Congress Fails to Act to Halt Medicare Cuts - posted 3-1-10

Congress failed to resolve the Medicare sustainable growth rate (SGR) crisis during the two-month extension that prevented a 21% cut from taking effect on January 1.  On Thursday, February 25 the Senate convened for the long weekend and failed to repeal the Medicare physician payment formula prior to their recess.  This will result in a drastic 21 percent payment cut to physicians who care for Medicare and Tricare patients.  Your practice should be aware of the following:  1.  Physicians have until March 17 to change their Medicare "participating" or "non-participating" status.  2. Your practice does not have to take / accept any new Medicare patients at anytime - period.  3.  The TMA/AMA hopes that there will be a resolution to this problem by the week ending Friday, March 5.  What they suggest is for physicians to continue to see Medicare patients who are already cued in your scheduling, beginning on Monday, March 1 and throughout all of the week.  Once the Senate reconvenes on Tuesday, March 2 they should act on reinstating the cuts. 

CMS has instructed carriers to hold payments to physicians for 10 days beginning March 1 to give Congress a chance to get this resolved.  That means that the new conversion factor is not official in the sense that, if it changes within the 10 days, it will not be used as payments will be calculated retroactively.  In essence, do not feel obligated to change it yet in your program.

The TMA has a guidance document on Medicare participation options for Tennessee physicians to address important considerations for physicians when making their 2010 participation decision.  Your practice may obtain a copy of this 7-page document by contacting the Medical Society at 901-761-0200. 

As you know, the Office of the National Coordinator for Health Information released an “interim final rule regarding the EHR incentive.  The CMS proposed rule outlines the complex provision related to the requirements that professionals must be “meaningful users” of “certified EHRs beginning in 2011, those qualifying professionals are eligible for up to $44,000 in Medicare incentives or up to $63,750 in Medicare incentives.  The “initial final rule” details the qualifications.  However, the stages that are required in years 2012 up to 2015 when physicians are suppose to have EHR implemented are heavy in requirements and many existing EHR vendors will have difficulties overcoming the barriers to meaningful use.  The MGMA has spoken to both CMS and also the majority of EHR vendors.  As we work toward ‘meaningful use’ keep in mind:

(1) During a practice's due diligence go back and look to see if the vendor you may be looking at went through the certified qualifications and are currently CCHIT certified.  You can go to http://www.cchit.org/ for this information.

(2) The leadership of MGMA has spoken with the majority of EHR companies which have said they plan to be certified during each stage of meaningful use.  Unfortunately, some vendors do not have the research and development dollars that it costs for the stages of meaningful use leading up to 2015.  The recommendation is that it be included in the contract that the EHR vendor qualify at each stage.

(3) There was also discussion (even though vendors may push back) that there be a penalty clause if the EHR vendor does not meet meaningful use and that this financial penalty be the incentive amounts (i.e. $44,000 or $63,750).

TMA 175th Annual Meeting  and House of Delegates

Friday, April 9 - Sunday, April 11, 2010 - Nashville Marriott - Airport

Join physicians from across the state for a weekend packed with important TMA business, issue-oriented events, educational offerings, networking and great entertainment.  The headline events this year will include the Gubernatorial Candidates' Luncheon, featuring the major candidates for our state's highest office answering questions about health care in Tennessee; the first Women in Medicine Forum; and the Medicine Ball: Battle of the Bands, featuring TMA docs who rock! Even if you are not a participant in the House of Delegates, we encourage you to make plans to attend.  There is no registration fee, so take this time to get your required CME on prescribing, take SVMIC's seminar that qualifies you for a premium rebate, and get a closer look at what the TMA is doing to help make our state a great place to practice medicine!  To register and for hotel reservations, please go to http://www.tnmed.org/.