eNews July 17, 2015 – Physicians and “Freebies”

 Dr. Joseph R. Maldonado
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July 17, 2015
Volume 15, Number 27

Dear Colleagues:

This past week, Joe Queenan wrote a column in the Wall Street Journal entitled “Is There a Doctor in the House?”  Mr. Queenan suggests that physicians ought to behave like many other business owners who throw a patient/customer/client a “freebie” once in a while.  He proposes that procedures that an individual undergoes on a regular basis should form the basis for the occasional freebie.  Mr. Queenan initially rejects the notion that major surgical procedures, imaging studies and other infrequent procedures should not be the subject of the freebie but then gives as freebie examples—  nasal endoscopies, acupuncture and physical therapy.  Mr. Queenan’s column is perhaps part tongue-in-cheek humor, but it reflects quite accurately the ignorance of many Americans regarding how much free work physicians do. Perhaps the ignorance is predicated on how he has constructed his view of what constitutes a “freebie.”  This is suggested by a question he raises—“But when you see a physician several times a year, shouldn’t you feel entitled to a freebie every once in a while?”

Americans, both rich and poor, have developed a sense of entitlement.  Programs such as Medicare, Medicaid and now, the ACA, have promoted a sense of entitlement for many Americans regarding healthcare.  They are not just entitled to care.  They are entitled to FREE care.  What Mr. Queenan fails to recognize is that we DO provide free care.  We do so, consciously and unconsciously. After going the extra mile, we often fail to bill for a service.  We merely decided that providing the service was “doing the right thing” and we fail to bill the patient.  Sometimes we are aware of the personal cost to a patient for a co-pay or deductible and we simply fail to bill the service altogether for fear that forgiving the co-pay or deductible will lead to criminal and professional charges.

In my experience, doctors never brag or advertise that they’ve done a good deed.   They just do their mitzvahs— no need to announce it.  In doing so, they risk engendering ingratitude from folks with a sense of entitlement who then expect freebies at every visit rather than every fourth visit.  Most of the time, these “entitled” folks are unaware of the charity work or medical missions their doctors have taken in lieu of a vacation – at personal cost of family time, resources and compensation.

Should we highlight more of our own freebies to our “entitled” patients?  I don’t think so.  We didn’t give the freebie to garner their loyalty or adulation.  We gave them for altruistic reasons, knowing many would not appreciate them but feel they “earned” those freebies.  In fact, I would suggest that some may feel that they are doing us a favor by coming to us and allowing us to bill for the other services which should have been freebies, too.  When Mr. Queenan realized his dry cleaner never threw him a bone, he stopped taking his business to that cleaner, even though, in his own words, “they were consummate professionals.”  Most of us would still remain available to ungrateful and entitled patients.  Others, having provided innumerable silent freebies to countless patients would be happy to simply say to those who feel entitled to another freebie and opt to leave us for greener pastures elsewhere—   “Don’t let the door hit your backside on the way out.”

Mr. Queenan, may I open the door for you as you leave?

Joseph Maldonado, M.D, MSc, MBA, DipEBHC
MSSNY President
Please send your comments to comments@mssny.org



NYSIF Announces Launch of Online Medical Provider Portal
The New York State Insurance Fund recently announced the launch of its new online Medical Provider Portal at www.nysif.com. The new portal will allow registered providers and third party billers to retrieve claims payment information regarding their workers’ compensation patients.

Once a provider registers at nysif.com, he or she will be able to self-serve and obtain access to an explanation of benefits (EOB), bill payment status (with amount paid), claims covered on an issued check and claim-by-claim pricing and payment accounting.

To register for a medical provider user account, go to www.nysif.com and follow the instructions for registration. Providers will need a copy of their latest check from NYSIF to complete registration.  To safeguard the privileged information of both the medical provider and the claimant, obtaining EOB and bill payment information will now require a log-on before accessing that data.

If a provider uses a third-party billing company, the biller must also register for an account to obtain access to the provider’s information.  Once the vendor completes the registration, NYSIF will send the vendor a unique identifier code that they must share with the provider. Once a medical provider has designated the vendor as an approved third party biller, the biller will have online access to that provider’s medical bill payment information and explanation of benefits. Please note only the medical provider can approve access to the portal for the third party billing company.

Please take a moment to visit nysif.com today and register! 

Fed Up with EHRs? Share Concerns during AMA Town Hall Meeting
This Monday night, July 20, from 7 to 8:30 p.m., the AMA, in conjunction with the Medical Association of Georgia, will be hosting a special town hall meeting in Atlanta to discuss concerns with electronic health record systems (EHRs). The event will be live-streamed so physicians can participate at home and via Twitter with #FixEHR.

