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Idaho Medical Association
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Inside this issue
Volume XXV No. 11, NOVEMBER 15, 2014
Your Health Idaho Open Enrollment 2015 In 2014, 76,000 Idahoans found health insurance at a price they could afford through Your Health Idaho, Idaho's health insurance exchange. In order to provide Idahoans with tools, resources, and information, Your Health Idaho has scheduled a series of health insurance open houses. Your Health Idaho has flyers announcing the open houses as well as educational brochures that practices can provide to their patients. In addition, if you are interested in hosting a presentation and/or question and answer session to be given by a Your Health Idaho staff member or an Enrollment Counselor, please send them an email and they will arrange a date and time that works best for you. The educational flyers and open house information is available at yourhealthidaho.org. They would also be happy to send educational brochures to you to have on display. All requests can be sent to [email protected]. In related news, on November 12, Kaiser Health News reported that Idaho is the latest state to launch its own health insurance exchange
(Continued on Page 2) Susie Pouliot Chief Executive Officer Margy Leach Communications and Membership Director Teresa Cirelli, CPC, CPMA Reimbursement Director Kathrine Forstie, CPC, CPMA Reimbursement Specialist The IMA accepts limited advertisements and announcements in this publication, but does not endorse them.
HIPAA in Emergencies 2
New IMA Members 2
SGR, CHIP Fixes 2
AMA Meeting Highlights 5
SCOTUS Challenge to Subsidies
5
Medicare CBRs 6
MPO Ads 11
IMA Member is NICU Hero 8
Physician Legislator Mtgs. 11
Verify and Update Your Physician Online Profile The IMA’s 2015 Referral Directory of Idaho Physicians will be published early next year. In order to ensure that the information that is printed in the Directory is correct, please verify that your current IMA membership profile information. You can check your profile information and make any necessary changes by accessing your Member Portal on the IMA website. Go to www.idmed.org and click on Member Login. If you have any questions, please contact the Membership Department at [email protected] or 208-344-7888.
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Your Health Idaho (Continued from Page 1) under the federal health law and the only one whose state government is completely controlled by Republicans. Oregon and Nevada have abandoned their troubled exchanges and are switching to the federal exchange. That decision may become much more significant since the Supreme Court on November 7 decided to hear a lawsuit challenging the government’s authority to grant subsidies to residents in states that do not run their own marketplaces. (See article on Page 5.) The Idaho exchange will charge insurers 1.5 percent on premiums to cover its overhead, compared to 3.5 percent on policies in the federal exchange. The lower surcharge will mean lower prices for consumers since insurers pass on those costs. The surcharge will be the main source of revenue for the Idaho exchange starting next year when all state marketplaces must be self-sustaining. This year, five health insurers and four dental carriers will sell 198 plans on the exchange – 52 more than last year. [Galewitz, Kaiser Health News, 11/12] Kaiser Health News (KHN) is a nonprofit national health policy news service. HIPAA Privacy in Emergency Situations In light of the Ebola outbreak and other events, the U.S. Department of Health and Human Services (HHS), Office for Civil Rights (OCR), is providing a bulletin to ensure that HIPAA covered entities and their business associates are aware of the ways in which patient information may be shared under the HIPAA Privacy Rule in an emergency situation, and to serve as a reminder that the protections of the Privacy Rule are not set aside during an emergency. The HIPAA Privacy Rule protects the privacy of patients’ health information (protected health information) but is balanced to ensure that appropriate uses and disclosures of the information still may be made when necessary to treat a patient, to protect the nation’s public health, and for other critical purposes. OCR’s bulletin on HIPAA Privacy in Emergency
