| |
|
|
| |
The WVSMA’s recent “Evening With the RAC” conference was a tremendously successful program. The large crowd at the conference was indicative of the interest in obtaining the most accurate and up to date information about the RAC.
The program began with a presentation by CMS officials, who explained the RAC program mission and the legislation supporting the RAC.
Following the CMS presentation, Medical Director Dr. James Lee and Healthcare Principal Christine Castelli from Connolly Consulting (the RAC for Region C which includes West Virginia), spoke to the group. They presented detailed information regarding Connolly Consulting, including information about the company’s mission and review processes.
Attendees, both physicians and staff, then were able to address both CMS and Connolly with their questions and concerns regarding the RAC. The presenters stayed until every question was answered.
Connolly Consulting and the WVSMA are partnering to ensure that our physicians receive any new information about the RAC in an expeditious manner. We will keep you informed and updated on changes or additions to the RAC program.
For more information about the RAC, please visit the CMS and Connolly websites,
www.cms.hhs.gov/RAC and www.connollyhealthcare.com/RAC.
|
|
|
Top
|
| |
|
|
| |
On July 1, 2009, CMS released the 2010 Medicare physician payment schedule proposed rule, including an announcement that the Obama Administration will change the definition of physician services under the SGR to exclude physician-administered drugs. The drug costs will be removed retroactive to the 1996/97 base year of the SGR formula, which will greatly lessen the forecast SGR cuts in future years, although there is still a 21.5% cut scheduled for 2010. This action will substantially reduce the legislative cost of congressional proposals to reform physician payments making a permanent solution to SGR disaster much more feasible.
CMS has also utilized data that it purchased from a new practice expense survey sponsored by the AMA and 72 specialty societies, as well as other health care professional organizations, in order to revise the practice expense relative values.
In addition to the new practice expense data, these impacts reflect a CMS proposal to eliminate Medicare coverage for consultations and redistribute the relative values to visits, as well as changes in the methodology for professional liability insurance relative values. Other changes in the rule include revisions to the e-prescribing incentive program intended to simplify reporting requirements, and addition of measures and more measures groups for the Physician Quality Reporting Initiative (PQRI).
The rule proposes to eliminate Medicare payment for consultations and use the money from these services to increase payments for visits. CMS states that the impacts of this change should be fairly minimal since the combination of the new practice expense data, the updated PLI values, and the redistribution of the consult values means that visit payments will be pretty close to what consult payments have been in the past.
Another proposal to the rule is a pretty significant increase in the relative value for the Welcome to Medicare visit, with the work value going from 1.34 up to 2.30. GPCIs are not updated this year and changes are not proposed to locality configurations, but they do discuss the comments they received on the locality report they issued last fall.
There are some positive changes proposed for the e-prescribing incentive program. CMS seems to recognize that it is administratively burdensome for physicians to have to report one of three codes on 50% of their office visit claims in order to prove that they are e-prescribing. Instead, in 2010, there will only be one code instead of three, and physicians will only have to report it 25 times. In addition, eligible services will be expanded to include home and nursing home visits, and there will be a reporting option for group practices.
The proposed rule is available online at: http://www.federalregister.gov/inspection.aspx#special. Comments on the rule will be accepted until August 31, 2009.
|
|
|
Top
|
| |
|
|
| |
This information has been provided for Centers for Disease Control and Prevention.
Antiviral Guidance for Suspected, Probable, or Confirmed Novel H1N1 Influenza
The Centers for Disease Control and Prevention would like to emphasize that it is very important to get the word out to clinicians, particularly those in primary care (including internists, pediatricians, family practitioners, OB-GYN physicians) and hospital-based clinicians (emergency physicians, hospitalists, intensivists) to emphasize early, empiric antiviral treatment for hospitalized patients and high-risk outpatients with suspected, probable, or confirmed novel swine-origin influenza A (H1N1) virus infection.
Preliminary information indicates that some hospitalized patients with novel influenza A (H1N1) virus infection have not been treated with antivirals or that treatment with antiviral agents was delayed until confirmatory testing was completed. In particular, some patients with chest x-ray evidence of pneumonia and influenza symptoms have not received antivirals early. While data from seasonal influenza indicates that early antiviral treatment is most effective (within 48 hours of symptom onset), some studies have reported a benefit in treating hospitalized patients. Therefore, initiating therapy at the earliest possible time is desirable, including at hospital admission, if patients were not previously treated.
