to Care: Passing tort reform will help attract and retain physicians. Missouri added over 1,000 new doctors from 2005-2012 when there were caps on non-economic damages. ;

2) Lower Costs: Caps on non-economic damages lower the number of frivolous lawsuits, which has a direct impact on premiums, cost of defensive medicine, and money spent toward patient care instead of the classroom. The cost of defending lawsuits dropped from $81 million in 2005 to $30 million in 2011.

3) Fair System for Patients: The numbers of lawsuits against doctors decreased by 49% after caps were installed in 2005, hitting a historic low the first year they were in effect. By lowering the number of lawsuits and unclogging the legal system, it is easier to identify patients who deserve attention and fair compensation.

Find more information on www.ShowMeTortReform.com

Pelopidas LLC and the Missouri State Medical Association (MSMA) teamed together to  launch www.ShowMeTortReform.com this week in an effort to fuel support for medical malpractice reform legislation. House Bill 112 and Senate Bill 105 would reinstate reasonable caps on non-economic damages in bodily injury claims, which were ruled unconstitutional this summer by the Missouri Supreme Court. There are two months left to send a bill to Governor Nixon and that success is largely dependent on physician engagement. Senators and Representatives are very responsive to constituent feedback, as ten calls or emails into a legislator’s office can put an issue at the top of their radar. By taking a few minutes to contact a few legislators, physicians can create a significant momentum shift in this debate and help prevent another medical malpractice crisis in Missouri.

Who You Can Contact & What You Can Say: Below are links that will give you contact information for your state Representative and Senator within a few seconds. We also recommend calling or emailing members of House and Senate leadership to express the importance of medical malpractice reform. When calling, you will likely speak to someone on their staff; however, it is not uncommon to get a call back from the legislator.  Whether talking to someone on their staff or the legislator, we recommend keeping your message simple and concise by urging their support for House Bill 112 or Senate Bill 105 and covering a few key points, such as:

1)      Access to Care: Passing tort reform will help attract and retain physicians. Missouri added over 1,000 new doctors from 2005-2012 when there were caps on non-economic damages. ;

2)      Lower Costs: Caps on non-economic damages lower the number of frivolous lawsuits, which has a direct impact on premiums, cost of defensive medicine, and money spent toward patient care instead of the classroom. The cost of defending lawsuits dropped from $81 million in 2005 to $30 million in 2011.

3)      Fair System for Patients: The numbers of lawsuits against doctors decreased by 49% after caps were installed in 2005, hitting a historic low the first year they were in effect. By lowering the number of lawsuits and unclogging the legal system, it is easier to identify patients who deserve attention and fair compensation.

Find more information on www.ShowMeTortReform.com

Calling All Metro Med Photographers!

Have you wanted to see your work as a cover shot? Well, here’s your chance. Metro Med’s Communication Committee is running a photo contest open to all members. We will select 3 winning shots for the cover of The Greater Kansas City Medical Bulletin. All submissions will be available to view online, at metromedkc.org.

CLICK HERE to download the official entry form. Deadline is June 15th!

A coalition of stakeholders including physicians, hospitals, dentists, nurses and others met with the Governor and his staff on January 18^th. Dr. McCandless was able to attend. Linda Lubbering, who heads the Missouri State Budget Office, discussed the impact on the general revenue of the state. The analysis included the direct impact of increased tax revenues (insurance companies would no longer fund the high risk pools and get a tax credit), reduced costs for the medical care in the correctional system and the reduced costs of mental health care because these would be shifted to the higher matched federal reimbursement. This is estimated over 7 years to have a net benefit to the Missouri State General Revenue of +$586.9 million. If Missouri would chose to participate in the modified Medicaid program, the state would pay 0% of the costs for the first 3 years and then gradually increase to 10% by 2020. The state could opt out of the expansion at any time without penalty. University of Missouri estimates that there will be a direct infusion of $8.2 Billion and an economic stimulus effect of an additional $9.6 Billion.

CLICK HERE for Ms. Lubbering’s slides.

HERE is the University of Missouri Study.

Jimmer Miller, MD recently returned from a tour in Afghanistan. Dr. Miller is a General with the Missouri National Guard and spent time working with the medical team.

John Stanley, MD and Jimmer Miller, MD with the Jackson County Medical Society Roll of Honor.