Situations may be found at: http://www.hhs.gov/ocr/privacy/hipaa/understanding/special/emergency/hipaa-privacy-emergency-situations.pdf Additional guidance on HIPAA in Emergency Situations: Preparedness, Planning, and Response can be found at: http://www.hhs.gov/ocr/privacy/hipaa/understanding/special/emergency/index.html The Idaho Medical Association Welcomes New Members A warm welcome to these physicians who have recently joined the IMA:
Scott Adelman, MD, Physical Medicine and Rehabilitation, Sandy, UT
Bradley G. Bishop, MD, Pediatrics, Meridian Sarah Daccarett, MD, Anatomical/Clinical
Pathology, Boise Robert Fairbanks, MD, Radiation Oncology,
Spokane, WA Elizabeth A. Kendrick, MD, Internal Medicine,
Boise Wayne Lamoreaux, MD, Radiation Oncology,
Spokane, WA Christopher Lee, MD, Radiation Oncology,
Spokane, WA Amber Messier-Gieri, MD, Neonatal-Perinatal
Medicine, Boise Michael C. Minick, MD, Internal Medicine,
Lewiston Edward Nelson, MD, General Surgery, Salt
Lake City, UT Stephen R. Preece, MD, Radiology, Idaho Falls William B. Stinger, DO, Obstetrics and
Gynecology, Pocatello
SGR, CHIP Fixes Potentially on Lame-Duck Agenda, but Prospects Look Slim The only major task likely to get done during the four-week lame-duck session that Congress started November 12 will be to provide continuing funding for the federal government, which is slated to run out of money December 11. That funding effort will include debate over the Obama administration's request for $6.2 billion in funding to fight the current Ebola outbreak in West Africa and prepare for future cases in the U.S. Most political observers expect there to be broad
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Highlights from the AMA Interim Meeting AMA Delegate Patrice Burgess, MD and AMA Alternate Delegate Vicki Wooll, MD have just returned from the 2014 AMA Interim Meeting November 7 - 11 in Dallas. Also representing the IMA at the meeting were IMA President Keith Davis, MD, President-Elect Ron Cornwell, MD, and CEO Susie Pouliot. Dr. Burgess provided the following highlights from the meeting:
The Secretary of the Veteran’s Administration gave an update regarding ongoing efforts to improve access and maintain a viable system for our nation’s veterans.
Multiple Ebola updates were presented, including from the CDC, regarding lessons learned so far. Dallas has surpassed the 21 day mark with no new cases. You can view the presentation from Arjun Srinivasan, MD, associate director for healthcare-associated infection prevention programs at the CDC and captain in the U.S. Public Health Service on the AMA’s YouTube channel at https://www.youtube.com/channel/UCE83i5yn_YQ1HnFO027BnnQ
Delegates considered multiple resolutions, including Resolution 207 from the IMA, regarding drug pricing and drug shortages. While Res 207 was referred to the AMA Board due to the complexities regarding the best way to advocate for improvements, it was clearly a hot topic with passion shared by many regarding the hardship this is placing on our patients. Stay tuned for the outcome from the AMA Board – IMA will keep you posted.
There were also many resolutions and discussions regarding electronic health records and meaningful use. AMA President Elect Steven Stack, MD made an announcement regarding a recent delay in the next stage of meaningful use penalties. Delegates renewed their request that the Centers for Medicare and Medicaid Services suspend penalties for failure to meet meaningful use criteria.
There was a call for limiting the use of prior authorization, citing how prior authorization often unnecessarily interrupts the delivery of care and places undue administrative and
financial burdens on physicians. The new policy directs the AMA to further address this obstacle to high-quality, affordable care.
A report urging Medicaid expansion was approved. The delegates voted to support Medicaid expansion and encourage lawmakers to identify realistic coverage options for adults currently in the coverage gap, even if states choose not to adopt the Medicaid expansion outlined in the Affordable Care Act.
The AMA celebrated four successive years of growth in AMA membership.
