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Earlier this week the Legislature held its monthly interim meetings, where they began in earnest their studies of various issues of interest. The WVSMA government relations team will be following and reporting on the work of the committees covering issues related to healthcare over the Summer and Fall months.
Click Here for a list of all the Legislative Interim committees and their topic assignments.
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On May 6 the WVSMA's newly formed Committee on Healthcare Reform met for the first time at the WVSMA office in Charleston. The committee was established by President Austin Wallace, MD to develop internally within the physician community healthcare reform solutions and to be a sounding board for proposals offered by other interests. The committee participated in a presentation prepared by Dan Hager, a Marshall University student interning with WVSMA throughout the summer, which provided an overview of current reform efforts nationwide, the effectiveness of recent West Virginia reform initiatives, and an evaluation of the state's healthcare reform climate.
The committee has plans to issue a survey to measure physician opinions regarding healthcare reform. Committee members were selected to represent a variety of specialties and geographic locations across the state, each offering a unique perspective concerning the issues facing West Virginian's healthcare system. |
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On Sunday, May 18 physician leaders from the WVSMA and the WV American Academy of Family Physicians sat down with the chairs of the Senate and House Health Committees, Senator Roman Prezioso and Delegate Don Perdue, and the consultant the Legislature has hired to design a healthcare reform package for West Virginia, Mr. Ken Thorpe, PhD. Mr. Thorpe is a professor at Emory University and is known for his work with the state of Vermont which recently passed a healthcare reform package. Mr. Thorpe is also currently working on efforts in California and New Jersey among other states.
Thorpe's plans for West Virginia are to create a "state-of-the-art health care delivery system for prevention and management of chronic disease". He states that he is not bringing an "off the shelf" package, but will steer the process so that the solutions are home grown and West Virginia specific.
Thorpe has established four working committees that are currently being populated. Volunteers are being solicited to serve on these four committees which will meet over the coming months utilizing in person meetings, conference calls and web based communications. The understood goal is to have some portion of the reform solution proposed in time for the 2009 Legislative Session which will begin in February 2009. The following are the committees:
1) Wellness and Prevention-Chair: Kerri Kennedy (DHHR, Office of Healthy Lifestyles)
Committee focus: Obesity prevention and lifestyle change in the workplace, the schools and the community
2) Health Care Redesign-Chair: Tom Susman (The Susman Group)
Committee focus: Health system redesign and payment reforms--how to build and sustain integrated delivery models for treating chronic disease in the state
3) Administrative Simplification- Chair: Carl Callison (Mountain State Blue Cross/Blue Shield)
Committee focus: Administrative simplification--credentialing, coding, reporting
4) Health Information Technology-Chair: To be Determined
Committee focus: Information systems and electronic health records
It is imperative that the physician community be part of this process.
The WVSMA is encouraging any physician or medical office staff interested in participating in this process to do so. You may reply to this message to Amy Tolliver or call the WVSMA office of more information 925-0342 ext 25. |
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The two Legislative Health Committee Chairs, Senator Roman Prezioso and Delegate Don Perdue held a joint press conference Monday, May 19 announcing a new collaboration of diverse organizations focused on increasing the public's interest in healthcare reform. This collaboration, "West Virginians' Campaign for a Healthy Future" has been organized by the AARP, PhARMA and labor groups to go hand in hand with the effort just underway by the Legislature to study the possibilities around full system healthcare reform. Last winter the Legislature contracted with Ken Thorpe, PhD from Emory University, to design a plan to re-vamp West Virginia's healthcare system. (For more on Thorpe's efforts, read article above WVSMA Leaders meet with Legislative Healthcare Reform Consultant)
The Campaign has adopted the following standards for Health Care Reform and is seeking organizations to sign on to their mission:
1) All WV must have access to high quality health care coverage, without discrimination or exclusions based on income, medical conditions, employment status, gender, age, geography or other factors.
2) Health care and coverage must be comprehensive and continuous, assuring that the medical and behavioral care needs of all WV are met throughout all stages of life, from birth to death.
3) Comprehensive health care and coverage must be affordable to all purchasers: individuals, families, businesses and government.
4) Wellness, preventive care, chronic disease management, and evidence-based best practices should become foundations of WV' health care system.
5) Financing of WV's health care must be a responsibility shared on a sustainable basis by individuals, businesses, and government.