After the January Metro Med Board Meeting, Dr. Miller stood with John Stanley, MD near the society’s newest historical acquisition. Metro Med is in now in  possession of a “roll of honor” board. This display was once part of Truman Medical Centers and lists the members of the Jackson County Medical Society who served the nation during World War II.

Jeffrey B. Kramer, MD, 2012 Metro Med President

During my Presidency, I have had the great opportunity of meeting with many of you.   One topic of almost universal concern is the encroachment of technology into our world – the advent of electronic medical records (EMR) – and all that it means to the practice of medicine.  I will admit that the unease is expressed to a great extent by physicians of my generation – the 50 and over crowd – but, in fairness, the concern is not solely confined to the tech-challenged members of the medical community.

Are electronic records a boon to medical practice or a hindrance?  Our opinion on that question is almost beside the point.  As part of the American Recovery and Reinvestment Act signed by President Obama in 2009, Medicare and Medicaid payments to physicians will become increasingly linked to the introduction of “meaningful use” aspects of EMR integrated into our practices.  The purposes are noble – to eliminate errors in prescribing of medications, to facilitate communications between providers, and to track “quality” which is an essential part of the value that should be inherent in medical care delivery.  Unfortunately, the systems we are using to implement this panacea for the ills of medical care delivery have been found not to be terribly user-friendly.  That sentiment seems to be independent of which proprietary EMR system is being utilized.

Traditionally, the medical record has been a tool physicians have used to communicate to each other and to ourselves.   Albeit grossly imperfect, paper charting sufficed in an era much less complex than the one in which we currently live.  Relatively simple EMR systems developed 15-20 years ago were functional, required a minimum of user skill and time, and served to make the practice more efficient – housing records in easy-to-access programs that obviated the need for a paper medical records “department” and the attendant personnel costs.  The simplicity of these systems, however, has proven to be limiting especially when applied to hospital-based services, largely because “documentation” has become of paramount importance, rather than “communication.”

Those of us who practice with the current generation of EMR technology – an increasing percentage of active physicians – are painfully aware of the downsides of the more updated systems.  Because government reimbursement incentives are linked to providing evidence that we are doing what beaurocrats say we should be doing, the medical record has become filled with an abundance of clinically irrelevant data – making it a challenge finding useful information among the clutter.   Other examples of problems and difficulties with the EMR are legion.  For example, good ICU nursing now requires not only excellent clinical acumen, but also the ability to navigate a complicated EMR, documenting every conceivable aspect of patient care.  Attention to the medical record often detracts significantly from the time spent on actual patient care, both in the hospital and office settings.  “Specialists” among us are caught up providing data about vaccinations and completing the 12-point Review of Systems, rather than focusing on the patient’s prime reason for seeking our advice.  In terms of cost savings supposedly engendered by the EMR, how are we to factor in layers of scribes and mid-level providers who are necessary to populate and manage the EMR on our patients?

Why is this happening and what can we do?

To be fair, there are great potential advantages of an EMR, and such systems can clearly improve patient care by organizing a complex set of patient data.  There is a disconnect though between the designers of the current EMR and its users that has complicated the interface to the detriment of our primary goal: better patient care.  Once again, we physicians have let events get away from us; we have become fragmented and ill positioned to affect the products as they come on the scene – especially in the hospital setting where we have little control over the manner in which the EMR is implemented.  Somehow, we all together – physicians and administrators alike – must find a way to eliminate the intrusiveness of the EMR and make changes that actually facilitate communication and patient care.  Physicians have to be proactive in seeing this through and those actually in charge of the EMR project – administrators, developers, and the federal government – must appreciate that practicing physicians (and other healthcare users) understand far better than anyone what makes the EMR effective and useful.  As the current systems get refined and refined again, we need to be in the forefront so that the journey to a workable EMR is not too long and arduous.

Thanks to our friends at the MSMA for the bulk of this update.

No other issue is going to occupy more of our time than tort reform. And it’s all because four judges got together and invoked the 1820 Missouri constitution. Way back in July, the state Supreme Court issued a ruling in Watts v. Cox Medical Center that struck down the $350,000 cap on non-economic damages in medical malpractice cases. In Watts, the court overturned at least 25 years of precedent, including an earlier case which upheld the constitutionality of the caps. So, for the first time in years, we are facing unmitigated risk and complete instability in the malpractice market.