As always, please don’t hesitate to contact your AMA delegation, Patrice Burgess, MD and Vicki Wooll, MD regarding any AMA issues. Your IMA staff is a great resource as well and the AMA website is full of great information - www.ama-assn.org. In Surprise, Supreme Court to Hear Challenge to ObamaCare Subsidies The Supreme Court on November 7 agreed to take up a new challenge to ObamaCare that Democrats fear could dismantle the healthcare law. The case, King v. Burwell, rests on whether the federal government can legally hand out healthcare subsidies in 34 states that have opted out of creating their own exchanges. About 87 percent of people enrolled in ObamaCare receive the subsidies. The decision comes as a surprise to many court-watchers and healthcare experts, who have warned that the case could seriously undermine the future of ObamaCare. If the high court rules against the premium credits, it would gut a core component of the law that’s already gone into effect for more than 4 million people in the U.S. That number is expected rise to 7.3 million people by 2016, according to a report by the nonprofit health policy organization, the Robert Wood Johnson Foundation. More than $36 billion in subsidies could be lost if the court sides with the law’s opponents, the report found. The ruling would a “domino effect” on other parts of the law, the researchers said. Without subsidies, they cautioned that the federal government would be forced to rethink its policies on the individual mandate, regulatory reforms and state exchanges. [Ferris, The Hill, 11/7]
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SGR Fix (Continued from Page 2) consensus around the need for additional Ebola funding, but the amount of the appropriation and where those dollars are targeted is likely to change as Congress scrutinizes the proposal. Beyond that limited agenda, there doesn't appear to be much appetite to take on other healthcare policy issues. “I believe that the lame-duck session is going to be limited to measures that are either emergencies like Ebola or must do's to keep the government open,” said Chip Kahn, CEO of the Federation of American Hospitals. “I don't see a lot being done.” But that isn't stopping various healthcare groups from pushing for action on their agenda items. The American Medical Association (AMA) and its allies are pushing for Congress to pass legislation during the lame-duck session permanently repealing and replacing Medicare's sustainable growth-rate formula for physician payment. Last year, Congress reached a bipartisan, bicameral agreement on a permanent repeal-and-replace bill but no agreement on how to cover the roughly $140 billion cost over a decade. Failure to reach a deal on financing led to a 17th straight patch that expires at the end of March. If there's no temporary or permanent fix then, physicians will face a 21.2 percent reduction in pay. “We're encouraged by where we're starting from,” said Dr. Robert Wah, the AMA's president. “We've already got bicameral, bipartisan legislation.” Earlier this month, the GOP Doctors Caucus of House members sent a letter to Speaker John Boehner (R-Ohio) and Majority Leader Kevin McCarthy (R-Calif.) calling on them to take up SGR reform during the post-election session. “We understand that discussions with the Senate have been derailed in the past by disagreements over offsets, but those negotiations must resume,” the 19-member group wrote. “We appreciate that hard decisions must be made on how to offset this proposal.” There is a similar push to extend funding for the Children's Health Insurance Program during the lame-duck session. The program, which has enjoyed bipartisan support in the past, is set to run
out of money at the end of September 2015. Advocates, including the Medicaid and CHIP Payment and Access Commission, argue that leaving CHIP in limbo heading into next year could cause states to restrict eligibility for the program, which currently provides coverage to roughly 8 million lower-income kids. [Demko, Modern Healthcare, 11/12] Medicare Comparative Billing Reports Comparative Billing Reports (CBRs) are educational tools administered by the Centers for Medicare & Medicaid Services (CMS). CMS has contracted with eGlobalTech to develop and disseminate CBRs. A CBR provides comparative billing data to individual health care providers. CBR's contain actual data-driven tables and graphs with an explanation of findings that compare physicians’ billing and payment patterns to those of their peers on both a national and state level. Physicians in Idaho are currently receiving reports from eGlobalTech. Current CBRs review family practice physicians submitting evaluation and management services with modifier 25. The data analysis reviews utilization on claims submitted July 1, 2013 – June 30, 2014. The report will indicate how the physician compares to peers and include educational information. A response to the results is not necessary. A practice may consider reviewing evaluation and management codes with modifier 25 appended to determine if the claims were coded appropriately. An internal review of the medical record could confirm accurate claim submission. The IMA also provides consulting services including coding audits at a discounted rate for members. These audits are performed by certified auditors. If you have questions regarding Comparative Billing Reports or IMA consulting services, please contact IMA Reimbursement Director Teresa Cirelli, CPC. CPMA – [email protected] or IMA Reimbursement Specialist Kathrine Forstie, CPC, CPMA – [email protected] or 208-344-7888.