Clinicians should be aware that influenza virus infection can cause primary viral pneumonia and early treatment of people with influenza-related pneumonia is desirable. Additionally, empiric treatment with influenza antiviral medications does not preclude empiric treatment for bacterial co-infections. Specific influenza testing should be performed for any hospitalized patient with suspected novel influenza A (H1N1) virus infection.
The CDC Antiviral recommendations are available at http://www.cdc.gov/h1n1flu/recommendations.htm. The CDC Testing recommendations are available at: http://www.cdc.gov/h1n1flu/specimencollection.htm.
Accordingly, the CDC would like to emphasize antiviral treatment for the following:
1. All hospitalized patients with suspected, probable, or confirmed novel influenza A (H1N1) virus infection should be empirically treated with oseltamivir or zanamivir as early after illness onset as possible. No comparative studies have been done to assess whether higher doses or longer treatment courses might be more effective for severely ill patients. However, a longer duration of treatment should be considered for severe illness that persists at the end of the usual 5 day course. Some experts also recommend higher treatment doses (e.g., 150 mg oseltamivir twice per day), based on concerns about the potential for lower oseltamivir absorption, higher viral loads, and reduced delivery of oseltamivir to damaged tissue among severely ill patients.
Patients who have received higher treatment doses or longer treatment durations have tolerated these regimens without substantial increase in adverse events, based on limited data.
2. All outpatients with suspected novel influenza A (H1N1) virus infection who are at higher risk for influenza complications should be empirically treated with oseltamivir or zanamivir as early after illness onset as possible.
3. Groups with a higher risk for influenza complications:
o Children younger than 5 years old. The risk for severe complications from seasonal influenza is highest among children younger than 2 years old.
o Adults 65 years of age and older.
o Persons with the following conditions:
- Chronic pulmonary (including asthma), cardiovascular (except hypertension), renal, hepatic, hematological (including sickle cell disease), neurologic, neuromuscular, or metabolic disorders (including diabetes mellitus);
- Immunosuppression, including that caused by medications or by HIV;
- Pregnant women;
- Persons younger than 19 years of age who are receiving long-term aspirin therapy,
- Residents of nursing homes and other chronic-care facilities.
|
|
|
Top
|
| |
|
|
| |
The following information is provided by the office of Bureau for Medical Services Commissioner Marsha Morris.
Due to the appearance of the H1N1 virus in West Virginia, the Bureau for Medical Services has received inquires as to the Medicaid policy on coverage of oseltamivir (Tamiflu) and zanamivir (Relenza), two influenza treatment agents known as neuraminidase inhibitors.
Medicaid’s policy for coverage of Tamiflu reflects the Centers for Disease Control and Prevention (CDC) recommendations for treatment of H1N1. The CDC’s guidelines are available at: http://www.cdc.gov/h1n1flu/recommendations.htm. Use of these medications should be focused on persons who are at increased risk of complications from influenza infection and on those who are hospitalized. Medicaid coverage is approved upon request when documentation is provided that individuals fall in an identified risk group. Examples of individuals at increased risk of complications include but are not limited to: pregnant women; children under the age of 5 years old (especially those under the age of 2); individuals with underlying health conditions (e.g., asthma, COPD, heart disease, etc.); and others. The CDC guidelines and the Medicaid policy statement include the full list of those groups considered at increased risk of complications. They are currently the same groups considered to be at increased risk of complications from seasonal flu.
CDC encourages judicious use of antiviral medications to help maintain the effectiveness of these medications against the virus over time (avoiding development of resistance).
Medicaid no longer requires results of the rapid-test or other flu tests for antiviral approval.
Medicaid policy can be found at: http://www.wvdhhr.org/bms/sPharmacy/drugs/drugs_NeuraminidaseInhibitor_0609.pdf
For more information contact Shannon Landrum at the Bureau for Medical Services (304) 558-1700 or via email Shannon.L.Landrum@wv.gov.
|
|
|
Top
|
| |
|
|
| |
PEIA recently held statewide workshops to update physician offices about changes to the program for state employees. Here is some additional information from that meeting.
Effective July 1, 2009, the Aetna Signature Administrators Preferred Provider Organization became PEIA PPB members' network for out-of-state services. Prior to implementation, ASA worked diligently to assure the PEIA members would see little network disruption from this change.