Conventional wisdom dictates that the only course of action for MSMA  is to push for an amendment to the state constitution. A couple resolutions to accomplish this have already been filed. While that would certainly settle the issue once and for all, it does have certain disadvantages. First, it would be just as difficult to pass as a statutory change, perhaps more so. Constitutional amendment campaigns can be, and usually are, very costly affairs, and our opposition would undoubtedly have very deep pockets. And there’s no guarantee the voters will approve the amendment. Once the people turn you down, it’s tough to get the legislators to re-consider an issue (see tobacco tax).
There is an alternative. Although the court struck down caps on medical negligence, earlier last year it upheld caps on wrongful death claims against physicians. The difference between the claims is that medical negligence is a part of Missouri’s common law, but wrongful death was created by the legislature. The court has determined that statutorily created causes of action – like wrongful death – can be amended (or even revoked) by the legislature.

Therefore, the legislature can cap damages if it wants. Whereas, in a common law cause of action they cannot. So, MSMA has a plan to remove medical negligence from the common law and create a statutory cause of action in its place. The legislature has done this type of thing before, most notably with worker’s compensation law, and the courts have routinely upheld it.

The bills to accomplish this goal have been introduced by Rep. Eric Burlison (HB 112), and Sen. Dan Brown (SB 105). As was the case back in the mid-00s, we expect premiums to rise to a level of total chaos and the practice environment to deteriorate, so please consider this a call to action. Please take the time to call your elected officials and urge them to support these bills. You can find their phone numbers and email addresses here.

Access your QRUR now!

The 2011 QRURs are now accessible through an internet portal, QRURinfo.com for physicians that are members of a medical group with at least 25 eligible professionals in nine states:  CA, IA, KS, IL, MI, MN, MO, NE, and WI. For these reports, a medical group is identified as a single Taxpayer Identification Number (TIN). The reports will be available for download by authorized personnel at each respective medical group until at least April 2013.

If you need assistance accessing your report from the QRUR portal, a Live Chat option will be available for you to speak with a representative between the hours of 10am-2pm CT.

Additional Details:

• Most resource use and quality information in the QRURs is displayed as relative comparisons of performance among similar physicians (i.e., a peer group)
• The Affordable Care Act also mandates that by 2015 CMS begin applying a Value-Based Payment Modifier (Value Modifier) under the Medicare Physician Fee Schedule. The 2011 QRURs preview some of the quality and cost data that could be used by CMS to calculate the Value Modifier.

Download Your Report and Let CMS Know What you Think

CMS wants to hear from physicians and their staff who have reviewed their 2011 report so that we may continue to improve and evolve the QRURs.

After reviewing your report, you can:

• Complete a brief questionnaire; and
• Attend a feedback teleconference scheduled for your region

Educational Resources:

More detailed information on the Physician Feedback Program, QRURs, and the Value Modifier can be found on the Medicare FFS Physician Feedback Program/Value-Based Payment Modifier website.

Specific information of interest includes the Value Modifier and QRURs for Individual Physicians Practicing in Groups. Also, CMS will host periodic QRUR and Value Modifier National Provider Calls to educate the provider community—stay tuned for details on upcoming events.

Members Art Fair Reception this Friday, September 21 in Metro Med’s second floor Plaza office. 315 Nichols Rd, Ste. 250. Join your colleagues from 5:30-8:30pm for:

Live Music
Drinks & hors d’oeuvres
Private restrooms
Spectacular bird’s eye view of art fair – start your evening here!
RSVP HERE! 
 

Metro Med 131st Annual Meeting – Wednesday, Oct 3

Metro Med President, Jeff Kramer personally invites you attend the Society’s 131st Annual Meeting – read more HERE.

Tickets are supplemented this year thanks to our generous sponsors – $25 a person for Metro Med members or their guest. Call 816.531.8432 to make your reservation.

Resident Event a Success

Thank you to the over 60 Residents and practicing physicians who joined us August 9th at Boulevard Brewing. John Gianino, MD, Metro Med President-Elect welcomed the attendees and Bank Of Kansas gave a brief overview of their programs for Residents and Physicians.  Pictured below are attendees on the deck overlooking Kansas City.