Among the national and local leaders who will be a part of the conversation will be Rep. Tom Price, MD, a Republican from Georgia’s 6th District, and AMA President Steven J. Stack, MD.

According to the AMA, physician participation in Stage 2 of meaningful use is less than 10 percent, even though 80 percent of physicians have adopted EHRs. Moving forward with Stage 3 could mean less time with patients, hindrances to practice innovation and costly penalties. Many physicians have complained that government requirements have affected EHR technology so it does not productively synch with physician workflow, such as interfering with face-to-face discussions with patients, requiring physicians to spend too much time performing clerical work and creating new costs that divert resources away from patient care improvements. Meanwhile, the much anticipated benefits of being able to share important patient health care information electronically among providers in different settings have gone unfulfilled.

CCNY Medical School to Welcome First Class in 2016
The City College of New York announced the establishment of the CUNY School of Medicine at City College in partnership with Bronx-based St. Barnabas Hospital, which is part of the SBH Health System. The new Harlem-based medical school, whose first class is scheduled to begin fall 2016, will be an expansion of City College’s Sophie Davis School of Biomedical Education. Established in 1973 on the City College campus, the Sophie Davis School currently offers a unique seven-year BS/MD program that integrates an undergraduate education with the first two years of medical school.

The new medical school on the City College campus builds on the strong record of achievement of the Sophie Davis School of Biomedical Education, whose mission is recruiting underrepresented minorities into medicine, increasing medical care in historically underserved communities and boosting the number of primary care physicians.

City College President Lisa S. Coico said the newly established school would nurture young students to embrace a career focused on caring for their fellow citizens with passion, empathy and respect. “The need for more physicians in many communities in our city, particularly in the communities surrounding City College, remains dire,” she said. “By establishing this resource, City College is both helping to address this critical need and fulfilling a vital community service.” 

CMS Releases Proposed Medicare Payment Rule for 2016
CMS recently released its proposed Medicare Part B payment rule for 2016.  To read the CMS press release highlighting some of most notable aspects of the proposal, click here.  The proposal begins to implement aspects of the Merit-Based Incentive Payment System (MIPS) enacted as part of the SGR repeal legislation as well as making changes to several of the quality reporting initiatives that will in 2019 be consolidated into the MIPS program, including the Physician Quality Reporting System (PQRS), the Physician Value-Based Payment Modifier (Value Modifier), and the Meaningful Use Program.   The SGR repeal proposal also provided for a 0.5% increase in the conversion factor July 1, as well as another 0.5% increase on January 1, 2016.

Among the issues items brought up in the proposal:

  • Establish Medicare fees for two advance care planning services provided to Medicare beneficiaries by physicians and other practitioners. (as referenced in last week’s MSSNY’s e-news);
  • Bringing up to 300 the number of measure reportable under the PQRS program. If an individual practitioner or group practice does not satisfactorily on PQRS quality measures, a 2% negative payment adjustment would apply in 2018;
  • Proposing a methodology to impose a 0.25% reduction in Medicare spending due to reductions in certain misvalued codes, as required by provisions incorporated in prior year’s legislation (the “ABLE” Act enacted in 2014).  CMS noted that it could make further misvalued code changes in the final rule to move closer to the statutory goal of 1% based on public comment.
  • With regard to 2018 Value-Based Modifier payments (which will be based upon 2016 performance), to set the maximum upward adjustment of +4.0 times the adjustment factor (to be determined after the conclusion of the performance period), for groups with ten or more EPs; +2.0 times the adjustment factor, for groups with less than 10 EPs;  as well as to set the potential penalty in 2018 to -4% for groups with ten or more EPs, and -2% for groups with less than 10 EPs.
  • Updating self-referral limitation provisions to establish a new exception to permit payment to physicians for the purpose of employing non-physician practitioners.

MSSNY will be working with the AMA and the federation of medicine to review the rule and to make comments on key components.  Here is a link to the entire 2016 proposed Medicare payment rule.

Telemedicine Companies Popping Up in New York
Pager — a New York-based service that’s looking to revive the practice of house calls by doctors — just raised $14 million in a funding round co-led by Aston Kutcher’s firm Sound Ventures, valuing the company at around $75 million. “Telemedicine” services, in which doctors diagnose and treat patients on the phone and online, have been multiplying lately—like Doctor On Demand, Teladoc, MDLive and HealthTap.

But Pager has spent the past year building a network of physicians and nurses in New York City who, in addition to telemedicine services, can visit your home to treat everything from minor injuries to the flu.

Rates are $25 for telemedicine and $50 for an initial doctor’s visit. Subsequent visits are $200 and reimbursable as out-of-network by some plans. Pager expects to be in-network with several major insurers later this year.  