PEIA and Wells Fargo will continue to maintain some direct contracts with out-of-state providers. To find out of state network providers, please use the link below:
www.aetna.com/docfind/custom/asa
PEIA reminds physicians that there are a few providers who are listed in the ASA PPO who are EXCLUDED from PEIA's network:
• UPMC Health System
• Boyd County, KY (includes Kings Daughters Medical Center, Our Lady of Bellefonte Hospital & physicians)
• In Gallia County, Ohio, PEIA is not using the ASA PPO, but is contracting directly with providers. Holzer Clinic is in-network but, at this time, Holzer Medical Center is out of network.
• In Washington County, Ohio, PEIA is not using the ASA PPO, but is contracting directly with providers. Marietta Memorial and Selby General Hospitals are in-network as well as several Marietta physician practices. However, the radiologists and emergency room physicians at both hospitals are NOT in-network. Also, the Mid-Ohio Valley Medical Center located in Belpre, OH, and Mid-Ohio Valley Medical Group are in-network.
PEIA's rules for accessing out-of-state care have not changed.
PEIA PPB Plan participants living in West Virginia or a bordering county of a surrounding state may access care from any of the following providers without receiving prior approval:
• any West Virginia health care provider who provides health care services or supplies to a PEIA participant, or
• any network provider located in those bordering counties.
Please note that all services, except emergency care, provided outside of West Virginia beyond the bordering counties requires prior approval.
PEIA has made special arrangements for PEIA PPB Plan participants who reside outside the State of West Virginia (beyond the bordering counties of surrounding states). Participants who live more than one county outside the State may seek care from any network provider. Care from network providers does not require prior approval, and that care will be covered at the in-network benefit level (typically 80%). Precertification of inpatient stays and certain outpatient procedures is still required.
To start the prior approval process for out-of-state services, contact ActiveHealth at 1-888-440-7342.
|
|
|
Top
|
| |
|
|
| |
On July 13, 2009, Aetna Inc. announced that the U. S. Department of Defense had awarded the TRICARE managed care support contract for the North Region to their company. Under the five-year administrative services contract, Aetna Government Health Plans will support health care delivery to approximately 2.8 million eligible beneficiaries who are active duty service members, retirees and family members based in the 21 states of TRICARE’s North Region.
Beginning April 1, 2010, Aetna Government Health Plans will be the Managed Care Support Contractor for beneficiaries in the North Region, which includes West Virginia.
According to Aetna personnel, the company has been increasing staff as they prepare to contract with providers.
According to TRICARE representatives, providers will continue to operate under the existing contracts. Physicians under consideration by Health Net and in the credentialing process will also continue that process. As it stands right now the new contract with Aetna will take effect on April 1st, 2010. Until April 1, 2010, TRICARE’s commitment remains unchanged to their beneficiaries and network partners.
More information about the new contract and the process will be provided to WVSMA physicians as it is received.
|
|
|
Top
|
| |
|
|
| |
The Greenbrier Valley Medical Society and the Greenbrier Valley Medical Center, in joint sponsorship with Charleston Area Medical Center Health and Research Institute, are hosting a CME conference on August 1, 2009 at Lewisburg Elks Country Club. There will be 4 CME credits available for attending providers as well as 4 CEUs for nurses.
The purpose of the conference is to provide education to the Greenbrier Valley medical community about medical services currently being provided and introduction of new physicians/specialists for providing optimal healthcare in the surrounding rural community.
The CME/CEU conference will begin at 8:00am, with registration and breakfast beginning at 7:30am. The conference will end with a luncheon at 12:30pm. Greenbrier Valley Medical Society and Greenbrier Valley Medical Center will be hosting a charity golf tournament with the proceeds going to Relay for Life beginning at 1:30 pm. Families are welcome to spend the afternoon at the pool, compliments of Greenbrier Valley Medical Center. A poolside BBQ will be provided for conference attendees, tournament players, and families beginning at 5:30pm.
For additional information, please contact Jody Baker, GVMC Director of Physician Relations at 304.553.5855 (jrbaker1966@yahoo.com) or Melissa Williams, GVMC Director of Marketing at 304.647.6079 or Melissa_¬¬Williams@chs.net
|
|
|
Top
|
|
July 17, 2009
|