6) The rising cost of WV health care and coverage must be effectively contained.
7) The quality of health care must be continuously improved.
8) Health care reform in WV shall not undermine existing levels of quality or coverage of care for anyone.
To read more about the Campaign or for your organization to sign on to the goals, visit their website: www.wvhealthyfuture.com. |
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Dr. Joseph Scotti reported to a Legislative Interim Committee this week that one-third of the veterans in WV have post-traumatic stress disorder (PTSD). Because this was an anonymous research project-- that might account for the fact that nationally, 22 percent of the veterans report PTSD symptoms. The report also said vets are not using the community mental health centers and that the veterans system does not have adequate resources for these folks either. Scotti said "while there is no cure, the biggest cure is a good job". The committee also learned the State Veteran group is to receive a $250,000 grant to fund social workers for the veterans' hospital and centers. |
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The State of West Virginia paid a whopping $407 Million for pharmaceuticals in fiscal year 2007 according to Shana Phares, West Virginia Pharmaceutical Advocate. Phares reported this news to members of the Joint Committee on Government and Finance on Tuesday, May 19. This figure is the total of the combined purchase of drugs for PEIA, Medicaid, CHIP, Bureau for Public Health, Corrections and the Regional Jail Authority.
Click Here to read the Charleston Gazette article on this topic. |
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The West Virginia Board of Examiners for Registered Professional Nurses has filed proposed changes to the "Limited Prescriptive Authority Rule for Nurses in Advanced Practice" (Title 19, Series 8). The Board held two stakeholder meetings over the past 6 months to receive advanced input on the rule as they were drafting the changes. The WVSMA and Board of Medicine were among the invited participants to this process. Of particular interest and concern to the physician representatives are changes that are being proposed to the expansion of prescriptive authority of controlled substances. Laura Rhodes, Executive Director of the Board issued a statement saying "After consideration of the needs of the public as well as the input from all groups, the Board is moving forward with some proposed changes". Written comments will be accepted by the Board throughout the Comment Period which will end on July 10, 2008 at 4:00 P.M.
Click Here for a copy of the proposed rule.
The WVSMA is interested in the response from our members on this rule. Please respond to Amy Tolliver by replying to this email to share your thoughts both positive and negative. |
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The WV Board of Medicine filed three proposed rules this week and is seeking input from interested stakeholders. The three rules were approved for filing by the full Board at their meeting on May 12. The following are summaries of each rule.
Definition of Surgery (Title 11, Series 10)
The rule aims to define "surgery" and thus limit those who can perform certain procedures. Of particular interest to the board is to attempt to limit those who can perform laser treatment including laser hair removal.
At the Board if Medicine's Board meeting where this rule was approved Deborah Rodecker stated that she believed this rule will garner much attention and response. The Board members discussed that they are throwing this out for public comment and expect to modify it based upon the input they receive.
Establishment and Regulation of Restricted License issued to an Applicant in Extraordinary Circumstances (Title 11, Series 2)
This rule was drafted per a modification made in Senate Bill 317 which passed this Legislative Session. This bill updated the licensure requirements for physicians licensed under the Board of Medicine. The bill included a provision to allow the Board to issue a restricted license to foreign medical graduates who don't meet all the criteria for licensure but who have "exceptional education or training and practice credentials" that are substantially equivalent to the requirements of licensure.
The rule that has been drafted is very tightly defined and as stated by Board President John Wade, MD is aimed at only the "truly extraordinary physician".
Licensure, Disciplinary and Complaint Procedures, Continuing Education, Physician Assistants (Title 11, Series 1B)
This rule has been drafted pursuant to the modification made in the law with the recent passage of House Bill 4144. The bill updated the requirements for physician assistant licensure and clarified that an applicant for a PA license may practice under a temporary license until the applicant successfully passes the National Commission on Certification of Physician Assistants' certifying examination. Additionally it clarified that a supervising physician of a PA must have a full unrestricted license.
The modified rule aims to implement these changes and includes some other changes including additional criteria for disciplinary actions against PA's and their scope of practice.
The WVSMA is interested in hearing from physicians on all three of these rules. Please contact Amy Tolliver by replying to this message with your comments. Additionally, comments may be made directly to the Board of Medicine through the close of the comment period on Friday, June 27.