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IMA Member Honored as 2014 NICU Hero Neonatologist Stewart Lawrence, MD, of Boise, was named a 2014 NICU Heroes Award winner by Mead Johnson Nutrition and Hand to Hold, a national nonprofit Neonatal Intensive Care Unit (NICU) parent support organization. Families from 30 U.S. states nominated neonatal nurses, physicians, and other healthcare professionals who helped make a difference for their preterm or medically fragile newborns. Sophie Carney from Boise nominated Dr. Stewart Lawrence for the compassionate, professional care he gave to her 25-week-old twins and their family while the twins were in Saint Alphonsus Regional Medical Center’s NICU for four months in 2013 and 2014. The twins were born after receiving a life-saving procedure for a rare condition known as “twin-to-twin transfusion,” or TTTS, in which the blood flow through twins’ placental connections becomes unbalanced, threatening both babies in utero. It affects less than 20 percent of identical twins. Dr. Lawrence’s achievements were recognized at the National Association of Neonatal Nursing (NANN) Annual Educational Conference held September 10-13, 2014 in Phoenix, Arizona. Mead Johnson Nutrition partnered with Hand to Hold to create the NICU Heroes Awards to reward the experience, professionalism, support and deep compassion these NICU health care professionals give their patients and their families. Congratulations Dr. Lawrence!
Have You Liked Us on Facebook? The audience for our Facebook page is growing by leaps and bounds. Here’s why: the IMA Facebook page a great source for time sensitive updates, resources, and other news from the Association. Recent posts have covered a broad range of topics including medical education, suicide prevention, the fight against ebola, and many more. If you haven’t already, please take a moment and like us at https://www.facebook.com/Idaho.Medical.Association today!
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Medical Practice Opportunities
Board Certified Family Practice Physician - Boise
We are seeking a board certified physician to join our busy family practice. We are independently owned and
operated with onsite lab and x-ray. We offer competitive pay, benefits and CME. Opportunity for
potential buy-in.
Contact: Theresa Young at 208-377-3368 or [email protected]
To place a Medical Practice Opportunities Classified Advertisement, please contact:
Margy Leach, Director of Communications at 208-344-7888 or by email [email protected].
IMA Brings Legislators to You!
Whether you are a political junkie or a casual observer, the IMA in cooperation with the local medical societies offer you a chance to talk about issues that concern you with your state legislators and hear firsthand about issues that are expected to arise at the Idaho Statehouse in January. A list of talking points that provide on overview of the IMA’s 2015 legislative agenda established by the House of Delegates is available at www.idmed.org by clicking on Communications and Legislative Reports. Here’s the schedule of upcoming meetings: November 18, 2014 Southwestern Idaho Medical Society 6:30 - 9:00 pm (MT) Treasure Valley Surgery Center, 4400 E Flamingo, Nampa November 19, 2014 Ada County Medical Society Physician Legislator Meeting 6:30 - 9:00 pm (MT) Riverside Hotel, 2900 Chinden Blvd., Boise November 24, 2014 North Idaho Medical Society Physician Legislator Meeting 6:30 - 9:00 pm (PT) The Orchid Room, 301 W Main St., Lewiston November 25, 2013 Kootenai - Benewah Medical Society Physician Legislator Meeting 6:00 - 9:00 pm (PT) The Coeur d’Alene Resort, 115 S 2nd St., Coeur d’Alene December 2, 2014 South Central Idaho Medical Society Physician Legislator Meeting 6:00 - 9:00 pm (MT) Brickhouse Restaurant, 516 Hansen St. S, Twin Falls Make plans now to attend the meeting in your area! Please RSVP to Stef at [email protected] or 208-344-7888.
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Calendar of Upcoming Events November 27 - 28, 2014 IMA Office Closed for Thanksgiving December 3, 2014 IMA Brown Bag in the Boardroom Webinar 12:15 - 2:15 pm (MT) CPT Changes 2015 December 10, 2014 IMA Brown Bag in the Boardroom Webinar 12:15 - 1:30 pm (MT) Challenges and Changes: Fourth Quarter Updates
Additional information and registration forms for seminars are available at www.idmed.org.