CMS Proposes Part A/Part B Medicare Bundle for Lower Joint Replacement
CMS has proposed to implement a new Medicare Part A and B virtual bundled payment model –  the “Comprehensive Care for Joint Replacement (CCJR)” model – under which acute care hospitals in certain selected geographic areas will receive retrospective reward payments or face financial liability relating to episodes of care for lower extremity joint replacement (LEJR) or reattachment of a lower extremity.   The initiative is designed to test “whether bundled payments to acute care hospitals for LEJR episodes of care will reduce Medicare expenditures while preserving or enhancing the quality of care for Medicare beneficiaries.”

Under the proposal, the program would be implemented in 75 MSAs across the country, including the New York City and Buffalo areas.  There would be a 5 year performance period, beginning January 1, 2016, and ending December 31, 2020.

Under the model, an episode of care would begin upon admission to a hospital for an LEJR procedure and would end 90 days after the date of discharge.  The episode would include the LEJR procedure, inpatient stay, and all related care covered under Medicare Parts A and B within the 90 days after discharge, including hospital care, post-acute care, and physician services.  While spending under Part A and Part B would continue to be made on a fee for service basis, the acute care hospital that is the site of surgery would be held accountable for spending during the episode of care.  Depending on the hospital’s quality and cost performance during the episode, the hospital would either earn a financial reward or be required to repay Medicare for a portion of the costs.  Penalties would not be imposed the first year of the program, and be phased in beginning Year 2.

According to a CMS webinar describing this proposal this week, only the acute care hospitals where the surgery is performed would be ultimately liable for making repayment in certain circumstances where spending exceeds a certain threshold.  However, of significant concern, the hospital could require others who provide care within this “virtual bundle” to be responsible for up to 50% of full the repayment amount, including up to 25% for any one “collaborator”.

CMS states that this payment structure is designed to “give hospitals an incentive to work with physicians, home health agencies, and nursing facilities” to reduce avoidable hospitalizations and complications.  CMS also states that participants would gain access to data and educational resources to better understand post-acute care and associated spending.”

MSSNY will be working with effected specialty societies and the AMA to respond to this proposal.  Comments are due by September 8.  For more comprehensive information from CMS regarding this proposal, click here.

Is Your Infection Control Certification Up-to-Date?
New York State law requires that all health care providers—including physicians, medical residents and medical students—receive training on infection control and barrier precautions every four years upon renewal of their license.  The Medical Society of the State of New York is approved by the New York State Department of Health to provide Infection Control and Barrier Precautions to all healthcare professionals.  Additionally, MSSNY is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

Measures to prevent the transmission of disease in health care settings have evolved over the years and, as such, this state-mandated course, with six elements total, includes the most updated information from the New York Department of Health.  The cost of the course is $50, payable online by credit card.  Upon successful completion of the course work, you will be able to print out your Infection Control Certificate of Completion.  Click here to take the course.

Analysis: ACA Plan Networks Offer Fewer Physicians
Health plans sold through the Affordable Care Act’s exchanges offered consumers access to 34% fewer health care providers than employer-based coverage, according to a new Avalere Health report. Avalere examined the largest rating region in the top five states by 2015 exchange effectuated enrollment: Florida, California, Texas, Georgia, and North Carolina. Compared with employer-sponsored coverage, exchange plans on average had networks with 42% fewer cancer and cardiac specialists, 32% fewer mental health and primary care physicians and 24% fewer hospitals. The study noted that the narrow networks can keep premiums low but often leave consumers with higher out-of-pocket costs. (The Hill)

PV-PQRS Users: Set up Your EIDM Account
CMS transitioned Individuals Authorized Access to CMS Computer Services (IACS) accounts to the Enterprise Identity Management System (EIDM). As of July 13, 2015, an IACS account can no longer be used to access a group or solo practitioner’s Quality and Resource Use Reports (QRURs); instead, an EIDM account will be required to access QRURs at https://portal.cms.gov. Below please find the action you should take as soon as possible in order to set up your EIDM account:

  • If you do not have an IACS or EIDM account, then follow the instructions provided here to sign up for an EIDM account with the correct role.
  • If you have an IACS account that you previously used to access QRURs, then follow the instructions provided here to sign up for an EIDM account. You will be allowed to perform the same tasks using your EIDM account that you were able to perform with your IACS account.
  • If you already have an EIDM account, then follow the instructions provided here to sign up for the correct role in EIDM.

For questions about setting up an EIDM account, please contact the QualityNet Help Desk at:

  • Monday – Friday: 8:00 am – 8:00 pm EST
  • Phone: 1 (866) 288-8912 (TTY 1-877-715-6222)
  • Fax: (888) 329-7377
  • Email: qnetsupport@hcqis.org

Additional information on accessing QRURs is available on the CMS website.



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