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As part of the long-term effort of the American Medical Association's (AMA) Private Sector Advocacy unit to prevent health insurers from merging into monopsonies, the AMA joined with the Nevada State Medical Society and the Clark County (Nevada) Medical Society on Thursday to urge the Department of Justice (DOJ) to withdraw from its proposed settlement with UnitedHealthcare and Sierra Healthcare. Unless abandoned by DOJ or rejected by the federal district court in Washington, DC, as "not in the public interest," the settlement would allow the two firms to merge and to control 56 percent of the commercial insurance market for the purchase of physician services in the Las Vegas area.
The medical society filing, supported by the Litigation Center of the AMA and the state medical associations, assembles the scholarship on medical insurer monopsony and features an affidavit from Northwestern's David Dranove, PhD. This is one of the most comprehensive statements to date as to why antitrust enforcers should protect physician markets from the exercise of medical insurer monopsony power.
One source of harm emphasized by the medical associations and supported by Professor Dranove is that the combined firm will push physician fees below levels that would prevail in a competitive market. Physicians who receive lower fees will be forced to do more with less, and consumers will not receive the level of service and quality associated with a competitive market. Moreover, because the merged entity also has market power in the sale of insurance, the lower physician prices do not lead to lower patient insurance premiums.
The DOJ's proposed settlement should also be rejected because, in this instance, the DOJ has arbitrarily departed from its past antitrust enforcement practice. Formerly, the DOJ has blocked mergers that are substantially similar to the United/Sierra merger in order to resolve concerns about the potential exercise of monopsony power in physician markets.
The DOJ is expected to respond within 30-60 days. That response will be in a filing with the federal district court in Washington, DC. The court may not finalize any antitrust settlements without determining that it is in the "public interest." |
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It's May 22nd - Are you Ready?
As of May 23, Medicare FFS will require and send NPI (National Practitioner Identifier)-Only in ALL provider identifier fields for all HIPAA and paper transactions where a provider identifier is required. If you send Medicare a transaction with a Medicare legacy identifier in any of the provider fields, your claim will be rejected. These transactions include all electronic and paper claims (837I, 837P, NCPDP, DDE and paper CMS-1500 and UB-04), the 276/277 claims status transaction, the 270/271 eligibility transaction, 835 remittance advice and SPR paper remittance.
NPIs for Secondary Providers
If the entity that is required to be identified in the secondary provider field (i.e., the ordering/referring/attending/operating/supervising/purchased service/other/service facility provider or prescriber) does not furnish an NPI, the billing provider must attempt to obtain that NPI in order to enter it on the claim. The billing provider may use the NPI Registry (https://nppes.cms.hhs.gov/NPPES/NPIRegistryHome.do) to obtain the secondary provider's NPI or it may need to directly contact the ordering/referring/attending/operating/supervising/purchased service/other/service facility or prescriber in order to obtain the NPI.
If the billing provider has exhausted all possibilities of finding the NPI of the ordering/ referring/ attending/ operating/ supervising/ purchased service/ other or prescriber, Medicare FFS is permitting the billing provider (in the X12N 837 transactions) or the service provider (in the NCPDP 5.1 transaction) to use their own NPI as the identifier for those secondary providers. Medicare will reject claims if Medicare policy requires a secondary identifier and there is no NPI present.
For service facility location loop, if the billing provider is still unable to obtain the NPI of the entity, no identifier should be reported in that loop.
Transcript for April 17th NPI Roundtable Now Available
View the transcript at http://www.cms.hhs.gov/NationalProvIdentStand/Downloads/Transcript_for_April_17th_NPI_Roundtable.pdf on the CMS website.
Need More Information?
Still not sure what an NPI is and how you can get it, share it and use it? As always, more information and education on the NPI can be found through the CMS NPI page www.cms.hhs.gov/NationalProvIdentStand on the CMS website. Providers can apply for an NPI online at https://nppes.cms.hhs.gov or can call the NPI enumerator to request a paper application at 1-800-465-3203. Having trouble viewing any of the URLs in this message? If so, try to cut and paste any URL in this message into your web browser to view the intended information.
Note: All current and past CMS NPI communications are available by clicking "CMS Communications" in the left column of the www.cms.hhs.gov/NationalProvIdentSt and CMS webpage. |
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May 22, 2008
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